Superficial

In moments of repose, I would think about how the conversations might go.

"Did you hear what happened to Heather?"

"Heather who?"

"Heather Harris."

"No."

"She died."

"What?"

"Yeah. No kidding. Malignant melanoma. Strangest thing. Apparently she let a mole go too long and then the cancer spread everywhere and now wešre on our way to her funeral. Do you want to come?"

"Can't. I've got a ton of laundry to do."

"Yeah, me, too. We're going to duck in and out." That was fine. I have never really liked any of my friends anyway. But the whole thing was just so embarrassing that I hoped my doctor might devise a way to preserve my life for a few more years, until it wasn't so pathetic and, well, unfashionable to find myself in the organic recycling bin.

The crisis began for me about five months ago. It was a normal Wednesday morning; I was drinking my coffee and watching morning television.

"Next up, some helpful tips on caring for your summertime skin. Do you know what to look for when you check your moles?" The vapid local newswoman seemed more a Public Service Announcement on the dangers of a lobotomy. I rolled my eyes and headed for the shower. In the bathroom, I turned on the water and pulled my t-shirt over my head. I glanced in the mirror, stopped, and studied my reflection more carefully. I have always had a mole under my right arm, immediately to the right of my right breast. It has always been symmetrical and uniform like a good mole. But today it looked different. I craned my neck and tugged at my skin. Perhaps it was a shadow, I thought. I leaned up against the full-length mirror and turned toward the light. Exhaling like a mouth-breathing bull, I obscured the reflection in fog. I backed up and craned my neck again. The brown edges of my mole were indeed bleeding onto the flat skin around it. I felt the tingly numbness of fear spread from the center of my body to my arms and legs, fingers and toes. Death by mole. Son of a bitch.

At work, I phoned my internist's office.

"Can Dr. Conger check a mole for me...soon?" I asked.

"Is this an urgent matter?"

"Well, I don't know. It kind of looks like it."

"He can see you in three weeks."

"Don't you have anything sooner?" I asked, damning the heartless troll for lording her scheduling power over me.

"Can you be here in an hour? He has a cancellation, but you can't be late."

"Fine. I'll be there in 45 minutes." I left a note on my supervisor's desk and rushed out the door. I felt better already. Dr. Conger had helped pull a polyp the size of a human head out of my father's colon (there was some speculation that it was my father's head, but that's a different story). I was confident that he could vanquish my diminutive lesion.

After 90 minutes in the waiting room, Dr. Conger finally called me back to the examining room. He looked at my mole for one minute and started scribbling notes.

"It doesn't look bad to me, but wešll send you to dermatology just to be sure."

"Can't you take it off right now?" I smiled sheepishly. "It makes me nervous."

"No, I can't do that here. But I'm sending you to Dr. Rubino. He's a Hopkins guy, one of the best in the field." Hmm. I accepted the Johns Hopkins surgeon as a reasonable alternative to the immediate removal of the offending nub, but I wasn't happy about it. I considered an at-home removal, perhaps with nail clippers or the really sharp Henckel knife I just bought. The worst-case scenario would be that I botch the job, end up in the ER, and some surgeon does what I'm asking of Dr. Conger right now. But my sister once tried to shave a mole off her temple. There was an absurd amount of blood. She looked like Carrie, which was really funny after we were sure she wasn't dying or psychotic. I returned to work, made an appointment with Dr. Rubino, and tried to act natural.

In the weeks between my appointment with Dr. Conger and my appointment with Dr. Rubino, the world seemed to be a series of references to skin cancer. Somehow, even though I never read Redbook, I found a Redbook article on young skin cancer patients. Like a child with a copy of Playboy, I shut my office door at lunchtime and pored over the article, hoping no one would knock. I read about a 38-year-old woman with metastatic cancer that had started as a diseased mole. She had a great attitude, which just made her sound stupid. It was embarrassing that she didn't know she was going to die, because we all knew. I could barely look at the picture of her with her enormous grin. I wondered if her friends would be too busy to attend her funeral.

"Heather?" The door of my office cracked open and my supervisor stuck her superfluous head in. Good thing I wasn't stealing office supplies or searching the Internet for another job or masturbating. That would have been uncomfortable for both of us. As it was, I only needed to explain what I was so engrossed in to a dolt who had been promoted according to the Peter Principle.

"Hey. I'm eating lunch." She eyed the article and smiled a rueful smile. She knew about my upcoming appointment.

"Worried?"

"Well, this girl is 38 and her mole was cancerous, melanoma, and it spread to her lungs and her lymph system, and, well, everywhere. She's 38." I shook the picture of the smiling cadaver in front of Kristen. My voice, usually home to sarcasm and disdain, was shrill and panicky. I felt vulnerable. Kristen stood there and blinked like a cartoon character. I could almost hear the pluck of a distant violin string each time her eyelids fell. I scrambled to recover my blasé demeanor. "But I think she spent a lot of time in the sun." I looked down at the picture. "And what the hell did she do to her hair?" This was a Heather that Kristen could deal with. She shook her head at my insensitivity and patted my arm.

"I'm sure youšll be fine." It's amazing she can find her way home every night.

My appointment with Dr. Rubino was on a Friday afternoon. After only a few minutes in the waiting room, the nurse took me back to the examining room. A folded paper gown was laid out on the table.

"Please undress from the neck to the waist and put that gown on." She said as she exited the room. The room was very quiet after she left, and I stood there and looked around for a minute. There were pictures on the wall of diseased moles. They reminded me of the dentist's pictures of diseased gums. How do people let their bodies become this ugly? I mean some of these moles looked like rotted fruit. Imagine walking around with a cluster of rotting strawberries on your body and ignoring it. What are these people telling themselves? I shook my head for a second, and then contemplated how awkward it would be if the doctor walked in on me, fully clothed and staring at his posters. I turned my attention to the demeaning, noisy, paper gown. I was certain that I needed to remove my shirt, and I did so, but the nurse had said nothing about my bra. I considered my options. I could go liberal, lose the bra, and trust that the doctor has seen it all. This naked option seemed sophisticated. But my sister again provided a caveat. She followed this line of reasoning once when she was mistakenly given a child's gown that barely covered one of her ta-tas. She changed and waited for the doctor to return, telling herself over and over that this was an issue only for her. He walked in the room, took one look at her and scrambled back out the door as quickly as his rubbery legs would carry him. The nurse came back a few minutes later with the appropriately sized adult gown. She still blushes and brings an unconscious hand to her chest when that story comes up. So I opted to go conservative. I left my bra on and donned the gown, open in the front. I could always gracefully remove the bra with a nonchalant 'of course' if the doctor requested. I positioned myself on the edge of the examining table, in my paper gown, on the paper blotter, and tried not to make too much noise or rip anything.

A knock at the door announced Dr. Rubino and his nurse. He came in looking down at my medical record. After a second he looked up, smiled brightly and offered his hand.

"Hello, Ms Harris. I'm Paul Rubino. Looks like we're doing a routine skin examination today." I smiled like the ridiculous pile of routine skin that I was.

"I have one mole I'm concerned about," I said, sure that the doctor was thinking, 'You piles of skin always do.' He demonstrated appropriate professional interest.

"Let's take a look." I turned the right side of my body toward him and pulled the gown back to expose the monster.

"It does look like it has experienced some trauma. Your bra probably rubs it every day." Indeed the under wire of my bra was even at that moment rubbing the edge of the mole. Dr. Rubino pulled at the skin to examine it without the bra's influence. I tried to assist by pulling the under wire out and to the left, but all the hands were crowding the area. I decided to slip my bra straps off my shoulder and subtly pull the under wire away from my body. This seemed to be working for a second, but I was upsetting the equilibrium of the bra. The tension that normally held the bra over my breast was now straining in a different direction. The bottom of the under wire was still under my chest, but the top was a few inches off my skin. Without warning, the bra inverted itself. Suddenly, the normally 'W' shaped bra was 'M' shaped, a lovely frame for my belly button. My 32A breasts were making their debut, and I had to feign the unself-conscious demeanor of a National Geographic model. I held my breath and stared at a tile on the floor.

"Looks like you have another old friend under your right breast," Dr. Rubino observed. "It's raised, so we'll remove it as well. The mark between your breasts is flat and unremarkable, so we'll leave that one alone." The nurse made notes in my chart. I waited for my senior prom date to walk in, or a roving hoard of interns with examination searchlights to join us, or my clothes to be permanently confiscated. But no such luck. Dr. Rubino moved down my arm.

"I donšt like this one. The edges are slightly inflamed." The nurse made more notes. Inflamed? I looked over my breasts, which now seemed to be taking up about 75% of the room, to the inflamed mark on my lower arm. Cancer and humiliation were in competition to see who could kill me first. I was getting ready to freak out. A few minutes later, Dr. Rubino announced his decision.

"I'd like to remove four moles and a cyst I found near your shoulder."

"I thought that was a scar," I said of the cyst.

"Nope. A cyst. And it will just get bigger." I moved to put my over-exposed torso back under wraps. "Make an appointment with the receptionist before you leave. We'll see you soon." I completed the re-adjustment of my bra with the cool movements of a child shooing a gigantic wasp. I paused for a second, as if to signal the beginning of a new and more dignified scene, and extended my hand to the doctor.

"Thanks so much," I said. Mentally I added 'for stoking the disconnect and the horror between me and my body.'


"Do you want to see my melanoma?"

My mother frowned. "Therešs no skin cancer in our family. And I lie out all summer."

"Grandpa had that thing on his ear."

"It was completely superficial. You do not have melanoma."

I sat at the breakfast bar and ate dark chocolate chips while my mother cleaned vegetables at the sink.

"Have some carrots, something better for you than that."

"Why? If I have melanoma I'm going to eat potato chips and dark chocolate until I bite it for good." My mother shook her head, but could not resist a small chuckle. Dark humor is a mainstay in my family, and death is just about the funniest thing we know. You should hear us talk about my late grandmother's brain tumor that caused her to start calling my brother 'Brian.' We don't know any Brian's.

On the day of my appointment to have the blemishes removed, it occurred to me that there would be cutting and needles. I hate needles. When I was a kid and I needed a shot, my sister would sing Sesame Street songs to distract me. I wondered if it would be inappropriate for me to ask the nurse to sing 'Sing, Sing a Song' during the procedure. I lose all sense of decorum when I see a needle, so I try to consider these matters ahead of time. Another option I played with is drinking before the appointment. It takes me two glasses of wine to board an airplane, so I figured a comparable amount of alcohol would help me face the gaping barrel of that first needle. But there was no one to drive me to the appointment, and a DWI didn't seem worth it. So I arrived at Dr. Rubino's office sober and without a chorus.

"I have a 10:00 a.m. appointment with Dr. Rubino," I told the receptionist. She nodded efficiently.

"Have a seat. We'll call you in a minute." I took my seat in the waiting room and looked around at the other patients. I wondered who was there for Botox and who required treatment for some foul skin putrefaction.

"Heather Harris?" A highly groomed nurse with a European accent called my name. I got up and followed her down the hall.

"How are we today?" she asked. I didn't get the impression that she really wanted to know, but I told her anyway.

"I really hate needles.

"Oh, you won't feel a thing. Please remove your sweater and bra and hop up on the table. Here's a gown." I pulled my sweater and bra off, draped them over a chair, and slipped into the familiar paper drape."

"That's what everybody says, but I always feel it, and it always hurts." She didn't hear me. She was busy pulling gauze down from a cabinet and arranging scalpels.

"Are you a mother?" she asked, still not looking at me.

"No. Why?"

"Well, I was going to say that if youšve delivered a baby, this will be absolutely nothing."

"I haven't had a baby. And I'm not sure that comparison makes me feel any better." She smiled at the cabinet. "I was going to drink before I came. Would that have been a problem?" She laughed.

"Alcohol makes you bleed. That would have been a problem. Now maybe if you had brought some for everybody." She looked over her glasses at me and smiled. Perhaps I could work with this girl. A quick rap on the door announced Dr. Rubino.

"Hi, Heather. How are you feeling today?"

"Nervous." No one seemed to be taking my apprehension seriously. "How long will this take?"

"Not long," he said. "The anesthesia works pretty quickly and the procedure is simple. Lie back on the table, please." This was starting to move too quickly. I could hear instruments rustling as I stared at the ceiling. I had to slow the pace.

"Can you tell me what is going to happen?"

"Sure. I've injected some anesthesia into the side of your breast. That will numb the area around the two moles we will remove on your chest." Injected? As in past tense? I wasn't sure whether to be relieved that I had missed it or panicked that this was moving faster than I thought. "Removing the mole involves an incision along each side of the mole, it looks like a football, that makes it easier to stitch and quicker to heal. There, those are done." I felt some tugging as he stitched the two holes in my flesh. The nurse moved from my right to my left, and back to my right. The wheels of his stool squeaked as he moved on to my arm. "There's the injection of anesthesia into your upper arm, and into your lower arm." That I felt, I winced. "Same procedure for these guys, although the inflamed spot of your lower arm is shallow enough that it will not require stitches." More tugging on my upper arm. "Turn over on your stomach, please. We're going to remove the mole on your scalp and then we're done."

"How do you inject anesthesia into someonešs head?" I asked as I turned over and planted my face in the pillow.

'The needle only penetrates the skin.' My skin has always felt pretty tightly stretched over my skull. I waited for the needle to scrape bone. It didn't. I slowly brought my chin down to my sternum and rested on the top of my forehead so my nose wasn't crushed and I could breathe.

"There. You're done. I didn't stitch the wound on your scalp because you have so much hair that it would have just been a mess. Be careful with that one." Dr. Rubino was removing his gloves. I lifted my face from the pillow. My lipstick had left an impression of my lips on the disposable pillowcase.

"That's Bobbi Brown's 'Brown Shimmer'. Nice, huh?" The nurse looked over.

"That is nice." I sat up and looked at my chest and my arm. Four bandages covered the fresh lacerations.

"Do you have antibiotic ointment and some bandages at home?" the nurse asked. I took mental inventory of my medicine cabinet.

"No."

"Here's enough to get you through 24 hours. Change the dressing twice a day for two weeks. Call us if the area becomes inflamed or increasingly tender." With these instructions, Dr. Rubino and the nurse left the room. As the door clicked shut behind them, the room filled with the kind of quiet that descends after someone turns a blender off. Once again, I took a minute just to breathe and look around the room. Five vials were lined up on the counter. Each contained some solution and chunks of my flesh ready to be sent to a pathology lab. One of the chunks looked like a Portuguese man-of-war. It reminded me that I was not out of the woods yet. Potato chips and dark chocolate morsels could still be in my future. But I felt lighter as I left the office.

"Thank you." I smiled at Dr. Rubino and his staff. I meant it.

A few weeks later, the pathology report arrived in the mail. I opened it as I climbed the steep and narrow steps to my apartment at the end of a typical day. Benign, everything was benign. But life is fragile so I still eat potato chips and dark chocolate morsels.

More About Heather Harris:

Heather is an MFA student at Goucher College concentrating on satirical nonfiction. She is also a nonfiction editor at The Baltimore Review, Baltimore's literary journal.