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A Battlefield Decision

The black spot on my arm looked different. I tried to ignore it but it was impossible. I rubbed it, it was elevated, and the color was not uniform: danger signs. Projections spiraled from the body of the lesion. It bled. It would have to be removed.

I looked in the directory for a dermatologist without hospital privileges. A doctor without a hospital affiliation is a red flag. It usually means a problem physician. Most of them have been kicked off for professional, political, substance abuse, or sexual abuse reasons. Sometimes they’re too ethical and can’t compromise. My case required anonymity. If the patients thought I had a malignant melanoma they would find a doctor with a future.

I found Dr. Stamp, board certified in Dermatology—hospital affiliation: none. This was my guy.

I called his office. He could see me that afternoon. Another bad sign. If he could work me in the same day I called, he was probably not successful. Still, I needed to get the damn thing off. Anybody can lop off a black mole.

I drove to Dr. Stamp’s office. The address was in a lower middle working class area, and since no one was working now, it was even lower.

I parked and locked the car. I hoped it would be there when I got back. The building was a converted brick bungalow home. I opened the door. The waiting room was the former living room and standing room only, with overflow into what was once the dining room.

The house smelled of rubbing alcohol. Young kids with acne or psoriasis lined the waiting room. Dermatology is easy, but you have to be able to stomach rashes.  I waited and rubbed the mole. I looked at it again. Perhaps it wasn’t so bad. I told myself there really was no change. I was getting neurotic. Too much stuff going down in the hospital.  My time was valuable too. I’m out of here, I thought—  the nurse came out.

She was petite, African-American, with large soothing brown eyes, bangs, and magenta lipstick framing a beautiful smile.

“Dr. Larco?” she called out.

I got up and put down a one year old Time. My stomach tensed.  I walked slowly.

The nurse said, “You look like you’re going to the electric chair.”

“I’m a doctor,” I said. “I know too much.”

Then I smelled something burning. Somebody was getting something removed.

The nurse saw me recoil.

“What’s worse,” she said. “We smell too much, now let’s see the little devil”


“The mole,” she said. “You white guys should wear sunscreen.”

“I play too much golf,” I said. “That stuff gets on your grips, the club flies out of your hands.”

“Sit in the doctor’s office, he’ll be in shortly,” she said. “And honey, you got to relax. It’s usually nothing. Give it to Jesus.”

“I’m half Jewish and half Catholic.”

“Then give half to Moses,” she laughed.

I sat in the chair and looked around. On his desk was a mound of cigarette butts, the ashtray a human skullcap turned upside down. Evidently, Dr. Stamp kept a piece of his medical school cadaver, an old tradition. I recalled med school: four students to a cadaver, the one who achieved the highest grade kept the skullcap.

I studied his diplomas. Harvard Med School, Parkland for obstetrics and gynecology, and general surgery in Boston.

I examined his credentials further. He trained in OB under Samuels, surgery under Malt at the General. He was chief resident both times. What was he doing practicing derm? Had to be the money.

Stamp walked in. He wore a long white coat, starched cotton. He was tall and chain smoker thin. His gray hair was buzzed in a military flat top. The cigarette smell grew stronger. He coughed and cleared his throat. “Dr. Larco, what’s the problem?”

“Well I have this mole on my arm,” I said. “It’s changed.”

“Hmm….” he said. “Roll up your sleeve. You’re getting too much sun. It causes cancer.”

What about the Pall Mall unfiltereds, I thought.

“You should wear sunscreen.” He pointed to the mole. “You’re worried about this thing? What else is going on in your life that’s making you neurotic?”


“It doesn’t look too bad. I’ll just lop it off and send it to the pathologist.”

“Where do you send the specimen?”


“Well, I can’t let my patients find out I have cancer,” I said. “They’ll leave.”

“Things haven’t changed that much in forty years” he said.

“What do you mean?”

“We used to joke that when the doctor dies the first thing the patients ask is ‘Who’s taking his calls.’ ”

I pointed to his diplomas. “You trained at some famous places,” I said. “But why did you train in ob-gyn and surgery?”

“I was weird. I loved my training. Up all night, operate the next day, every other night on call. No idle time. There was always something to do. I finished my obstetrics and gynecology training and realized I needed to learn more. In OB I was responsible for two lives. That’s why I went back and trained in general surgery.”

“Why would an OB man need to be a general surgeon?” I asked.

“Like I said, I was responsible for two lives. If I had credentials in surgery, I could do more.”

He lit another Pall Mall with his previous one. He chained. I hadn’t seen that in years. He also French inhaled blowing smoke out and inhaling it back into his nostrils.  I hadn’t seen that in a while either. His hands were tobacco stained but delicate and manicured. They belonged in an operating room.

“I had this woman’s life and her baby’s life in my hands,” he said. “I was there to save her and return her to her husband and children. The responsibility gave me the edge, the adrenaline rush, the meaning.”

“Still, a monkey can take out ovaries,” I said.

“That’s why I got board certified in general surgery,” he said. “One time I was doing a hysterectomy and I felt around in the abdomen, which was my custom, just to make sure nothing else was going on. This lady was about forty and I felt a mass in her pancreas. It felt like cancer. I did a biopsy, and it came back cancer. I didn’t wake her up, I removed the pancreas, did a full classic Whipple’s right then and there.”

I could not talk for a few seconds. My brain was making connections. Could this be the guy? He was famous years ago but dropped out of sight.

“Are you the guy?” I asked.

“What guy?”

“The gynecologist who did the Whipple’s procedure without informing the patient?”

“I did it more than once,” he said.

“You’re a legend. That took balls. You’ve made the textbooks on ethics. You were one of the best surgeons in the country.”

“It didn’t take balls. It took brains, and skill. The only way you cure pancreatic cancer is if you accidentally find it and cut it out. Same with ovarian cancer. I took out scores of ovaries.”

“Yeah, but what about informed consent?”

“She had no choice,” he said. “I trained in surgery, I know the risks. It’s unethical to give them a chance to make a decision. The patients don’t know their ass from their elbow. You can’t empower them to make the wrong decision. It was also a different time in surgery.  Not like the dog and pony show going on now.”

“You do that now,” I said, “you’d get your ass sued and kicked out of the hospital.”

“Hospitals,” he laughed. “Such lovely shark tanks.”

“But why did you give it all up?”

“Well,” he said. “When you’re in the water with sharks don’t bleed. I started to bleed.”

“What happened?”

“Got into a jam. I needed a practice that was office based. No more hospitals.”

He lit another Pall Mall, crushed it out against the skull.

“What happened?”

“Let’s get that mole off.”

He snapped on latex gloves.

“Put your arm out.”

He took a bottle of lidocaine from the shelf, filled a syringe, and shaved the area. His hands were steady and special. He injected the skin with anesthetic, it burned, then nothing. The mole rose and looked bigger and more sinister.

He took the scalpel and made long incisions.

“We need wide margins. Make sure we get it all,” he said.

“Think it’s malignant?”

“I’m not saying anything. And Larco, stop worrying, we’re not getting out of this world alive.”

“Yeah, but when you’re dead, you’re dead for a long time. Okay, so what happened— why are you doing dermatology?”

“It was in the mid-sixties.  I went into practice with a man who was a few years older. He had a good practice, but there were a lot of procedures he didn’t know how to do. His best attribute was that he was smooth. I made him legit because he was an average obstetrician and a lousy surgeon.”

“I know the type,” I said.

“And, after a few months in practice with him I ran into a string of bad luck. I had to attend to three teenagers who got gas gangrene from illegal abortions.”

He shook his head.

“Do you know that, in the sixties, the United States had the highest mortality for illegal abortions,” Stamp said. “There were more than a million illegal abortions done yearly. You ever see a girl die of gangrene?”

“That’s because you trained after Roe.”

“I’ve seen pictures,” I said.

“The gas bubbles out of their body. It splits their muscles, destroys their nerves.

You can’t give them enough morphine. They were so young and they had so much life left and they were begging me to let them die. I couldn’t take it.”

He teared up, then cut off the mole and dropped it into a specimen bottle. The black flesh sunk. My arm was bleeding but he didn’t notice. He lit up again.

“Anyway, I was approached by a female detective who told me that if she could find girls scheduled to have illegal abortions would I do them?  I thought it could be a trap, but the woman seemed sincere, so I agreed.”

“You trusted her?”

“It turns out the woman was legit. We took care of several girls.”

“You did a good thing,” I said.

Stamp shook his head, shrugged his shoulders. “I don’t know if I did a good thing. It’s been decades, but I still think about it. I wouldn’t do them now. Mine was an agonizing, painful decision. Now they’re done for convenience rather than conviction. Anybody who tells you you’re not taking a life is wrong. You sure as hell are.”

“So why did you do them if you thought you were taking a life?”

“Gave up one life to save another, rather than lose two. It was a battlefield decision.”

“This all still doesn’t explain why someone with your talent is doing dermatology,” I said.

“My abortion practice grew. I didn’t charge the patients any professional fee. I couldn’t. Eventually my partner found out. He confronted me and I explained that I did the abortions on women who were scheduled to have it done by an illegal abortionist. I didn’t tell him about the detective. I told him I was doing so many that I couldn’t keep up. To my surprise he was sympathetic and volunteered to help. He went on to say that since he was rising up in the medical administration of the hospital he could get the pathologist to read the specimens as free from products of conception. Nobody could find out that the procedures were abortions.”

“You trusted him also?” I asked.


“So what happened next?” I asked.

“The detective comes to me and is mad as hell. She said she learned that we were running an abortion mill and doing the procedures for money and for anybody who wanted one.”

He crushed out the cigarette, picked up the ashtray, and emptied the butts into the wastebasket, then set the ashtray back on the desk.

“I assured her I only did the procedures on her referrals. ‘Then who is running the scrape clinic,’” she asked. “I told him it was my partner. She told me I had to get him to stop.”

“I approached my partner, and he turned everything around on me.  He said ‘the hospital pathologist said eighty percent of my work was showing retained products of conception.’ He had the records. He was clean. If I did not leave town immediately, he would go to the prosecutor. And by the way I was to sign my share of the practice over to him.”
“So he was doing illegal abortions on demand.”

“Not on demand. The patients had to have money and had to be prominent in the community. He faked the records and made it look like I was the only one doing them. And remember, abortion was first-degree murder, electric chair stuff back then. I had a wife and two children.  I left in the middle of the night.”

“That guy was a sociopath,” I said.

“Yeah, but he said the right things to the right people. He did anything the board of directors wanted.  Also, it turns out that illegal, but safe abortions were a major source of revenue. The hospital was new and most people went downtown to the older established hospitals for care. The abortion business tied the hospital over.” 

He put the specimen bottle in a Styrofoam container.

“But now all your skills have been wasted,” I said.

“I promised myself to never work in a hospital again,” he said.
“I’ve probably lost all those skills by now.”

“Maybe not,” I said.

He lit another cigarette.

“About your lesion. I’ll get back to you. It may take a little while because I like to read the slides myself and I send them to The General for confirmation. It’ll be worth the wait.”

I left the office. It was dark.

I had to wait for ten days. During that time I was obsessed with that black tissue sinking to the bottom of the specimen container. I could not concentrate on my work, became short with patients, and colleagues. My fate rested in the secrets contained in those cells. It made me think. I was only forty-five and for a doctor that trains for twelve years to become a physician, I was hitting my prime. I was always pushing to the next professional goal. My career dominated my life and I waited for the time that I could stop striving. I was there. I knew what I was doing. The practice was running smoothly. I could spend more time with my wife, the children. I made a mental list of what I would do if only that lesion was benign. I wanted to attend a parent teacher conference, my kid’s soccer games, a ballet recital.  I would reconnect with family and friends that I had ignored. There were people who needed to know I loved them—and now it could be too late. I assumed there would always be time, but this clump of cells could take it away. I had a weird notion that because of my obsession, I deserved and needed cancer. Something to wake me up. That mass of cells, about the same size as the tissue removed in an abortion, had become so important. Where those cells wildly dividing cancer cells or cells still constrained by microscopic rules of order? The same rules that allow cells to divide and in nine months create a human being.

Then, a letter:

Darfur, May 2006

            Dear Dr. Larco,

            Once again I had to leave in the middle of the night. I’m working with physicians without borders (sans frontiers) and am in Darfur. I can’t believe it.

Yesterday I did a hysterectomy on a woman and felt up into her abdomen and found a mass. I removed her pancreas, did the Whipple’s procedure and didn’t wake her up from anesthesia. It was cancer. She thanked me. It was like old times. If you have the gift, and in all modesty, I have the gift, you never forget how to operate. It’s like riding a bike, or making love.

            I told you my story because I knew I was leaving. Tell if you want. It doesn’t matter, especially to a man who has smoked as long and as heavily as I. I was thinking of quitting now that I’m here but it would not make much sense. Besides, there is not much to do except operate, read, listen to music, and smoke. I’m told that thirty thousand women die yearly here from botched abortions.

Come join me someday when you’ve had enough.

Do no harm


Dr. Stamp

p.s. Your lesion was benign. Take out your stitches.

“A Battlefield Decision” was nominated for the Pushcart Literary Prize.

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