Jacob Brogan

The world is always ending

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.