My experience with skin cancer, part 2: Mohs Surgery

Catch up on part one of the story here.

Previously... we had made it to the night before my surgery.

We all went to bed and I spent some time in bed before I fell asleep just reading my book and enjoying the feeling of having everything prepared.  (Well, I should say that my lesson plan for my last day of time off was not yet done, but I was planning to finish that in the waiting period after the first cut of the surgery.) Just before I went to sleep, I found my mind looking ahead to the surgery and wondering what I should expect.  I had been so busy with all of the preparations that I hadn't really taken the time to think ahead to the process I was about to go through.  And so, at about 9:45 PM that night before surgery, I made the mistake of googling "my experience with Mohs surgery".  I happened upon a few  stories here and here that were a little difficult to read (don't click on those links unless you'd like to see some graphic before and after photos).  It was tough to fall asleep after reading those stories-- I tried to reassure myself that another person's experience wouldn't necessarily be mine, but the unknown was beginning to plague me a bit.  I did eventually drift off, sometime after 11:30 PM.

I got up at 5 AM the next morning to do a final run on the treadmill (I knew that vigorous exercise would be prohibited for some time after the surgery so I wanted to enjoy that!) and then packed a lunch and several snacks since I didn't know how long I would be waiting.  I had breakfast and coffee and took a quick shower (I knew this would also likely be my last shower for at least a few days).  M took N to the high school early after some hugs and kisses, and was on his way back home to take the younger girls to school.  I hugged and kissed the younger girls and they wished me luck, then just after 7 AM my parents and I were on the road to the dermatological surgery.  We arrived a few minutes before 8, right on schedule.  I was feeling pretty optimistic at this point-- the stories I had read the previous night were still vaguely with me, but, well... basically I knew that I just had to get this done, no matter how hard it was, and I knew that I had the support to get through whatever came my way.  I felt fortunate in my loved ones!

I got checked in and was inputting the WiFi password into my laptop when they called me in, barely five minutes after I arrived.  I gave my parents a final hug and went in.

The surgeon's assistant led me to the surgery room, which was just like any other exam room at the dermatologist's office, but with a slightly more elaborate exam chair.  She asked me a few questions about my skin spot, and gave me a quick low-down of what was about to happen-- no new information, just some reminders.  She left to get the surgeon and he came back within a few minutes.  I was asked to sit in the chair-- somewhat like a dentist's chair that reclined all the way down and the foot rest came up so it became a sort of operating table.  The surgeon was very friendly, asking me questions about my job and when he found out I was an orchestra teacher, he was asking me a lot of questions about that as he worked and talking with me and the assistant about all of our different musical experiences.  I recognized that this was partly to keep me calm as he worked, and I appreciated that about him.  He gave me a shot to numb the nose, which was again eye-wateringly painful, but after that I felt absolutely nothing; in fact, I thought that he was still finishing the numbing shot when he said, "Great job!  I'll be back in an hour to give you the result," and left the room.

The surgeon's assistant came over to bandage my face-- she gave me what she called a "pressure bandage" which was basically a thick piece of gauze with three large pieces of tape running very tightly over it so that my nose was kind of squashed-- they did this to keep pressure on the wound and minimize bleeding.  But because my nose, and really half my face, was still numb, it wasn't uncomfortable.  I simply had to be a mouth-breather for the next hour.

My parents were allowed to come in to the exam room and sit with me for the waiting period.  It seemed to go by quickly-- I was almost to the end of my sub plan for my final day off when the surgeon's assistant came back in.  It had been just over an hour of waiting.  She informed me that there was still a little more cancer that they needed to get, so I would need to undergo a second cut.  My parents left to go to the outside waiting area, and they began to prepare the room for the second procedure.

The surgeon came back and by that time enough of the numbness had worn off that I had to have another shot.  Again, this was the most painful part.  The rest I didn't feel at all.  I did notice that I felt more blood dripping out the second time, which makes sense because the cut was deeper.  But again the whole thing was done in less than five minutes, and the surgeon left the room and the assistant gave me another pressure bandage.

My parents had decided to go for a walk so I was alone for this waiting period but still feeling very good.  I was able to completely finish my sub plans and get everything sent off, plus check a few more items off my to-do list.  Almost as soon as I had finished up, one of the assistants came back in to tell me that they had gotten all the cancer!  He said the next step was to weigh the options for repairing the wound and decide how best to go forward.  The assistant explained that if the wound was small enough we could let it heal on its own, or there was the option of a skin graft if the surgeon thought it was necessary.  He said the surgeon would be back in soon to discuss it with me and then we would do the repair.  Although I was getting hungry (it was about 11:30 AM) I decided not to start eating the lunch I had packed, since it seemed likely I wouldn't have enough time to finish.

I ended up waiting almost another hour for the surgeon to come back in-- apparently he was busy with another skin repair.  I didn't mind the wait; I was finishing up some last work items and then I enjoyed reading my book for a while.  I was also able to text the good news that I was cancer-free to all of my family who were waiting to hear.

When the surgeon finally did come in, he explained the options for repair of the wound on my nose.  He said there was the option to let it heal, or to do a skin graft from the other side of my nose, or from my ear.  Because he had seen the size of my wound, I could tell from the way he was talking that his recommendation was a skin graft and not the "let it heal" option.  He described taking skin from my ear as "less invasive"-- I think mostly meaning it would be less damage to my nose, and the skin would come from a less conspicuous area.  He asked if I wanted to see the wound before we made a final decision, and although I wasn't sure I could stomach it at the time, I said yes, and I'm glad I did.  He held up the mirror to reveal a nickel-sized hole in the side of my nose, probably 3-4 times the diameter of my original spot.  I had prepared myself that it would be much bigger, but it was still a bit of a shock to see it.  After seeing it I agreed that no more damage to my nose was probably a good idea.  I gave him the go-ahead to take the skin graft from my ear.

To prepare me for the procedure, they painted my entire face with iodine, covered my eyes with what felt like wet washcloths, and put a surgical drape over my entire head with holes only for my nose and my right ear.  For each of the first two cuts during the cancer removal, the surgeon's assistant had put on soothing ambient background music, but this time he asked me what I wanted-- he remembered I had said my students were playing Vivaldi's Four Seasons, and he asked whether I wanted that, or maybe Bach?  I suggested the Bach Brandenburg Concerti, and he said, "perfect!" and found it on his iPad.  I thought that was a nice touch :)

He checked my nose again for numbness before beginning, and I needed a few more shots in that area, as well as several in my ear, of course.  Again those shots were pretty pinchy but after that I didn't feel much.  This part of the procedure, however, took long enough that the numbness started to wear off at certain points, but whenever the surgeon felt me flinch he would say "little pain there? sorry about that" and give me additional numbing shots.

I sensed the point at which he stopped working on my ear and started working on my nose.  There was another doctor in the room assisting, and an assistant as well.  As they helped him complete the work they talked congenially, and the surgeon seemed to be sort of teaching them the different techniques he was using.  I could feel tugging and pulling and knew he was probably finishing up with the stitches.  On the second to last stitch I started to feel a bit of pain again, and the surgeon said "this is the last stitch!" and I knew I could tough it out because I was about to be done.  He said, "You did great!  I'll see you in two weeks," and then mentioned that the other doctor and the assistant would bandage me up and then I would be free to go.

After he left the room the other doctor reiterated what my dermatologist had originally told me-- she said that this surgeon was the best Mohs surgeon in the country!  She told me my repair looked great and was going to "heal really nicely".  As they were bandaging both my ear and my nose they were giving me instructions on how to care for both wounds.  At one point I said, "you're going to write all of this down, right?" because with numbness starting to wear off it was a little hard to focus on what they were saying.

They bandaged my nose with a relatively small piece of gauze and tape, but my ear was a bit more complicated.  They first put some kind of medical foam over the wound; they said this would form a kind of "scab" and that I should not remove it but just let if fall off.  Then they covered the foam with gauze and loosely taped the gauze.  Because I needed to have the "pressure bandage" like before, they had to wrap my entire head so that the dressing on my ear would be quite tight and stop the bleeding.  They gave me all the papers and instructions and prescriptions I needed, and scheduled the follow-up appointment to remove the stitches for two weeks out.  Then they released me to go home!  I had texted my mom and dad to warn them that I would be coming out (they were in the general waiting area) with a huge bandage on my head.  They met me, gave me smiles of relief that it was done, and we got in the car to head for home.

We stopped at the pharmacy for my three prescriptions-- an antibiotic to prevent infection, a strong painkiller, and an anti-nausea drug to counteract side effects of the painkiller.  While Mom and Dad went in to pick up the prescriptions I texted M and the girls a picture of myself to prepare them for my stylish new headband:

I ate my packed lunch as we drove home and as soon as we got there I decided to take one of the prescription painkillers.  Numbness was already wearing off and I thought it would be better to get ahead of it.  Only after I took that painkiller did I google the name of it and realize it was an opiate called Tramadol.  So, that was my first experience with those kids of drugs!  I felt pretty sedated for the rest of the evening, but it was okay since I basically had to sit on the couch and do nothing-- Mom and Dad were wonderfully helpful, and M had prepped some burgers and fries ahead of time so all he had to do was heat them up.  I filled the girls in on how everything had gone and what my healing process would look like, and we binge-watched some Downton Abbey and Jane Austen movies for the rest of the day, until it was time for bed.

I found that my mind was trying to jump ahead and plan for all the healing time that needed to take place.  I had originally thought that I would only be bandaged for a week, but now due to the skin graft it would be two.  For those entire two weeks I wasn't allowed to remove my nose bandage, or get it wet.  Did this mean no showers for two weeks, I thought?  It was enough stress on my mind to think of having to teach with a big bandage on my face for two weeks, and explain everything to my students and colleagues, but if I also couldn't shower... let's just say my own vanity came into play a little bit more than I would have liked as these thoughts swirled in my head.  I tried to keep myself calm and tell myself I would just take things one day at a time, and focus on rest and recovery in the next few days, while trying not to worry too much about the future.

To be continued…

Move on to part three here.