After surviving the scourge of cystic acne and seven surgeries for basal cell skin cancers on my face, I realized I don’t see women like me on television, that grand purveyor of what is stylish and acceptable. I see women portraying assassins who kill half a dozen men, are thrown against walls, break mirrors with their faces, marked only by a smudge or two of blood as badges of courage. I see talk show hosts with different hair styles every day, pristine cheeks, eyes lined and mascaraed, fashionable clothes, and manicured nails long enough to function as deadly weapons.
What I don’t see are facial scars, not invisible scars caused by rejection, bullying, lost love, not surgical scars in places that can be buried in layers of clothing. I am talking about a track in a cheek, on a nose, dividing a lip into asymmetrical halves, flaws of the flesh that detail the map of a life.
My scars began to carve their presence in young adulthood when stress, hormones, and maybe genetics, ravaged my face. I went to a dermatologist who lanced and drained and prescribed antibiotics. After a tumultuous episode of sobbing in his office, so loud and uncontrollable the doctor insisted the office assistant stay with me, I managed to get back to my dorm only to have to eat dinner with my friends with my freshly assaulted face on full display.
I felt the throbbing pain, not from needles, but from the humiliation of being on the cusp of adulthood and cursed by a disease that presented itself in such an obvious place, a place there was no way to hide. I wondered what I had done to deserve such punishment, because that is the way young people think.
Things settled down for a while. I accepted the uneven landscape my face and labeled it dimpled, like a water puddle in the street being textured by raindrops. I knew in reality my face emulated the moon.
I graduated from college, married, moved, and started my first job, all things my parents’ core values and signs of approval taught me I should accomplish if I wanted to be considered successful. My husband subsumed himself in TA responsibilities, chemistry experiments, and mastering the new tech language of the flourishing computer age, FORTRAN.
In the small, college town ICU where I worked, I nursed a man who died from burns caused by a fan belt when he fell on his tractor with the motor running. I stared at the girl, almost my age, brain dead from carbon monoxide inhalation when she and her boyfriend parked in a cornfield for privacy, left the motor running for warmth, and failed to notice the exhaust backing up into the car. I watched the drunk leap over his side rails, fly through the air, and land in the arms of a diminutive colon-rectal surgeon. My face broke out, each bump a monument to the tragedies and surprises life presented.
My co-workers, the people who watched the same horror show as I, became family. We routinely gathered at the mom-and-pop pancake house for breakfast. At night, we went to movies or drank and danced at the nearest bar, which happened to be a gay bar. It didn’t matter. We felt safe until grief from the losses we shared challenged professional distance and dissolved personal boundaries. Dancing became experiments in tongues and hips and breasts and buttocks in a place where no behavior incurred judgement. I wanted to experience as much as I could before I died, because death, sadness, loss, seemed as prevalent as an acrid cup of crappy hospital coffee. I began to explore the things that might bring me from numbness and oblivion to hyperacute being. My face rebelled. Tetracycline became as routine as a daily vitamin to calm my erupting face.
Like many health care professionals, I believed the rules of well-being didn’t apply to me. I told myself that caring for sick people provided a protective barrier against the havoc nature could impose on the body. I read pages of warnings about the side effects of Tetracycline. Photosensitivity I interpreted as intolerance of bright lights.
I forgot those warnings when, after years of taking the drug on and off, a friend and I took a summer road trip to Galveston. A move inspired by my divorce had landed me in Texas. We left Dallas on a whim. When we arrived in Galveston, all the motels were booked, so we spent the entire day on the beach, until my friend noticed my face.
“You face is as red as a stop sign. We’ve got to get you out of the sun.”
We paid a ridiculous amount to a scruffy stranger in exchange for his cheap, dilapidated beach front room. Faded pastel prints adorned the walls. The bed was made with sheets that looked like they hadn’t seen a washing machine. I made ice packs for my face.
I had learned the magic of ice therapy when I pulled an unexpectedly heavy turkey from the oven. The roasting pan slid and grazed my forearm as I maneuvered to keep the turkey, drippings and all, from hitting the floor. I watched the blush of the burn, my arm, embarrassed by the heat. I remembered learning in my anatomy class how heat caused the capillaries to dilate and fluid rushed to the site causing blisters. Ice prevented blisters. That time, my skin healed without a blister or a scar.
On the way home from Galveston, my friend and I stopped at a drug store. I alternated ice and the commercial poultice of the day. My face peeled and healed. I thought I’d invented a cheap, natural way to exfoliate and never dreamed damage from the abandoned caution of one week-end when I was twenty-eight would hibernate, only to haunt me as I aged.
In a small college town, I could ride my bike anywhere and logged one thousand miles in a year. When I moved to Dallas, my body lost its tone and stress dominated my mind. I decided to start running. I bought the cheapest pair of running shoes in case my flat feet would betray me and force me to find another form of exercise.
I discovered I loved to run, especially in the heat of the day. A slick coat of sweat made my body glisten around mile five. I memorized the contours of hills, which streets had the prettiest yards, which yards had weather worn wooden fences from which their dogs might give chase. I learned to avoid cruisers who’d slow their cars and offer me rides. Seven miles left me roasted, inside and out. When I got home, hot and content, I glugged a half a gallon of water to replace what the heat took from me.
I didn’t wear sunscreen, sun glasses, or a hat with a visor. I didn’t read about the damaging glare from the asphalt. My running became a habit as strong as nicotine. While I ran, I felt both peaceful and in total control.
One day I looked in the mirror, admiring my outrageously sun-bleached hair and the unexpected deep tan masking my usually fair skin. I saw a rough spot on my lip and scraped it with a finger nail. It pulled away leaving a perfect circle, as if I’d plucked a weed from the dirt all the way to the root. A minute bead of blood appeared. In a day the spot healed, but a dip no bigger than a pinhead remained. I made an appointment with my dermatologist, Dr. Cheek. I picked him because I liked irony.
Before the invention of the Mohs procedure, doctors cut by sight and touch. I trusted Dr. Cheek, a mild man who looked quizzical, not amused, when I asked if he’d ever received a STAT acne call. He numbed my lip, something no more painful than being given a local anesthetic by the dentist. I sat on the edge of the examination table. I sensed rather than felt the scraping begin. Time loses substance when a hand holding a sharp instrument pushes and rakes across the lip you no longer are sure is there, until the instrument hits a nerve and you shift with anxiety. “That hurt,” I said, “I felt that.”
“Not much more.”
The procedure ended not long after that. How long? I’m not sure. I left the office with a dime sized hole in my lip that made the worst cold sore seem like art. I learned basal cell tissue had a different texture compared to healthy tissue. When there was nothing left but healthy tissue, the excavation stopped. I suppose I was thankful the good Dr. Cheek hadn’t put a hole in my lip and that I had a few days off before returning to work in the high splash profession of ICU nursing. I suppose I went running the next day. I suppose I figured this would be the only time I’d have to endure such trauma.
Believers say “Make a plan and God laughs.”
What riotous glee must have echoed through Heaven.
Decades later, despite a solid marriage, a challenging job, and a new house, my plan unraveled. Had God been laughing all this time? It started with a small spot on my nose requiring a snip and a stitch. Then, a fleshy mole in the hairline of my left temple grew into a plump, textured monster taking over one side of my head. A general surgeon I worked with worked me into his schedule. I arrived for my appointment dressed in workout gear; I never dreamed of missing a workout.
Dr. Lewis numbed me and positioned me on my side. The paper covering the examination table rustled and sighed and reminded me it was my turn to be a patient. The local anesthetic given, Dr. Lewis put on his gloves and, using a scalpel, sliced away the creature claiming territory on my body. “You’re bleeding a bit, but I don’t think I’ll stitch it. I’ll bring the biopsy report over to the unit.”
Except for the wad of gauze on my head, I felt great. I knew eventually my hair would cover the scar. We shook hands. I hopped off the table and headed for the gym. Yes, I did go work out. It was a time before Dr. Google educated the general public about the community prevalence of Methicillin Resistant Staph Aureus, a time before I realized I was mortal.
By the time a rough spot appeared on my nose, Dr. Lewis had succumbed to Alzheimer’s. A colleague and fellow runner referred me to a doctor who ran a clinic like a car assembly line. Rooms with plastic flags, each a different color, lined a long corridor. I arrived for my appointment to find half a dozen other people waiting to be prepped and cut. The doctor impressed me with his efficiency, his ability to put me at ease, and, ultimately, his dismissing my surgery as no big deal. He lied.
A young woman with on-the-job training, no formal education, explained she was going to numb my nose. Nothing had ever hurt like the needle piercing and accidentally penetrating the entire thickness of the side of my nose. The woman sucked air, paled, and hurried her exit with a “I’ll let the doctor know you’re ready.”
Fortunately, I asked my husband to drive me. He ushered me to the car with a mound of gauze on my nose. I couldn’t see over the dressing. I paced around the house avoiding the bathrooms and their tempting mirrors. I paced some more. I went into our bathroom and stared at the mirror. What horror hid beneath the bulge of the dressing? I peeled back the tape as gently as I could and lifted the gauze. I don’t know what sound I made. An “oooh” or an epithet. My husband rushed in afraid I had fainted. A dark hole the size of a quarter stared back at me. Emergency reconstruction took place a few days later.
A plastic surgeon I knew and trusted did the repair. I didn’t know it would be a two-step process. The first surgery created a flap on my nose. The doctor retooled the blood supply by operating along the natural crease of my cheek. It was hardly noticeable. But the flap bloomed like the bloated cap of an earthstar mushroom. The mirror became my enemy. I was scheduled to return to work at a job positioning me up close, face-to-face, with patients.
For two months, I wore a flesh-colored oval Duoderm patch over my nose, all day, every day. Not one patient ever mentioned it. No family members ever asked me about it. People spending days in an ICU, dependent on strangers, hooked to noisy machines that alarmed, rather than reassured, rendered my trauma invisible to them.
The time came to debulk and revise the flap. After surgery, I could look in the mirror for the first time without wanting to die. My grief lingered, coupled with a twinge of shame. I longed for the face of the young woman I used to be. I was ashamed of my failure to take care of myself. And the doubter in me, the part of me who questioned the existence of a higher being, again wondered what I had done to deserve such torment.
My most recent biopsy has healed. I await another Mohs procedure. This time the diagnosis is more ominous, squamous cell. It is a frightening diagnosis, but what frightens me more is the new path that will be carved in my face. While I wait, I’ll workout, play with my cats, write, drink wine, and watch television, where I see no women like me.