While I awaited the results of my biopsies (The Beginning) I couldn’t help but wonder what would happen when they came back positive. From the dermatologist’s reaction there seemed little doubt that they would. What would the next step be? Who was going to take them off? What would the procedure be like? I went back for my followup and sure enough all of the biopsy sites were positive. Basal cell and squamous cell cancer the dermatologist told me. He told me that on my way out the woman at the front desk would have a list of doctors that they could refer me to. And indeed she did.

“We have two physicians that we usually refer skin cancer patients to”, she started. “This first one is a plastic surgeon. He’s good but he’s a real asshole.” Some choice there I thought wryly. “The other one is a mohs surgeon. Our patients seem very happy with him.” There you have it I thought. Happy on the one hand. Asshole on the other. But what, I wondered, was mohs surgery? Remembering the rather insensitive slur from my youth I wondered would it turn me into a ‘mo or was it the sort of thing that only ‘mos went to? Time for some research.

The web was nothing like we know it today, no Wikipedia or anything like that, but I was able to use it to find out that Mohs Micrographic Surgery was a technique for removing skin cancer in layers. It was created, or pioneered if you will, by Dr. Fredrick E. Mohs in 1936 at the University of Wisconsin. With my ever expanding knowledge base I now had to decide. Plastic surgeon, and that conjured up good repair and no scarring in my book, on the one hand and Mohs Surgery on the other. I opted for Mohs but I was nervous and unsure all the same.

I called Cary Skin Center and scheduled an appointment for surgery with Dr. Robert E. Clark. The doctor people were happy with. No asshole for me by golly. The surgery was scheduled for two weeks down the road (a busy place apparently) and at a very ungodly time of the morning. I had a lot of time to let my imagination wander at the possibilities of this surgery. And wander it did. While I had made some friends in the physician profession I still was not comfortable when I was the patient. Those two weeks could not pass quickly enough.

Pass they did though and I arrived at the appointed time and place.

I walked through the front door and was greeted by a woman whose name tag indicated that she was Ingrid. Friendly, but also sort of stern and reserved. Kind of like her name. She made a copy of my insurance card, gave me what seemed like a mountain of paperwork to fill out and told me to take a seat. The waiting room was very spacious. High, wide open ceilings with glass and plenty of light. A big TV was situated in front of a sofa a chairs just to the left of what looked to be a nurses station. There was an urn of coffee on one of the tables with plenty of Cary Skin Center mugs. A water cooler and glasses were available if you weren’t the coffee type. As I settled in to fill out the paperwork I looked around at my fellow patients and my first impression was “my God, I must be in the wrong place. Look at how old all of these people are!” I was at least 20 years younger than any other patient in the waiting room. I guess cancer doesn’t really care about how old you are.

I finished filling out the paperwork, got up from my chair, walked back to the front desk and handed it over to Ingrid. Someone would come and take me back for surgery she informed me. Lucky me. I headed back to my seat and didn’t have long to wait. A nurse came walking around the sofa, introduced herself, and escorted me back to one of the surgical rooms. We exchanged pleasantries as she got me settled in. She looked over the paperwork I had filled out earlier.

“No stranger to skin cancer are you?”

“No, unfortunately not”, I replied.

“Ever had Mohs?” she asked, making it sound more like a disease than a procedure. Maybe penicillin would cure it I thought to myself.

“Never have”, I said.

“Do you have any allergies?”

“Only to pain and blood”, I told her. A hint of a smile showed at the corner of her mouth.

“How about lidocaine or latex?” Latex ‘eh? Maybe I’d stumbled into some sort of a sex shop and didn’t know it.

“No, neither one.”

“Very good. Make yourself comfortable and someone will be with you shortly”, she said.

After she left the room I took a few minutes to get the lay of the land. I was sitting in one of two chairs that were side by side, sandwiched between a desk on one side and a counter on the other. The desk had a 17 inch flat screen monitor, a digital card reader, a business card holder with six different cards represented, a few stray magazines and a Compaq computer securely chained under the desk. Must have a dicey clientele, I thought, if they had to lock down the PCs. Never knew when one of the octogenarians would put one under their overcoat and walk off I suppose.

The counter had a sink flanked by containers holding qtips, gauze pads, latex gloves and other assorted surgical goodies. There was antibacterial soap, a paper towel dispenser and next to the towel dispenser was a bio hazard container for scalpel blades and syringes. There were several drawers and a couple of cabinets underneath those. No telling what they housed but I could guess and I figured that I’d know for certain in due time.

Next to the desk was a window that ran from floor to ceiling. It consisted of a number of privacy panes and only a few panes that you could actually see through. In front of the window was a stainless steel tray on a base with rollers. It was covered with a blue surgical drape that was laden with instruments, gauze, syringes and lidocaine. Next to that was a chair of sorts. It was covered with a white sheet and had a pillow and a maroon towel on it. There were four foot pedals behind it that controlled raising and lowering the foot and head part of the chair as well as raising and lowering the chair itself. Clearly this thing cost more than most people made in a year. Hanging on the wall next to the chair were a digital thermometer, a blood pressure device and a cauterization tool. Let the games begin I thought as I heard the door opening.

“Hi. I’m Paul Toth”, he said extending his hand as he entered the room. “I’m Dr. Clark’s PA.”

“I’m Gregg Morris”, I said as I shook his hand.

“Dr. Clark will be with you shortly. In the meantime, can I answer any questions for you?”

He could not have been more genial and his bedside manner was very comforting. We talked a bit and then we were joined by the nurse who proceeded to take my vitals and get me to sign the surgical consent forms. You know, the ones that say if they screw up it’s your fault. I signed and shortly thereafter Dr. Clark came in and explained what he was going to do and how the morning would proceed. He could not have been more professional or more comforting than he was. Soft spoken but very direct and very confident. I could tell within minutes that I had made the right choice in coming to Cary Skin Center. I may have been unlucky with the skin cancer but I was unbelievably lucky to have Dr. Clark to see me through it.

I still remember it as if it was yesterday. I awoke at the customary hour, 6 AM, went down to get coffee for my wife and bring it back upstairs so she could drink it as she got ready for work. We were living in a condo that had one and a half baths and since she had to be out of the house and off to work before I did that morning she had dibs on the shower. I drank my coffee, fed the cats and puttered about until she was out the door. I went upstairs to get my shower and as the water was warming up I looked at my face in the mirror. And there it was. Big. Red. Blotchy. Located just under my left jaw line and right on top of the left gland. I knew with a certainty I cannot to this day explain that it was skin cancer. It was 1983.

I had spent the 10 plus years previous to that working as a tennis professional so I wasn’t really surprised. But there was a shock value even so. Skin cancer was starting to get some traction in the media and there was starting to be talk about sun screens instead of sun tanning products. The little Coppertone girl and her dog were joined by the likes of a bullfrog. A good friend and a mentor in the tennis business had a brush with a very dangerous form of skin cancer, melanoma, when we were working together in the mid-70s. It started as a mole or growth on his left forearm and got to be quite good sized before his wife finally beat him up enough to get him to go see a plastic surgeon who we knew through our dealings with the tennis community. The plastic surgeon removed a good sized chunk of that forearm. And my friend was lucky. The melanoma had not spread and to this day it has still not raised its ugly head. Those of you who know something of skin cancer will probably know that 90 some odd percent of them go metastatic and become the deadliest of cancers that we know.

So, I jumped in the shower hoping that maybe it would be gone by the time I finished. No such luck I noticed as I was shaving afterwards. Maybe it would just sort of go away on its own accord. We were in the process of moving to Atlanta at the time and while we were still a few months from the move I wasn’t quite sure who to see in the medical profession. So, I did what most guys are always accused of doing with medical dilemmas, I put it off. It wasn’t bothering me in any way and it didn’t seem noticeable to anyone but me. My wife never commented on it and from one standpoint I was lucky. My light skinned, Nordic complexion, hid it very well.

Our move to Atlanta culminated at the end of the summer. My wife had been working down there since the first part of the summer and I joined her in September. I had resigned my position with the club I was teaching at and looked forward to a new beginning in Atlanta, whether that beginning was still in tennis, Atlanta and ALTA was arguably the biggest tennis market in the United States, or in some other endeavor. Time magazine had named the IBM personal computer it’s Man of the Year in 1982 and I had been developing a curiosity ever since. The work of two of my tennis heroes if you will, Vic Braden and Dr. Gideon Ariel, had already convinced me that computers could do more than just screw up your bank balance. They were doing some wonderful pioneering in the field of biomechanics and I was hooked.

I had the opportunity to go to work with an old friend at one of the oldest and most respected public tennis centers in Atlanta but I decided against it. I wanted to pursue something in the computer/software field and there was this lingering spot on my neck. And it wasn’t getting better on its own. Staying out of the sun was probably a good idea I thought. I went out and bought a TI 99 and all of the peripherals and went about teaching myself al that I could. That eventually led to a job at Software City via a somewhat circuitous route that I’ll post on later perhaps.

While managing that Software City I befriended several physicians and surgeons. At the time doctors were very much interested in computers and software. They still are it turns out. I’m sure it has something to do with their innate intelligence and curiosity. At the same time, that spot on my neck was getting worse. It had started to scale and scab and shaving over it every morning wasn’t helping it. I had started keeping a bandaid on it every day and finally one Saturday morning at the store, when all of the docs were congregated and we were discussing the merits of certain Apple software, one of them pointed to my neck and said “What’s that all about? It’s been there for some time now.” I tried to slough it off but they weren’t having any of it and they made me loose the bandaid. The abrupt intake of air, from the one who had asked, when he first saw what was underneath the bandaid confirmed what I already knew of course. Trouble was brewing.

They called a general surgeon friend of theirs and I was in his office first thing Monday morning and I was on an operating table at Saint Joseph’s Hospital the first thing Tuesday morning. He removed the tumor that was on my neck and also one on my chest and back. Those he had discovered while he was doing a body scan of sorts while I was lying on the operating table. He stitched me up and sent me on my way and sent the tissue sample off to be biopsied. Two of them were squamous cell carcinomas and one was a basal cell carcinoma. Not melanoma thankfully which it turned out is what all of the docs had suspected after they first had me remove the bandaid. The crusty, dark scabbed over tumor looked to them like melanoma. And given its location just above a major lymph node site I can understand why I heard that sharp intake of air when they first saw it.

After I went back and had all of the stitches removed the surgeon did a more in depth body scan (‘We’re going to go over you with a fine toothed comb my friend”) and didn’t find any other suspicious areas. He did tell me that I had probably made a good career move in terms of my health by getting out of the tennis business. Other than those three tumors I wasn’t bothered by any more recurrences while we were in Atlanta. We had sold the Software City stores (just months before Egghead and CompUSA came to town – talk about timing!) and I started consulting, doing some custom software development, and finally going to work for a software development company who made programming libraries for Microsoft’s Professional Basic Compiler. Over the years that this was going on I remained cancer free as they say. My “sun time” however started to increase again as we had “son time” to attend to. Both of our boys played baseball and soccer throughout the spring, summer and fall and I helped coach a number of those teams and if I wasn’t coaching I was on the sidelines cheering them on.

In 1994 I went to work for another software development firm and in July of that year we moved the company to Morrisville, NC. Shortly thereafter, just before getting in the shower one morning (are you sensing a pattern here?) I noticed a spot on my left cheek. It looked different than that first one in 1983 did and I didn’t have the same conviction that it was cancer as I did back then but it continued to progress until it had eaten a hole about the size of a pea in my cheek. No matter how much filler I put in it or how many bandaids I placed over it, there was no denying what it most likely was. So, I gathered a few recommnedations and decided to go see a dermatologist at Chapel Hill Dermatology. He happened to be on vacation when I called to make an appointment so it would be almost two weeks until he could see me. I would however be his first appointment when he got back.

He came into the examining room. We exchanged pleasantries after which he asked “What brings you here today?” I pointed to the hole in my check as well as to several other lesions that I had noticed elsewhere and he proceeded to go nuclear. He told me I needed to see I a psychiatrist as well since I was clearly in denial about my condition. (Note to self and those of you interested. Never schedule yourself as a doctor’s first appointment when he or she comes back from vacation. They can be a little cranky.) His nurse kind of rolled her eyes a bit at this and she followed him out of the room as they went to get a biopsy kit and whatever he felt they might need. They both came back in rolling a big tray with instruments that looked like they were designed for torture not biopsies. Or maybe those two things would turn out to be the same.

As he was numbing the sites in preparation for the biopsies the doctor had begun backtracking a bit on my need for therapy to treat my denial and we talked about how dermatologists were now trained to treat skin cancer in its early stages, surgically with repair if need be, and how there was no need to put off coming in to see him whenever a suspicious lesion showed up. They gathered the biopsies into little specimen jars and sent them off to be read. The results would be back in a week or so and they would talk with me about the results in a followup visit that we then scheduled. I left the office and headed back to work wondering where this odyssey would lead.