"Out, damn'd spot! out, I say!"

Friday, May 15, 2009

The crowd in the waiting room was interesting. Out of context, you would not be sure what group, specifically, they represented. There was one older, conspicuously wealthy woman who’d had a lot of cosmetic surgery done, who clearly spent large sums of money on her clothes and her hair, and who, I’d wager, looked down her geometrically stylized nose at most everyone around her. There was a young woman who looked like an east European refugee who’d married well, who not coincidentally had ridiculously large McBreasts, and who took one look at the crowd when she walked in the door and cast her lot with the rich lady, beside whom she chose a seat. Nearby sat two women with wrist splints of a type used for addressing carpal tunnel syndrome, and a guy with a gigantic cauliflower ear that brought to mind an obscure Cirque de Soleil character; the ear itself had stage presence. Elsewhere around the room were people who appeared normal, which could mean anything: Legitimate or ill-advised plastic surgery was in their future, or perhaps hand surgery or skin cancer removal. Those were the primary areas of expertise at the plastic surgery clinic where I was awaiting evaluation, in Flowood, Mississippi. I was skin cancer. It was a recent development.

I had not even finished unpacking from the Sultana book tour when I experienced one of those sudden, dramatic segues for which the book itself is known. The nexus of the change was a tiny spot on my right quad muscle that had been there for as long as I could remember, but which had recently started to grow. At least, I thought it had started to grow; the change was coming on so slowly that I might have attributed it to my imagination had it not eventually developed into an actual bump – a verifiable, tactile indicator. I knew at that point that something was happening. So it was that I found myself in the office of a plastic surgeon named Dr. Kenneth Barraza, who looked at my suspicious spot and pronounced it not a classic melanoma; said it was probably benign, but, two days later, informed me that the biopsy had indicated otherwise: It was malign. It was melanoma, which doesn’t sound as evil as it is. It sounds like melatonin, which helps you sleep. Or melamine, the 1950s dinnerware. But it is evil. Fortunately it is not invincible.

Within a span of 11 unnerving days, beginning that afternoon in Dr. Barraza’s office, I boarded the initial horror-house ride that every cancer patient must submit to, but with the most fortunate possible outcome. At the end of my ride the car lurched to a stop, the bar was raised, and I got out. Dr. Barraza had excised the tumor (which was only .73 centimeters in diameter – smaller than a pumpkin seed); had had it biopsied; had reported the naturally horrifying news to me that it was cancerous; had set up a series of tests that proved to be awesome revelations about western medical technology (rooms like Transformers, which remade themselves around you, robotically, and saw inside you); and had, finally, gone to work on me in earnest in the reassuringly ultra-modern operating room of the Plastic Surgical Center. Before he started, as I lay on the gurney clutching my hairnet, which I was reluctant to wear even though I was dressed in a gown and electronic support hose, I felt compelled to ask Dr. Barraza to tell me, one more time, that he was 99 percent sure he had already cured my melanoma. All I could think was that I wished they could keep me under until the pathology report came back. I dreaded the waiting, the not knowing whether any additional cancer cells had been found. Dr. Barraza then proceeded to remove what now looks like about a pound of flesh from the tumor site, plus one lymph node to verify that the cancer had been contained prior to the tumor’s removal, plus another spot on my back that was benign but whose presence Dr. Barraza considered unnecessary and inappropriate. Afterward he sewed me up one side and down the other. There were about 30 stitches in all, here, there and there.

I’d been told that the path report would not come back for several days, but after the surgery, as I lay in the recovery room, Dr. Barraza told he was confident we’d nipped the melanoma in the bud. Everything looked good; he’d be extremely surprised if anything was amiss. I was grateful for the encouragement, but dubious. In a postscript he added that every inch of my body would have to be thoroughly scrutinized every three months, until further notice.

It was only later that I discovered that Dr. Barraza is not only a skilled surgeon, but something of an artist. Once the swelling subsided, a braided scar was revealed that was so uniform, and so neat, that it occurred to me I might have asked him to scarify my name in cursive writing across my thigh; at the very least, he might have done a monogram. I do not mean to make light of things -- at least, not any more than is necessary to enable me to TELL this story. The entire episode (and I choose to see it as just that, an episode) was terrifying, and terrifies me still. Melanoma is very different from the more common basal cell carcinomas, which people seem to get it confused with, as in: “Oh, that’s not really that big a deal, people have them removed all the time,” which requires a corrective: “Actually: It is A HUMONGOUS DEAL.” Carcinomas are generally non-threatening; melanoma is curable if you catch it early, but potentially fatal if you don’t, because it can spread to the brain, lungs, liver or bones through the lymphatic system. Beyond that, I don’t really want to talk about it just yet, so please keep your horror stories to yourself. Being told that cancer has appeared in your body sends a person into emotional free-fall, and even thoughtful observations from other people tend to alarm you even more.

Of course there is a Sultana angle to all this, and not only because in trying to talk myself through my first-ever panic attack I drew deeply from the well of Sultana survivors’ knowledge. In fact the Sultana tour, and specifically my tandem engagement with Marshall Ramsey at the Winston County Library, was directly responsible for the diagnosis of my melanoma. I’d been thinking I needed to get the curious spot checked out, but when was that likely to happen? The spot could be anything, right? Or nothing. Or everything. It had been there, causing no trouble, for 54 years, so why would it turn on me now? To get it checked out would be to admit that something could be terribly wrong. Plus, I had no time. Seriously, I had no time. Then, at the Winston County event, Marshall mentioned his experience with melanoma eight years ago, which ended with an impressive scar but an otherwise clean bill of health (he has not had another episode since). Marshall said he makes a point of mentioning his melanoma at speaking engagements because it’s important for people to know that early detection can save your life. I am among the believers, now. In fact, it is not much of a stretch to say that Marshall may have saved my life. I could easily have gone too long, and waited until my commandeered spot began to devour other parts of me, before doing anything. As it was, Marshall not only prompted me to take action but referred me to Dr. Barraza, who had found a melanoma on Marshall that had been overlooked by at least two other doctors.

When my first biopsy came back, Dr. Barraza stressed that the melanoma was small, shallow, in its early stages (so small, I later found, than some doctors likely would not have even biopsied it), and that while he knew there was no point in telling me this, I really should not worry about it beyond agreeing to do what he suggested I do. But how could I not become overwrought? I had cancer. It’s everyone’s worst fear. Dr. Barraza’s nurse, Gretta, told me she sees the full range of emotional responses to the delivery of such news, from people pretending they don’t care to people who immediately start planning their funerals. I confess that I tended toward the latter category; overall my response was to freak out each morning, then go for a long, hard run, after which I felt better. I ran on the Pearl River levee, ran on the mountain bike trails at Butts Park, ran on the Mississippi College cross-country trails. I ran especially hard because Gretta told me it would be six weeks before I could run again, post-op.

Before the follow-up surgery Dr. Barraza said it was impossible to be 100 percent sure of anything, but that he really was 99 percent sure that my problem would be cured by the surgery, and that, in all likelihood, it had been cured when he first excised the offending mole. Still, he wasn’t taking any chances. As Marshall noted when I described the extent of my incisions, “Those people don’t mess around.” To me the chances of success or failure felt more like a 50-50 proposition. Either things would return to normal or they VERY MUCH WOULD NOT. I had, for the moment, lost control of my life, or at least what control I thought I had over my life.

When it comes to survival the most important factor is luck. If you’re unlucky when disaster hits, it may not matter how you respond. But if you’re lucky, you will likely have the opportunity to make follow-up choices, and some of them will be crucial. Having the melanoma was unlucky; finding it was lucky; making the decision to have it checked was crucial. After that, the list of choices gets longer, and each one matters. It’s true of challenges big and small; it just becomes more obvious when they’re big.

During my period of limbo, between surgery and prognosis, I thought of the Sultana guys, as I often do when trouble looms. It helps to put things in perspective. If it’s cold and rainy and your cell phone’s dead and all the cabs are full and someone you care about is sick and you can’t get to them or call, it helps to tell yourself: At least I’m not starving and standing in a flooded prison camp with gangrene! Seriously. Now that my problem was the loss of control that came with a cancer diagnosis, I thought of the horror those guys must have felt when the gates slammed shut behind them at the prison camps, and they faced what seemed to be the total, perhaps irreversible loss of control over their own lives. A person in such a situation may respond any number of ways. He may freak out, get mad, become obsessed with just how screwed-up his world is, try to lay blame, etc., or he may recognize that his world has changed, that he has a new set of circumstances to evaluate and adapt to and potentially make the most of, and maybe even make work. I felt better, thinking of it that way. The appearance of the melanoma presented a new world, whether I liked it or not, and not liking it could not overshadow the necessity of operating as best I could within its unfortunate framework. If it turned out the melanoma had spread, another new world would have presented itself. If it turned out the disease had been nipped in the bud, I would be eternally grateful.

This was life. This was how it unfolds.

I will be the first to admit that “accepting things” is not my forte. I tend to look for trouble. That’s why I was initially drawn to the Sultana story. I like to highlight weakness in order to determine what’s strong. To those who think it’s best to put on a happy face, I will point out that my propensity to look for trouble is what got me to the doctor in the first place. And yet. It’s hard to stop looking, even when it becomes self-defeating.

It’s very important to know when you’ve gone too far down a particular path, because what worked at one point might not work later on. To everything there is a season, turn, turn, turn. Faced with a major life challenge, you have to continually update your model of the world. I realized I had gone too far down the looking-for-trouble path when I began to feel the first waves of panic, at which point I had to sit myself down, say, hey, this is getting out of hand. Think. Keep a level head. Anger is sometimes helpful; panic, never.

Two possible responses came to my mind at that moment. I could look at what Dr. Barraza had told me about my melanoma this way: He had found cancer and needed to operate AS SOON AS POSSIBLE because it could EASILY have SPREAD. Or: He had found cancer, had removed it and wanted to explore further to make absolutely sure it had not and would not spread. Those two interpretations represented similar yet profoundly different views. I sampled both and found that the second was more easily sustained, and it helped me function during the period of limbo. I think it is also the more accurate of the two, not that that would have mattered had I been determined to continue down the looking-for-trouble path.

My melanoma story isn’t over, of course. It’s going to be a long-term project. There may come a time when I once again lie on a table beneath those very bright lights, anesthetized, in a hair net, while a stranger shaves my body, paving the way for someone else to make subtle determinations about whether I’ll live or die – all because of a sunburn I got at Pensacola Beach in 1963. It is also possible, and in fact statistically probable, that the OR scene will never be repeated. Hopefully what happened is only one of nature’s random acts of vandalism. I’ve been tagged.

The Sultana story tells you that people can survive just about anything, but it also illustrates that a lot of people disappear from each successive frame. Survival is a process, not an achievement, and there’s no way to know where you are in that process. But there are almost always going to be choices to make, which is why it’s important to pay attention, to constantly reevaluate, to identify strength even if it means focusing on weakness, to keep a level head, and, as Marshall and I can both now attest, to have someone check out that mole. Seriously. Forget the shape of your nose. Have someone look at that mole.