I'm prone to melanocytic nevi: moles on my skin. I have a lot of them, too. And I’ve probably had more removed (somewhere north of 27 at last count) than many people will ever have in their life in toto. I used to have a whole galaxy of them on the left side of my face as an adult, until my mother’s chronic need for aesthetic perfection overwhelmed her and she coughed up many thousands of dollars to have them and several others excised by San Francisco’s top dermatological surgeon, Seth L. Matarasso. Admittedly, I don’t miss them.
Many years ago, I was advised to have a ‘mole check’ every year or two, as a guard against cancerous lesions: Many types closely resemble normal moles, which to my untrained eye might not warrant medical review. Further, being used as I am to having a diversity of irregularly colored dermal excrescences, I might overlook even a not–so–mole–like growth. And so: mole checks.
Since then, I’ve had several different dermatologists emphasize the need for the checks, including Matarasso, who strongly suggested he should do one—free of charge—after removing three moles during one of my visits. His attitude in that moment changed the tone of our interaction from what had really been a business association, he providing a simply cosmetic service to me in exchange for payment, to a true doctor/patient relationship, wherein he was expressing clear concern for my continued good health. His earnestness conveyed to me his belief in the importance of mole checks and thereafter I was far more conscientious in their scheduling.
Interestingly enough, a few years later another dermatologist informed me that long-term studies hadn’t shown significant benefit in regular mole checks and that I probably didn't need to have them anymore. But he gave me one that day anyway.
Two years later I scheduled another check, albeit with a different dermatologist, Dr. Moskowitz. I admit to have felt slightly sheepish in doing so. Moskowitz, however, was very glad to see me, and spent seven or eight minutes, with an illuminated magnifier, carefully examining my skin head to toe, while providing a detailed commentary to the resident physician who was accompanying him that morning. During our subsequent discussion he made it very clear that he felt that biennial mole checks were a very good idea and that he looked forward to seeing me in a couple of years.
Two years later, I dutifully scheduled another appointment. I was glad to get to see him in part because of an irregular reddish flat patch on my left forearm that was clearly not a mole. My internet researches had suggested it could be a malignancy, unlikely but potentially very nasty, or a precancerous lesion, more likely but certainly not an outcome that would alleviate all of my apprehension. The appointment was for October 18th.
As I lay there on the examining table, I nonethless couldn’t stop thinking about the earlier dermatologist’s admonishment against regular mole checks—even as Moskowitz once again carefully scrutinized my skin with his illuminated magnifier. Everything was fine as he looked at my legs, my chest, my face. He stopped when he came to the patch on my left arm: “I really want to take that off today,” he said. “Absolutely,” I responded with no hesitation. In that moment, my latent doubt as to the importance of regular mole checks was severely undermined. He added that he didn’t remember the patch from my visit two years earlier, which impressed me.
Then he had me roll over onto my stomach. I could roughly follow where he was looking out of the corners of my eyes: My left shoulder and left upper back. Okay. My right shoulder and... “I really want to take this off, today, too,” he said. He touched a spot on my right shoulder blade. Instantly I was very happy, well extremely glad, well, really some kind of strongly positive feeling that I was getting regular mole checks. That I had two thises that he really wanted to remove right then and there was a bit unnerving.
He touched a third spot, this time on my lower left back. “And I really want to take this off, today, too.” I had been lost in thought. I jolted. I was up to three thises. “I know this isn't what you came in for, today,” he continued. Then he argued again for immediately removing all three of the thises, and threw in at least a couple more “reallys” for good measure. His aggressive use of that damn adverb and his enthusiastic desire for immediacy added to my anxiety. I began to think about annual mole checks. Perhaps even monthly ones. Okay, so maybe I was overreacting a bit.
Not once did I raise an objection or even ask any questions. I just encouraged him to go ahead and within ten minutes he had performed three nearly painless ‘shave biopsies’ and I had three little roughly circular divots in my body, each dressed with astringent, a dab of salve and a small round bandage. (The areas removed ranged between 3.0 and 5.0 millimeters in diameter.)
As I put my clothes back on, in typical medical fashion he calmly told me that there probably wasn’t anything to worry about and that he would call me with the biopsy results most likely within a week, perhaps even within three or four days, though sometimes they could take up to two weeks. But that was very uncommon. I thanked him, shook his hand and left.
Three days passed. Four. Five. A week. No results. I grew a little nervous, imagining additional lab work being done to verify a diagnosis of something hideous. Finally, on the tenth day after the my appointment, I received a phone call on my cell phone. Well, more correctly, a voicemail notification appeared on my iPhone: where I live I have really awful cell service and cellular calls made to me while I’m there usually go straight to voicemail because my phone can’t stay connected to the cellular network.
The voicemail was from 510-752-1000. It arrived at just after 4:30PM on Friday afternoon and I discovered it on my phone a few minutes after that. I looked at the number. I recognized the number. Well, sort of. I knew I’d seen it before and that I should know it. But I work with a lot of headhunters and recruiters that have numbers like it, with lots of zeros; I thought it might be one of them. I tried to listen to the message, several times, to no avail. I couldn’t connect to the network. I went back to work. Very little business could get done at ten–to–five on a Friday, anyway.
Several minutes later it struck me: 510-752-1000. That was the master phone number for Kaiser Permanente's Oakland Medical Center. Moskowitz! It had to be. The results of my biopsy were just a voicemail away. I wanted to hear it immediately so I could let go of my latent anxiety.
I couldn’t play the damn message. I kept trying. I went outside my home and started walking around my neighborhood. One bar. Two bars. Connected! Barely. But I still couldn’t get the message to play. The little indicator that the iPhone displays when it is fetching a voicemail just kept spinning ’round and ’round, even as I paced down blocks, even with my briefly–attained maximum of three bars.
Now, I’m not superstitious but I am imaginative and I couldn’t help but romaticize my technical problems into a bad omen. The phone didn’t want me to hear the results, I joked to myself. I finally accepted I wasn’t going to be able to listen to the message until I could venture beyond the limits of the telephonic black hole that sucks in all of the wireless signals in my neighborhood. And that couldn’t really be until about 6:30, when I was to pick up my wife. It was already after 5PM; I'd spent the more than twenty minutes trying to get my message. It—and I—could wait another seventy more.
As I was driving to pick up Kate, I held my cell phone in my left hand. (But I did have my legally required “hands free’ headset plugged into the phone.) I’d opened the phone to its voicemail feature before leaving my driveway. My thumb was poised to click the message. As I drove, I couldn’t help but glance briefly at the phone every few seconds, waiting for those four or five signal strength bars that would indicate a strong connection between my phone and my cell carrier’s network. ...Bingo! My thumb descended. And I listened.
“Hello Mr. Howell, it’s Dr. Moskowitz from Kaiser. I want to talk with you about your biopsy results. My direct line is [number]. I’ll be in my office for about another hour. If I don’t hear from you by then I’ll talk to you on Monday.” I compulsively looked at the clock in my car, even though I knew it’d been 6:30 when I’d left my home, already an hour after he’d left his office. Damn.
Couldn’t Moskowitz at least have said that “everything is basically okay but I’d like to talk to you about a few things?”
My mind has been racing all weekend. Just about eleven more hours until I will finally know.
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