Double Island Pedicle

I am doing the A-Z challenge; today’s letter is P  for Pedicle.

Double Island Pedicle

I was the center of attention, in the dermatology wing of the San Francisco Veterans Affairs Clinic the other day, having a double island pedicle performed for my benefit.  Normally that would not be my first choice, because I hate the spotlight, but under the circumstances, I was more than delighted to afford medical personnel the opportunity to see this particular procedure in action.

I had no idea, when I embarked for San Francisco, with Annie, what having a Mohs surgical operation was all about.  The way it was explained to me, was that the doctor would remove a small segment of infected skin from the center of my chest, to examine it under a microscope, to see whether all of the cancerous tissue had been removed.  It sounded pretty basic to me.

However, as the procedure progressed, it turned out that the area in question was a lot bigger than what I thought, more than two inches in diameter.  Additionally, after waiting for two and a half hours (we had been advised it would take at least that long) it turned out that more tissue had to be removed for further perusal, under that trusty ‘scope.

That is what the term Mohs Surgery alludes to: a procedure in which cancerous tissue is closely examined under a microscope, bit-by-bit, until it is deemed that all of the infected area has been removed.  I thought only the nickel-sized red spot would be removed, but there was a lot more around this area, that had to be examined.

Several times, the term “island pedicle” was bandied about, to the point where I asked the surgeon to spell it for me.  The anesthesia was a local one, so I was not asleep; rather, I had a front-row seat, albeit with my eyes closed, while a team of medical personnel worked on my chest.

This is where the interesting part comes into play.  Not all medical personnel are warm and fuzzy.  Years ago I had reconstructive shoulder surgery performed by a man who certainly knew what he was doing; it’s just that he had the bedside manner of a blood-sucking, saber-toothed, clam.  He was a mean, nasty, uncommunicative banana slug of a doctor.

On Tuesday, I was surrounded by professional, considerate individuals, who made it clear that they were there for my benefit, and that my welfare was uppermost in their collective minds.  They were happy to permit Annie to be in the operating arena with me; they were happy to give me information and answer my questions; and they were happy to take on a challenging procedure, because it was deemed the best course of action.

Because I had a gaping hole in my chest, there was a need to cover this crater with new skin.  Since I was the handiest candidate, from whom to get the skin, they did this very cool procedure which involved cutting skin from both sides of the crater, and reattaching it over the hole, while leaving the tip of each flap of skin attached to the rest of my chest.  This was possible, because the skin from my chest was reasonably flexible, and in the end, they stitched the two triangular sections together, over the crater, making it all flow together as only surgeons can do.

I have simplified matters considerably, but the end result is no gaping hole, and the potential for a very cool scar.  Lord knows, when one hits sixty, it’s important to have some very cool scars on your body.  Actually, one reason the procedure attracted so much interest, is because it is usually performed on one’s leg, or maybe an arm.  But a chest?  Big things going on!

Dr. Sarah Aaron was the head doctor, but Dr. Berliner did the bulk of the work.  They began the closure together, but Dr. Aaron soon departed, because she had other surgical procedures to which she had to attend.  Dr. Berliner worked methodically, with a nurse practitioner always in attendance, and she was awesome.  Dr. Goughia stopped in several times, in a consulting capacity, and several other individuals dropped by to see how things were going.

The whole scene was very mesmerizing to me; I listened to the conversations going on around me, and asked questions or made editorial comments, in the most comfortable manner imaginable.  I felt relaxed, and most importantly, I felt I was in the best hands possible.  After the team had been working close to three hours to stitch me up, I asked how many stitches were being required.  Dr. Goughia did a quick count and announced, “seventy-five,” while chuckling and adding that it was very important to have that piece of information, “for bragging rights.”  They definitely got it.

Now, three days later, the worst of the discomfort is over, there is no sign of infection, and I am going to leave the comfort of our Willits duplex, for the more rigorous site up on the mountain.  I have followed all of the rules set down by Annie, not varying in any way, because even I see the precarious nature of taking unnecessary risks.  All I want to say is that I continue to be astonished at the quality of the care the Veterans Affairs facilities provide for me.  

These facilities are staffed by conscientious and caring individuals, and I need to acknowledge that.  I did write a letter of appreciation to the director of the San Francisco VA, to express my feelings, and I did thank the folks in the operating arena.  

Since I do not have any tattoos, I at least have a snazzy new scar to show off.  I can tell everyone it’s a war-wound; I got attacked by a vicious typewriter, running amok...