CHAPTER ONE HUNDRED AND THIRTY: THIS WILL LEAVE YOU IN STITCHES

CHAPTER ONE HUNDRED AND THIRTY: THIS WILL LEAVE YOU IN STITCHES.

 A wrong has finally been righted! It’s taken two years, but the wood strip that Dudley’s Marina ripped off the stern of Slow Motion has been replaced. And the memory of Dudley’s simply awful docks and pilings is fading away, finally. That wood piece nearly hit me in the eye when Dudley’s dock plank yanked it off. But now there is no sign of that near tragedy – hurray! This is a great day for Slow Motion. Thank you, Admiral, for your fine carpentry skills and for your ability to work in the middle of the hottest, most humid summer in Delaware City history. So what if you have to change shirts 4 times a day. You have your Diet Peach Iced Tea to keep you cool. And you just worked a miracle, turning Slow Motion’s stern into the brightest, whitest, cleanest, whole-est stern in the western boating world. No more will new trawler owners look down their noses at Slow Motion’s peeling paint and the missing wood. They’ll look with envious eyes at her pristine new stern in all its glory. Oh yeah. Life is good with a master carpenter who has an indomitable work ethic.

Yes, we are still docked at the Delaware City Marina. However, that has not stopped me from making a 5 day round trip to California last week. My dog, Zorro, is still the sweetest dog in the world – and smart! He had something that looked like a cut on his paw, so we went to see Dr. Sage, his new vet, and when she asked to see his paw, he turned toward her, and lifted his injured foot and put it right into her waiting hand. No, she didn’t say: “Give me your paw.” She used vetspeak and asked him if he would turn around and let her examine the injury to his right paw. I swear he understood every word. And he gave her the right paw. On the day of my departure, as I awoke at 4 a.m. to go to the airport, Zorro came running to my room to say goodbye, and he was there, head hanging down, as I went out the door 20 minutes later. This guy knows how to get to me. He and Ruby and I had great walks/hikes in the park during my short stay. Lucy Gracie joined us most of the time, so Zorro had his harem. Of course, he had to show off in front of them by herding a calf back to its mama – all in a Blue Heeler’s day’s work. The highlight of the California trip was a visit with Marie, who is out of the hospital after a six week ordeal battling infection, which followed a one week stint for surgery to remove a tumor. She still does not feel well and the docs are uncertain about their diagnosis, but for all that, it was great to talk with her for more than an hour. She looks as young as she was when she joined the DA office more than 25 years ago – this, in spite of the fact that she has had five different cancers at the tender age of 57. Give her a break, O Mighty Spirit – give her a speedy recovery and years and years to enjoy grandchildren.

My hosts in California were, as always, Royal and Brenda and Olivia, who are Zorro’s foster parents. Royal is publishing a political blog, Monterey Bay Partisan, which is much more enlightening to read than the Monterey County Herald. That rag has become a few pages of news from sources outside the county, ads and obits. There is an opinion page, but it contains things like: “We Have a Serious Water Problem” (duh) and “Public Education is in Trouble” (double duh). In other words, the new editor keeps telling us stuff we already know, and stuff which is not Monterey County-directed. Of course, when you live in another county and have been made the editor of that county’s paper AND the Herald, with no pay increase, you may not be motivated to get involved in Monterey County or to learn enough about its issues to write knowledgeable editorials. Anyway, Thank God for the Monterey Bay Partisan, which covers distinctly Monterey County stories. And thank you, Royal, for the delicious ribs from the grill. They were the best!

Oh yes, the reason for going to California was to have Mohs surgery on the tip of my nose, which had some squamous cells, according to a biopsy from a Maryland dermatological group. That group offered a Mohs surgeon to remove the cells, but the surgeon was a one note doc. He could remove the cells, but could not restore my nose after the surgery. This would have meant wearing a bandage over my nose until I found a plastic surgeon to stitch me up. I am not fond of this two-step process. And with Dr. Greg Morgenroth, the best Mohs surgeon in the world, I never had to wait for the stitching after the surgery. He has a one-stop shop, because he is both a Mohs surgeon and a plastic surgeon. At the Admiral’s urging, I tried to locate such a versatile doctor on the East Coast near Delaware City. I thought I had found such a rare bird at the University of Pennsylvania, because his web site said that Dr. Miller did Mohs surgery and the follow-up reconstruction. So I called to make an appointment. His pleasant staffer said that because he was so popular, the first date she had for me was in the last week of August – and that was for a “consultation”, not the actual surgery. The first date for the surgery was the last week of September. I asked for assurance that Dr. Miller would do both the surgery and reconstruction at one sitting. And the assistant said he would decide whether he could do the reconstruction at the August consultation. What? How do you know just by looking at the tip of my nose if you can sew it up again, after taking out the offensive cells? I had heard enough. The next call was to Dr. Morgenroth’s office to see how long I would have to wait. I called on a Monday, and they were ready for me the next day. Wow! I asked about an appointment a week from that Tuesday, and they had an opening then too. So with a little help from Delta, using my miles to get a ticket, I made it to California and had the surgery July 29. That’s July – uh-huh – not September. And Dr. Morgenroth put 12 of the tiniest stitches in the end of my nose, after scraping off the squamous cells (one scraping – a miracle!). He is the best!

The Admiral said I have to blog about the process of getting the stitches removed today, August 5. So here goes. The Admiral had called MedExpress, an “urgent care” facility near Delaware City, to ask if a doctor there would remove the stitches from the Mohs surgery. They have to be removed a week after the surgery, and I only stayed in California one more full day after my appointment. Dr. Morgenroth looked a big peeved that I wasn’t returning to his shop for stitch removal, which would have guaranteed that his high quality work was honored and protected by the P.A. in his office who would have removed the stitches. It was pretty foolish of me not to stay for the removal. However, the Admiral seemed to have found a very good alternative – albeit an unknown stitch remover in Delaware. I had suggested that I return to the dermatology group Maryland that did the biopsy, but the Admiral said we really did not need to travel several hours, since MedExpress had personnel who could do the removal. This morning we headed to MedExpress, and I walked up to the window with my surgery aftercare paper from Dr. Morgenroth and asked for someone to remove my stitches. The receptionist furrowed her brow and said she would have to check with the doctor. I told her I had called before coming and was assured that the doctor would do the job. She went to find the doctor, and when she returned, she said the doctor flat out refused to do the stitch removal, because it was “cosmetic” in nature and they didn’t do any cosmetic work. She apologized for the wrong information I had been given. I told her I needed to get the stitches removed – could she ask the doctor for a referral? She furrowed her brow again, but went back into the clinic. A few minutes later she returned with a list of four cosmetic surgeons in the area. With one more apology by her, we were out the door and I was dialing the first name on the list.

Okay, here’s where it gets interesting – or sadistic – or both. The first cosmetic surgeon worked alone, and he never, never, never took the stitches out of another cosmetic surgeon’s patient. If he did not do the surgery, he was not touching the stitches. All right, I thought, a prima donna. Let’s move on to a group of cosmetic surgeons, where at least one of them might have a little common sense and compassion to take out the stitches. Furthermore, I was asking for a Physician’s Assistant on staff, because they are usually the expert stitch removers. The next office I reached had about 10 plastic surgeons (not sure about the number of PAs). Surprisingly, each of them had the same verkakte “policy” – if you are not their patient, they will not remove your stitches. I said I wanted to become their patient today for the purpose of stitch removal. And the receptionist said but you are not their patient, so don’t bother to come here. None of them would remove the stitches, according to her. So who knew that cosmetic surgeons do not have anyone on staff for the sole purpose of removing stitches, whether or not they have done the surgery? I certainly didn’t. The Admiral says it’s most likely something their liability insurance companies make them do – or not do—so they can’t be sued for a botched stitch removal case on a patient who had not been stitched up by them. I hope it’s the evil, narrow-minded bean counters at the insurance companies behind this loathsome policy, but I fear that the cosmetic surgeons themselves may not see stitch removal as a money maker, so why waste anyone’s time on it? At this point, the Admiral was talking about going to a hobby store to get some kind of very sharp, small instrument (an X-acto knife) to remove the stitches himself. I’m sure he would have done a fine job. But I pressed the receptionist for the large cosmetic firm for an alternative, and she suggested a hospital emergency room.

Of course! Why not the most expensive treatment option in the entire medical system? Let’s overburden our emergency rooms! Why didn’t I think of that? Well, rather than travel to a nearby emergency room to get a quick turn down, I called the closest ER, Christiana Hospital ER, and asked the ER administrator if I could get the stitches on the tip of my nose removed. She said “Yes” without hesitation. So we were off – just 3.8 miles more to sit in an ER, as ambulances brought real emergencies into the back entrance, and wonder if my turn would ever come. The big sign in the waiting room said that patients were called based on the seriousness of the condition. Hello! It was important to me to get the stitches removed a week from the surgery date, but I didn’t see this condition competing well with heart attacks, stab wounds, or even the flu. As it turned out, Tuesday morning was a slow time for the Christiana ER, so my wait was limited to about 20 minutes. I was ushered to an examining room and a petite PA named Robin showed up shortly thereafter. She looked at the stitches and said they were the smallest she had ever seen (Dr. Morgenroth is an artist!). She worked slowly and meticulously with the worst pair of scissors – three times the size of what was needed for the job. Fortunately, she was very careful and she was able to remove the stitches without tearing the skin or causing bleeding. So there is a chance, a pretty good chance, that my nose will heal well – and Dr. Morgenroth’s excellent work will not have been done in vain. Thank you, Robin, for having small hands, for being patient, and for caring about your work. Score one for ER Physician’s Assistants.

But is this the health system we want? I thought that if you had health insurance, you would be seen by a specialist, when you need one. You would not be thrown into the Emergency Room mix with people with real emergencies. You would not be overtaxing that resource for things that could be done in a doctor’s office. And you would be able to have a simple procedure like removal of stitches done by someone who does that for a living, like a PA in a dermatologist’s office or a cosmetic surgeon’s office. I bet if states allowed PAs or nurse practitioners to put out their own shingles, these independent health workers would not have turned me away. There should be at least one PA in Delaware who has her/his own office who is trained to remove stitches. That is not too much to ask for in a rational world with a rational health care delivery system. I bet Germany and even Canada have PAs who remove stitches. Ah, the health care system – the “care” part is almost non-existent, hidden among the layers of bureaucracy and the ruthless decisions of insurance company adjusters, who apparently never have a sick day in their lives. I feel a longer rant coming on, but it’s time to say “Good night”. In the next exciting chapter, the Admiral and I visit a – you guessed it – a revolutionary fort. Read on!