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The Recorded Diagnosis

The Appointment

Three weeks ago I noticed several small, dry, rough-textured patches on the top of my husbandís head. They were easily noted because of his thinning gray hair which he pulls back daily into a small pony tail. I decided it was time to call the dermatologist for a full head-to-toe checkup. To convince my husband of the importance of this visit, I made an appointment for both of us. "After all," I told him, "neither one of us have seen a dermatologist for at least four years."

We met mid morning at the doctorís office where we filled out several questionnaires, including the usual HIPAA form. Colorful pamphlets lined the counters advertising chemical peels, facials, dermabrasions, and a variety of laser procedures. I thought about how dermatology has changed over the years from a focus on medical skin conditions to the practice of professional medical makeovers. I studied the people in the packed waiting room wondering how many patients were here for cosmetic reasons versus medical skin problems.

Just then the receptionist called out my name and asked me to follow the nurse to the exam room. I sat in a chair next to the computer desk while the nurse entered data and asked a few questions. "Iím a nurse also," I told her thinking that sharing that information might give us a sense of camaraderie. No reaction was noted. Her eyes focused on the computer screen until she abruptly pushed her chair back, gathered up some loose papers and headed for the door. Turning my way she said, "Take off all your clothes, except for your panties and put the gown on leaving the back open. Someone will be in to see you soon."

I slipped into the blue flimsy paper gown tying a matching belt around my waist. Sitting on a leather chair, I waited fifteen minutes until the P.A (physician assistant) entered the room. She had dark hair pulled back with a fancy barrette and an accent which made it difficult to understand her name and what she was saying. "Are there any suspicious areas," she asked.

I pointed to a reddened patch in the middle of my chest, two inches below my neck, and asked her to take a look. "I definitely need to biopsy that," she said staring into the uneven pinkish patch of skin. "How long have you had this?"

"Iím not sure," I told her feeling a bit stupid. "I think itís been there for at least a year. It was inflamed about six months ago, but I thought I had scratched it or irritated it."

I asked to see the doctor and get her opinion before agreeing to a biopsy. The P.A. walked out of the room with a disapproving look on her face and within five minutes entered again with the doctor. "Letís have a look," she said. The P.A. pointed to the area of concern with her forefinger. "I agree," the doctor said as she studied the small reddened patch. "This needs to be biopsied with a 4 millimeter punch."

"Whatís a punch," I asked while trying not to imagine what it might be. "This is a technique which involves the use of a circular blade that is rotated down through the epidermis and dermis, and into the subcutaneous fat yielding a 3-4mm cylindrical core of tissue sample," the doctor said still gazing at the area in question. Itís a technique for obtaining a diagnostic full-thickness skin specimen."

The Biopsy

The painless procedure took about seven minutes which included suturing and a dressing. An aftercare sheet was handed to me and I couldnít wait to leave the office. In the waiting room my husband showed me the top of his head where the areas of concern were burned off. I showed him a small round Band-Aid on my chest and told him about the biopsy and stitches.

The procedure came as a complete shock. I never expected to be biopsied for cancer. I thought I might argue about having a few moles burned off or be lectured about using more sunscreen, or to make yearly appointments. The question of cancer took me by complete surprise.

The Recording

I waited a week for the pathology results, hoping that it was nothing, knowing that it might be something. I couldnít even say the "C" word or think about the possible diagnosis without feeling a bit down. A week later, I retrieved my home messages from work. The fifth message was from the P.A.óI recognized her accent. She identified herself and proceeded to leave a detailed message:

"We received the pathology report. It came back positive for infiltrative basal cell cancer. You will have an excision and there will be a long scar along your chest area." She repeated the part about the "long scar" three different times. "Please call the office to schedule a consultation about the surgery." All I could think about was the word Ďcancerí which took me by surprise. I wished I could push the "repeat" button, but I was still at work. I wished I could be asleep and wake up from a bad dream. I wished she hadnít left the message on my phone recorder. I wondered what happened to HIPPA. I wondered what happened to common courtesy. I wondered what happened to our healthcare system.

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