Guest Posts, The Body

Topography of a Scar

March 15, 2017
biopsy

By Krista Varela Posell

For four years, I’ve had a wound that won’t heal. A lesion is the technical term, according to Google.

It’s a dark spot on my right forearm, smaller than a dime. It could be just a mole. That’s what it looks like anyway.

But every few months, the skin around the spot will get dry and bubble up, almost like a blister. I try not to pick at it, but I can’t help it. Each time I do, I hope that there will finally be a pale white scar underneath so that I can just forget about it and go on with my life. Instead, picking at it just opens up another wound, like a door that leads to another door in some kind of eternal dream. There’s no bleeding, but the new skin underneath is sensitive, a deep rose color, and the spot scabs over. Then eventually the thin scab falls off, but the small dark spot is still there. Moles don’t do that, do they?

I don’t remember exactly when it started. I just remember looking down at my arm one day, perhaps it was in the car or in the shower, and I thought, that spot has been there a while. Weeks? Months maybe?

***

Soon after, I went to a dermatologist. Dr. Google had scared me enough into getting checked out. The doctor told me to stop picking at it and gave me a steroid cream to put on it. Come back if it doesn’t work, he said.

It didn’t work. The small dark spot still lingered, and the skin kept blistering.

I didn’t go back.

Two months after my doctor’s appointment, I lost my school health insurance. I had already paid $150 for the dermatology visit and another $40 for the cream. As a new college graduate with nearly $30,000 in student loans, $200 was a fortune. I didn’t want to know what it would cost without coverage, especially if it was something more serious. At the time, it was easier not to know. And yet, whenever my skin would blister over again, I’d have this feeling gnawing at me, like each new scab was one step closer to unleashing a complete annihilation on my body.

***

I finally have health insurance again, but it takes me nearly a year to get to the doctor to have my arm checked out a second time. At this point, my lesion is just one thing in a laundry list of unrelated symptoms I’m experiencing: insomnia, back pain, heart burn. I’ve just turned twenty five and I still get mistaken for a teenager all the time. But my body feels worn down, like a seaside cliff, with a small part of me eroding each day and dropping off into the ocean forever.

When I get a checkup with my new primary care physician, she asks me if there’s anything she should know. She’s a quiet woman who looks to be in her forties, and her smile makes me feel at ease. I tell her I’ve had trouble sleeping and that my back hurts nearly all the time. She asks if there’s anything else. I show her my arm, and she looks up the number for the dermatology department right away.

“How long have you had it?” she asks, her smile disappearing.

“A couple years,” I say. I’m too embarrassed to tell her the truth.

She asks me if anyone in my family has a history of skin cancer.

Last January, my dachshund Quincy had a melanoma. While cleaning her teeth, the vet found the tumor growing on her gums. After three procedures in which a surgeon removed the entire right side of her lower jaw and all of her teeth, Quincy was cancer-free. Though she didn’t require radiation or chemo, the recovery from the surgeries turned my world upside down. For weeks, Quincy had to be hand fed from a spoon and given pain pills and antibiotics around the clock. Even now, a year and a half later, there isn’t a day when I don’t look at Quincy, with her little tongue that now hangs out of the right side of her mouth, that I don’t think cancer.

But the doctor is looking for some kind of genetic link, a predisposition. No, I tell her, no one in my family has a history of skin cancer.

Then she brings out a cloth measuring tape and lays it against my skin. She measures 13 millimeters. When she puts a number to the lesion, it sounds bigger than I thought. I curse myself for having the misfortune of growing up in the desert, for all of those summer afternoons spent outside without sunscreen.

Before I leave, the doctor schedules an appointment in the dermatology department two weeks from now. She signs me up for physical therapy for my back and prescribes me some Ambien to help me sleep.

I go to bed that night, excited for a full night’s rest for the first time in months. I pop a pill as soon as I slip beneath the sheets, just like the directions say, expecting to feel a wave of grogginess lull me into a dreamless slumber. The Ambien doesn’t work. I stay awake for hours, running my fingers over the spot on my arm.

***

I’m sitting in the waiting room at my dermatology appointment. I look down at my lesion. I have been trying hard not to pick at it for the last few weeks, even though the dry skin is back. It’s the beginning of September, and California has been experiencing unusually high temperatures with little humidity. My skin is irritated. I grab an outdated People magazine from the table next to me and flip pages mindlessly to keep my hands busy and away from my arm.

I’m sure the doctor will do a biopsy. This, the process of scraping away a layer of my cells in order to perform a diagnostic evaluation, doesn’t make me nervous. I’ve become used to it by now.

This is my second biopsy this year.

About six months ago, I had an abnormal pap smear. With my newly instated health insurance, I had decided to take care of my annual gynecological exam before dealing with my lesion since I was out of birth control. I had assumed everything was fine and forgot about it when the OB-GYN called me back a month later with the results and asked me to come in for a biopsy. My cells demonstrated high-grade changes, I learned, which was just a fancy way of saying those cells were closer than not to developing cancer. Precancerous. The whole thing made it sound like fate, like each individual cell had a destructive destiny to fulfill if left to its own devices.

I had a procedure to remove the precancerous cells, but there is always a chance they will come back.

My body has always been fighting a battle against itself. In elementary school, I sat on the basketball court with a stuffy nose and itchy legs while other students ran two laps around the grassy field every Friday afternoon. In middle school PE, I carried around an inhaler with me in case I felt my chest tighten while playing Capture the Flag. As a teenager, I spent one afternoon every week in a clinic receiving allergy injections while also taking a daily cocktail of antihistamines and decongestants, all of which only made the spring slightly more bearable.

But there was something about my biopsy earlier this year that unsettled me. Learning that my body—a body capable of cancer—was on the verge of destruction, in the very place where new life has the potential to enter this world. When I feel mysterious aches and pains, I hold my breath and wonder if my body is continuing to plot its own demise.

People were worried when I bought a motorcycle when I was 20. You’re going to kill yourself on that thing, they’d say. I have never been afraid of going out that way. I have always been more worried about the dangers within, scared of spending my final days in a hospital bed trapped in a body that doesn’t recognize its own will to live.

***

I’m finally called from the waiting room, and the nurse leads me through a maze to take me back to an exam room. I try to memorize the turns—left, left, right, left—so that I don’t get lost on my way out. Worrying about whether I will be trapped after my appointment gives me something to distract myself.

When we finally reach the room, my eyes are drawn to a poster on the wall. It’s labeled “The ABCs of Skin Growths,” with pictures of normal and abnormal growths in different categories:

A – Asymmetrical

B – Border

C – Color

D – Diameter

While I wait for the doctor, I try to figure out which picture my lesion is most like. I’m not sure if it’s big enough for me to be able to say if it’s asymmetrical. I also can’t tell if it has definitive borders or not. It does look like it’s all one color, though. And the diameter does seem within the normal range. Too difficult for me to diagnose myself.

After about ten minutes, the doctor finally comes in. She shakes my hand with a grin and asks to see my lesion. After taking a short look and asking me how long it had been there, she pulls over a tray with the biopsy tools and gets right to work. She uses a purple marker to trace around the area she is going to cut out.

“Are you afraid of needles?” she asks, and I shake my head no. An upside from spending afternoons in my teenage years receiving an allergy shot in each arm.

She injects a small needle with some anesthetic into my arm, and I feel a small burn below my skin. This burn is familiar to the anesthetic my gynecologist used. Somehow that is strangely comforting, like I know what to expect next. When she pulls the needle out, the area is swollen, like a goose egg.

Next the doctor takes a small tool. It looks like a butterfly Band-Aid with a razor on it. I can’t see what she does next because her hand is blocking the way. I can’t feel it either. But she drags her hand across my arm with one short, swift stroke. The next thing I know, she’s done.

“How are you doing?” she asks, her hand still covering my arm. She’s such a natural. I wonder how many patients she has that get queasy or pass out from a procedure like this. But I feel like a pro by now. I nod my head, tell her I’m fine, and she removes her hand.

When I look down, I can see how much she cut away. There’s a small crater in my arm, with a clearly defined ridge all the way around the layer of tan skin, about the size of a dime. I’m surprised to see the skin underneath is white.

The whiteness fascinates and embarrasses me, like being naked in front of someone for the first time. But the whiteness also feels clean, like fresh snow. It reminds me of looking at the sun, a whiteness so pure that I can’t stare directly at it. I’m also relieved that there are no discolored spots, no visible cancer lurking underneath. I don’t know if this is how it works, but it still makes me feel better.

She dumps the skin sample into a small test tube and dabs some Vaseline on the spot before covering it with a Band-Aid.

“Will it hurt,” I ask her, “when the anesthetic wears off?”

She thinks for second. “Not really,” she says, “maybe it will burn when you wash it in the shower. But otherwise, you probably won’t feel it.”

The doctor tells me the results will take about a week. Again, I know to expect this from my last biopsy. No surprises so far.

I’m out of there in less than 15 minutes. I grab my bag and head into the hallway. I’ve already forgotten the way out, but a large red exit sign guides me through to the lobby.

My car is already an oven and the leather seat burns my thighs. The afternoon sun shines directly on me as I drive, on my face and arms. By the time I get home, the Vaseline has melted and mixed with sweat, soaking through my bandage. As I change the Band-Aid, I stare at the small white cavity on my arm and think about the blood vessels underneath, dozens of tiny underground rivers rushing at full speed to begin the healing process.

***

A few days after my biopsy, a tough leathery scab forms over the biopsy site. There’s a ring of red around it, a dark crimson, almost like a bruise. It makes me nervous, but I have to remind myself that this is what normal scabs look like.

My crater has now formed a mountain. Miniature biological tectonic plates beneath my skin have grinded together, a volcano erupting skin cells to cover the gaping wound.

I don’t remember the last time I had a scab this big.

I try not to pick at it. I don’t want a scar. I have too many already: a pock mark on my cheek from the chicken pox when I was six; a hard nodule on my pinky when it got stuck in a VCR trying to force out a tape that wouldn’t eject when I was eight; a blemish on my right breast from the shingles my freshman year of high school. My body has miles of rough terrain.

***

Six days after my biopsy, I get the results. They come as a concise e-mail from my doctor at 10:30 at night.

Good news! The biopsy showed a benign growth called “seborrheic keratosis”. There was evidence of irritation.

I know that the word “benign” is good news, but I still feel uneasy by the brevity of her response. I search the term seborrheic keratosis: “Some look like a dab of warm, brown candle wax on the skin. Others may resemble a barnacle sticking to a ship.” The juxtaposition of these two images unnerves me, but Google comes through for me this time and assures me that it’s not cancer, nor will it ever turn into cancer.

I wonder how it feels good for anyone involved to deliver the news electronically: the doctor, sitting at her computer, late at night, telling her patient that she doesn’t have cancer; the patient, waiting anxiously for that phone call, only to be comforted by her computer screen.

I’m not relieved to discover it’s not cancer. It seems so improbable that someone could escape from her second biopsy at twenty-five years old and live the rest of her life perfectly healthy. Instead, it feels like I’ve just swung strike two.

***

A month after my biopsy, the skin is flat and red like a desert, the ground baked red from the sun. The hair in that spot has begun to grow back, shooting through like weeds forcing their way through the cracked dry ground.

Six months later and the scar has faded to a pale shade, the color of pink sand. I have my own little island amongst a sea of olive skin. I still have trouble sleeping at night. Sometimes I find myself running my finger over it again and again, trying to read it like Braille, struggling to decipher the map my body has given me.

I don’t know when my body will decide to betray me next, when it will decide to go rogue and hand over the controls to those cells, the ones inclined to corrupt and destroy. For now, it continues to endure, fortifying its walls to preserve the imperfect landscape.

Krista received her MFA from Saint Mary’s College of California, where she is now an English professor. She is the managing editor for The East Bay Review. Her work has appeared in Toasted Cheese Literary Journal, Blotterature, Vagabond City, and Sugared Water.

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2 Comments

  • Reply Barbara Potter March 15, 2017 at 6:35 am

    Im so glad you don’t have cancer. I have a tendency to get those as well. 🙂

  • Reply Christine Carter March 21, 2017 at 10:19 am

    This was so beautifully written. I’m so glad you were cleared and I do hope you stay that way. <3

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