Yesterday found me scooting down the highway to Boston again. The dermatologist at MGH had a cancellation, and I was in need of a checkup. Almost twenty years ago, at the age of 30, I had a basal cell carcinoma removed from my lower back. My father had numerous, lesser skin cancers, as well as melanoma, and one of my sisters has recently had a basal cell removed. Given the family history, I have been a tad too casual about screening, and this was going to be my first head to toe check check ever.
When I became a card carrying member of the cancer club, any other physical complaints were quickly ushered to the back of the bus. If a symptom is not directly related to my lung cancer, I’m pretty apt to dismiss it. I had a cracked molar that had a filling (its second) which was almost as large as the tooth itself. My dentist wanted to put a crown on it; this was two years ago. Although I had not yet been restaged, I was well aware that there was a significant amount of something in my lungs. Dr. Tom Lynch was my oncologist at this time (he has moved to New Haven as Director of the Yale Cancer Center), and “schmutz” was his word for this unknown entity. At one of our scan reviews, I asked just how many nodules, or bits of “schmutz” was the radiologist describing. “Oh, approximately 33”. The “approximately 33” cracked me up: sounded pretty specific to me. On the other hand, it was incredibly sobering. If this was cancer, I was loaded.
Anyway, back to the dentist. She suggested the dental work just after my scan review. I just flat out told her that I wasn’t even sure how long I was going to be alive, and that I was not inclined to spend either money or time on my teeth. Instead of a do not resuscitate order, I issued a directive to do only what was absolutely necessary. Two months ago I had the long delayed dental work done. It was a vote of confidence: I am now of the mind that I might be here for awhile, and that I should take care of my garden variety problems. So, along this meandering line of thought, I figured it was time to follow up on my skin cancer.
I arrived at the office perhaps fifteen minutes early, and hadn’t time to even fill out the paper work before I was led into an exam room. I was handed a paper gown and told to disrobe entirely. The gown fit as well as any paper garment might be expected to, and I did my best to make myself comfortable. Within minutes the doctor entered, introduced herself, and asked if I would permit several residents who were shadowing her to observe. This is a request that I seldom refuse, as I feel it is a small contribution that I can make to the practice of medicine.
As this was a teachable moment for the residents, a discussion immediately ensued as to the significance of a basal cell cancer at the age of thirty. Evidently that is young, and could point to a possible underlying disorder. The palms of my hands, the joints of my fingers, and my jaw were all examined, and it was determined that I had none of the markers of this disorder. I was as curious as the residents, as the dermatologist who removed the basal cell had seemed perfectly nonplussed about it.
And then it was time to disrobe and undergo the full body check. Momentarily, I regretted my willingness to admit the residents, as there were going to be not one, but four individuals gazing at my naked self. I summoned my courage, but not before telling them that there were not many things that made me more anxious than sitting on an exam table dressed only in paper. The residents laughed nervously and I realized that perhaps they were uncomfortable as well. That made four out of the five of us. The doctor checked me front and back, top to bottom, noting some benign features as well as one mole that should be watched. She did question me about the white circle on my back, wondering whether or not that was the result of a medical procedure. I had forgotten to mention my tattoo.
I left the office with most of my dignity intact and an appointment for next year. I will write it on my calendar for 2010 with a particular joy, as making plans for one year hence is nothing to take for granted. I won’t be a no show.