"Skiagraphy," by Barrett Bowlin

Barrett Bowlin

Barrett Bowlin

Barrett Bowlin's stories and essays appear in places like Ninth Letter, Hobart, Michigan Quarterly Review, The Rumpus, Salt Hill, War, Literature, and the Arts, and Bayou, which awarded him the James Knudsen Prize in Fiction. He is the director of the Writing Center at Binghamton University, where he teaches film and literature classes, and where he moonlights as a contributing editor for Memorious.


I share the clinic's lab space with Lucas, who is into Jesus, like big time. As in, on my second day of work, once I've signed all the orientation handouts and watched each of the HazMat videos on how to clean up blood spills and how to secure the chemotherapy bins from leaking, he asks me if I recognize that God is the almighty, that Jesus is his son, and that salvation can be achieved only through Him. He says this after drawing five vials of blood from a grandmother who's come in for a battery of labs. She leaves, he tosses his butterfly needle into the sharps container, and then turns to ask me about the redemption. Then there's Jenny, who is into the sacrament, too, but just the liquid part of the show. In between phlebotomies on patients with low platelet counts, we talk about the new malbec at the sushi bar near the mall, or how the growing wine-in-a-box trend no longer means a Franzia hangover. And then there's the oncologist who's into guns, and the hematologist who loves tennis and Pete Sampras and the Virgin Mary, and the other physicians, who are looking for elevated neutrophils and antigen levels on paper receipts, and then there's me, who's just trying to find the next patient who's left their nipple jewelry on in the radiology room.

It starts with Julie. Six months out from a CT scan that showed zip of any remaining breast cancer—which is just miraculous, she tells me, hands clasped together in praise—her doc's got her back in at the clinic for an exam and a set of chest films. I'm new to the medical group, still green from getting certified down in Fort Smith on core and chest radiograph procedures as a tech, and now I'm back in town and calling Julie's name in the waiting room.

It's nice out there. We've got a television tuned to CNN, which we'll use in a few months to watch the dust roll out from where the Twin Towers will fall, and there's a fish tank in the corner, and a set of blinds that are good about keeping the sunlight pared down. Vaulted ceilings, complementing blue-green carpet and paint layers, all of it muted and calming. In the early evenings, when I'm working on a rush-job lumbar puncture with one of the docs to check for leukemia, it's quiet in a way that none of the rest of the day has been quiet.

Right now, though, Julie hears her name and pops up like someone waiting to hear her fate. Can't blame her, really. Have her mutated cells gone hiding or have they metastasized, spread out to her lungs or worse? Will she be clear for another six months, or will she be back in the treatment chairs, chemo dripping into her after another round of radiation therapy? Because we're taking silent bets back here in the exam area. The other medical assistants and lab techs and I do this each time we haven't seen a patient in a while, every finger among us crossed for the best.

I flip quickly through her chart as she stands and circles toward me, and I'm looking for my handwriting somewhere in there as a reminder if I've met her before, but no. It's my first time to bring her back.

"I'm Barrett," I say, holding my hand out. She's young. A brunette with silver-hoop earrings and a belle-sized hairdo that's just made its way from Friends episodes into the salons of Arkansas.

She takes it, smiles, gives me her name, which is something different from what I'm calling her here. I'm calling everyone from my days at the clinic something different now—Lucas and Jenny and Julie and all the rest.

Julie clips over to the scale, dropping her purse onto the side table where we've stacked boxes of tissues next to the medication and nutrition pamphlets. There's a new one I haven't read, a purple and white insert on total body bone scans, which I know is something we don't do in-house.

She adjusts the scale on her own, moving the balance back up from the weight of the rail-thin insurance adviser I'd brought back from the lobby just before her.

"Well, that's good," she says, nodding in approval at the numbers. She's done this all before—having her vitals taken, her patient history updated—which means she's been to our clinic and has fought through the labs and treatments and procedures at least once already.

So we dive into the second exam room on the right, and she plops down into a chair in the corner. I lumber over to her from the computer for the rest of the vitals: her pulse, her respirations, her temperature, taken orally, the probe sticking out of her mouth like a pipe on a coiled string.

"So the doc and one of his nurses will come in for the exam, which is why I need you to change into this," I explain, pulling out a cloth apron from a nearby drawer. "And then I'll see you again if he needs a couple of films."

"See you then," Julie says, knowing something I don't.

When her oncologist pokes his head out from the room twenty minutes later, I'm ready for him.

"Can we get a PA and a lateral on her?" he asks, and then he's gone, back to the physicians' office at the rear of the clinic, next to where we park our cars and keep the sand-filled smokers' pole.

The gold chain around her neck is the thinnest I've ever seen, and I almost forget about it when I ask her to come with me down to Radiology. She's removed her t-shirt and bra already, and the wedges of her styled cut of cinnamon-brown hair dip onto her freckled shoulders. The pattern on the cloth apron that's covering her breasts is red checks on a taupe background, and it's ugly as a picnic table cloth. It's like whomever's made these breast exam drapes has done so from material that's been thrown into the garbage behind a Michael's or a Hobby Lobby, and I watch as Julie looks down at the worst couture the clinic has to offer.

Save for the heat of the closet where we keep the developer, the rest of the room where we house the x-ray machine is the coldest in the building, and the patients remark on it like it's the weather.

"Chilly in here," Julie says, moving over to the bucky where I've loaded the film.

Her doc has asked for both a posteroanterior and a lateral shot on Julie, the industry standard to check for masses from both a rear-to-front and a side view apiece. Once I get her placed, Julie's chest will be pummeled by radiation, twice, so we can find something in her that shouldn't be there.

"I think it's because of the equipment," I say. "For some reason, the CTs, MRIs, and ultrasound machines tend to work better in colder environments. Same with x-rays, I guess." I see the glint of Julie's cross again and ask, "Hey, mind I hold on to your necklace for a second? Swear I'll give right back."

Julie nods and unclasps the chain from around her neck. I've asked her this because, just like it is with the calcium in a patient's bones, photons shot out from the x-ray tube will get absorbed by the metal on her necklace. The metal will fluoresce and might result in a double exposure, and even sometimes overshadow some of the surrounding soft tissue. There's a chance we might miss something important on the films when they pop out, and the docs want to make certain they can see damn near everything on the radiographs, without having to worry about what artifacts might show up.

When I feed the two cassettes of film into the developer afterward, what pops out first is two dashes of light near the bottom of the image. Two short, staccato lines that look like I've accidentally stapled the gel sheets together. But when they slide apart, I post them both up to the light box to see what I've missed, and there they are: two small barbells of white light amid the silver-blue of the background, two studs clipped through Julie's nipples like miniature gym equipment. Two dot-dash-dots on the morse code of her chest, shining out like a message.

"Want me to shoot her again?" I ask her doctor. I'm hesitant about this, knowing full well that Julie might not even have remembered the metal pins were there. She's back in the exam room now, waiting for the news that she'll be alright for six months longer, and that she won't have to come back to us until then, praise be.

"No?" says her doc. It's more of a question than an answer, and I watch as he puts on his reading glasses and pokes his nose closer toward the light box. "No," he says, tracing the outline of her ribs and heart and lungs. "We'll wait for her markers to come back and send her over to the hospital if we find anything."

And just like that, Julie leaves our clinic with her clothes back on, her purse in hand, her secret of the metal in her skin something the three of us won't ever mention to each other.


Archie wears nipple rings, too, but he seems proud of his. Like they’re little pushpin reminders of something ornate and painful. He tells me afterward he takes them off for the fights.

"That guy's in the Tough Man competition," a coworker says, smiling white teeth and waving at him as he comes in the door. "Different weight class than my husband, though. I think he won last year?"

The man doesn't have the heft of a fighter, but he's got the reach of a boxer. Tall, solid, comes in wearing Wranglers and boots that have kicked shit on a farm someplace. Orange hair, not red, thick with curls, worn up like a comic book character and with the same easy smile of a Riverdale teenager. Once Lucas is done with him in the chair for a CBC, he hands me his report—his white cell counts look good, and so do the reds, with only the platelets a bit over the normal range—and I call his name in the lobby.

"Glad to know you," he says. I like him instantly. I start peppering my responses to him with the word 'man' or 'dude.'

"Same, man," I tell him. "Looks like you're here to see the doc for your annual?"

And Archie looks thoughtful at this, chews on it for a second, says, "I believe that's it. Fingers crossed, you know?"

On the in-house patient records software, I see that we have only one entry on him, from just after when the exam room computers were first installed. But his paper chart is thick, and I see that we've pegged him down as a lung cancer survivor, non-small cell. It'll be a diagnosis that will define him for us for as long as he's one of our patients. We'll only change it if he adds on a metastasis to other places: his heart, his pancreas, his liver, or worse.

"How're you feeling?" I ask. "And did I hear from a friend that you fought in the Tough Man last year?"

The south's answer to Vegas's Ultimate Fighting Championships is the Tough Man, and it's stocked with beef-fed bruisers and former high school football players whose full-contact careers were supposed to have stopped at graduation.

"Two years ago," Archie corrects me, "but that was right before I got diagnosed. I won, though." He says this smiling, tucks his chin down onto his flannel shirt as if he's bashful about it.

"Dude, that's excellent!" I say. "Congratulations."

Archie's here under similar circumstances to Julie: an annual exam with labs and a couple of radiographs to make certain nothing's showing up on film that we might miss on his tumor markers.

While I'm going through his medications—a multivitamin, from what I remember, and that's about it; impressive for a cancer survivor—Archie blurts out, hands clapping together, "It was the weirdest thing."

"What's that?"

"Before the chemo, I had this straight, blond hair, almost white, you know? Spiked up and everything." He pats the top of his head, eyes wide and disbelieving. "But it came back in curly and ginger, I swear."

I've heard of this: of how a patient's hair will regrow differently after chemotherapy, in amount and density, and sometimes with a change in color.

"Oh, I believe you," I say, laughing and taking measure of the man before I leave the room. "I think it suits you, though."

Later, in Radiology, when I ask Archie to take his shirt off, he faces the bucky and touches his chest to the grid, and, like it was with Julie, I don't see the metal on his chest until I've fired his PA shot off from the lead-lined control booth. It's when he turns to the right for his lateral view that I exclaim, "Oh, damn."

Archie looks down and sees what I see. He leans in close and whispers, "You know, I didn't even think about this, but I'm wearing my hardware today." He turns and points, and there, on his areolae, are two ball closure rings. Getting a better look now, I see they're small and metal, with a single stainless-steel bearing dangling at the bottom of each piercing. He asks, "Think I need to take these off?"

"I'd say so," I tell him. "And you're going to hate me, but we'll need to retake that first shot."

Archie nods his head and starts unscrewing the metal balls, where the ring connects to the bearing. Back at the grid, his rings set safely on the x-ray table we rarely use, he flattens up against the wall, and I check again that the light field will hit him squarely on the spine, and that I'll capture the view from his clavicles down to the points of his lungs and ribs. I move the dial just a hair to adjust the peak kilovoltage, leaving the measurements of the amps just as they are, and then, once I say to Archie, "Take a deep breath for me," I push a button. At that moment, a surge of electricity superheats a coil of tungsten, sending the electrons through the cathode tube and toward the fighter in waves, fluorescing the silver-based gel sheet that I've clamped into the cassette in front of him.

I switch positions on the grid and ask Archie to turn to the right and lift his arms like a springboard diver. "Another deep breath for me?" I say, and he breathes in and holds it.

"Thanks, man," I tell him, and I slip out the cassette as he dresses back out for the exam room again.

In the red light of the developing closet, I slip all three films into the machine: the posteroanterior view, the lateral view, and the PA shot with the rings left in. For a laugh, I clip all three films up for his doc on the light boxes.

"Well, that's interesting," he says. Archie's oncologist clicks an orange GlaxoSmithKline pen in his hand, in and out, in and out like a habit he can't hear anymore, and we stare up at the fighter's rings in the soft blue light of the viewing room.

Waving out from the gel sheets are two small atoms of hydrogen, like they used to appear in chemistry textbooks, with the faint white webbing of a nipple apiece serving as clouds of nuclei.

"It takes all kinds," sighs the oncologist, and he walks out of the room to visit with Archie again. But I stay behind, remembering that I somehow got a better contrast on the shot with his rings still attached than I did with the film where they were absent. I like knowing this: that a man who used to take fists and kicks to his chest wears this jewelry in his target zones when he's not fighting. That the small pieces of metal can be removed quickly but are worn as regularly as a wedding ring. In the short minutes I've known Archie, I come to think that this suits him.


Susan’s jewelry isn’t like Julie’s or Archie’s. It’s there for a different kind of pain. See, the veins on her arms are blown and bruised. They're purple where we've poked her one too many times, and they're yellow from where they're either just starting to heal, or where they're just starting to show the damage. And the skin on top is sallow, like rancid butter left out on the counter. She's not in a good way, and this is just the middle of things for her.

"I've still got a little of my appetite," she tells me. "Mostly cold and sweet things. My husband keeps the freezer stocked with ice cream." She smiles and tells me this while I'm laying out the equipment so her doc can install her central line.

She sits in the procedure chair behind me. If I push a series of buttons on an attached controller, the chair will recline, her feet'll be pushed up, and we can lay her back and lift her up closer to where her doc will poke a needle full of local anesthetic into her chest.

"That's good," I tell her. "It's good you're eating."

Susan is blonde and wears her hair up and behind her ears in an elastic headband, like she's just come from the gym or is heading there after her appointment. She's a runner, or she was before chemo started, and I know the diagnosis of Non-Hodgkin's Lymphoma has hit her like a fist to the chest. When she was referred to us after she saw her primary for the weight loss and the chills and the sore abdomen, she put together a plan and fully intended to stick to it: aggressive treatment, no matter how she was feeling, combined with a reduced exercise regimen and an even healthier diet than what she'd been on before. What she didn't expect was that the lymphoma's symptoms would knock her flat, and that all her plans would be tossed.

And this is why she's in the chair, ready for her oncologist to run a venous catheter down through her chest and closer toward her heart. It'll make it easier for the nurses to pump her meds through her system, and she won't have to worry about the painful bruising along her lymph nodes, where the lab needles and IVs have poked and prodded her since her Stage III diagnosis.

"This won't take too long," I tell her. "Afterwards, we'll pop down the hallway and shoot an x-ray so we can make certain the line's in there properly. Then Lucas or Jenny will come in, flush your port with some saline, and I think you'll be on your way."

Susan's eyes trail toward the wall in front of her like she's staring into the middle distance, like she can see the next few months of this and where it'll all go wrong. But she smiles back at me and asks if she'll need to change into a gown or something.

"The bad news is that I've got an ugly piece of cloth for you to drape around your chest," I explain, and I take another apron out of the drawer under the procedure chair. It's a light blue swatch this time, faded like it's been scissored out of the back of an old pair of hospital scrubs. I forget what the good news is.

"Well," she exclaims, opening up the folds of the cloth, "this is kind of hideous, isn't it?" And because she laughs to herself, I smile and do the same.

Ten minutes later, her oncologist has her supine in the chair and is running a guide wire through her chest and down into her vena cava. A stream of blood from the wound runs down the side of her chest and streaks a line of red down into the fold of her arm, and it'll leave a stain on the apron that we'll have to bleach out before it can be worn by the next patient.

Her doc sends her down to Radiology with me, and she holds my arm like her blood pressure is apt to bottom out and onto the carpet. In the cold room and in front of the chilled bucky, Susan sways but stays put when I tell her to breathe and to hold it, and while I send electrons through her body and into the gel film in the cassette in front of her.

"Did you get it?" she asks.

I move the cassette to the developing closet, and before I shut the door, I tell her, "I think we did, but I'll come find you if we didn't."

Susan looks at me, frail as I've ever seen her. In two months' time, she'll be gone. All this after the diagnosis, the chemotherapy, the stem cell apheresis. After all the time spent in the chair, pushing poison through her body and getting bruised for it.

"Mind if I hang out?" she asks. "To see if we need to take another shot?"

"Sure," I say. "Absolutely." And I shut the door to the developing room and plug the cassette through the machine.

Up through World War I, before it was called 'radiography,' the practice of using x-rays to produce images on film was called 'skiagraphy.' Translated from a collage of Latin and Greek, the term meant, literally, to write with light and shadows. Magic lamps, silhouette tracings, images painted onto cave walls from fires: we used light and shadow to write people's histories, and now, if we looked closely enough at what was revealed, we could tell a patient's future.

From behind the door, I hear, "How does it look? Everything in the right place?"

When I post the silver-blue film up to the light box, with Susan just outside the room and waiting to see what I can see, we'll trace the central line together: where the tube slides into her chest, where it streams down toward her heart, where the line's been sewn into her skin with sutures and a curved needle, and where it'll stay put until she's done with this cycle of chemo.

I close up the cassettes and the rest of the gel film sheets so that light from the exterior Radiology room won't burn into them when I open the door. "Come on in," I say, opening it once the red light overhead's been turned off.

On the light box in front of us, Susan's new plastic jewelry will shine out dimly, pale compared to the white stretch of her spine. Before she leaves today, her oncologist will check the curvature of the line on the radiograph to make certain we haven't punctured a lung or gone down the wrong vein. Her insertion site will be cleaned and taped up with a patch—"Like I'm a bicycle tire," Susan will say—and the front desk will schedule her to return tomorrow for her next push of meds, delivered now through the new hardware. Sitting inside of her rib cage, the central line swoops and whirls like a parasite, like something she’s eaten or inhaled by accident. Its plastic-molded head and tail lie dormant and passive, but it seems ready to feed on the poison that will get pumped through her each time she comes in for chemo. I know that this is a faster way for her to die, but it’ll mean fewer punctures into her body while we kill her, fewer stabs of a needle into withering veins. Today, though, right now, the jewelry Susan wears in her chest means she's ready for whatever pain is sure to come next.