Variants of Unknown Significance


My gynecologist won’t stop bothering me about getting a genetic test done. I don’t see how knowing or not knowing will make a difference—my mammograms will start at twenty-five anyhow, and you didn’t have any mutations but were still afflicted. In the worst case scenario, they’ll tell me to get a mastectomy, but I think it might be nice to have a flat chest, to wear swimsuits that actually fit, to exercise without impediment, have the globules of fat shaved off with a cutting wire. At least that’s how I imagine it: a clean cut, the doctor a ceramist removing blocks of clay.

I rarely wear bras. I always wondered why you wore one, despite the negative space. Maybe to retain some femininity, maybe to cover the scars purpled with age, maybe because you thought all women should wear one regardless of necessity. I cannot remember a time when you weren’t flat. I study old photographs, try to decipher if your size was similar to mine. When my grandmother asks for help buttoning her blouses, I glance between the folds and try to fill in the gaps.

It takes three months to get an appointment with the genetic counselor, and on the specified morning, I oversleep. Another three months pass, and I am finally in the waiting room surrounded by pregnant women, my own uterus happily hollow. I go to the bathroom and open the door to an impending mother, her eyes frantic with the need to release something. Everything about her is swollen, including her chest, and I wonder if it feels like puberty pain or another kind I might never know.

The geneticist comes to collect me. Her hair is thinning and her back is stooped and she carries herself with the humble regality of a famous author. In the office there are newspaper clippings of her research and conferences, but mostly I notice that there are no pink ribbons, so I think I might trust her. She asks me questions and makes a chart of my family tree, but we can’t get further than my grandparents because anyone older had been lost.

When I was sixteen and applying for a driver’s license, the form asked if I wanted to be an organ donor. The last time I asked you about it, after a health class, you said, “Never donate your organs.” “Why?” “I’ll tell you when you’re older.” But then I was older and you had never told me, so I thought oh, well and checked the box. My ID printed with a pink donor circle, although I imagine no one will want my body parts if my test comes out a certain way. No point in harvesting spoiled fruit.

The counselor and I decide on a panel of sixty-seven genes. There are also options for thirteen or forty-nine, but I don’t understand the pros and cons when she explains them to me, so I pick a number arbitrarily. She must sense my disinterest because she keeps reminding me that the test is for my benefit. After the meeting she sends me a summary of my genetic history, and I see that she reported my parents as incestuous first cousins. When I correct her: “Sorry for the error—don’t know how I misunderstood that.”

I have been careful my whole life. I scrape the carbon dregs off my toast, I stand on the other side of the kitchen when the microwave blasts my oatmeal with three thousand megahertz, softening the grains into a pulpy mass. I put SPF on everyday, especially when it’s cloudy and even on my lips; I don’t sleep with my phone next to my face; I don’t breathe when people around me smoke. I don’t eat meat for the animals but I tell my family it’s to reduce my risk, because they can accept that.

At the bottom of the email is a note saying I will have to wait for the labs to clear my insurance—”Right now the out of pocket will be $399, or we could send the sample to a different lab, where the maximum co-pay will be $250.” I don’t want the test in the first place, but I don’t think I can go back to my gynecologist without facing another lecture, her disembodied voice chiding me from between my legs.

I half-hope that both doctors will forget about me, but I receive a reminder from the gynecologist every week asking for updates, the encrypted emails mixing with my homework assignments. In turn I message the geneticist, who always writes back, “Still waiting, sorry for the delay.” Every time, I respond with a cheery “No worries!” because I am not worried.

I figure I should seem more invested in my results, so I go to the library between classes and check out The Cancer Journals by Audre Lorde and Illness as Metaphor by Susan Sontag. There’s nothing on genes, but I read the books cover to cover anyway. You never told me how you felt when you were dying, to the point that I forgot you were—which was probably for the best. I try to learn about the experience from these writers, but they are composed and critical and born in the 1930s, and they are not you.

I’ve always been a compulsive list-maker, but after the consultation, my “Grocery” and “To-do” lists change to “Things I Don’t Know About You/Forgot to Ask” (thoughts on abortion, favorite kind of tea, what it’s like to grieve your own death, if you thought your job was one of the saddest in the world), “Things You Wouldn’t Like About Me Now” (more than two piercings, GPA, weed), and “Things I’ve Inherited” (cat, car, cardigans). There’s also your life savings, the 401k and life insurance, split evenly with my brother. When people ask how I pay for my expensive college—and they ask all the time—I say you died so I could go to school.

In high school I only ever wrote about losing you, because it was the worst thing that had happened in my short and privileged life. My teachers ate up the trauma, or at least I thought they did, and it seemed like an easy A when my peers were writing about awkward Thanksgiving dinners. I packed you into tight little narratives; I stapled and turned you in so many times that I thought I wrote you to death. For the past three years, in college, I thought I had finally moved on, writing about identity and race and relationships, yet here we are again.

I go through my computer and find everything I ever wrote about you. There’s a lot of bad poetry, most of which is just prose with line breaks. One is a freshman English assignment I worked on in the hospital hallway while watching you through a plexiglass window covered with juvenile paintings done by volunteer groups. The poem is an extended metaphor about origami, and the last stanza reads, “An ordinary piece of paper is turned into a boat / Sailing away with the hopes to float.” Paper boats because you taught me how to make them, a beach setting because it was your favorite backdrop. The Corona Del Mar beach specifically, where you drove my brother and me without warning one day after picking us up from school. “I don’t want to go to the beach,” I complained in the car. “I have homework.” But you insisted, and after walking out over the sand and settling on our serape blanket, you told us you had news. You would try to make it to my brother’s graduation, you said, but probably wouldn’t make it to mine. Try, because you would never voluntarily leave us. Probably, as if there was a chance, even though you knew the more accurate word was definitely.

In class we turned our poems in anonymously and workshopped them in groups. Mine was chosen to be on the exemplary “Wall of Fame” board, and a senior friend later told me that the teacher had also shown it to her AP Lit class. I think I write all my best work when I’m crying.

I impulsively decide to get a tattoo, as people do when their loved ones die. I make an appointment for the next day at a shop near campus, and go after my English lecture. The gun feels good against my ankle, the sterile metal opening up my flesh. Lying on my side, I add “tattoo” to the list of things you wouldn’t like about me. When the artist is done she covers her work with a plastic seal and I practically skip home, feeling euphoric. After I peel away the bandage, releasing an oozing puddle of plasma and excess ink, I contort my leg in the shower and rinse with cold water, unveiling a small paper boat. The lines are thin and precise, the skin around it red and irritated. Carrying the image on my exterior is like carrying you with me, the wound as fresh as if you had died yesterday.

It takes a month for the insurance to be cleared, and another month until I am back in the geneticistI’s office, drawing blood into a green-capped vial. The sample will be packed into a box, padded with black foam, and flown to a lab in California less than an hour from where you used to work. The geneticist says she will call me in a week with the results, although some prefer to receive them in person, so they aren’t ambushed mid-workday. I can choose either option. Everything is in my best interest.

My grandmother tells me I will be fine, that you only contracted the disease because you were exposed to excessive radiation during your residency. “Be a pediatrician like your mom, but not an oncologist,” she says. I imagine you in a lab in California sorting through green-capped vials, a red liquid accidentally spilling onto your hand and resulting in some sort of chemical blast. If life were a comic book you would have morphed into an astrological cancer crab, using a pincer to amputate children’s tumorous limbs. A superhero or villain, I can’t decide.

There was a doctor you used to work for who adopted children with missing or otherwise dead limbs. At the annual hospital picnic in Griffith Park, I saw an older one handing out toys with one arm, while the younger kids were loaded onto small trains that went around a track faster than they’d ever be able to run. Every time I saw them I felt blessed, although I don’t think that’s the effect they were going for.

After I leave the office I take the Q train to the restaurant where I work. In the subway car I stick a hand up my shirt, knead the rolls of fat on my stomach until the skin is warm and clammy, a nervous tick to pass the time. Before becoming a waitress, I worked as a college brand ambassador for a mass market lingerie company. Sometimes they invited me to focus groups at their offices, and my student peers and I would spend hours deciding whether prints looked better as an accent or all over, zippers or clasps, logos printed or spelled out in script. I wonder if my opinion would still matter if I couldn’t test wear—my company freebies would really go to waste if I only used the bottom halves.

When I was sixteen but looking more like thirteen, I went bra shopping by myself. It was a boutique I had resorted to because department store bras never fit my chest, my cup size disproportionate to my circumference. An employee measured me in a dressing room, swiveling my body in ways that felt irrelevant to the task at hand. “30E!” she proclaimed, smiling. “Surprised?” I flushed, the number sounding obscene, and upon seeing my embarrassment she asked if my mom knew I was there, shopping alone. I told her no. Last year a co-worker asked what I did for Mother’s Day, and I said I called you. I don’t like making people uncomfortable.

On your death anniversary, one of your friends sent me an email, saying, “I know you must think about your mom everyday, because I do.” But how is that a way to live? I thought.

Halfway through the week I decide to download a dating app, use my chest for all its worth before it might disappear. I tell my brother my plans and he makes fun of my tendencies, says you would be disappointed in me.

I forgot about the time you told my brother not to have premarital sex, but I remember the time you gave me a box of pads, because tampons were too invasive and vaginas weren’t meant to be plugged like sockets. My brother wonders if you were really a prude, or if it was just a show in the face of our youth. I stay up trying to remember, but all I really do is dismember you, tearing at the edges of your wraith.

Sometimes I reread my lists and wonder what would happen if I met you now, if the seven-year gap would render us strangers. I don’t know the answer but it is one of my biggest fears.

I like my chest despite, and sometimes because of, its disproportion. I like the way people look at me differently when I wear something tight, deviating from my normal attire of baggy shirts and dresses that could be described as sacks. I wonder if a marked and linear body would have the same effect, or if I would become the kind of woman who has sex in the dark, the kind who keeps her top on even when her partner insists they don’t care. I care, even though I know I shouldn’t.

The only time you exposed your midriff was when you sat on the striped reclining chair, your shirt folded halfway up to your chest. The tools were spread haphazardly on your lap and in the furniture’s crevices: an alcohol wipe, a bottle of ointment to make your stomach shiny, a syringe pre-filled with liquid medication. You flicked the tubing to get the air bubbles out, the sound of nail on plastic both solid and pliant. I always thought it was primitive, the way treatment blurred self-harm and self-preservation. Every night when you pinched a roll of fat and inserted the needle you looked to be on the verge of tears—or maybe that was just my projection.

I message a few people on the app but can’t muster the energy to meet anyone. I stay in and take a hot shower with my phone’s speakers wedged against the bathroom mirror, reverberating indie pop music until the screen goes steamy. I have to bend over repeatedly as I rinse, pull long strands of black from the drain. I have a tangled ball in the soap dish by the time I am done. One of my roommates loses hair when stressed, although I don’t think I could be capable of the same. When I emerge from the bathroom I ask her to hold my dripping hair, tilting my head sideways, and we compare weights.

You were never good at maintaining a clean shave so your head was covered in wisps, not like the soft down of a baby but like the oily strands of Gollum, from Lord of the Rings. Whenever I see a bald woman on the street or in the subway, I wonder if her lack of hair is genetic, aesthetic, or because she is dying.

The next day I go to work, and during my lunch break I order sautéed broccoli because the internet says it is a preventative superfood. Despite the garlic, I taste nothing as it jostles my tongue, gets stuck between my teeth. I drink water but it does not help; my mouth feels as if it is coated in a film of chalk.

When my shift is over I go to my writing workshop, where I have a classmate who only submits stories about their dead mom. I ran into them once on the G train, and we exchanged numbers and texted about starting a dead mom cult. They suggested I read Roland Barthes’s Mourning Diary, so I checked it out from the library and spent the week bookmarking passages. In one of Barthes’s entries he asks, “Does being able to live without someone you loved mean you loved her less than you thought…?” I know exactly how much I loved you, at least comparatively. Almost immediately after you died I had a falling out with a best friend I’d known since kindergarten. I didn’t fight very hard to keep the relationship, and our plans to be college roommates and each other’s bridesmaids dissipated. If I can live without you, can’t I live without anyone?

When you were in the hospital, my ex-best friend said she had stayed up all of one night crying over you, with no consolation except for the morning light. What about my nights, I thought, my past twenty-eight-going-on-twenty-nine nights with no consolation except for the mourning of you.

Sometimes I took walks around the hospital, “buying snacks” my excuse to get away from the sterile air in your room. I ran into your nurses once in the elevator, dressed in scrubs and talking about when they’d be able to see the movie 21 Jump Street while their patients lay bedridden in the surrounding rooms. You died in the hospital where you spent fourteen years clocking in five days a week—how’s that for work-life balance?

Two days after you died I went back to school, and was completing problems about diameters and circumferences when my math teacher hugged me without a word—the other students must have thought it very strange. At the end of the year I was invited to the school awards ceremony, and the only award I received was for geometry. I had a C in the class.

Almost a week after the blood draw I go to my statistics lecture, taking notes as the professor explains edges in a graph, how disconnected paths can never make a complete circuit. I doodle loops in the margins of my paper and think about the topless photos I’ve sent, how they would be considered artifacts if my chest were to become etched with parallel scars, freshly pink. Four dotted vertices connected by two edges. What gifts I’ve given.

During my last year of high school, a counselor suggested I apply for the Julie Inman Courage Award, a scholarship given to a senior who graduates “in the face of adversity and/or life-changing obstacles.” When I won, I found it difficult to believe that my obstacle had been the worst out of everyone in my class. I went to the front office alone during lunch to pick up the check. I didn’t attend the senior awards ceremony because it was the only award I received.

After the lecture, I walk to a Greek restaurant, find something with heady spices to revitalize the taste in my mouth. Cumin and saffron and za’atar—I ask for it all and more on the side.

When I bite into the lentils it tastes like your forty-eighth birthday dinner, when the restaurant owner saw your bald cap and sat next to you, inquired about your health. “I have a friend,” he said. “He’s cured so many people, all natural remedies. Western medicine has a cure but they won’t tell you because they want the money, you can’t trust them. Trust me, go to my friend, he can save you.” You smiled, ate the shish kebab that was his profession, and didn’t tell him about your profession.

Every other week I meet my stepmom for lunch, a woman from Vietnam who is ten years younger than you, with dreams of becoming a doctor in the US. B remarried two months after you died, and even though you were divorced, it felt like a slap in the face. All those hours he spent driving you to chemotherapy and radiation, was he just biding his time, hoping your cells would continue to divide?

In the hospital he was always recording, swiveling his phone to survey the room while you lay with tubes and drips dangling from your arm, lips chapped and too drained to speak. “You’ll want these later, as a souvenir,” he told me. When he went to the bathroom I unlocked his phone, deleted all the photographic evidence, threw out every plastic keychain- and postcard-memory of our hospital trip.

I don’t want to think about you anymore. I don’t want to think about your genes living inside me, killing me. I only want to think of your hands, and how they made me, holding me.

Something doesn’t sit right in my stomach, maybe the food, maybe the waiting. For whatever reason I spend the evening curled in bed, feeling short of breath. I email my professors, tell them I will be out tomorrow.

When I was young I read about a surfer who experienced phantom pain—she felt stabs and aches in her arm even a year after it had been bitten off by a shark, a specter of a limb still wholly attached. I wonder if it is possible to experience phantom pain from losing a whole person, genetically attached.

I miss the geneticist’s call at 8 a.m. because I am asleep. I call her twice but she doesn’t pick up, so I leave a voicemail. There is nothing to do but sit for hours and wait.

On the morning of the day you went to the hospital for the last time, in the parking lot of the shopping mall: you bent over and heaving, one hand on the car’s rear bumper, one hand on the width of your thigh, the drawstring ties on the bottom of your khakis trembling. I couldn’t drive and I couldn’t touch you, and so I stood and watched until you straightened up, and then I got in the passenger seat and you drove home.

I look in the mirror hanging on the back of my door, lift my shirt to observe the curvatures underneath. I consider taking a photo but it feels gratuitous, so I just stare. The cliché would be to call them ticking time bombs, incendiaries permanently strapped to my chest. All it would take is the press of a button, a phone call.

The geneticist finally calls me back and tells me I have no conclusive mutations, only variants of unknown significance. “So I’m not at a higher risk?” “No, well, we can’t know; you have some mutations but there’s not enough research yet to know what they mean. You should come in and we can talk more.” I make the appointment, put the phone down. All this, I think, just to appease my gynecologist.

I lie on my bed, slip a hand under my shirt. Variants of unknown significance. I poke and prod, begin at the base of my sternum and make my way up and around. Variants of unknown significance. You, on your bed, making croaking sounds I had never heard and have not heard since. Variants of unknown significance. My body tightens; I feel on the verge of tears; I feel a lump in my chest.

Variants of unknown significance.


Rumpus original art by Clare Nauman.

Mai Tran is a writer based in New York. Her writing has appeared in The Guardian, Lit Hub, Apogee Journal, and elsewhere. You can find her online @maiittran. More from this author →