#MOC19: Thin-Skinned

At last week’s tail end I had my first medical appointment since this mess started. I was supposed to have had a dentist’s appointment in the middle of April, but the state’s dental board had recommended its members cancel all appointments and remain available solely for emergencies…so that was off. Religious flosser though I am, I’m missing that smooth-tooth feel I relish in the weeks after a cleaning.

Because I tend to be vague about dates on the calendar—as in when they are, what they mean, and why they should be of significance to me—I tend not only to enter appointments on my electronic calendar, where they’ll be propagated to all my many devices so I can summarily ignore them after they buzz and chirp at me, but also to leave the appointment cards fixed on the side of my refrigerator. In theory, I visit the refrigerator often enough (which is to say, way too often) that on occasion the card for the next appointment might catch my eye.

This month my backup strategy worked. I noticed the card for an upcoming dermatologist’s appointment a couple of weeks early, and I wondered to myself whether or not it would happen at all. Would I have to sit in a waiting room with other patients? Or had specialists followed the same path as Connecticut dentists, and shut down their practices? I could remember one of my friends remarking on Facebook that he’d had a telemedical session with his dermatologist for a suspicious mole. Sitting in a cold office in nothing but my shorts while a near-stranger peers at my skin for abnormalities is bad enough. Was I now going to have to contort myself like a circus freak, as I guided my phone’s camera over every square inch of my embarrassed naked flesh?

I started visiting my dermatologist about six years ago because of a condition that affects the sides of my face; I was breaking out in tiny bumps right along the bone surrounding the eye sockets, which would inflame and turn scarlet, leaving me looking like a raccoon. My regular doctor was mystified; the dermatologist had me test out a series of medicated lotions and gels that turned my redness into vivid scarlet crescent moons. Eventually we hit upon a combination of low-grade antibiotics and a sulfur wash that eliminated the outbreaks. “It’s not really rosacea acne, but let’s call it rosacea acne,” he told me. (My regular doctor: “I guess it could be. Dermatology is kind of a crap-shoot, isn’t it?”)

I’m grateful for the clear complexion I’ve had since, but the price for it is having to visit the dermatologist every six months—and honestly, I truly dislike my dermatologist.

Every time I visit my dermatologist I come away with some new grievance or horror story to share. He’s paranoid. He’s grandiose. He freaks out if someone misses an appointment, because it affects his bottom line. He’s also outright offensive: there were the multiple times he informed me that “Old folks like you are my bread and butter.” (Thanks, buddy.)

Once I had to sit in the waiting room and endure him chew out his long-suffering elderly receptionist because she’d booked an appointment for someone he had banned from his office for non-payment. On another occasion, I had to listen to him scream at top volume at the poor woman again because she’d told an elderly woman from the Nathaniel Witherell nursing home that she could sit in the office for a few minutes until the home’s shuttle picked her up after an appointment—then during my own appointment he raved the entire time about the grievance until finally he opened up the examination room door (with me clutching my t-shirt to my naked chest in horror) to yell at the receptionist, “I DON’T NEED SOME NINETY-FOUR-YEAR-OLD KEELING OVER IN MY WAITING ROOM.”

Yes, I very much dislike my dermatologist, but honestly, my appointments are short and he doesn’t seem to be doing me active harm. Basically I’m too damned lazy to try to find a new one and get my records transferred and start all over again.

So although I wondered whether I’d be seeing him at all last week, his service called to remind me that I had an appointment on the 24th, and to please let them know if I needed to cancel at least 24 hours in advance. Seven days in a row they called, while I stubbornly refused to dial them back because they said that I only needed to return the call if I was canceling. I drove to the guy’s medical complex, parked and tied on my mask, then was surprised to see him waiting for me at the top of the stairs inside.

“Come in, come in.” It was more of a demand than an invitation, really, but I let him pull open the door for me, then watched as he swabbed at the knobs on both sides with disinfectant wipes, and locked the door behind him. The waiting room was empty; the receptionist’s office behind the sliding glass window was dark. “It’s just me here. I’m only seeing one patient at a time…for obvious reasons.”

It made sense. He was masked as well, and as he washed his hands and disinfected, I started taking off my hoodie and shirt. My all-over body exam usually is in October; in the spring, he only looks me over from the waist up. “How has all this affected your—?” I started to say.

“I’m down to about ten percent capacity,” he interrupted. “I have to say, I’m very disappointed in most of my patients over this. They don’t seem to understand that I have a practice to maintain, and they just don’t show up to their appointments. Now, are there any changes in your medications?”

As I hopped up on the exam table, I shook my head and told him everything was the same, although the previous week I’d had a mark on my neck that I thought was from using my clippers directly on—

But he was off on another tangent. “You know how they say a crisis is a crucible that shows people for who they are? Well, that’s what it’s done for my patients. Ungrateful, ungrateful people, all of them. It’s terrible how disgusting people are.” I closed my mouth and let him rant as he lifted up my left arm and gave it the once-over from all angles. “They’re bad enough under normal circumstances, but now I’m expected to be available to them at all hours of the day so I can look at their moles over Skype. Telemedicine sucks, I tell you. It sucks. It’s stupid. I didn’t spend years and years in medical school to look at people’s moles on a smartphone.”

I pointed to my neck again. “I did have a mark—“

“And it’s bad enough that during normal times I already think I’m being socially ostracized. Maybe I’m a paranoid person. Maybe I am. But do you know that no one in my social circle has called to check up on me? Here I am in the front lines, risking disease and death every day, and for what? Not a single call.” He laughs as though he hopes it’s amusing, this notion that anyone would ostracize him. I’m someone, however, who’s basically seen blood streaming from this guy’s eyes because a 94-year-old had to wait a few minutes for her ride back to the nursing home. So instead I’m sitting there shirtless, arms held out like the Vitruvian man, understanding how deeply possible his social exile might be, even despite his noble sacrifice of being a first responder on the dermatological frontlines with ancient folk like me. “I’m circling a red spot on your lower back because I don’t think I’ve seen that before.”

“And if you could look at this spot….” I say, pointing beneath my jawline.

“Already I’m the black sheep in my family. Everybody thinks that I’m a fool. But you know what? I’m the one with a medical degree. Do any of them have medical degrees? The answer is no. They don’t.”

I’ve heard this particular diatribe before, usually in my autumn visits right before Thanksgiving. His brother-in-law makes fun of him. His wife’s family treats him like he’s a joke. Even though I usually approach these appointments telling myself, Oh, he might not be so bad this time, I had reached the inevitable stage of the consultation in which I remembered exactly why I should be switching doctors, if only switching didn’t sound like so much wooooork, and if I weren’t such a lazy bastard. It’s only when he finally lets me put my arms down and he turns to his laptop to make some notes that I managed to say, “Last week I had a big red mark, here, on my neck. It was probably from using my clippers on the skin, but if you could look….”

“My synagogue,” he continued, seeming to ignore me. “My wife is on the board of my synagogue. Very important position. Very important position. But have any of the other board members ever invited us for dinner? Not now, of course. Are the rest of them inviting each other to dinner? I just bet they are. I bet they have dinner together all the time. But do my wife and I get invited to dinner? No. Even though she’s on the board.” I pressed my lips together, hoping the rant might climax more quickly that way. “They have an excuse not to invite us, now. But before. Did anyone invite us before? They did not,” he said, as if I were in danger of getting a word in edgewise and actually speculating an answer to the question. “I tell my wife that nobody is friends with us at synagogue, and that it’s making me crazy, crazy paranoid, and do you know how she replies? She says, ‘Well, I have friends.’ Yeah. Like that. ‘I have friends.’” I opened my mouth to speak again, but he turned around bearing an antiseptic wipe in one hand and a needle in the other. “That thing on your neck is just a pimple, probably an ingrown follicle, just keep it clean and it’ll clear up. But I am going to shave off this red spot on your lower back.”

It was a painless process of a small pinch, a light numbness, then a standard band-aid. All the while he continued talking.

“Do you think any of this is going to change once this COVID nonsense is over? It’s not going to change. It’s just makes me paranoid, I tell you. It just makes me paranoid.”

I hadn’t really said much of anything by the time our fifteen minutes were over—and yet I was exhausted. “Are you taking copays?” I asked, once I was dressed and itching to go. “Or will someone call me later?”

“I have to disinfect the entire exam room after you leave. By myself,” he emphasized, using the same tone my mom used when I was a kid and she would complain about having to clean all the bathrooms. I wondered if he expected me to grab a bottle of Scrubbing Bubbles and pitch in and help. “So no. I think you might even have a credit, but my billing guy will call you if he needs to. In the meantime, keep safe, and make sure you keep your next appointment.” Sotto voce, he added, “Unlike the rest of these ingrates.”

As I escaped down the stairs and out into the parking lot, I reflected to myself that if a crisis really does show who people are, this particular crucible had melted my dermatologist down to his bitterest essence.





This essay has been written as part of the Mass Observation: COVID-19 writing project. If you'd like to join our volunteer writers, visit our Call for Volunteers at https://bit.ly/3aes2AQ .