I’d seen a lot of unusual cases in my time as a dermatologist. The human body produces no shortage of strange and baffling conditions. Skin is no exception.
When Flora Springs first sat in my office chair, however, she nor her skin seemed strange or baffling at all. She was a young woman, still in her late twenties. A quick review of her chart prior to her appointment stated she’d developed a few lumps on her stomach. There was no change to skin color, no pain, no hardness. Just a series of soft abdominal growths.
I met her with a smile and handshake.
“So you’re here for some growths,” I said.
“Yes,” she replied. “They don’t hurt or anything, but they’re…weird.”
She was holding tight to her husband’s hand, obviously anxious. He gave her a reassuring squeeze.
“No pain tends to be a good sign,” I said. “Do you know if your family has a history of cancer? Melanoma, carcinoma?”
“No, nothing like that, I don’t think.”
“Alright. And when did you first notice the growths?”
“About a year ago,” her husband answered for her. “After —”
He was cut off by a subtle tug at his hand. Flora’s eyes flicked quickly towards him. There was an odd expression in them, a note of pleading. I maintained my professionally neutral air despite the curiosity that that look had roused in me.
“About a year ago,” her husband repeated. This time, there was no follow up.
I made a mental note to return to the “after”, perhaps when Mr. Springs wasn’t present.
“Alright, well, why don’t you lie back and I’ll take a look. Do you mind lifting your shirt?”
Flora settled back on the exam table and pulled her shirt up to reveal her stomach. She was a petite woman, slender, and the growths were immediately noticeable. Four of them, all lined up in a neat row above her belly button. Their uniformity made them look like they could have been subdermal implants. After pulling on a pair of gloves, I gently felt the lumps and the area around them.
“Any tenderness or discomfort?” I asked.
“No,” she said.
“Have they been growing or changing shape?”
“Growing a bit, yeah. The shape’s been pretty much the same.”
She was still clutching her husband’s hand. Her eyes were trained on the ceiling. I understood well the anxiety that accompanied such growths. I did my best to keep the exam short.
“The good news is that they appear to be cysts. Fatty, benign tumors. They’re fairly common and really nothing to worry about. The fact that they’ve grown together like this, and maintained such similar appearances, is unusual, but not concerning.”
The relieved smiles that spread across both of their faces were bright and genuine. He bent down and kissed her forehead with a short, choked laugh.
After allowing them a moment, I said, “I’d like to biopsy at least one just to be safe. You have a couple options going forward: we can leave them as they are if they’re not bothering you or we can remove them. It’s really up to you.
Flora didn’t hesitate. “I want them gone.”
We scheduled a follow up appointment for a few weeks out and she and her husband left. I noticed Flora kept her hand protectively over her belly as they exited, despite her loose fitting shirt. Cysts often brought on such insecurity and I was only too happy to help her get rid of them and return some confidence to her.
The next time I saw her, she’d been put in a paper gown and prepped for her outpatient procedure.
“How’re you feeling today?” I asked while pulling on my mask and visor.
You could never be too careful when it came to cutting out growths. Some of them had a tendency to spray.
“Ok,” she said, staring pointedly up at the ceiling. “A little scared.”
“It’s going to be fine. You won’t feel anything except for some minor tugging, ok?”
“Ok,” she didn’t sound entirely convinced.
“Someone’s here to drive you home?” I verified.
“Yeah, Xavier. My husband. He’s out in the waiting room. He doesn’t handle blood so good.”
“That’s alright, not everyone can. We can always call him back if you need him though. Now, you’re going to feel a few pinches. That’s just the anesthesia. After that, I’m going to be making an incision at each cyst and extracting it. I’ll be taking out the whole growth, not just draining it, so it doesn’t grow back.”
Once Flora was as settled as we could get her, I injected the anesthetic and waited a bit for it to do its work. While it took effect, I referred to my notes from our previous meeting and saw I’d written “One year ago, after?” with an underline. I recalled that she’d stopped her husband short when he’d started to tell me about when the growths had first appeared.
“So, Mrs. Springs, last time you were here, you said that the cysts has started to grow after something. Did something occur last year? A health scare or lifestyle change?”
Her response was short and final. The way she said it left no room for further questions.
I ensured the anesthetic had taken hold before encouraging her to relax and asking my nurse to wheel over my instrument tray. Flora’s abdomen was wiped down with antiseptic and I marked my incision lines with a sharpie.
The first cyst was removed with little trouble. The sac it was encased in remained intact and I dropped it into the waiting bowl on my tray.
“One down,” I told her cheerfully. “How’re you holding up?”
“Good,”’she said with a weak smile. “I thought it’d be worse than this.”
“I’m trying to take it easy on you. You’re doing great.”
I cut into the flesh over the second cyst. As my scalpel passed over the top of it, the blade jumped just slightly, as if something underneath had pushed against it. I paused mid-slice and frowned behind my surgical mask.
A hand tremor, I wondered? While I’d never had one before, I wasn’t as young as I used to be. It wasn’t out of the question.
I steadied myself with a quiet, deep breath and continued. The second cyst was a bit more deeply rooted, unusual for a group that had grown together, but I managed to extract it in one, clean piece.
“Do you want to see?” I jokingly offered after plopping it in the bowl alongside the other.
“Maybe after,” Flora giggled nervously.
“On to number three then.”
The tip of my scalpel glided over the protruding nodule and I gently pulled the skin apart to reveal the cyst below. I slid my fingers beneath it to feel for its size and froze.
The cyst had wriggled against my touch.
I stared down at the milky white casing. It was streaked with blood and bulbous, as most cysts are, and unremarkable. It remained still.
“Dr. Leben? Everything ok?” Darla, my nurse and only employee, asked quietly from over my shoulder.
“Is something wrong?” Flora had heard the question and parroted it anxiously.
“No, everything’s fine,” I assured them both.
I worked as quickly as I could, while still remaining diligent, to remove the third cyst. I let it fall into the bowl and watched it carefully for a moment. There were no signs of movement. I was sure I’d felt something. Darla was watching me, though, and I still had one cyst to remove. I’d have to study that third one more, after I’d finished and was alone.
“Just one more, Flora. Still hanging in there?”
“Yeah. It’s not so bad.”
“You’re one tough cookie.”
The fourth and final cyst was the most anchored of all. It had really rooted itself inside of her and didn’t want to give in as easily as its counterparts.
“This one’s being a bit more stubborn,” I said conversationally. “I might not be able to get it out intact. If you smell something funky, don’t be alarmed. Ruptured cysts can really stink.”
“Ok,” Flora said.
I had cut out a good three quarters of it before the sac started to split.
“There goes my perfect score,” I said. “The last one always wants to open. Nothing to worry about, just remember what I said about the smell.”
But it wasn’t the smell, a heavy, curdled odor, that erupted when the cyst finally popped as I pulled it out.
A high pitched wail, like that of a newborn, filled the room. Startled, I let it fall from my hands into the bowl, where it landed on top of the others. In response, the three cysts beneath it began to writhe and squirm, as if something was trying to break free of each.
“Dr. Leben?” Darla had backed up against the door, her face pale. “What’s happening?”
The opened cyst continued to shriek from the bowl while the others convulsed.
“I don’t…I don’t know!”
The cries grew in volume and I slapped my hands over my ears. Darla fumbled for the door knob and fled the room. I tore my eyes from the pulsating, fleshy masses in the bowl and looked to my patient.
Flora was not frightened. There was no panic or shock on her face. There were only tears and anguish while the cysts screamed and thrashed hard enough to rattle the tray.
Slowly, she turned to face me.
“You hear it now, too, don’t you, doctor?” Her voice cracked as she spoke.
“What?” My tongue felt fat and clumsy with fear. “What is it?”
She looked away from me, down towards the bowl, and a forced, haunted smile tugged at her lips.
When I didn’t speak, she met my gaze again.
“It was my fault. It was all my fault.”
The infantile screech faded as soon as the words left her mouth, replaced by the shuddering sobs of an agonized woman. The bowl became still again.
Not knowing what else to do or what I’d just experienced, I let my professionalism take control and cleaned Flora up while she wept. By the time the stitches were complete, she’d gone quiet. We sat in silence for a long time.
“I was supposed to be a mother by now,” she whispered softly at last.
I glanced at her, but her eyes were fixed on the ceiling again. They still sparkled wetly.
“I was told four times I was going to be a mommy and…” she trailed off, her struggle stamped clearly on her face. “Four times, it…it didn’t happen. I tried to do everything right, you know? Went to all my doctor visits, took my vitamins, didn’t eat cheese. My first pregnancy was only two months along. The second made it to three. The third to five. The fourth…”
Flora’s voice hitched sharply.
“The fourth made it to eight. She didn’t survive the birth. Her name was Therese, after my grandma.”
She inhaled a long, shuddering breath. Without thinking, I reached out and took hold of her hand. She held it tight, her nails digging into my flesh.
“I failed them. All of them. I should have done more. I should have been better. I wanted them so badly, but…I couldn’t. After we lost Therese last year, I started growing those…those things. I could feel them moving. I heard them crying inside of me. They wanted me to know the pain they were in. They blamed me. I know it. I can feel it!”
“Do you want me to get your husband?” I asked softly when she paused to regain control of her voice again. I didn’t know what else to say.
“No,” she said. “He doesn’t know. He can’t know. He says it’s not my fault, but I know it is and so do our babies.”
“Miscarriages aren’t the mother’s fault, Flora,” I said gently.
She sniffled noisily and renewed tears sprouted in her eyes.
“I wanted them,” she whispered, and her voice was broken. “I wanted all of them so badly.”
She turned to me and her grip on my hand became desperate.
“Do you think they knew? Even if they blame me, do you think they knew that they were wanted? Do you think they knew that they were loved?”
“Yes, Flora. I’m sure they do.”
When I finally called Xavier back to the exam room, he was entirely unphased. If he’d heard anything at all, he didn’t show it. He said he’d seen Darla rushing out the front door, but he’d assumed it was a personal issue. I stepped out of the room and allowed them to have some privacy. Flora had told me she was finally ready to tell him what she’d been experiencing.
I sent Flora home with antibiotics and the telephone number of a good friend of mine. A family therapist who specialized in fertility issues. She promised to call. I hoped she would.
Long after they’d gone and I shut the office for the day, I sat at my desk with a sealed specimen jar. Inside were Flora’s cysts. They’d not moved or made any sounds since her confession. I studied them through the plastic, slowing turning the jar in my hands.
The longer I looked at them, the less I saw them as cysts, or any other medically recognized thing. They were not anything that I’d find in any of my textbooks. They were not something I could categorize or biopsy. In a world built on reason and logic, I was holding something that could be explained by neither, and that I would never share with anyone else.
These were a woman’s guilt, misplaced as it was, manifested.
They were years of pain and longing that had been growing inside of her.
They were a mother’s unconditional love and unfathomable loss, worn just beneath her skin.