Tuesday, July 17, 2012

Sea of Unease

             “This is not good,” I tell my husband. We're in bed. From the house in which we will soon slumber, or try to, we can hear the ocean stirring. It pounds against, and gnaws at, one of the most exquisite islands in the Atlantic. I have been searching for suspicious moles, moles that eat away bodies, since the morning of my physical. I've stretched out my naked right arm and, with my iPhone, taken a picture of what I consider to be a particularly suspect mole, centered, and burrowed deeply along the outer ridge of my armpit, and I am comparing it to the onerous looking moles of the online medical journals that I’ve culled from the Internet with my laptop. Mine is an old, curmudgeon of a mole. At one time it was a pageant-worthy beauty mark, whether adorned by a simple black camisole or a paisley silk sheath. It was a freckle at birth.

Now, it is swelled in various shades above the skin where it meets a charbroiled crescendo; it seems as maddened as a volcano on the verge of blowing, like the sick, angry moles I see on the vast Internet: multilayered and gibbous, some with dry, crusty patches, areas that look like burnt chicken skin, or tiny clusters of flying fish roe. I am jumping from website-to-website for evidence that will justify my fears, and with each hit my anxiety balloons. I see more: cancerous black lesions with uneven borders, red and blue-gray blemishes that indicate malignancy. The photos I’ve taken just won’t do so I tuck my head into my armpit, even though it’s nearly impossible for me to get a decent view of the mole from this angle (or any angle for that matter), and stretch the skin around the dark nub. Michael pulls his book away from his face and gives me a look. What am I doing? I know that he thinks I’m loopy. But this doesn’t prevent me from searching, armpit and Internet, even as I become aware of the increasing anxiety that will keep me from a solid night’s sleep.

“This is bad,” I say to Michael, as if he has not heard my first complaint. “Does this not look like melanoma to you? And why is my doctor concerned about this one?” I point to the dark nebula. “This one looks like all the others. Should I be worried about the others?”

I know Michael wants to say, Yes, you should be worried about the others, just as you worry about everything else. Yes, worry, dammit! Worry and then shut up. But he doesn't say this. He tells me simply to have it removed when we return home. We are on vacation, after all. But I take Worry with me wherever I go.

Instantly I want to shout, Easy for you to say, you're not the one with all the raging moles! Instead I say nothing and he tells me to stop reading about melanoma. I think about my father, my brother-in-law, and one of my closest friends, all of whom I’d lost to cancer in short time. I think about my sister whom had layers of squamous cell carcinoma shaved off her nose. She is in the clear now. It was just last September when my now annoyed and fatigued husband spent three hours on the operating table having his prostate removed. (How in the world could I have wished to utter, Easy for you to say?) Cancer. I’ve become hyper-vigilant. It is quiet, quiet, and we can hear the sea, in and out, and the constant wind gusts, and we can smell the mist from the ocean that comes up in squalls, over the dunes, into the hollow and through the house. We are on the eastern side of the island and the beach is a walk away over the dunes. A large, gentle pond sits on the other side of the sandy, rosa rugosa-lined path that divides house from water. I could be anywhere, though. Anywhere, and I would still tend to Worry.

Earlier in the day, we had taken the high-speed ferry from Hyannis to Nantucket with our two teens. We’d come to visit and relax with my in-laws who own a small home in Quidnet. My father-in-law met us at the wharf where the ferry pulls in. It’s a lovely area of the harbor, trimmed with grey wooden docks, shingled structures and bricked and cobblestoned roads which spill into the island’s historic downtown, where, by way of special zoning bylaws, no large restaurant franchise or retail chain can be found with the exception of a Ralph Lauren store, which Lauren acquired at a cost of more than six million dollars prior to the passing of the bylaw. It all seems so quaint and pristine, so very removed from the rest of the world and all its commercial trappings and corruption. Madras-clad, Sperry-footed people strolling the streets, no hurry, no worry, no mission other than to pass the moment blithely. During one of our previous trips to Nantucket I had read that the island’s early settlers, the Wampanaug Indians, referred to this golden bib of land as a Place of Peace, or in their own language, canopache. To the native peoples, this island was also removed from the world, a faraway place, and so they named it Nantucket, meaning, in their native tongue, faraway land. And it occurs to me now, as I stretch out my armpit mole that the only thing that seems faraway to me is my ability to relax.

We loaded our bags in my father-in-law’s black Range Rover and he drove us out beyond the slick cobblestone, alongside lush, undulating pastures, and pretty ponds dotting the salty landscape, east, down Polpice Road and out to Quidnet, where we quickly changed into our bathing suits and charged back out to the island’s south side, to the narrow strand of beach known as Nobadeer.

But even on Nobadeer’s ribbon of packed, turbinado sugar-like sand that falls out into the wide-open Atlantic, into the blue, blue horizon, I was too anxious to relax.  On the shore I wondered how this fine-grained land must have looked when it first rose from thawing ice sheets, when it was nothing but sandur, an outwash plain from Earth’s last glacial period, separated from Cape Cod’s mainland by the icy retreat; how pristine it must have been! Pristine it still is, in many ways, and even more so during the off seasons, fall through spring, when the island’s population is one-fifth of what it is during the summertime.

Yet, it is not entirely unsullied. It overpopulates in the summer months, especially during the time when we are here—the days that flank both sides of the 4th of July—with a noticeable accrual of noise and litter, especially downtown. This summer, it may be even more populated due, in part, to being recently named the best island in the world by National Geographic. But even with its quaint village, and remarkable landscape, its dramatic drops from highland to sea, it’s hard to imagine that Nantucket would be more beautiful than, say, Bora Bora (though I’ve never been to a land that faraway).
Just above Nobadeer’s dunes is Nantucket Memorial Airport, and early afternoon during the week of July 4th planes descended above heads every ten minutes or so. Later afternoon, the same planes took off with such reverberating thrust that we could not hear one another speak across a beach blanket.

On this island, a place where money is no object, where waterfront is often reserved for the rich, I peered out at the sea before me, at the narrow shoreline, at Max and Lulu on their boogie boards searching for the big wave to Bliss, and then turned back behind me to view the shedding dunes that make clear this earth is still undergoing a glacial warming. Nobadeer slowly erodes, I am told, by ten feet per year—which, to me, hardly seems slow. What was once a wide swath of silky sand is now this narrow strip of beachfront. One can still maneuver a car along the edge of the sandy fraying ribbon just above the high water mark, but it is tricky and, at times, hazardous. There are no lifeguards, no restrooms, nor any facilities, for that matter, at Nobadeer. Summer residents drive out to the beach in SUVs or Jeeps packed with provisions for the day. They open the backs of their vehicles, tailgate style, set up tents and tables and large, colorful beach umbrellas, and spread their feast across the sea-green tablecloth.

Nantucket style—as if there were never meant to be a care in the world.

I sat in a canvas chair by the water at low tide until tall, foamy swells began to wash in and overtake my canvas nest, and observed the busy airport. How long would it be before the constant process of the wearing away of expensive soil and pebble cut into the airport proper and all the turbinado sugar washed out to sea? It appeared that there was hardly a hundred yards from rolling tide to runway. Let's see, ten feet per year, a hundred yards, in roughly thirty years there would be no more fine dining at Nobadeer.

Already, a good portion of Nantucket's seashore had been closed to protect the nesting piping plovers, so access to the ocean was restricted. If you are on Nantucket in the summertime you may not be happy about this, especially if you’re a big beachgoer and the island is swollen with company. Or, you may be elated and thankful for the efforts of conservationists. I was happy that we’d found a beach where the piping plovers do not nest, where we could gather with our hosts and new friends, and watch the children surf and in the rough littoral, and literal, tumble of the breakers, and rake up smooth, white shells. This was a place where the sun stayed pasted in the sky all day and I could simply be there, without obligation, except to sit in a low chair, half-way under a beach umbrella, book bag at my side, consuming food and drink enough to last us a week. Soon, though—maybe it was the pulsing heat—my attention to the distance from shore to airstrip, the sloughing of the beach and dunes, and the private jets and puddle jumpers descending above our sunburnt heads faded, and in a seamless shift I found myself hyper-focused on the itchy, dry, raised mole perched at the nape of my right armpit, above the grooves and swells of axillary folds; it was the nub that was sure to keep me from vacationing. Had it changed over the years? I wasn’t sure. Why didn't I know this? The more I inspected it, the more uglier, angrier looking, it grew. This was not the mole that my general practitioner tapped with her index finger and insisted—as she did the day before we left for Nantucket—must come out. That mole, what she called “irritated and suspicious looking,” floats atop the soft, creamy skin of my upper abdomen and is part of a constellation of small, chocolaty moles that, together, if closely observed, resemble the inverse image of the Little Dipper. That little nebula hardly looks suspect to me.

“She’s wrong about this,” I say to Michael. I’m irritated. “The sick one, the angry one is this one!” I shove my iPhone before his face so he can bear witness to the gruesome, pixelated details of my monster mole, the one that’s infiltrated my body.

“You’ve got to stop thinking like this,” he sighs. “Let’s get some sleep, please.”

The ocean stirs a savory potion, and I want to gulp it down, I want it to magically quell my nerves, to melt the stone in my chest, to make worries go Poof! But I torment myself with Worry into the wee hours before I'm finally lulled to a half-sleep by the salty elixir.

It is like this for the next week. We are on Nantucket, then the Cape. The mole stays angry, I double up on sunblock and get little sleep. A rock stays lodged in my chest. I know it's bad. I wonder if my GP should be the one to disturb the suspicious mole and the hostile armpit mole; mining them from my body. (Where are all the mined moles stored?) There had been a prior excavation—neighboring moles had merged just above the belly button. Moles that merge are always suspect and they are excised with little inquest. In the case of my conjoined moles, former constituents of the abdominal constellation, a half-inch core of skin, fat and tissue to which the moles were attached was cut out with a sharp knife by a Boston dermatologist, who dropped the gory specimen in a liquid preservative housed in a glass jar and jiggled it before me, like I was a spectator at an old wild west hanging. I later learned that the procedure was unnecessary as the mole cluster was determined to be benign. Yet, I was glad for the news, even the cutting, despite the fact that now set at a 45 degree angle a few inches above my navel is a one-inch scar that looks like the fossil of a centipede. I do not wish to have my torso marred by ghostly arthropods.

But I worry.

I say nothing to anyone but my poor, patient husband. I am disgusted with myself. I should be happy, carefree, grateful for the opportunity to be vacationing with Michael’s extended family, all of whom generously host our Cape Cod and Island excursions (of which, otherwise, we couldn’t afford). I resolve to find easy moments with family, and I do: warm, sea-salty moments that are sprinkled, no, flooded with lively, fresh seafood dinners, quiet walks on the bay, excited faces on the little Boston Whaler that takes us out to the little barrier island of Sandy Neck. I am able to shave layers of weighty anguish off the rock. The sky is blue, the weather temperate, and in the late evening the empyrean vault sparkles with amazing firework. All is well until I go to bed. There, I tell myself I am eroding. Like Nantucket’s ecosystem, my body is bearing its fragility. I am aging, deteriorating, and well, something is bound to go seriously wrong with this body. Can't we reasonably expect this?

Back home, where there is no ocean to see or smell for miles, I unpack my suitcase and empty the contents of my book bag. Tucked inside the bag's zippered pocket I find two well-preserved seashells that I'd plucked from the shoreline of Nobadeer. They are large, beautiful shells that look like marble or limestone spiral igloos, not the common mermaid's slipper found on Nantucket's beaches. These shells had once protected muculent inhabitants: snails of deep water—the moon snail. He burrows, too, into mud bottoms, searches for prey, clasps a clam with his gelatinous foot and bores a hole through his prey’s armor with his toothy, chitinous tongue, an acid-tipped killer drill. Even soldier crabs run from the moon snail.

But the shells’ inhabitants are gone, dead, their flesh devoured by other sea creatures, their armament souvenirs. Nothing is immune. I place them on my writing desk.

Monday morning I call my dermatologist's office and beg for an immediate appointment. I have a seething mole, I tell the receptionist. The offender should be extracted at once. I have another, less benign looking mole that my GP, with whom I don’t agree, wants removed from its cosmic configuration. The receptionist slides me into an 8:30 a.m. opening on Tuesday. She'd prefer, I'm quite certain, to slide me into a psychiatrist's schedule. I would not argue this. I try to remember when I'd last seen my dermatologist (or psychiatrist). Why had she not noticed the armpit mole? Or had she?

It was this time last year, late July, early August, that I observed my children digging trenches in tidal flats at the tip of Sandy Neck—a Cape Cod barrier beach—constructing hermit crab hotels designed for the protection of vulnerable crustaceans. This, they did, despite the shifting tide which would soon send these crabs scattering beyond the hotel, abandoning their fabricated home. They knew then, too, that as the crabs grew larger, they would eventually toss their borrowed shells in search of roomier ones. The borrowed and discarded shells were small, tiny snail shells, not at all like the heavy shells of deep seas (yet, as my moon snail shells reveal, weighty armor does not insure defense). Watching the kids attempting to offer the crabs a safe harbor reminded me that they would soon shed their own shells. It could be this very summer. Soon, they’ll traverse a world foreign and potentially dangerous, treading further into the deep sea. To where will they retract when threatened? Do they possess the moon snail’s killer instinct? Should they be fearful? Do they sense my fear? I try, I try hard, to keep Worry at bay. I wish them not to be frightened, only aware.

Tuesday morning Dr. Kirk circles the innocent abdominal speckle with a purple indelible marker, writes "2 x 3" above it and takes a photo. She does the same with another in the constellation. With her magnifier, she zooms in on the mad, bulging blot
that now spits from the ridge at the nape of my armpit. This one looks...hmm, she says, as the magnifier scans the surrounding skin, fine. Given my skin's pigmentation, she explains to me.

It is as if she has waved smelling salts beneath my nose. Fine? Fine! I breathe again. I am lucky. (But acutely aware that luck is the card not dealt to all, reserved for no one, and the game invariably changes, so I do not apologize for being an alarmist. I have lost my father, my dear brother-in-law, and one of my closest friends to cancer, all within short time.) Nevertheless, I explain, I would like it removed before it is un-fine. It has been bothersome and prone to snags. This is fine, too, she tells me, but today is not her surgery day.

The others, she points out, are on watch. Should these change, darken, enlarge, action will be necessary. In three months I will return to her office. It will mark one full year from my first skin scan. (Skinscan, I later discover, is an Apple application for the monitoring and analysis of moles. I don’t download the app.) At that time, and though she thinks it’s harmless, Dr. Kirk will remove the underarm mole at my command, along with another mole she’s deemed odd; she’ll hew them down like cleaved trees that do not bear good fruit, slicing them from where they’re rooted with a hand-held straight edge blade. Later she’ll tell me that the mole that kept me up for nights on end is normal. No sign of cancer. The other odd one, she’ll say, is atypical, which means I’m oddly fine for the time being.

“The internet is the worst thing to ever happen to doctors,” she tells me.

“And to patients,” I concur.

I thank Dr. Kirk for her support. I call my GP and cancel the procedure. The rock in my chest is a pebble, my face pink with embarrassment. Unlike the moon snail, I have no knack for slaying. Beneath my pale outer covering is only accumulated fear and worry. It feels counterintuitive, yet I know I must do this, I clearly sense it, I must shed fears, let them loose in my Sea of Unease, expose this timorous being to the elements, the rough seas, the cold winds atop ice-capped mountains, or to things like jets and puddle jumpers that I no longer board, or zip lines, any lines, the aging lines, rimples and knots of my body, all conditions approached with trepidation. Yet, the instinct is to flee.

Here is the rub. I cannot flee. Can anyone? Not even to faraway lands or islands where money is no object. It’s futile. Danger and risk are not unique to the mainland. I can only be aware. Watch the coastline and all things that sail on the horizon, listen to the ebb and flow of its waters and their simple message. Don’t make more of it. You just get in the current and float—you’ll drift right back in round the other side, I was told just days prior, as I stood on the beach of Sandy Neck’s duck-bill tip, fretting about my flimsy aquatic abilities. “Oh, yes, it looks so easy,” I’d replied, while surveying the cold current running a hook around the shoreline. And as I gazed out as a crow flies, into the bay’s channel, drifting peacefully in the horseshoe flow were my two children and Michael, coasting along, round to the other side.