skin check

One cool thing about living in the desert is that when you have a string of cool, drizzly grey days in the middle of summer, everyone looks around in wonder and says, “isn’t this weather amazing?” I’ve gotten rained on three times in the last week, and still I don’t carry an umbrella with me. Being outside in the rain is pretty beautiful, and anyway this is desert rain: it dries off before too long.

And then there’s rainbows! Every afternoon we’ve had these enormous rainbows that stretch across the whole entire sky, literally from horizon to horizon, in every possible color; sometimes two on top of each other, glimmering brilliantly like mirrors. The first three or four days these rainbows came out, I ran outside, stood in the middle of the street like a little kid, and said “Whoa! No way!” Now I’m afraid of getting spoiled by the onslaught of so much ridiculous beauty. Really, what more can you possibly even imagine when you’re being bombarded by enormous crazily beautiful rainbows every single day?

I’m doing dermatology at the VA and I actually love it. I’m not sure why there’s such a pervasive compulsion in medical culture to complain enthusiastically about the VA, but I feel at home there. The one here is like a carnival. Every morning the lobby is full of volunteers making popcorn, and four-foot-tall old ladies serving people teeny cups of coffee and exactly one vanilla sandwich cookie behind the Information desk, and old-timers in those huge baseball caps with the pins on them that say “Korea War Veteran,” sitting on benches and nodding wisely together; and—yes—a Mexican folk band made up of about 27 people, at least 11 of whom have either crutches or wheelchairs, and they’re all joyously singing songs like “De Colores” and amiably squinching out of the way whenever people need to get by them. Every morning! How can you possibly be in a bad mood when this is what greets you upon entering your workplace every day?

More importantly than the sideshow in the lobby, which I could really sit and watch all day, are the veterans I get to work with, who are so beautiful and sad and dignified. The vast majority of them are men in their seventies and eighties who are coming for routine skin checks. Many of them have had skin cancer before, and we biopsy suspicious lesions on at least half of the ones we see. We examine them, inch by inch, sometimes with magnifying glasses and penlights, from the waist up. It’s a strange, incongruous, overly scientific gesture for the setting, because ultimately there is something so human and humbling about an eighty-year-old man with his shirt off. The belt, the suspenders, the coarse hairs in surprising places, the way age has settled the belly. The pale tender places the sun doesn’t touch. We carry our histories in our skin: the scars the world has bestowed upon us, and also those hidden vulnerable untouched places even the most gnarled and weathered among us still have. I don’t take these careful examinations lightly.

One of the last people I saw on Friday was a guy about my age who came back from Iraq about seven months ago and has had no end of health problems since his return. “Yeah,” he sighed, leaning deep and long back into his chair. “I’ve never been the same since that deployment.” He sustained significant head and leg injuries and has been unable to work steadily since then. Because he hasn’t been able to work, or sustain his former level of physical activity, he’s been sitting around the house a lot and he gained 50 pounds, and now he has hypertension and diabetes even though he was, up until recently, a completely healthy man in his early thirties. In addition, he’s been hospitalized twice for severe skin infections requiring IV antibiotics, and the day I saw him he came to the derm clinic with strange lesions on his legs suggestive of skin manifestations of TB. That’s a lot for a young person to take on.

“How are you doing, just in general?” I asked him.
“I’m depressed!” he said cheerfully. “Ya know? I’m not the person I used to be and it’s frustrating. But what am I gonna do? This is how it is. I could mope around forever or I could just keep going.”
We sat in silence for a while.
“Know what I realized the other day?” he asked.
“What?”
“I’m so thankful to be alive. Even after everything, you know?” He looked down, picked at the cracked vinyl arm of his chair. “That’s something.”