To Excise a Malignancy by Emma Burger
Most of the jobs on Craigslist were looking for girls willing to sell their bodies. “Exotic bottle service girls, girls needed for bodywork, surrogates needed ASAP, Wall Street $$$$$$ is back!! Earn 6 figures year 1 no license needed.” Half of the postings were completely unintelligible. It was clear though, that most people on the site were either overseas bots seeking to extort you, or sleazy promoter types looking to sell sex.
It caught my attention immediately then, when I came across a post from a legitimate-sounding company called Uptown Dermatology. “Dr. Azarian has been in practice on the Upper East Side for over 20 years, and boasts a roster of New York’s elites as her loyal patients. We’re looking for a professional, personable, and attractive face to greet our valued patients. The Medical Receptionist provides exemplary customer service and is responsible for handling front office reception and administration duties, including but not limited to answering phones, handling company inquiries, collecting all paperwork associated with patient registration, and maintaining inventory.”
That would be fun. I always loved skin. When I first heard of trypophobia - the fear of holes - I diagnosed myself with trypophilia - an intense, compulsive attraction toward them. Trypophobia was a common loathing, apparently. People were especially freaked out by clustered, microscopic, sinister-looking holes like pores. Me, I couldn’t get enough. I’d stay up late at night watching pimple popping videos for hours. Pore strip slow-mo’s, botworm removals, and cyst excisions were my kryptonite. I loved inspecting the disgusting build-ups of sebum and bacteria, the suspense of the aesthetician pushing, pushing, pushing against the patient’s sealed-tight pores. The will it or won’t it of it all. And finally of course, the satisfying release as the skin’s surface breaks, bursting forth the hardened lesion.
It felt dirty, perverse even. So untoward in fact, that I clung to my secret for two years before finding out there were lots of fellow trypophiles out there - a condition I’d always thought of myself as having invented. The videos online, initially targeted at med students and dermatology residents, were a hit with a whole population of derm-obsessives like me. It was such a hit that they made one derm’s page into a TV show, Dr. Skinner. Patients cried tears of joy as Skinner MD pointed to the benign tumor that had finally been removed after fifteen years of neglect. Still glimmering with a gelatinous sheen, it would jiggle in the kidney dish as the patient hugged Dr. Skinner, the camera panning in for a close-up, no matter the freshness of the now-gaping wound on the lower back, the shoulder, the cheek. That was my jam.
This job was perfect, then. I could speak passionately about cysts, nodules, whiteheads, blackheads, blisters, burns, hives, keratosis, rosacea, carbuncles, psoriasis and melanoma. Sing the praises of regular facial resurfacing. Wax poetic about waxing gone wrong. I did so promptly, not holding back an ounce of my dermatological zeal in a single-spaced cover letter. I hit submit and headed out the door, stopping for an almond milk cappuccino and heading up 1st Avenue toward Gramercy to see what it might take to sneak into the park.
I hadn’t made it past 18th street when my phone buzzed in my back pocket - a 212 number. “Hi, is this Louisa? This is Catrina from Dr. Azarian’s office. Is now an okay time for you?” Their last receptionist had left last week on maternity leave. She’d gone into labor three weeks earlier and they were scrambling for a replacement, she explained. “Do you have any availability today? We’re really looking to fill the position as soon as possible,” Catrina said, her voice sweet but urgent-sounding.
I looked down at my watch. The office was at 86th and Park, thirty minutes on the Six. “I can be there by 3:00,” I replied, looking down at my workout leggings. I pivoted on my heel, heading down toward Union Square. I could duck into Forever 21 and pull something together. It’s not like I had anything worth wearing at home anyway.
The Union Square Forever 21 was gigantic - the bottom floor was filled with spaghetti-strapped crop tops and ass-hugging mini skirts. Nothing decent enough for a job interview. I grabbed a three-quarter sleeve cream sheath dress off the sale rack, hidden deep in the recesses of the third floor clearance section. It was a little low-cut and you could see my cleavage peeking out of the V-neck, but it was a cosmetic dermatologist’s office - this could be exactly what they were looking for. An attractive and friendly face. According to the derms I followed online, the French face went from your forehead to the skin below your breasts. The V-neck framed my moisturized and tended to French face. It would show them I knew their business inside and out. The value of a well-kempt décolletage. At the very least, it would have to do for now.
The women working at Dr. Azarian’s office all had the same lips. Their pouts looked fresh and dewy, their cupid’s bows a perfect U-shape - a smile within a smile. Each of the nurses wore black jogger-style scrubs. They had long, thick dark hair, all straightened in the same smooth style. Their skin glowed warmly, their faces made up simply. Their deep complexions highlighted lightly at the cheekbones, thick groomed eyebrows framing their faces, not a hair out of place. When it came to skincare, they led by example. I wondered whether they were all related.
Dr. Azarian, or Dr. A as they all called her, was an East Coast surgeon. Her clientele was considered sophisticated, unlike the nouveau riche LA housewife types that populated plastic surgery Instagram. Instead of maximally inflated lips and taut shiny foreheads, Dr. A was known for her subtlety and her light touch. Her philosophy, detailed in gold looping script framed behind the front desk, was to perfectly balance science and art to enhance her clients’ natural beauty.
Catrina, the medical assistant I’d spoken with on the phone just an hour earlier, offered me a Pellegrino and walked me down the quiet hall to an office in the back. The halls were lined with mirrored shelves. Rows and rows of quartz-colored bottled serums, lotions, cleansers and toners, all branded with the same silver Uptown Dermatology script. I glanced at myself in the reflection of a shelf as we passed by, suddenly noticing where I’d mindlessly picked at a scab on my right temple. It was too late now to do anything about it.
Catrina offered me a seat in the dusty blush velvet armchair that sat centered in front of a large glass desk. She took her seat opposite me, swishing her perfectly coiffed jet black mane behind her shoulders. “So Louisa, tell me about yourself. Why are you interested in working at Uptown Dermatology?” I smiled and rattled off an answer about my lifelong curiosity about dermatology, my background in customer service, my interest in aesthetician licensure. It wasn’t a lie - I was enamored with the idea of becoming a licensed aesthetician if I could ever afford the program in New York State. Nothing would energize me more than waking up to a day of pimple popping and lasers. This job aligned perfectly with my career interests, I summarized, feeling self-assured as Catrina nodded, scribbling something in bubbly handwriting in the spiral notebook on her desk.
“Well, great! I think this sounds like a great potential fit. I’m going to go get Dr. A so she can meet you. Is there anything I can get you while you wait?”
I shook my head no, trying not to look overly excited. “I’m all good, thank you!” Catrina shut the heavy glass door behind her on the way out. I swirled the Pellegrino in my bottle, watching the bubbles slowly migrate to the top and then burst on the water’s surface, like little lesions being freed from the epidermis.
Above Dr. A’s desk hung her diplomas, each framed in the same rectangular mirror-like frame, seamlessly coordinated with the shelves that lined the halls. Bachelor of Science from UCLA, Doctor of Medicine from Johns Hopkins, Dermatology Residency from USC, Mohs surgery fellowship from Memorial Sloan Kettering. Impressive. I shifted in my seat, pulling up the collar of my V-neck. Clicking my dark red nails against the glass desk, I imagined coming into work here each morning. Carefully making sure each quartz bottle was aligned. Offering the parade of patients a cappuccino, an espresso, a sparkling water. Waning daylight streamed through the chiffon curtains lining the office’s entrance. It would be a nice place to sit and pass the time. Perfectly pleasant, to be surrounded by pretty things and pretty people.
It felt like an hour had slipped away by the time I heard the door swing open behind me. I stood up, turning on my heel and extending my hand. Dr. A smiled wide, extending both of hers. She touched the back of my hand with her left as she shook mine, a professional embrace. Her skin felt poreless and soft like cashmere, her long fingers wrapping around my hand. Like Catrina and the nurses I’d seen walking the halls of her office, she too had long, inky hair which she wore parted perfectly down the middle. She looked luminous – somewhere between 45 and 48, I gathered. Her skin showed no signs of wrinkling but also wasn’t stretched too tight, either. Instead, it rested effortlessly across her striking bone structure - her cheekbones high, her jawline square. She looked familiar. I wondered whether I’d ever come across her Instagram and forgotten all about it deep in a late night state of dermatological fanaticism.
“So, Catrina tells me you’re interested in joining the Uptown Dermatology family,” she smoothed her beige silk slacks as she sat down in the swiveling desk chair, flashing a gleaming white smile. I repeated an abridged version of my earlier spiel - what a fan I was of her work, what this job would mean to me, what I could bring to the table - er, front desk haha.
She didn’t ask any more questions, just told me how nice it was to meet me and that she was really looking forward to working with me. “I’m out two days a week. We have a shop at the Fontainebleau and I have clinic there on Thursdays and Fridays. Catrina will email you with the details regarding orientation. Anna is the PA who covers for me here when I’m in Miami. The main thing for you to know is not to schedule any Mohs surgeries when I’m not here. Anna is great for lumps and bumps though - she can do everything else besides Mohs.”
Dr. A pulled out a light pink cardstock folder, pushing it toward me across her desk as she stood up to leave. “It was so nice to meet you sweetheart. I think you’ll fit right in here,” she reached for my hand again and I didn’t want to let go. Her handshake, so soft and warm, felt like a hug. “Catrina can show you out.”
Embarrassed as I was, I squealed audibly as I shut the building door behind me, a crisp fall breeze almost blowing the folder out of my hands. A little old lady in a beige pea coat turned to look at me as if to question what it was someone like me was doing on her block. It didn’t even matter, though. I had a job in New York City. A nice, fancy, dermatology job at a nice, fancy dermatologist’s office on the Upper East Side.
I stopped in Dean and DeLuca and bought a celebratory chai latte. It was more money and more sugar than I normally would’ve gone for, but I deserved it. “Autumn in New York,” Billie Holiday crooned into my headphones, “Why does it seem so inviting?” I was a walking cliché, but I didn’t even care. “It was written, I should be loyal to the cliché of my choice,” I thought.
Still beaming, I walked all eighty blocks home to my apartment that evening, watching the sunset through the impeccably groomed Park Avenue trees, their leaves just starting to turn. As I walked, I leafed through the folder, which included a “Welcome to Uptown” packet and my salary details. At 35 hours a week and $18 an hour, I’d net out at just under $33,000 a year. Nowhere near enough, but it was better than nothing. That was part of moving to New York, right? Besides, that was before factoring in savings on skincare.
New York, I was quickly finding, was a great place for someone like me. Despite the offensively high rents, the stench of hot garbage that permeated the city, the fruitful, multiplying rats, it was a great place. In a city of strivers, there was a real market for someone like me – an undisputed non-striver. People’s faces would soften as soon as I told them I’d stopped going to school after community college, their Botoxed brow falling a millimeter as they realized they didn’t need to worry so much about impressing me. As far as they were concerned, the separation between us represented safety. I wasn’t after their job, their man, their child’s spot in the preschool class. They were safe with me.
Maybe I should’ve gotten a CIA job or something. I was so unassuming here, it made people want to spill their guts. The bartender at the place on my corner told me he’d been stealing from the owner. A crying girl on the train told me about her abortion. Four different little old women on the street told me I was pretty. One said I had an open face.
Once I started working for Dr. A, I discovered that there was a whole economy in this city devoted to accomplishing the aesthetic goals of the overeducated, upper middle class women who ran it. We weren’t exactly the Uber drivers who ferried them from brunch to yoga, or the Doordashers who left Sweetgreen outside their door as they rolled Zoom calls. Instead, we were a subclass of girls and gay guys dedicated to waxing, sugaring, microneedling, styling, CoolSculpting, blow drying and training these wellness devotees into the women they wanted so badly to be. Physical beauty was a religion here, and these women practiced it with fervor.
For the most part, these underlings were like me. Attractive enough that the clients at a place like Uptown would feel okay about leaving their face and several hundred dollars in my hands every few weeks. A majority of the women who went to Dr. A’s would complain of sagging brows, discoloration, deepening laugh lines. My favorite part of the job though, would have nothing to do with Botox or microdermabrasion. My favorite part were those Monday and Tuesday morning appointments, when we’d schedule patients for Mohs surgery.
Three weeks into my receptionist responsibilities, Dr. A had me follow her into the operating room, where a 70-something year old man lay supine, his body covered entirely by a light blue surgical drape, aside from his nose, which poked out of a hole toward the man’s head. A rough, brown splotch of melanoma decorated the side of his nose, circled clearly in purple ink.
“How are you feeling, Mr. Johnson?” Dr. A asked, placing a hand on his shoulder.
“Pretty good, other than I can’t feel my face,” he chuckled, his disembodied voice warm and gravelly. “I’ll feel a lot better when you get this thing off of me.”
At Sloan Kettering, where Dr. A had done her fellowship, she explained, a trained lab tech would’ve been the one transporting samples to the path lab. They had people who did nothing else all day but run from the OR to the lab and back again with tissue samples. “But hey, now I’m training you!” She exclaimed, her hand steady as she carefully removed the top layer of the affected skin.
The precise excision of the tumor repeated layer by layer soothed the part of my brain that liked methodically raking my little Japanese Zen garden in concentric circles. In a world where entropy so often prevailed and a random mutation could result in the uncontrolled multiplication of cells, this procedure represented a methodical return to order. If only this same surgery could be applied to the ugly, malignant parts of my entire life. I would give anything to lie anesthetized in Dr. A’s office, eyes closed as she peeled back the layers of my compulsive drive to hit the self-destruct button. As each layer of my malignancy was removed, she’d follow some other lab tech out of the room, examining the sample under her microscope, making sure not a trace was left behind. She’d stitch me up, the stiff blue stitches a reminder of the psychic ugliness that had once threatened to kill me.
Emma Burger is a writer and healthcare professional working in oncology research. She splits her time between Ann Arbor, Michigan and New York City. Her debut novel, Spaghetti for Starving Girls, was released in September 2021. You can find her work in Schuylkill Valley Journal, Across the Margin, Idle Ink, and The Chamber Magazine, or online at emmaburgerwrites.com.
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