My Own Dermatologist - Pt. 01

MY OWN DERMATOLOGIST

With my family having a history of skin cancer, we have found the need to protect ourselves while we have been at the beach or around the pool or anywhere outside for prolonged periods of time. Unfortunately, we did not learn this important skin-saving fact until much later in our developing & adult years. So, in time we have also found the necessity to seek out a reputable dermatologist for precautionary reasons just in case any skin cancer causing growths developed for needed medical attention. That being said...

Fast forward to about 3 years ago...

Well, Dr. Rick, I'm back for my next regular appointment as I might be seeking your services again. I've been calling him by his first name since I had been seeing him these past five or so years.

As he greeted me, he asked how my other medical procedures had healed and if there were any special reasons for my current visit. Before I could respond, he also asked if I would allow a graduate student from a nearby university to sit in and view my exam. He had made similar requests in past years and I always obliged.

Since I was a teacher with fourteen years of experience, I again said of course since I knew observation was an essential way to learn any craft. Plus, I personally thought very highly of Dr. Rick's ability, and I believed any student could learn a great deal from him.

As the female graduate student walked into the room she said, "Hello" and I continued with my conversation with Dr. Rick. I mentioned that the freezing of the several actinic keratoses and the removal of two basal cells had healed nicely.

While some of the scars were still noticeable, he responded by saying, "George, in a short amount of time they all should begin to fade".

Before the actual appointment had begun, an exam room nurse had given me one of those paper gowns of which I was asked to change. Sometimes those things are a pain to unwrap and place over one's body as they are very flimsy.

Over these past five years he has always started with the usual overall body exam after a bit of friendly banter. He usually finds my issue/s even before I need to point them out to him. He began his scan by carefully checking my face, arms, fingers, legs, feet and toes. He studied this mole and that freckle... this growth and that 'irregularity'... perhaps growling and ruminating a bit on one or two areas as his eyes roamed slowly from one area to the next. He asked the graduate student to view several items that he had observed and write down any comments in her notebook for them to discuss later. When I removed the top of the paper gown so he could investigate my upper torso, he isolated the primary medical concern that was currently bothering me on the back of my shoulder. He said that it didn't appear as large as my last two, but he would do a biopsy and get the results back to me shortly. He still thought it was definitely another basal cell carcinoma. To complete the scan, he then asked me to stand down from the exam table from where I had been sitting. It was at that point my paper gown fell to the ground in front of me. I had noticed that Dr. Rick's graduate student eyes had expanded greatly when all that was left to cover me were my snug fitting underwear I had been asked to leave on previously by the exam nurse. While this did not phase me too much at the time, I still enjoyed her reaction. Dr. Rick then did a quick peek down the back and front of my underwear to finish his exam before completing the biopsy and using some liquid nitrogen to freeze those unwanted skin issues away from my exterior.

I had returned a few weeks later to have the confirmed basal cell removed in a specialized surgical room. However, his medical student was not there as he told me she would be graduating at the end of the semester. As he concluded this brief out-patient task, Dr. Rick mentioned his job within the practice might be changing in the near future as he was now certified to perform Mohs surgery. After congratulating him, I asked if that would affect any future appointments with me. He mentioned the practice was considering an expansion with the possibility of hiring more staff since their patient size had grown considerably. He wasn't sure if he could continue with his daily workload while performing his Mohs duties. Anyway, he suggested we should schedule my normal next appointment and let the chips fall where they may.

In the course of my own teaching and everyday activities, I hadn't thought about my next appointment at the dermatologist office until I received a notice in the mail many months later. I was being informed that Dr. Rick would still remain with the practice as a specialist, but in the future I would be seen by one of their new PA's (physician assistants). While I was not happy that Dr. Rick would no longer be my regular dermatologist, I appreciated that he gave me a heads up at my last appointment to forewarn me. Plus, my current PCP (primary care provider) had been a PA for the last three years, and I had a very comfortable & professional relationship with him. Lastly, if there was a special need, Dr. Rick would still be there within the practice. So, he wouldn't be very far away if the PA required his expertise.

At my assigned appointment, I entered the door to the dermatologist practice and noticed a number of changes including several new names labeled with their credentials. Dr. Rick's name was listed higher on the business name board, and he was right about the office expansion too. The receptionist area was larger, brighter and more modern. It appeared as if they must be doing more than 'just OK'. After registering I waited for my turn to be escorted to one of the newly remodeled exam rooms. Eventually my name was called and the exam nurse led me down the corridor to room #4 and gave me one of those nasty paper gowns.

After changing I waited a few minutes and then heard a knock on the door and was very pleased to see Dr. Rick. While we briefly exchanged pleasantries, he then introduced me to my new dermatologist. Well, he said we're asking PA Jill Daniels to handle your current and ongoing needs if that is all right. She looked familiar and I then realized she was the graduate student that was present at my last office visit. Dr. Rick mentioned he had reviewed my entire case history with her, and he believed I would be in very capable hands. He also addressed her qualifications and background but still reiterated that their entire staff would be supporting PA Jill and all other new hires as well. He made me feel more at ease and confident to accepting the ongoing changes that were taking place throughout the practice. He said goodbye and we wished each other the best of luck.

PA Jill tried to appear very professional, but I noticed she was a bit nervous too. She then told me the various doctors on the staff had introduced her using a similar routine to other new patients of which she was being assigned. Anyway, we shook hands and I wished her success in her new and promising career. I also told her to relax and just try to be her own best professional self. My exam seemed to be very routine as PA Jill observed all the same body areas that the doctor covered. However, she took more time as it seemed she did not want to miss anything during her first official review. Plus, I noticed that her right hand would lightly trail over each inspected area. I found this to be increasingly stimulating as her touch seemed to locate many new nerve endings all over my skin surface. My body reacted slightly as the bulge in my underwear became more easily seen to both her and myself. As this exam came to a close, she did not finish like Dr. Rick had done by making a quick peek inside the back and front of my underwear. Perhaps what was now currently showing below, might have changed her mind. Anyway, she told me I had a wonderful review and I must have been taking very good care of myself since the last session with the doctor.

PA Jill then asked me a question if I was still teaching at the local junior high school. While I thought that was an odd question at this point in our time together, I replied that I was and asked why she asked that.

Previously, when she was making her rounds with Dr. Rick she thought I might be the same person she has once known even though my appearance had changed. However, it wasn't her place to say anything at that time as she was only observing the doctor. Now she wanted to bring it up because she wanted to make sure we would both feel OK going forward.

She then floored me by saying "I guess you may not remember me, but I was one of your social studies students 10 years ago along with Jean Truex, Bill Bridges and our bunch of good buds." At that point I hesitated - thought for a few seconds and said, "NO WAY!" "I do remember you now, but OH MY GOSH have you changed as I did not recognize you at all. ... Many students have come and gone and it is hard to place all of them, but when you mentioned the other two I can picture you and your group of friends. However, seeing you before me now and recalling the Jill from ten years ago, is almost like night and day." In my mind those words could have been taken a couple ways, so I wanted to reassure her what I meant. "In my junior high experience, many kids might have looked and acted similarly ... like a typical adolescent. The person that is standing before me now has grown into a beautiful young woman that just happens to be an aspiring professional starting out on a new career". I'm sorry that I did not immediately recognize you." She blushed a bit when I mentioned that.

She then said, "That's all right as I know I have changed quite a bit in the last decade. However, I wanted to ask you this because while I have always enjoyed science classes more, you were our group's favorite teacher. I saw the way you really loved & taught your subject and it showed each and every day". Now I was a bit embarrassed, but I thanked her for the compliment.

After I inquired regarding her group's present whereabouts, we shared a couple laughs about those past times. However, she needed to press me on one further area before seeing her next appointment. She asked would the fact of her being one of my former students possibly interfere with our new patient/PA relationship? She was hoping it would not, but she knew this was a different type of familiarity.

I thought about this for a moment so I could give her a correct and proper response. ..."Jill, you have grown into a capable, caring and thorough young professional that will only get better as the years progress. As a teacher I know it takes quite a while to become competent and comfortable in one's line of work. You have an excellent staff here that will also guide you on your way. I would be honored to assist you in any way to further your expertise and become more skillful in your profession."

With that she blushed again, smiled very nicely and thanked me. We closed out this appointment and eventually scheduled our next session six months from now. I believe both of us would be anxiously looking forward to our next meeting.

As the school year progressed along its busy path, I received my normal update from the dermatologist practice regarding my next scheduled appointment. While I had almost forgotten about my past visit, I started to self-investigate my body looking for any possible anomalies over the next several weeks. It seems Dr. Rick always found several items that needed freezing each time I saw him. However, PA Jill found none this past time which was a relief.

On the day of my office visit, I had to rush there as I was involved in an after school club. After checking in with the receptionist, I was led back to an exam room where I was told there was no problem with me getting there a few minutes late as I was PA Jill's last patient of the day. So I changed into the paper gown and waited for her arrival. When she opened the door after a few minutes wait, it was evident by her smile that she was pleased to greet me. After exchanging our initial hellos, I mentioned to her that her bright grin showed confidence and hoped that was because her last several months working at the office had been a positive experience so far. "Indeed" she replied, as I had read her mind, but she thought that seeing me as her last patient would also help to finish off a great week of work. She then asked if there were any particular problems of which she needed to be made aware. I had hoped not but there might be something on my lower back that I could not identify. Since it was hard for me to see it clearly, she said she would check it out when we got to that portion of the scan.

As done previously, she used great care and attention on each area of my exposed skin. With her fingers gently gliding from one arm to each finger, she tenderly crossed my face and around each earlobe. PA Jill then repeated this portion of the exam along my lower extremities as she knelt in front of me. As she checked my toes, calves and thighs I sensed I was becoming much more uncomfortable with her immediate frontal position. Perhaps she noticed it too as my underwear started to strain from her professional attention.

Then she said let's check the rest of you. So, I removed the paper gown from my chest for her to continue the review. While she brushed her hand carefully across my chest, I even felt my own nipples harden from her inspection. She believed the front of me appeared OK, but now wanted to view my entire back with greater focus. Her free hand traced each muscle from one side to the other from the top of my neck to my waist and to the area just above my underwear. While there were some minor issues which we expected to find, she asked if she could lower my underwear to see if that was the area that was causing me discomfort. I told her to follow what needed to be done. With my back facing her, she peeled down my underwear and immediately saw the problem of which I was complaining. As I said, it was difficult for me get a clear vision of that area. She said it appeared to be another basal cell and she would take a biopsy to be sure.

After trolling over the rest of my back side, she then asked if I would allow her to view my front since we were performing an entire full body scan. While this seemed to be an uncomfortable situation, I had really hoped everything might lead to this. How could I actually say NO to this possibility. When I turned to face her, my penis was still fairly inflated since her tender touch was very evident all over my body. The level of our eye contact had shifted as she was now focused down on my turgidly extended member. She nervously said, "Um ... ahem... it appears you have been well-blessed."

I shyly replied saying, "Yeah, it seems that way."

Then PA Jill said, " I bet that must come in very handy sometimes". With that she also said, " Oh my gosh! I'm very sorry as that was way too forward of me, and I should not have said that to you. I am very embarrassed as it was totally unprofessional."

Not wanting her to feel totally upset and beside herself, I told her to relax and not to be too hard on herself. While she needed a few moments to compose herself, I asked if she wanted to continue with the exam or just take a biopsy and complete the minor freezings.

She eventually responded by saying, "No, I got this. Let's finish what we started." As she again knelt down to closely examine my genital area, she was naturally a bit more self-conscious. However, I still found it difficult to remain composed with her that close to me. "Professionally & unprofessionally speaking' she uttered your penis looks very healthy". However, I do see something on your scrotum which appears a bit unusual. It looks like a hemangioma."

I said, "A what" she told me what a hemangioma was and I should not be alarmed by it. On my part I was not even aware I had this red mark on my ball sack as I wasn't looking for it either.

She said not to worry, but we could monitor it from now on for any changes. She said these are birthmarks that sometimes disappear or appear later in life depending on the person or circumstances. Well, I guess I was partially relieved to hear that and also glad that it took her mind off our previous alarming discussion.

The remaining part of the exam flew by without issue as did the followups in the weeks to come when I had the basal cell and its stitches removed.

Thinking we might now have passed any possible predicament, life continued for both of us until I ran into PA Jill at the nearby grocery store two months later. With my next appointment not scheduled for another four months or so, I was taken aback to see her there and in casual attire. I asked if she was visiting or living nearby with family or friends? She said she had just rented a new condo after one of her college roommates moved out with her boyfriend. She also wanted to get a new place that was also closer to her job as well.

She then asked me if I lived within the school district where she used to live or someplace close by. I mentioned that I too was not that far away and was told by a former mentor years ago that it might be wise to keep my distance from your employer. When this advice was given to me, my mentor thought it could have both good and bad implications in the future. I decided to play it safe and never looked back even after my divorce. As I brought this up, Jill was not even aware I was married, but I told her that the issue had been settled amicably seven years ago.

We continued our conversation in the parking lot for a short time before going inside to pick up a few items. Walking through the food store aisles, she told me she had recently purchased a number of pieces for her new place from IKEA and a Marshall's department store. Later this evening and over the next several days she was hoping to start getting her new condo put together. Sounding like this might be a major job, I somewhat timidly mentioned if she needed any help assembling her brand new furniture, hanging pictures or just wanted to borrow some tools... I could be of service to her. I brought this up generally because I had offered assistance several times in the construction of our school district's theatre productions and was quite handy if I did say so myself. She thanked me for the offer and sounded pleased that perhaps she would not have to complete this monumental task alone. With her father's passing two years ago, she mentioned she still occasionally relied on the help of others and their specialized skill sets.

After paying for the items, we made our way to the parking lot where I again offered my help anytime when needed. She thanked me and said goodbye Mr. Roberts when I promptly said. "Hold on, I have been calling you PA Jill or just 'Jill' since school days. We are now both adults - both equals - you should now call me George like everyone else. Plus, looking back to my past office visit exam, I believe we can possibly be a bit more open and honest with each other." With that she was very relieved I had offered both to be a bit more friendly with our names and possibly the need to uncrate & assemble the boxes in her new living space. Since she was also unsure of how our relationship within the office would proceed after our last encounter, she also realized today's chance meeting might help to smooth over any possible uneasiness. I thought the same as well.

The next morning I was able to sleep in as my weekend responsibilities did not start until later in the afternoon. So after my mid-morning run, a light breakfast and workout routine, I took a shower and completed some small tasks around my home. Before lunchtime I was surprised by a phone call since I did not recognize the number on the screen. Upon answering it the voice sounded familiar, but it still could have been a crank call or one of those telemarketers.