The boys finished pulling on their boots and ran outside. My daughters weren’t quite ready yet, so I told Gord to go on ahead. Five minutes later the girls and I departed.
When we emerged from the path that opens onto the clearing at the top of the hill I spotted Gord right away. It wasn’t that difficult – at 6-foot-5 he was easily the tallest of the dozen or so people milling about. Even from a distance I could tell something was amiss. I waved at him and shouted, “Did you find it?”
Instead of answering, he loped over to me. Uh-oh.
“There was no GT tied to the bench,” he whispered, “but that kid over there has one that looks exactly like ours.” He jerked his thumb in the direction of the throng of people at the summit.
“Do you think it’s ours?” I asked.
“I’m pretty sure.”
“Did you talk to him?”
“Yeah.”
“What did he say?”
“He said he got it for Christmas.”
I went over to take a look.
The boy was facing the opposite direction as I approached. There was a GT immediately behind him. I scrutinized it closely. In addition to being brand spanking new and sticker-free, it was sporting the same abominable knot. How suspicious can you get? I tapped our suspect on the shoulder.
He twisted around lazily and appraised me. He was a gangly 12-year-old boy with saffron hair, an explosion of freckles and pale blue eyes. A hint of a smirk played about his mouth.
“Hi, I’m Dr. Gray,” I said. “What’s your name?”
“Josh.”
“Josh, this GT looks a lot like the one I accidentally left out here last night. Do you think it could be mine?”
He tilted his head back, looked me straight in the eyes and said, “Nope, it’s mine.”
“When did you get it?”
“At Christmas.”
“Are you sure, Josh?”
“Yep.” He turned away from me in a blatantly dismissive manner. I could feel my hackles rising.
“Hang on, Josh; I’m not quite finished yet. Like I said, I’m pretty sure this is my GT. What’s your mother going to tell me if I call her and ask if you got a GT for Christmas?”
He wasn’t expecting that. His smug look faltered.
“Um… .”
“What’s your last name, Josh?”
“Uh… .” He started to fidget.
“What’s your phone number? I’ve got a cell phone right here in my pocket.” Of course I was bluffing, but he didn’t know that. The last remnants of his cockiness vanished.
“I don’t know!” he bleated nervously.
“Do you seriously expect me to believe you don’t know your own phone number? Come on, Josh; give me a break. What’s your phone number? Maybe I’ll talk to your father, instead.”
His eyes widened in horror.
“I promise you, I don’t know!” he wailed.
By this time several curious snowboarders had coalesced around us. A few of them started snickering.
“I promise you, I don’t know!” someone trilled in a squeaky Josh-like voice. The rest of them guffawed loudly.
“Josh, this is my GT, isn’t it?”
“Y-yes,” he stammered at his boots.
“What’s it called when you say things that aren’t true?” Gord asked him pointedly.
“L-lying.”
I relieved him of his plunder and gave it to Kristen. She hopped on the sled and went rocketing down the hill. Josh slunk away guiltily.
An hour later I was sitting on the bench taking a breather when Josh approached me.
Aha, he’s come back to apologize. There’s hope for him yet!
“Dr. Gray?” he ventured, eyes downcast.
“Yes?”
“Can I borrow your GT?”
Legerdemain (Sleight of Hand)
Most weekday mornings I do a couple of scheduled minor procedures in the emergency department. Patients used to have to sign a consent form prior to undergoing minor procedures, but a few years ago that antiquated ritual was laid to rest. If registering at the front desk, sitting in the waiting room for half an hour and then remaining perfectly still on an uncomfortable stretcher while being poked and prodded by sharp instruments isn’t proof enough that consent has been given, I don’t know what is.
Wart removals and cortisone injections are usually quick and predictable. Biopsies, on the other hand, are an entirely different kettle of fish. Minor biopsies involve removing only a tiny sliver of tissue, so sometimes the entire procedure lasts no longer than a few minutes. In those cases it probably takes more time to fill out the various forms that accompany the specimen to the laboratory than it does to remove the lesion itself. There are times, however, when much larger blocks of tissue need to be expunged. Sometimes this is because the lesion itself is bulky; other times it’s because the mole looks cancerous and we want to make sure all traces of it are eliminated. When it comes to lumps-and-bumps removal, there’s nothing more disconcerting than receiving a pathology report that states the lesion in question is an incompletely excised malignant melanoma.
When I enter the treatment room I always ask my patient to confirm the procedure they’re expecting me to perform. I find this is the best way to avoid injecting the wrong joint, removing the wrong mole, etc. Why make malpractice lawyers’ jobs any easier than they already are? After I’ve verified we’re both on the same wavelength I begin to gather the necessary hardware. If my patient has that familiar white-knuckled look I’ll chit-chat with them as I assemble the supplies. First I place my latex-free gloves on the counter behind me. I then open the biopsy tray and pile the scalpel, needles, syringes and suture material onto it. Next I pour chlorhexidine into the stainless steel bowl. After instructing the patient to lie down, I adjust the spotlight to ensure the lesion is optimally illuminated. When I’m satisfied with the lighting I put on my disposable blue facemask. Breathing with the facemask on always makes my glasses fog up, so after a few seconds of looking like a total loser I dispense with the glasses and deposit them on the counter. I snap on my gloves with dramatic flourish, draw up the local anaesthetic and whirl like Zorro to face the doomed lesion (okay, so maybe not quite like Zorro). I wash the skin with the antiseptic solution and drape clean towels around the area to maintain a sterile surgical field. I give fair warning that I’m about to start injecting, then infiltrate the vicinity with the anaesthetic. Once my target is fully frozen (does this hurt? – poke, poke) I’m ready to proceed.
I gently rest the blade of the scalpel on the surface of the skin. A moment later I apply firm downward pressure. As the blade bites into the tissue I begin carving an ellipse around the lesion. Sometimes bright red blood wells up through the incision, forcing me to stop and compress the area with a wad of gauze until it settles. Fresh blood has an unmistakable odour. I used to find it disturbing, but now some days I hardly even notice it. When the field is no longer obscured by blood I resume cutting a swath through epidermis, dermis and subcutaneous tissue. Once the ellipse is complete I fillet the chunk of flesh out and drop it into the specimen jar. Oftentimes I’ll put a couple of dissolvable stitches deep inside the wound before closing the more superficial layers with regular suture. I dry the skin with some fresh gauze, slap on an adhesive dressing and voila! Mission Accomplished, as Dubya would say.
For most physicians, these basic procedures become automatic. Like driving a car, once the skill has been mastered we no longer need to devote every iota of our attention to the process every time we do it. For certain tasks it’s safe to temporarily activate cruise control and give the overseeing, self-aware part of our brains a chance to disconnect and take a breather. Don’t worry – it checks in regularly to monitor how things are going. It just doesn’t strain to analyze and micromanage every nanosecond of the procedure. It’s a useful little technique that helps stave off burnout.