I was encrusted. Flat-backed on a padded examination table, I confined my hands to my pockets and stared at the ceiling, tracing the outlines of the antiseptic white tiles with my eyes. The left side of my face had been nicked over and over by a pointed knife, which my doctor kept low over my topographically unnatural facial terrain, like a Stuka dive bomber at the nadir of its attack. Small white squares of paper covered my cheek, collecting blood. The doctor dipped the knife into another pore. I was being prospected, drained, aerated. The tissue paper square at the edge of my peripheral vision dampened and drooped as the red line of absorbed blood advanced. This was the only way, I had been told. I needed to clear the skin, remove the grime, and start fresh.
It wasn’t as though I hadn’t been trying. There was benzoyl peroxide, the active ingredient in Clearasil, tingly and pungent, which I used when the red bumps first surfaced. There were Minocin and Tazorac and then the Erythromycin and Tazorac combination, which escalated into Erythromycin and Retin-A when it became clear that the standard course of treatment was insufficient. I caked my face with cream. My hands gleamed from the obsessive washings that I hoped would block the transfer of dirt to my abundantly welcoming pores. Dr. Weinberg lanced another whitehead and tore off a square of tissue paper. All that was left, he said, was to go back on Accutane. The logic was irrefutable; I was about to be a sophomore in college, and I still had acne.
For 13 years, my complexion had been flawless. I worked as a child actor, and in my debut on “Days of Our Lives” I was shown in a full screen close-up shot, a crowd-pleaser, it seemed, because I was brought back for seven more episodes. For most of middle school, I worked as a model, ditching fourth-period history to drive up the Malibu coast for photo shoots where hair stylists would bicker about exactly how much pomade to massage into my hair (“He’ll look like Mick Jagger!” “Honey, no, Mick Jagger’s, like, a million years old”). I had headshots, job offers and an agent. I smiled down at Kmart shoppers from giant posters above the children’s clothing section. I strode before Dockers executives at a company meeting in Palm Springs. I was pretty.
The pimples arrived in stages. They were unobtrusive at first, and when the first precocious scout zits breached the surface of my skin, I made sure not to overreact. I established a perimeter around each new arrival, isolating the red gelatinous mound. Then, I carefully cleansed and scrubbed before shutting my door and smothering the pimple in cream, prepared to wait it out.
These were the pre-popping days, the optimistic period of facial combat where the directions on my tube of Clearasil were gospel. The message was clear: Thou shalt not pop. My uncle Willie popped his pimples and now his face was cratered and uneven. He pinched, no doubt, squirting pus on the bathroom mirror, overjoyed as the large snow-capped zits melted into more socially invisible mosquito bites — a quick fix with little regard for future epidermal health. I abided by the safety-first school of thought. The pimple problem was, at that point, a matter of placement. A centrally located pimple meant a truncated weekend activity schedule, while a more remote outbreak did little to restrict my Bar Mitzvah party-hopping. By my freshman year of high school, my face was studded and scaly, and the second wave of bacterial facial eruptions was underway. I dreamed of affixing a broad, adhesive strip of paper and ripping out my pimples, suctioning the bulbous red and white hillocks by their roots.
In ninth grade, I went to a birthday party at my friend Keith’s house. Sloppily energetic, my friend Ryan and I flung ourselves from Keith’s roof into the pool while Keith and Paul spun a plastic bottle in the Jacuzzi and kissed Colleen, Devon and Samantha. An hour later, as we dried off and the girls waited outside for their rides home, Keith shared the secret of his smooth face. Everyone pops, he said. What matters is how you pop. It’s methodology. Attention to detail. The excavation of pus required a pin — sanitized of course (“is the hot water from the faucet hot enough?” “I think so”). I had to prick the pimple head and press down on opposite sides of the hole. Stuff should ooze out, steady and controlled. Once home I zipped open my mom’s sewing kit and selected three gleaming metal lances. Not wanting to take any chances, I boiled a pot of water and dropped the pins inside. Ten minutes later, I started popping. Within weeks I abandoned the pins and began tearing the tops of the pimples with my fingernails. My mom took me to see a doctor.
Dr. Weinberg warned me about Accutane before I took it. He told me about the senator who tried to ban the medication because his son grew depressed and committed suicide while on it. I had to consider the effects of dryness and sensitivity to sunlight. Liver damage was a definite possibility. Was I mentally prepared? Was I confident and strong-willed, resistant to the psychological side effects? My physical health was fine; my heart rate was normal, my kidneys functioned properly, and I was pain-free. But mentally, something was amiss. I saw Dr. Weinberg as my personal messiah of cosmetic perfection. My pockmarked self was substandard. I wanted to be better, handsomer. Dr. Weinberg wrote the prescription.
Accutane does not come in a pill bottle, but rather in dramatic cardboard packages. The pills are individually locked in private compartments, sealed by plastic and tinfoil. The backing contains identical silhouettes of a pregnant woman, each one slashed by a bold red line, a stern warning to prospective parents about the dangers of Accutane-related birth defects. Each of my doses (20mg twice a day, twice as strong as my first, unsuccessful Accutane attempt) promised to strangle my oil-producing glands, desiccating the bacterial breeding grounds. It was the drain-the-swamp approach to aesthetic excellence.
After the knife-prick facial cleansing, I wandered through the parking garage of the medical building, hiding behind my sunglasses and clutching my sample bag of Accutane while searching for my car. Another six-month course of the drug was now inevitable. I stared at my horrendous face in the rearview mirror. Then I ran my index finger along the bumps and pronounced their death sentences. I started the car and drove home. When my dad came into my room he found me sitting on the floor, my forehead resting against the large mirror that covers the outside of my closet. I’d been staring at my wounds for an hour, trying to count the individual incisions but always losing focus. Large, round pimples were ringed by clusters of smaller ones, all peaked with dried blood.
“Hey kid, how’s it going?” I mumbled a reply and got up to give him a hug. When I sat back down on the floor, I noticed the mirror was smeared with oil from my forehead.
“Ah, kid, I swear. God, everything is going perfect in your life. Everything.” I looked back at him. “Yes, I know. Everything except that. Ah, kid. I’m sorry.”
My dad left and closed the door. I twisted the trial package of Accutane in my hands, slowly peeling back the protective seal. How bad could the new dose be?
As I sat in front of the mirror, I had no way of knowing that in the next couple of days I would drive to Rite-Aid and buy out their supply of Chap Stick Lip Moisturizer (the one with the blue label, which I knew would be the only one powerful enough). My lips, already dry, would turn bright red with repeated lickings, the faint outline of a scabby moustache beginning to assert itself beneath my nose. I’d slather the Chap Stick on my lips, willing the moisture to seep back into my arid skin. During the first course of Accutane, I had failed to take precautions, and tiny incisions at the corner of my mouth had gotten infected, morphing into solid, crunchy sores. Two months later I’d be staring at myself in my dorm bathroom, brushing ropey strands of dead skin from my cheeks. My friend’s exfoliating apricot scrub would sit on the counter, and as the water warmed, I’d pump large dollops of orange liquid into my hands and slather them on my pimple-free face. Thin, rough granules embedded in the lather would scrape off layer after layer of useless dead skin, like innumerable bits of sandpaper. The sores would be back, despite my precautions, and they would sting from the foreign chemicals. I’d have long since forgotten why I ever went on Accutane. I’d think about the battery of moisturizers arranged near my bed, and the thick pile of dead skin that accumulated on my pillow by the time I woke up. And I’d scrub my face, digging the granules into my skin, laughing to myself as strand after strand of my face came off in my hands. I’d scrub harder and harder, free, finally, from my cosmetic nightmare. The dead skin gone, my face would be blemish free.
Then my suitemate would walk in and stop when he saw me. “Jeremy, Christ, your face.” I’d have rubbed myself raw. The next day would be Halloween, and it would be far too late to buy a mask, so I’d pretend I’d put makeup on my face. I’d take a picture with my suitemates, one dressed as Popeye and the other as a transvestite hooker, but only I would stand out, my plump cheeks a fiery, pulsing red. Charging into my room, I’d tear the boxes of Accutane, flinging the cardboard cutouts of the slashed out pregnant woman onto the floor. I’d get drunk and be miserable for hours. Months later, when my second course of Accutane would long be over, my skin would be clear and the chapped lips a distant memory. But I couldn’t have known all that.
If I knew that, knew that the symptoms were as bad as the pimples themselves, I never would have offered my face to Dr. Weinberg’s scalpel. I undressed and went into the shower, turning on the faucet and leaning my head into the sharp, cold water. I washed my face with noncomedogenic soap.
After showering and dressing, I walked to the kitchen and poured a glass of water. Fingering the trial package of Accutane, I thought, briefly, that I didn’t need it, didn’t need the stress, the dryness and the blood tests to check my liver function. I could clear up my skin some other way.
Then I thought better of it and tore open the package. I pried two oblong magenta pills from their tinfoil crypts, placed them on my tongue, took a sip of water, and swallowed.