I'm going to blame my Internet absence on the fact that I'm now missing a small piece of my right ear. I had no idea that all of a person's motivation could be localized to one very small and specific zone on the body, but there it is. Don't blame me, blame science. Or cancer. Yeah, back up, maybe blame cancer.
Having part of your ear cut off is not as fun as you think it's going to be, for the record. I made the same mistake this time as I made when I had a similar procedure performed on my back-- I disregarded everything the doctors said beforehand.
My dermatologist recommended the Mohs procedure for my melanoma removal; Mohs is a removal method that allows the doctor to take incredibly small sections of the area at a time and microscopically verify right then that the borders are clear. This in contrast with the removal procedure my previous dermatologist used on my back, a procedure called crazed serial hacking.
So I show up at the surgery center first thing in the morning with my Kindle and my baggie of almonds and my toe socks and an extra Diet Coke in my purse because after the doctor removes the first swath of skin it takes anywhere from three to six hours to find out if more skin has to be taken, and you have to remain in the office during that time. I'm not a hundred percent sure on why-- unless it has something to do with not wanting to loose a pack of barely cauterized facial surgery folk on the local restaurant community.
The doctor held up a mirror and explained exactly what was going to happen, information I would gladly share with you now except that my brain disregarded it immediately and replaced it with, "It's cool, don't even worry about it." I do remember he said something about trying to keep the curl at the top of my ear intact if it was possible; apparently trying to recreate that feature of the ear is, quote, "complicated".
Pssssshhhh. Doesn't look complicated. Pussy.
No, I'm joking, save the curl.
There were several extraordinarily painful shots to numb the area, and then the doctor began removing the melanoma on top of my ear. We chatted about the kinds of things you chat about when one of you is performing surgery on the other (the state of integrated air and missile defense, Foucault, etc.), the assistant cauterized the open wound, bandaged me up, and sent me back out to the waiting room for three to six hours.
The surgeon only sees one melanoma patient per day; it takes significantly longer to test the melanoma tissue than your other skin cancers and one is all they can do. I asked the nurse at the reception desk if they had a lanyard or a badge or something I could wear with MELANOMA on it, something to signify my obvious gangster status in this room full of wannabes. She did not. Rest assured I claimed my rightful position anyway by immediately laying claim to the comfy chair. Had there been a television I would have commandeered the remote. There was no television, however, so I had to settle for permanently naming all the fish in the fish tank.
Four hours later the doctor called me back. I pointedly left all my stuff in my chair, wishing too late that I'd thought to designate a Number Two to manage shit in my absence (the guy in the full neck bandage with his shoes off and all the good magazines on his lap, for example), ignored someone's grandchild calling Whiskerpants "Nemo", and went back.
"Good news," he said, "We got it all the first time. The borders are clear."
Excellent on all kinds of levels.
"So we'll see you first thing tomorrow morning."
That's how it works with Mohs. Because no one can predict how many times the doctor is going to have to remove tissue, it's impossible to plan to do the "closing" surgery that same day. Instead you're recauterized, bandaged up, sent home, and you come back the next day. Whereupon the doctor performs the skin graft / reconstruction surgery.
The nurse removes the temporary bandage and starts gathering the supplies she needs to really wrap up my head. In the midst of this she makes a fatal error.
"Do you want to see it?" she asks.
She holds up a hand mirror.
You know how sometimes you see an obviously photoshopped image where the intent is to make the observer believe that an inflight airplane only has one wing, or a new puppy has seven legs? That's exactly how I felt looking into that mirror. Like something was vitally wrong. It took me a split second to even identify what I was looking at; it was my ear, sure, but someone had photoshopped the top off.
I started laughing. And then I teared up just a little. The nurse then realized her mistake.
"It's going to be fine!" she said quickly. "Once he does the reconstruction, it'll be so much better, I promise. Seriously," she said. "Seriously."
Despite my repeated insistence that I was fine, she refused to take a picture of it with my cell phone.
As an added bonus, it hurt quite a bit once the shots wore off. I took a couple of the provided percocet, slept on my left side, and the next morning I was surprised at how much better it felt.
Piece of cake! Fuck you, cancer!
Right? Here's how the reconstruction went.
And I'm paraphrasing here because a) you can't quote an event, and b) I wasn't really listening.
The doctor pulled off the bandage. I'm guessing he didn't actually PULL it off, he most likely REMOVED it, but it sure as shit felt like he pulled that shit clean the shit off. Like pulling a wad of duct tape off the ends of your hair.
He administered more of those numbing shots. Straight into freshly cauterized tissue. Which really didn't seem that bad... once he started cutting that cauterized tissue completely off.
He took the skin graft from behind my ear. This was made pretty clear by all the eerily painless snipping and pulling going on back there. He sewed the skin graft onto the surgery site, stitched it up, stitched up the skin graft site, cauterized the absolute fuck out of everything, and left me in the capable hands of Nurse Regretful to wrap my head into a gauze vise.
Up until this point I was pretty proud of myself for the maintenance of my hair; I'd pinned it back out of the surgery site so it wouldn't get it the way, and it was still relatively blood and gore free. Nurse Regretful stopped that train in its tracks with a big handful of hair slime; she slicked it back all the way to the crown with a fistful of medical grade pork fat.
"There!" she smiled. "Now don't get that wet for a week."
So no washing my hair for a week. I pretended like this was going to be an inconvenience for me.
For the record, that big white bandage behind my ear came off inside of two hours. From then on it was just me and Big Tape. Big Tape and I ran an accelerated gamut of relationship stages, eventually ending in a standoff of mutual disgust. We passed through curiosity, bland acceptance, boundary testing, itchiness, irrational anger, complacency, stickiness, and smells weird.
Before I wrap this up I feel like I need to interrupt myself to mention how unbelievably painful this second procedure and its healing turned out to be. That first night before the skin graft was slightly unpleasant; the night after was fucking unbearable. I got home and felt good. I knew enough from the night before to expect the local to wear off in about four hours, I assumed I'd take a pain pill to sleep, and then based on experience I assumed I'd wake up the next morning at 90%.
That was safely not the case. I did everything but snort the pain medication and my whole head refused to not be on fire. I couldn't sleep, I couldn't turn my head, I couldn't convince Big Tape I just wanted to be friends, it was ridiculous.
When I went back a week later I was ready to cut Big Tape off with an ice pick. Big Tape did not feel the same, judging by the raw tenacity with which he decided to hold on.
This was a different nurse than my mirror-wielding surgery nurse. I couldn't see what she was doing, but I knew the end goal: get this fucking tape ball off my head. She's got scissors, she's got a scalpel, she's ripping it with her teeth... And every tug is just another tug on a twice-cauterized, freshly skin-grafted wound. Surprisingly enough I don't know all that much about skin grafts so I sort of picture them peeling off willy-nilly. Like Colorforms.
"I swear to god I'm gonna punch you in the face," I gritted at one point. She just furrowed her brow and nodded sympathetically.
"The ears are so sensitive," she empathized. "Bear with me."
It finally came off.
"Oh," she breathed, "It looks so good!"
She held up a mirror.
I laughed. "That does not look good."
It looked a lot better than it had when Nurse Regretful held a mirror up before the reconstruction, but it still looked pretty scalped.
New Nurse laughed with me. "It looks good to us," she explained, "The skin graft didn't die."
Oh. Well. Silver linings and all that. Way to not die, skin graft. Wooooooooo.
New Nurse gave me a new sheet of instructions to lose in my car. Big Tape wiggled his passive-aggressive goodbye from the biological waste can. I left and drove straight to my parents' house.
Who agreed that it was so much better than it could have been. And yet from a certain angle... yeah, not great.
But I said then and I maintain now that it's ONLY MY EAR. They literally could have removed it completely and I'd still be dancing in the streets if it meant not having cancer.
Plus, Nurse Regretful was absolutely right:
I truly cannot believe how well this guy has healed. I just can't believe it. And I took this picture about five weeks after the surgery, it looks even better now. You can see the tail of the skin graft site there behind my ear.
Having said that, I'm still amazed by how much it hurts. Not all the time, but I have to really prepare to sleep on it. And when I hug someone and I hug to the left, I invariably end up wincing when my friend's head presses against my ear. I would say something except that hugs are spontaneous things and I hate to bark out a series of rules outlining a three-second embrace.
It reminds me too much of Big Tape.