Skin in the Game

Don’t cut off your nose to spite your face, they always say. And they…and we won’t quibble about who ‘they’ are…have an excellent point. These are words to live by. Which I’m currently doing, right this very minute.

When your nose has some miscreant basal cells growing near its tip, damn straight, they’ve got to go. Lock them up, I say. Even better, cut them off. Without a cent. About time they made it on their own.

Someone makes an appointment with a dermatologist, and this person takes one look and says cut. Just like a Hollywood director. Now, if you happen to be part of my health plan, to have this little bit of dermatological surgery performed, you head north. San Rafael, 25 miles closer to Canada, is where this stuff happens. And inexplicably, being America, it happens at 7:30 in the morning. This means leaping from ones quadriplegic bed at 5 AM. But no matter. You can’t stop dermatological progress. Skin waits for no man. So get up, get caffeinated, and hit the freeway north.

And, sure enough, just when you are convinced you are lost, your GPS guiding you through a neighborhood of suburban tract homes, there it is. Kaiser San Rafael. Kaiser Permanente being the full name of the outfit. And lest you go scurrying around to learn about some little-known 19th-century German invasion of Spain, it’s not that. The real story is too boring. And that’s the name.

At 7:30 AM, nothing seems very permanent about Kaiser Permanente. On the fourth floor of the medical office building, the receptionist hasn’t even arrived. A surgical nurse wanders out and has a go at the formalities. Sign here. Wait. Follow me.

And having a fully adjustable wheelchair – and I can thank Messrs. Kaiser for that – I don’t even have to get out of it for the cut-the-basal-cells-off experience. I tilt back, the surgeon slips a needle here, inserts a needle there. ‘Ouch’ he says, supplying the soundtrack. It’s okay. Psychologically effective. Besides, I want my face numbed. I also want a towel over my eyes, yes, to protect me from the surgical light. But also to protect me from the surgical sight. I don’t want to know what’s happening. But whatever is happening is happening quickly, and soon there is the smell of burning flesh, vis-à-vis, cauterizing the wound. I love it. It’s barely 8 AM. I roll out to the waiting room to, you guessed it, wait with Jane.

Mohs surgery is named after a guy with that very name. And what I’m waiting for is a high-speed cell analysis in some laboratory offstage. The nurse has warned that this could take an hour or an hour and a half. But at this bright and cheery hour, damned if we’re not done in 45 minutes. Let’s have brunch, I say to Jane. Would you like to join us, I chirp to the nurse. Gosh, but I can be a merry quadriplegic at age 71.

Oh, I know, there’s more. The surgeon has to close the wound. And, once back in the surgical room, he explains that he’s going to pull a little flap of skin across my large Jewish nose. Whatever. More numbing injections, towel back over the eyes. And a vague sense of pressure is all that suggests the man is slicing here, nipping there, tucking wherever. As he is wrapping up, literally in this case, bandage upon bandage being applied by the nurse, he conveys final instructions. Take some antibiotic pills waiting in the pharmacy. The stretched skin will slowly relax. Leave the pressure bandage on for 48 hours.

This is beginning to sound a little too involved. I have vague forebodings. Spatial relationships are becoming slightly vague too, owing to the great white bandage now prominent on my left cheek. I knew that the guy was up to something, what with his pressing and probing. Was he working something under the skin of my cheek? Yes, he says lightly. No further information. None sought, either. ‘A flap of skin,’ he calls it. And over the next year, everything will sort of settle down. Skin relaxing, scar lightening, happy days.

Meanwhile, I make a quick trip to the men’s toilet. There is a mirror in there, and my face is revealed to look very much like that of someone who has survived, but badly lost, a major barroom brawl. I don’t know why this happens, particularly the black eye. I mean none of this involved my eye. Nevermind. My cheek is one big bruise. And although they say ‘don’t get your nose all bent out of shape’, well, it’s too late for that.

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