Scars

Annie Mills died two days before her 16th birthday. At an age when her greatest worries should have been borrowing her dad's car and sneaking back home after curfew, Annie was driving a morphine pump and overnighting in the oncology ward.

The spirit of the teenager is remarkably strong, even in illness. Annie watched lots of TV from her hospital bed, music videos mostly, and was in love with one of the Backstreet Boys. Lance, I believe it was. I used to visit her regularly in her salmon-pink-with-green-plaid-accents hospital room (pastel versions of body fluids, and not remotely soothing), as I worked down the hall and around the corner--not in a patient area but in a lab. Usually I'd find her on the phone to her best friends, surrounded by stuffed animals of the too-precious variety, dangling the phone cord over her IV lines and proclaiming loudly to the invisible voice at the other end that so-and-so was "crazy . . . a total slut . . . he's soooo gorgeous . . . you should totally just buy the tickets and tell your parents later . . ."

Such drama! I imagine how mortified she'd be now to think back on her silly-swooning teenage self. But she will never age beyond 16 or beyond my imaginings.

I met Annie at a summer camp for children with cancer. It was on a deep, craggy lake in northern Ontario. It's a magical place where laughter and songs and the smell of old campfires mingle with mosquito repellent and pine to smell like summer. The sometimes blue, sometimes green water sparkles in the July sun, and on any given day the wooden swimming dock is scattered with towels, sun hats, and prosthetic limbs, as their owners splash each other and squeal in the not-quite-warm-enough lake.

Annie and I were both rookies that summer: I was a counselor, and she was a kid newly diagnosed with cancer. After two years of graduate school spent considering the molecular intricacies of how cells arm themselves to repair damage and prevent cancer-causing mutations, I felt a need to connect my life in the lab to those affected by the disease. Little did I realize the type of research incentive that a 14-year-old girl could provide.

I distinctly remember Annie clutching a pillow from home and looking wide-eyed around her as she climbed down from the yellow school bus that had ferried the kids 2 hours north from the city. Older than most first-time campers, Annie looked easily as anxious as the six-year-olds at the melee of enthusiastic cheers, face-painted, costumed counselors, and freshly penned welcome signs that greeted the arriving campers.

Somehow I recognized her as one of my charges and directed her toward juice, freshly baked cookies, and a quiet shady spot by the flagpole, slightly removed from the noisy summer reunions taking place by the buses. Annie was a big-boned girl with a very round face, fair complexion, and long, dirty-blond hair. She had lovely, clear, pale skin, a shocking irony I would later come to resent. After camp, when I got to know her family, I realized that she looked just like her stocky, slightly awkward father, while her younger brother had inherited her mother's fine, pretty features and freckles.

Timidly, still clutching that pillow and with suspiciously watery eyes she asked me, "Do the two weeks go by quickly?"

I smiled and reassured her that they would, while silently wondering the same thing myself, then confessed to her that I was new and slightly nervous, too.

We became fast friends.

There were five other 14-year-old girls in our cabin group, and three counselors. On one of the first days of camp all the girls were gathered in our cabin's common area getting ready for swimming lessons (much dreaded by girls of that age) and matter-of-factly discussing their particular cancers.

"ALL," one veteran camper announced. "How 'bout you?"

"Same. B cell type. I got it when I was four so I don't really remember much except for having to stay in the hospital. But I still have a port scar."

With this Amy showed us a five-centimeters-long white scar below her collarbone where an external tube had been embedded to deliver medicines directly into her vein.

"I lost all my hair, though," Amy continued. "My mom says it came back in a different color."

There are nods of recognition all around the room at this. Most of these girls, I realize, are on their second head of hair.

"What do you have, Sara?" one of the girls bluntly asks.

Sara Douglas was small for her age, bald, wore a terrible blonde polyester wig (often at an odd angle), and walked with a pronounced limp. Despite this, she was the most dignified child I have ever encountered. She had a deep husky voice like a 1940's chain-smoking screen siren, most incompatible with her freckled face and pre-pubescent body.

"Osteosarcoma," Sara replied, barely listening. She knows these girls from previous summers and thinks they're cliquey.

Failing to engage Sara, they turn to Annie, the shy new girl. She has been silent until now, trying to make her sturdy body disappear into the corner of the room. Anticipating their inevitable question, Annie volunteers hastily that she was only diagnosed the previous February, but "I just have skin cancer."

It's a funny thing to say, I think, that you just have skin cancer, but I suppose she means that she hasn't lost her hair, hasn't had chemo, hasn't thrown up every day for a solid week. In any case, Annie was intimidated by these confident teenage girls and doubtless would have found herself lacking, no matter what the comparison.

It was shortly after this exchange, when the topic had moved on to who the senior boys were this year, that Annie asked me shyly if I'd put sunscreen on her back--where her scar was, she explained. Sunscreen is de rigeur at a cancer camp--we have it in dispensers like liquid soap, scattered at convenient "sun-stations" all over the property. Kayaking, water-skiing, even arts and crafts come to a halt if everyone isn't "lubed up."

I remember noticing that this was no ordinary Coppertone that Annie handed me, but something in a prescription bottle. She lifted the T-shirt she was self-consciously wearing over her Speedo racerback bathing suit, and for the first time I saw her scar. Running the length of her back and as wide as my hand, it was an ugly, indelicate thing that had no place being on a child's body. Not merely was the top layer of skin missing, but much of the muscle mass underneath was gone, and I could envision a faceless surgeon not just scraping but digging to get rid of that tumor. I looked at the counselor standing beside me, and I know the shock on her face mirrored my own.

Just skin cancer, indeed.

It's two years later and Annie has become a veteran camper. She's a "senior girl" now, hoping to be chosen to return the following summer, and I'm a counselor to a group of unruly 11-year-old boys. We pass each other on the wooded paths that course through the camp property, connecting sailing to the climbing wall, canoeing to arts and crafts. She's usually linked arm-in-arm with her cabin mates, but she smiles and waves, and occasionally gives me an over-zealous hug. We've both found our niches, I smile to myself, and now the two weeks of summer seem to fly by much too quickly.

It is shortly after camp that summer that Annie dramatically relapses. Initially, she and her mom just attend scheduled visits to the outpatient clinic at the children's hospital where I work. I am a senior graduate student now, in the thick of my PhD studies, conducting experiments, writing papers, and trying to keep on top of the burgeoning literature of findings being published in my field. If cancer research can be described as experiencing a boom time, then this is it. Annie develops a routine of calling me in the evenings to tell me they will be in the following afternoon, and do I want to wander down the hall from my lab and say hi? I do, and between needle pricks and bandage changes she has camp pictures to show me and stories to tell (often out of her mother's hearing). It's all strangely social, and I begin to look forward to it as a break from bench work.

Then suddenly Annie is a full-time hospital resident, optimistic and missing her friends at first, then slowly, quietly slipping into the introversion and exhaustion that characterize the chronically ill. She is heavily sedated and mostly sleeps now, and my visits have become somber and stealthy. Her hair has dulled in color and is coming out in clumps each time it's brushed, revealing smooth, pink patches of scalp. Long-blond hairs stick to the pillow when she lifts her head, but Annie stubbornly won't let her mother cut the rest of it off. I watch her sleep and think the child in the hospital bed seems like a daguerreotype of the vivid, giggling, and popular young woman I've watched mature through the past two summers.

"It's back," her slim, dark-haired mother whispers to me over the steady hum of the monitors that accompany Annie's breathing, and I know precisely what she means. "They want to do chemo this time. On top of the radiation."

She looks sickened at the idea, and I notice she's lost weight, almost at a pace with her weakened daughter.

"I have something that I've been told will work better, though." She looks at me in a slightly challenging way when she says this, and I wonder what's coming. "It's a special tea, made from shark cartilage and these really rare herbs . . . something Chinese, I think. It's very expensive. Supposed to be a miracle cure that the doctors don't know about yet."

Then she asks me, "Do you think it will help? I can tell the oncologist thinks I'm being ridiculous, but you'll know, you're a scientist doing research on this kind of thing . . . do you think this could cure her?"

And then I'm faced with it. Hope and reality. Science and belief. I don't know what to say to this woman who has lost her job because of absentee time spent at the hospital, who never sees her husband anymore because he works extra night shifts, whose son is angry with her because she spends all her time with her dying daughter, the girl she calls her best friend.

And so I tell her it could help, that she should continue to brew the tea for Annie three times a day, as the herbalist prescribed, and that there is much that science and medicine don't completely understand about cancer yet. And she smiles and says okay, I knew you'd be honest with me, Chris. And I smile back and tell her I'm hopeful too, and know I'm lying.

Annie Mills died suddenly a week later, two days before she turned 16. Her parents delayed the funeral by a day or two so it wouldn't fall on her birthday. It was a sharp, cold winter day with a dusting of snow on the ground, and summer camp seemed just a halcyon memory. Her mother didn't wear any make-up to the funeral, so her tears would fall unimpeded and unsmeared, and this practical dignity made my throat tighten.

Many of Annie's former cabin mates were there, looking strangely unfamiliar to me in their winter clothes and high school hair: they seemed much older than their freer summer selves. They were solemn but not weepy, which surprised me until I remembered that these were not ordinary 16-year-old girls, but wiser souls who knew all about illness and dying.

In the end, Annie's death caught me by surprise. Kids are resilient, I thought, and she would be okay, after the chemotherapy, after the radiation, after the miracle tea, perhaps. What teenager dies of skin cancer, after all?

This one did--score one for the grim reaper--and it angered me. In this era of modern medicine, of microchips and gene therapy, we treat cancer by poisoning. Chemotherapy and radiation are toxins dosed to kill the cancerous cells just before the patients themselves are irrevocably harmed. It's a therapeutic approach akin to eighteenth-century women bringing a blushed, seductive look to their made-up faces by taking just enough belladonna to dilate their pupils, but not so much as to stop their hearts.

For a long time, I felt oddly complicit in Annie's death. She died of the disease I was studying, the disease on which my career advancements have been based. How could science not have cured her? How could gleaming, modern research facilities, creative minds, dedicated hands, and billions of dollars in grant funding not have been enough to save one ordinary, and extraordinary, girl?

I still don't know, seven years, a PhD, and a postdoctoral fellowship later. The incremental progress made in the lab, the occasional a-ha moment, the treasured publications we scientists take as acknowledgement from our peers and celebrate with bottles of champagne, sometimes all these milestones seem like little consolation.

Copyright © 2003 The President and Fellows of Harvard College.
All rights reserved. Comments. Last modified Mon, Nov 3, 2003.