Losing Face: Layer One.

Before

The dermatologist has been breezily freezing off spots on my face for years. There's not a lot of chit-chat. He gives me a glance, blasts my spots, asks me if there's anything else I want him to look at. There's about half of me that I've never even seen, and I thought he might have volunteered to have a look, but the fact that he asks makes me feel like there's something sort of unseemly about it. So I say I guess not. Then he hands me a brochure about actinic keratoses and packs me off for another year. This summer he looked at my nose and said, breezily, "well, let's put some cream on that this year," and waved a photo of some violently pink people at me. "You might look a little sunburned for a while," he explained, "and then you'll have skin like a baby's bottom." Which can be good or bad, depending.

"I don't care how I look," I told him. "Is this spot precancerous or something?"

"Okay," he said, breezily. All righty then. Cream it is. Do I need to stay out of the sun?

"If you want," he said. "Whatever. My nurse can give you the details." And he's off.

One week

She said if I have a wedding to attend or something I could put this off until October, and I did, so I do. In the intervening months, my friend Vicki, who is doing the same basic treatment, clues me in, and I spend some time on the internet. Where I find out that the treatment, ideally, is supposed to turn your face into a flaming, pulpy, oozing mass of fried nerve endings and reduce you to hammering your fingers to distract yourself from the pain before it starts working. Various victims have posted progress photos on the web. Not much happens for the first few days and then spots light up here and there, mass together, and erupt. Helpless villagers flee. After a few weeks it is hard to distinguish between the eruptions and the marks left by attempts at self-strangulation. In the final photos the patients can be seen licking out the inside of the Oxycontin bottle. 40% can't bring themselves to continue to that therapeutic level. Sleeping is impossible, because of the screaming. The cream is called Efudex, or F.U. for short. Oh boy!

I put on my first application of cream. Twice a day for fourteen days, my doctor says. I know from my research that most people go three or even four weeks. I stare nervously at my face. We have started something here, and only great pain will resolve it. It is like finding yourself pregnant with a really ugly baby.

By day five, when most people begin to see spots and blotchiness, I look normal. I feel normal. Not until three days later do I begin to see the dawn of disfigurement. By day fourteen, when  I am supposed to quit, I don't look good, but nothing has erupted, nothing is oozing, nothing is crusting over, and--even according to my instructions--I have not reached the level of "therapeutic effect." I'm not even uncomfortable, just a little chapped. The doctor doesn't take calls. He's got a nurse for that. I call her.

"Yeah, you should probably keep going," she says, "but let me message the doctor. I'll get back to you."

Two weeks

She gets back to me. Nope: fourteen days it is. I should quit. He'll see me in six months.

"Are you sure?" I say. "I  mean, I've gone to all this trouble, and I'm willing to keep going. Am I supposed to lose all this time in? What if he tells me next time I have to start over? I'd have to murder him, and that wouldn't be good for either of us."

"I'm sure," she says. "It's right here in black and white." Well then. Can't argue with those colors.

So there it is. My dermatologist wants me to march right up to the edge of cancer with spears and cauldrons of boiling oil, and then stop short of the fortress and go booga booga booga. If my actinic keratoses are as easily startled as I am, it just might work.

To be continued.