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  End of Summer 2007

  Sometimes I get this weird feeling that I might be attractive.

  When you have acne, it’s all about the lighting. I was in the bathroom at my dermatologist’s office. It has these soft, fake-candle incandescent lights on the sides of the mirror, and one of them was broken. It was so dark, I’d soak the floor if I tried to pee. It was perfect. My jawline looked sort of defined and my cheeks weren’t too bumpy. But maybe it wasn’t just the light. Maybe my face was actually getting better.

  “Kevin?” Mom said, knocking on the door. “Sweetie, are you doing okay in there? Dr. Sharp is ready for you.”

  I opened the door and squinted in the harsh light of the waiting room.

  “Is your stomach upset?” Mom whispered. She thought I might have ulcers. In eighth grade I used to fake being sick all the time to stay home, so she did have a lot of evidence. Someday I should probably get around to telling her that none of those stomachaches were real.

  I shook my head, told her I was fine, and stared at the floor while I followed a nurse through the hallways to the exam room. I sat on the padded table with my head down, and the nurse closed the door to leave me alone in front of a huge mirror and beneath about a dozen fluorescent lights. It felt like sitting in a police interrogation room.

  I tried not to look in the mirror, but I caught one accidental glance when I lay down, enough to make me realize what an optical illusion the bathroom had been. My forehead and jaw were covered in purple-red splotchy scars. The skin around my mouth was inflamed and raw and bright red, like I had just finished eating a watermelon. My nose and forehead were shiny. There was always a layer of oil on my face, no matter how many times I washed it. Under those lights I felt like a buttered lobster. My face looked as bad in the mirror as it did in my head.

  Dr. Sharp knocked on the door and stepped inside. “Kevin,” she said, looking at my chart. “How are things?”

  “Good,” I said, leaving out the part about wishing someone would throw me into a pot of boiling water where I could scream until I died.

  “How’s your face doing?”

  She always asked me that, and after two years it had never become any less ridiculous a question. For one thing, she can see it better than I can. And my face doesn’t exactly do anything, besides sting, leak goo, bleed, and highlight me in class photos. Her question always made me wonder if my face should be enrolling in art classes at the community college or something.

  “It’s, um, not any better, I guess. I mean, it’s, like . . . bad.” I pulled my eyes off the floor to look at her, wondering how she’d react. I’d never admitted defeat like that to her before.

  “Okay,” she said, setting the chart down and leaning in to stare at my face. “Have you been squeezing anything?”

  “I mean, I guess. Not a ton. Sometimes.”

  “I know popping the whiteheads makes them go away for now, but in the long run touching your face and squeezing with your fingernails will cause scarring. I see there are some pustules around your nose and mouth.”

  What was I supposed to say to that? Thank you for noticing — I grew them just for you? I stared at the floor silently.

  “May I extract them?” she said. I was a little offended she didn’t get down on one knee to ask.

  I shrugged. She had me lie back on the table and I saw her take two metal rods out of a drawer. “This may pinch a little,” she said while poking the sticks into my zits and squeezing them dry. She did six of them and they all hurt. She wiped blood off my cheek with a napkin and I swear I saw the sides of her mouth curl up in pure delight. Of course she didn’t want me popping my zits. If I did, there’d be none left for her.

  She wrote a prescription on her notepad and handed me a sheet. “I want you to stay on the Retin-A gel for a few more months to see if it starts working.”

  Tenth grade was starting in a few weeks. I didn’t really have the luxury of waiting months for this gel to possibly, maybe, if it felt like it, start having any actual effect on my face other than continuing to dry it into a flaky croissant.

  I stared at the prescription in my hand. Ask her. Before it’s too late. I’d been prepping for days to ask her one question, and now was the time, but my mouth was dry and I kicked my heels into the side of the table over and over, annoying the hell out of both of us.

  Ask. Her.

  “I was, um, reading online, or, like, heard about, uh, you know, about this, uh . . . this thing . . .” Get it out. “Accutane?”

  She sat down on the stool, looking concerned. “Accutane is really a last-resort kind of treatment,” she said.

  I bit my lip; heard my heart thump. After all this, was she just going to tell me no and send me home?

  “You feel there hasn’t been any improvement with the previous medicines?”

  I shook my head and forced my heels to be still.

  She said, “There are a lot of potential side effects,” then opened a drawer and handed me the largest pamphlet I’d ever seen. It was like a full newspaper. “It’s not something you can just test out for a month. You have to commit to at least a four-month regimen, taking two pills a day, and you can’t miss any of them.”

  I nodded. My eyes flicked over the massive list of side effects in the pamphlet: depression, joint pain, yellowing of the eyes, breathing problems, irregular heartbeat, skin rash, thoughts of self-harm, swelling of the lips, severe headaches, dark urine. The last one sounded like the title of a Japanese horror film.

  “Do you want to try one more month on the Retin-A Micro gel? And then you can come back and see me in September and we’ll see what you want to do?”

  I swallowed. My instinct was to avoid this potential argument, give up, and do whatever she told me to do. Since my face had gotten bad enough to need prescriptions two years earlier, I’d always taken whatever Dr. Sharp felt like giving me, and nothing had worked. The constellations of zits on my face representing the Flaccid God of Guys Girls Don’t Acknowledge had only shone brighter. My skin was awful and I hated the thought of suffering through tenth grade with a face like a red-and-purple tie-dyed scab. “I think I want the Accutane.”

  “You’re sure?”

  I nodded again. The side effects seemed worth the risk. All I wanted was to be able to look at myself in the mirror again. I didn’t tell her that.

  “There’s a lot of regulation with this drug. You’re going to need to sign up online for the iPLEDGE website. You won’t be able to fill the prescription before you complete that. You’ll need to go to that site every month and fill out a questionnaire in order to activate your next prescription. And you’ll need to have your blood tested once a month to make sure there aren’t any adverse internal reactions with your liver or digestive tract.”

  “Okay,” I said.

  “Your parents are okay with this?”

  “Sure, they know,” I lied. I’d never brought it up because Mom would turn it into a big deal and freak out, but if I just got the prescription on my own and slipped it into Mom’s pile of stuff s
he took with her to run errands, she’d get the pills for me without even knowing what they were. I could get her to buy me a barrel of cocaine if I slipped the request into her stack.

  “Okay. Your parents will need to sign off on this before the prescription can be activated.”

  Shit.

  She tore off the new prescription and traded it for the Retin-A one in my hand. “I recommend the diagnostic lab on the first floor of this building for the blood tests. You’ll need to have one done before you get this prescription filled, okay?”

  I nodded.

  She put her hand on my shoulder and looked into my eyes. “I hope it works for you.” Then she opened the door and left. She’d never talked to me like that before. With the other prescriptions she’d just fling the paper at me and leave, cracking her knuckles in anticipation of the next kid’s pimples she’d get to pop. I figure it’s a big deal when your dermatologist touches your shoulder out of empathy and not just to scrape off a mole.

  “You look happy,” Mom said when I walked back into the waiting room.

  I shrugged and said it went fine. I didn’t bring up Accutane with her yet. I knew she’d have a million questions. I’d need to do more research and figure out responses to her fears about side effects before I even mentioned it to her.

  But it would be worth it. Everything would get better when the pills cleared up my face.

  “Did you have any more diarrhea in the office?” Mom said, two feet in front of the receptionist.

  I stared ahead blankly, pretending I had no idea who that strange lady was. Whatever happened with Accutane, it could only be uphill from there.

  I got on our computer in the family room that afternoon, put in my headphones, and did more research. I’d forgotten where I’d even heard about it in the first place. Accutane is just a thing kids know about. It’s like herpes or Aerosmith. No one ever sits you down and gives you a lesson about these things. They just exist in the ether and float into everyone’s consciousness.

  I read about a study done on acne that came to this gem of a conclusion: “People with acne are at substantially higher risk for depression in the first years after the condition appears. The reason for the association is unclear.” Was there supposed to be a sitcom laugh track after that punch line? The reason for the association is as clear as the slime that leaks out of my pores when my face has run out of pus, blood, and yellow mystery wax: you walk around knowing you look like a goddamned monster, and if you’re ever lucky enough to get distracted by a math worksheet and forget about your gross face for ten minutes, you’re instantly reminded by people’s horrified reactions to all the physical manifestations of your insecurities dotting your skin. How could anyone make it through this not depressed?

  I found a bunch of blogs where people wrote about how they felt bummed out and didn’t have much energy to do anything while they were on Accutane. There had been lawsuits against the company that made it, from patients who’d developed things like ulcers and Crohn’s disease, and there were a few hundred official complaints from people who got depressed or had suicidal thoughts, and there were even some comments from the parents of kids who killed themselves while they were on it.

  Their stories all started the same way — they’d tried every other prescription their dermatologist could think of and none of them had worked.

  Under my sink in the bathroom I shared with my sister were dozens of clear-orange pill bottles and flattened tubes from prior failed attempts to clear up my face.

  In ninth grade I’d been on adapalene gel, which made my face sting and shine like a glazed doughnut every night after I put it on. I’d lie in bed frozen stiff, keeping my eyes on the ceiling, paranoid that I’d roll on my side and get stuck to my pillowcase.

  Before that there were minocycline pills that did nothing. When I was taking them, I grew this marble-size lump on the corner of my left jaw that I couldn’t stop fiddling with until it exploded in biology and I ran to the bathroom looking like a gunshot victim.

  And then there was the Proactiv that Mom had subscribed me to back in middle school when the zits started sprouting up on missions to research if my cheeks were a good spot to colonize. I’d soak my face in that sting-y green juice twice a day, but I still had enough full bottles piled up from the monthly deliveries to wash a car.

  I researched how Accutane works, and an article explained that Accutane is just a brand name and the actual medicine is called isotretinoin. Scientists still don’t know 100 percent for sure how it works, but they know it shrinks oil glands and makes them produce less oil, and it slows down how fast skin cells regenerate inside pores, so the pores don’t get clogged. A lot of research suggests it works by causing apoptosis — cell death — of the sebaceous gland cells that make faces oily. Of course it makes you think suicidal thoughts. It is killing the building blocks of you.

  I’d read an article one time where this scientist said the cells in our bodies are naturally dying and being replaced by fresh cells constantly. He claimed the average life of a cell in the human body is seven years, which means we’re technically an entirely different person when we’re in tenth grade than when we were in third grade. And then we’ll be another entirely new physical specimen when we’re twenty-two.

  There are some asterisks in the theory, and I think some other scientists disagree with it, but the concept stuck in my head. It’s not so much for the science. I like the poetry of it.

  Every seven years I’ll be an entirely new person. Every seven years I’ll have a chance to start again.

  Mom shouted from the kitchen that dinner was ready. Shit. I felt the prescription paper in my pocket and on the walk downstairs tried to cobble together some plan for convincing Mom and Dad to sign it.

  When Mom says she “cooked” dinner, what she really means is she ripped open a frozen cardboard box from an international food corporation and microwaved the plastic tray inside. That night it was turkey with gravy, prepared with love in a Siberian sweatshop nine years ago.

  Kate brought glasses of water to the table. If she were older, she might have been of interest to me, but as a twelve-year-old, she had no valuable information or advice. Everything that surprised or excited her happened to me three years ago and I no longer cared.

  I wished I had an older sister. The kind of older sister who has sleepovers with friends who call me Kev and mess with my hair when they see me. A sister who could teach me enough about clothes so I can compliment girls without seeming like a creep. She’d let me read her magazines and I’d learn key terms like scrunchie and camisole and find out the secrets to coming off as understanding and nonthreatening. She would show me what movies girls watch when they’re bored and alone, and what girls eat for snacks. She’d give me conversation topics that girls don’t feel weird talking about in school. She’d leave bras hanging off the bathroom doorknob, so I’d be used to seeing them and when Emma’s green bra strap was hanging out of her T-shirt sleeve in Spanish, I wouldn’t have been temporarily paralyzed and unable to think about anything else for the rest of the day. Maybe after living with an older sister for fifteen years, I wouldn’t think girls my age were a different species. My hypothetical older sister would be incredible. But I had Kate. Our main interaction was when I’d burp and she’d say I’d never have a wife.

  Dad was at the kitchen table reading work emails on his BlackBerry. I stared at him for a while, watching the reflection of his in-box in his glasses. He scrolled through an endless list of charts and numbers, never looking up. He’s a real estate agent, so he gets to pretend that he’s working 24/7.

  You know that feeling when a kid goes to your school for years but you’ve never talked to him and don’t know anything about him but it would be weird to ask now because it would seem like you never cared? That’s what it was like with Dad. I knew nothing and it was too late to show interest. I could have asked all the questions I wanted when I was eight, but I blew it.

  “Put your thing down,” Mom told
Dad as she sat beside him and Kate sat next to me. Dad clicked off his screen and shook himself back to reality. Mom scooped hot reanimated meat onto our plates. “Do you remember junior year when Craig wanted to cook a whole turkey one night for no reason? And we drove around for hours going to different grocery stores and we finally found one in Gwinnett and by the time he cooked it, it was two in the morning and everyone was asleep?” She laughed.

  Dad thought for a second. “I thought it was a chicken.”

  Mom turned to me and Kate. “You’d never know it from seeing him now, but our friend Craig used to be the wildest, most spontaneous guy we knew. One time he filled up his dorm room with little plastic balls, like the ones in a McDonald’s PlayPlace.”

  Kate giggled. “That’s crazy. Like, that’s totally certifiably insane.” She had recently discovered words longer than three syllables.

  Dad said, “There weren’t as many balls as he’d hoped for. Nothing really happened.”

  It’s always like this with them. Mom tells a tall tale and Dad stands there next to her like some anthropomorphized Snopes.com and holds out a measuring tape and says, “Ma’am, I’m going to have to inform the audience here that this tall tale is in fact only a small story, hardly worth telling at all, that’s been radically blown out of proportion for dramatic effect.”

  I’ve never been able to imagine them meeting in college. They were eighteen when they met, not that much older than me. I sat there watching them chew and thought about cells being replaced every seven years. My parents have been through, like, seven rounds of that. Were they completely different people back then? I’ve seen pictures of them in high school and they look like themselves, but I can never imagine the reality — them in 3-D, their voices, who their friends were, how much they spoke up in class, if my dad made jokes with other guys at his lunch table about jerking off, if they ever cried alone in the bathroom.

  “How was Courtney’s house?” Mom asked Kate.

  “Wondrous,” Kate said. “She showed me all her old report cards. Her parents say a B is good and they give her presents when she gets Bs.”

  “B stands for bad,” I muttered. “You should get As. School isn’t that hard.” Her conversation was even more obnoxious than usual because I had something important to bring up.