Wednesday, February 9, 2011
The Good News or the Bad News?
I promised you that I would have a story for you under this header, so here it is. When I say a ‘story’ by the way, I don’t mean it’s made up. If at times I exaggerate a tinsy bit - and, I confess, that might happen now and again, then I’ll make that pretty clear to you, or you’ll know.
Just thought I’d clear that up.
This was about four years ago, in my other incarnation. That is, well before 3 December 2009, when the world blindfolded me, spun me around twenty times and told me to try walking a straight line.
I was at the surgery of an top-notch skin specialist who is so well known in this town I won’t name him, though many locals will know who he is for sure. We were inspecting deep wounds to both my legs, inflicted by this excellent doctor and which I’d voluntarily allowed him to perform.
‘Ah, very good,’ he said, looking at his neat stitching with justifiable pride. ‘Now, do you want the good news or the bad news?’
Tracey says that these days I find decision-making a painfully slow process, or at least, it’s slow as hell for her. She asks me what I want on the other piece of toast, and I find myself in a sea of indecision. Should it be Vegemite, or Maureen’s Marmalade Jam (you know, real marmalade jam, with the orange peel sliced fine as a hair’s breadth that wins prizes at the Show, not the mystery marmalade you get from Coles)? Or honey? Or neither? Heck, this is hard!!
Well, I have to admit, the doc’s question, even four years ago, was equally made for indecision on my part. But then, he WAS the doc after all who, when I rang him about a biopsy result, was trying to remember who I was from when he’d seen me two weeks before, and he asked me, ‘Were you the short fat bloke?’ Sadly, I had to agree, with some reluctance, that I probably was. So I had a slight chance of paying him out for his accurate but sad description by my pathetic hesitation.
You may have gathered from this that, though an excellent skin specialist, his bedside manner left a little to be desired, given his description of me in the identification line-up on the phone. But with someone as direct as he, a question about which sort of news he was going to deliver first was a weighty matter. If I said ‘the good news’ and it was really bad, then could I take the bad news? But if I said ‘the bad news,’ and that turned out to be that I would drop dead the next morning, then there wouldn’t be much point in hearing the good news. The edge would have been taken right off my curiosity by the prospect of my next Weetbix being my last meal.
So I let him stew a little while I made up my mind. He did have a peculiar grin on his face, but then again he had already proved he had some sadistic tendencies.
I had visited him initially because of a strange mark on my leg – a scaly sort of thing. My GP had noticed it, said it looked suss, and bundled me off unceremoniously to the skin guy. He took one look at it, said it was probably a basal cell cancer but could be something else. He’d take a biopsy sample and examine me from head to toe. Strip down to underpants, pronto.
Now this could well explain why he identified me on the phone so definitely as the short fat bloke, even though I was wearing my Superman undies on that day and he could just as easily have remembered those. ‘You were the guy, slightly stocky build, in the Superman underpants, weren’t you?’ would have been a triumph of diplomacy for him and salvaged a little pride for me.
But he had seen it all, every hectare of my skin, going over what was obviously mounds of obese flesh in his quest for more suspicious scaly bits, and had even managed to turn up a second, smaller one on my other leg. Oh goody! Another bit of flesh to punch out a sample from.... and each in a place that was actually pure muscle, not flab.
The biopsy turned up a basal cell cancer – both of them were. Now, basal cell cancers aren’t that great an issue. There are far worse skin cancers than these, which he described, very accurately, as a sort of ‘skin weed’. They don’t do much but they must be removed, or they’ll spread, and in the end you’ll have a lot more trouble with them. The moral is, get them dealt with, as soon as possible.
So, we talked options once the biopsy result was known. He could take his scalpel and cut them out right away, or we could try a cream that had a 70% chance of success. The latter would take six weeks or so to work, if it were going to work at all. It was quite expensive and you got a tiny little sachet of it for a pretty hefty price. You pierced the sachet with a pin, squeezed out a minuscule bit, and carefully dabbed it on the affected skin with a toothpick.
Now I knew this cream and I felt lucky. I’m the sort of bloke that if it works for 70% of people, I’m one of them. If the most common blood type is O or something, that will probably be mine. (I know mine is a very common type but to be truthful even after all these blood tests over the past year or more I still don’t know for sure now what it is, and I can’t remember from the time I used to give blood. Weird, that.) So you can see my drift, right?
He also drew with a marker pen on my leg what sort of piece he would take out if we went for the surgery. Holy smoke! For something the size of a 5 cent piece, did he really need to start at my ankle and go to my navel? (OK, I’m exaggerating a teeny bit.) But why not just cut around the immediate area? It may not heal properly, he said. You could get ulcers if we don’t make a longish incision and stitch it together. Fair enough. That made sense to me. I’d had enough bits of my skin stitched back together in my time to get that.
So, we opted for a course of the cream. At first it seemed to go well, with the expected reaction by the cancer spot that it should have if the cream was going to work. Then it just sat there, and by the end of six weeks, the spots looked as cheery and content there on my legs as they had at the start. We decided to extend the treatment, but at the end of it, there they still were, not the least faded. It was as if they'd relished the cream, in fact. 'FEED ME!' It was like something out of the Little Shop of Horrors....
No choice then. The surgical option was the go. The date was set and the operation performed. Under local anaesthetic of course, I’m not that much of a wimp. Bits of the tissue were sent to the lab just to be sure there was no mistake about what we were dealing with.
So, here I was, right at that point, the doc inspecting the neat surgery he’d performed and then popping me that question – the good news or the bad? with that crooked, vaguely sheepish grin on his face.
Of course, I opted for the good news, after making him wait long enough for the grin to fade a little. I hoped he was thinking about whether or not his indemnity insurance was fully paid up. Well, if I'd actually thought about it, I would have given the impression I was thinking that.
‘The good news is that it confirmed it was a basal cell cancer and you are completely clear of it.’
And the bad news?
‘We didn’t have to perform this surgery after all.’
‘The biopsy on the tissue we took out showed that the cream had actually worked – probably in the first few days when you saw some action. The skin obviously needed much longer than usual to fade back to normal. That’s never happened in my experience before.’
He was right. We had made the right decision under the circumstances. There was no clue at the time that the skin cancer was nuked; and in any case, the deed was done. No use crying over spilt blood.
But sometimes I wonder if these deep incisions cutting through muscle and tissue have subsequently had some effect on blood circulation, and partly explain why my ankles and feet are now extra likely to swell up.
Probably not. I’ve made some terrible self-diagnoses in my time. I wasn’t cut out to be a medical doctor, just a play one, as one of my medic friends reminds me as often as he can.
Hang on, from start to finish, how long did it take you to get your medical degree, Doc?
‘Five years. And your degrees, including Ph D? How long?’
Start to finish? Ummm, fifteen years, actually. Much more thorough than you lot.
‘Ahhhh. Very slow learner. I thought as much....’
He’s right. I am a very slow learner, and that’s a fact.