I had an appointment on Monday afternoon with the dermatologist in Cartago for MOHS surgery to remove the basal cell carcinoma.  We stopped for lunch outside of Cartago where we had a three course meal but only ordered an entree!  First we enjoyed delicious seafood soup.  Bill then had the best casado ever while I had what was called a chicken crepe but was really a spinach wrap with a creamy sauce.  Dessert then appeared which was a dense mini cupcake, also tasty.

Then we drove right to the hotel, checked in, and waited until it was time to see the doctor.  We’re navigated our way there easily, but when we got there the news was not good.  Dr. G, who had gone to NYC  three weeks ago, was still there due an emergency with his son.  One of the other people who works in his office said she tried to call me over the weekend to let me know my appointment would have to be the next week, but even that was not a guarantee.  Very upset that the cancer would not be decimated immediately and the stitch was still in my head, I cried while debating with Bill what to do.  Another doctor might be able to see me in a couple of hours, but all he could do at that point would to consult with me.  Why hadn’t she emailed me???  Finally, after going back and forth, she in broken English, and I in equally weak Spanish, she decided to go talk with Dr. Bravo about seeing me later.

Not long after she came back with the doctor! He went over my file with me and looked at my head.  He said it was not an emergency, and that he could do it in a week.  He did admit the cancer could go through my skull and into my brain, but that could take years as it grows slowly, about a half a millimeter a month.  An additional factor was that we were going Panama next Monday for three days so we could renew our visas here, a necessity to keep driving.  Whenever Dr. Bravo was going to do the surgery, I would need to stick around for a week for a few follow-up wound reviews.  This was all complicated.  Finally, this very understanding man, said he had a cancellation for the next night at six o’clock, and he could do the surgery then.  Yes!

After checking the elasticity of my scalp he showed me the kind of incision he would have to make in order to create flaps to close the wound.  It looked like the symbol for a hurricane, appropriate given my emotional state.  There was a good chance he would have to do a graft instead.  The problem is that I would then have a large permanent bald spot.  Very scary.  He had the receptionist check the availability of a pathologist and the rest of the team and got a green light.

Since we had not left the cats enough food and the one neighbor with keys to our gate and house was also in San Jose we went back to the hotel, checked out, and drove the three and a half hours to get home….in the dark, on a twisty mountain road, in the fog, with a lack of reflectors to indicate the sharpness of turns and lanes.  At one point we almost flipped because the lane marker suddenly narrowed and there weren’t enough reflectors for Bill to see the situation. We made it back home about time to go to bed.

The kind Dr. Bravo offered us the name of a hotel near his other clinic closer to San Jose where he would be doing my surgery.  He even had the chief of operations email me the link to that hotel and another one!  We chose the closer one, about 50 meters away, and ended up with a suite for twenty dollars less if we paid in cash.

Tuesday we drove back up the mountain to his other office about forty minutes further on.  After settling in at the hotel, finding the clinic, and eating midafternoon, we walked the half block to face the knife.   Dr. Bravo came out to the waiting room to greet me and had me go with one of his team to cut my hair from where he would be doing the surgery.  Through a few tears while she clipped and then he clipped some more I tried to have a sense of humor and said I would be twins with my husband.  I heard a bit a low talk in Spanish during this and wondered what was going on.  When he took me back to the surgery room he clipped a bit more, took pictures, and then said he wanted to show me what he had found….another suspected cancer.  Oh, boy….more tears.  He explained he would have to take a biopsy of that, too.  The pathologist came in  to meet me and said in English he needed a piece of my head, but I thought he said he wanted a picture since many were being taken.  I didn’t know until two days later that asking for a piece of my head embarrassed Dr. Bravo.

It takes thirty minutes to get a diagnosis of a biopsy as he has to cut the piece and then the pathologist has to watch the stain travel to see if there are clean margins and to determine if the second smaller one was also cancerous, which it was.  The concern then was that if the removed second one did not have clean margins, it could mean the two rumors were really one as they were so close together….which would mean he couldn’t make his flaps but would have to do a skin graft.  Feeling devastated….and more hair was clipped away…..tears fell along with the hair….

First the results came back that the bigger one had clean margins.  While waiting for the results of the smaller one Dr. Bravo planned how he would do the flaps if he could.  I felt encouraged he was going to try to please me.  Finally we got the second results…..negativo!!!!  All margins were clear, and flaps were attempted.  I felt some cutting and a lot of pressure as he took those flaps and torqued them to close the 2 cm hole.  Pictures were being taken all through this, and when Bill saw the before and after, he was amazed.  Stitches and cauterization of blood vessels were next and finally came the bandage.  I had a very thick pad held in place by gauze wrapped around my head going under my chin.  It was very tight and uncomfortable, but I had no more cancer and at least some of my hair.  I call it fringe as there is shaven hair in the middle.  I thought of the three stooges for some reason.

By then it was nine o’clock at night.  I was given an antibiotic and painkiller and sent back to the hotel to sleep with pillows on either side of me to minimize any movement.  As I got into bed I thought of Debbie Graves who had to sleep like that for several nights after eye surgery.

Sleeping on my back wasn’t comfortable so I ended up propping myself up using three pillows.  I think it created different pressure points.  I woke up at two and had some pain but wasn’t due for another pill until four-thirty.  I woke up a bit later with more pain but was able to get back to sleep until 4:45 when I took another painkiller.  It is not one that is used in the states and doesn’t seem to be very strong.

Wednesday I went back to the office for a bandage change which was done by the resident who had watched a lot the night before.  Dr. Bravo kept popping in to see his work and check the resident as he had another appointment in his office.  She had to clean the wound with sterile water which really stung and continued to do for several hours.  Although the gauze she used to keep the bandage in place was much looser it tightened up somehow as the day went on.

Needing a change of pace we walked around the neighborhood.  It is a mix of older architecture amongst the modern.  There was even a cobbler with a bazillion shoelaces….should you need one or two…

For a late lunch Tues. and lunch again on Wed. I enjoyed Aztec Soup.  The first time it was served all in one bowl – tomato soup with avocado, cheese, tortilla chips, and sour cream.  Wednesday we rested at Hotel Dunn Inn and their version had the tomato broth in a small bowl and a large bowl with all the other ingredients.  I just poured the tomato soup over the rest.  It wasn’t as flavorful as the day before but still good.

Before heading home yesterday Dr. Bravo had to check the wound and redress it.  As Bill was going to have to do that this morning he was given a demonstration.  After he wrapped the gauze around my head again he gave a few quick tweaks to my hair trying to fix it without a clue as to how.  He said, “Beautiful”.   We all chuckled and I replied, “Right…”  After finally washing my fringe this morning, ably done by my husband who has been very supportive in all this, he set to work and did pretty well.

Here’s a photo I took with my iPad Wed. night.



Bill took photos of my scalp this morning and had me look at them.  Hmmm.   More hair is gone than I thought so don’t know  if I will be able to make a ponytail to cover it or not.  Should I add a photo???