The Schopenhauer Cure(2)

Julius sat in his car after leaving his internist’s office. His heart pounded so hard the car seemed to shake. Taking a deep breath to quell his mounting terror, then another and another, he opened his cell phone and, with trembling hands, called Bob King for an urgent appointment.

“I don’t like it,” said Bob the next morning, as he studied Julius’s back with a large round magnifying glass. “Here, I want you to look at it; we can do it with two mirrors.”

Bob stationed him by the wall mirror and held a large hand mirror next to the mole. Julius glanced at the dermatologist through the mirror: blond, ruddy faced, thick spectacles resting on his long imposing nose—he remembered Bob telling him how the other kids taunted him with cries of “cucumber nose.” He hadn’t changed much in ten years. He looked harried, much as when he had been Julius’s patient, huffing and puffing, arriving always a few minutes late. The Mad Hatter’s refrain, “Late, late for a very important date,” often had come to mind when Bob rushed into his office. He had gained weight but was as short as ever. He looked like a dermatologist. Whoever saw a tall dermatologist? Then Julius glanced at his eyes—oh oh, they seemed apprehensive—the pupils were large.

“Here’s the critter.” Julius looked through the mirror as Bob pointed with an eraser-tipped stylus. “This flat nevus below your right shoulder under your scapula. See it?”

Julius nodded.

Holding a small ruler to it, he continued, “It’s a shade less than one centimeter. I’m sure you remember the ABCD rule of thumb from your med school dermatology—”

Julius interrupted, “I don’t remember squat from medical school dermatology. Treat me like a dummy.”

“Okay. ABCD. A for asymmetry—look here.” He moved the stylus to parts of the lesion. “It’s not perfectly round like all these others on your back—see this one and this one.” He pointed to two nearby small moles.

Julius tried to break his tension by taking a deep breath.

“B for borders—now, look here, I know it’s hard to see.” Bob pointed again to the subscapular lesion. “See in this upper area how sharp the border is, but all around here on the medial side it’s indistinct, just fades into the surrounding skin. C for coloration. Here, on this side, see how it’s light brown. If I magnify it, I see a tad of red, some black, maybe even some gray. D for diameter; as I say, perhaps seven-eighths of a centimeter. That’s good-sized, but we can’t be sure how old it is, I mean how fast it’s growing. Herb Katz says it wasn’t there at last year’s physical. Lastly, under magnification, there is no doubt that the center is ulcerated.”

Putting down the mirror, he said, “Put your shirt back on, Julius.” After his patient finished buttoning up, King sat down on the small stool in the examining room and began, “Now, Julius, you know the literature on this. The concerns are obvious.”

“Look, Bob,” replied Julius, “I know our previous relationship makes this hard for you, but please don’t ask me to do your work. Don’t assume I know anything about this. Keep in mind that right now my state of mind is terror veering toward panic. I want you to take charge, to be entirely honest with me, and take care of me. Just as I did for you. And, Bob, look at me! When you avoid my gaze like that, it scares the shit out of me.”

“Right. Sorry.” He looked him straight in the eyes. “You took damn good care of me. I’ll do the same for you.” He cleared his throat, “Okay, my strong clinical impression is that it’s a melanoma.”

Noting Julius’s wince, he added, “Even so, the diagnosis itself tells you little. Most—remember that—most melanomas are easily treated, though some are bitches. We need to know some things from the pathologist: Is it melanoma for certain? If so, how deep is it? Has it spread? So, first step is biopsy and getting a specimen to the pathologist.

“Soon as we finish I’ll call a general surgeon to excise the lesion. I’ll be by his side throughout. Next, an examination of a frozen section by the pathologist, and if it’s negative, then great: we’re finished. If it’s positive, if it is a melanoma, we’ll remove the most suspicious node or, if necessary, do a multiple node resection. No hospitalization required—the whole procedure will be done in the surgery center. I’m pretty sure no skin graft will be needed, and, at most, you miss only a day of work. But you’ll feel some discomfort at the surgical site for a few days. Nothing else to say now until we learn more from the biopsy. As you asked, I’ll take care of you. Trust my judgment on this; I’ve been involved with hundreds of these cases. Okay? My nurse will call you later today with all the details about time and place and prep instruction. Okay?”

Julius nodded. They both rose.

“I’m sorry,” Bob said, “I wish I could spare you all, this but I can’t.” He held out a folder of reading material. “I know you may not want this stuff, but I always distribute it to patients in your situation. Depends on the person: some are comforted by information, others would rather not know and just toss it on the way out of the office. Hope after the surgery to tell you something brighter.”

But there was never to be anything brighter—the later news was darker yet. Three days after the biopsy procedure, they met again. “Do you want to read this? said Bob, holding out the final pathologist’s report. Seeing Julius shake his head, Bob scanned the report again and began: “Okay let’s go over it. I gotta tell you: it’s not good. Bottom line is that it is a melanoma and it has several…uh…notable characteristics: it’s deep, over four millimeters, ulcerated, and there are five positive nodes.”