Jacob Brogan

The world is always ending

Seen and Unseen

            A few months after my surgery I cold called the pathologist who had dissected my thyroid. I had found her name buried in the report my surgeon had handed me, a sheaf of baffling documents that I studied with a fervor most would reserve for sacred texts. Wanting to know what it was like to hold the organ, to pull it apart, to place it under a microscope, I rehearsed my questions as the phone rang, only to freeze up when she answered.

            More puzzled than I was, she stayed on the line longer than she would have liked, speaking grudgingly at first, but gradually warming to my hesitant queries as we spoke. Growing bold as the thaw set in, I asked her whether she would be willing to show me the slides of my thyroid. Words slowing, her tone once again became glacial. There is nothing to see, she said. Nothing you would understand.

 ---

            For months more I saw nothing at all, nothing but the flush of the scar on my neck. At my endocrinologist’s office, someone handed me an ultrasound order, the first I remembered holding since the barrage of tests that revealed the cancerous nodules. This one, I was told, would be routine. No one expected to find anything, but they had to look twice a year, just to be sure. Accepting the form with one hand, I counted off months with the fingers of the other. Had it really been six months? It had.

            Six months, largely unseen. Time enough that I no longer feel the time passing. Unmarked by illness, the days accumulate invisibly. Six months. Half a year. A good one too, maybe my best. Our New Year’s traditions almost always invariably assume that we are leaving behind troubled times. Last year, our resolutions say, we ate too much, loved ourselves too little. Rushing onward, we make like inverted images of Lot’s wife, refusing to look back. Standing at the edge, I found myself wanting to linger. My therapist laughed when I told him I had resolved to make this year more like the last one. That’s fine, he said. But maybe try not to get cancer this time?

            Looking back is no more a sin than looking close, but neither comes easily. In the days just before and after my surgery, I refused to watch as the lab techs drew my blood. Feeling I had already lost too much, I could not stand to see them take more. Always afraid of needles, I had grown more so during the biopsy following that first ultrasound. Reassured by the procedure’s fussy name – “fine needle aspiration” – I nevertheless recoiled when a doctor offered to present the long, thin implements that she would plunge into the soft tissue of my neck. I think she meant to comfort, to show me I had nothing to fear. This will be, she said, a minimally invasive procedure, one that would leave no mark, and cause no pain. I appreciated the gesture, but I still turned away, dreading both the instrument and what it might reveal.

            My neck craned back, I couldn’t see what she was doing as she worked, but I was close to tears at the possibility that I might. Somewhere outside, Catherine was lost in the labyrinthine corridors of the hospital basement, trying to find the room they had taken me to. Glad she couldn’t see me like this, I still wanted nothing so much as to have her there. In her absence, one of the techs took my hand and held it tightly. It was this kindness that finally set me to sobbing. Comfortable with the knowledge that others would hold me up, I collapsed into my own anxious sorrow. My eyes were fixed on the ceiling where someone had pinned a picture of tulips, newly blooming, to the acoustic tiling. The tech remained faceless to me, perfectly caring in her anonymity.

            Afterward, another doctor arrived to study the slides of my purloined tissue. Cheery, she broke protocol as she looked over the first batch. I see inflamed cells, she said, evidence of Hashimoto’s disease, but no sign of cancer. If the tech was still gripping my hand, she must have released it then. While the rest of us bantered, the doctor continued her work in silence. Standing, she told me that she would pass her report of to my endocrinologist, that I’d get my results soon. She made no mention of what she’d seen on the second slide.

--- 

With Catherine, after the biopsy, mid June 2014

With Catherine, after the biopsy, mid June 2014

 ---

          Six months out, an ultrasound tech ushered me out of the waiting room, introducing herself as R--. Following her as she wound her way through baffling corridors, I felt a tingling sense of familiarity. It took me the full walk to recognize her – I had hardly seen her face – but the warmth of her tone, clipped with the careful precision of post-colonial schooling, called back the steady pressure of her hand around mine. Were you there for my biopsy? Do you do that sort of thing too? I asked. She studied my chart for a moment, perhaps feigning incomprehension. Not today. Just an ultrasound today. As I leaned back, she coated my neck in gel, and I was surprised by its heat, as if it were the first time I had been in such a room, endured such a test.

            Before I left, R— handed me a CD, images of my neck, the ones she had just made. My laptop sputtered and growled at me when I slipped the disc into its drive, unfamiliar with the feel of physical media. I did not hesitate before opening the images, but I could make no sense of what I saw there. Indeed, there was nothing to see, just the tattered expanse of an unmade bed. Hard as I looked, I could find no sign of the thing I’d feared. I didn’t understand the images, of course, but I also knew enough to know that there was nothing left to see. My thyroid was gone and the cancer with it, leaving only a tangible absence where a butterfly had been.

            These days, I sometimes turn to watch as the vials fill. Somehow the process goes faster when I do. The techs seem to approve. Hurts less that way, doesn’t it? one of them tells me, slipping the needle into my arm. Strange how the veins do the work, tricked into releasing that which they hold dear. And yet that steady stream is not lifeforce leaving so much as it is a reminder of life carrying on.

            In the future, I will not mark the time since my surgery in days or months, but in drops of blood and waves of reflected sound. I will watch the shapes they make as they wash up on my shore.

The tattered expanse, January 31, 2014

The tattered expanse, January 31, 2014

Caress and Carry

            The cat – and he is that now – does not understand that the various parts of my body are distinct. Where I pet him with my hands, he merely feels flesh flattening his long fur. When he wants to play, he will sometimes pounce on my knees, as if expecting them to grapple back. And when I stretch out on the carpet, he pokes at the place on my side where my shirt rides up, asking exposed skin to respond in kind. To him, any gesture, even the mere collision of bodies, can be a caress.

            Animals understand things about contact that we have long since forgotten. In Seattle, Meto, my mother’s dimwitted goldendoodle, would approach Catherine in the morning and extend a single paw. For this, she seemed to expect neither treats nor praise, wanting nothing more than the gentle pressure of a hand closing. Courtly as she was, however, she would forget about Catherine minutes later, having wandered out of the room and then in again. Taken aback by the suddenly alien presence, she would stand, barking her alarm, in the doorway. Still, I think she would have been content to sit with Catherine, pads to palm, forever. Contact assured her that the world was stable. In touch, we make the things we love real.

            Sometimes too we must touch the things that frighten us to rid ourselves of them. My grandmother learned that she had cancer a month or two before I did, though hers was of the colon, and was large enough to have spread. Worrying over her condition was a preparatory exercise for doing the same with my own. Nevertheless, the seriousness of her condition eluded me at the time, partly because the West Coast seemed far away and partly because events moved so quickly. It was stage two, we learned soon enough, and operable. She was in surgery within a week. The incision was small, the thing they removed less so. My mother saw a photograph of it resting in the surgeon’s cupped hands, its mass underscoring the literal gravity of the situation.

            A dog’s paw has weight when we grip it, as a tumor does when we carry it, within or without. However strong we are, holding a thing, any thing, pulls us down slightly. This is why we hug: When we circle ourselves around one another we hold each other up. For a moment, you take on my burdens and I take on yours – the one and the other in equal measure – so that we can both stand with confidence. Sometimes, like Meto, I hesitate when someone moves to embrace me. I don’t step back for fear of contact, but because the intimate generosity of the act takes me by surprise.

            And what surprises us more than the fact of love? On the last warm weekend of the year, some of our friends rented a farmhouse in rural Maryland. Catherine and I arrived last, dusting up the driveway in the early hours of Saturday afternoon. Coming from the garden, a bundle of turnips in hand, Thom opened his arms by way of greeting when we approached. Happy as I was to see him, I felt my brows scrunch together and my head cock to the side, briefly perplexed by the realization that I had a friend in him, that he was real and that friendship was real.

            In the evening, Thom and Marin harmonized in the basement while the rest of us lounged on long couches. I kept photographing them, trying to capture an experience that already had the texture of memory. Though we were deep in fall, I wanted to ask them if they could sing Belle and Sebastian’s “A Summer Wasting.” Buoyed by song, surrounded by the voices of my friends, I thought back to a July night in a larger barn, when I cried as others sang. Then as now, what could have been a summer of wasting away had merely been a summer luxuriously wasted. Each in their own way, my friends had wrapped themselves around me, held me up.

            They had held me up, each according to their nature. The day that I was diagnosed, my housemate Lydia had heard me passing the news on to my mother. What does that mean? my mother had asked. It means I have cancer, I snapped back, too fast and too loud. Always in motion, even when she is still, Lydia was coming down the stairs as I spoke. I felt her pause between steps when my words made their way to her, as I must have secretly hoped she would. She waited out of sight in the kitchen until I had hung up. Occasionally evasive, but never aloof, she came into the living room and perched like an inquisitive bird on the arm of the couch. Then, the simplest, kindest thing: She laid one hand on my shoulder, telling me with a touch that this was no dream from which I would awaken.

            Sometimes while I am writing, the cat makes a ball of his body on the unmade bed beside my desk. When one of us picks him up to carry him into another room, we cup him carefully between two hands to let him go on sleeping. Encircling himself, he is like a small planet, a tiny globe of flesh and fur. Lifting him aloft, we make his gravity our own.

Quiet Company

            The language of survival tells us that there is no such thing as life after cancer. Even when it is gone, we carry on as if it might linger, knowing that what was invisible once might haunt us again. Survival implies endurance and endurance suggests that there is something we must endure. Living with cancer, then, entails living with the fact of cancer, living with the mere idea of it. That idea projects backwards in time as surely as it does forward, rewriting our old narratives. How long was I living with cancer before I was living with it?

            In an early meeting, I asked my surgeon just that. She studied my chart for a moment. Given its size? Two years, maybe three. A vague figure, named so casually that I took it to be inconsequential at first. If it had been there that long and was still so small, the month between diagnosis and surgery presented no real danger. Only later did the weight of time begin to settle on my shoulders. Had it been there when I first met Mick? When Celeste and I broke up? Sickness bespoke a secret history, a story that shadowed my own.

            The horror of cancer may always be partially retroactive. We worry first over what it did before we discovered it, how large it grew and how far it spread. Laying claim to time we had thought was our own, it lends a new meaning to the word disease: Diagnosed, we catch a glimpse of a figure that must have been watching us before we knew it was there, always hiding just out of sight.

            It is, of course, only retrospection that summons up such specters. When we say that we are living with cancer, we typically mean that we are living in spite of it. Life itself turns antagonistic, becomes a running fight. There was, however, a time when we simply lived together. Until we met, my cancer and I were like roommates on different schedules, the one always waking after the other walked out the door. Illness is a domestic stranger. We do not play host to cancer so much as we unknowingly sign a lease with it.

            After my first semester at Georgetown, I returned to Ithaca to teach two last classes. I took a room in an anonymous apartment building downtown where I was joined by a visiting British mathematician, pleasant enough but dull. Locked in our separate spaces, we would sometimes go days without seeing one another. Only the dirty dishes that would occasionally pile up in the sink reminded me that I was not entirely alone. That knowledge made me happy to wash them without complaint.

            As the snow melted that spring, sea lampreys found their way up the shallows of Cascadilla Creek. Unimpeded, they soon established a spawning ground in the slow moving waters between Tioga and Aurora, mere blocks from my temporary home. Creatures out of another epoch, they seemed to change their shapes as I watched them from the sidewalk, serpentine bodies weaving against the slight current. A foot long, sometimes longer, and thick as gym class ropes, they evoked an atavistic dread. These, I kept thinking, were visitors from a forgotten past, a time from which we could only run.

            I visited them regularly, keeping count of their numbers.  As if to prove that I was not afraid, I occasionally scrambled down the embankment to examine them from the water’s edge. By day they were stationary, sleepless sentinels under the sun. Like all monsters, they were invisible at night, but sharp splashes would sometimes cut through the evening silence. They stayed in town as long as I did. We were both gone by midsummer.  

            An invasive species, sea lampreys threaten to wipe out all other fish throughout the region. Theirs is a parasitic form of life so prolific as to threaten those on whom they prey. Holding tightly to a thing, they literally drain it of life, gradually emptying the bodies of water that they fill. Mindlessly predacious, they aspire to their own annihilation. Thinking of them now, it is tempting to compare them to the cells that were multiplying within me as I studied them. And yet their story is farther from illness than it is from my own behavior. They kill the things to which they cling, much as I was killing myself by clinging.

             Lampreys lose their teeth in the spawning season, leaving empty circles in the place of spiked maws. They latched onto me all the same, holding on in the way that nightmares do before the first cup of coffee. After my departure, I likewise held to the place I had left and the life I was losing, clamping down with my teeth as new currents pulled me downstream.

            My grip failing, I floundered in the months that followed, unfair to myself and crueler to others. When I could, I composed long letters to the friends I had left in Ithaca, rendering the mundanities of my life in the District as richly as I could, seeking to close the gap between here and there. In a conversation with Celeste, I worried aloud that I was made entirely of sorrow. My psychiatrist, in plainer style, but with a professional commitment to paradox, simply wrote, Patient presents with minor major depression. These feelings were not entirely new, but Ithaca had held them at bay in its constancy. Inconstant now, I felt for a time that I was drowning.

            I carried a constant with me through all of this, though I did not know it at the time. Today, illness inscribes itself over that narrative, my departure from Ithaca made darker by the shadow of a cancerous cloud. But that it does so need not produce terror. To the contrary, I take strange comfort in the knowledge that something joined me on one side of my sorrowful season and did not leave me until another had arrived. Cancer sat with me in the way that Catherine would when we learned it was there, persistent even in silence. So, if I must always live with cancer, I would prefer to dwell on the ways it kept me company, on the ways that we have already dwelt together.

            Months after my surgery, I dreamed that my tumor was still with me. In the dream it had become something else, no longer cancerous. No friend, it was not a monster either. It was just a lazy roommate, its unwashed dishes slowly accumulating in the sink.

Scar Tissue: IV. Time Teaches

            Ben is only thirty years old, his scar half a year younger. He tells me that it curves around the left side of his torso, exterior mark of an impossible rib. Others would ask him about it when he was younger, ask him about it after they swam. Why shouldn’t they? Old injuries mark our otherness. Once wounded, he showed himself in his specificity.

            I have had my share of surgeries, but I find it difficult to picture Ben’s. He was so small, so small at the time that they had to cut him open to clear the pneumonia from his lungs. It must have been difficult for his doctors to imagine it too: None of them had performed such a surgery on one so young before – no one had, not in his hospital at any rate. His experience, an infantile blur of inexplicable feelings is literally unthinkable, far as it is from the class of sensations that adults call sensible. Improbably, then, I envision him through the eyes of his parents. Surely they were terrified, uncomprehending at the sight of their breathless son swallowed up by machines.

            These days, Ben says, no one inquires after his scar. As he has aged, it covers less and less of his flesh. Scars, it turns out, are like puppies’ paws or kittens’ eyes, already the size they will be, almost from the start. They do not shrink as we thicken, though they may seem to. I would have thought they grew with the body, but instead they stay just as they were, paradoxically constant and inconstant.

            Memory, we know, mutates: We elaborate it as we go. Always a conversation between has been and now happening, recollection selectively constructs the former to meet the needs of the latter. If scars inscribe memory on the skin, they always remain in the moments they remember for us. In this, they are more honest than our actual memories, which reshape themselves to meet the needs of the moment. Ben, of course, has no knowledge of his infantile illness, too young at the time to secure even an image of it. Perpetually present, his scar simulates memory by whispering of an unknowable past. But in its insistent immutability, it betrays itself, so unlike memory in its refusal to change as he does. Scars indicate the mere fact of anteriority, signifying the past without dictating its meaning. What does Ben’s scar say? Just that he once was smaller. Just that he once was sick.

            Sometimes our bodies tell us even less. Below my right eye a crease slopes over my cheekbone at a forty-five degree angle. It has been there at least as long as I have been studying myself in the mirror, though I have never learned what caused it. Such bodily marks are like Linear A, the untranslated script of the Minoans. They suggest meaningful things that transpired before we learned to make meaning. At best, we can write over them, tell stories about them. Ben’s scar, my crease, these things are like the blank lines in my notebook, inviting a narrative whose form they cannot dictate in advance, a narrative synonymous with the bare fact of living on, of endurance.

            All scars may be memories, but not all memories are conscious. Ben and I are both marked in ways that suggest places in our pasts we cannot visit – little islands, lost islands. Something, these marks say, once hurt us, hurt us before we knew how to distinguish hurting from the mere pain of being. Insofar as they refuse to grow with us, they suggest that past pains might be just that. Unless it fades completely, a scar always stays what it first was. But to wear a scar is to be something else, something other than we were then, something made different by the ongoing fact of survival.

            There is a lesson in this: Tragedies that overwhelm us at the time need not grow with us. Though Ben’s scar chases his age, from another perspective it is always six months old. No mere indication of childhood pain, it is a child in its own right, a small thing that can only ever seem smaller. When we are sick, others speak to us in the deadeningly hopeful language of cliché: This too shall pass, they say. Most things do not pass. Many of them mark us forever. But so long as we refuse to worry over them, so long as we don’t reopen the wounds that sit below our scars, that which does not pass cannot grow. Scars tell us to take time, standing still as our own worlds spin like second hands.

            Some acts are irrevocable: We cannot unsay the cruel word spoken before a breakup any more than we can reverse the poor decisions we make afterward. Likewise, once we have been sick we have always been sick. Maybe our bodies remind us of the things we cannot recall to show us how we have grown, and how much we will grow. Time teaches that things do not pass. Time teaches that what seemed large was small from the start.

            Time teaches that I was small once. In a photograph that Catherine unearthed at my mother’s house, an impossibly young version of me glances backward over his shoulder. His hair is still curly and he is smiling. I have no memory of ever being so beautiful, so free of scars.

 

                                 At the house by the arboretum, mid 1980s

                                 At the house by the arboretum, mid 1980s


            -September 16, 2014-October 15, 2014

            Washington, DC and La Plata, MD

Scar Tissue: III. Topographies of Grief

            -for CP      

 

            In the middle of a summer that already feels ancient I explored the ruins of old Aptera. Located on a hill high above Crete’s Souda bay, Aptera bears witness to the island’s long and troubled history. At other sites, one finds traces of Crete’s first known inhabitants, the Minoans. Aptera, however, evidences generations of the occupiers who came after. The remains of a Doric theater lie near the parking lot. Following the trails, one comes to a Roman villa built hundreds of years later. Elsewhere, a twelfth century Christian monastery still stands, as does a nineteenth century Turkish fort. Near the summit, the underbrush rises to reclaim artillery emplacements left by the Germans who held the island during the Second World War. As in some Byronic poem, goats and sheep wander freely.

            Climbing the hill, moving from one ruin to the next, I felt as if history itself were accumulating. We often speak of epochs as if they follow one another, but at Aptera each one piles atop the last in the way that days do, always gathering, always rising. There is a lesson in this topographic peculiarity: New civilizations do not grow out of the ruins of the old, but on the soil that buries those ruins. Concealed beneath the dirt, their predecessors cannot inspire; they can only make their descendants a little taller, let them see a little farther.

            It is apt, then, that Aptera stands so high above the Aegean Sea, that it commands such a sweeping vantage of the inland plains. It was this height that led so many to erect homes and cities here over so many centuries. Did the hill stretch upwards from the things they left behind? Some say that there are other ruins, Minoan ruins, buried just a few meters beneath the soil, hidden these three millennia. I know there can be none beneath those, but I like to imagine they go all the way down, each strata a forgotten story. How many civilizations would have to fall to raise such a hill? How many to give us such a view?

            On a hill in Crete I explored old Aptera, but I did not explore it alone. I walked with Celeste, walked with her as I often did then, as I so rarely do now. And as in a dream where events seem to follow one another with little to connect them, we made our way from one site to the next, studying what remained of each. Together, we followed dusty paths, paths that cut through fields of wildflowers. Paths are accidental excavations, and walking along them is a way of digging by habit alone. As we trace them, the ground gradually gives way. In time, stream beds form where our feet have fallen, the land itself changing beneath us. We dig faster when we dig together: To walk with another is to texture the world. Our tragedy is that we inevitably cover over the landscapes we make as we wander.

            Almost two years to the day since Celeste and I ended our relationship, I can no longer walk the trails we dug with our passage. At first I thought they were gone because I was, gone because I had distanced myself from the world we made together. Remembering Aptera, I wonder now if they are really so far away. Like the unseen Minoans, they must rest beneath the terrain I explore today, lingering just below my feet. They contour the ground on which I walk, but subtly so. The past speaks to us in a language of peaks and valleys.

            Each new phase of our lives is a scar that forms atop those that preceded it. And scars? Where scabs tell stories of healing, scars are the marks of a body that has long since healed. Cancerous, I finally buried the years I spent in grad school, entombing my time with Celeste beside them. My disease inters most of a decade, just as those years did to others in their own turn. This new present coheres to the curvature of the past, taking its shape from the shattered structures of abandoned homes and empty classrooms below. Ruins are the residue of dreams from which we think we have woken, the residue of dreams that are already slipping away. If we exhume them, we do so in the hope that we might get back something so dear we could only ever forget it.

            Cancer buried the ruins of my past in a rich soil, replaced old dreams with newer ones. Though Aptera’s Hellenistic inhabitants built their own temples on a Minoan topography, they did not push out those who came before them. That earlier civilization fell to its environment, crumbling in the face of volcanic eruptions, famines, plagues. The end of my relationship with Celeste was, likewise, a matter of climate, of a glacial chill that froze the spaces between us as I pulled away. I cannot, then, fault my illness for the loss of the dreamscape it blankets; cancer merely grounds a new beginning, one rich with possibility and hope.  Why, then, do I still grieve? I grieve because I am inescapably aware of the invisible forms that shape the uneven earth on which I build.

            Our lives are burial mounds, each new layer a monument to the ways we were before. They grow, these mounds, expand slowly, but they are not tumors. Call them scars. Call them swellings of the soul.

                       With Celeste, Souda Bay, Crete, 2009

                       With Celeste, Souda Bay, Crete, 2009

Scar Tissue: II. Memory’s Line

            At our final meeting, my surgeon handed me a sample size package of scar cream. The attached pamphlet suggested that with regular application, I could make the mark of my procedure all but invisible. A sample image showed me what I might expect after months of regular application: Redness and ridge would fade and flatten. Nothing is ever truly lost, but memory can be made less distinct. To induce amnesia, apply twice daily.

            In the scheme of things, my cancerous month occupies a tiny portion of my life. Studying the calendar, I count twenty-nine days and a handful of hours between diagnosis and the conclusion of my surgery. It was another nine days before I received the pathologist’s report, and with it the knowledge that I was in the clear. Added together, those patient weeks account for just over a quarter of a percent of my life to date. As years come, and they only ever can, that fraction will grow more fractional. However much those days may mean, other eras of my life will surely eclipse them.

            Days, hours, minutes accumulate endlessly, piling up too quickly for us to hold them in place. No wonder, then, that we most often recollect our pasts in still images, images that freeze the world in order to halt the relentless erasure of self-knowledge by the constant arrival of new information. In one such image – my first – I see my mother and father arguing in the kitchen of our rented house, the one out by the arboretum. It is night and they do not know that I am awake. Cloaked as I am by the living room’s darkness, silent as I am in my smallness, my presence goes unnoticed. I cannot say how long I listen to them, much less what they are saying, but in the perpetual present of recollection I have been waiting in those shadows all my life.

            My mother tells me that this scene is impossible. She says that they would have never argued while I was in the house, not until after the divorce. Tangible as the scene feels, she is surely right. We must gather our pains before we can paint such pictures, mixing colors from pigments found here and there. Still images condense whole swaths of personal history, making our pasts manageable by making them small. This condensation gives rise to the illusion that isolated moments matter most, that traumas always befall us in a flash. Surely they sometimes do, but it may be our slow motion tragedies that ask the most of us: Not the blow, but the broken jaw. Not the breakup, but the months before. These are the experiences that befuddle us. Theirs are the feelings that elude the understanding.

            A possibility, then: As a child, I surely knew that something was wrong in our house before I could say what it was. The air must have been heavy with incomprehensible ill-will. Memory makes all those ugly hours collapse into a single explosive evening, inventing a fiction to account for an unbearable reality. Like a rain storm on a hot day, a fight might have come as a relief, even if it left me shivering. However unpleasant it would have been, at least I could have grasped it. The scene framed by the kitchen doors is small enough that even my small eyes could take it in, take it in all at once before turning back to the surrounding dark.

            Sometimes I close my eyes and run my finger along the length of my scar. A mere two months since I woke, coughing, in the recovery room, it still stings slightly when I touch it. What seems raw to me must be invisible to others, though. I still sometimes catch myself pointing it out, pulling down the collar of my shirt to show it off. I display it especially to those I have not seen for some time. You’re looking well, they tell me, sometimes quizzical, as if unsure that I was ever sick. I offer them my scar as evidence that something was wrong, that I paid a price, however small, to be well again. I show it to them to prove that they missed something, something important to me, a part of my life. A single month, unrepeatable.

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            My scar is evidence, yes, evidence of a month that I would not repeat but do not want to lose. That month’s images accumulate: there were two ponds behind the barn where my friends made music while I cried. Swimmable, but thick with silt, they pulled out feet down as we waded out. Fish flitted about, showing no interest in either our floating bodies or the unbaited hooks that we would cast their way. At night, bullfrogs thrummed in chorus amongst the reeds. What could be smaller than these things? What could have meant more to me? For a month, every day was just that and in that every day was just right.

            Studying the scar cream, turning it over in my hands, I asked my surgeon whether anything would happen if I didn’t use it. Not really, no. My scar would be a little more prominent for a little longer, would recede a little more slowly. Eventually, it would disappear into the fold of my neck, much as Sarah’s had. Okay. Good. I would let it linger, image of a time that would inevitably fade, a period that had not been a full stop. Pain shapes us as loss makes us. Let the line of my scar last, securing what has been in a single image of what was, thirty-eight days as full as they were fearful.

            Time, I keep writing, is a field. And memory? Memory is a line. When I close my eyes and run a finger along my scar, I feel the way events unfolded, each following the last. When I open my eyes and study the breadth of it, I see the way they join hands.

            This is how our bodies remember. A scar is what gathers.

"Lucky"

            The day before I went into surgery, one of my students approached me as class was ending. Almost carelessly bright, she would smile even when she was serious. She was smiling now, and her tone was severe. I want to wish you luck, she said, hesitant. But I don’t believe in luck. So. Hope it goes well? A wry nod. Thank you. And I left to begin my fast.

            I do not believe in luck either, but I keep calling myself lucky. Lucky to see the endocrinologist who found my cancer, lucky to meet the surgeon who removed it. Lucky that the nodules were so small, lucky that the disease had not spread. Lucky for my insurance, for my friends, for the kitten who sometimes sleeps on my chest. What can I call this conglomeration if not good fortune?

            A few days after I came home from the hospital, a woman I have never met wrote to me about her own thyroid cancer. A different, more pernicious variety than mine, it was the product of a genetic endocrine disorder that had gone untreated for too long, leaving her with inoperable masses throughout her body. My prognosis is good, she suggested, though she didn’t say so in as many words. Maybe I heard that phrase because it’s one that keeps recurring, a sexta-syllabic balm seemingly meant to assuage the helplessly healthy as much as it comforts the interminably ill. I wrote back with empty confirmations, unsure how to comfort someone whose condition was so much more extreme than my own. She did not respond. I think of her sometimes, wondering if she is well.

            The enormity of illnesses like the stranger’s renders me timid, uncommonly uncertain, especially when I relate them to my own. She had asked me about my surgery, about what might be ahead, and I struggled to tell her anything at all, anything that would not pale before what she had already experienced. I would have liked to offer some wisdom, but I know that I had little more to give than the silence of an attentive ear.

            Nominally speaking, our disease diverged only at the tertiary level: Cancer, yes. Thyroid cancer, yes again. In light of these large correspondences, the scant sounds that distinguish my papillary thyroid cancer from her medullary thyroid cancer seem small things. But here language fails us, unable to efficiently capture the vast difference between our distinct ailments. My good fortune divides me from the stranger, places an ocean between us.

            This lonely asymmetry returned to me weeks later as I spoke to a colleague about the death of his father. Similarities to the stranger’s illness came back at first: A growth on the brain, a swelling that surrounded it. Wanting to commiserate, I could once again only listen, head nodding. Until this: My father did not die of cancer. It was the diabetes. Diabetes, a disease he had regulated for years, decades maybe, with diet and exercise, made suddenly unmanageable. By what? By the very drugs he was taking to treat the cancer.

            My colleague’s office window was open, and he occasionally let something outside catch his attention as he spoke. I can’t say when I started to tear up, but I was glad he couldn’t see me when I began. It seemed somehow unfair to cry over the story of another’s loss, and he had lost so much during my own cancerous summer. I was ashamed, ashamed not because I was crying, but because I was crying over events that my colleague must have felt more deeply than I could know.

            In his story, though, I found an unexpected congruence with my own, as if I was looking into a warped mirror that showed me myself larger. Listening, I thought of the fuzzy days after my surgery, of the way my blood sugar levels kept climbing. No amount of insulin seemed sufficient to contain them. Convalescent, already helpless, I had felt my everyday regimes of self-care crumbling. I remember briefly thinking the surgery hadn’t been worth its consequences. But my own glycemic crisis was ultimately brief, survivable. A single week bound its horizon. Nevertheless, in this story I saw my own queasy loss of control play out on a more sorrowful scale.

            Decades before, my colleague’s father had moved to western Ireland. On Inis Meáin, the middle of the three Aran Islands, he had helped to establish a textile mill that still stands today. I had hoped to visit it, but the unamicable Atlantic had made the trip too difficult, leaving me to explore Inis Mór for another day.  Had the rough terrain of the islands spoken to my colleague’s father as it had to me? I know this: On Inis Mór’s towering cliffs I had learned how small I am. I learned this lesson again in my colleague’s story. Smallness is a vantage: To know yourself small is to observe the world moving around you. Watching giants stride, I think myself not lucky, but grateful.

            Still, call me lucky if you like, but not just because I am healthy. Call me lucky because my story is so small. If I am a creature of good fortune, I must still admit that my fortune amounts to a paltry sum. I could not, would not, will not ask for more. I want only to stay small, to keep telling small stories, stories like pebbles on a rocky beach, pebbles made smooth by the force of a rougher sea.

Scar Tissue: I. Adhesive

            Bandages are a dividing line, a boundary between the body and its environment. In this, they are not unlike the frames that surround works of art. They at once delineate the limits of the skin and pertain to the world beyond it.

            The thumb – the thumb whose tip I severed long ago – never quite healed right. Sometimes I sense that the old wound longs to reopen. It did last December when my new paring knife slid through nail and flesh, curving around bone, as I too hastily pulled it from its packaging. Unable to find any gauze, I wrapped it in toilet paper. The white tissue discolored almost instantaneously, as if flushed with embarrassment at my overeager clumsiness.

            When it is wet, toilet paper tends to break down to its component parts. Its errant fibers attach to whatever happens to be nearby, especially open nicks and cuts, making it a surprisingly powerful coagulant. Watching my hastily prepared dressing darken and dampen while I walked to the corner pharmacy, it occurred to me that an exchange was taking place: As my blood blended with the paper, the paper was giving a part of itself over to me, offering me a second skin.

            This gory potlatch sketches the logic of the bandage in crimson ink. A bandage is an inoculation against otherness. Holding at bay the world from which it derives, it protects us by replacing part of what we have lost, however temporarily. But just as bandages protect us from the world, they hide a part of our bodies from us. Occluded by a bandage, an injury becomes almost invisible. Bandages engage in an unbearable intimacy with injury, cozying up to our wounds so that we don’t have to.

            Two weeks to the day after my thyroidectomy, I pried the bandage off of my neck, ready to refamiliarize myself with the skin beneath. Fumbling with an object I had previously refused to touch, I realized it was little more than a thin film of glue covering the stitches my surgeon had already removed. I had expected something larger, perhaps a gauzy pad through which blood might leak, a pad not unlike the ones I wrapped around my thumb after the toilet paper came off. Instead it was almost invisible, little more than a discoloration of the skin. Small and gray with the grime it held off, it often went unnoticed.

            It wasn’t until I was peeling it off that I remembered I had seen one just like it before. Catherine had pointed out a woman whose wound was identically dressed in a Port Townsend café. At the time, I had supposed that her own thyroidectomy was already receding into the past. Pulling the adhesive from my neck so soon after surgery, I realized that she must have been a few scant days out. Though I can no longer picture her face, I can’t help but project a dazed look over her hastily recalled features. Where I once wanted to ask her questions, I now long to assure her as one might a frightened child. Everything will be alright, I would coo. You are already alright. And she is.

            I would comfort her as I might a child who has lost something very dear. I would comfort her as if she were a child because I felt like one as I stood in front of the mirror, peeling my bandage back. As it came off, I kept forgetting that it wasn’t really a part of me, that it wasn’t like the scab that formed over my injured thumb. Something about the way healthy skin puckered where the glue still held contributed to the illusion of organicity. Only the way it crumbled beneath my fingers reminded me that it was made of rubber.

            I took it off in two stages over the course of a long morning, first the right half and then, a few hours later, the left. Both times, it momentarily occurred to me that I should keep the piece I had just stripped off. For two weeks, this artificial skin had hidden an absence. Perhaps it could guard against my new lack a little longer. I considered sealing the adhesive halves in small, glass-windowed boxes to guard them against gathering dust and passing time. In the palm of my hand, these formless fragments seemed almost adorable. Twice I felt a twinge of regret as I dropped them into the garbage can.

            Precisely insofar as they seem a part of us, bandages sometimes become advance images of our scars. As I removed the adhesive from my neck, I imagined I might catch a fleeting glimpse of an injury I had felt, never seen. But beneath it, I found only the bandage itself in miniature, the redness and ridge of a more permanent border.

            No more bandages. My real scar is keepsake enough. I will wear it like an amulet.

Heat Lightning

(for SK and BS, in advance of their wedding)

 

            We have all known bright rifts that tear open the sky, diagonals on diagonals, angles acute and obtuse, shattered signs signifying the mere fact of electricity. What does the lightning bolt tell us? It tells us that for a moment, only a moment, heaven and earth might come together. A narrow path binds them. We must sprint if we hope to traverse it.

            When we are children, it is not the flash that frightens us, but that which lags behind. The lightning bolt is beautiful; we delight in it. It is the sound that shocks us, the audible crack that chases the light. Thunder names everything that comes after the first flash of affection. As we age, we learn to hide our fear, but somewhere inside we still run from the sound. By the time our ears stop ringing, we are elsewhere, gazing up at the sky, waiting for the next storm.

            When I was a child, I sometimes imagined that love, like the sound of thunder, had a constant speed. How else to explain why adults always fought on road trips? Was the interstate traffic simply too fast for the heart to keep up? From the back seat, I would watch as clouds gathered, knowing there was no time to take shelter, no way to flee. Its arrival would go unannounced by lightning. Only the explosive call and response of thunder waited.

            Perhaps heat lightning put me at ease because it is silent. For an instant the whole horizon lights up. Then again and again. With no definite source, these diffusions of distant storms seem to be one long moment of illumination. Too far from us for sound to carry, their intermittent yet uninterrupted light is all that we know, all that we can see. Heat lightning has a quiet beauty, a beauty without bluster.

            Part of me remains stranded in the Ohio summers of my childhood. See me standing on the edge of an endless corn field, my body dusted by rain. Light blooms to the east, blooms like a closed fist slowly opening. In the absence a sudden peal, the light itself seems to roll toward me. It lingers like the memory of lavender , gathers like a benign scar on the brain. It fades but the tentative brightness stays with me. The rain falls like a blanket, and I am warm.

            Love names the hope that a light will fill the Midwestern sky. A light that will last.

 

            -August 23, 2014-September 13, 2014

            North East, MD - Washington, DC - Beacon, NY

Survival: IV. Love Sick

            The two narratives of my fast fading summer intertwine in a chiasmic knot: Falling in love made me sick, but in a later sickness I learned to love a little more fully.

            It starts with this: Shortly after I met Catherine, a rash appeared on my lower back. I had been wandering through the woods of my childhood that morning, reminding myself of its sacred spaces – the cave, the broken dam, the spring. It occurred to me that I could have brushed up against poison ivy, but how would it have touched my lower back alone? A single swath just above my right iliac crest, it resembled a crudely charted island on an otherwise unmapped sea.

                                           In the woods of my childhood -- the spring

                                           In the woods of my childhood -- the spring

            Passing through Pittsburgh on my way back to Catherine, I showed my flushed, rough skin to Celeste who nonchalantly diagnosed me with shingles. What triggers shingles, I asked the Internet, embarrassed by my ignorance. Excess cortisol, probably. And what produces excess cortisol? Lots of things, it turned out, but one caught my eye: Falling in love. And I was.

            The first flush of a new romance almost always resembles an illness, though it rarely takes the form of a real rash. It should be no surprise, then, that we employ metaphors of sickness to make sense of the otherwise overwhelming sensations that we feel when we are in the thick of it. Think of Sappho, who describes as yet unfulfilled desire in feverish tones. Singing across the multi-millennial divide in Anne Carson’s translation of Fragment 31, Sappho describes “fire… racing under skin” even as she allows that “cold sweat hold me and shaking / grips me all.” Though she speaks of paralysis throughout the poem, the contrapuntal pull of fire and ice most clearly dramatizes her romantic inaction. Shaking grips her precisely because emotion pulls her from the one pole to the other and back again.

            These are the conjoined sensations that leave us bedbound when we are ill, unable to comprehend the paradoxes of sensation. Those we love sometimes render us silent and still by evoking similarly contradictory feelings. Like a patient with a fever, and like Fragment 31 itself, we vibrate, vacillating too quickly between one state and the other to move ahead. As Sappho puts it another poem, “Easy to make this understood by all”: Loving desire is nothing but a sickness that we wish would linger.

            My rash suggested that the connection between sickness and love might be material as well as metaphorical. I was unwell even before I felt it rubbing up against my shirt. Surely you know what I mean, know that dizzying spiral that curls around your spine, now tensing, now relaxing, only to contract again. And when life resembles a fever dream, the manifestations of a real sickness can come as a kind of relief. The scarlet eruption of shingles confirmed the otherwise intangible fact that something strange was happening in my body. It was a displacement from the first cause, yes, but no less helpful for it. In love, I fell sick, and in sickness I knew that I was falling in love.

            If the rash had lasted longer, if it had penetrated any deeper or bloomed more widely, I might not have seen it in such terms. As has so often been the case recently, my prognosis was implausibly positive: I experienced none of the disabling nerve pain that sometimes hobbles others, none of the infection’s lingering effects. The doctor I visited a week or two later shrugged it off, explaining that the worst had already passed.  He turned instead to more chronic conditions, wrote out a referral for the endocrinologist who would, a month later, carefully inspect my neck. I did not dwell on shingles any longer than it dwelt on my flesh, too busy coming to know its direct cause.

            Our bodies are strangely incapable of distinguishing what is good for them from what is bad. Joy can have the same consequences as anxiety, and love can make us fall ill. Here we find no fault in ourselves, just as we think no less of love when we weaken in its wake. We might, however, think less of ourselves when we come to love our sicknesses. For years before my cancer diagnosis, I had been like a man fumbling through the fog, finding it difficult to write, to read, sometimes even to think. Improbably, cancer cleared the skies, set me into motion again, clothed me in a language I thought I had lost. What was I to make of this newfound energy? Was I only able to enjoy it because my malignancy was “unusually benign”? More simply, should I feel bad that I felt good about something that makes others feel so much worse?

            When I mentioned my concerns to a colleague, she nodded conspiratorially. Hedonic adaptation, she said. Hedonic adaptation? Two words, familiar alone, made strange by juxtaposition. It was a term from contemporary psychology, a dispatch from a discipline whose codes are not my own. I looked it up as I had shingles. It was first used to describe the strange experience of prisoners who came to love their cells, or at least those who found something pleasant in confinement. Surveying these studies, I felt the shock of recognition. Cancer had not incarcerated me, but it had become a site of improbable release, a release that came from its menace and not in spite of it.

            I suspect that prisoners do not delight in the smallness of their cells so much as in the fact that they have so little control within these confined spaces. When we do not make all of our own choices, every choice that we do make becomes that much more significant, that much more meaningful. This logic grows dangerous when taken to its extremes. Nevertheless, it speaks to the surprising connection between imprisonment and illness: I did not bring my cancer into being any more than the prisoner decides when the lights go out. I can only speak of my cancer’s genesis in the passive voice: It was caused by forces beyond my control. Knowing this, knowing there are things I do not and cannot cause, I began to better understand the power of my own hands.

            Let me admit this, then: I loved my cancer, loved it a little, even if I was happy to see it go. Should that love leave me guilty? Would I feel the same if my situation had been different, if my disease had been more terrible? I can’t say. I hope I’ll never have to. And yet I delight in what I can say and in the ways cancer helped me say it.

            Small things beget small feelings:

            I loved my cancer, but only a little.

            I miss my cancer, but only in passing.

Survival: III. Full Fathom Five

            Shortly after the shipwreck that opens The Tempest, Ferdinand, prince of Naples, washes ashore by himself. Before the young nobleman can catch his breath, the spirit Ariel arrives to taunt him in song:

 

            Full fathom five thy father lies

            Of his bones are coral made

            Those are pearls that were his eyes

            Nothing of him that doth fade

            But doth suffer a sea-change

            Into something rich and strange.

 

These lines suggest Ferdinand is truly alone, and not merely lost. Ferdinand’s father, Alonso, has sunk with his ship. With him sinks any possibility of comfort, any semblance of home. Shakespeare underscores this sentiment of loneliness in loss by aestheticizing Alonso’s supposed death, Transformed into coral and pearls, his body becomes something to be admired, not to be touched. Centuries before Kant’s third critique, this verse implies that beautiful things can have no bearing on our lives. In death, Alonso has been enriched, but this very richness makes him a stranger to the boy who would inherit his wealth.

            Suppose you are on stage during this scene. The set is spare, a sunsoaked beach suggested only by yellow gels over blinding stage lights. Your costume is more sumptuous, composed as it is of layered velvets, artfully stained and torn to suggest the ravages of the ocean. Ariel’s song drifts to your ears, though you never glimpse the spirit that sings it. Listening, you learn that your father is far from you. How do you respond?

            Eager to move the audience, you might first think to convey sorrow. No community theater ham, you would not drop to your knees, shake your fists, curse the sky. Instead, you would let the revelation of loss wash over you, inexorably but slowly, much as the now calm tide caresses the shores of Prospero’s island. Your jaw would unclench, molars separating invisibly. Tiny muscles around the edges of your eyes would begin to twitch. If you are lucky, these miniscule contractions might make a single organic tear roll down your cheek. As it fell, you would straighten your back, reclench that slackened jaw. Knowing loss, already learning to mourn, you would soon set out, ready to meet the Miranda who awaits you.

            But what if you felt you might feel something else? What if guilt, rather than sadness, caught you in its currents? How many mariners were cast overboard during the storm? You hardly knew those men, addressed them only by their titles – the master, the swabber, the boatswain, the gunner and his mate. Your regal father is only the symbolic summation of these innumerable and unnamable losses. Knowing this, knowing their faces, you cannot straighten your back, you cannot prepare yourself to meet your Miranda. This new world has no people in it, none of yours, anyway. Without them, you do not know how to be brave. You are guilty because so many others have drowned, guilty because you have survived. Sorrow, even a lonely sorrow, can ultimately beget agency. In guilt we are truly stranded, cast away from those who would make us bold.

----

            Few forms of cancer are more survivable than mine was, and few have been curable for quite so long. Papillary thyroid cancer can sometimes be treated – as mine was – by purely surgical means. As such, it theoretically became possible to remove it from the body as early as the 1870s, when new anesthetics and antiseptics made it increasingly feasible to operate safely on the neck. Other cases are more intractable, but doctors have employed radioiodine, which targets thyroid cells, to treat disorders of the gland since the 1940s, long before the development of most similarly focused forms of radio- and chemotherapy. The techniques for both forms of thyroid cancer treatment have continued to develop in the subsequent decades, made ever more precise and painless in the process, but the fundamentals of successful care have been in place for far longer than they have for most other more aggressive cancers.

            Insofar as we are ever lucky when we develop cancer, then, I was fortunate to find myself with a kind that both grows slowly and can be treated with relative ease. In his mammoth Emperor of Maladies, Siddhartha Mukherjee mentions thyroid cancer only three times, and on those occasions he only alludes to it analogically. Surely he does so because his book, which he subtitles A Biography of Cancer, is really a history of cancer treatment’s vicissitudes, as if disease were only worth discussing when we must struggle against it. His elision of my own ailment can only be a product of the relatively simple story of its defeat.

            And yet I do not imagine that these medical victories came easily. I think of the diagrams my surgeon drew for us when we first met her. She showed us how close the nerves of the vocal cords were to the thyroid. With patience and care that smoothed over any threat of alarm, she told us what might happen if they were damaged. You could, she said, lose the distinctive qualities that give your voice its sound. Or you could lose your ability to project loudly across a room. (Here a thought drifted by: Too old to play Ferdinand, I would never again creep about the stage as Caliban.) She discussed also the steps she would take if the trachea were torn open during the procedure. Such accidents were rare – here and elsewhere she had statistics – but they happened and we should be prepared.

            She told us all this and more, but mostly she described the steps she would take to prevent such traumas, meticulous and always particular to the individual patient. Though she did not speak of it, a long history of mishap must have hung behind her own caution. Other patients had suffered under other surgeons’ hands so that I could emerge from my surgeon’s operating theater breathing clearly with my voice intact. These nameless others are my king Alonso, my Alonso and the mariners for whom he stands, an endless procession of symbolic fathers. Theirs are the faces that sunk beneath the waves so that I might swim to shore.

----

            This is what I mean to say: I cannot help but think of those who suffered to ease my own treatment. Beneficiary of the sweat of some and the pain of many more, I have already been healthy longer than I knew I was sick. But my health has the texture of an unearned inheritance. Unaware of Prospero’s art, Ferdinand must think he survived thanks to the ministrations of drowned men. Even in his royal privilege, he must wonder for a moment whether and why he deserved such care. I know that I wonder.

            Still on stage, still wearing salt-stained raiments, you must pause for a moment after you clamber to your feet. You must pause and stare out at the sea. To stand when others have fallen is rarely to witness their fate. Ferdinand only thinks himself a sole survivor because Ariel claims the waves have made him an orphan. Precisely because he escaped, he cannot know what it would have meant to sink. If he is guilty, then, he is guilty because he knows that things could have been so much worse, knows that and knows nothing more. There is a kind of knowledge beyond his ken, if not his kin, that others have gained. He does not hold it, and his empty hands make him a survivor. He knows, then, that he only is what he is because of what he does not know.

            This is where I find myself: How can I say that I have survived something I never really knew? I am confronted by the simple fact that I remain what I am because others are not, or because they are no longer. Even as I revel in my own persistence, I am haunted by the silence of those unable to revel with me. Guilt may inhere in the very concept of survival. I experience my ignorance of a literally fatal knowledge as a fault, perhaps as a crime. This is not to say that I romanticize suffering or aspire to martyrdom. But I know that others have suffered where I did not, and so that I would not. This knowledge circumscribes everything I do not know.

            Ferdinand, at least, finds some solace. Ariel’s song is a ruse. Alonso lives, as do the crew members of his miraculously preserved ship and all its passengers. They will fête this fact together before their drama is done. Here, though, I must break from literary likeness, refuse to further aestheticize the losses that predicate my own survival. Cancer can never become coral and a pain is not a pearl. Those who came before me may be gone, but they are no less real for it. If I am to celebrate I will do so by learning their names.

Survival: II. Empathy

            In my dream, I am addressing the Washington, DC Spinoza Society. The group’s organizer has invited attendees to discuss issues they have been mulling over. Having spent much of the time since my diagnosis writing on Spinozian themes, I decide to tell the others about my blog. I raise my hand, am called on, stand.

            In the way of dreams, the room is full, but I recognize none of my fellow attendees. They are an indistinct mass, present to me only as a heaviness that expands and contracts at regular intervals. Like my own breath, their presence is a mere fact of what it means to be here, in this room, speaking. But in the way of dreams, something changes as I open my mouth. Not long ago, I begin, I was diagnosed with thyroid cancer. Immediately a wave of sorrow crashes over me. How else to put it? I feel their feelings for me. Temporarily unable to continue, I begin to cry.

            In my dream, I pause to wonder over my tears. Though I have not yet concluded my remarks, I of course know that the story has a happy ending. The audience is responding only to the first words I have spoken. Surely they will be assured, comforted, as I continue. Why, then, am I responding with them? Why does their immediate sadness catch up to me before I can share my more recent joy? In my dream, these feelings run at once in advance of my story and behind it. I am left standing in the surf, salt water all around.

            Neuroscientists long puzzled over a similar lapse in our structures of perception. When light hits the photoreceptors of the eye, there is a microscopic lag – one-tenth of a second – before the brain processes this information. As such, we are incapable of cognizing events in real time, always just a little behind. To compensate for the lag, our brains produce probabilistic images, extrapolating the future positions of other bodies from their prior states of motion and rest. In the process, we create a now that is little more than an anticipatory afterimage of what has been.

            Philosophers tell us that the present is that which is always disappearing, turning into something else as soon as we point to it. Conceptions of the absent present typically turn around the conceit that it is evasive, fleet of foot. We experience the immediate, they say, only as it slips past us. The moment we attempt to indicate a moment called Now, it is already Then. Neurologically speaking, however, we never experience the present as such; there is nothing to point to in the first place. The present is the one thing we literally cannot see. It designates nothing more than a blind spot in perception itself.

            This is all to say that when we act, we do so not in response to what actually is, but to the ways we think things will be.  When I cry in my dream, I likewise echo the presumed impact of my words, not their actual consequences. Like vision, relational empathy is a form of perception characterized by anticipation. As the empathetic act, they imagine the feelings their actions will elicit in others. They predicate their own subsequent movements on what might be felt, not on what is felt. While the lag in our visual apparatus is ultimately negligible, the temporality of empathy has real consequences. Far from a connection generated in the moment when we produce and display emotions, empathy is a form of projection in at least two senses. First and most obviously, we project our own emotional understandings onto the other. Second, we project those understandings forward in time, eliding the actual present of feeling. Insofar as it is projective, empathy – the very capacity that predicates human connection – institutes an interpersonal delay, a structural disconnect between us.

            In speaking to others about my health – and I have spoken to so many others – I have grown accustomed to the responses it generates. I have seen so many crinkled brows, so many pursed lips. I have seen these expressions arise spontaneously, summoned up by the word “cancer” itself. Knowing what is to come, I feel what will be felt, and I shape my story accordingly. As I speak, I make myself smile, cutting possible futures off at the pass. A simulation plays out within: At first I feel what I imagine they will feel and then I feel what I would like them to feel instead. Having been sick, I set out to make others well. Ultimately sending rather than receiving, I often leave little room for myself.

            In spite of all this, empathy remains a form of care. Indeed, it is in anticipation that we are most careful: Feelings take time to set in, and it takes longer still for them to cross the void that separates you and me, me and you. Distantly aware of this fact, we feel for one another in advance, reaching out across the gap. Without such a capability, we could not live together at all, as we would always be arriving too late on the scene of sadness. We live every day with this paradox: The very capacity that facilitates community keeps us at a distance from one another, a distance in time if not in space.

            Shall we fault ourselves for avoiding the present? Are we wrong to let life unfold in the convolution of “was” with “might be”? Perhaps not. I, for one, have come to distrust immediacy. My cancer played out in a perpetual present. And when I flee from my anxiety, I defer an uncertain future in favor of a familiar now. It is in the present that I have felt least alive, least powerful, least myself. Where we are normally blind to the present, embracing the moment can only blind us to everything that surrounds it. Live in the now and you will find yourself frozen, incapable of seeing, feeling, acting.

            In my dream, by contrast, paralysis lasts only as long as it takes me to think these thoughts. I finish my story clumsily, rushing along so as to get to the pleasant parts more quickly. To my surprise, no one seems moved. I have empathically misjudged their own inclination toward empathy. As I sit, it dawns on me that the tears I cried belonged neither to me nor to my audience. And yet, in my dream, those unowned tears have pooled all around me, indistinguishable from the saline sea.

            Still asleep, I wade into the surf.

The Kitten

-for K.B. and her cats

 

            This is the first disappointment: We learn that the kitten stays a kitten only as long as the summer lasts. Other things befall us, worse things, but it is the appearance of a full grown cat that stings the longest: We see a creature of pure joy become one of disinterested lethargy. Some say that kittens sleep nineteen hours a day, but they always appear to be in motion. The cats they become move only to evade you, and they insistently sleep in your field of view. This, at least, is how it feels when you are a child. This is how it feels when you first lose a friend.

            How many of us spend our lives reenacting this small trauma? In romances that spoil, jobs that turn sour, parties that go dark. In all these things and more, we once again watch the kitten become a cat. Each time, we tell ourselves that we have lost something, but the unbearable truth is that we have gained too much: Call it a sense of texture – a more specific understanding of that which we once merely loved.

            Roland Barthes claims that the word “adorable” names the inarticulate excess of every love and every desire. When something makes us happy and we don’t know why, we announce that it is adorable. Tautological from the start, “adorable” can only describe itself. The adorable, Barthes writes, is what is adorable. And what could be more adorable than the kitten? Why do we love the kitten? Because it is the kitten.

            The kitten is that which is not yet formed, that which we do not yet know. We do not yet know it because it is not yet formed, which is to say we do not want it to grow. I have known what it is to know that something still shapeless is growing. I have also known what it is to adore such a thing: Three weeks after my thyroid cancer diagnosis, I came home from a trip to the West to meet a kinder unknown. He emerged from behind the couch as I set my bags down, such a small thing that I could have held him in the palm of my hand. His eyes were as huge as they were empty, and I loved him for them.

            For three days, the kitten danced as I wrote. While I lost myself in anticipation, he chased phantoms around the living room, outpacing his tomorrow and mine. Someone said, Tell him that he is not allowed to get any bigger. Like children, we dreamed that he might not. Like children, we pretended he was not taking shape before us every day.

            When I returned from the hospital, he would sometimes launch himself onto my chest to paw at my neck as I rested. Teething, he took to nipping at my fingers and nose. Irritated, I would groggily swat him out of the way. Inevitably, he would move to the coffee table to plunge his face into the copper mugs of water I kept close. He is not drinking, Catherine said, watching him. He just likes to dunk his face in there. We were coming to know the kitten a little more each day. Or maybe this: Maybe the kitten was becoming something we could know. Still, his fur was soft, and seemingly thicker than he was. If he was growing beneath it, we could not tell.

            When we speak of loss, we mean that something has gone missing, and usually it has.  But sometimes we lose what we have loved because it is surrounded by something else, by a knowledge that spreads like moss on an aging tree. As the kitten becomes a cat, we must remember that we do not love it any less, we simply know it a little better.

            The kitten is resting on my lap as I write these words, purring out a lullaby. Our mid-August sun is setting. He will be a cat soon.

The Sitcom Uncanny

            I have spent more of my life running from anxiety than I have from the things that make me anxious. Above all else, anxiety is an early warning system. It tells us that we must coil our muscles as we surmount the ridge or turn the corner. Why, then, is it so unbearable? Perhaps because it leaves us suspended between states. In anxiety, we are rarely certain whether we are preparing to leap or to be leapt upon. When anxiety’s objects are ambiguous, anything unknown becomes a source of concern. As it does, we realize how little we understand. In this way, anxiety invades everything around us, turning the mere fact of the world into a source of dread.

            When the unknown looms, it is sometimes easiest to embrace the meaninglessly familiar. If I were a little older, I might have learned to put on a much loved record in my weaker moments, letting the wear in its grooves become a barometer of my fears. I would have said that the music provided comfort, but the truth would have been that I simply knew it, knew it intimately. Mere familiarity would have been enough to smother my threatening awareness of the unknown and the unknowable.

            Once, I might have listened to a much loved record, yes, let it hum reassuringly in the background. Today, my options have multiplied, and they have become more all-consuming in the process. Ensorcelled by my fears, I have learned many counterspells, but casting them takes all my concentration. It could not be otherwise: The familiar is a blanket. I crawl underneath it and block out the world in order to hide from my anxiety.

            When my endocrinologist first discovered the small protuberance on my thyroid, I wanted that blanket, wanted to hide. Careful not to alarm, she told me it was probably nothing, told me that nodules were to be expected with Hashimoto’s disease. She did not tell me what might lurk on the other side of that probably, and I did not ask. You will need an ultrasound, she said. Nothing invasive. Just a routine checkup. I should have found comfort in her lack of immediate concern, but instead I turned her attitude into an excuse. My logic seems strange when I spell it out now: I was worried, but my doctor was not. Therefore I would not act on my worries. It played out like this: She called later in the day to explain that she had left a referral at the front desk. I told her I would bike right over to pick it up. I stayed home instead.

            I stayed home and I lost myself in activities I had done many times before. I replayed videogames long since beaten, prepared meals already mastered, sped through hours of television shows I knew all too well. In conversation with my therapist, I spoke of these activities as “nothing behaviors.” They offered me no real pleasure, but neither did they cause me any pain. At ease with what was coming, I anesthetized myself against the haziness of the new. If these empty pursuits threatened to intensify the things I was avoiding, I took no notice. I was, after all, resisting anxiety itself, not its triggers. Allaying a symptom, I left its causes to simmer, letting them cook down into something thicker and stickier.

            This went on for a week, maybe two. Somewhere along the way, I began to rewatch the first season of New Girl, a show clever enough to make me smile and formulaic enough to lull me into a waking slumber. I burned through fourteen episodes in too few days. Nothing was unusual, and that was good. Nothing was unusual until I came to the fifteenth episode.

            Have you seen it? Do you remember the plot? Suffering from a sports injury, Nick reluctantly goes to the doctor. As he is swallowing the pain pills she has given him, she notices something amiss. Investigating his neck, she announces that there is a growth on his thyroid. Just as my endocrinologist had, she tells him that he must go in for an ultrasound. At first, he resists, despite the panicked urging of his friends. After a night with them on the beach, he comes around and heads to the hospital. He emerges soon after. I didn’t hear anything after they said you don’t have cancer, he explains. Nick is fine. Beach House’s “Take Care” swells on the soundtrack. The gang’s bond grows stronger. Everyone is fine. Everything is fine.

            Everything is fine? I wasn’t. Looking back on the episode now, much of it seems laughable: The neck of Nick’s sweatshirt covers his thyroid when he swallows. Before diagnosing him, the doctor prods at a spot directly under his jaw, a full four inches from the edge of my own small scar. Throughout, thyroid cancer – which one of my doctors would later describe as an unusually benign malignancy – is made out to be nightmarishly fatal. At the time, I noticed none of this. I was, instead, shattered, all my defenses downed in an instant. Fleeing my anxiety, I had run straight into that anxiety’s cause. This was a Monday morning. I picked up the ultrasound referral that afternoon, made a call, took the first available appointment.

            Weeks later, Celeste laughed when I told her this story. That, she said, is the structure of the uncanny. A psychoanalyst by training and trade, she meant that it was uncanny in the Freudian sense. In his most famous essay on the topic, Freud examines a story by E.T.A. Hoffman in which the protagonist mistakes an automaton for a living being. Our hero, Freud suggests, has exteriorized repressed elements of his unconscious onto the world around him. This projection animates otherwise inert bodies, imbuing them with a semblance of life, a semblance that is nothing more than a double of our hero’s inner life. The idea is this: When we cannot stand to confront something within, we must face it without. Thereby displaced, it becomes all the more terrifying.

            Of course, I was never wholly unaware of the growth in my throat. Far from repressing it, I was struggling to repress the anxiety that it produced. But the very behavior I had embraced to avoid my fear of what it might mean made the growth itself unavoidable. So, it was not repressed, not quite, and my experience was therefore not quite uncanny either. It was instead an improbable – and improbably apt – coincidence, a third act collision of A-plot and B-plot. What was this if not the formula for a diverting half hour of television? Not the Freudian uncanny, then, but maybe the sitcom uncanny. I wouldn’t believe it if it hadn’t happened to me.

            One way or another, our worries always catch up with us, however quickly we run from worry itself. They show up at our doors, knock three times. I suppose I was lucky: Mine made me laugh when it came home.

Survival: I. Nothing Lost

            Nothing is ever truly lost. I know this maxim from Freud, for whom it founds the theory of the unconscious. Something always stirs beneath, he suggests, a remainder of what has been that declines to remind us of what was. How difficult it must have been to convince his earliest readers that they preserved more than they consciously remembered. How much harder was it to show them that there were unthought regions of the mind, regions that underscored every action of the body? There are ghosts, he might have told them. Ghosts inside us. They possess us every day.

            Nothing is ever truly lost. These are the words my surgeon seemed to speak. She performs hundreds of surgeries like mine a year, has removed countless thyroids. Still, she explains, there is always something she can’t quite reach, an imperceptible remainder. Completely radical thyroidectomies – those that would cut to the root – are effectively impossible. Because the gland rests on the trachea, no surgeon could remove all of the surrounding tissue without profoundly impacting the patient’s well-being. As such, the operation always leaves a fine dusting of thyroid cells behind, microscopic wood shavings on the shop room floor.

            I know of only one way to make these tiny traces show themselves, a flash that would simultaneously illuminate and erase them. When papillary thyroid cancer metastasizes, the cure comes in the form of a drug called radioiodine, or I-131. Unusual among cancer treatments, radioactive iodine targets only thyroid tissue and its derivatives. As it disseminates, it hunts down cancerous cells that stem from the gland, seeking them out wherever they may be found in the body. It selectively destroys all that it meets, paring away at the invasive malignancies, but leaving their beachheads intact. Once it has had time to spread, a radiation scan will reveal where and how far the cancer has traveled. The drug thus offers an alternate cartography of the body, generating a map not of the homeostatic whole, but of contested territories.

            In the process of eliminating cancerous tissue, radioiodine also assaults the more benign cells, especially the invisible residue that surgery leaves behind. This was what my surgeon really told me: It might look like your thyroid is still there. On the two dimensional plane of the scan, these remainders sometimes constitute the shape of the absent gland. The targeted radioactive barrage enables a kind of spirit photography, showing us the ghostly afterimage of an absent organ. Like the Hiroshima shadows – those first specters of the atomic age – this flat, phantasmagoric thyroid lingers after the annihilation of the body that gave it form.

            For the briefest instant, I felt a twinge of guilty disappointment when I learned I would need no further treatment. Guilty because others, so many others, suffer far more than I have for far smaller gains. And here I was, briefly wishing things had been just a little worse. The thought was foolish and I knew it: I am thankful for the relative ease and comfort I have enjoyed. I take none of it for granted. Still, I realized then that I had avoided a chance to glimpse my thyroid, to glimpse it for the first and last time.

            My doctors looked at me strangely when I asked if the pathologists would photograph the gland before they began to dissect its lobes. There would be no pictures, no evidence that it had ever been. In the millennial glow of compounded uranium and plutonium, I might have seen it at last, if only for a moment. This is how my thyroid appears in dreams: An array of votive candles, their wicks running short, organized and lit by the very hand that will soon snuff them out forever.

            But, then again, nothing is ever truly lost. These cells, the smallest of things, are all that I have left, all that remains. So long as they go unseen, they may live on. They are invisible; may they stay that way. Let them haunt me, suspended between states, forgotten and remembered at one and the same time. Let them persist as I survive, quiet in the unconscious of my throat.

Healing: IV. Past, Perfect

            Strange how quickly skin knits. Stranger still how slow we are to see it.

            When I was five, I sliced off the top of my left thumb. I remember being overcome by a sense of calm in the car ride to the hospital. Bleeding, I must assume, profusely, I demurred when my father suggested I shake my hand to relieve the pain. That will make it bleed more, I told him. Shaking makes the blood flow. Shaking the other hand relieves the impulse. I was right, but can I have said such a thing at five? How is it possible that this tiny version of me already knew what little I know about wound care? I can dutifully summon up an image of the school nurse offering me this information while treating an earlier, more minor cut. And yet I cannot believe that I said these things.

            This much I remember with certainty: A doctor numbed my hand with local anesthetic and went to work on my miniscule thumb, reattaching the severed segment. He used a curved needle and translucent thread that jointly resembled the tackle we employed when we fished Lake Erie. The doctor had told me the needle wouldn’t hurt going in, and I suppose it didn’t, but I could feel it all the same, slight pressure of entry and exit, entry and exit.

            I had to keep my thumb wrapped in bandages for the rest of the summer. Surprisingly flimsy, these dressings could not stand up to water. Undeterred, I sometimes went swimming with a plastic bag over the whole hand, stretching rubber bands around my wrist to seal it shut. Later, my thumb turned black and scaly from base to peak as the outer layers of skin crumbled to make way for new ones. I would sometimes pull back my gauze armor to frighten other children with the spectacle of digital undeath, two percent zombie all of August. This image is crystalline: I am standing in the gravel outside of the dining hall of the summer camp where my half-sister now works. The bandages slide off easily and I brandish the monstrous thing underneath to a group of older campers. They play it cool, but I know they are horrified.

            Vivid memories begin for me that summer, with that wound and the months of healing that followed. Why shouldn’t they? Our pasts always return to us like the aches of old injuries. History is a wound. Memories are nothing but benign scars on the brain. When we are ashamed by something we have done, it is because the memory of the action remains a part of us. At best, we can learn to live with these revenant pains.

            Consider this: When the bandages came off, my thumb’s landscape was lunar. I think of it as ugly, though others rarely notice unless I point it out to them. Learning to tell my left from my right, I would make two circles, tapping index finger to thumb on each hand, orienting myself by the roughness of the one more than the smoothness of the other. Watch me weave my way through an unfamiliar city and you’ll still see touch my fingers together today. Knowing it would always be an inescapable memory, I turned my thumb into a lifelong reminder of something else.

            Cancer is not yet a memory. The mother of my first friend – a woman who appears in my adult thoughts only as a generous shadow – writes to tell me how hard it is to realize that we are never really free of cancer. In remission for over a decade from an illness far worse than my own, she must live with many scars. But is what cannot be forgotten ever really a memory? The paradox of memory is that we must forget before we can recall. That which is never forgotten, even in passing, can only be a persistent element of consciousness. Can we come to peace with what we merely are? Do cancer’s wounds ever close?

            In the most literal sense, my own has, though it still needs time and care. My surgeon pulled the sutures out herself last Friday, the slightest hint of delight crossing her features. My wound has closed, then, closed already, and yet it hasn’t, not yet, not quite. Some things are simple: I had a thyroid; my surgeon took it out. By contrast, I can only say that I had been cancerous before she removed it. This fact is only available to me in relation to another, never as something in and of itself. Often more ideational than substantial, cancer detaches itself from the physical means by which we treat it. The past perfect – my “had been” – locates one occurrence before another. Surgery eliminated two small tumors, but what experience in the last two weeks could expunge the idea of disease? Cancer is in the past now, but its past is not simple. It awaits the arrival of an event that has not yet already occurred.

            In writing about healing, I have attended primarily to the physical. On that front, things proceed apace: Yesterday I rode my bike to campus. Today I will take less calcium than I did a week ago. There are passing moments when I forget it happened at all, and, as I forget, memory’s scars take shape. I am healing from surgery, but not yet from my disease. Cancer’s toll has been psychic, a weight on the mind rather than the whole body. I can do push-ups again, but it will be some time before I am strong enough to lift cancer. I will be in recovery much longer.

            Still, time is a field. Let me imagine that in a month or two I meet my five year old self there. If I know him, and I do, his nose has probably been bleeding, even if it has clotted by now. We each ask after the other’s summer vacation. He brandishes his left hand. The stitches have fallen out, though it will never look entirely normal. Cut off my thumb, he says in his small voice. You? –Got cancer, I reply.

            Already a memory. Already a scar. The start of a story.

 

-July 22, 2014-July 29, 2014

Washington, DC

To My Surgeon

To my surgeon,

            Patients often refer to their doctors as “godlike.” When we are sick – especially when we are sick and scared, as all those with cancer must be – anyone who offers respite seems an agent of higher powers. There is something dispiriting in this conceit. When we call you divine, we are admitting we have no power of our own, that we are entirely in your hands. In doing so, we unwittingly submit to the sad cultural logic of disease, a logic that tells us we are weak, impotent before an internal evil that exceeds us in every way.

            I will not call you godlike, then. Since this began, I have struggled to retain my agency: Cancer threatened to alienate me from myself, to make my body other as it inspired cells no longer wholly my own to replicate and spread. I need to remind myself that this body is my body, that it acts under its own power. So you cannot be like a god, but I know this: I was in your hands. And I felt safe there.

            The day of my first appointment with you, one of your students struggled to locate the right nodule on my thyroid. As you pointed it out to him, he pressed in suddenly with two fingers, an accidental aggression that made me recoil in pain. Your reaction was both immediate and divided: You spun on him, saying nothing, but glaring in a way that made him shrink in shame. Simultaneously, you gently stroked my left arm, just once, a gesture of impossibly full compassion and care. In that moment I needed nothing else.

            Under those two fingers, I had felt cancer for the first time, the rounded protuberance of the tiny tumor taking concrete shape in my throat as it pushed back. This knowledge pained me more than the pressure, an unbearable substantiation of what had been abstract before. Your brief caress taught me a different lesson. I knew in an instant that I would be well. The next day, I began to write.

            A different feeling overcame me after I saw you yesterday. For most of the morning, I cried, small chirping sounds like the inchoate song of a baby bird grasping for language. I did not realize until noon that, despite my tears, this sound was not correspondent with sorrow. It was instead the stuttering start of laughter. I was happy, really happy, for the first time since my diagnosis. My joy was spontaneous, expansive, and somehow unexpected. We are never really prepared to encounter cancer. Having met it, we are still less ready for the elation that comes of knowing it is gone.

            In your office you had handed me a stack of stapled papers, five pages crowded with information. While you spoke, I scanned them as one might a heat mirage in the desert, seeking signs of life. There were none. Pointing to the first sheet, you explained that the pathologist had found very little, almost nothing, in my excised gland: Two tiny tumors, one of eight millimeters on the right side, one of two millimeters on the left. There was some cellular growth in the thyroid itself, but the lymph nodes, you said, were free of disease, as was the other surrounding tissue. What does this mean? It meant the carcinoma had not metastasized. It meant your work was done. It meant that I would need no further treatment.

To my surgeon.JPG

            I did not stop listening. I know that dangerous cells may linger. I know that my body will be studied for the rest of my life against the possibility of cancer’s return. I know that different doctors will examine me to ensure the growth you pulled out was a solitary anomaly. I know other things too. I know you were not alone in this, that others aided you, others whose names I may never learn. I know that my own case was not especially dire, that you have faced far worse. I know that I was never in much real danger, however frightened I may have been. I know all this and yet I laugh, laugh because for the first time in a month I can laugh with my whole body.

            When we tell stories about the gods, we often speak of the way they shaped the heavens. I will offer no such fables: The stars above me preceded your arrival in my life. Other forces set them alight. Your work was terrestrial, but no less meaningful to me. You removed a small thing from my body, a small thing that loomed so large it occluded the sky. You have given me back the sun.

 

            With boundless gratitude,

            Jacob 

Healing: III. Breath

            We never breathe alone.

            Kitty tells me that she and an old friend have a custom of sorts. When one realizes she hasn’t heard from the other in a while, she dashes off a message, just two words and a punctuation mark: Still breathing? Despite its interrogative form, this strikes me less as a question (Um, are you alive?) than as an imperative (Hey, you! Keep Breathing). In either case, a single Yes suffices by way of answer. The bare fact of contact sustains us, fills us up. Friendship, real friendship, is always an affirmation, even when our friends challenge us. Friends, real friends, remind us of the things we should already know, the things we should do without thinking. You must inhale, our friends tell us. You must release. Go slow.

            Breathe now: The evening after my procedure, a medical technician brought a device into my room that vaguely resembled a translucent electric kettle, one free of cords and circuitry. The night nurse called it an incentive spirometer, a name that made it sound like a device for dispensing treats to clever lab rats. It was, she told me, designed to test and improve my lung strength. Drawing air slowly out of an attached tube makes a blue plunger climb the main cylinder. Along the way, it passes markings placed at intervals of two hundred and fifty milliliters, guidelines that offer a rough metric of lung capacity. Inhaling now, I watch as it steadily ascends – three thousand, three thousand five hundred. It stops just short of the top, makes its way back down. Still breathing? I am.

Post-surgery, mostly 094.JPG

            Physiologically speaking, pulling air out of an incentive spirometer roughly mimics the effects of yawning, flooding hungry lungs with fresh air. Anesthesia, the nurse told me, weakens the responsiveness of our muscles. Because respiration is, in some sense, a muscular activity, surgery’s artificial sleep can leave us yawning fruitlessly long after we wake, struggling to pull in molecules we are too weak to hold. Surgery enfeebles us in other ways too: The morning after mine, my legs felt rubbery and my arms unusually flimsy. I wanted to drop into an immediate set of pushups, to do jumping jacks by my hospital bed. Alas, my discharge papers forbade any strenuous activity for two weeks. If I wanted to test my muscles, the incentive spirometer was all I had.

            I have known other incentives, other devices. When I first discovered my diabetes, Jess would sometimes propose an insulin making contest. The deck was stacked in his favor: He always won. On other evenings, we would play “the blood sugar game,” using my glucometer to see whose plasma was sweetest. Still breathing? I am, but my pancreas isn’t doing so well. After my release from the hospital last week, everyone joined in. Catherine and my mother both took turns with the spirometer, my housemates too. It was Corey, though, who showed us all up. On his first and only attempt, he casually pulled the plunger past four thousand until it collided with the column’s plastic roof and stopped. Singer’s lungs, he told us. Irritated by his triumph, I matched him later in the afternoon. It was much easier than making insulin.

            Breath occupies a peculiar space in the ways we imagine embodiment. This overlap is most clearly evident in the Sanskrit word for soul, atman, a term that derives from a root meaning breath. As we aerate our bodies, this co-construction suggests, we also constitute and reconstitute our very essence. Surprisingly, this implicit yolking of corporeality to ensoulment through the ephemeral often gives way to rigidly dualistic philosophical systems. Breath, which should intertwine matter and spirit, instead marks the dividing line between the one and the other in such conceptions. For the dualist, breath is like the frame, which belongs to both the art work and the world, alone in the transit between our physical shells and our incorporeal selves.

            It is, however, more frequently the case that meditation on breath provides an occasion for considering the values and valences of the body itself. Theravada Buddhism, for example, propounds a doctrine of anatta or “no-self.” Here, the path to enlightenment involves the gradual relaxation of our conviction that we are anything more than a self-reflexive bundle of sensory operations. This goal is metaphorized by the word that names it: Enlightenment is a kind of breathlessness. In this sense, dispelling the illusion of the soul also stills the pulsations of the body. One could point to other cases, from the auto-asphyxiatory path toward Jainist sainthood to the respiratory reunion proposed by Patañjali’s fourth century Yoga Sutras. These systems are all distinct in both their ideals and their goals, but they share a conviction that breath is a glue – to desire, to karma, sometimes to the world itself. Passing my spirometer to my friends and my family as if it were a cumbersome, empty bong, I understand the stickiness of breath a little better.

            Life after surgery means walking a special kind of middle path. While I was asleep something was literally taken from my body, but when I woke, my body itself was not wholly my own. My limbs are softer than I remember them being, my stride a little less assured. What would I rather be doing now? Biking in the afternoon sun, counting off pull-ups in a door frame. In activity, I will find my way back to my body. I will jog again soon enough, but for now I simply breathe. I breathe and my breath fills me up. It fills me up and reminds me that this body is all that I am. I am not broken, but I am weak – weaker than I have been, weaker than I know myself to be. I will be stronger soon, stronger because you breathe with me.

            Still breathing?

Healing: II. Hiding

“What I hide by my language, my body utters.” – Roland Barthes

 

            Early in his Fragments of a Lover’s Discourse, Roland Barthes imagines an emotionally fraught scenario: Having wept alone, he dons a pair of dark glasses before meeting with his lover. He does so in part to hide the fact that he has cried, but in part to solicit “the tender question” that will allow him to take them off. Wanting to announce his sorrow, but reluctant to do so on his own behalf, he wears sunglasses indoors so that others will ask him why he wears sunglasses indoors. Apparel, Barthes suggests, can be semiotic as well as functional. In their very ambiguity, certain accoutrements invite interpretative discourse.

            I dwell on this image each morning as I gingerly wind the scarf around my throat. Catherine had handed it to me the night before we left for the hospital, perhaps thinking it would provide me some comfort in an uncomfortable place. She could not have given me a better gift: Like my lavender sachet, it is woven from airy linen. A boldly abstract floral print covers its surface in alternating tones of rich blue and the natural white of the textile fibers. It is a twilight garden, remade in negative and positive space. She told me that she had to work with the company to track it down, finally using my health to speed them along. Who could blame her? We would soon be beyond the time when having cancer was an acceptable excuse. Best to take advantage of this small blessing while we could.

            So, a floral scarf: A comfort, much needed. But also, as it turned out, medically necessary. Just as my surgeon’s instructions for pain management were minimal, so too were her directions for wound care. Indeed, she offered only two: I was to carefully dry the site whenever it was wet and I was to protect it from the sun, preferably with a lightweight scarf. Think of my delight! Fashion always teeters between the wholly practical and the purely aesthetic. Here I was told that Catherine’s gift – this beautiful small thing – was of the former pole despite its pretensions to the latter. Finally a reason to wear scarves in the summer. Mine was literally just what the doctor ordered.

            The scarf quickly became a means of grasping for control in a situation where I still have very little. If my neck needed defending, I would do everything I could to defend it. My neck remains covered even as the sun is setting. I adjust the scarf constantly, forever struggling to ensure both maximal UV protection and minimal fabric flesh contact. Sometimes, as I fuss with it, my knuckles brush up against the slight swelling that surrounds the incision, reminding me what I am protecting. Like my medicines, the scarf is as much a tool of self-mastery as a path to recuperation.

            A floral scarf in the summer inevitably attracts quizzical attention. Its stark permutations insist upon themselves. On the street, I keep thinking that I’m catching judgmental stares. The eyes of strangers seem drawn to my neck, as if captivated by the slubby weave of the fabric that encircles it. Sometimes I think those eyes roll, perhaps because they assume that in the pounding summer heat I am suffering for fashion. Am I imagining things? Almost certainly, and I know it. Nevertheless, I want to stop them so that I can explain myself. This is no ordinary scarf, I’d contend. This scarf is prescription strength.

            Barthes wears his sunglasses to show his puffy eyes by not showing them. Cloaked by my scarf, I likewise point out the very thing I hide. I wear it in part for the pleasure of taking it off, unveiling the flushed line beneath. I want others to see the evidence of my surgery, but I want to turn its visibility into an event rather than an ordinary fact. Only the eyes of others can confirm for me that this mark, this mark which causes me no pain, is real. In the end, strangers fail me in much the same way my family disappointed me when I courted their anger. Everyone is very polite. No one insults my apparel.

            For a month, cancer was the center around which my life revolved. In the wake of my surgery, I am no longer in cancer’s orbit, but I have not learned to trust my own gravity. Having chosen to be sick in public, I have largely avoided the shame that too often accumulates around illness. I have avoided shame, avoided it for a month, and yet I am slightly ashamed as I study my scarf tonight. Barthes hides his sorrow behind tinted lenses so that his lover will make him reveal it. What do I hide behind my scarf if not the fact that I no longer have cancer? I no longer have cancer and I do not know what that means.

            I hide, but I will not hide what I need from you: Ask me to take my scarf off. Show me what it conceals.

Healing: I. Self-care

            There was a prescription for Percocet in the papers I was handed when I left the hospital. I had been told that I likely wouldn’t need to fill it. Pain management? You’ll be fine with Tylenol. Probably. We’ll give you something else just in case. Still thrumming with anesthetics as I signed the discharge forms, I was unconvinced. Five days later, I realize to my puzzlement that even the aspirin I took at first was largely unnecessary. My neck had been open on an operating table. Catherine saw blood on the surgeon’s shoes. Shouldn’t I hurt more?

            We are creatures of sensation. What are we when we are without feeling? I have shrugged off pain medications for most of my life, but not because I am particularly tough or resilient. Watch me whimper as the nurse pulls out my IVs and you’ll know how weak I can be. To the contrary, I have neglected narcotics because I can’t convince myself that they’ll do any good. Perhaps at some level, I am also afraid of going numb. If I flee from my pain, don’t I also flee from myself? In this question I bury a belief that pain makes me. How, then, do I care for myself in the wake of a procedure that leaves me feeling almost nothing at all?

            In the absence of pain, surgery itself does not seem entirely real. It had taken time for the emotional reality of cancer to set in. Now I find it difficult to believe that the disease is actually gone. I am not entirely free of discomfort, of course: Something in my neck occasionally throbs. Once in a while I have difficulty swallowing. But these feelings are nothing new, hardly distinct from the spare symptoms of my sickness. Mostly I ache, and in aching know that aches are as distinct from pain as they are beholden to it. Aches are nothing if not the body’s longing for a more acute species of feeling.

            In the first days after I came home, even aching eluded me. My discharge papers indicated that I should call in if I noticed a tingling or numbness in my lips. This would signify a calcium deficiency caused by the temporary displacement of my parathyroids. While I understood the risk intellectually, I was not prepared for the disappearance of everything below my nose and above my Adam’s apple. Plunge your fingers into ice water and you can still see them, even if your body refuses to acknowledge their presence. The same is not true of our features. At lunch with Dave, I prodded at my face, trying to remind myself that my jaw was still there, that I was still there.

            Staving off this numbness had consequences of its own. At my surgeon’s instructions, I began to take a massive daily dosage of calcium, a dosage so large I also began a regimen of clinical strength vitamin D to help me absorb it. These supplements, distributed throughout the day at regular intervals, have largely done away with that terrifying non-feeling. Just after I began to take them, however, I was overcome by a depressive exhaustion. This, at least, I recognized: I had felt it during the first onset of Hashimoto’s disease. These were signs of hypothyroidism. As best as I can tell, the calcium tablets were interfering with my levothyroxine, the medicine I take to replace the thyroid hormone T4. The next morning, I was able to avoid the effect by waiting an hour between my first wave of pills and the second of supplements. And so began a process of rigorous diurnal organization.

            Discipline. My day segments monastically. This is my Horarium: Three whitish pills of increasing size with Prime. Two orange ones and a chalky tablet in place of Lectio Divina. More chalk at Chapter, Sext, and Vespers. Shots of clear insulin injected throughout. Introspective self-evaluation, both biomedical and emotional at all times. Two more orange pills after Compline. More insulin and chalk too. Then to bed.

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            Such ordered restrictions might easily feel like restraints on our very personhood, but they need not. In his final works, Michel Foucault suggests that a commitment to self-making was at the heart of ancient stoic self-care. Preoccupied with issues of regularized appearance and comportment, the stoics sought to structure the ways that others saw them. No mere quietist submission, these routines were designed to delimit any claims the world might make on those who practiced them. In the process, stoic rituals allowed philosophers to better understand their own capacities and limitations. Stoic self-care, Foucault proposes, was ultimately a matter of deliberate self-formation.

            Selves are not made in the fact of feeling, but in the ways we negotiate what is and is not felt. Chronic illness invites rituals of self-care. Passing sickness disrupts those rituals, and in disrupting remakes them. Merely staying on my feet demands discipline, but in discipline I feel myself moving, breathing, surviving.