Prologue: The Face in the Ceiling by Anthony Youn, M.D. (an excerpt of In Stitches)

[Editor’s note: The follow excerpt–the prologue–of In Stitches is published with permission from Anthony Youn, M.D. This story complements our interview with him, also appearing in this months issue. Read that here.]

What a pair. Double D’s. Poking up at me like twin peaks. Pam Anderson, eat your heart out.

Too bad they’re attached to a fourteen-year-old boy.

I ease the black marker out of my lab coat pocket and start drawing on my first surgery patient of the day. Phil. An overweight African-American boy. Phil has severe gynecomastia—in layperson’s language, ginormous man boobs. Poor Phil. Bad enough being fourteen, awkward, and a nonathlete in a tough urban Detroit school. Now he has to deal with breasts?

***

Two weeks ago.

I sit in my office with Phil and Mrs. Grier, his grandmother. Phil lives with his grandma, who’s raised him since he was ten, when his mom died. He’s never known his dad. Mrs. Grier sits on a chair in front of my desk, her hands folded in her lap. She’s a large woman, nervous, well dressed in a light blue dress and matching shawl. Phil, wearing what looks like a toga, sits on a chair next to her. He stares at the floor. “It happened fast,” Mrs. Grier says. “He shot up, his voice got deeper, he started to shave.”

She speaks in a low rumble. She looks at her grandson, tries to catch his eye. He can’t see her. He keeps his head down, eyes boring into the floor.

“Then he became quiet. Withdrawn. He would spend more and more time in his room alone, listening to music. He would walk around all day wearing his headphones. Seemed like he was trying to shut out the world.”

Mrs. Grier slowly shakes her head. “Phil’s a good student. But his grades have gone downhill. He doesn’t want to go to school. Says he’s sick. I tried to talk to him, tried to find out what was wrong. He would just say, ‘Leave me alone, Nana.’ That’s all he would say.”

Phil clears his throat. He keeps looking at the floor.

Mrs. Grier shifts in her chair. “One day I accidentally walked in on him when he was drying off after a shower. That’s when I saw . . . you know . . . them.”

Phil flinches. Mrs. Grier reaches over and touches his arm. After a moment, he swallows and says in a near whimper, “Can you help me?”

“Yes,” I say.

I say this one word with such confidence that Phil lifts his head and finds my eyes. He blinks through tears.

“Please,” he says.

***

The night before Phil’s procedure.

I can’t sleep. I lean over and squint at the clock on the nightstand. I twist my head and look at my wife, deep asleep, her back arched slightly, her breath humming like a tiny engine. I exhale and study the ceiling.

A shaft of light blinds me like the flash from a camera. My mind hits rewind, and I’m thrown backward into a shock of memory. One by one, as if sifting through photographs, I flip through other sleepless nights, a string of them, a lifetime ago in medical school, some locked in the student lounge studying, some a function of falling into bed too tired or too worked up for sleep. Often I would find myself staring at the ceiling then, the way I am now, talking to myself, feeling lost, fumbling to find my way, wondering who I was and what I was doing. The memory hits me like a wave, and for a second, just as in medical school, I feel as if I am drowning.

My eyes flutter and I’m back in our bedroom, staring blurrily at the ceiling. I see Phil’s breasts, pendulous fleshy torpedoes that have left him and his grandmother heartsick and desperate. I know that his emotional life is at stake and I am their hope. I know also that isn’t why I can’t sleep. I blink and see Phil’s face, and then I see my own.

I was Phil—the outsider, the outcast, the deformed. I was fourteen year-old Phil.

I grew up one of two Asian-American kids in a small town of near wall- to-wall whiteness. In elementary and middle school, I was short, shy, and nerdy. Then I shot up in high school. I became tall, too tall, too thin. I wore thick Coke-bottle glasses, braces, a stereotypical Asian bowl-cut hairdo, and then, to my horror, watched helplessly as my jaw began to grow, unstoppable, defying all restraint and correction, expanding Pinocchio-like, protruding to an unthinkable, monstrous size. I loved comic books, collected them, obsessed over them, and as if in recognition of this, my jaw extended to a cartoon size. I was Phil. Except I grew a comic-book jaw while he grew National Geographic breasts. Like Phil, I only wanted to look and feel normal. I just wanted to fit in.

It hits me then.

My calling—my fate—was written that summer between high school and college, the Summer of the Jaw. My own makeover foreshadowed my life’s work. Reconstructing my jaw showed me how changing your appearance can profoundly affect your life. Now, years later, I am devoted to making over others—helping them, beautifying them, changing them. I have discovered that plastic surgery goes beyond how others see you; it changes how you see yourself. On occasion, I have performed procedures that have saved lives. I believe that I will save Phil.

My mind sifts through my days in medical school, and in a kind of hallucinogenic blaze, I conjure up every triumph, every flub, every angst-filled moment. I remember each pulse-pounding second of the first two years of nonstop studying and test-taking, interrupted by intermittent bouts of off-the-hook partying. I see myself in years three and four, wearing my short white coat, wandering through hospital corridors trying to overcome my fear that someone—an administrator, a nurse, or God forbid, a patient—would confuse me for a doctor and ask for medical attention. I teetered a hair’s width away from those moments that might mean life and death, facing the deepest truth in the pit of my stomach: that I had absolutely no idea what I was doing. And neither did any of my medical-school classmates, those doctors in training who stumbled around me.

But things changed. Thanks to my small circle of close friends, my focus, work ethic, and drive to succeed, I slowly grew up. I entered medical school a shy, skinny, awkward nerd with no confidence, no game, and no clue. I came out, four years later, a man.

A smile creeps across my face. My eyelids quiver. I catch a last glimpse of the face of my younger self in the ceiling as it shimmies and pulls away. Sleep comes at last.

Phil’s surgery goes well. Ninety minutes, no complications. I lop off his breasts with a scalpel, slice off the nipples, then suture them back onto his now flat chest. I nod at his new areolas. They have decreased in diameter from the size of pie plates to quarters. I leave Phil stitched up and covered with gauze, a normal-looking high school freshman. Good news, Phil. You will not break new ground and become the first male waiter at Hooters.

***

I once saw an episode of Grey’s Anatomy in which a character suggested that she—and every doctor—experienced an “aha moment” when she realized she had become a doctor. That never happened to me. I experienced an accumulation of many moments. Some walloped me, left me reeling. Others flickered and rolled past like a shadow. They involved teachers, classmates, roommates, friends, family, actors playing patients, nurses, the family of patients, and patients themselves, patients who touched me and who troubled me, patients whose courage changed my life and who taught me how to live as they faced death, and of course, doctors—doctors who were kind, doctors who were clueless, doctors who were burned out, doctors who inspired me and doctors whom I aspired to be, doctors who sought my opinion and doctors who shut me down.

Thinking about all these people and moments, I see no pattern. Each moment feels singular and powerful. They stunned me, enveloped me, awed me, but more often flew right by me unnoticed until days, weeks, months, years later. Until now.

This is my Book of Moments.