falling face-first for the very last time

It was spread out like a last meal. The Blimpie sandwich was cut into neat little quarters. It was my favorite - ham, salami and cheese with onions, lettuce, oil and vinegar. A Devil Dog waited in its wrapper. Ice cubes melted in a large cherry soda.

Although saliva gathered in my mouth and hunger rumbled like a train in my stomach, my appetite turned to ash. Where was my usual boloney and mayo on Wonder bread? Why was Mom stationed like Vanna White at the table, a painful smile plastered on her face?

"What's going on?" I asked suspiciously.

"Nothin', babe. I got you Blimpie," Mom's voice oozed artificially sweetened syrup. Something was up.

"Where are Chris and Erin?"

"Aunt Theresa took them out to lunch. Here, sit and eat."

Twice before I had been lulled into bad news by a meal. There was the revelation that Mom was pregnant with Erin, and I would have to share my bedroom with a wailing newborn. That had prompted a McDonald's Happy Meal and a trip to Toys 'R Us. And just last year, there was the big "C" scare.

Mom had picked me up after school and taken me out for pizza, while Chris and Erin went home with my cousin. Sitting in Filippo's, Mom patted my hand.

"Noreen, I need you to help me the next few days."

"Okay," I mumbled, funneling oozing hot cheese from the slice into my mouth.

"You need to help Daddy with Chris and Erin," Mom's voice cracked and her lips quivered.

"Why? What's the matter?" I asked, putting down my pizza.

"I have to go to the hospital. The doctor found something and he wants to check it out."

"What did he find?" I demanded, suddenly angry with Mom and the doctor who "found something". Why couldn't he just mind his own business? We didn't need to find anything. We had enough problems that had already found us.

"It's probably nothing. Just a little lump in my...." Mom touched her breast, and the pizza turned to a brick in my belly.

"Is it cancer?" I asked a little too loudly. Mom looked around anxiously, hoping no one had heard.

"No, of course not! I don't know. I don't think so. The doctor has to take it out and check, that's all. He thinks it's nothing, but he has to be sure."

We walked home quietly. I stole quick glances at Mom's face to gauge how serious the situation really was. Her lips worked silently back and forth. I knew she was either praying or worrying. I was doing both.

"Can I stay out for a while? I'm going to see if anyone's in the park." I knew Mom couldn't refuse after what she had just told me. It was unfair to lie to her at this moment, but it was for her own good.

"Go ahead. But just for a while. Be home for dinner."

I kissed her on the cheek, something I had gotten out of practice in doing, and ran off.

Stopping at the entrance to the park, I turned and made sure Mom was out of sight. I bolted away from the park, and ran up the steps to our church across the street.

Incense enveloped me like a warm blanket. I sat in the back pew and surveyed the empty church. Interlacing my fingers tightly together, I said ten Hail Mary's in quick succession. I wasn't sure if there was a God, but I couldn't take any chances.

My eyes avoided the statues and stained glass windows. If there was a God, I figured he hung out in the dark wooden rafters, where it was cool and quiet and he could survey the entire congregation at once. I looked straight up at the ceiling and offered up my plea.

"God, please don't let Mom have cancer. She comes here every week and she is always polite to the nuns, even when they're mean. Mom really hates to throw up. I don't think she could handle that. And, she finally has a nice hairstyle. It would suck, uh, I mean stink, if she lost her hair now. Please, God, I swear I'll never ask for anything again. I'll say the rosary every day. I won't argue with Mom that I don't want to go to church. Please help her, and I'll help you. Lots of prayers and good deeds and stuff, and I'll take whatever you give me without complaining. Thank you, God. Amen."

I sat in the church a while longer, saying a bunch more Hail Mary's and Our Fathers and Acts of Contrition. I would do whatever it took and I would keep my promises to God, so long as he kept Mom healthy.

Mom's lump turned out to be nothing more than a benign cyst. I kept my promises to God, for a while. The rosary beads that I had kept under my pillow slipped under the mattress, and I never retrieved them. I used every excuse to avoid weekly mass, from cramps to softball practice. Complaints trickled off my tongue in a steady stream. And I had asked God for things. Lots of things. Stretchy jeans that made my butt look bigger. Passing grades on Math tests when I had watched a movie instead of studying. Giving Piss Pants Rick leprosy for telling everyone I had AIDS. And of course, the most frequent request of all: that the medication would work and make me look like a normal girl.

I had kept virtually none of my promises to God. And now, I was afraid I would have to pay for my lies.

"What's going on?" I asked Mom.

"Nothing! Just sit down and eat your sandwich before it gets cold."

"It is cold. It's a ham sandwich."

"Hurry up and eat it anyway. You have to get back to school, so go ahead and get started."

I chewed and chewed, but the sandwich just turned to glue in my mouth. Mom hovered over me, smiling at each bite. I took a long pull from my cherry soda and pushed back from my lunch.

"I can't eat like this. Tell me what's going on." I demanded.

"Nothing!" Mom protested, her voice high and shrill.

"Are you sick?"

"No!"

"Did Dad get into an accident?"

"God forbid!"

"Are we being evicted?"

"Of course not!"

"Then what's going on?"

"It's nothing serious. The doctor's office called."

In all of the weeks that I had been going to the dermatology clinic, they had never called me. Not once. This couldn't be good.

"What did they want?" I asked quickly, wanting to get the bad news out of the way.

"They want to see you tomorrow."

"But, why? I have an appointment on Friday."

"I know, but they need to see you now." Mom paused, her forehead twitching with uncertainty.

"They said you can't take the medication anymore."

"What? Why? Did we lose our insurance or something?"

"No, it's nothing like that. It's your blood work. There are some concerns."

Mom then spouted of a list of words shrouded in mystery: triglycerides, liver functioning, kidney-something-or-other. This was it. I was going to die. My obituary would read: cause of death - vanity. I had killed myself in the pursuit of clear skin. What had I been thinking?

"Am I okay? Am I sick?"

"You're fine!" Mom assured me, lighting a Salem and sucking on it like oxygen. "You just can't take the medication anymore. The doctors will explain everything tomorrow."

"But they told you I'm okay?"

"Yes! You're fine. Tell you what. We'll make a day of it tomorrow. You'll take off from school. After the doctor's, we'll have a nice lunch in the city. Just you and me. Then I'll take you to Sears and we'll get you an outfit. Whaddya say?"

Mom didn't know that shopping for an outfit at Sears could not be considered an award. But, it was what we could afford. Maybe I could pick out a tasteful dress to wear to my funeral.

"Sure," I shrugged, already feeling the life draining out of me.

I dragged myself back to school, dreading the diseases that could be ravaging my young body at that very second. Along the way, I stopped to stare in the side view mirrors of parked cars to admire my clearing skin. Tiny red bumps dotted my hairline, but the flashy Vegas showgirl pimples were nowhere in sight. My lips were no longer chapped and I hadn't had a bloody nose in a couple of weeks. The medication was finally working. I had survived the worst of the side effects. What would happen to me now?

With my shoulders slumped and my head hung down, I entered the classroom wearing a stricken expression to convey the hopelessness of my situation. I sighed heavily to ensure that no one would miss my mood. It was my one melodramatic moment, and I intended to milk it.

"What's wrong?" Tiffany asked.

"My doctor just called," I whispered with a sniffle. It produced the desired effect. Within seconds, every girl in the class encircled me.

"Are you okay?" Laura asked, petting my hair. I shrugged noncommittally, gulping for air the deliver the bad news.

"I might be dying," I croaked.

"Oh my God! Sit down. Tell us everything," Butch insisted as she guided me to her desk. I couldn't believe Butch was concerned for my health! She was the class bully, and had personally tried to end my life on no fewer than three occasions. Had I known this was the response my dying would provoke, I would have done it years ago.

Slowly, and with many breathless pauses for dramatic effect, I inflated the sketchy details my mother had provided. I wondered aloud if an iron lung could be transported to and from school. I hoped that I wouldn't have to wait long for someone with my tissue type to die quickly and painlessly in a car accident, donating a healthy liver and kidneys to me.

"I'm sorry. I just can't talk about this anymore. I'm feeling really tired," I gasped.

"Want me to braid your hair?" Tiffany offered.

"You should sleep over on Saturday, if you're not in the hospital," Daphne suggested.

"I'll talk to my dad," Sara asserted. "We'll organize a blood drive."

"Or a bake sale!" Butch added.

The girls fussed and preened over me for the rest of the afternoon. The attention almost made me forget that I was terminal. I envisioned my memorial service. There would be no church funeral. Instead, all of my family and friends would gather in the park. The children's choir would sing Amazing Grace. Balloons and doves would be released. The concession stand at the little league field would be named after me. Butch and the rest of the girls would cry over my coffin before I was buried under my favorite climbing tree. No one would ever recover from my premature passing.

The newfound celebrity brought on by my impending death had some perks. Butch carried my book bag home, while Tiffany and I lagged behind her. I was about to learn the deepest, darkest secrets of the prettiest and most popular girl in class.

After swearing on the lives of my family members, under penalty of my own grizzly death at the hands of Accutane, Tiffany felt safe enough to tell me her secrets. She leaned in so close that I could smell her cherry lip-gloss.

"I let Billy feel my boob," she blurted.

"Really?"

"Yeah. The left one. It's my favorite."

"You have a favorite boob?"

"Sure."

"Why is the left your favorite?" I asked.

"It's bigger and rounder than the right. And, there's something else." Tiffany's words came out in a low mumble. Her hands cradled her right breast protectively.

"I was born with a defect on my right breast."

"Wow! Does it hurt?"

"No, it's nothing like that. It's more...cosmetic."

Images of a green nipple and veined skin floated before my eyes.

"I have a birthmark!" Tiffany blurted.

"Oh. That's not so bad. I have lots of them."

"I don't know how you do it! No offense, Noreen, but if I looked like you, I don't think I could ever leave the house. Thank God my defect isn't on my face."

My fists balled and my muscles tensed as I prepared to punch Tiffany in her perfect mouth. But when I looked at her, I realized she didn't mean it as an insult. She was actually looking at me with an expression I had never seen on her unblemished face before - kindness.

"Really, you're so brave. I really admire you."

"Thanks, I guess."

"This birthmark, it's terrible! It hangs off of my skin, and it's hard and brown. It looks like a Raisinet! I'll die if Billy ever feels it!"

"Why don't you just have the doctor remove it?" I suggested.

"My mom says no plastic surgery until I'm eighteen. I don't know how I'll keep Billy away from my right boob until then."

We walked the rest of the way in silence. Butch and Tiffany insisted on helping me up the stairs. Butch clapped me roughly on the back, and Tiffany gave me a long hug.

"Remember. Tell no one! You're the best."

I thanked them both and walked into the apartment, confused and elated and terrified by all of the new developments.

The pampering continued at home. Mom made my favorite dinner that night - chicken and mashed potatoes with Stove Top stuffing and corn right out of the can. Forgetting that I might be dying, I ate every last kernel on the plate.

After dinner, Mom ceremoniously planted the remote control into my palm after fluffing a pillow and resting it behind my back.

"Now, don't you two bother your sister. She's not feeling well," Mom warned Chris and Erin.

I wasn't feeling well? Why? What was wrong with me? Should I not be feeling well? I cleared my throat to check for soreness, but there was none. My nose wasn't stuffed and my stomach didn't hurt and my bones were all in their proper places. Was I so sick that I didn't realize I was sick?

"Mom," I called from my deathbed on the couch.

"What is it? What's wrong? Mom came rushing in.

"Can I have some Advil?"

"What for? What's hurting you?"

"I don't know. Nothing. Everything. And can I have a wet cloth for my head?"
Mom felt my forehead with her cool cheek.

"You don't have a fever."

"I think I'm getting one. Can I just have the Advil and the cloth, or should I get it myself?"

"No, no. You stay there. I'll get it."

Mom raced out of the living room and came back with an Advil, a glass of Seven-Up and a cool, damp cloth. I popped the pill into my mouth, guzzled some soda and lay the soothing cloth on my head. Chris and Erin sat silently by as I surfed through channels and loafed on the couch. If this was the type of treatment I could expect while dying, I could get used to the idea.

I heard the key turn in the lock and sat bolt upright. What was Dad doing home? He was supposed to be driving the cab. I strained my ears from my perch on the couch as mom and Dad whispered at the front door. A few seconds later, Dad walked into the living room carrying a large white box.

"How you feelin'?" he asked cautiously.

"Fine. I'm fine. Shouldn't I be feeling fine?"

My paranoia was reaching hysterical proportions.

"Sure you should be feelin' fine. Just checkin'. Here. This is for you."

Dad handed me the box and awkwardly leaned down to kiss my cheek. Dad never kissed me, except for special occasions. It wasn't my birthday or Christmas, so the special occasion must be my impending death.

"What's this for? I asked suspiciously.

"Nothin' special. I was in the neighborhood and I know you like them. So, enjoy."

Dad watched as I opened the box to reveal an assortment of chocolate and creamy pastry goodness from my favorite bakery in Brooklyn.

"Thanks. But I'm not very hungry now."

"Why not? What's a matter? You don't feel good?" Dad asked as he scanned my face for signs of sickness.

"No, I'm fine. Just tired. I think I'll go to bed," I said as I pulled myself off the couch.

"You sure? You can stay up late and watch TV if you want. Your mother says you don't have to go to school tomorrow."

"No, thanks. Maybe some other time."

Nestled under my blankets, I began to worry in earnest. Dad was missing a night of work to bring me pastries from a bakery that was out of his way. Mom was keeping me home from school, taking me to lunch and buying me an outfit. Chris and Erin had been eerily quiet all day, not even protesting my possession of the remote. Fear snaked through me like an electrical current. What if I really was sick?

Mom and I walked through the cold clinic and headed straight for the lab. The doctors wanted my blood drawn before they saw me. I dreaded the rough nurse more than the painful prick of the needle.

In the beginning of my treatment, the clinic had allowed me to have my weekly blood work done at a small lab in my neighborhood. The old man who drew my blood was so tall and thin that he resembled a cardboard cutout. He was a kind man who let me suck on a lollipop while he stuck my arm with the long needle. Despite his calming voice and steady hand, I passed out virtually every time he drew my blood. He would patiently awaken me with smelling salts and then feed me sweet cookies and juice until I recovered enough to make the short walk home.

Several weeks into my treatment, however, my blood work showed some irregularities.

"These levels can't be right," the doctor scoffed. "They're much too high. We haven't seen these results in other Accutane patients."

"What does that mean?" Mom worried.

"It means that your lab is incorrect. From now on, I want the blood drawn here at the clinic. You can't trust these little mom and pop labs."

For the past two weeks, I had stopped at the clinic's lab before seeing the doctor. The nurse's fingers were bony and cold, and she always pinched my arm with her chipped nails while looking for a vein.

"Just so you know," I warned her the first time, "I pass out every time I give blood."

"Yeah? Well, don't," she shot back without even looking at me. Mom's neck veins protruded like worms and I shook my head sternly, warning her against attacking the nasty nurse.

Naturally, I did not disappoint. Each time she drew my blood, I awoke to find her blowing hot air out of her nostrils like a bull, impatiently waiting for me to vacate her premises.

I had a pleasant surprise awaiting me in the lab that day. The bony nurse with the ferocious nails was nowhere in sight. In her place stood an embarrassingly handsome male nurse with a toothpaste commercial smile and broad swimmers' shoulders. He handled me like a kitten and purred apologies as he guided the needle into my vein painlessly. I was so busy planning our wedding that I forgot to faint altogether.

"Good luck, gorgeous," my future husband winked as I floated out the door.

"Umph!" I responded as my forehead met the door frame on the way out. He winced in pain for me as I righted myself and rushed away before I could humiliate myself further.

The blush of newfound love (and public humiliation) quickly faded as I entered the exam room and was met by three of my doctors. I rarely saw the same doctor twice at the clinic. I didn't even know them by name. And I had certainly never seen more than one doctor at a time. On this occasion, Doctors A, B and C awaited my arrival. I wondered if there was already a gurney outside the office, waiting to whisk me to a room in ICU. Mom must have been sharing my thoughts. Her complexion went pasty as I felt the late onset effects of a faint buzzing in my ears. Mom guided me to a seat before my rubbery knees could give out.

"Hi, Noreen. How are you feeling?" Dr. A asked.

"Fine. I'm fine. I feel fine."

"She's fine. She feels fine," Mom added for emphasis.

"Good. We're glad to hear that." Dr. B nodded and scribbled into her pad.

"There are some things we need to discuss," Dr. C started.

"Your blood work is not good." I think it was Dr. A who spoke. At this point, I lost track.

"Not good at all."

"Troubling, actually. We've never seen results like this from Accutane."

"Nothing documented, at least."

"You need to stop the medication."

"Right away. You can't take it anymore."

"If you continue, there could be serious consequences."

"Liver damage, kidney disease...."

"We're not exactly sure."

"Interesting case, actually."

"Very."

"Yes. We'd like to do some tests on you. Some more blood work, some scans. Get a better understanding."

"The results would all be published. It's a highly irregular case."

"Highly irregular."

"Fascinating, actually."

"Indeed!"

"So we'll need you to sign consent, and we'll get rolling on the tests we'd like to perform."

"Just sign here, please."

"And initial there."

"Wait a minute!" I interrupted, my brain vibrating with questions.

"How sick is she?" Mom asked, her hands trembling in her lap.

"What?"

"Who said she was sick?"

"She's not sick."

"Not at all!"

"You mean, I'm okay?" I asked, barely keeping my voice under a shriek.

"Of course you're okay."

"You just have to come off the medication."

"Other than that, you're fit as a fiddle."

"Then why do I need to have tests done?"

"For research purposes, of course!"

"These results have never been documented."

"You are a very unique case."

"But what about her blood work? You said there could be complications." Mom was trying as hard as I was to piece together the doctors' puzzling talk.

"As long as she doesn't resume the medication, all of her levels will go back to normal in a matter of weeks. Everything should be fine."

"Now, how about that consent?"

"So, you're telling me I'm not sick?" I asked, a throbbing hot ball of fury growing in my chest.

"That's correct."

"What about my skin? What happens now? Will it keep getting better?"

"I'm afraid not. After the medication is out of your system, your skin will most likely revert to its previous condition."

"However, there are other remedies."

"Oral antibiotics."

"Creams."

"Gels."

"Have you tried avoiding greasy foods?"

"How about a sugar-free diet?"

"Are you people crazy?" I erupted, jumping to my feet. Mom stood next to me, her hand protectively on my back.

"Pardon?"

"Do you have any idea what I've been through?"

"We know treatment has been...."

"I've eaten most of my meals through a straw. Kids say I have AIDS. My nose bleeds so bad that my sheets look like a crime scene. I hurt everywhere. I used my own face as a Science project. And now you say it was all for nothing?"

Tears of rage coursed down my face as my finger pointed accusingly at each of the doctors.

"Calm down," Mom warned.

"I will not calm down! And I will not be a goddamned guinea pig. You're not doing any more tests. You're not taking any more of my blood. I'm finished. Fuck all of you!"

"Noreen!" Mom gasped in horror.

I raced out of the room, leaving Mom with the doctors. I was too infuriated to be fearful that I had just used the "F" word in front of my mother.

I waited for Mom on the sidewalk outside of the clinic. Steam rose up from a manhole cover. A vendor was selling roasted peanuts on the corner. The streets were crawling with people rushing towards warmer places. A numbing emptiness crowded out all of the air in my chest. I had never felt so alone.

I had seen every doctor and tried every remedy. I wanted so badly to trust them, to believe that they could turn me into the kind of girl I longed to be. I had done it all, and it had failed. I would never see another dermatologist. There would be no more poking or prodding, no more mysterious pills or sickening side effects. This was me, as I was and probably always would be.

I was on my own.

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