Side Effects

by Susan Nash

In our family we don’t get cancer. We get drunk. We take drugs. We smoke. We have a wide variety of personality disorders. We fall down and break bones and have very high cholesterol, but we don’t get cancer.

That’s what I used to think anyway. But I was wrong. I now know that my dad has had prostate cancer, although he claimed at the time that he was just having his appendix out. I’ve had multiple basal cell carcinomas removed, even if those don’t really count. And then my sister got a rare and aggressive lymphoma that irrevocably and unalterably confirmed that Cancer is part of our family.

Still, when I went in for my annual mammogram just over a year ago, I wasn’t worried, and not just because of the decades of clear scans. Besides, life was going well. I had moved to Palo Alto from Los Angeles to attend a mid-career program at Stanford. I was busy. Focused. Taking care of things. I was building a new community, looking forward to the next phase of my life. I flew back and forth to Seattle often, helping my sister and her family. At some level I think I believed that my busy life immunized me from getting any “real” cancer myself.  

Then the doctor called with the news that (i) I definitely needed a second mammogram, (ii) there was an eighty percent chance I’d need a biopsy after that, and (iii) there was a forty to fifty percent chance that the biopsy would show that the weird spots lighting up the first mammogram were cancerous.  

A long-forgotten math competency in my brain insistently spat back the result: a thirty-two to forty percent chance that the weird spots were some form of cancer. 

My immediate response was: No, I don’t think I’ll do this right now. 

It reminded me of when I went into labor with my second son: This hurts a lot and I won’t be having a baby today, thank you very much.

So, I decided, I would not do anything about any biopsies or additional mammograms. I would just get on with my life. Perhaps I would blow my entire nest egg in the next five years and have a whopping good time. Fuck the consequences. Seen chemo, would rather see Rio.  

But of course reason prevailed, and I had the second mammogram, and then the biopsy, and the odds fell on the short side. The Monday after Thanksgiving the doctor called again, with the diagnosis that one of the spots was a Ductal Carcinoma In Situ. DCIS, as it’s commonly known.

A DCIS spot is not invasive or life-threatening, at least not unless and until it leaves the “site” where it starts, which it may never do. But the standard treatment is to remove such spots surgically, to eliminate any potential spread. 

As breast cancer goes, DCIS is the best kind to have, referred to as “Stage 0,” whatever that means. There’s a debate in the medical community over whether DCIS should even be called cancer.

Rebellion over, I dutifully called the Stanford Women’s Cancer Clinic to make an appointment—a moment that, from a patient’s standpoint, makes any debate over whether DCIS is a form of “cancer” seem pretty academic.

In the days leading up to the SWCC visit, I tried not to think too much.

Then I got mad. 

Blindingly mad.

Mad about having to be resilient and a good sport.

Mad about being sixty-three years old and single and having to address even the remote possibility, raised in one of the initial telephone consults, of losing, or voluntarily giving up, my left breast. It’s hard enough to get a date at this age even with two breasts.

Mad that it wasn’t fair to make me deal with this, not right now, not by myself.

Mad that this had happened to me, someone who clearly did not deserve it. Yes, I actually had that thought—while looking down to see if the ground would open up and suck me straight into hell.

This phase was not a good time to cross me . When a leak developed behind the bathroom wall in my apartment, it was not a good idea to tell me, as the tenant and a retired lawyer, to get someone out to fix it. This is not my problem,” I told the landlord. This is your building, not mine. You get someone out here.”

I’m pretty sure I was right on the substantive legal obligations of landlords and tenants, but perhaps a little over the top in explaining my position.

Next, I moved into bargaining mode. Whatever happened, I would not turn into one of those people who wear long skirts and Birkenstocks and do juice cleanses and sport pink ribbons. I would survive but I would not be a “Designated Survivor.” I would have the surgery but it would have to be done quickly. One and done.

           Oh God, I thought, they’re going to tell me to give up wine. I’ll give up one, red or white, whichever. Not both.

           I told my sister and a couple of friends. To my sister, after what she’s been through, the idea of having a lumpectomy probably sounded like going in for a flu shot.

My friends were sympathetic, if tentative. I was bristly. “I need help,” I wanted to say.  “I’m fine,” is what usually came out.

           Sitting in the line of cars at the cancer clinic, it took me a while to label what I was feeling. Pain. Shortness of breath. Tears behind my eyes.

This was actually happening.

I was terrified.

           The physician’s assistant was endlessly patient, unfazed by my crossness. She ordered an MRI to see what further mysteries my breast might yield. She prescribed Ativan to take before the procedure.  

She looked up at me.

“Maybe I should add a few extra?” 

“Yes,” I said.

In my family, our bodies are not temples.

           We didn’t settle on a plan but we made an outline, a plan to have a plan. After the MRI, there would be a consultation about the surgery—how extensive and for what, exactly, were not clear. I felt a breath of something for a minute, as we finished up. I remembered a recent lecture by Roshi Joan Halifax, talking about hope living with uncertainty. For a moment, I thought I understood what she meant.

I picked up the car and managed to thank the attendant, politely.

           I opted to have the surgery in Los Angeles, where my older son lives. The day after New Year’s he drove me to the hospital, around the same time that his younger brother was boarding a plane in New York to fly out. This was the first time in their adult lives that I asked my sons to show up for me. Both leapt to the occasion.

The surgeon had me on the table for four hours as she removed what were eventually determined to be two DCIS spots in the left breast, connected by an unseen line of more Stage 0 (almost-cancer?) material. Then she took a bit of tissue out of the right breast, just to even things up.

Both sons came to see me when it was over.

           The upshot of the surgery was a pair of scarred but perkier breasts, a result that women all over the westside of L.A. pay thousands of dollars for out of their own pockets, without any kind of diagnosis at all. 

           I flew back to Palo Alto as soon as I was cleared in the post-op, ready to put the episode behind me. But it turned out that the margins were not quite what the DCIS protocol requires, even though the chances that anything left in the area would turn into an invasive cancer were slim. Also, the chunk taken out of the right breast included a teeny tiny bit of a different kind of breast cancer, or potential breast cancer, that might never have shown up but for the standard technique of testing all tissue removed during any breast surgery.

I tried not to think about the fact that the new spot on the right side was not detected in any of the mammograms.

After another series of appointments and discussions, I returned to LA for an outpatient version of the surgery, just on the left side, to get that last bit of margin. As for the different and impossibly tiny amount of almost-cancer tissue extracted from the right breast, the doctors left it to me to decide whether to take the five years of pills that might, or might not, cause hair loss, weight gain, brain fog, loss of libido, headaches, fatigue and/or nausea. For better or worse, I opted not to go down a medication path that treats against a possible but unlikely recurrence of a possible but unlikely invasive breast cancer that would not have been found but for the evening-things-out surgery.

And then I was done, both breasts reasonably intact, the fortunate beneficiary of state-of-the-art treatment and a deeply researched part of Western medicine.

There was still the small matter of a month of radiation back in Palo Alto to round out the protocol, but I was assured that this would not affect my life, except for the likely need to take naps. Both breasts would be radiated, just in case. Ironically, given the too-little-too-late protective measures I now take against the sun, I was told to expect a sunburn in one of the few places where my skin is lily white.

           The building housing the radiation oncology clinic is quiet. It is not unpleasant but it is a serious place. None of the clientele wants to be there. Everyone is respectful of everyone else. A volunteer piano player often serenades the lobby. Sometimes I sat there for a few minutes before going downstairs to check in.

           Each day the man with the big eyes and one of his helpers would set me up just so, adjusting the positions, calling out fractions to each other. During this process the man’s eyes were inches from my breasts. He was nice and so very kind, but I couldn’t help thinking that he should buy me a drink first. I felt disappointed on the days he was not there.

           I was left alone during the actual radiation, lying motionless, holding my breath and exhaling on command from a voice miked into the room. The machines moved around me like the robot doctors in Star Wars, whirring and clicking in a language of their own. I kept my eyes firmly shut.

At the end of the first day, I made myself a Cosmo. It tasted so much better than the bitterness of my usual white wine. By the end of the week, I had a burning desire for a chocolate cupcake, a craving that I would eventually indulge.

Cosmos and cupcakes almost certainly contribute to cancer.

Occasionally I was annoyed by the new routine, carving out an hour every weekday at 4 pm or so. Most of the time I remained deeply grateful for having this event occur in the 21^st century and not a minute before.

After twenty sessions of radiation, the team gave me a graduation certificate and a blue dot pin. Blue dot pins are the radiation equivalent of pink ribbons. The man with the big eyes and everyone else in the room offered their hearty congratulations and genuine wishes for good luck. I choked up. The odds that l will never have to deal with this again are resoundingly in my favor.

On my way out I found myself wishing that the man I had a drink with two days earlier, a man I last saw forty-two years ago in college, was waiting outside for me. I wanted arms, male arms, surrounding me.

I shook it off and got into the car. Back at home, I pinned the blue dots to my baseball cap.

A few days later it is Sunday, and I walk over to the All-Saint’s Church to listen to chamber music. The quartet will play Haydn, Mozart, and Brahms, exploring the B-flat note that begins the Hunter’s call in a fox hunt. My breasts itch. I have heard from the man from college again, and we will hike in two days’ time.

The building is stark in its lack of ornamentation, and the pews are hard, as if the Episcopalians need a constant reminder that this is a Church. There are no snarling gargoyles or cherubic angels looking down from above. The floors are concrete, unadorned by any covering. And yet it is clear that this is a holy place, or a place, at least, where something holy might happen. A gold cloth drapes over the altar; fragments of a cross float in the open space above.

Four chairs and four music stands sit in a semi-circle—black, steel, simple. Here, at last, is a small rug, possibly to absorb the sound or cushion the players’ feet. Only thirty people have turned out for the concert, in ones, twos and fours, leaving all of us with room to ourselves.

The musicians enter and take a bow. They take a seat and tune their instruments, then wait until the room fills with silence. They lift their bows and play the long first note.

There are many moments during those two hours of music when I am completely, abundantly, at peace.

Susan Nash is a former lawyer who has traded years of writing briefs in favor of chronicling the experiences of older women in our culture. Her work appears on Punctuate, Considerable.com, and multiple websites at Stanford University.

The Texture of Scars

by Karen J. Weyant

At seven, I already had scars. 

The comma-shaped scrape near my left eye was from Chicken Pox. It was a small notch, but deep enough that I could feel the tiny fold of skin with my fingers. A fine white slash on my cheek was from a cut on a barbed wire fence. This smooth scar was nearly invisible, but sometimes, when my fair skin burned and freckled from the sun, the line appeared brighter, a thin white string etched across my cheek.

Outside of listening to the origin stories of these blemishes, I didn’t know much about scars, but somehow I realized that they were undesirable. I wasn’t sure why. Perhaps it was because they never really went away, unlike the other scratches, bumps and bruises I obtained from riding my bike or playing at the local playground.

So that was why the summer before I started second grade, I listened to Nate White, who offered a helpful strategy on avoiding one kind of scar: the alleged mark left over from a mosquito bite that was scratched too much. Nate, who was one year younger than I was, but seemingly far wiser about the world, deemed himself an expert when it came to killing mosquitos.

According to Nate, you waited until a mosquito landed and slid its long needle into your skin. While the mosquito sucked your blood, you pulled your skin tight around the insect. Nate’s theory was that the needle would get stuck, and unable to withdraw, the mosquito would feed until it eventually burst.

This idea fascinated me. Mosquitos caused me great misery, so this tactic sounded like the perfect revenge. During the mugginess of summer, I seemed the food source for every mosquito in the neighborhood. They bit my ankles, my legs, my arms, even my face. I would find mosquito bites in the most unlikely of places, including the skin between my fingers or the space between my shoulders. Once, a mosquito got stuck underneath my shirt, and when, in a fit of shirt pulling and swatting, I was finally able to slap it away, I found a line of bites, red angry and inflamed like a constellation of bumpy stars, sprinkled across my stomach.

My mother covered me with smelly bug spray, but I guess mosquitos in rural Pennsylvania are extra sturdy because they bit through the spray. Then, my mother dabbed my bites with Campho Phenique crème, an over-the-counter medication that smelled worse than the spray. When I complained, she tried homemade remedies made with baking soda. No matter what she did, the bites still itched.

And I was not supposed to scratch them.

“You will break them open and cause scars,” she said.

Scars were something I didn’t want, so I tried Nate’s advice. I waited until a mosquito landed on my arm, and I pulled the skin around the insect taut. And then I waited a bit longer.

I don’t remember exactly what happened, except that the mosquito didn’t explode. Maybe it was so hungry it didn’t mind staying for extra food. Maybe I didn’t pull my skin tight enough. All I remember is that the result of this experiment was one of the worst, most inflamed bites I ever had. 

I didn’t listen to my mother’s warnings. I scratched that bite raw, until it broke open, leaving spots of blood smeared on my skin. 

But it didn’t leave a scar.

As a teenager, I learned to wear foundation to cover the thin line on my cheek. My textured bangs covered the chicken pox scar. Still, I earned other scars along the way. I have a thin scratch on the back of my hand from a broken mirror and an oval scar just below my knee from running into a shopping cart in a parking lot.

“Interesting scars tells interesting stories,” a friend once told me, but until I was thirty-five, I didn’t think that any of my scars’ stories were that intriguing.

Then came my diagnosis of thyroid cancer, and two surgeries that left a line of pinched skin on my neck from the removal of suspicious nodules.

At the time of diagnosis, I wasn’t worried about the scar. I just wanted the cancer out of me. But when I got home from the hospital, I stared at myself in the mirror, where black stitches were sewn across my neck. I fingered the string, marveling at how something that looked like it could come out of a sewing kit could help piece me together. 

It was there at the bathroom mirror I realized that while the stitches would be removed, a scar would remain. I could disguise my other scars, but this one would be visible to the world. The only way I could hide it was with a turtleneck sweater.

At the time, I received a lot of advice about how to make the scar less noticeable. “Mederma”, my doctor said, while my friends advised using cocoa butter or Vitamin E. Nothing really worked, however, as the skin pulled and tugged, finally settling in place. 

For the first year or so, I worried more about the cancer than the scar. I worried that my regular scans would pick up a bulging lymph node, one that could suggest that the cancer had resurfaced and spread. I worried that blood tests would find something abnormal. I worried that I would have to undergo surgery again and perhaps undergo more drastic treatments.

But test after test came back clear, and I started to be more concerned about my scar -- a scar that had faded from an angry, red thick line to a thin patch of white skin. I found myself explaining my surgery to complete strangers, such as a waitress who told me that her twin sister had a similar type of surgery to a young neighbor who worried that her little boy had to have neck surgery and she was concerned about the side effects and the pain.

I found myself reassuring my little neice who touched my neck.

“Boo-boo?” she asked, her whole face twisted into a worried frown.

“Yes,” I explained, reassuring her that “It was all better now.”

Now, over ten years later, I barely notice it, even when I look in the bathroom mirror every morning. This scar is now as part of me as my brown eyes or pale skin.

Still, there are days when I remember it’s there. Often, when I meet new people, I feel as if their eyes wander down from my face to the puckered skin. I’m a college professor, so when I know I am going to face a new class of students or when I give a public presentation, I search for creative ways to mask this blemish through turtlenecks, scarves, or beaded chokers.    

But I know the pinched scar is there trying to peek through my disguises. It has joined my other scars, with perhaps a more interesting story to tell.

Still, in spite of my mother’s warnings etched in my memories, I don’t believe that I have a single scar from a mosquito bite.

It’s as if the body itself decides what it wants to mark, and we, even as wearers of our own skin, have little to say in the matter.

Karen J. Weyant's essays have been published in Barren Magazine, Carbon Culture Review, Coal Hill Review, the cream city review, Lake Effect, Punctuate, Solidago Review, and Stoneboat. She is an Associate Professor of English at Jamestown Community College in Jamestown, New York. 

Cleveland City Blues

by Joe Kowalski

In the autumn of 2016, my car was double-booted because I had forged a single-day parking pass, and so I had to take the RTA Blue Line transit to Tower City in order to walk from there to Cleveland State University. Along the way, I stopped at the corner store formerly known as For Goodness Jake’s. There was an older man inside, beard peppered and scattershot against his pale skin. His clothes looked like they had been found outside of Goodwill. The dude bought a candy bar and struck up an energetic conversation with another man sitting outside on a bike.

The shabby man was speaking intensely, so I stopped to make sure that he wasn’t harassing the poor cyclist. He was clearly drunk, but the cyclist didn’t seem threatened by him. The conversation turned to politics. Eventually the man turned to me, his pupils swirling a bit before focusing.

“Your name?”

“Joe.”

“You’re voting for Trump, right?”

“Not a chance,” I said.

“I was a steelyard worker for years. Trump is for the workers.”

“As far as I can tell, Trump is only for himself.”

Although class would begin shortly, the man and I continued our lively conversation on my way to campus. He was homeless, he said, mostly because he couldn’t afford to pay off any more DUIs and had become estranged from his daughter. He was bothered that I hated Trump, but he liked that I was in school because “It’s important to learn how to think, and at least you’re thinking. There’s not enough of that these days.”

We passed another homeless man. They knew each other and struck up a conversation. My walking companion gave him a generous five-dollar bill and ended up giving away the candy bar he had bought too, saying, “I don’t need the sugar anyway.” He also joked around for a minute with a construction worker. I made sure we stayed on the busy sidewalks of Euclid Avenue, so that there was little chance that anything dangerous could happen.

          He didn’t. The further we walked, the more I interpreted him as lonely rather than hostile, although I imagine a big factor in my subsiding fear came from the unearned privilege of my being a white guy.  I was subjected to stories about his time in jail. How he had been “reformed.” He said that he changed because of a “little book called The Bible” and with the help of a well-known individual ... I thought I knew where this was headed.

          “You ever heard of Jack Kerouac?” he slurred, taking me by surprise.

          “The writer? Yeah.” We crossed the street.

          “Thought you might. He was a mastermind of words. You got an address? I’ll mail you something amazing.”

          “I’d prefer not to tell you that. Sorry, man.”

          “I think maybe you deserve it. No one ever talks to me like this. Plus, you’re a smart kid.”

          “What is it?”

          He scratched his beard. “When I was in jail, I read his poetry daily. Jack’s. Memorized it. It said a lot to me. Made me rethink everything. Made me see how we’re all connected. Genius. Taught me how you didn’t need a whole lot of words to say a lot. ‘I’m merely exploring souls and cities,’ etc. etc. See, Jack Kerouac used to write on this weird, long paper stock. Almost like a scroll. His notebooks were wild. You’d never believe it, but I found one of his original manuscripts in a crate at a flea market.” He looked at me expectantly, arms raised upward.

          “... Huh.”

          The man nodded vigorously, smile growing. “I don’t think they understood what it was. But I read those words a million times in prison and had to have it. Since then, I’ve had this thing at every important moment of my life. It’s back at the shelter as we speak. Kid, I want you to have it now.” He clapped me on the back.

          “I appreciate that,” I said. “But I don’t feel comfortable giving you my address.” We were rapidly approaching the school.

          The man blinked for a minute and then pointed at the trash can outside of the Law Building, all while attempting the feat of standing steady. “Hm ... see that right there, Jim? It was Jim, right?”

          “Joe.”

“Okay. I’m going to leave the manuscript in there tomorrow. That way you can have your life changed too. Look for it there tomorrow after 10 a.m.”

          “What if the trash gets emptied?”

          “Okay, okay…” He swung around, still off-kilter. The next target was the sparse foliage that lined the grey brick of the building. “There then. Right in those bushes. 10 a.m. Priceless manuscript.”

          “I’ll check for sure.” We shook hands and he was off, singing a song I didn’t know.

          I know it was stupid, but I had to check the next day. Wouldn’t you? I felt a bit silly combing among the mulch, but I had to be thorough. It was the time of year when the temperatures were starting to dip and people scurried by, ignoring me just to get inside. I wondered if they weren’t attempting to ignore me in a similar manner that people ignored my drunk acquaintance the day before.

Nope. Nothing. Of course. Although, it’s quite possible that maybe I didn’t look hard enough. Maybe you should check the shrubs outside the Cleveland State University Law Building when you are in town in case I missed it years ago and it’s still there, water damaged and concealed in mulch, just waiting to change your life.

Joe Kowalski's films and online videos have allowed him to work with the likes of Henry Winkler (Barry), Jonathan Demme (The Silence of the Lambs), John Green (The Fault in Our Stars), and Mara Wilson (Matilda). His short film adaptation of I Am the Doorway was given the blessing of Stephen King. He lives in Cleveland and can be found online @PogieJoe.