Thorn in My Side

The nurse practitioner looked at Paula’s side to inspect the mole of concern. It wasn’t exactly on her side; the lesion in question was a bit more around her right side toward her back. She had become concerned because, as best as she could see by the acrobatic twisting she needed to do using two mirrors, it had changed in the last month.

“That’s not a mole, not officially,” the nurse told her.

“So, what is it, officially, then?” Paula asked. “Do I need to be worried?”

“Oh, no, not at all. It’s—officially—seborrheic keratosis.”

“Which is…?”

“Seborrheic keratosis is non-cancerous, just a bunch of cells from your epidermis.”

“That’s good enough for me,” Paula chirped. “Let’s freeze it off.”

“Well, no. Not unless you want to pay. Insurance won’t cover that. It’s considered cosmetic.”

“Oh,” Paula said. “Well, I’m starting a new job next week in Newport. Maybe my new insurance will cover it. I’ll just keep an eye on it till then.”

Paula’s statement proved to be ironic, for the lesion, over the next month, grew into an eye.

Paula herself didn’t even notice for weeks, paying little attention to it since observing it wasn’t very easy. When she did see it, however, she panicked when it saw her right back. She didn’t know what to do.

Paula Davies, 22 years old, was all alone in a strange city where she had just accepted her new job as the traffic girl on WX5-TV. As was traditional, the traffic girl on local television needed to be aware of cosmetic concerns. For now, however, her secret was safe. Still, she wondered, would her insurance cover her now to remove it?

Her appointment in Newport with her new dermatologist couldn’t come soon enough, but her doctor wasn’t prepared for what he saw. (One could only imagine!)

He left the room abruptly and without explanation, leaving her, unclothed around her waist, to wait on the exam table . She pulled her loose blouse back down and waited. A quarter-hour later he returned with two colleagues from his clinic.

“Paula,” Dr. Miller said, “this is Dr. Erica Palmer and Dr. Leon Cabibi. Would you please lift your blouse and show them, um, your…positive finding?”

Paula turned her back toward them and exposed her back at the waist again. The two other doctors joined Dr. Miller in disbelief of what was staring back at them.

“Did it just wink?” Dr. Cabibi asked.

“Oh,” Dr. Palmer said, “it’s not just the one. There’s another lesion.”

“So there is,” Dr. Miller agreed, looking with a magnifying glass.

“Yes,” Dr. Cabibi added, “I believe it’s another eye.”

Dr. Miller now straightened up and looked at both of Paula’s eyes with his magnifying glass. “Same color, doctors,” he reported.

“Obviously an autosomal dominant mutation,” Dr. Cabibi opined.

“Yes,” agreed Dr. Palmer. “A pineal tumor that metastasized?”

Dr. Miller returned to Paula’s waist. “And the other eye looks to me to be the same, just smaller; same color as well. I mean, it’s hard to tell, being so inchoate.”

“Yes,” concurred Dr. Palmer.

“Yes,” said Dr. Cabibi, adding, “wait now! There’s a very small lesion next to them.”

Dr. Miller honed in on Paula’s back.

“I think I see lips,” he said. The other two doctors gasped.

“A whole face,” Dr. Palmer intoned. “Like yours, but uglier.”

Paula fainted.

When she came to, she was on a gurney being rolled by EMT responders onto their ambulance.

“Where am I going?” Paula cried. Dr. Miller was helping them roll Paula’s gurney.

“To the ER, Paula,” he answered. “I don’t think this is something you can just walk off.”

“No way, Dr. Miller,”she answered. “I want it taken off, not walked off.”

“We’ll do what’s needed, Paula, I assure you.”

On the ambulance ride, Paula was alone in the patient carrier area, strapped to her gurney whose wheels had been secured in wells on the floor. She used her foot to kick the wall to the driver and his partner.

"What is it, Miss Davies?” the driver called back.

“Can you turn off the sirens?” she called out toward the front of the vehicle.

“Why?”

“Because it’s talking to me and I want to hear what it’s saying.”

“Who’s talking to you?” the driver asked.

“It! It’s talking to me. My new face! That thing on my back!”

“Paula, Paula, Paula…” the thing said to her.

“What are you?” she shouted.

“I’m your conscience,” the thing replied.

“My conscience? You’re my conscience?”

“Yes. You know, that thorn in your side that keeps bugging you to do the right thing.”

“Oh, so what is it you’re telling me to do? What is the right thing? Wait! Why am I even having this conversation with a mutant mole!”

“Paula, Paula, Paula…” the thing said.

“Stop that!” she ordered. “Stop saying that.”

“This is all new to you, I know,” the thing went on. “It’s a lot to deal with, having something growing on your back telling you the right things to do. So, I’ll spare the lectures right now. But I hope you pay attention to the things I say from now on.”

“This is crazy,” Paula concluded, dismissing the entire episode.

“Not really. You see, the human body has a wonderful way of dealing with irritating things. Say you get a splinter. Or a thorn tip breaks off. It goes under the skin. It can even lodge deep in your body. And it sits there. And it is at odds with what your body wants to do. So your body launches a vigorous immune reaction. White blood cells collect around it trying to eat it up. Inflammatory cytokines get released. The whole immune cascade gets rolling. But if this irritating foreign body is too substantial to get eaten up by your immune system, your body tends to push it out. That offending invader will be exteriorized, pus and all, into an abscess in your skin. Until it pops. And then it goes away and heals. That’s how your body deals with it.”

Paula didn’t say a word.

“But I’m not a foreign body,” the thing pointed out. “As I said, I am your conscience. Something that’s a part of you. I shouldn’t be at odds with you. We should get along. You shouldn’t reject me. But although I’m being exteriorized—your body’s struggle to get rid of me—I’m not going to pus out and burst like some common carbuncle. No, Paula, I’m going to continue to chime in and say the things you need to hear out loud since you won’t listen to me internally.”

“Like what? What’s so important? What do you have to tell me?”

“Lots, Paula. Everyone has lots of things they need to listen to every day of their life. Little things—like that lipstick you pocketed at the salon, itemizing those things you deducted on your taxes, and that lie you told your boyfriend. But, oh, Paula, the big things, too, like that hit-and-run that killed that man on his bicycle.”

“He died?”

“Yes, Paula, not that you stopped to see.”

“I was starting my new job the next day. My whole future was just beginning.”

“As the traffic girl. How ironic.”

“He came out of nowhere!” she protested.

“I’m not rebuking you for the accident. But for leaving it. He might have lived.”

“Oh, my God!” Paula sobbed. “I’m sorry. I didn’t mean it.”

“Too little, too late, Paula,” the thing said.

“I promise I’ll listen to you from now on. You can sink back in to wherever you belong.”

“No, Paula, I’ve heard that before. Should I continue with the list of things I’ve been saying which you’ve ignored?”

“No, no!”

“I think I better stick around a while.”

By this time the EMTs had pulled over and were entering the patient carrier area.

“Paula? Miss Davies? Who are you talking with?” the driver asked.

“Are you hallucinating?” his partner added.

“Shut up, the both of you!” she screamed. “I’m listening.”

“It’s about time,” her thing said.

“Did you hear that?” the EMT driver said.

“I didn’t hear nothin’,” his partner replied defensively.

“See what I mean?” the thing on the man’s back blurted out.

“Nice to meet you,” Paula’s thing offered the man’s thing.