Lipoma

1.

Vin stood in front of the bathroom mirror studying the lump protruding from his left shoulder. Pinching it between his thumb and index finger, he manipulated the rise with force.  He felt no pain but was agitated nonetheless. From the downstairs bathroom Vin called out to his wife, Veronica, who was cleaning up in the kitchen. 

“It’s bigger than before, Ronnie,” he said, nodding at his reflection in the mirror, “No question about it.”

The faucet running in the kitchen stopped.

“The lump on my shoulder, Ronnie,” he called out louder, “it’s gotten bigger.”

Vin heard silverware being loaded into the dishwater before Ronnie responded, “I can’t make out a word you’re saying, Vin!”

“My lump!”  he shouted.  To himself, he added, “What else?”

“What, that again?!” It was Ronnie’s turn to be exasperated. “If it bothers you so much, see the doctor! I don’t know what else to tell you.”

2.

Ten days later, Vin met with his primary care physician, Dr. Kim. Vin usually saw Dr. Kim once a year for his annual physical. Dr. Kim directed him to remove his shirt.  Now in his late fifties, Vin’s compact body had gone slack and his chest hair was flecked with gray. Dr. Kim gazed at the lump for a moment before reaching over to squeeze it gently. 

“Any tenderness?” 

“Nope.” 

Dr. Kim’s face showed no sign of concern; Vin relaxed.

“It’s a lipoma, Mr. Cronin.”  The word meant nothing to Vin. 

“Lipoma: from the Greek words for fat – lipos - and tumor - oma – meaning fat tumor. They’re usually benign.”

“Benign is good,” Vin responded, “but will it keep growing like a mushroom? It’s already noticeable under my shirt.”

“Maybe…”

“Cause I’m starting to feel a bit self-conscious.” 

“If that’s the case, I can refer you to a surgeon to have it removed. It’s a simple procedure, but not something I do. My advice is to first check with your insurance, Mr. Cronin. You may have pay for some or all of the cost out of pocket because they normally classify it as cosmetic surgery.” 

“Huh.” 

“Think about it,” Dr. Kim said, ready to move on, “I’ll see you again for your annual physical in about five months.”   

“Alright, Doc.  Thank you.”

  That night at the dinner table, Vin filled in Ronnie on his visit with Dr. Kim.

“He says I’ve got a fat tumor, Ronnie.”

  “What, your head?”

3.

Dr. Vincini, the surgeon referred by Dr. Kim, practiced over the border in Rhode Island. Vin’s GPS brought him to an office located in a low rise, 80s’ era strip mall that also housed an insurance agency and an attorney who specialized in DUIs. Behind the reception desk sat a pear-shaped lady with her polished auburn hair piled high. The nameplate on the counter read: Estelle Bromkowski, Office Manager. A cream-colored bichon frise was curled up on the carpet next to Estelle’s chair.    

“Vin Cronin, here to see Dr. Vincini.”

Estelle took Vin’s insurance card and puzzled over it for a moment.

“I’m not familiar with this insurance plan.”

“I live in Massachusetts; it’s popular there.”

“Do you know which co-pay amount applies – the lower one for an office visit, or the higher one for seeing a specialist?

“Probably the latter.”

“Tell you what I’m going to do,” Estelle said decisively, “I’ll bill it as an office visit and we’ll see what comes back.” She smiled benevolently. “Doesn’t hurt to try, right?”

“I appreciate it.”

“Follow me,” Estelle said, stepping carefully around the dog. She led Vin to an examination room at the far end of a dimly lit hall. The door was open and Estelle directed him with her hand to enter.

“Dr. Vincini will be with you shortly.”

The door closed behind Vin and he mounted an examination table covered in a thin sheet of paper. The beige walls were bare except for a color poster illustrating the human circulatory and skeletal systems. After a few minutes, two male voices began conversing, muffled because they emanated from another room, probably two doors down. One voice was louder and more authoritative than the other. Vin deduced that was the doctor speaking, but he still couldn’t make out what they were saying. Then the louder voice said distinctly, “Nothing to be sheepish about.  I can write you a prescription, if that’s what you’re asking.” There was a subdued murmur and Dr. Vincini responded, “Ok, that’s what I’ll do.” 

The office lapsed into silence again while Vin’s right hand absentmindedly kneaded the lipoma beneath his shirt. Abruptly, a brisk rap at the door announced Dr. Vincini’s entry. Hunched forward in his starched white coat, Dr. Vincini already had one arm extended for a handshake.  Vin took his hand, struck by how old Dr. Vincini looked.

“Ok, let’s take a gander, Mr. Cronin.”  Bushy eyebrows danced behind Dr. Vincini’s glasses.

“My primary care doctor called it a lipoma,” Vin said after he had his shirt off. 

“Correct.”  Vin stiffened as Dr. Vincini’s blunt fingers probed the lipoma.

“I’ve lived with it for almost a decade, Doc.”  Vin was eager to tell his story.   “It all started when me and my brother Steve were cleaning out our mother’s house after her death.”  He paused, momentarily distracted by his reference to that event. “Anyways, Steve and I were loading an oak bureau into the U-Haul – even without the drawers in, it was still as heavy as a safe…”

Dr. Vincini had finished his examination and nodded at Vin to show he was listening.

Vin continued, “So, as I walked backwards on the ramp into the van, I was holding one end of the bureau in both hands at ear level – like this,” Vin demonstrated, “and I lost my footing for, like, a milli-second, and the bureau landed square on my left shoulder.  You should have heard me bellow.”

“Ouch,” Dr. Vincini offered in sympathy.

“A few days later, I noticed a small nub rising from the exact spot on my shoulder where I took the blow,” Vin paused, “and from there, it grew very, very slowly into the size lump you see here.”  Vin’s raised right index finger pointed down at the lipoma.

Dr. Vincini suspected where Vin was going with this but let him finish.

“Which jibed with what I read online, Doc - that the body can react to a blow or some other trauma by generating a protective cushion, so to speak.” 

Dr. Vincini shook his head.  “No, that’s an old wives’ tale, Mr. Cronin.  No one’s sure why these lipomas develop.”

“But common sense tells you…” Vin started.

“Trust me,” Dr. Vincini cut him off, “there’s no persuasive evidence for that.”

There was a beat of silence between them.

  “Well, you’re the doctor,” Vin responded begrudgingly.

“Anyways, we’re here because you’ve decided to have the lipoma removed,” Dr. Vincini reminded him. “I used to do the surgery here in the office until one of my patients fainted on me. Now we use the hospital. You’ll be in and out of there in a couple of hours.”

4.

In the early morning darkness, the hospital’s silhouette resembled a nineteenth century asylum. Vin had never been there before, and because the signage was either nonexistent or obscured in shadows, he couldn’t find the entrance for the day surgery patients. After driving around the building a couple of times, Vin flagged down a guy emerging from his car who pointed him in the right direction. Once inside, a nurse directed Vin to change into a gown and situate himself on an empty hospital bed on wheels. Left alone to wait, Vin rebuked himself for his vanity; as Dr. Kim predicted, the surgery wasn’t covered by insurance. Vin was resting his eyes when, without a word, an orderly took hold of the hospital bed from behind and wheeled Vin through double doors and down a shiny corridor. Under the brightly lit entrance to the operating room at the end of the corridor Dr. Vincini and a young woman in scrubs waited for him. Vin thought: she looks no older than Kelly, his daughter in her junior year at UMass Amherst.

“Good morning, Mr. Cronin!” Dr. Vincini sounded almost giddy. “Ready to rumble?!” 

Vin blinked up at him, “Unlike you, I haven’t had my morning caffeine yet…”

“Ha!” barked a delighted Dr. Vincini. 

5.

Vin was lying on his side with the hospital gown pulled away from his left shoulder.  Dr. Vincini dabbed ointment on and around Vin’s exposed lipoma.

  “I’m numbing the area before I inject you with a local anesthesia,” Dr. Vincini explained, “You’re not squeamish about needles, are you, Mr. Cronin?”

“Nah.”

“Didn’t think so.”  Dr. Vincini took the needle from the nurse.  “Thank you, Maria.” 

“You’ll feel a pinch for a second,” Dr. Vincini said.  Vin exhaled as the needle penetrated his skin.  Dr. Vincini handed the needle to Maria who returned wheeling a small tabletop with surgical instruments that she parked at the end of Vin’s hospital bed.  Dr. Vincini studied the contents of the tray while Maria resumed a conversation the two of them were having before Vin arrived. 

“Yeah, so I’m flying down to Turks and Caicos with my boyfriend next Tuesday.  Our first time trying this island.”

“Never been to the Caribbean myself,” Dr. Vincini said. There was a tingling sound as he handled the steel instruments. “My wife and I did a cruise in Alaska three years ago.  Normally, neither of us go in for cruises, but it was better than we expected.  Saw some killer whales and a bald eagle.”

“Very cool.”

“Also packed on about ten pounds from feeding on the all-day buffet.”

“I know, right? We’re staying at an all-inclusive resort like we always do…but this one has a water park.”

“No kidding.”

It was like Vin wasn’t even in the room.   

“Which is why we avoid the school vacation week; otherwise, it would be swarming with kids.”

“Well, enjoy it while you’re young, Maria.”  Dr. Vincini cleared his throat.

“Your shoulder feeling pretty numbed up, Mr. Cronin?”

Vin realized he was being addressed with a question. After a split-second confirmation that his shoulder was indeed numb, he answered, “Yup,” and then made eye contact with Maria, “You ever been to Bermuda?”

“Not yet.”

“Bermuda’s nice.”

  “Someday.”

“We digress, people.” Dr. Vincini interjected, positioning himself close to Vin.  “Mr. Cronin, I’m going to remove your lipoma with a scalpel now.  You won’t feel a thing.”

With effort, Vin submitted himself to the loss of control. The sensation of the scalpel carving into his frozen skin invaded his suspended thoughts. Neither Dr. Vincini nor Maria spoke while the scalpel painlessly curved and dug under the lipoma. At first, Vin subdued his mind into a blank state, blanketing his consciousness with a gray-wash static.   But then the static thinned out and, weirdly, he found himself thinking about his dead mother. Up until the last half year of her life, she still lived “independently” in the family house, but that was a fiction. Vin and Steve divided up responsibilities for her, but in truth, Steve took on the lion’s share. Vin could admit that to himself now. His mind latched on to a particular memory from the August before her death. Steve and his family were down the Cape for the week so it was on Vin to keep tabs on their mother. Enjoy the respite, he told his brother. But it got extra busy at work and Vin didn’t call his mother for four straight days. He still told himself that work, not neglect, was to blame but admitted that he had no memory of what was so pressing that week. Vin had advised his mother to always keep her cell phone within reach, so when she wasn’t picking up on his drive home from work that Friday, his body flooded with stress. He pounded his fist on the steering wheel as the pickup detoured to her house, a battered split level shrouded in darkness. Once inside, Vin stood in the foyer and called out, “Ma!  It’s Vin!” before bounding upstairs.

Vin’s mind paused for a beat to register the weightless extraction of the lipoma from his shoulder.

He found his mother in her bedroom at the end of the hallway.  Opening the door, Vin heard the noisy air conditioner unit in the window rattling in the dark.  In the same moment, the smell of a soiled diaper assaulted him.  Vin flipped on the light: a white nimbus of flyaway hair fluttered in the cool-charged air as his mother teetered on the edge of the unmade bed, gazing placidly at the stranger in front of her.

Body and mind together cascaded downhill from there and within days she was ensconced in a nursing home waiting to die.   Even now, Vin’s chest tightened when recalling his fudged explanation to Steve of what transpired that week.

Vin felt his skin tug as Dr. Vincini began stitching together the crevice where his lipoma used to be. 

“No need to come back to have the stitches removed,” Dr. Vincini said as the sewing continued, “they’ll dissolve on their own.”

6.

There was one final tug.  “And we are all set, Mr. Cronin,” Dr. Vincini said from behind Vin.

“Appreciate it, Doc.”  Still lying on his side, Vin closed his eyes, depleted. 

Dr. Vincini and Maria conferred briefly; then Doctor Vincini came around front and asked Vin:

“Would you like to see the lipoma?” 

Vin’s eyes opened, but before he could answer, Dr. Vincini’s gloved hand slid in front of his face: a flesh colored dumpling washed in crimson rested in the doctor’s palm. 

Repelled, Vin muttered, “Smaller than I thought.”

“I’ve seen bigger.”  Dr. Vincini turned toward Maria who had joined him with what looked like a baggie in her hand.  “We’ll send the specimen out to be biopsied, but they’re almost always benign.  Not to worry.”

Vin watched Maria hold the specimen bag open as Dr. Vincini tipped his hand to let the lipoma drop, but it bounced off one edge of the open bag and plopped on the tile floor, leaving a halo of blood where it landed.

A stop-action hush descended on the three of them.  In the opening, Vin glimpsed the arc of diminishment that awaited him and sought refuge in the fleeting silence – even one breath would suffice - before time resumed its relentless unwinding.

Richard Lehan is a writer living in Massachusetts.  In addition to being a published essayist, a short story of his appeared in New Student while he was a graduate student at University College Dublin.

Photo credit: Krin Van Tatenhove via Midjourney AI