Monday, August 07, 2006


Today was great on two accounts:

Saw a patient today who had a forehead defect that I tried to close last week. There wasn't enough mobility of the skin, so we closed the two sides and left a circular defect in the middle to heal by second intention. He looked REALLY good. There was no bruising, the sutured areas looked great, and the central hole was healing nicely. After seeing him, I realized though, that what looks good to physicians may not be considered "looking good" to patients. A simple reason might be that the patient had untouched skin before he came to you, and left with (at the minimum) a linear incision. For us, having been there after the skin cancer was excised and left with a gaping hole to try to put back together, it's almost a miracle that the skin heals so nicely after being messed around with. But the patients never get to see that intermediate stage (ie big gaping hole on forehead) but rather see the end result (still a hole on the forehead) that is "worse" than what was there before... The other reason may be that we see so many incisions/scars that we see the whole range of "nice scar" to "ew... scar," and it's always a treat to see the nice ones. Whereas if you're the patient, your only scar might look ugly to you even if it would be the Miss Universe of scars...

Can you see the fungus??

The second thing awesome thing: I saw a patient's skin lesion today, thought "it must be XXX", knew WHERE to get the supplies to do a KOH preparation, did it, and looked under the microscope for fungus. Is that cool or what? Yeah, yeah, it might be boring to YOU, but compared to a few weeks ago, when the above sequence would have taken five times as long and involved getting answers from 3 people, it's AWESOME. I mean, it's the little things that count, right? Now I just have to work on seeing those darn fungi under the microscope...


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