Surfacing the Toxins by Audrey Burges • Empty Mirror

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The twinge beneath my left breast was slight but insistent. My heart thrummed its customary rhythm, but every tenth or twelfth beat caught like a guitar string plucked by a hook beneath my sternum. I took a deep breath and glanced down at my chest as if I could watch the vibration on my skin. It’s fine, I thought. That’s probably normal, I whispered while shaking a tumbler full of neon-yellow powder and almond milk. You’re just adjusting, I said aloud while slurping slurry through a straw.

My sense of normalcy had been recently upended. After tumbling down a full flight of attic stairs, I’d limped into an urgent care center, expecting x-rays and some painkillers. The on-call doctor found no breaks or sprains, but circled my weight on my discharge paperwork and recommended physical therapy “for balance, and to get that number way down.” Thus sentenced, I spent weeks squatting and lunging and stretching on a vibrating platform, goose-stepping across carpet squares as the physical therapist recommended a visit with a sports medicine doctor.

“I’m betting they could match you with a trainer,” he said. “That’d help you learn to work out safely. You could get hurt if you don’t start slow.”

The sports medicine doctor said a trainer would be a waste of time until I fixed the underlying problem with my arm. Seeing my puzzled expression, she continued: the problem was my arm, because my arm was feeding my mouth. She suggested that I consult a nutritionist who could help me control my traitorous limb.

So I met with a nutritionist, who stood me on a scale and announced that I was “dangerously inflamed.” The best option was an anti-inflammatory elimination diet to address toxins that hobbled my body’s true potential. I soon learned that “elimination diet” was really just a fancy term for “eat nothing but this turmeric concoction that you’ll mix with almond milk three times a day. If you’re very, very good, later on, you can have kale!”

The diet was six weeks long.

Four weeks in, I woke up with a rash on my chest, buzzing with the kind of vague sensation you might get after brushing up against a cactus. It wasn’t painful, exactly, but noticeable. My husband reached toward it and said, “Is that…normal?” And I snapped (because I was hungry) that it was probably from the detergent I’d used to wash my bra. I don’t need to go to the doctor. (Doctors mean scales, scales mean scoldings, scoldings mean referrals, and before you know it you’re eating nothing but turmeric and almond milk.)

Two days after the rash appeared, the pain in my chest began. I’d been lifting weights and wondered, at first, if I’d pulled something. The pain didn’t go away if I changed position; it intensified as I breathed. It felt equally distracting if I stood or lay down. I applied my family’s general approach to all things medical: you’re fine. But by midafternoon, the pain was starting to stomp around on my chest and call me names.

I plugged my symptoms into a search engine and ignored the bold and frightening headings, honing in on a less scary one: costochondritis, an inflammation of the sternum. That sounded plausible. I called across the hall to my coworker. “Ever heard of costochondritis?” I asked.

“Agony!” she shouted back. “Had it a couple years ago! Thought I’d broken a rib.”

Bingo! I thought. See? No need to call 911. Calm down. You’re 28. I had only recently gotten established with a family medical practice (another impact of scoldings) and had gone there only once, for a bad cold. But, I reasoned, part of having a primary care doctor meant having a place to go when you weren’t feeling well, so I called.

“And what’s going on with you?” the receptionist asked, a keyboard tapping in the background.

“I have… a pulled muscle? Nothing bad, just kinda painful. Thought maybe I should just check it out…?” I heard my sentences bending upward into questions, making little hammocks of words I could use to swing my anxiety away. No-thing-bad…no-thing-bad…

“We could see you at 2 PM on Friday,” she said. That was two days away.

“Do you happen to have anything…sooner?” I asked.

“Could you get here in 15 minutes?” she asked. “I just had a cancellation.”

“Yes. Yes. On my way,” I said. I ran for my car to make the 25-minute drive, peeling into the parking lot at the 18-minute mark. I was not made for running. I approached the reception desk red-faced, sweating, and almost doubled over with pain. The receptionist looked at me suspiciously.

“Are you my 1:15?” she asked.

“Yes, that’s me.”

“Have a seat. We’re running a little behind.”

Nearly three quarters of an hour later, I followed the nurse who called my name into a smaller room, submitting to the usual rigamarole of height, weight, “you’re up two pounds since we saw you last,” “what brings you here,” and all the trappings of the medical visits I tried so desperately to avoid. I sat on the too-tall examining table and waited for another thirty minutes.

The doctor came in, willowy and harried, staring at a clipboard. “Afternoons are always crazy. Sorry to keep you waiting. I hear you’re having some pain in your chest?” She looked up, then looked up and down the length of me.

“Are you having pain in your chest? That should have been flagged.”

“I—yes, kind of. But I’ve been lifting weights and I thought I just might have pulled a muscle. Also, a friend of mine had costochondritis last year? So that sounded possible? I didn’t think it was anything to worry about, but it was hurting a bit.” No-thing-bad, no-thing-bad…

“Did we do blood work the last time you were in? I’m looking for results I don’t see any—we should have put you in for a full workup. Let me check your breathing. I’m trying to decide if I need to send you to the ER.” She started to advance toward me with the stethoscope, then stepped back to open the door and call into the hallway. “Bonnie? Bonnie, can you come in here, please?”

I grimaced. “I really think I’m fine. I’m breathing fine, it’s just that my chest hurts in this really weird way. It started twinge-ing yesterday, which is why I thought it might be a pulled muscle.”

“What do you mean, ‘weird way?’” the doctor asked. “How does it hurt?”

I gestured in a sweep down my sternum, under my left breast. “I don’t know how to describe it. Sometimes it feels like burning, or like an electric shock.”

The doctor still hadn’t closed the door and stood framed by the hallway outside. “Bonnie? Could you please come in here?”

I took a deep breath. “There’s one other thing that’s kind of weird, and my husband made me promise to ask about it. I have this rash on my chest. I don’t think it’s connected…”

The doctor glanced back in my direction, pointing at my dress. “Show me.” The door to the hallway was still wide open, waiting for Bonnie, who still had yet to enter.

The doctor stared at me expectantly, then held her hand to her side, palm upright, its meaning clear: “Well?”

I hesitated slid off the examining table. My dress was one long garment, no buttons or openings at the top, cascading from the shoulders through a slight A-line and ending below my knees. Its simplicity was part of its appeal. I told my husband that I liked to wear dresses because they were called exactly what they were: you put one on and boom! Dressed.

The appeal disappeared in a cold medical office, in front of an open door and a doctor running behind, needing to see my chest. I pulled the dress up to my neck as Nurse Bonnie walked through the door.

“Shingles,” the doctor said. “Classic presentation. I wondered as soon as you went like this, see?” She mimicked my gesture, down the center of her chest, under her left breast. “When you mentioned the rash, I knew right away. It’s only ever on one side, following a nerve. That’s where the rash is. See?”

She pointed the rash out to Bonnie, who nodded and said that her dad had had it too, that I was lucky it wasn’t on my face, it can blind you, you know.

I stood, dress held to my neck, door open to the hallway, as the symptoms and presentation of shingles were explained to me. They didn’t tell me to put my dress down, and I didn’t ask.

A concrete diagnosis is a gift: not just to the patient, but to the doctor. A diagnosis is a subject that can be explained, that can float as a buffer between the person treating and the person being treated.

“Some people say it feels like a heart attack, actually,” the doctor said.

I nodded. “That makes sense,” I said.

“The treatment is a course of strong antibiotics. You can’t go around anyone who hasn’t had the chicken pox until you’ve been on it for at least 24 hours. That’s very important. It’s basically the same treatment for a herpes outbreak, because it’s the herpes virus. And we can give you some Vicodin for the pain. Are you on any medications? I don’t see any on here,” she said, gesturing at the chart.

“I’ve been seeing a nutritionist, and I’m on an inflammation diet…?”

“What kind of inflammation diet?”

I reached into my purse, where I had a pre-measured scoop of shake powder and its ripped-off label for instructions.
“This stuff,” I said, handing it to her.

The doctor looked at the label and snorted. “This is—fine. It’s basically just protein and vitamins. It shouldn’t cause any kind of reaction with the medication. Is it working?”

“Working how?”

“Are you losing any weight?”

“I haven’t weighed myself since I started.”

Another snort. “Well, that’s not going to help much, is it? Are you supposed to check in with anyone?”

“I have an appointment with the nutritionist on Friday.”

“Okay, good. Just tell her about this,” she said, indicating my chest and still-bare body, “and about the medication you’re on. On your way out, make an appointment to follow up, okay? And it’s very, very important that you come in every year for a full physical. You really need to start paying attention to your weight. Okay?”

I nodded, as if my weight was something I didn’t pay attention to. As if my weight were not a physical presence that I felt intensely, intimately, every day of my life. As if it were not currently billowing around me, exposed to two medical professionals and a busy hallway, no longer concealed by a dress that I’d fooled myself was flattering and slimming and nothing was, really, how silly could I be? How misguided?

I contemplated how I could feel, at one time, both enormous and infinitesimally small; both inconvenient and invisible.

“Feel better,” the doctor said, and hustled out with the nurse, closing the door behind them.

I lowered my dress, grabbed my purse with the neon powder, and walked out of the office without stopping at the reception desk for my prescriptions. From the parking lot, I called the front desk and said that I’d had to run back to work and completely forgot to stop, and could they call the prescriptions into my pharmacy, please. I was so sorry for the inconvenience. The receptionist said, “Sure, hon,” and didn’t ask about another visit, and I didn’t volunteer.
On Friday, I returned to the nutritionist, two days into an antibiotic regimen and dosed with ibuprofen, afraid the Vicodin would make me sick to my stomach. I told her about the shingles, and her eyes went wide. “That’s wonderful!” she said.

“What’s wonderful?” I asked, perplexed.

“Shingles! It’s heat. It’s the heat and the toxins and the inflammation your body has built up coming to the surface! I knew this regimen would work for you. I’m so proud of you! You’re making so much progress!”

The logical part of my brain set off a clanging Klaxon alarm. Danger! It said. Danger! Not okay! Not okay!

But another voice oozed over the alarm, dampening it. It whispered, she says you’re making so much progress. She’s proud of you.

I saw her monthly for close to two years. The scale dipped and rose and returned to the same place, never far from where it started. But there was always a reason, an explanation, a note of pride. As long as I went to see her, I was doing something. I was armed with a defense whenever I went to an urgent care facility (as I never returned to the family medical practice). If an on-call doctor frowned at the scale, I could forestall the lecture: “I’m seeing a nutritionist,” I could say. “I’m working on it.”

And the doctor would nod, and I would tell myself the nod meant approval, meant pride. She knows she can’t be trusted with her own body, it meant. Thank goodness, I thought, for turmeric, for vitamins. For long talks about toxins.

They were everywhere, you see. In everything I put into my mouth. In every sideways glance, every comment about my too-big arms squeezed into a blood pressure cuff or the sleeves of a tie-back gown. I heard them hissing underneath exasperated, endless conversations about BMI. I breathed them in and absorbed them, drawing their judgment deep into my bones, hidden far beneath my skin.

The toxins moved within me, invisible, until the next voice ordered, “Show me,” and opened my nakedness to the world.

About Audrey Burges

Audrey Burges writes novels, satire, and essays in Richmond, Virginia. She has published work in McSweeney’s, Medium’s Human Parts, The Belladonna, Slackjaw, and Points in Case. You can follow her on Twitter at @audrey_burges and find more of her writing at

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