Dermoid


She was sitting in a black leather chair in the corner by the window holding a magazine in one hand. A small, thin woman in jeans and a black sweat shirt with  short blond hair, she watched the room like a television screen. Even in the confusion of a pregnancy-filled waiting room, she looked oddly at ease, content, smiling at the life around her: a parent at a kindergarten. She even seemed pleased to see me, although I’d never met her.

With all the problems I encounter during an average day, it is a pleasure to see someone who is happy, someone for whom the Fates have not cast a crooked die. She followed me almost casually along the long corridor to my consulting office and sat in the little hard wooden seat across from the desk as a queen might: relaxed, at ease, regal.

There was a short note from her GP outlining the reason she had been referred, but I couldn’t read the handwriting -only the name and the age: Martha, 25. “So what can I do for you today, Martha?” I said, hoping she actually knew.

She let her eyes rest on the picture hanging behind me for a moment before they fastened on my enquiring expression. A beatific smile crept slowly across her face and her eyes unlocked briefly as she considered her response. “I have a visitor,” she said finally, barely able to confine her growing enthusiasm.

My eyes narrowed for a split second before I could stop them. “A visitor..?”

“Dermoid,” she replied as factually as if she were informing me she had a sandwich in her purse and no further explanation was necessary -as if the very word would answer all I could possibly want to know.

“How..?” I wasn’t quite sure where to start.

“I had some pelvic discomfort so my GP ordered an ultrasound, and voila: 6 centimeter dermoid, left ovary.”

Succinct, factual, if a bit unconcerned, she seemed comfortable with the condition. Most people confronted with an ovarian tumour would have been worried about cancer. “Well, I’m going to have to get a bit of background but you seem quite knowledgeable about the diagnosis… I take it you’ve looked up dermoids.” She looked so calm.

She sighed and would have rolled her eyes had I not been watching her. “Of course! Wouldn’t you?”

I smiled and nodded my head. It was clear she wanted to tell me about them, so I decided to forgo the history for a moment. “So what do you understand the term to mean?”

“Want the Wikipedia explanation, or one from a university website?”

I shrugged; she probably knew more about them now than I did.

“I’ll put it in my own words then, okay?” Now she was the bright child in class who had an answer to the teacher’s question. “Dermoids are interesting,” she started, her enthusiasm visibly building as she spoke. “A dermoid is a tumour that develops almost entirely from the ectoderm -one of the primary germinative cell layers in the early embryo. Tumours that develop from the germ cells are sometimes termed teratomas.” She studied my face for a moment to see if I was understanding her. Evidently satisfied that I was, she continued. “Ectoderm develops into skin, nerves, and so on…” Pleased that I seemed to be following her, she added “Mesoderm develops into muscle, Endoderm into gut…

“So anyway, a dermoid cyst is derived from ectoderm and contains… oh, like hair, sebum, cartilage, teeth… Teeth! Can you imagine that! And sometimes even thyroid tissue…” She sat back in the chair, eyes at peace now that she had explained her rapture.

I sat back as well; she wasn’t finished.

“Dermoids are usually removed -especially the bigger ones- because they can twist, cutting off their own blood supply… And a small percentage can develop cancer. Skin cancer -can you imagine?” she said excitedly and then suddenly focussed on my face, a hopeful expression on hers. “Do you know why they develop?” She read my expression. “No, I guess not; nobody seems to have a clear explanation…” Her face brightened. “But everybody seems to have heard of them. My boyfriend’s in business school and even he knows the name.”

She paused; I blinked, happy to be able to say something. Anything. “They’re called ‘Medical Student Tumours’ because they make such an impression on medical students that they remember them years later, even if they’ve gone into Cardiology…”

She smiled contentedly, pleased to be associated with something so popular.

“But…” I wondered how to put the question. “Why did you say you have a visitor, Martha?”

This time she did roll her eyes. “Ectoderm, right?” She waited for my nod. “And Ectoderm makes brain?”

“Well, nervous tissue…” I wasn’t sure what she was getting at.

She crossed her arms and stared at me like a parent waiting for her child to make an obvious connection.

But I didn’t; I still haven’t. I know I disappointed her.

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