Jacob Brogan

The world is always ending

Anticipation: IV. Clean

            My thyroid came out clean. According to my surgeon, the cancerous nodule itself presented little difficulty. What’s more, there was no sign of the yellow fatty tissue that would indicate likely metastases beyond the organ. While she was operating, she noticed that one of the parathyroids – tiny adjacent glands that regulate calcium uptake – looked off. She removed it, but left the other three intact, left three when we only need half of one to function. A section of lymph came out too, as did the thyroid itself and its non-cancerous right nodule. Only this last bit of tissue presented any real resistance.

            My thyroid came out clean, but we do not yet know how clean it really was. On Friday, I will see my surgeon for what might be the final time. She and her clinical nurses will examine my neck, ensuring that it is healing properly. More importantly, though, they will tell me what the pathologists found when they examined the glands – thyroid and parathyroid – no longer my own. If I am lucky, this is the last any of us will speak of it. If I am not, if the cancer has spread after all, I will begin treatment by radioactive iodine soon after. One way or another, they will clean me out.

            When surgeons first began to remove tumors with regularity in the 19th century, they were puzzled by the recurrence of disease. Growths of the kind they had cut out reappeared without obvious reason, obviating their often dangerous work. As Siddhartha Mukherjee explains, it was only with careful long-term study that physicians came to understand biological facts we now take for granted. They discovered that new growths almost always sprang up along the perimeter of the surgical site. Cancer, even when it was easily operable, survived through cells that evaded the medical eye. It was not that the bodies of cancer survivors were predisposed to disease, as centuries of Galenian theory had suggested, but that they had never really been stripped of their diseases in the first place.

            Today, living as a cancer survivor means living with the possibility of relapse. We necessarily persist in a climate of anxious expectation, forever on the alert. That we do so is itself a scientific accomplishment, the consequence of those 19th and early 20th century longitudinal investigations. Our fear of cancer does not come to us naturally in the way of, say our fear of snakes. Before surgery, I was told that the global rate for the return of thyroid cancer after treatment is around twenty percent. This is already a pleasingly low number, but various factors make it lower still in my case, likely placing it in the single digits. How many thousands before me gave shape to these reassuring figures? Whose eyes ordered them into meaningful constellations? My knowledge of my disease is always already a biomedical knowledge. Accordingly, it is never quite my own. I was born beneath the sign of a scorpion? Why now the crab?

            Before I went under, my surgeon visited me just long enough to draw a line across my lower neck, dotted like Orion’s belt. Its significance was, of course, more functional than mythic: In a picture I took of it, only a cartoon diagram of scissors is missing. Cut here. Pull. Fold. Glue shut. Traces of those markings still linger, almost a week later, smudged in a way that extends the angry breadth of my gathering scar. The night after surgery, an apparitional doctor woke me to say that I should not be afraid of what I would see in the mirror. Some of the paint is still there. Your wound is smaller. Smaller than it looks. I cannot remember his face, but I hear these words each time I study my reflection.

            My thyroid came out clean, but my neck is still dirty. Look at it now and see flecks of gauze and black-grey adhesive stains. I am allowed to shower, allowed and I do. Allowed to shower, but not yet to let the water fall directly on my wound. It trickles down from my face as I shampoo my hair, neck washed and yet not washed clean. Like my knowledge of cancer, the surgical site is not entirely my own.

            My thyroid came out clean, but I did not. Not yet. The grime of both cancer and cure stay with me. Make no mistake: I do not, will not, live in fear of this thing, despite the distant possibility of its persistence or return. Still, it clings to my body, awaiting the warm water of a bath I cannot yet take.



            -July 13, 2014-July 21, 2014

            Seattle, WA and Washington, DC