Cancer Is the Secret of This Company Town

"Twitchell" by Leah Hampton, recommended by Deb Olin Unferth

INTRODUCTION BY DEB OLIN UNFERTH

Union jobs, forest fires, suicides, stranded wildlife—by the time Leah Hampton landed in my classroom, she was already writing these intense, gut-wrenching stories pulled from the depths of the Appalachian communities she knows so well. I could tell she’d shown up at the Michener Center with an artistic vision, and this book, F*ckface, is the realization of that vision. The title alone expresses the quintessential humor and rage that you find in all of her stories, a weird combination of humility and pride. Her characters who are down but never defeated.

“Twitchell,” from the middle of the collection, is just such a story. The protagonist, Iva, brazen, yet bewildered, navigates perimenopausal blood, mammograms, and breast biopsies. The backdrop is Twitchell, the area’s local chemical company which is likely responsible for a run of cancers running back decades. Heartless enemy, perhaps, though the locals are torn—they’re protective of their livelihoods but they also know they’ve been screwed. Iva is as local as they come. I love how there are no simple problems or answers in the story. Help could come from anywhere, but usually not from where it’s supposed to.

And I love the awkward fumblings of Iva’s husband. He’s the strong, rugged type, not accustomed to talking about emotions. He’s fairly useless at comforting her, poor guy, though he means well. Less sympathetic is the male doctor. 

I won’t tell you what happens, but I will say that grace is not gone from these mountain villages, though it may feel that way to Iva on the day she finds herself sitting in blood-filled capris at the Arts Council picnic. Grace is there all along, beside her, from first page to last, whispering, Hush, I can’t promise you’re okay, but I can promise you’re not alone.

Deb Olin Unferth
Author of Barn 8: A Novel 

 

Cancer Is the Secret of This Company Town

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“Twitchell”
by Leah Hampton

For the first half of Margie Pifer’s pottery lecture at the Arts Council picnic, Iva Jo Hocutt thought the Russian girl was asking for a tampon.

“What?” Iva Jo whispered. “No. I don’t know.” She dodged the Russian girl’s mortified stare for the fifth time; Iva didn’t want Margie Pifer to think she wasn’t listening.

The Russian girl was shaking her head and ignoring everyone but Iva Jo. On the little stage at the front of the white rental tent, Margie Pifer was lecturing about “the mountain craft tradition.” Iva Jo sat in the second row of folding chairs, in the very last seat. She was bored and hot and thirsty, and her body felt to her today like a series of lumps. She wore a loose pair of linen capri pants and a gray Arts Council T-shirt. Iva stuck her leg out a few inches, just beyond the shade of the tent. The sun cast a bright, hot shard of July onto her freckled shin.

The tent was next to the soccer field, which was across the street from the elementary school where Iva Jo was the head office assistant. The whole complex occupied the left hand of the stippled body of Queensport, Tennessee, a valley town in the green Blue Ridge where Iva Jo spent her life. Houses dotted Queensport’s seventeen capillary-thin streets, and Main was its spine. The Arts Council picnic was held every summer in this northwestern outskirt; the buzzing tents and booths looked from above, from atop the mountains, like colorful beetles held in the town’s palm.

The Russian girl was perched alone on a bench a few yards from the tent, directly in Iva’s line of sight. The bench occupied a shadowy patch under two willows.

Margie Pifer held up a big, rustic, multicolored bowl. She was made almost entirely of angles, so the swooping arcs of the bowl’s edges looked sloppy in her hands.

“Sanitary,” the Russian girl hissed again, her smooth, pale cheeks blushing livid.

Iva Jo squinted.

“There is blood,” the Russian girl mouthed. She bared her teeth. “You have sanitary?” Her h in the word “have” was wet and phlegmy.

The mention of blood shook some compassion from Iva Jo, and she wondered briefly what she could do to help, but she didn’t have anything in her purse. Iva was forty-nine; she hadn’t had a period in months.

Poor thing, thought Iva, remembering the embarrassments of teenage menstruation. A breeze thwopped the tent’s taut roof and wafted across the crowd. She ran a ring finger under each of her eyes—blue, bright, her best feature, she always thought—to wipe the sweat pooling there and focused on Margie Pifer and her bowl. Knowing Margie, there might be a quiz later.

Finally the Russian girl pointed at Iva Jo’s feet with a rude thrust. The girl’s delicate, quivering finger compelled Iva to pick up a foot and look at her sandal.

She was bleeding all over herself.

Two scarlet rivulets were dribbling down Iva’s thick calf. Her green capris were soaked almost black, her white plastic chair an abattoir. She had no cramps, had at this moment no sense of herself emptying out. Iva Jo felt nothing now except piercing alarm radiating across her scalp.

In the universal synchrony women find in such moments, Iva Jo and the Russian girl set about a tacit, determined series of looks, signals, movements. First, Iva looked up at the Russian girl in white horror and humiliation. The Russian girl snapped into dutiful action. She rooted around and found a crumpled paper tablecloth, recently blown hither from some other tent. The Russian girl snatched it up and signaled Iva with wide eyes. I am coming. Iva eyed back, Thank you; please hurry.

The Russian girl bent over, crouched low, and weaved her way around the tent poles separating them, trying not to be seen. When she got to Iva Jo, the Russian girl bobbed her head and gave more eyes to tell her to stand up, that she would cover her with the tablecloth. She put cold fingers on Iva’s upper arm, which meant, I will walk behind you; we are going inside the school, across there, to the bathroom, together. Iva coded back with glances and tensed muscles that she needed her purse; someone would see the blood on her chair. The Russian girl shook her head and crouched even lower. Leave them; they don’t matter. Go.

Iva Jo stood up slowly and made it four steps before she passed out cold.


When she got home from the hospital that night, she found that Margie Pifer had dropped off a casserole, a get-well card full of Bible verses, and the deformed bowl from her lecture.

Hank patted Iva Jo’s shoulder as she eased herself onto the sofa. “You want a glass of tea or anything?” he said.

Margie Pifer had dropped off a casserole, a get-well card full of Bible verses, and the deformed bowl from her lecture.

She asked for a Pepsi, and her phone buzzed. She picked up. “I’m so sorry I missed your lecture,” she said, stroking her stomach. “Mm-hm. Oh, now, don’t worry, Margie. I feel fine.”

She listened for a long minute. “Hank will, but I’m not hungry. I’m just sick of myself.”

Iva listened again. Hank came in with a fizzing glass for Iva and a plate full of Margie’s casserole. He turned on ESPN and muted it, then picked at the casserole.

“They cleaned me up, did an ultrasound. Said I need hormones. Mm-hm. No, they reckon that was the heat, made me pass out. But they don’t know. I don’t know.”

She listened again, lips pursed. She fussed with the ties on her pajama bottoms. “No, Margie, I don’t want to do that. Because it’s surgery. Radical surgery.”

Iva watched the baseball players on ESPN chew and spit and whomp their bats in the sparse grass. “Mm-hm. At least it’s summer. Time off to figure things out. All right now. God bless you, too, honey.”

She hung up, drank the Pepsi, and tried to forget about the rock of fear in her gut.

Iva went to bed early. She bled through the night, so much she had to get up three times. There was still no pain, only an elevated heart rate that roared in her ears like soft static. Finally she changed into a Depends she found in the guest bathroom, left over from an elderly aunt’s visit. Iva lay in bed and longed for her mother. She wept. She prayed for a granny witch to appear in the backyard, thin and spooky like a haint, and spare her whatever health crisis was coming, to cast a spell or make her a magic poultice of roots.

Then nothing.

The next day it was like the blood had never happened. The thick, extra-long maxi pad Iva Jo stuck in her panties stayed dry apart from a few rusty streaks, and by supper time she was in a half-bright mood. She was patting out a couple of hamburgers when Hank came home from work and touched her on the shoulder.

“You all right today, girl?” he said, and sniffed the patty in her hands.

“You want more A.1. than that?”

Hank nodded and began to empty his pockets into a basket  on top of the microwave. He ran his hands into the various hiding places of his long body, the folds of his work pants, his work shirt. There were pockets on every limb. He produced four pens, a thin-framed pair of glasses, then a wallet, two sets of keys, a tape measure, a handful of change. He patted his broad chest, rubbed his backside, and frowned. The lines on his tan cheeks were deep and spidery.

“I left my—” he said, and held up two fingers. “Gonna run back out to the truck.”

Iva Jo washed her hands, gathered dressings for the burgers, and opened a can of beans into a red pot on the stove. Her kitchen was dark but tidy. Theirs was a splanch-style house, and the kitchen and living room were on the sunken end. Iva’s kitchen windows were flush with the ground. When she looked out, she saw the world through the trunks of hedges.

On her way past the microwave, she peeked into the basket and checked Hank’s pocket leftovers. She looked for stray bits of paper, business cards scribbled with private numbers. Realtors liked Hank. His inspections were always spot-on and filed fast, so he got sent to a lot of the country clubs and newer developments. Lady realtors flirted with Hank. Lady realtors, Iva had observed, all had wispy hair and even, snowy teeth.

Hank returned with a thick binder, two clipboards, and a dozen spray roses wrapped in supermarket cellophane.

“There now,” he said, passing the flowers to Iva, whose palms were still pink and clammy from handling the ground beef. “You’re gonna be just fine.”


At church the following Sunday, Pastor Rob said a special prayer for Iva Jo, which she appreciated. Hank wasn’t much for religion, so she carpooled with Margie most weeks.

The church was First Baptist—large, brick, and stalwart at the base of Queensport’s spine.

“Lord, we’ve had so much cancer in our congregation,” said Mrs. Pickering after the service.

Mrs. Pickering was ninety and diminishing. She got confused about things.

“Iva doesn’t have cancer,” Margie said.

They were in line for refreshments, inching down a long, white, crowded hallway stretching from the main church into its newly renovated hall. Margie was wearing a sleeveless dress covered in tiny zigzags that matched her spiky hair.

“I had it in both my breasts,” Mrs. Pickering went on. She gripped her cane and leaned against the oak doorframe of the Sunday school hallway. “My sister, too. And my niece.”

Iva Jo tried to be helpful. “Two of my cousins had it. One was cervical. And Hank’s brother’s in remission from liver cancer.” They moved up a few steps in line as the low murmur of the congregation swelled, subsided, then swelled again around them. The rhythm of chatty crowds. “It touches near about everybody.”

Mrs. Pickering nodded. “All the local families, all the ones been here a good while.”

Margie rolled her eyes. “Here we go,” she mouthed at Iva.

“Makes you wonder. I’ve been wondering.” Mrs. Pickering shut her eyes tight, lifted her face to the fluorescent light above, and shook her head. “I’ve been wondering years.”

“Well, it’s not Twitchell, if that’s where this is going again,” said Margie. “I’ve told you, Missus P, that’s the price we pay for having jobs. Industry.”

“I never worked there,” said Mrs. Pickering. “Did you?”

Iva didn’t answer. Margie stared at her, but Iva kept her eyes on Mrs. Pickering, whose thin blouse, which looked like a daffodil, rippled as the old woman exhaled.

“My husband did,” the old woman said. “Died of lung cancer. Never smoked a day.”

“But he had benefits,” said Margie. “Y’all were better off than if we’d been a coal town.”

Stewie Pifer, Margie’s husband, was the director of planning at Twitchell Chemical, the biggest employer in the county. Margie defended the company even after they got in trouble for all those EPA violations, even after they dumped eighty thousand gallons of corrosive slurry into Jubal Creek and poisoned twenty farms downriver. No one in the county drank from their own wells anymore.

Queensport and Twitchell were not special. Similar plants, and similar spills, abounded in the region, hidden up old logging roads, behind bribes.

Queensport and Twitchell were not special. Similar plants, and similar spills, abounded in the region, hidden up old logging roads, behind bribes. There was some talk of groundwater testing, a few settlements paid out. A film crew from the university tried to make a documentary. Not much else.

“Oh, my, yes,” said Mrs. Pickering. “Coal is another thing altogether.”

“Tourism’s just as important, though, Margie,” said Iva Jo. “Tourism’s the future.”

“But Twitchell’s the last one standing. We can’t all be kayaking instructors. People have got to have real work.”

“Iva, what exactly is the trouble?” said Mrs. Pickering. “Pastor Rob didn’t tell us.”

“They’re still figuring that out,” said Iva Jo.

“Menopause,” said Margie. “It’s just the menopause, is all she’s got.”

“Ah,” said Mrs. Pickering. “Don’t you fret, now.” She patted Iva’s hand. “The Change is just terrible, but in the end, praise Jesus, you’re free.”

The Change is just terrible, but in the end, praise Jesus, you’re free.

“Why go through it?” said Margie. “Do like me and get the hysterectomy. Best thing I ever did. I’ve been telling her. Be done with the whole mess.”

“I’m going to see Dr. Philip this week,” Iva Jo said.

“Well,” said Mrs. Pickering, “I didn’t go that route. Either way, you ought to find yourself a lady doctor. A female.”

“She’d have to go all the way into Knoxville then,” said Margie.

“Don’t let a man cut you up,” said Mrs. Pickering. She shook her head, squinted again. “They always want to cut. Get yourself somebody who understands a bit better.”

The line had slowly advanced, and someone handed Mrs. Pickering a plate of cookies and offered to find her a seat. She took her leave and squeezed Iva Jo’s wrist. “You hang in there, honey. It’s just like giving birth. Just breathe full and ride it out.”

Margie bit her lip and watched Mrs. Pickering dodder off. She handed Iva a paper cup full of watery coffee and pulled her by the arm into the church hall. “She’s forgetful. That’s all.”

“Oh, I don’t mind.”

Iva knew Margie and her friends talked about her. They counted her miscarriages for years and told each other Iva Jo Hocutt puts on a brave face, that Hank Hocutt was a good man for sticking around. She never told anyone it wasn’t something she mourned. Every time she’d lost a baby, relief had washed over her, warm and keen. Hank had never pushed the subject. Iva felt, at least on that one score, at least sometimes, like the luckiest woman in town.

“I’m so fortunate; I know that.”

“Amen,” said Margie, and held Iva’s fingers in her own.

They sat at a plastic folding table near a narrow window and drank their coffee.

“I should do something for that Russian girl,” she said. “The one who helped me. She was from Blue Sunshine. I should drive out there.”

Iva knew the Russian girl was Russian because on the day of the picnic she’d seen her get off the Blue Sunshine Camp bus and herd a bunch of little ones toward the “Arts 4 KIDZ!” exhibits. The children had bounded toward a face-painting table in a haphazard stream, and the Russian girl and her colleagues had sighed and wiped their foreheads and looked for shady places to be alone.

Blue Sunshine Camp employed tons of them, more than most. The girls—mostly Ukrainian, not Russian, but Iva Jo always forgot this—worked on temporary visas as counselors in the camps throughout Sylvan County. The camps’ huts and hiking trails skirted the boundaries of the national park, and every year they brought in Eastern Europeans to work in the woods for room, board, and a pittance. Iva Jo could always pick Russians out from a crowd. They all had the same plump lips, the same severe ponytails, and a pale, quiet fear of being so far from home. Some of them must have come from steppes or other flat places, because they ogled the Blue Ridge with wide eyes. They pointed at each mountain and compared them, making the rough shapes of peaks in the air with their hands. Every summer they came. Slowly Iva Jo and her neighbors had started to see Russian girls in the winter months, too, after all the tourists left, after leaf season. Immigrants.

“Oh, no,” said Margie, pulling her hand back from Iva’s. “Don’t go getting involved with all that.”

“All what?”

“That girl’s going home in a month or two anyhow.” Margie looked around and lowered her voice. “At least, she better be. Being pregnant and all.”

Iva Jo leaned forward. “What? That tiny little thing who wrapped me up in a paper tablecloth? She barely looked eighteen.”

Margie nodded. “They found out right after she got here. Andrew said the whole camp knows. They’re pretty upset with her. They think she was…you know. Already carrying it when she came over.” Margie’s nephew Andrew ran a laundry service. He delivered to a lot of the camps and knew all the staff gossip.

“So?”

“So,” said Margie. “If she’s too far along at the end of the summer, she can’t fly home.”

Iva Jo shrugged, shook her head a little. And?

So,” said Margie. “If she can’t fly back to Moscow or wherever, she’ll have to stay. Have the baby here. Then she’s got herself a little citizen. You know.”

Iva didn’t know.

Margie rolled her eyes. “An anchor baby.”

Iva Jo thought about the Russian girl’s wide eyes, those downy eyelashes, and how earnest she’d been about helping her to the bathroom.

“Oh, I don’t think she’d pull a scam.”

“You’d be surprised,” said Margie. “A lot of them do it. Out of wedlock and everything.”

“That’s not a big deal nowadays.”

“Iva.” Margie frowned. “Sunshine is a Christian camp.”

“But Russians,” said Iva Jo. “They go to church, don’t they? None of this sounds too terrible. Sounds to me like she’s just in a little trouble.”

Margie sniffed a concession. “At least she’s not Mexican. I doubt one of them would have helped you.”

Iva Jo didn’t say anything.

“Mexicans don’t even come to the Arts Fair,” said Margie.

“Did you invite any?”


The following day, Iva Jo drove out to Blue Sunshine. Scam or no scam, she owed the Russian girl her thanks. She waited until five o’clock, though, after all the daytime staff, the locals, the Christians, had gone home for the night.

The camp was a scatter of lodges, cabins, and metal gazebos all hodgepodged around the fork of Pigeon and Jubal Creeks. Iva’s jeep wagon crawled up the dirt road past Blue Sunshine’s stack-stone gate.

She gripped the steering wheel with both hands and ducked her head to look at every cabin and shanty she passed, trying to figure out which one might be the Russians’ barracks. A thin-shouldered girl with a foreign look about her walked across the road carrying a toothbrush and a towel. Iva Jo  watched the girl disappear into a sad-looking brown lodge behind some trees. Splotches of dark moss dotted its sagging roof.

Iva Jo pulled over and got out. She looked at the brown building, then at the rustling creek. The woods here made a canopy that blocked out sound and sun. Iva knew if she kept walking east from this spot, eventually she’d hit a stand of laurel trees bordering her eldest cousin’s property. It was the biggest patch of laurel she knew of anywhere, and though it was too late in the summer for them, she still pictured their white blooms snowing the forest floor.

She walked in the direction of the lodge, then stopped in the middle of the dirt road. Iva closed her eyes and tried to imagine being young and in trouble in some foreign place. She tried to imagine sleeping in a camp counselor’s dormitory bed and chasing after other people’s children all day while suffering from morning sickness and tender breasts and the lonesome terror of a first pregnancy. Iva wondered, How did she even see me? What makes a frightened girl hold a strange woman’s hand and cover her with paper?

What makes a frightened girl hold a strange woman’s hand and cover her with paper?

“Can I help you? Are you a parent?”

She turned, and a clean-cut teenage boy addressed her again. “Are you lost?”

“I’m looking for—” Iva’s tongue stopped behind her teeth. She didn’t know the Russian girl’s name. She thought she had brown hair, but it might have been blond. She couldn’t be sure, and asking identifying questions would mean embarrassing both herself and her savior.

“Never mind,” Iva said to the boy. “I’ll find it.”

She walked back to the jeep, climbed in, and drove home.


“Now, Iva,” said Dr. Philip. “I don’t want you to worry.”

“Over what?” Iva Jo was sitting on the exam table. Her short hair was all mussed up at the back; she could tell when she touched it. The curls felt soft and twizzled, like they did after a day at the beach.

“Over what happened,” he said.

“What did happen?” Iva was dressed. Her exam was over, and the smock she’d been wearing sat in a heap beside her. “I still don’t understand why I bled like that. Out of nowhere.”

“That’s what we’re trying to determine,” said Dr. Philip. “You don’t have a polyp. In the meantime, we’ll start you on hormone replacements to help with your symptoms. It can take a while to get your dosage right.”

The lights in the exam room glowed on his buzz cut. His hair was silver, the skin under it pale and bumpy. Your head could be the moon, thought Iva.

He wrote something on her chart. “You’ll need to come back and see me in two months.”

“So this is normal?” As she spoke, she swung her feet like a little girl.

Dr. Philip rubbed the back of his neck.

“Hard to calibrate. You’re the right age for menopause.” He flipped up a stack of papers in her file, a worn manila folder with feathery, gray edges. “And you’ve never carried a child to term, so this is all”—he bobbed his head back and forth—“sort of normal.”

“I don’t want a hysterectomy.” She shifted her legs, rustling the table’s paper cover.

Dr. Philip frowned. “You might not need one,” he said. “But they work like a charm for a lot of patients. We do them all the time.”

“I don’t want one.”

“We’ll just see what’s best, Iva.” He clicked his pen. “By the way, when was your last mammogram?”

“You told me I didn’t need one until I turned fifty.”

Dr. Philip clicked his pen again. “Oh. Well, let’s get the jump on that for sure. Every woman”—he smiled—“is different.”


Iva Jo drove home from Dr. Philip’s office with a purse full of scrips. She drove past the CVS, past Kmart, and two other places where she could have got them filled. She drove past the gated entrance to the Twitchell plant and didn’t look at it. She didn’t look at its long, familiar drive or its white smokestacks that loomed above town and glowed at night. She drove right past it all, through the whole body of Queensport, without stopping.

Hank got home around six o’clock and ambled into the living room. Iva was leaned back in her squat blue recliner reading a pamphlet called Perimenopause: Your FAQs.

“He says I need tests. Wants to try me on some pills.”

“Tests?” said Hank.

“Well, a mammogram. And some blood work.”

“You want me to come with?”

Iva laughed. “Oh, I don’t think they’d let you. All those boobies everywhere.”

Hank smirked, leaned against the bookshelf opposite her, and began to say something. His shoulder brushed the ugly bowl Margie had given her the week before. It wobbled on its base, tipped forward, and crashed to the hardwood floor.

“Oh,” said Iva Jo, reaching out. She fumbled out of her chair toward the shelves.

Hank put his hands to his face, round eyed and sorry looking.

“Oh, Hank!”

“Careful, don’t cut yourself. Stay back.”

“I’ll never live it down,” she said. “That was her best piece.”

Hank crouched down as Iva Jo slumped in the wreckage. She picked up a large, jagged hunk of glazed crockery, and a tendril of crude rage began to hum and tingle inside her.

“I’ll glue it back together,” he said.

“No,” said Iva Jo. Hank reached toward the hunk of bowl. She slapped his hand away. “Get off. Get the fuck off.”

He reared back. Iva swept her hands across the floor to gather the bits together.

“The hell? You didn’t even like the damn thing,” he said. “Hell, half the time you don’t even like Margie.”

“That’s not the point,” she moaned, and ran her hands again into the breakage.

“You’ll cut yourself. All the little pieces.”

“Sshh,” said Iva Jo.

“Let me get my trouble light.”

Hank jogged into the hallway and scooted around in the closet. She listened to him rustling, then felt the vibrations of his booted feet pounding back toward her. He pulled the trouble light onto his head, adjusted the straps, and knelt beside her. He reached up and twisted the light on. Its halogen beam blazed across the floor, and each shattered piece glowed.

“Let me do it,” he said, reaching out.

She slapped his hand away again, harder this time. “Get the brush. And the dustpan.”

Iva had never slapped Hank before. The sensation of hitting him rung deep in her bicep. She couldn’t tell whether she liked doing it; she only knew she felt like hitting him again.

“Goddamn,” said Hank, standing up. “You’re worse than the girls at the office.” He cut off the trouble light’s beam. “Every woman I know is on the rag this week.”

Heat seared up her neck and across her face. She tasted sweat on her lips.

“Shut up,” she said through her teeth. “Even if we were, it wouldn’t matter. But we’re not. None of us.”

“Well,” Hank said, dusting off his hands and backing away. His voice deepened. “Means the same to me either way.”

Stop it, she thought. Stop. Stop.


“Elena.”

“Hm?”

“Elena,” said Margie. “That’s the girl’s name, the one who helped you. I asked Andrew.”

They were in a grim, dingy medical office on a rank day in August, waiting for her first-ever mammo. Margie had tagged along for support.

“Elena,” said Iva Jo, adding music to the syllables. “That’s nice.”

“Andrew said the daddy works at the same camp. I think he’s Russian, too.” Margie’s hair, normally so blond and carefully spiked, looked wilted. It was early and already humid outside.

“What’s she doing now?” asked Iva.

“Andrew said she went home,” said Margie.

“What, back to Russia? You mean she’s gone?”

“That’s what Andrew said.”

“And the father?”

Margie shrugged.

Iva blinked. “But what will she do? About the baby?”

“Miz Hocutt?”

Both women popped their heads up, and Iva reached for her purse. “Can my friend come with me?”

The mammographer gripped a metal clipboard and smiled. She wore a loose bun, no makeup, medical scrubs, and clogs. “It’s a pretty tight squeeze in there. Your friend can wait out here and meet you afterward. Why don’t you come on back?”

The exam room was about twelve feet square and filthy. The floor was strewn with thick black wires and boxes of medical and office supplies. In the center was a massive beige machine that looked like those robots in the movies—the ones that can turn into cars. Everything was coated in a thin, gray fur of dust.

The mammographer, who barely met her eyes the whole time, gave Iva Jo a paper vest and a few instructions. She asked some questions about medical history, date of birth, the usual. One of the questions was “Have you ever worked at Twitchell Chemical?”

Iva stammered a little, then said no. The mammographer ticked a box and turned to the door. “Undress from the waist up,” she said. “I’ll be back in a minute.”

Iva took off her blouse and reached back to undo her bra. She stared at the metal blinds on the window and hoped nobody could see in. She pulled on the blue paper vest and laid her purse and clothes over a chair in the corner. The mammographer knocked gently and came in.

“I’m big,” said Iva, holding herself under the vest. She nodded at the machine, and the paper scratched against her neck. “I don’t think my girls’ll fit in that thing.”

The mammographer produced a dark glass plate the size of a sheet of paper. “You’ll be fine,” she said.

For the next few minutes, Iva Jo hunched and contorted and gripped the sides of the machine like an awkward dance partner while the technician nudged Iva’s torso and squished her breasts between the glass plates. Friends had told her mammograms were painful, but Iva didn’t feel much. It reminded her of the gropings she’d giggled through with high school lovers. The plates weren’t even cold. Then it was over, and she put her clothes back on, and Margie took her out for a fancy brunch of shrimp grits and mimosas.


A week later Dr. Philip called while she was folding sheets and said there was a “spot” in her right breast, and she might need a biopsy.

“Might,” said Iva Jo.

“Often it’s nothing. Could just be a bad image.”

“Is this anything to do with that awful period I had? The bleeding?”

“No,” said Dr. Philip. “Well . . . I don’t think so.”

“Do I have cancer?”

“That’s unlikely, but we’re just going to check and see.”

Dr. Philip said the Knoxville Breast Center would re-scan the spot. If it turned out to be a lump, they would do the biopsy. He said they were very nice at the Knoxville Breast Center, and after her appointment there, Dr. Philip would give her the news one way or the other.

“How much is all this going to cost?”

“Depends on what they find,” said Dr. Philip. “But again, it’s probably nothing.”

Iva’s neck began to sweat. “When will I know?”

“It’ll take a while to get you in for a referral. A few weeks.”

“Can’t you do it? Can’t you check me?”

“I don’t have the resources here,” he said. “This is a small town, Iva.”

“Well,” she said.

“Iva,” asked Dr. Philip, “did you ever work at Twitchell?”

The dryer buzzed in the background. She leaned against the laundry room door.

“Because if you did,” he said, “they might pay for some of your treatment. There was a big case a while back. Class action. There’s a settlement fund.”

“I remember,” said Iva.

“Well, that might help some.”

They both breathed into their phones.

“All that poison,” he said. “It’s a real shame what they did over there.”

“Hank’s gonna flip out,” she told Dr. Philip, who told her not to worry.


The dingy breast clinic sent her a CD of her mammogram images to take with her when she went to Knoxville. She was curious and tried to look at them, to see inside herself, but the files wouldn’t open on her laptop. A few days after that, she got a terse, official letter in the mail notifying her she had “high density breast tissue.” State law required them to tell her that unlike average women, her boobs were mostly boob tissue, not fat, which made them hard to see through, so legally they couldn’t be held responsible for any faulty images or future errors in diagnosis.

“What in the world am I supposed to do with this?” Iva Jo asked Hank.

Hank frowned at the letter. “Frame it,” he said. “Means you got real knockers.”

Iva Jo laughed, and Hank put his arm around her.

“Maybe I’ll give it to Margie,” she said.

Then she and Hank sat down and cried and prayed for a while.


Hank drove Iva Jo to Knoxville on a Tuesday near the end of summer. They stopped for breakfast at a diner and ordered mushroom omelets and talked about what they would do if she had cancer.

“I’ll be right there,” said Hank. “The whole way.”

Iva Jo stared at the abstract watercolor on the wall above their booth. It looked like a sea.

“I don’t think I want to be friends with Margie anymore,” she said.

Hank opened a vial of creamer and poured it into his coffee.

“And I don’t think I want Dr. Philip to be my doctor anymore. I shouldn’t have had to wait this long to get all this sorted out. Lady at church told me she got all her results inside a week. All her tests and everything. And you know he hasn’t called me back once? Not once. I’ve been going to him six years.”

Hank nodded, sipped his coffee.

“We’ll do this however you want, Iva,” he said. “But I don’t think we’ll have to.” He pointed his coffee cup at her chest, moved it back and forth. “I think everything’s all right in there,” he said, and took another sip.

“That Russian girl went home. Margie waited until she was gone to tell me.”

Hank raised his eyebrows and poked a fork into his omelet.

“I guess I shouldn’t have told her we broke her bowl.”

“It was your bowl,” Hank said. “She gave it to you.”

Iva picked up her soda, took a sip. “How many people do you know have cancer?”

Hank swallowed a bite of omelet and raised his eyes to the ceiling to count. He rattled off names under his breath. “A lot.”

“You think it’s Twitchell? Everybody I know from those days got something.”

Hank cleared his throat. “Does it matter? It’s too late now. That was thirty years ago.”

Iva drew her shoulders back. “Well, I never would’ve . . . If I’d known. I might’ve had a baby, even.”

“Honey,” Hank said. “You can’t blame it on that.”

“Well, it’s obvious, isn’t it?” she said. “Whole town suffering, breasts coming off everywhere, your brother’s liver, lost babies, and nobody talking about it. They should tell us. The state. Doctors. They should investigate.”

“That plant’s been there since before we were born, Iva,” said Hank. “We’d know by now if it was anything dangerous.”

“Well, Margie should have told me, anyway.”

“About Twitchell?” said Hank. “You want her snooping around those old silos?”

“No, about the Russian girl. Elena. I’d have gone to see her. Helped her. Found out what she did about her baby.”

“Eat up,” said Hank, crinkling a paper napkin. “We’ve got to get across I-40.” He looked out the window. “All that traffic. I don’t know how people live like this.”


The Knoxville Breast Center looked like a spa. They had a fountain out front and valet parking. Hank kept his hand in the small of Margie’s back while she filled out paperwork at the check-in desk. The check-in nurse told them to wait, Iva would be called back, no men were allowed beyond the lobby.

Whole town suffering, breasts coming off everywhere, your brother’s liver, lost babies, and nobody talking about it.

They had sleek leather chairs in the waiting area. They had real coffee and fishing magazines. The lobby was full of husbands.

“Iva Hocutt?” a woman in lavender scrubs called. They both stood.

“OK, honey,” said Hank. His voice tightened. “I’ll be right here.” Iva Jo grabbed his hand.

“We’ll know, Iva girl,” he said. “At the end of this, we’ll know. That’s the main thing.”

Iva Jo nodded and kissed his cheek. Hank gripped Iva’s arm so hard she thought it might leave a bruise. Then she followed the lavender nurse through a thick wooden door.

The nurse brought her to a changing room. The doors to each room were slatted mahogany. It looked like a fancy department store.

“Everything off from the waist up,” she said, “then pick your color!” The nurse waved to a wall of shelves stacked neatly with folded scrub vests. Pink, blue, some with moons and stars. “Find one that fits, and just tie it in the front. You can put your things in a locker outside. No purses. Keep your locker key with you.”

Iva followed instructions. She chose a royal blue vest, a small locker. She put her purse, her blouse, and her bra inside, then pulled the key out of its lock and stretched its spiral lanyard around her left wrist. Her breasts flopped and swung as she walked to the waiting area. They felt soft, full. She pushed her arms against them to hold them in place, feel their warmth.

She waited. A tall woman in a pencil skirt led her into a white corner room and gave her a 3-D mammogram. The 3-D machine was fancier and cleaner than the one she’d danced with at the dingy clinic.

“We might let you go after this,” said the 3-D woman. “Or they might call you back. Depends on what we find.”

Iva waited. They called her back.

Ultrasound. A sage room. Warm and quiet. The sonographer wore pink scrubs and had a name tag. Mei. Thin face, a perfect sheaf of dark hair. She sat quietly with her hands in her lap.

“Just lie down. They’ll be here soon to explain everything,” said Mei.

Another woman arrived, then another. A fourth.

“Is all of this for me?” asked Iva Jo. “Y’all are making a fuss.”

Everyone chuckled. “I’m Pam, and this is Janelle, and that’s Maria. We’re gonna walk you through your biopsy, Miss Iva. You ready?”

Mei would find the lump on the ultrasound.

Janelle would perform a needle biopsy on the lump.

Pam would watch over everything. The needle would hurt.

Maria would hold Iva’s hand and help whoever needed assistance. A doctor would look at the ultrasound, a lab would test the biopsy sample. Iva would know soon, in a few days at most, whether it was cancer.

Hank couldn’t be with her. No men. Not even the doctor. Not for this part.

The room was dim and cozy. Iva lay on a soft exam table covered in gray blankets and tried not to cry. Maria surrounded her with pillows and dimmed the lights even lower.

“When it’s all over, I’ll give you this,” said Pam, producing a small pink disc encased in gauze. “It’s a little ice pack. We’ll put it on the spot where the needle goes in.” Pam scrunched her nose and smiled. “I think it feels good. Nice and cool. You can keep it.”

Maria put a foam block under Iva’s shoulder and positioned her for the ultrasound. She untied the royal blue vest and pulled Iva’s hand over her head, then stood behind her. Maria rubbed Iva’s hand and forearm. Mei squirted warm goo on Iva’s exposed breast and started looking for the lump.

“Will I be all right?” Iva said.

She settled her neck into her pillow. She didn’t know what to do with her free hand, so she reached for her thigh, pulled at the pocket on her jeans. The ultrasound wand coasted around in the goo, beeping and looking.

Maria asked, “Are you cold? We’ve got extra socks.”

“No thank you,” said Iva. “Just don’t let me get too hot. Might pass out. That’s what started all this.”

The wand glided to the side of Iva’s breast.

“Uh-oh,” said Pam. “Do you have a history of fainting?” She leaned over to look at Iva’s chart. “Did we know that?”

She sighed and told the story of Margie’s pottery lecture. Of the Russian girl. The tablecloth, the bowl. Meanwhile, Mei found the lump, and she and Janelle worked in tandem, cleaned her, marked a spot. As iodine sighed across her skin, Iva stared at the foam tile ceiling and felt herself sinking into the blankets, the pillows, into the goo.

“And I just…” said Iva. “I never understood. All that bleeding. There was so much.”

Pam laughed softly. “I hate it when that happens.”

Maria squeezed Iva Jo’s fingers. “Yeah, I’ve had that, too. The Flood.”

She tilted her head back to look at the women behind her. “It happened to you?”

“A couple times, right before I hit menopause,” said Pam. “Nobody tells you about that part.” She shrugged and smiled.

And that was all. Pam’s lips were full, and her hair was coarse and unruly. From Iva’s upside-down vantage point, everyone looked so plump and full in their pink and purple scrubs. They looked like berries. She thought about the Russian girl, her impossible ponytail, her impossible bright skin, her pouty lips. So I bled, thought Iva Jo. It happens.

“Pam?” she said.

“Yes, ma’am?”

“I used to work at Twitchell,” said Iva. “A long time ago.” Another cold wash of iodine doused her breast. She winced.

“Oh,” said Pam. She whispered to Mei, “Is that the petrochemical place over the mountain?”

Mei nodded and lowered her head.

“It was only a few years,” said Iva. “I quit when I met Hank. Then I was a secretary.”

“All right, honey,” said Maria. “All right.”

“Do you see a lot of patients who worked there?” asked Iva.

“A fair number,” said Pam.

“It was good money,” said Iva. “I don’t tell people. Our town’s pretty divided about it.”

“Here comes the needle,” said Janelle.

Maria squeezed Iva Jo’s hand. “You might not even feel it. Some of us don’t.”

The pillows around Iva Jo felt thick and lush. She did not think of cancer, or of those years at Twitchell, distant years full of acrid smells and thin, clanging doors, or anything but the moment as it was.

Iva turned her head away so she wouldn’t see the needle going in. A dull, distant bite pinched somewhere deep in her chest. Someone patted her shoulder, every woman hushed, and together, all together, they took a breath.

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