Fremantlebiz - Paul's Letter from Australia

A visit to the cutaneous surgeon

Yesterday I mentioned I was going to see a specialist doctor in Fremantle about a small lump above my lip. The lump was a typical basal cell carcinoma (BCC). It seems these days if middle aged adults in this country don’t have one then they are not really “Australians.”

Since I became aware of my imperfection, I have noticed how common they are on others. Watching out for them on TV identities and politicians is now a sort of sport. A case of spot the lump and “knowingly” diagnose it. Cheeks are a favourite resting places for these cheeky little growths. Of course nothing is so simple as the lay view. They can have other explanations.

The expert opinion seems to favour the theory that BCCs are encouraged by solar damage at some time in the past. Maybe even thirty years ago. Then there is a latent period before they begin to materialise. As I understand matters, they generally can sit wart-like on the surface and behave themselves indefinitely. They are the cutaneous version of a stromatolite.

This doctor I saw is a recognised expert in his field, a cutaneous surgeon no less, and so he has a lot of patients referred to him by lesser qualified general practitioners. He is also a man of action, and prefers to go on the attack against these things in the first instance. Like on the first day he sees a patient. This is a highly admirable trait, because dealing with some members of the medical profession can be a fairly drawn out process.

So when one makes an appointment with him, the receptionist warns that several hours should be set aside. Having an appointment-time does not actually mean what it sounds like. It just means you are there lined up ready on the starting blocks. I put aside the whole day. I am very calm about time taken on such occasions.

The staff were extremely pleasant, and informative. This is a good sign. In the waiting room there was a good assortment of magazines – expensive ones that only doctors or their wives can afford. So it was an opportunity for me to catch up on the latest trends in Vogue. I noticed too that there were quite a few with titles like, “Perfect holiday destinations in the South Pacific.” You can tell quite a lot about medical professionals from the literature they provide in their waiting rooms. There were also free coffee making facilities and a tub of complimentary samples of sunscreen lotion. A notice reminded greedy patients to only take one.

In due course I was ushered in to see the doctor. This was a very pleasant experience too and he spent the first five minutes putting me at ease and chatting about my past. What sort of work had I done and the like. Well I have done lots of things, but felt a bit like I would have been wasting his time if I ran through the lot, so I plucked out a couple I thought a skin doctor would be interested in. Surfer? Yep that got a tick. Soldier in sunny Vietnam? That didn’t seem to spark much interest. Drive-in theatre projectionist? Bingo. Turns out that he had a passion for drive-ins, especially the now defunct Lakeway in Claremont. Clearly it had played an important role in his social education, as these places did for most men now of our age. He greatly lamented the passing of the drive-in era. Such are the nostalgic dreams of older men. I remember the Lakeway for Passiona and Minties. We agreed that arc lamps on movie projectors were a good source of UV.

I noticed too that he had a few items of cricket memorabilia on the wall alongside his diplomas. The man was obviously a keen cricket fan. What's more I later discovered he is the official doctor for the WACCA - that’s the governing cricket body in this state. This means he is probably very expert in treating broken fingers, sprained thumbs and bruises. It also means he gets free tickets to the best seats in the Member’s Stand. I suspect that when test matches with visiting international teams are underway he might take a few days off from his cutaneous pursuits. My mind started to wander, thinking about when the next Lilac Hill one-day match will be. I love going to those events.

Niceties aside, I was taken into a treatment room and examined with a video microscope thingo. This hand-held gadget brings up the skin nasties for diagnosis on an adjacent video monitor. There are two switchable functions; the surface view, and the subsurface view. It could see what was going on under the skin. Magic! Much better than my own microscope.

BCCs are interesting things when magnified. They have a blood supply and it is obvious they have clearly settled in for the duration. Like an alien parasite in a way. A real life version of a Goa’uld, like in the Stargate TV series.

Then it was up onto a bench to hit it with a local anaesthetic. I don’t usually mind injections, but this set was like being zapped with a half dozen bee stings. No, change that to wasp stings. Back to the waiting room for a long wait. After all, that’s what waiting rooms are for. The anaesthetic cocktail contained a compound to shrink blood vessels and thus reduce bleeding under the knife. This process takes at least a half hour to swing in, but it was actually about an hour and a half before he got back to me. By this time I had gotten well into a Gideon Society’s Bible and was quite enjoying looking up all the famous lines courtesy of an index at the front. I have decided some of them could do with a rewrite.

Then I was led to the surgery, a real surgery. Not the grotty sort of excuse for a surgery that many GPs put together. Up onto a bunk with a nice soft pillow. Left alone for another 15 minutes. I did some simple yoga while I waited. Then Action Man arrived and came around behind me where I couldn’t see him. Sneaky. I think he sliced the top off the BCC straight away to test if it was numb and bloodless. Then he and the nurse placed a paper cover over my face. Just a small hole for where he was working. I think this is so they are not distracted by the terrified gaze of patients. Conversely it might be to prevent the patient’s misinterpretation of expressions of alarm on the surgeon’s face. The paper had a peculiar smell, reminiscent of freshly cooked biscuits.

I had casually mentioned my academic background when he was checking out my work history. Now he wanted to know more. What, where, when? He discovered it had been related to marine resource exploitation in WA and that I had also done a separate post-graduate study of Ningaloo Reef. This was the cue to treat me to a non-stop monologue of his fishing expedition last year to Coral Bay and Exmouth - all the while steadily working away at my face. I was totally relaxed. A much better experience than going to the dentist. There was quite a bit of surgical activity. Slice, dice, nip, tuck. I unestimated the size of the chunk he had to remove. Sort of upside-down pyramid-shaped. Just the right size and shape to use as fishing bait on a number 7 hook. This left a hole which he refilled by taking some surplus meat off the side. Then it was all stitched up with soluble micro-stitches. Lots of them. I would have liked to watch. He could have a nice little sideline selling videos. I have to go back on Friday when he will check his workmanship, and decide on the next course of action for some other non-malignant blemishes. I am looking forward to it.

© MMIV Paul R. Weaver.

About the writer

Check out the index of my "common-man" monologues about survival in 21st century Australia – plus a little history occasionally. An original essay is added most days.

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