IN THE SHADOW OF THE SUN
“This is my hand. I can move it, feel the blood pulsing through it. The sun is still high in the sky, and I…am playing chess with Death.”
—Ingmar Bergman, The Seventh Seal
It all began with a beauty mark that looked like a spider.
I had three moles on my upper arm, and two moles on my back. I could see only one of those two. The other lurked beneath my bra strap, waiting. Until I got pregnant.
My final pregnancy was tough on my mind, body, and soul. It was even tougher on my baby. She didn’t make it. The first trimester was a conflicted and obsessive time, one that added insult to injury.
I’d had a tough delivery with my son, Sean. We’d both hemorrhaged. He’d had brain surgery at ten months. My husband, Brian, lost his mother when Sean was two in 1998. My parents were in failing health. But we’d been married thirteen years, and I was nearing forty.
Finally, we went after the brass ring one more time, armed with temperature charts and ovulation kits. Three months later, we were shell-shocked, happy, victorious, with two lines instead of one on my stick. Another baby!
Nature had other ideas, though. An ovarian cyst my second trimester necessitated bed rest. I drove to my next OB checkup with foreboding, past a dead doe on the highway median, an omen to me, an homage to Death. Feet in stirrups, I heard the bad news I’d expected. No detectable heartbeat.
One week, alive. The next, dead and gone.
A week and a D&C later, I was emerging from shock and entering rationalization. Dressing for bed, I took my bra off and shrieked.
“Spider!” I shouted. “Get it off!”
“What?” My husband came running. “What’s wrong?” He was grieving, just like me, but he was still my hero, the only one I’ve ever known.
“It’s a spider! Or tick! There! On my back! Get it off!” I flailed around, trying to reach that spot where it’s impossible to scratch or fasten a bra.
“It’s there! On my back!” I tried to point at the dark spot nesting between my left shoulder blade and spine. To my nearsighted eyes, it seemed to have little stubby legs.
“Oh, that,” he said. “That’s no bug. That’s the mole your dermatologist said was nothing.”
One wave of relief left, and another of apprehension replaced it. I pivoted, attempting to get a better view of this ugly irregularity that was now part of me. It wasn’t going to be as simple as a brush of the hand to kill it. It wasn’t the mole a dermatologist had removed and biopsied the year before.
I had no paid leave, so opted for a nearby physician available on a government holiday, instead of my regular doctor, for a prepregnancy skin check. I’d done my research. He was a five-star practitioner, one of Washingtonian Magazine’s Top Docs, which meant his peers respected him. He had seemed hurried, though. He hadn’t asked me to take my bra or my jeans off. He hadn’t looked under the bra strap where the second mole was lurking.
I pointed out the mole that itched to the doctor. I figured it was the same one my husband had mentioned during lovemaking, because it itched. It was difficult to see any small dot on my back, with or without my glasses, standing feet away from a mirror, craning my neck like a flamingo. He peered at my mole with a dermatoscope. Only he examined the wrong mole. Brian was the only one who’d seen the lethal one.
* * *
I was a kid who liked dirt. I liked to roll in it, dig in it, eat it. When my father brought home lots of red, muddy clay to fill in our new backyard, I rejoiced. I made mud pies with my new BFF, Scooter. He was a quick, funny kid with a crew cut who always carried tools in his pocket. Eccentric for a child of four, and that’s why I loved him.
We made the pile of earth our personal sandbox—molding clay animals, slathering our bodies in it, climbing up and down the mound pretending to be explorers on Everest. The third day of digging, hoping to hit another continent as my father kidded us might happen, I came upon a small, shiny, black creature. I ventured closer. I loved mud most, but bugs were a close second. This one was mesmerizing, but sinister in its stillness.
“Look, Scooter,” I began. He’d already run to get my mother.
My mother shouted at me not to touch the spider while Scooter, in cool preschool levelheadedness, ripped a screwdriver out of his pocket and thrust it into the spider. Its legs wiggled and then stilled again. Only a shriveled ball with sinewy, broken-twig legs remained. When Scooter rotated the screwdriver, all three of us could see its red underbelly.
A black widow.
My mother marveled at Scooter’s speed and common sense, and at my narrow escape. My father shoveled all the dirt to fill the slope to create our new backyard. I forgot about the black widow as soon as I met another adventure. I sliced open my chin chasing my kitten and got plenty of stiches. I was not a careful child, but I never saw a live black widow again.
Black widows like dark places. Both males and females live solitary, long lives, up to three years. Humans rarely see the males. They spin their webs close to the ground. There may be good reason. “Black widow” comes from the female’s reputation of eating her doomed partner after mating. Yet this time, we were the conquering, and the spider, the vanquished.
The spider died. I lived.
* * *
Though still adventurous, I don’t ignore my health. My grandmother feared swallowing needles. My mother was terrified of spray deodorant. I’m afraid of vomiting. Hypochondria runs in the family. From the Deep South, my maternal line carried death’s inevitability around like lipstick in our purses.
Even at three, I’d noticed the black widow. How could I have overlooked this lurking avenger so close to my spine? Perhaps because it was more insidious than any spider. Because I tried to disregard my pale white skin in an age of tanning oil. Because I hated moles. Because I hated thinking about illness and death.
I’ve always thought my “beauty marks” were ugly. I was furious with a school chum who used a marker to link the moles on my right tricep, dot-to-dot fashion, to create a clown face. But despising my moles, willing their disappearance, did not make my skin darken or my moles evaporate. At fourteen, I added freckles, which a doctor also checked out annually. Although I never spent as much time in the sun as my friends, and my mother coated me in sunscreen, I did sunbathe in my teens. “I’m either a ghost or a lobster,” I’d joke. “No in-between.”
Unlike the moles on my arm, this tiny new mole was indigo-black. A seal and pact with the sun. A memento of too much time snorkeling and hiking. Ironic that a bright summer sun could produce a black-as-night imprint on my skin.
I went to my regular dermatologist later that week. Dr. Mally sliced the lesion off, saying she wasn’t concerned, but it needed biopsy. I received the diagnosis a week before Christmas.
The doctor and her nurse marched in wearing Santa caps and handed me a candy cane. “I’ve got to give you your diagnosis,” Dr. Mally said. “It’s melanoma.” She never said “malignant.”
I sat befuddled but silent, calm, not understanding what “a melanoma” meant.
Dr. Mally assured me that “plenty of people like me” were walking around alive, and that the surgeon who’d be slicing out the rest of the tissue from my upper back had “experienced great success.” I wasn’t sure how medical prowess translated into prognosis, but before I summoned enough brain matter to ask, she handed me a pamphlet, gushed holiday greetings, and poof!, was gone.
I read the pamphlet and lab report on the subway. The word “malignant” appeared in front of “melanoma.” Worrisome was that all of the tissue biopsied had been malignant. What had been vague became clear as a sky-blue day without clouds. One minute I’d been excited for Christmas; the next, I wanted to cancel it. Everything I had known the world to be, everything I had known myself to be, was transformed in infinite ways. Safety, security, health, and happiness flew away.
One minute, my baby had been alive; the next, dead. If my baby could die in an instant, so could I.
I called my husband, and he left work right away. Brian hugged me a long time. Was he hiding his distraught expression in that hug? After he released the embrace, he told me about a woman who’d just died, featured in our newspaper.
“She spent her last days decluttering her house, getting things organized for her family.”
“If I’m dying, I’m going to Paris one last time, not cleaning your house.” I did have to admit he would be left behind to clean up my mess and raise our son.
“I don’t want to die at forty,” I said. “I’ve lived the great life I wanted. But we have a child. I certainly don’t want to leave Sean behind. I don’t want to leave without publishing my book either.” I said “book,” but I meant “books.”
The plastic surgeon’s receptionist squeezed me in for a New Year’s Eve appointment. He was in the Caribbean for the holidays. I called the doctors who’d performed my lumpectomy for a fibroadenoma. The breast surgeon said he’d see me the Monday following Christmas.
I went through the motions of holiday hustle like an offspring of the Grinch and Ghost of Christmas Yet to Come.
I burst into tears without warning, and then, because I didn’t want my son to know I was upset, I’d leave the room. Difficult behavior during supposed-to-be-merry holidays. One minute, I’d berate myself for waiting for pregnancy too long. The next, beat myself up for not being there for my family more at Christmas. Was the lost baby aware in some heaven, or simply gone? Why did anyone have to leave a toddler behind? Why did my unborn baby have to die? Why did anyone get a terminal disease while pregnant?
Gradually, fear overtook my grief. I might be making the same journey my baby had soon. I’d leap out of my seat at the slightest noise. A sadness poured in, as gigantic and heavy as Sisyphus’ stone, and just as constant, as futile. I’d never get to the top of the mountain. Instead, I’d become a dusty part of it.
My strong will and stubbornness then overtook my fear. I resolved to stay upon the earth to raise the son I had.
Until Christmas Day.
My husband, a jokester, devised a treasure hunt for my gift. I wasn’t up to it. I was the one who’d left her credit card at the gasoline station two days prior. Had a fender bender days before that. I tried to go along with the mirth. Twelve clues later, I was boiling mad.
“Just give me the damned gift!” I shouted at Brian, watching him and Sean deflate.
Then went to the bedroom to cry. What kind of wife and mother was I?
Returned with red cheeks, swollen eyes, and a big fake grin. My son pointed toward the tree, his wide eyes glum. It had been hanging on a branch all along.
I opened the box to a bracelet of diamonds and sapphires, oblong links that expressed my husband’s love for me.
I was not grateful. “What am I going to do with this thing?” I asked, when my son left to watch Elmo on video. “You can’t bury it with me.”
He looked as if I had slapped him. My heart sank. “Thank you, Bri,” I said, touching his cheek. “I’m sorry. It’s hard for me to man up right now.”
I wanted to tell him I was ashamed that I wasn’t more macho. Brave like him. He’d had his rib cage reconstructed when he was five, and had only partial lung function. He never complained. He’d recently stepped in front of me and Sean when a man sprayed Mace at us in a hotel parking lot.
“I vow I’ll do better,” I said instead, all stoic cowgirl.
* * *
“You’ve probably caught it in time,” the breast surgeon told us on December 26th. It was small, and therefore probably superficial, but “we can’t be sure until we drill into the area and find nonmalignant skin cells.” Prognosis is dependent on the depth of a melanoma, which usually, but not always, corresponds with its diameter. This one was deeper than it should have been, considering its circumference. He recommended a conservative approach, but expedited surgery.
I tried to take his words in, but that black widow kept crawling back, gaining ground. Like my mole, the adult spider is no more than half an inch long, but its venom more toxic than a rattler’s. They seldom strike, but they are nimble, waiting in secret for just the right instant to attack, the sands of time running red on their underbellies. Most people don’t feel the bite. The excruciating pain begins fifteen minutes later, overwhelming the nerve cells.
Most healthy victims survive the spider’s sting. A melanoma lodges in the skin, and you sit there unaware as it attacks the immune cells, then organs. Chemo often isn’t effective. Life expectancy for metastatic melanoma in 1999 was less than a year. Had mine metastasized? Weeks after a failed childbirth, was I healthy enough, was my immune system strong enough, to overcome the stealthy cancer cells floating in my lymph?
The second surgeon had different advice. He sent the mole out again for another biopsy report, then recommended excising more rather than less skin. “You don’t want these things returning,” he said. “But these things tend to reorganize themselves for weeks. You have time. It’s only been a few days.”
“It’s been twenty-eight,” I said.
I decided the plastic surgeon would operate, not the breast surgeon. Another week of waiting. Finally, on January 12, 1999, I walked in the George Washington University Hospital, where a “wide re-excision” was taken.
We entered the hospital at 7:00 A.M. by the same door Reagan had been rushed through when surgeons saved his life from an assassin’s attack. We’d risen at 4:00 A.M. to take my son to my friend Laura’s until preschool began. We drove first thirty minutes north, then sixty minutes south. No breakfast. No coffee. No water.
Laura would die in 2005 from pancreatic cancer after surgery, experimental treatment, and chemo. After this surgery, I would live. No new treatments. No chemo.
The long registration line and forms to complete lulled my mind. It was simple outpatient surgery. I had requested no general anesthesia because I had bad asthma after my pregnancies, and I was more phobic I’d never wake up post-surgery than of feeling them cut. I’d been awake for my C-section, and I had a D&C without any anesthesia.
“It will be easy,” I told my husband as I signed my legal waiver.
It wasn’t, totally.
My doctor entered with an entourage. I had an interesting case.
The surgeons were performing a wide excision to eradicate the melanoma’s chances of survival in my cells. They injected my back until it was numb.
“We’ll be cutting down to the muscle,” Dr. Macht told his interns.
“You need to stay still,” he told me. “No movement. At all.”
I held my breath.
“Breathe,” he instructed.
He taught as he cut.
“Wow!” one intern remarked. “Not much fat!” I was proud my back was muscular.
“How many millimeters?” another asked.
“I’m cutting so I can create a skin fold,” Dr. Macht replied.
“I’ve never seen that done,” an intern said with awe.
They asked a lot of questions. After fifteen minutes, I began to shake.
“Are you cold?” the nurse asked.
No, I wasn’t.
My body was going into shock, a common occurrence when it’s cut deep and wide. My body thought it was dying, even though I kept telling myself it wasn’t.
The doctor sliced off five millimeters of flesh in every direction on the left side of my back, just below the shoulder blade. A perfect square. “See?” he instructed his students. He held up my skin like cow hide. “All the way down to the muscle.”
They oohed and ahhed like they do on medical television series.
“Almost done,” the nurse said, draping a heated blanket around my neck. The doctor created the skin flap. Stitched it all up. All that was left was a vertical scar along my spine from my shoulder blade to my bottom rib, like I’d had disc surgery.
They were done.
Opening the locker, the clothes warming my body. Still shaking. Fumbling with the buttons. Sitting down, dizzy, then standing again. Relief so profound it was akin to joy. Still shaking. Brian’s expectant face in the waiting room. Walking out the same revolving door that Reagan and I had entered.
We’d both lived.
Brian didn’t understand the postsurgical pain until he changed my bandage. “Wow!” he said. “That’s a quarter of your back!”
It wasn’t, quite. The scar is a 3.5-inch (nine-centimeter) line on my spine. I was happy they’d taken the diseased flesh away. Burned it in an incinerator somewhere. To Dust.
You either live on after melanoma, or you die. There’s no in-between. The clock ticked on, giving me plenty of time to think about floating cancer cells and toxins. About why cancer cells invade. About why spiders attack. It may depend on the kind of prey or predator. On the environment. Scientific American tells us spiders’ decisions are not random. Nor are malignant cells.
* * *
A week passed, and I received the pathology report. No cancer remained. None.
“You’re lucky!” the surgeon said. “My resident just died of a brain tumor! He was in perfect health, aged twenty-eight.”
He omitted “until…”
I had to remember: My tiny malignant tumor had died. I had lived.
I became pariah or celebrity at any gathering. My colleague Stuart asked me why I’d lost a few pounds. “It’s not the cancer, is it?” he whispered.
An acquaintance followed me around all night, surprised to see me. She assumed I’d already succumbed.
My friend Jackie called to emphasize melanoma was “devious.” She told me to exercise great caution. “I have a friend who had a friend who died fifteen years after they sliced the mole from her leg.”
Macabre. Eerie how I’d lived for decades—same friends, same mindset, same spiritual base, and a single sentence—“There’s no fetal heartbeat” or “It’s melanoma”—changed my every perspective, my truth. For all intents and purposes, this ordeal was over in six weeks. Yet I continue to transform today.
For example, I nearly breathe prayers—spontaneous, automatic. I pray for the trivial, the inane: safe rush-hour journeys, relief of my stiff back, prompt replies. As much as I pray for my kids’ happiness. To remember to be thankful. For our health.
Although I am considered “cured,” it took me months to realize I wasn’t healed. Despite our hurry-up, got-to-have-it-now society, healing won’t cooperate with deadlines. I work daily on staying present, not speeding life up or slowing it down.
I cope with my biting, self-deprecating sense of humor. I learned not to laugh off every challenge, though. Crying can make you strong. Tears make me a better worker, mother, wife, friend.
One in every seventy-five persons died from melanoma in 1999, but I could not find a support group. My self-doubt and vulnerability lingered. I joined a generic, all-inclusive, no-patient-left-behind support group, but I only attended twice. I needed to stop feeling guilty that I’d live and others would die. To step into my future, I had to trust myself again.
I’d been certain of the world. I’d had career tunnel vision, always in a hurry for the next promotion. I’d just know if I’d gotten the job, or should move on, or stay put. I’d thought I could intuit danger too. Yet I’d been so hell-bent on having a second child, I’d gotten pregnant when I’d had a melanoma growing too. I’d never felt any danger at all.
I quit one job, found another, tried alternative health treatments, and became a coach, wrote my books. Some of these changes caused friction. Friends and family wanted pre-melanoma me, but the doubt began to recede.
I called Dr. Mally in January 2000 for an annual skin check, glad there’d be no candy canes and Santa hats. Her receptionist said she’d retired the week before. She had esophageal cancer.
She died. I lived.
Life is good, if precarious. I’d be lying if I said I don’t feel afraid any longer. Swollen lymph nodes, abnormal cervical cells, inflammatory bowel disease, and ovarian cysts have visited me the quarter-century I’ve lived as a cancer survivor. The doctors call all of these maladies annoying but benign, but that’s what that first dermatologist told me before I tried to get pregnant. He’d seemed sure, even cocky, everything in my body was fine and healthy. He’d told me I was safe to get pregnant. My obstetrician was shocked I miscarried so late. He’d told me that the baby was out of the woods when I entered the second trimester. I’d hear that reassuring heartbeat at every office visit.
Until I didn’t.
Scooter’s screwdriver and the doctor’s scalpel averted death, but it will return. Death is an eventuality.
Yet melanomas and black widows become treacherous only if not seen and understood. The female’s bloodred hourglass covers her belly to warn potential predators, not to spew out her lethal juices. Neither gender is aggressive unless threatened or hungry. Instead of some evil, malicious predator waiting to inject me with its venom, my mole was the part of me that catalyzed transformation in my life.
I’ve lost many since my health crisis in 1999. My father died in 2001, my mother in 2003, my closest colleague Michael next, my sister-friends Laura in 2005 and Stacey on my sixtieth birthday. One day, despite trying to ride the currents well away from its strongest rays, I’ll fly too close to the sun, like Icarus. I will hear Death say, “Checkmate,” just as my loved ones did. I’ve come to see the black widow’s belly as a wake-up call, not an aggression.
Brian only stares at sports games or good murder mysteries. In 2000, he was staring at me.
“What?” I entreated.
“Nothing,” he said. “The strength you’ve gained this last year shows.”
“375 days,” I replied.
It’s hard to be thankful for hardship, but I thanked him, said I was sorry I’d been such a bitch at Christmas. We lingered in that gratitude. I was still here. With the man I loved and the boy we’d raise to a man. I was grateful for my time in the shadow as well as in the sun. It’s our dark side that balances our light side, makes us human, and works toward making us whole.
We were traveling to China to pick up our new daughter, Aimee Xiao Wei Ramsperger. My biological baby had been due early summer 1999. Aimee was born April 14, 1999. Not a coincidence to me. We lit twenty-three candles for her this year, and she has only one fear.
* * *
This year also brought another biopsy. This time Brian’s. He goes to the dentist one day; the next week, he’s at the oral surgeon’s. Two weeks of waiting for the lab report.
“It’s what we thought,” the surgeon tells us as the rain starts to fall. We inhale.
“What’s that?” my husband asks.
“It’s hyperkeratosis,” the dentist says. “Definitely benign.”
That word we all long to hear. We exhale. For now, there’s more living to do.
Someday, though, they’ll take him off to surgery, or lift me into an ambulance, for the last time. Our lives on this earth don’t last. If we are lucky, we have lived. If we’re blessed, we have loved. Our memories fill our last days because they transformed us. Our hearts break because they loved. The sun casts its shadow because it shines so bright.
Author’s Note: Only a doctor and a biopsy can determine whether a mole is malignant or benign. See your physician now and get a second opinion if you notice any new mole, or a mole that has changed in size, shape, color, texture, or feeling (itchiness, tenderness, scabbing, or pain).