Mohs Nose Woes

Yesterday I had another dermatology appointment about my nose, where a patch of skin cancer was removed over two years ago.  My doctor has been trying to erase all evidence of my surgery – at no cost – ever since.  Yesterday he brought up two final options: another surgery, or microdermabrasion.  Neither come with a guarantee, and both come with risk of actually making things worse.

“I think it is what it is,” I declared.  The truth is, I’m done.  No more procedures.  This has become my new normal, and I’m done with these Mohs nose woes.

Our scars tell our stories, and this is but one small chapter of mine…

Back in 2015, a small sore appeared on my nose that just wouldn’t heal.  It was annoying but not alarming, until one day a friend said, “I think you need to get that checked out.”  That night I went home and did exactly what I always tell students never to do:  I googled a medical question.

And heck if I didn’t diagnose myself with skin cancer after the third click.  And damnit to heck, my diagnosis was right.

Remember the Seinfeld episode where Jerry calls his dermatologist doctor date “nothing but a pimple popper”?  Yeah, me too.

I made an appointment with my local pimple-popper’s office, where a biopsy was deemed necessary.  I’m not gonna lie:  this part hurt like a mother-you-know-what.  Something about needles and noses and nerve endings.

Ten days later the verdict was in:  basal cell carcinoma.  It certainly wasn’t the news I wanted, but it was totally curable so I kept it in perspective.  The doctor recommended a Mohs surgery to remove my skin cancer.  Mohs-trained surgeons remove cancerous tissue, analyze lab specimens immediately, and (once clear margins are established) reconstruct the wound.

We arrived at 7:15 AM on surgery day.  Clark was stuck in the waiting room while I sat on the edge of a surgical table down the hall, nervously swinging my legs and signing consent forms.  They stuck a cold pack on my back for the cauterizing machine.  I was fully dressed and wide awake when the nurse asked me to lie back and wait for the doctor.

I was scared.  I had no idea what was to come, but the one thing I could control was the barrette digging into my scalp.  I unclipped it and slid it into my vest pocket.  I spent the rest of the morning clenching that barrette so tightly it nearly pierced my palm.

The doctor draped a blue towel over my head, exposing only my nose.  I was dreading the painful needle again, but he had a better technique than the physician who did my biopsy.  This time the local anesthesia didn’t hurt at all, and I knew I was in good hands.

For the next 15 minutes I felt tugging and pressure.  No one spoke through the entire procedure; the only sounds I heard were sparks from the cauterizing machine and a classical music arrangement that seemed better suited for a funeral visitation.  I was frozen stiff to that table, paralyzed with fear.  Add the blue towel over my face and I felt like an anonymous body in a morgue, and perhaps the surgeon was my embalmer.  My mind can get to spinning like that sometimes.

Thankfully this part was over quickly.  They disconnected me from the cauterizing machine, and I bunched up the cord and tucked it into my vest pocket next to the barrette.

I was escorted to a crowded waiting room where Clark was glancing through the newspaper and drinking bad Keurig coffee.  I had a huge bandage on my nose, and before long three other patients filed in with big facial bandages of their own.  We were all waiting for pathology results to learn whether the doctor needed to cut deeper or move on to the repair.

After about 45 minutes a nurse called me back to the surgical room.  “We were able to remove all your skin cancer the first time,” she said.

What an absolute relief!

“I’d like you to sit down so I can show you the wound.”

I sat on the edge of the surgery table, and she gently removed my bandage before reluctantly handing me a mirror.  A two second glance was all I needed.  I turned the mirror to my lap and fought back tears.

She nodded and said these exact words:  “You do have a hole in your nose.”

Clearly she wasn’t referring to either of my nostrils.

Maybe some old codger in nursing school taught her to be brutally honest and direct, but when you see a dime sized gap in your nose the last thing you need from your nurse is to articulate the obvious.  To slam you with your new reality.

“The doctor may take tissue from behind your ear or your forehead to fix this,” she explained.

Oh great, more numbing needles and stitches.

“He will try his best to make you look normal again,” she promised.

Really lady?  Did you see the size of that hole?

My thoughts were coming too quickly to articulate, so instead I just whispered, “Can you get my husband?”

To his credit, Clark didn’t even flinch when he saw my face.  He grabbed my hand and I squeezed his instead of my barrette, which felt infinitely better.

The doctor whizzed in to analyze the damage and determine the best course of action.  “Bilateral something flap” he announced.  He preferred to cover the wound with nose skin so it would heal the best, and proudly declared he would make a little jigsaw puzzle of my face.

Clark took a seat by the wall, and I laid back onto the table once again.  I clutched my barrette as they covered my face with the blue towel for the second time.

This time Simon and Garfunkel was playing.  “I like this music much better,” I uttered from under the towel.

“You didn’t like my classical?” the doctor asked.

“No.  I felt like I was in a morgue.”

“They don’t play music in morgues,” he flatly replied.  And then he got to work.

My body does this weird shaking thing when it is under stress.  My legs shook vigorously and uncontrollably when I was in labor with both kids, and I could feel it starting again on the surgery table that day.  I clutched my barrette harder, took deep breathes, and wondered why the hell people did this surgery without medication?

For me, the repair was the hardest part.  It’s probably because it was the longest:  thirty minutes with every sense on hyper alert.  My eyes were closed and covered with a towel, but the bright surgical lights still pierced through my eyelids.  I could hear the buzz and smell the metallic burn from the cauterizing machine.  There was nothing to do but take deep breaths and push down negative thoughts.  Without a doubt, the worst part was the sound of snipping.  I couldn’t see the scissors, but I felt the doctor inject Novocaine all the way into my forehead, and I could sense him snipping skin between my eyes.

“I hear snipping,” I accused.

“You are imagining things,” he lied.

Why was he cutting so high?  Why was there so much tugging?

Finally I felt string on my cheek.  It must be stitches.  Thank God.  There was more tugging as he sewed me back together, and the mood lightened.  Small talk replaced silence.  Where did you grow up?  Where did you get your sunburns?  When and why did you move to Alaska?  Through the conversation I was able to bend my knees, let go of the barrette, and breathe again.

When he was finished the relief was palpable.

The towel was removed from my face and I became a real person again.  I was surprised to see Clark still sitting against the wall; he had been so silent, even during the small talk, that I thought he left.

Clark was amazed at the repair.  “What did you call this?”

The doctor sat with his back to us, jotting down notes as he repeated the technical term (which I cannot recall).

“Did you learn how to do it at plastic surgery school?” I asked.

“Yup,” he replied.  “It’s a night course.”

We laughed.

“Online,” he continued.

More laughter.  The best medicine, for certain!  Once the technical job was complete, the doctor looked me in the eye, drew me diagrams, answered all of my questions, and made sure I absorbed the answers.  He sent me home with very specific instructions about bandages and wound care.  The surgery fee included all follow up care, no matter how long it took.  He said he wouldn’t be happy until all evidence of this surgery was gone.

Which brings me to today, nearly 2 1/2 years later.  I can’t say we fully achieved that goal, because there’s still a pucker at the bridge of my nose that feels heavy and weighted.  But the cancer is gone, and it hasn’t recurred.  Honestly, does anything else really matter?

There’s nothing worse than innocently scrolling through a page and stumbling upon graphic images you can’t “unsee” – so I’ve put all the photos of my healing process on a separate page.  If interested, you can see them here.  Don’t say I didn’t warn you!

4 thoughts on “Mohs Nose Woes

  1. You are perfect without undergoing more risky surgeries! The most important part is that your cancer hasn’t returned during all this time. You can barely see it anyway. Can’t wait to hang out in a couple months! ❤

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