July 24, 2009--The Ladies of Forest Trace: Basal Cell Carcinoma
“I’m calling to see how he is doing.” It was my 101 year-old mother who lives at Forest Trace, a retirement community near Ft. Lauderdale.
I was in the midst of a project and for a moment didn’t know who she was referring to. She sensed that, “I mean your brother-in-law, how is the treatment?”
“It’s completed. He’s through with it. He handled it magnificently. And now he is on the road to recovery. Just yesterday he said to me that he was able to eat some French toast; and that he ate it, as he put it, ‘in normal circumstances and in normal style.’ I was so impressed by the news, including how he described this, that he and I have been talking about the meaning of things being normal. How, if we are fortunate, we take normal for granted; and that . . .”
She cut me off in mid-sentence, “To tell you the truth this is not why I called.”
“Go on.”
“I care about him. He is a very fine young man,” fine being her ultimate compliment.
“So why did you call? Of course,” I raced to add, “I always love hearing from you, talking with you. It’s always my . . .”
“They tell me I need to have Moose.”
“What? Moose?”
“The Moose operation. Surgery. On my face.”
“Back up a minute, mom. I’m having trouble understanding. I know you had a doctors appointment. I forget which one you have so many doctors.”
“Just five. My internist, my cardiologist, my ophthalmologist, the one who prescribes my antidepressants, and him.”
“Him?”
“And of course I have my dentist. I forgot him. He’s a doctor too.”
“But the last one you mentioned. The one you called ‘him.’ Who is he and what happened, I am assuming something did, when you saw him?”
“When I saw him last week he’s the one who scheduled the Moose surgery. My dermatologist. He saw something he doesn’t like. On my face. On my right cheek. He set up an appointment to do the operation.”
“Ah, I’m following you now. You mean Mohs surgery. M, O, H, S.”
“Yes, that’s it--Mohs. I keep telling you I’m losing my memory.”
“I hope when I’m ‘only’ 90 I’ll have a memory like yours.” In truth, about that and abut almost everything else with her, she has lost remarkably few capacities. Her worst affliction is some arthritis in her left hip and a little unsteadiness when walking. All she really needs is a cane. As much for security as to help her walk. “Tell me mom, what happened. Start from the beginning.”
“I will tell you, but I want you to know, before I start, that I really want to talk about Obama and health insurance. I’m thinking of writing to tell him what he should do.”
“Fine. But let’s first talk about the dermatologist.”
“He said I have a basal cell carcinoma there and he needs to remove it with the Mohs.”
“That’s the procedure, isn’t it, where you go to his office and he takes off a layer of skin, cells actually, and in the office does a biopsy; and then if he hasn’t gotten all of the ones that are pre-cancerous, he takes another layer, tests it, and then if necessary removes a third one, and so on until he has it all? Right?”
“Exactly! You see, I told you you should have gone to medical school like your brother did.”
“This sounds like a lot to put you through.”
“I’ve experienced worse.”
“But . . .”
“Be patient. I’m not through. I saw him on Friday and over the weekend I thought about it. I was having second thoughts about the operation.”
“Procedure, mom, procedure.”
“You can call it whatever you want; but to me, at my age, everything is an operation.”
“I understand. So why didn’t you tell me about this, but more important what did you think about over the weekend?”
“Whether or not I should let them cut up my cheek. Among other things I’ll have a big hole on my face for the rest of my life.”
“But, mom, if you need to do this you should . . .”
“That is my point--do I really need to do this. So I called him yesterday, when he has office hours, the doctor, and he got on the phone himself, which never happened before. Maybe because I have a son who’s a doctor he extended me a little professional courtesy. And when he got on the phone I said ‘I won’t keep you more than a minute,’ you see I had written down what I wanted to say to him, ‘I am calling,’ I said, ‘to ask if as a 101 year-old I need to have the operation.’ He said, ‘When you have basal cell I always remove it.’ I said, ‘I understand, but in my case how long, how many years will it take before what I have becomes a melanoma?’ In other words a big problem. And he said to me, ‘Oh, many years.’ So I said, like I told you I had written this down, ‘So why don’t we wait those “many years” to see what develops?’ He didn’t say anything, so I said, ‘At my age that could take forever.’ Do you get what I meant by that?” This was directed at me.
“Yes, I understand what it means--that you’re 101 and in all likelihood, you will . . .”
“No need to complete your thought. We both understand.”
“Agreed. So what happened next?”
“We cancelled the appointment for the Mohs and agreed I would come to see him three times a year and he would monitor the situation.”
I was relieved to hear that. “This is excellent. I’m very impressed with how you thought this through and handled the situation. I wish I was as good as you in dealing with my doctors. I always feel so intimidated by them.”
“This is not all.”
“But I thought you cancelled the procedure, sorry, operation, and that you would make appointments to be monitored and . . .”
“That’s really my point and what I want to write to Barack Obama about.”
“Again, I’m not following you.”
“Why, I want to know, should a 101 year-old have a dermatologist?”
“Well, if you have . . .”
“Exactly if I have a melanoma or something else very serious. Psoriasis. Which is not as bad, obviously, but still then I would need to go to see him. But for this? What’s to monitor? And why three times a year?”
I was beginning to see her point. It was going to be about healthcare tests and procedures.
“An old lady like me, unless as I said I have a serious condition, should not ever see a dermatologist. Anything I might develop is not going to kill me before time kills me.”
“Mom, why are you talking about yourself this way?” Even though she’s 101, I have difficulty imaging her no long here. Much less thinking about her being killed, even by time.
“Because as the ladies were saying over dinner last night, you know us, we love our doctors—where would we be without them-- and we worked so hard to get our benefits; but take Anna for an example, there’s really nothing wrong with her except a little this and a little that. She goes to the same internist as I do—in fact I was the one who recommended him to her. Her doctor didn’t have the time of day for her. To him she was less than a number. In and out, in and out. That’s what going to him was like. So I got her to switch to mine. She loves him, of course. But I already told you that. I’m sorry. I’m rambling again.”
“You haven’t been rambling mom. I know this is an emotional subject—your health.”
“It’s really not about my health. I’ve been blessed. I know that. I still am. And that’s my point. The girls feel, I feel that we all should have the best healthcare in the world. This is America. Why should they have better other places? And why should we have to pay so much for it? More than any other country. Bertha thinks her Medicare costs nothing. She keeps saying, “It doesn’t cost me anything! Isn’t this a wonderful country?’ Poor thing, she is losing her mind. I keep saying to her that it’s not free. That we paid for it when we were younger and we are paying for it now with our taxes. And with the government borrowing. Nothing is for nothing.”
“And so what is it that you want to write to the president?” I wanted to help steer her back to what she had told me was the real reason she had called.
“Yes, that. I was just setting a context. From the girls. Those of us, I want to tell him, who need all kinds of doctors and tests should have only the best. But those like me, and younger people too who are on Medicare who have nothing really to complain or worry about, for us they should just do what they can to keep us healthy. He is talking about that—prevention. And that is good. But with my dematologist. What I first told you about. Tell me why I should be seeing him three times a year? Or anyone without a serious condition?” Before I could speculate she added, “Because that’s how many time a year he can get reimbursed for seeing me. Three times. You’re good with research. Look it up. I’m sure that’s what you’ll find. That Medicare permits that and so I have three appointments already scheduled. One in October, another one next February, and then another one I forgot when. As I said to him on the telephone, ‘I should live so long!’”
“Well, of course I’m glad you’re fine and that the growth on your cheek is really nothing to worry about, and that . . .”
“For someone my age it is nothing to worry about. About you it’s another thing. And on that subject I hope you’re going for your regular checkups. Including with the skin doctor. You sit out in the sun too much.”
“I do. You don’t have to worry about me.”
“You’re telling your mother not to worry about her son? I’m still be worrying when they put me in Mount Hebron.”
“I wish you wouldn’t . . .”
“But again I’m digressing. I have one final thing to tell you.”
“Yes?”
“He thinks I’ll be coming to see him in October and then more times next year. Well, little does he know that I won’t. As soon as I hang up with you I’m calling to cancel all those appointments. He’s a wonderful doctor who took very good care of your father and me—your father really needed him he had so many basal cells—but I’m another story. I never sat in the sun, and I’m 101. So I’m going to begin—I want to write this too to Obama—I’m going to begin rationing my own healthcare. He didn’t answer that question honestly at his conference on Wednesday. When the reporter asked him about what people will have to give up so those without insurance can have it and how we can cut the cost of Medicare. The honest answer is rationing. He didn’t say that. I understand why. But I’m going to ration myself. I plan to tell him that. The president. I have trouble holding a pen now with the arthritis in my thumb so it will take me a few weeks to do it. But I will.”
“I hope so mom. I wish I was there to help you.”
“I wish you were here too. But I want to do this on my own.”
“And I promise to do the research you mentioned.”
“What research?”
“About how often Medicare will pay for you to see Dr. . . .”
“Forget that. We already know the answer. And as I told you—I’m rationing myself.”
I was in the midst of a project and for a moment didn’t know who she was referring to. She sensed that, “I mean your brother-in-law, how is the treatment?”
“It’s completed. He’s through with it. He handled it magnificently. And now he is on the road to recovery. Just yesterday he said to me that he was able to eat some French toast; and that he ate it, as he put it, ‘in normal circumstances and in normal style.’ I was so impressed by the news, including how he described this, that he and I have been talking about the meaning of things being normal. How, if we are fortunate, we take normal for granted; and that . . .”
She cut me off in mid-sentence, “To tell you the truth this is not why I called.”
“Go on.”
“I care about him. He is a very fine young man,” fine being her ultimate compliment.
“So why did you call? Of course,” I raced to add, “I always love hearing from you, talking with you. It’s always my . . .”
“They tell me I need to have Moose.”
“What? Moose?”
“The Moose operation. Surgery. On my face.”
“Back up a minute, mom. I’m having trouble understanding. I know you had a doctors appointment. I forget which one you have so many doctors.”
“Just five. My internist, my cardiologist, my ophthalmologist, the one who prescribes my antidepressants, and him.”
“Him?”
“And of course I have my dentist. I forgot him. He’s a doctor too.”
“But the last one you mentioned. The one you called ‘him.’ Who is he and what happened, I am assuming something did, when you saw him?”
“When I saw him last week he’s the one who scheduled the Moose surgery. My dermatologist. He saw something he doesn’t like. On my face. On my right cheek. He set up an appointment to do the operation.”
“Ah, I’m following you now. You mean Mohs surgery. M, O, H, S.”
“Yes, that’s it--Mohs. I keep telling you I’m losing my memory.”
“I hope when I’m ‘only’ 90 I’ll have a memory like yours.” In truth, about that and abut almost everything else with her, she has lost remarkably few capacities. Her worst affliction is some arthritis in her left hip and a little unsteadiness when walking. All she really needs is a cane. As much for security as to help her walk. “Tell me mom, what happened. Start from the beginning.”
“I will tell you, but I want you to know, before I start, that I really want to talk about Obama and health insurance. I’m thinking of writing to tell him what he should do.”
“Fine. But let’s first talk about the dermatologist.”
“He said I have a basal cell carcinoma there and he needs to remove it with the Mohs.”
“That’s the procedure, isn’t it, where you go to his office and he takes off a layer of skin, cells actually, and in the office does a biopsy; and then if he hasn’t gotten all of the ones that are pre-cancerous, he takes another layer, tests it, and then if necessary removes a third one, and so on until he has it all? Right?”
“Exactly! You see, I told you you should have gone to medical school like your brother did.”
“This sounds like a lot to put you through.”
“I’ve experienced worse.”
“But . . .”
“Be patient. I’m not through. I saw him on Friday and over the weekend I thought about it. I was having second thoughts about the operation.”
“Procedure, mom, procedure.”
“You can call it whatever you want; but to me, at my age, everything is an operation.”
“I understand. So why didn’t you tell me about this, but more important what did you think about over the weekend?”
“Whether or not I should let them cut up my cheek. Among other things I’ll have a big hole on my face for the rest of my life.”
“But, mom, if you need to do this you should . . .”
“That is my point--do I really need to do this. So I called him yesterday, when he has office hours, the doctor, and he got on the phone himself, which never happened before. Maybe because I have a son who’s a doctor he extended me a little professional courtesy. And when he got on the phone I said ‘I won’t keep you more than a minute,’ you see I had written down what I wanted to say to him, ‘I am calling,’ I said, ‘to ask if as a 101 year-old I need to have the operation.’ He said, ‘When you have basal cell I always remove it.’ I said, ‘I understand, but in my case how long, how many years will it take before what I have becomes a melanoma?’ In other words a big problem. And he said to me, ‘Oh, many years.’ So I said, like I told you I had written this down, ‘So why don’t we wait those “many years” to see what develops?’ He didn’t say anything, so I said, ‘At my age that could take forever.’ Do you get what I meant by that?” This was directed at me.
“Yes, I understand what it means--that you’re 101 and in all likelihood, you will . . .”
“No need to complete your thought. We both understand.”
“Agreed. So what happened next?”
“We cancelled the appointment for the Mohs and agreed I would come to see him three times a year and he would monitor the situation.”
I was relieved to hear that. “This is excellent. I’m very impressed with how you thought this through and handled the situation. I wish I was as good as you in dealing with my doctors. I always feel so intimidated by them.”
“This is not all.”
“But I thought you cancelled the procedure, sorry, operation, and that you would make appointments to be monitored and . . .”
“That’s really my point and what I want to write to Barack Obama about.”
“Again, I’m not following you.”
“Why, I want to know, should a 101 year-old have a dermatologist?”
“Well, if you have . . .”
“Exactly if I have a melanoma or something else very serious. Psoriasis. Which is not as bad, obviously, but still then I would need to go to see him. But for this? What’s to monitor? And why three times a year?”
I was beginning to see her point. It was going to be about healthcare tests and procedures.
“An old lady like me, unless as I said I have a serious condition, should not ever see a dermatologist. Anything I might develop is not going to kill me before time kills me.”
“Mom, why are you talking about yourself this way?” Even though she’s 101, I have difficulty imaging her no long here. Much less thinking about her being killed, even by time.
“Because as the ladies were saying over dinner last night, you know us, we love our doctors—where would we be without them-- and we worked so hard to get our benefits; but take Anna for an example, there’s really nothing wrong with her except a little this and a little that. She goes to the same internist as I do—in fact I was the one who recommended him to her. Her doctor didn’t have the time of day for her. To him she was less than a number. In and out, in and out. That’s what going to him was like. So I got her to switch to mine. She loves him, of course. But I already told you that. I’m sorry. I’m rambling again.”
“You haven’t been rambling mom. I know this is an emotional subject—your health.”
“It’s really not about my health. I’ve been blessed. I know that. I still am. And that’s my point. The girls feel, I feel that we all should have the best healthcare in the world. This is America. Why should they have better other places? And why should we have to pay so much for it? More than any other country. Bertha thinks her Medicare costs nothing. She keeps saying, “It doesn’t cost me anything! Isn’t this a wonderful country?’ Poor thing, she is losing her mind. I keep saying to her that it’s not free. That we paid for it when we were younger and we are paying for it now with our taxes. And with the government borrowing. Nothing is for nothing.”
“And so what is it that you want to write to the president?” I wanted to help steer her back to what she had told me was the real reason she had called.
“Yes, that. I was just setting a context. From the girls. Those of us, I want to tell him, who need all kinds of doctors and tests should have only the best. But those like me, and younger people too who are on Medicare who have nothing really to complain or worry about, for us they should just do what they can to keep us healthy. He is talking about that—prevention. And that is good. But with my dematologist. What I first told you about. Tell me why I should be seeing him three times a year? Or anyone without a serious condition?” Before I could speculate she added, “Because that’s how many time a year he can get reimbursed for seeing me. Three times. You’re good with research. Look it up. I’m sure that’s what you’ll find. That Medicare permits that and so I have three appointments already scheduled. One in October, another one next February, and then another one I forgot when. As I said to him on the telephone, ‘I should live so long!’”
“Well, of course I’m glad you’re fine and that the growth on your cheek is really nothing to worry about, and that . . .”
“For someone my age it is nothing to worry about. About you it’s another thing. And on that subject I hope you’re going for your regular checkups. Including with the skin doctor. You sit out in the sun too much.”
“I do. You don’t have to worry about me.”
“You’re telling your mother not to worry about her son? I’m still be worrying when they put me in Mount Hebron.”
“I wish you wouldn’t . . .”
“But again I’m digressing. I have one final thing to tell you.”
“Yes?”
“He thinks I’ll be coming to see him in October and then more times next year. Well, little does he know that I won’t. As soon as I hang up with you I’m calling to cancel all those appointments. He’s a wonderful doctor who took very good care of your father and me—your father really needed him he had so many basal cells—but I’m another story. I never sat in the sun, and I’m 101. So I’m going to begin—I want to write this too to Obama—I’m going to begin rationing my own healthcare. He didn’t answer that question honestly at his conference on Wednesday. When the reporter asked him about what people will have to give up so those without insurance can have it and how we can cut the cost of Medicare. The honest answer is rationing. He didn’t say that. I understand why. But I’m going to ration myself. I plan to tell him that. The president. I have trouble holding a pen now with the arthritis in my thumb so it will take me a few weeks to do it. But I will.”
“I hope so mom. I wish I was there to help you.”
“I wish you were here too. But I want to do this on my own.”
“And I promise to do the research you mentioned.”
“What research?”
“About how often Medicare will pay for you to see Dr. . . .”
“Forget that. We already know the answer. And as I told you—I’m rationing myself.”
posted by Steven Zwerling at
6:18 AM
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