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Thursday, November 18, 2010

OFF SUBJECT: Dr. Benjamin Lesin, M.D.

I've often imagined what a real-life experience with someone like the doctor from "30 ROCK", Dr. Spaceman, might be like, but I didn't honestly believe that this kind of thing existed in the real world.  Until now.

About two years ago I discovered what felt like a single grain of sand underneath the thin skin of the under-side of my right wrist.  Over time, this tiny nodule grew little by little from a grain of sand to perhaps the size of half a BB.  It seemed to be attached to the underside of the skin and was not at all interesting or troubling except that if it was bumped or pressed it felt like a sand granule being pressed into the soft tissue underneath.  I am right-handed, and because of the continuous activity of my right hand I found that it got bumped with expected regularity.  Eventually it started to become a little inconvenient for normal life activities or even wearing a watch (yes, I wear it on my right hand though I am right-handed, I don't know why and that is outside the scope of this article).  It was in no way incapacitating, but it did hurt and so upon my exciting qualification for Motion Picture Industry health insurance I figured this was something I could have resolved fairly easily.

I went to see my excellent doctor at the MPI health center, she poked around at it and said it was a little cyst and would likely present no trouble, but because it was indeed causing pain she said she would recommend me to an orthopedic surgeon for further analysis.  A simple extraction could be a little dangerous due to all the complicated biology that occurs in that corner of the body, and we definitely don't want to do anything dangerous in so critical an area.  I received the referral in the mail, and this is what led me to the doctor that is central in this story.  It would be irresponsible of me to mention the name of this doctor to avoid slander, so I will simply call him The Buffoon.  This is, after all, a public format and we must all be cautious in our litigious society.

The Buffoon's office was quite a far drive for me, but since I wanted to have this situation resolved I made the trek to Van Nuys in rush hour traffic for my appointment about a week later.  The office was clean and appeared to be well run, and I was sitting in a patient chamber within minutes of my appointment time.  The Buffoon was about sixty, medium height, pudgy and pasty faced with splotchy reddish skin that didn't look it had seen sunlight in a decade.  His head was topped with thin, salty hair, white wisps of which were pulled over his shiny dome in a last, desperate attempt to maintain the comb-over he had probably had since the seventies.  He shuffled in with a flurry of distracted apologies, he'd been busy that day, and staring at me with his blue/gray eyes that seemed glazed in a translucent haze of red, yellowed teeth chewed as he asked me what the trouble was.

After prodding around at my wrist he determined that the offending fleshy nodule was "a lesion of some kind", and signed me up for surgery at the MPI hospital in Woodland Hills - but first, some x-rays.  The medical assistant shot two sets of x-rays, sent me back to The Buffoon for review (revealing nothing of note) and I was told that I would be called for an appointment at the hospital.  This seemed a little over the top considering the tiny problem that I had, but in these cases it usually seems best to let the professionals guide me.

A few days later I got a call to schedule the surgery, as well as schedule my pre-op appointment and blood tests.  Pre-op and blood tests?  Again, this seemed a little heavy handed, and even though I told them I had a yearly physical only weeks before this apparently was inconsequential as a pre-op, and they needed more blood tests in order to determine what my anesthesia reaction would be.  "Anesthesia?" I asked, "he wants to put me out?"

"Yes," the nurse replied, "but just twilight, no need to put you all the way under. It's just a little complicated of a procedure and some people might freak out a little."  For those of you that don't know me, it takes quite a lot to "freak" me out, and I am certain that I have sustained far worse accidental injuries in my life than this minor surgery would entail, and even with considerable pain and blood streaming from these traumatic injuries I did not "freak out".  But I must concede to a doctor that is supposed to know more than me.  I scheduled the pre-op and blood tests for about a week before the surgery.

When I showed up for the appointment, I mentioned that a work obligation had gotten in the way of my current surgery appointment and I would need to reschedule.  They said it would not be a problem.  After the compliment of weighing, temperature and blood pressure taking I was put into a patient room, asked to disrobe and wait for the doctor.  This was not my normal doctor as she was unavailable, but Dr. Tran was delightful and put me through the half-hour process of what essentially amounted to a physical.  Which I'd had only weeks before with my regular doctor.  Once complete and satisfied he asked to take a look at my cyst and I pointed it out on my wrist.  He felt around the base of my thumb and once he found a mass of muscular tissue asked, "is this it?"  I replied that it was not, and then pointed more specifically at the tiny offending lump.  Dr. Tran blinked, looked at me and said, "that little thing?"  I could see immediately that he was just as puzzled as I was about why a full pre-op had been required, but that is what The Buffoon had ordered and they were obligated to carry it through.  Anesthesia can be testy, you see, and they need to have a complete picture of my health before they know how to treat me.

The fact that I had been put completely under by my dental surgeon for a wisdom tooth extraction (read: violently pulling bone out of my head through my mouth) earlier in the year without this kind of attention was irrelevant, I suppose.

After Dr. Tran ended the appointment with a wordless exit, as doctors are wont to do, I trundled down the hall to have my full panel of blood tests.  The Buffoon had ordered a massive blood panel, never mind that I had just done this as part of my physical as I mentioned before, and again they were obligated to his orders.  Four tubes of my blood were taken for analysis.

As I mentioned, I had to move my surgery appointment for a work obligation and once I did I was then informed by The Buffoon's assistant that I would need to back in for more blood tests, as the tests are supposed to be no more than seven days before the surgery.  I pleaded with her to relieve me of this responsibility as all of my tests over the last year had showed nothing less than a picture of good health - but The Buffoon had spoken and his word was law.  Grudgingly, I went in for a new panel a week later.

It was my first time at the MPI hospital, and I have to say that it was without a doubt the most pleasant hospital experience of my life.  It is a lovely oasis-like facility with a massive outdoor garden and retirement community in the rear, lined with winding paths amongst beautiful old trees, and while I waited for my appointed time I wandered around in the perfect weather, wishing I had time to take a nap in the lush, green grass.  Everyone I spoke with was extremely kind and helpful, and they made me feel like I had found some kind of Utopia amongst medical facilities.

Even though it was an outpatient procedure, I had been assigned a patient bed, and was asked to put on my hospital attire.  I donned the padded paper gown, a plastic hair cap, they taped my earrings to my head to avoid catching them on the medical equipment during surgery, put me in a wheelchair and covered me with a warmed blanket for my roll down to the surgery pre-op room.  Again the staff was incredibly courteous and kind, easy to talk to, and I felt like I was receiving totally personalized attention.  A rare treat in the medical community.  A very friendly male nurse took over the wheel chair and put me into the prep room, equipped with Direct TV, painfully but apologetically installed an IV into the veins on the back of my hand (he said that I had perfect veins - damn right, mister), and left me to enjoy a slow hydrating drip until the doctor arrived for the surgery.

All this time, it must be remembered, I was here to have a tiny cyst removed my wrist, and I felt like I was being prepped for a kidney transplant.  It was like being treated with a medical bazooka when all I needed was one of those little pull-string popper things that shoot a tablespoon of confetti at parties.  It was a really interesting experience, that's for sure, but all the while I'm looking around and thinking about the dollar signs attached to all of this, ka-chink-ing away as I relaxed watching the Discovery Channel.

The big moment finally came, and I was wheeled by a crew of five people into the operating room, which was everything you'd expect a major operating room to be.  Bright overhead lights, cold, and lots of machines going "ping" that I was immediately connected to.  I had a chance to take a look at my own brain waves for a short time, and my last mental image before the lights went out was of a grinning anesthesiologist looking down on me with an expression of unmasked envy.

The surgery went perfectly, and I was shown my extracted flesh in a small vile as I woke up on the table.  The entire event resulted in exactly three stitches, and after a short post-op and a croissant sandwich I was sent home to recover on my couch watching "Dexter".

The wound healed quickly and very well, and two weeks later I returned to the Buffoon to have my stitches out.  It was during this appointment that I resolved to write this article.

I trudged my way back to Van Nuys and waited almost forty minutes before being ushered into the patient room.  After ten more minutes of waiting, The Buffoon joined me in exactly the same state as I had seen him the last time, again apologizing for being so busy.  He looked through my paperwork, which declared that the biopsy had come back with nothing evil contained within my now absent BB of flesh, and that it had been determined to be a DERMATOFIBROMA.  I asked The Buffoon exactly what that meant, and I must admit that this was a loaded question because I could tell from his expression that he didn't know.  I was gratified with a stammering explanation that I could have come up with myself, and it was enjoyable to watch him fumble around with an explanation that attempted to break down the word into its components using simple reason to piece together a vague meaning.  Eventually it came down to "we don't know", which I had already determined.  Interestingly enough, after some home research, that definition is almost exactly what DERMATOFIBROMA means: "a cutaneous nodule of unknown origin" occurring underneath the skin - and no one knows what causes it.  The somewhat ironic difference, however, was that he didn't know what it meant, not that it meant they didn't know.  It's most often found in women, however, so I'm not sure what that says about me...

But aside from that, I was there to get my stitches out, and shortly he began that procedure.  The first two stitches were removed without incident, but as he held on to the final suture with tweezers, pulling it up to be snipped with the medical scissors, the head of the stitch suddenly flew off, leaving the rest of the suture still intact underneath my skin.

"Shit!" exclaimed The Buffoon, "I can't remember the last time that happened."  Immediately it was clear that there was no easy way to get the rest of that suture material without excavation, it was fully buried under my skin.  I could see the small black line of it left sitting perhaps 1mm deep.  He pressed around on it, trying to push an end into grabbing range, then jabbed at it a little with the tweezers resulting in a muffled yelp from me for which he apologized.

The Buffoon then explained my options: "Usually in a situation like this we just wait for the suture material to work its way out, which it will usually eventually do. Or we can dig into it, which I'm not really thinking I'd like to do right now."  But I had come to get my stitches out, dammit, and I wasn't going to stare at this little black line on my wrist for however many years it would take to "work its way out".  "Let's dig, doc," was my decision.

He left the room and the assistant brought in a syringe of clear numbing solution, some rubber gloves, and a cotton ball, which she wet with alcohol.  My friend waited for about as long as it took for the alcohol to on the cotton to completely evaporate before returning to continue.  He wiped the now dry cotton on my wound impotently, the blood pulling off strands of cotton which stuck to my skin.  He then grabbed my wrist and roughly began injecting my little cut with a full CC of numbing solution for my 1/2" cut.

"That sure is a lot in that syringe for such a small area, doc," I observed as he squeezed the syringe hard enough for the fluid to come squirting back out of my skin, generously splattering the table and opposing wall.  "It's not as much as it looks, if I had a larger syringe it would look like less", the Doctor of Medicine observed in return.  He left once again while the solution did its job, leaving me waiting.  With no Direct TV.

I didn't want to tell him how to do his job, but I could have told him that using a tiny needle as a prod to exhume the lost suture was not going to work very well, but at this point my wrist felt like rubber so I was content to watch just how far he would go with this.  He pressed with fingers and tweezers, tried to dig into the now freely bleeding hole, blindly groped with the sharp tweezers, but all to no avail.

"I don't want to send you away with stitches to get your stitches out," he said.  I agreed. 

At one point he even tried to convince me that there actually wasn't anything left to pull out.  I was not satisfied with the explanation as I could easily point to the very obvious black line just under my skin.  The lighting was poor on his little table and he tried to turn on a lamp to improve the situation, clicking the switch back and forth with no result.  Helpfully, I plugged it in for him.

Then, while the needle was probing around the innards of my wrist, the very place that they had been supposing to protect by going all the way to hospital for this surgery - the cell phone in his pocket rang loudly enough to stun small animals in a one mile radius and briefly change the air pressure of the entire office.  Startled, The Buffoon and I both jumped, and all I can say is that I'm glad I was numb at the time.  Without word or acknowledgment, he took the call and left me there.  I could hear his conversation down the hall, and he was gone for such an inordinately long time that I actually began a countdown from sixty at which point I decided I was just going to leave.  Five.  Four.  Three.

And he returned to continue the mission.

Eventually the tweezers tweezed successfully, and the 1/4" piece of suture material left inside me was finally disinterred.  Now complete, he did not bother to clean or sterilize the wound, and his final act was to cover the site with Neosporin directly from the tube on to my bloody skin.  Not on to a cotton swab or other medical type applicator.  Sure glad I don't have anything contagious in my blood for the next person to be serviced in that room.  A butterfly band-aid and that was that.  I was elated to now be finally free of this man.

Until he mentioned that he wanted to see me again in a month to make sure I was healing okay.  "Really?" I blurted, unable to contain my surprise.  "Yes, make your appointment at the desk."   With that The Buffoon's job was done, and off he went to his next life-saving venture.

The woman at the desk asked if I wanted to make the appointment now or call in with a time.  I told her I would call.  This was the final straw for me, and a blatant grab at as much money as the insurance would pay for my case.  A clear abuse of insurance benefits so he could get a few hundred bucks for my next visit to inspect a wound that has clearly, cleanly, and completely healed.  I can't imagine the thousands of dollars this entire event has cost my insurance plan, and if there were a way to apologize to them, I would.  I just wanted my painful dermatofibroma to be removed, not to become part of the insurance problem.  I needed to draw a line.

So, here I will admit to all who have read this far that I lied to the desk lady.  I will not be calling in.

Special thanks to Andrea and Sam for their clever observations, which I have stolen and included here.

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