A while ago I visited a dermatologist’s office to get a medical opinion on a couple of bumps I thought might be ominous. I say "dermatologist’s office" and not "dermatologist", because I visited the office three times in the space of as many months, and never once saw the actual doctor, even during a biopsy.

Earlier this week I had an appointment to review the results of the biopsy. Throughout my earlier visits, the place had been nearly deserted, but suddenly the lobby was standing room only. It seems they’d massively overbooked appointments. Some people had been waiting in the lobby for two hours or more. One elderly man had to cancel his appointment and go home because his supply of life-sustaining oxygen was about to run out. I’m not making that up.

After about an hour of waiting, during which time the harried desk clerks were explaining that the overbooking was due to the doctor having only just returned from his vacation (three months? Some vacation!) I was finally shown to an examination room where I stared at posters of stage III melanoma for another half an hour. At this point, I was entertaining the notion that there really was no dermatologist, that he was an entirely fictional construct created by the nurses and assistants to enable them to open their own collective office. The truth was somewhat more disturbing.

Eventually, I heard a man’s voice in the hallway, and heard the sound of my file being noisily extracted from its bin hanging on outside the door of my cheerless and chilly examination room. The knob turned, and I met the doctor. Or, at least, what was passing for a doctor.

It was a hobo.

It was the two-week-old neckbeard, exactly the same length as the stubbly hair on his shorn head, that was the first visual anomaly. The second oddity was his peculiar half-lidded expression and marked tendency to close his eyes and turn his head away when he spoke, his voice a sort of buzzing mumble. Still, I listened intently to what he was telling me about the initial results of the biopsy, reading his lips closely, because I couldn’t always make his words out clearly. Nonetheless, I was perfectly prepared to accept this man as a bona fide doctor of medicine as he explained my prognosis. Nothing was really out of the ordinary.

Then I saw his hands. Since he looked to be in his early to mid-fifties, the appearance of age on his hands was not unexpected. The appearance of filth, however, was an entirely unpleasant surprise. About half of his thickened, yellow, badly-trimmed nails had the sort of black, compacted material underneath them that one might easily expect from trades more commonly associated with axle grease and sparks, such as mechanics, machinists, oil rig workers, and tow truck drivers. His hands in general were the sort of manipulative appendages one would find on a man who has toiled at hard manual labor his entire life, had you just caught him mid-shift. Mind you, this man was supposedly a dermatologist.

At this point, I actually began to wonder if he really wasn’t some wino the staff had picked up off the street to impersonate a doctor, and so continue their ruse undetected. When the "doctor" made some forgettable joke about melanoma indicators, I naturally gave him a pro forma chuckle. He responded in kind, though a tad more heartily than I might have wished, for I got to see a glimpse of the inside of his mouth. The good "doctor" was missing several teeth, and those that were present were, shall we say, not in a state that my dental hygenist would find at all pleasing.

I didn’t think I lived in the sticks, but it turns out he’s the only dermatologist in the entire county. Convenience or no, I think that filthy hands, strange mannerisms, missing teeth, and a three month vacation (jail time for a "Drunk and Disorderly" citation at the shelter? Who knows?) all add up to looking elsewhere for any future professional dermal attention. I hear there’s a couple of guys who sleep behind the dumpster of Pete’s Beer & Wine who say they’re doctors.