Ever Get a Punch Biopsy?
So we’re all sitting around in the examining room at Johns Hopkins feeling a little bored. It was the same old routine – gouge my forearm with a needle, draw out several vials of blood, run it through the labs, get a physical examination and then head on up to the Infusion Center for the IV drip of MDX-1106. Blah blah blah. Sure, we’d had the melanoma scare and got to slice off parts of my neck and ribcage. We’d had the liver enzyme scare. That was fun and all, but that was then. What about now?
“This clinical trial sucks,” said one of the nurses.
“BORing,” said another.
We sat around tossing hypodermic needles at the back of the door until it occurred to me: “Hey,” I said, “that rash on my shins has gotten a little weird.” This perked up the room and everybody gathered around as I pulled up my jeans over my calves. The nurses peered at the rash where it had become more inflamed and welted, some appearing to kind of scab up.
“Awesome,” whistled the first nurse. “That’s just hideous,”
“Oh, we gotta cut into that,” said the second.
And we were on, baby – finally, something new and interesting to do. I was put into a gown and the nurses scrambled to find some good cutting tools.
At least, that’s how I think it went down. I can’t remember for sure because I think everyone here knows that I pass out or cry like a baby around needles and knives. So it’s all a little bit of a blur. What I can recall with certainty is that Alice and Michelle, two of my nurses, were concerned enough about the rash that they wanted to get a biopsy. So we did. Right then and there. Think of it as a medical impulse buy. Alice called in another doctor who performed a “punch biopsy.” During the previous biopsies to check a couple of moles for melanoma, the doctor came in with a scalpel and shaved off the moles, kind of like slicing a bite out of a cantaloupe. A punch biopsy, however, is performed with a funky little razor that looks like pen with a wide grip. The wide grip allows for twisting action, and that narrows into a cylindrical neck that ends with a round, hollowed piece of metal that turns out to be a razor.
The doctor stuck me with a needle to inject some topical anesthesia, which felt like a little hornet had stung me. The initial prick wasn’t pleasant, but the burning of the anesthesia is what you really feel. After a moment, the doctor took her James Bondy razor pen, “punched” it into my calf and began twisting it clockwise. This allowed her to extract a small chunk of flesh, which she popped into a small vial of fluid. She let me look at it (because I am like a little kid and always want to see this stuff, provided it doesn’t make me puke or faint). The flesh was whitish and red and looked like a toy replica of shark chum. I wanted to hook it to the end of some fishing line and toss it off the dock.
It’s unclear what they’ll do with my chunk of flesh. They’ll send it to a pathologist who will examine it, but I’m not sure what we’re looking for. I think this is more for scientific/medical curiosity than any concern that it may be threatening.
I think I’m going to get me one of those razors, though. Drop by my office and I’ll perform a punch biopsy on you. It’s kind of cool.