Mole Biopsies and Other Love Notes

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If your mother is an oncologist and your father is an internist, you can talk about your genital mole over pork chops. It was a normal weekday meal, and my mother was discussing which of my sisters’ potentially malignant moles might need to be removed, when I, around age eleven or twelve, confessed to a discovery.

“You know what,” I said, reaching for the serving bowl. “I have a mole, too.”

What I had seen in the shower the other day looked innocent enough—a mole no larger than a speck of pepper, on what I learned later was my clitoris. Though it seemed harmless, I was concerned because of the number of moles recently removed from my sisters’ skin. I planned to mention it quickly, have my mother dismiss it, and then she could go back to cutting things off my sisters. But instead the conversation stopped, and my mother stared me down across the dinner table.

“Where?” she demanded. Like all mothers, mine has a mental map of her children’s bodies that she’s been drafting and reworking since our births. I’m the one with the chunkier limbs and plusher hands; my older sister Angelina’s grin reveals my mother’s two inwardly turned front teeth; and my younger sister Gabriella has my mother’s oddly shaped toenails. My mother’s map of me didn’t include this mole. I could feel her thinking across the table. How could I have missed it? And, Can I get rid of it right now with this butter knife?

shower“The mole is on my genitals,” I said. “You can’t examine it at the dinner table.”

“Do you mean, Corina,” my mother asked, “that you have a mole on your vagina?” Her tone suggested this was the worst place to harbor one.

“It’s there, but it’s so small. It’s nothing.”

I was convinced my mole was a good egg, not one of those under-the-radar cancer moles, one of those shape-shifters. Though I knew it was bad, I had no idea what “discoloration” might mean. And this was just a little guy. The size of a 16-point period. The end of a sentence.

“It’s a healthy little mole, Mom,” I said. “It just wants to live. Don’t cut it off in the prime of its life.”

“You know, Corina, I’m really concerned. Your vagina? It’s on there? It is actually on there?” She stopped eating.

“Yeah, it’s on there.”

“That area is particularly suspect, Corina,” she said, shifting in her chair. She was transitioning into doctor voice. “It doesn’t matter if it’s small or not. We should have it removed.”

Removed. Such a cold word. I was horrified to think about what would be involved in removing this particular mole. Chopping away down there. What if they got sloppy? What if they took off a key, you know, chunk? My preteen vagina was so young and fragile. It had yet to see the world.

*

Our family seems to have more moles than average, which in other households would just play out like an overabundance of freckles or charm. But in our family, moles had meaning. Today it could be a beauty mark on your cheek; tomorrow it’s a malignant breeding ground. We all knew that bad moles are not always obvious. They don’t have to be the biggest on the block, bumpy and wart-like; they could come off as innocuous, maybe just with a raggedy border, a slight change in shape, a minor growth spurt. Bad moles lurk. If this were a comic book, Bad Mole would be skulking in a dark alley, wearing an ill-fitting trench coat.

I hadn’t wanted to tell my mother about the mole, but I feared cancer like other kids fear snakes or gym class. It wasn’t just moles I was concerned with. The left side of my chest would ache occasionally and I was pretty certain it was late-stage heart cancer. If it really was just me “becoming a woman,” why did I feel pain on only one side of my chest? What the hell was that? Was only one breast growing?

“There is no such thing as heart cancer, Corina,” my mom said.

“Well, some other kind of cancer, Mom. Something that affects your heart. You know, you’re a physician. That cancer. I’m sure you know what type of cancer I’m talking about. Leukemia or whatever.” This “whatever” would kill me in a year, I was convinced.

It was hard not to be a hypochondriac in our house. Illness came to our dinner table every night, whenever my parents discussed a joint patient’s case or a new consultation.

test tubes“His chest CT didn’t show an aortoesophageal fistula,” my mother might say, setting down the meatballs.

“Please, Babes,” my father might reply, winding spaghetti around his fork. “He was throwing up blood all night.”

Illness was in our fridge. I would open the refrigerator door to find vials of dark blood squeezed beside the yogurt, the silicone gel at the bottom of the test tubes looking like congealed bacon grease. “What the hell is this?” I asked my mother. “Is this your blood? Please tell me that’s at least your blood.”

“Tests.” I could hear the shrug in her voice. “Just move those to the side.”

*

I grew up in Beaumont, Texas, home of Spindletop, the largest oil gusher the world had ever seen in 1901—and the beginning of the oil craze in the Lone Star State. After the field dried up, the petro-chemical plants took over, supplying a world made out of things made out of oil. In this region with almost no skyscrapers, the plant pipes stand in for a skyline.

No one imagined the nightly plumes of smoke billowing into the sky could be a good thing, but when so much of the city was employed by the plants and the potentially asbestos-filled shipyards, who wanted to know the extent of the harm? The oil and chemical companies certainly weren’t going to point to a direct correlation. We rolled up our windows when the rotten-egg smell of sulfur hit our nostrils. Like hurricanes and brown-water beaches, this had became just another undesirable but accepted part of living here.

*

Recently, as I watched my mother prepare lunch for us in her kitchen, I asked her about the chemical plants.

“Did you know about the high cancer rates where we grew up?”

“Sure,” she said, opening the fridge to look for leftover rice.

“Did you worry about it?”

“Of course,” she replied, closing the fridge door. When my mother feels anxious about a topic, she reverts to monosyllabic speech. We had moved down to Texas when my father bought a former medical professor’s practice there. Once established in the area though, my mother never lacked for cancer patients, and her terse reply told me she didn’t want to spend much time dwelling on why. I waited until we sat down to lunch before asking again.

“What do you think caused all that cancer?” I prodded, knowing I could continue on this path of inquiry for only so long.

“The chemical plants, I imagine.” She cut into her chicken. “But you know, Corina,” she added, taking a small bite, “people in Texas are also big smokers.”

Most horror stories about smoking came from my father, who would talk about his older patients who couldn’t quit. Smoking actually didn’t seem as popular down there as chewing tobacco, evidenced by the telltale outlines of Skoal cans wearing permanent circles in men’s back pockets. They would spit viscous, orangey-brown phlegm onto the side of the road or out of their pickup trucks, and keep Styrofoam cups to spit in next to cans of beer.

I don’t know if I’ll ever know the complete truth about why the cancer rate was so high, or how much it would help at this point. But every time I return home I’m reminded of how much the chemical plants look like an enchanted city of the future, lit up by 24-hour floodlights. The Oz of Southeast Texas. If you squint your eyes and pretend for a moment, the fumes are like fairytale clouds framing the city—smoke from the genie’s lamp, granting my hometown its every wish.

*

My mother chose to concentrate on what she could control.

Deli meat was banned from our fridge. “Full of nitrates,” she said dismissively. I had no idea what nitrates were, but I’m sure they were delicious. Instead my mother would make us sandwiches with canned pink salmon full of tiny circular fish bones that would crunch when you took a bite. I opted for cream cheese sandwiches instead, all the while dreaming of the unexplored deli cases at the grocery counter with their easily sliceable salamis, tantalizing roast beefs, and mind-boggling selection of hams: smoked, peppered, black forest—dear God, even maple-glazed.

We didn’t take two steps onto the beach without slathering on SPF 50—that was unspoken family law. Using SPF 8 was like snuggling up to the Reaper. For a while I didn’t even realize they made sunscreen with SPFs that low, and when I finally did spot a bottle of SPF 8 on the drugstore shelf, lying next to the SPF 50, I gasped in horror. “How could they do that? It’s so irresponsible. Don’t they know?bad mole Who are these drug companies that would take sunbathers’ lives into their own hands?” In my family, tanning beds were considered cancer vending machines. I didn’t need to be convinced: I would stare with premature half-grief at the Texas girls with year-round tans, imagining their funerals. I was also kind of an asshole. “You have that romantic, Victorian-era glow,” I would say to my alabaster-colored friends, stroking my naturally tan, half-Asian skin. “Don’t you understand how beautiful it is to be pale?”

I wasn’t allowed to sniff gasoline fumes. This was not the greatest denial a kid has ever known, but gasoline has always smelled to me, well, nice, and here was the allure of the forbidden. That my mother felt my pain only made me wonder what kind of creepy olfactory genes she had passed down. “I know, Corina,” she said once, climbing back into our SUV after a fragrant pumping. “I enjoy the smell of gas as well. So good, right?” She paused. “Highly carcinogenic though. Highly.”

In spite of all these home-banned substances, my mother wasn’t a health freak, one of those parents who equated buying Frosted Flakes with sending their kids off to the guillotines. My sisters and I drank Nestle Quik and often ate Jack in the Box for dinner. We were normal enough. But every once in a while, perhaps because of some patient she had seen near the end of the day, my mother couldn’t help bringing the doctor home with her. She did her best diagnosis over reheated pot roast. You could be passing her the peas, and she would notice that your nail beds were less rosy than usual (anemia?). “How long has it been like this?” she would say, as if I had some sort of color chart against which I checked my nail beds each night. She would lean over half-eaten spaghetti to have us roll our eyes to the side so she could check for additional signs of iron deficiency. As often as she dismissed my hypochondria, she indulged it as well.

She needed to know what was going on with her daughters’ bodies. She would draw our blood if we were “looking a little pale” or if “it had been a while,” and we left her office bruised and bandaged. “Look at me,” my little sister Gabriella cried one day, walking out of our mother’s office. She extended her arms to reveal purple bruises where my mom had failed to find the vein. “I look like a smack addict.”

Flu season was the worst. When Angelina and I were little, my parents would always take us to Baskin-Robbins for ice cream after Sunday evening mass—but on flu shot night, there would be no ice cream. Just an unannounced drive to their office after hours. “Where are we going?” I inquired. From the front seat of our Volvo station wagon there would be silence on my dad’s side, and the reply “Oh, to the office,” on my mother’s.

Once there my parents began by shooting each other up first, to show us how easy it was. The whole thing went down like a bad public health video. My mother delivered her lines well enough, but my father overplayed his. Though a brilliant physician and a skilled musician, the man was no thespian.

“Ok, just tell me when it’s over,” he’d say, chuckling to himself as he rolled up his sleeve and my mother filled up the syringe. I read somewhere that the needle for the influenza vaccine needs to be at least one inch, but swear to God, the one my mother used clocked in at about five.

As she punched it into his shoulder muscle, inches of the needle disappearing into his upper deltoid, I would wonder how the body could even take a needle that long, if the muscles had to separate from such a powerful intrusion. But if it hurt, my father didn’t show it; he was too busy focusing on his lines.

“Wait, wow, is it in?” he would ask, knowing the needle had already landed. He looked down at his shoulder like he had never seen it before.

“Yes, it’s in,” my mother chirped back. “It’s nothing, right?”

“I didn’t feel a thing!” he exclaimed, as she removed the needle and pressed a small piece of cotton gauze against the pinprick. Anyone who hadn’t seen this play already could almost believe this performance, wanted to believe it—except my father couldn’t help hamming it up at the end.

“Really? No, wait, are you really done? It was like a mosquito bite!” And then: “No, do it again, I didn’t even feel it! Do it again!”

My older sister and I had poked our heads around the corner of the doorway by this time, one foot in the room and one foot about to sprint on down the corridor. We knew this was a play staged for our benefit every year, as the script, much like the quality of the acting, never improved. Still, we couldn’t look away. The application of the bandage was our cue to exit the scene, and we were off—flying around their square-shaped office, sometimes in tandem, sometimes splitting up, as they chased us around the dark corridors. They would run after us for a little while—minutes? hours?—the night growing darker, this whole charade going on for way too long, all four of us knowing, deep down, that my parents would get my sister and me in the end.

Angelina usually capitulated first. I think they had broken her spirit early on. She told me about a time when she’d needed an allergy shot and made it out of the office and all the way down the block before they caught her and dragged her back. My mom reached for the needle, and my father sat on his oldest daughter. “He sat on me, Corina.” I imagine her squeezed like a tube of toothpaste, her flailing arms and legs sticking out on both sides. Now after a few rounds around the office, they knew to pick her off as the weaker member of the herd. Circling her at one of the doctor’s tables, they would try to coax her quietly, bring her in gently—then I would hear it from the next room, that eardrum-popping scream when they stuck her with the needle. A few minutes later, I spied her bouncing up on the yellow vinyl couch of their waiting room, an old copy of Highlights in her hand. Crisis over.

I knew my time was running out. When they finally caught me, it took both of them to grab my arms and legs as I went down squealing like a stabbed pig. My father pinned me down while my mother brandished the syringe.

“You know, Corina, the less of a big deal you make of it the less it will hurt,” she said, letting out a sigh as she jabbed the needle in my butt.

*

When it came to moles my mother played the role of the enforcer and my father, her loyal henchman. As an internist with a subspecialty in infectious disease, cancer was not my father’s area of expertiseit was my mother’s, and he trusted her judgment. She was one of “the top cancer doctors in the area,” he would remind us when we were kids, and “your mother worked at M.D. Anderson, the top cancer hospital in the country,” he would add for emphasis, which must have been impressive in physician circles but to a kid of ten or eleven was like saying she was from Planet Nerf.

My mother had our moles checked out by a dermatologist to verify that they needed to be removed, but it was suspicious just how many she was right about. My older sister had a two-inch long mole on her butt that I mistook for a large palmetto roach when we were little. Don’t ask me why I thought a roach would luxuriate on her ass from age three to ten, but by the time Angelina was a teenager, it had been removed. My younger sister’s jagged-edged mole on her knee that I used to pinch while she was sleeping in her crib? Goner.

Until my vagina mole, I had skated past the knife. I could have just stroked my lesion lovingly and called it a day. But it’s no fun celebrating your good fortune if you don’t pick on the less fortunate.

“Holy crap, Mom totally carved you up, dude!” I remarked to my little sister Gabriella years later, catching a glimpse of her upper back one day as she changed out of a shirt. “Look how many scars you have!”

“Shut the fuck up, Corina,” she said. My little sister has never been a big talker. Hastily pulling on a t-shirt, she stood up from the bed and stomped away.

I moved on to Angelina. “Hey, remember when I thought you had a cockroach on your ass but it was really just your butt mole? And remember you had that darker skin by it, which was like the same shape and size as the mole, and I thought it was the shadow of the roach? Now that it’s gone, does the shadow miss the roach?”

“Every day, Corina,” she replied. “The shadow misses its friend every day. Sometimes, I hear it crying.”

*

No one else was subject to my mother’s mole hunts—not uncles, not cousins, not that one Filipino friend of hers who hit the moley jackpot with a huge honker on his chin that had a single, four-inch-long hair growing from it. “It’s weird looking, huh?” my mother said after he’d left. “In the Philippines, growing a hair out of your mole is good luck.”

Sometimes my mother drops these cultural nuggets from her homeland, leaving me both curious and terrified. Apparently there are several websites out there that outline Filipino superstitions about death, life, poverty, pregnancy, and moles, and in addition to learning that people with curly hair are ill-tempered, and that pregnant women who witness an eclipse will give birth to kids who blink too much, I discovered that a mole can be a sign of prosperity, good health, or attractiveness, depending on where it is located on your body. Most of the moles my mother had removed from my sisters were on their backs, and according to the site WikiPilipinas, moles there are just a sign of laziness. It all made sense now. With a few quick trips to the dermatologist, my mother had rescued my sisters from cancer and a lifetime of sloth.

*

In grade school, I used to be envious of the notes that my classmates’ moms would leave in their lunches, just a little “have a nice day” or something like that. It would have been nice to receive notes nestled next to my sandwich, but my mother just rolled her eyes when I asked about it. Between working at three hospitals and two offices in different cities, she focused on what she thought was most important. Mole removals were her love notes to us, one scar at a time.

I saw the chemo room in her office, the lazy chairs arranged in a circle where patients would sit for hours hooked up to her chemo drip. I attended the annual dinner parties that she would host to toast the cancer survivors that year. I listened to my father ask my mother, “Why do you read such trash?” and gesture to her Harlequin romances, and I heard her reply: “Do you know what I deal with every day, Ross? I want to relax.” My mother rarely talked about the consultations she had with patients, about how many years they had left and what there options were. “It’s worse when it’s the kids,” is all she said to me once. As doctors they are trained to separate themselves, to let go of what happens at work, but no one can completely divorce oneself.

I remember coming home from high school one day to tell my mother about my classmate Brian’s mom, who had recently been diagnosed with cancer.

“Brian says things are looking better for his mom, that her health is improving. They’re feeling hopeful.”

“That’s great, Corina,” my mother said. “What kind of cancer does she have?”

“Stomach cancer.”

My mother shook her head. Her voice got quiet. “No, Corina. The survival rate is very low for that.”

“But they said she’s getting better. Brian said she was really improving.” I wanted to be supportive of my classmate, and surely he knew better what was going on with his own mother.

“No, Corina,” she said. “She’s not going to make it. That’s one of the worst ones to have.”

Within a year, Brian’s mother was gone.

Back then I thought my mother was blessed with a superhero knowledge that laymen could only dream of, wisdom that took her that many more years of schooling. The doctor, and what’s more, the cancer doctor. I still believe this, but now I wonder how much she has had to sacrifice for it. If someone close to her were to pass away from cancer, could she allow herself to walk through all the stages of grief? She has lost the privilege of not knowing, the solace of ignorance. I’ve watched my mother fear that every stomach issue she has might be her own burgeoning tumor, as if by fighting cancer for so many years she deserves to get it herself.

*

About ten years after my youngest sister Gabriella left home for college, my parents retired, left Southeast Texas, and bought a house in a suburb of Seattle, to be closer to my older sister Angelina and me.

My mother has stopped asking about our moles, but still finds plenty to worry about: my father’s health, if Gabriella is getting enough protein with her pescetarian diet, if the street by my house is too dark at night. She still has the habit of ordering us to do the obvious, like demanding I put my coat on before we leave the house, not after we get to the car, as if at age thirty-nine this idea might not have occurred to me. There’s something about my her forcefulness that has always made me feel like she will outlive us all, and now that she is growing older, any information to the contrary frightens me. Why didn’t she remember to close the garage door that time? Did she forget to take out the trash? She’s demanding today, but is she quite as demanding as usual?

I have also come to realize that escaping the scalpel doesn’t mean I was the lucky one. My sisters might have acquiesced because they were less confrontational—or they might have believed that, in this case, the old adage held true: mother knows best. It suddenly struck me as ridiculous to worry about what might happen to me when I could take preventive measures.

Three years ago, during a routine visit to my dermatologist, I asked that he look at my mole. My usual exchange with him—“Gimme that lotion so my scalp doesn’t fall off, thanks”—only takes about two minutes, so I had time to kill.

molesWe had dispensed with the paper gown so he could look over my entire body quickly, as I perched naked on the edge of the examination table. However awkward I felt, the doctor appeared triply so. He approached the examination table tentatively.

“Okay, so uh, I will examine you here and uh, just check all your moles, so okay, uhh….” I could tell he was itching to rush through this part, so he could go back to handing out scalp cream.

Then it hit me: I had forgotten where the mole was. It had been over twenty-five years since the vagina mole debate with my mother, and far from being the model of female sexual health and know-how, I actually hadn’t looked down there in a while. My vagina has ceased to intrigue me; these days I keep my eyes on the shower curtain when I bathe, on the lookout for exciting new mold.

“Sorry, give me a minute,” I said to the doctor. Leaning in for a closer look, I started rummaging around down there like I looking for an extra quarter.

Finally I spotted it—so small, I almost missed it.

“Wait, wait, here it is!” Keeping my finger on the mole with one hand, I gestured to him with the other.

He stepped closer, and together he and I peered in to forecast my future. The little pepper speck… was still a little pepper speck. It had not grown since I was a kid.

“I think that one’s okay,” he said, sounding a little bored. “Let’s look at the other ones, okay?”

Looking me over in a detached but careful fashion, like I was a cadaver he was about to dissect, he motioned toward a faint, jagged-edged mole on my thigh. “Keep an eye on this one,” he said. “This one too,” he added, pointing at my left shoulder, where I’ve had a raised, chocolaty brown one for as long as I can remember. “Also, don’t forget about that one on your arm.” There were so many potentially bad moles to keep track of—too many. I returned the next year and I could sense the dermatologist wishing I were a little less thorough with my skin-check request, as we went rooting around down there again. But every time I hope up on that examination table, I can hear my mother’s voice whispering to me: “You know, Corina, that area is particularly suspect…” For how often I’ve refused my mother’s help or denied her advice—no I will not put on that coat, no I will not get that flu shot—it is curious what remains.

I asked my mother recently if she remembered my vagina mole that we had discussed so many years ago. She had forgotten about it, she said, and berated herself for not having it removed. Then as if no time had passed, she made the demand.

“I want to see it.”

As if no time had passed, I made my refusal. “I’ve been getting it checked out,” I reassured her. “My mole is good. We’re both good. Happy little mole.” Eventually, she let the subject drop, which surprised me. Maybe she trusted that I was taking care of my own health issues as an adult, or maybe she simply forgot.

Lately I worry more about her then I do about myself, or at least as much as I do about myself. I fret about her health, especially now that she is now over seventy. Now that several people we know from Southeast Texas have developed cancer, she is broaching the topic more these days, and I am the one saying I don’t want to talk about it, that it will only upset me. There is nothing that can be done about that and other potential ailments, except exercise and a healthy diet, blood drawings, mole checks. The future is a goliath we face together, checking our skin for marks.

***

Rumpus original art by Elizabeth Schmuhl.


Corina Zappia is the nonfiction editor at Pacifica Literary Review and a former staff writer for the Village Voice. Her essays have appeared in Gastronomica, The Morning News, The Awl, and Nerve. More from this author →