A Plague of Spots

John Gamel Click to

John Gamel is Professor Emeritus of Ophthalmology at the University of Louisville School of Medicine, where he still practices and teaches. He is the author of numerous book chapters and articles in scientific journals, and his recent essays based on his decades of medical training and practice have appeared in The Antioch Review, The Gettysburg Review and Epoch.

Since birth, I have endured the Scotch-Irish curse of spots. By this I mean freckles, freckles everywhere—face, chest, back, arms and legs. At a swimming pool in Atlanta, during my high school years, a Yankee gaped at the quarter-sized freckles on my shirtless torso and shouted, “Hey, kid, what’s wrong? You got leprosy or something?” Scattered among the freckles there are also a few nevi, also called “moles”—those pigmented bumps that afflict most of the human race.

My spot-related anxieties first came upon me during a lecture in medical school, when I saw the photograph of a ragged black spot on a patient’s thigh. An X-ray showed his lungs filled with malignant nodules the size of golf balls. The man had a melanoma, an insidious skin cancer that can resemble a nevus during its early stages. My God, I thought—that could be me! I raced to the surgery clinic, where a resident agreed that a nevus on my chest had a worrisome pearly border. I still bear the scar of its almost instant excision. To my immense relief, pathologic examination showed no sign of malignancy.

My anxieties lay dormant for three years, until I examined a young law student who had dark nodules scattered beneath his skin, nodules that had spread from a melanoma on his scrotum. The poor victim was my age, almost to the day, and in the rush of an instant, this dreadful coincidence set my old obsession aflame.

I tried to calm myself with reason—this was nothing, just a foolish anxiety like all those that had gone before—but a terrifying truth kept fighting its way through my defenses: six of my spots are on a place where half the human race doesn’t even have a place. Not on the scrotum, like the malignant lesion that had spread through the law student’s bloodstream, but damn close. Five of these spots look like innocent freckles, while the sixth shows, by a slight elevation above the surface of my skin, the features of a nevus. But was it really a nevus, or was it… could it be… a melanoma?

The moment the doomed patient left my exam room, I took an early lunch break, then rushed, sweaty and tremulous, to the dermatology clinic. Here Doctor Gantry, the chief resident, listened to my story and examined me carefully, peering through a magnifying lens held inches from the organ under study. He was a good man. His deep, soothing voice calmed me down. He assured me this was not a crisis, since the lesion causing me so much distress was almost certainly benign, though there might be some risk —  very small —but one that had to be considered, since on rare occasions a melanoma can arise from what appears to be a benign nevus. He would consult his colleagues.

The word “colleagues” disturbed me.  With how many doctors would he share the story of my worrisome spot? Soon after he left the exam room, I heard a murmur of voices, zipped my fly shut and cracked the door, only to discover a squadron of white coats gathered in the hallway. It seemed that every student and resident and faculty member in the whole department had gathered for an avid discussion. Surely, God forbid, this wasn’t all about me?

It was. At last the gentle Doctor Gantry entered the exam room with a female colleague in tow. He closed the door, then explained that, after some debate, two schools of thought had emerged concerning the management of my problem. One school—the more conservative, to which he belonged—advocated a policy of live and let live: keep an eye on the worrisome nevus, and if anything changed, then a biopsy would be in order (by whiteside at http://www.dresshead.com). From this debate, however, there had also arisen a more aggressive approach, one advocated by Doctor Taylor, the sturdy, dark-haired woman standing impatiently by his side.

To this day I remember her first words to me.  Not “Glad to meet you,” or “How are you today,” but “Ok, let’s see it.” Yet more disturbing were the words that came after Exhibit A had been hauled out and inspected with a magnifying glass. “Ah, no question—they’ve all got to come off!”

“All!” I spluttered. “But those… those others… the five, except for this one… those…surely… they’re just freckles.”

“Freckles!” she said with a derisive snort. “To get freckles, you’ve got to have sunlight, and I don’t think… you tell me—have you…?”

No, I confessed, my precious parts had yet to see the full light of the noonday sun. But surely, I argued, all six spots looked benign. Couldn’t we just wait and see, do a biopsy if there was any change?

“Sure we could wait,” Doctor Taylor said. “But if the pathologist found malignant cells, to be sure he got all the tumor, the surgeon would have to go back and excise several cubic centimeters of adjacent tissue. An alarming prospect, wouldn’t you say, given the, uh, body part involved?”

Alarming indeed. My legs trembled so badly I could hardly stand. After she left, Gantry told me to sit down and stepped from the room to bring me a cup of water. There was no rush.  No reason to panic.  His voice droned on and on, so gentle and reassuring I expected him to pat me on the head. In any case, he said, I needed to see a plastic surgeon, the specialist best qualified to perform such a delicate procedure.

* * *

The next morning, I skipped a lecture and made my way down to plastic surgery clinic, where the receptionist, a tiny blonde woman, got things off to a bad start by asking the fatal question:  “What’s the nature of your problem?”

“Well, uh… I… uh… .” I said. After an awkward silence, “Let me wait… I’ll tell the doctor myself.”

“I’m sorry, sir,” she said, “but we need this information so the nurse can prepare you for the doctor’s exam.”

“Oh, God,” I said, then covered my mouth with my hand. We stared at each other. She held her pen poised over a clipboard, eager to record the nature of a problem that seemed so bizarre it would surely evoke fits of helpless laughter. I imagined the receptionist rushing about the clinic to share my riotous story with every female in sight, or leaning toward me across the counter, her eyes wide in disbelief, shouting, “Noooooooo, you’ve got to be kidding!”

“Look,” I said at last, “you’ll just have to take my word for it. I don’t need a nurse to help me show my problem to the doctor. I can do it all by myself, and it won’t take a second. Trust me, please…”

“Well…” she said, giving me the look one might give a stubborn child. “Ok, if you insist.”

Relieved for the moment, chart in hand, I was led down a corridor to a cubicle that contained a sink, an examination table, and a small metal stool. When the door closed behind me, I unbuttoned my shirt, ripped two paper towels out of the dispenser above the sink and tucked them into my sopping armpits. I sat on the stool for what seemed like an hour, listening to occasional footsteps and muffled voices in the hallway. At last, a brief knock announced the arrival of my savior.

It was Doctor O’Riley, the chief resident in plastic surgery, a squat Irishman with a cheerful lilt to his voice. The instant he stepped through the door, I gave a sigh of relief. He had red hair and pale skin. A constellation of reddish brown freckles spread across his nose and down his cheeks. Three darker spots—nevi, no doubt—were clustered on the lower lid of one eye. I also recognized an irregular, yellow-brown conjunctival nevus on the white of that eye. Here was a fellow who could sympathize with my plight.

When I told him about Doctor Taylor’s dogged insistence that I submit my organ for multiple biopsies, O’Riely scowled.

“Damn that woman,” he said, “she’s at it again!”  Apparently Taylor had referred other terrified males for surgical extraction of spots from their delicate parts. O’Riley explained the hazard of her whack-‘em-all-off approach—bands of residual scar that might cause ripping pain when put under the tension of an erection. Moreover, a surgeon would have to excise thousands of benign nevi before he discovered one melanoma.

“Okay,” O’Riely said at last, “let’s take a look.”  When I unzipped my fly to expose myself for microscopic examination, he exclaimed, “Only six lesions!” Hell, I’ve got more than that. Don’t worry about the damn things. Come back if you notice any change. By the way, I think you’re right—those other five lesions are most likely freckles. And leave that little nevus alone. It isn’t nearly as dangerous as a drive down the Bay Shore Freeway.”

“Thanks… thanks a lot,” I said. “I can’t tell you…”

That was the truth—I couldn’t tell him. The lump in my throat made it hard to speak. I left the clinic in a rush, lest my spotted Irish savior see the tears of gratitude gathering in my eyes.  Worse yet, had I stayed around another moment, I might have lost all, thrown my arms around the poor man and kissed him on a rosy cheek.

My spots have behaved themselves for four decades.  In return, I have spared them the scrutiny of yet another microscopic inspection.  And unlike many of Dr. Taylor’s victims, I don’t double over in pain every time temptation comes my way.


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