says Dr. G. How about I let Nykki freeze these off?
The patient nods. "Sounds good to me." Great. Write down how many and where, and catch up with me.
And he leaves me with the liquid nitrogen and a man whose back is covered in benign (but itchy) little seborrheic keratoses.
It felt good.
You see all kinds of folk at the dermatologist's office, O Best Beloved. You see the man whose chief complaint is that tape is coming through his skin; has been for twenty years. Sometimes, he says, sounding quite reasonable, it comes out inside his throat and he chokes. Tape. Adhesive tape. Coming out through his skin. "Kill it before it kills me." Diagnosis: Lichen Simplex Chronicus, atopy.
He's got allergic skin and he's been scratching and it's responding by building up plaques. Secondary diagnosis: schizophrenia.
A woman whose hand I held a moment too long. "I know you." She peers at me, then my nametag, and laughs. "So you do!"
Nursing student, construction worker, stay-at-home mom. They are all smiles for me, full of good wishes and congratulations.
The boy today with a mostly-healed wart. Eighteen, just, and O, Best Beloved, he was lovely.
"Not much to learn on here," he says, voice much lower and smoother than I might have expected, brown eyes through a fringe of overlong hair, suit jacket over T-shirt and jeans. "It looks pretty good now." Lovely boys.
A lot of acne. A lot of women who are very concerned about subtle flaws in their faces. A lot of elderly folks with basal cell carcinomas and squamous cancers. Melanoma in situ
of the leg. There are any number of strange dermatologic mutilations. Ladies in their sixties and seventies who laugh, and smile, and tell me how they worshipped the sun when they were my age. It is hard to picture them lithe and sleek in bathing suits on the beach, hard to make otters of them now.
Children with atopy - eczema - skin scaling from head to toe. Beautiful girls with scaling psoriasis hidden under long sleeves. Moles removed; spidery leg veins injected with sclerosant to wash them away. Laser treatments for wrinkles I have not seen; the laser comes only a few times a month, and only at the office I am not technically supposed to be at. I trade ER stories with the PA, who has been everything under the sun and now does a fair amount of the office surgery. I learn about homeopathic remedies, olive oil to moisturize the scalp, and the importance of eating well from Dr. D, who trained in Mohs surgery
from Dr. Mohs himself. I follow Dr. G like a white-coated shadow. I smile and sparkle and repeat the same ten conversational topics over and over again; it is not hard to be charming in soundbites.
It is a high note to end on, O Best Beloved; it is intriguing and exciting and fun. Tomorrow is the last day of my medical school rotations.