The Podiatrist Will be in Shortly to Work on Your Nose - Richard Hulse
I’m in my mid-seventies and most of my life failed to fully protect my skin from overexposure to the sun’s rays. Used sunscreen when I thought about it, but not to the extent I should have. The result, four surgeries to remove cancerous tissue from my chest, shoulder, ear, and back. Along with these operations, I’ve had many precancers burned off my face, top of my head, various other places on my body.
A few months ago, a scabby spot appeared on the side of my nose as it had many times before. This time it bled a lot more than it had in the past. I didn’t think it was a big deal until I mentioned it to my wife, Debi.
“It might be cancerous,” she cautioned. “You should get it checked by your dermatologist. Look at the tip of my nose. I have a scar from the basal cancer my doctor removed using the Mohs procedure five years ago.”
“Mohs?” I said.
“Yes. Don’t you remember? The surgeon cut thin layers of tissue one at a time from my nose. Had it examined by a pathologist using a microscope, who let the surgeon know if it was necessary to remove more.”
I looked closely at Debi’s beautiful face. “I know you had that ground-breaking surgery,” I said, “but I can’t remember how many layers they removed before they got it all.”
“Four.”
I gulped. “Maybe I should just let things be. Take my chance it isn’t cancer.”
“You’re too smart for that, Rich. Aren’t you?”
I contacted my Kaiser dermatologist via e-mail and explained my situation. She asked me to send a photo of the spot on my nose to give her an idea what we were up against. I captured two clear shots of the bloody, scabby tissue with my cell phone and sent them to her. After examining both pictures, my doctor arranged an appointment for me at her office in Camarillo, a fifteen-minute drive from my house in Oxnard.
The day of my visit, I sat in the waiting room with half a dozen other masked patients. A female security guard routinely greeted everyone who entered and pointed at a chart.
“Good morning. Have you had any of the covid symptoms printed here? Have you recently been exposed to anyone with covid? Have a nice day.”
Everyone questioned responded in the negative.
When my name was called, I followed a nurse down a hall, where I was weighed, escorted to a room. “Please be seated, Mr. Hulse.” She took my blood pressure. Asked what medicines I took. How much I exercised. The nature of my visit. Finished with, “Dr. Malakouti will be with you shortly, sir. Please take a seat in the exam chair.”
Having been with Kaiser for over forty years, I knew what was coming next. Twenty minutes of me sitting staring at charts on the wall, instruments, machines with blinking lights, the clock, before my dermatologist knocked on the door and entered the room.
After closely examining my nose, she gave me the news. “I think the spot in the area known as the supra alar crease is cancerous. We’ve got to find out what type. I’m going to perform what is called a shave biopsy where I use a razor-like instrument to remove tissue from the questionable area.”
A bit nervous and anticipating pain, I managed a smile. “Go ahead, doc. Do what you gotta do.”
She swabbed my nose with an antiseptic, then took out a hypodermic needle. “This shot will numb your nose and keep it from hurting when I do the biopsy.”
I’ve felt pain before. Am usually tolerant of any type. But wow, when she jabbed the needle in my nose, it hurt so bad, I thought I might shoot through the roof. When she did it a second time, I did my best to avoid yelling out the f-word. Gritted my teeth and squeezed the arms on my chair until the pain finally subsided. Within seconds, my nose felt numb along with my right cheek and right eyelid. Even my upper lip.
After Dr. Malakouti, removed tissue from my nose, she placed the biopsied tissue in a container and handed it to her nurse. “Richard, we should know in a few days if the spot is cancerous, and if it is, what kind.”
I received a phone call from my doctor’s nurse with the results a week later. “Mr. Hulse, the biopsied tissue was cancerous, but it’s the basal cell type which is the least dangerous skin cancer. In most cases such as yours, it is nearly one hundred per cent treatable and rarely returns.”
“When can I get it taken care of?” I asked.
“How about we set you up sometime the last week of March? What is known as Moh’s surgery will be done at the Kaiser Woodland Hills facility by another doctor.”
“Fine by me. I am familiar with the procedure. My wife had it done a few years ago.”
Debi drove me to Kaiser Woodland Hills the day of my appointment. After I checked in, we sat down and waited for my name to be called. A nurse appeared from behind a door.
“Richard,” she said.
I stood up. “That’s me.”
“This way, sir.”
We walked down a hallway and she ushered me into a room. “Sit down and take off your shoes and socks.”
I did as she asked and waited for further instructions.
“I’m going to take your blood pressure before Dr. Kline sees you.”
“Dr. Kline?” I said.
“Yes, Dr. Kline.”
“I thought Dr. Liang was going to take care of me.”
“You’re not Richard Pringle?”
“No, I’m Richard Hulse.”
“Oh my God! Excuse me, Mr. Hulse. You’re the wrong patient. I’m so sorry for the mess up.”
I laughed. “Don’t worry. I was wondering what removing my shoes and socks had to do with removing cancer from my nose.”
After nearly being treated by a podiatrist, I ended up under the care of Dr. Liang’s nurse in another room. She took my blood pressure, reviewed my meds, asked me to put on a surgical bib and lie down on the adjustable hospital bed.
A friendly, perky Dr. Liang entered the room. She explained the Mohs surgery procedure and clarified, “This may take anywhere from an hour to four hours to complete. Hopefully the lesser time.”
“Go for it,” I said. “I have all the faith in the world of your ability. Kaiser has always done good by me.”
The doctor examined the area of my nose where she planned to operate. “First, I’m going to use a surgical pen to outline where I may have to cut, clean the area with alcohol, deaden your nose with a shot of anesthesia.”
The nurse draped a sterile dressing around my nose. I prayed the needle wouldn’t hurt like it did when my other doctor performed the biopsy. Wrong. IT HURT LIKE HELL!
Within seconds though, as with the biopsy, my face felt numb from the bottom of my chin to the bridge of my nose.
Dr. Liang removed the first layer of tissue and treated the area with a process known as electrocautery. Smoke rose from my face, and I smelled what I can only describe as rancid burned flesh.
“You wife can come in and be with you while we microscopically examine this first layer of tissue,” my surgeon said. “Hopefully, you’ll be heading home soon.”
Debi joined me for the next half-hour. We small talked about the weather. How our grandkids were doing. What we should have for dinner. She thumbed through a magazine as I laid there contemplating whether there was more cutting to come.
Dr. Liang rejoined us in a less perky mood. “I’m sorry, we didn’t get it all. We’ll have to cut out another layer. Mrs. Hulse, you’ll have to return to the waiting room.”
Debi gave me a thumbs up and left.
Anesthetize. Cut. Cauterize. Debi visits. Examination of tissue under a microscope.
During the operation part of this process, I felt comfortable and didn’t even feel a smidgen of pain.
We went through this routine two more times, before Dr. Liang returned to the room with good news. “Richard, we finally got it all! You and your lovely wife are free to head home after we dress your wound, explain your post-operative treatment, and finish the paperwork.”
I felt relieved, until Dr. Liang removed the bandage covering my nose. “You know, I’m not totally satisfied with the results of the surgery. If I leave it the way it is, there may be a bit more disfigurement. I think I need to suture your nose and pack the remaining gap with some of this special healing stuff I’ve got here.”
Thinking we were close to being out of there, I readied myself for hopefully the last round of treatment. I watched as the doctor systematically worked a needle and thread up and down in front of me. By the time she finished, Debi and I’d been at the hospital nearly five hours.
As we breezed home on the freeway, I felt pleased the surgery was behind me.
“How’s it feel?” Debi asked.
“I can’t feel anything if you mean pain. Nada. Zero. Zilch. Nothin’.”
“Good. I didn’t feel anything either after I had my surgery.”
The rest of the day I took little cat naps, because I’d slept very little the night before. In between winks, Debi read the recovery instructions to me.
“It says you shouldn’t bend down at the waist, which can increase blood pressure in the head and increase the risk of bleeding.”
“Keep the wound covered with Vaseline and a bandage if you go out in public.”
“Shower, but don’t run water directly over the healing area.”
“Keep the treated area elevated above the heart as much as possible during the first week.”
That evening, we enjoyed pizza and glasses of chianti. My nose still felt numb and so did my upper lip and teeth. I chomped on a piece of pepperoni, tasted blood.
“Son of a bitch,” I yelled.
Debi leaped to her feet. “What’s wrong?”
“I think I bit the inside of my mouth, although I didn’t feel it.”
“I’ll get you some cotton swabs to dab it.”
Forty-eight hours after my surgery, Debi announced, “It’s time to remove your bandage and examine your wound.” She gently peeled it off as I stood in front of the bathroom mirror with my back to it.
“What’s it look like?” I asked.
“Look for yourself.”
I turned around and managed a smile. “It looks gross, but not as much as I expected. The doc said what she cut out was about the size of a nickel.”
Debi laughed. “Looks more like four cents to me. Let’s clean it with this q-tip then apply more Vaseline and a fresh bandage.”
For the next four weeks, my wife dressed my wound a minimum of three times a day. Each time I examined the area where the surgeon sliced and diced me, it appeared a tad smaller.
Thirty some days after the surgery, my nose is as close to looking like it did before I went under the knife. And I learned two things—Dr. Liang is a genius. I need to religiously apply sunscreen to exposed parts of my body when I go out in the sun.
Also, I’m never going to look like Paul Newman, but my wife says under the circumstances, I’m still a good-looking son-of-a-gun.
I am a retired school teacher who lives with my wife in Hollywood Beach, California. We both enjoy taking walks on the sand and enjoy watching dolphins surf the waves at sunset. I have written two narrative nonfiction books: My Brother Bo: Addicted in Paradise and Forty Crazy Years of Friendship.
