he who knows nose

by: Tara Ruttenberg

i’m back again, this time with more conviction. “let me be guided to the right decision today,” i shared silently with the cosmos, my intention clear as the elevator reached the seventh floor. they were surprised to see me as i slid open the glass door; the empty office awash in dust and fresh paint. “can we help you?” they questioned, not sure what to make of me with my sandals, feather earring and unkempt sun-bleached hair, looking like i stepped out of a parallel universe. i tilted my head to the side, confused. “yes, I have an appointment with Dr. A at 11:00am?” i’m unsure myself now – am i at the right place? did i get the day wrong? that must be it; the appointment was for tomorrow and i was a day early – now it makes sense. “oh yes, Ms. Ruttenberg, i remember, the one with the broken nose who now has insurance… yes yes, right this way.” Dr. A jumps up from his relaxed position in the formerly elegant reception area and, noticeably embarrassed, leads me through the door. “tranquilo,” i assure him. it’s no big deal he spaced on my appointment, i was just glad he was actually there and willing to see me.


dozens of framed certificates of achievement that once adorned the bare walls now crowded the desk as i sat opposite him in the newly expanded office; they’re renovating and it’s apparently taking longer than expected. he begins writing my name on a blank piece of paper in frantic script, seemingly quite eager to get this done and me out of there. “you live at the beach, right?” i pause. that should be an easy one, but truth is i’m not sure how to respond, since quite frankly i don’t really live anywhere at the moment. i had spent the past few days helping my parents at AmaTierra, and before that i was on the road surf-tour guiding along the Guanacaste coast, and before that i was visiting my sister and meeting her new baby in Connecticut and traipsing through the snow in Maine, and before that i was camping out dancing to the moon in the middle of nowhere, and before that i was at the beach in Jaco for a few weeks and even paid the friends i was crashing with what little rent i could afford, so maybe that qualifies as living at the beach... “yeah, I live in Jaco,” i said finally, not wanting to delve into the details; there was obviously no time for pleasantries. 


“so when do you want to do this?" he asked, "and is your insurance going to cover it?” slow down, Ace, i thought to myself, i just got here – don’t you want to ask me how i’m feeling or look at it first? wine and dine me a little bit? “well, that’s what I wanted to talk to you about," i'm apparently equally all business now. "the only way I can do it is if insurance covers it. i broke it on November 7 and didn’t get insurance until November 29, and now it’s late March and i need the insurance company to pay for it if i’m going to even consider it at all.” As i spoke, fresh doubts grew in my headspace. i hadn’t yet convinced myself that this was the right thing to do. i made the appointment on a whim since i would be in the neighborhood, and really, over the past few months i had already decided i wasn’t going to do it, and that i was okay with having a twisty nose forever and always. if i get it fixed, then it will just be a liability and chances are i’d break it again some other time on some other crazy surf adventure in a foreign sea and have to go through the whole process again. and really, my friends assure me, it’s not that bad. but after a week on the road eating a bunch of junk i felt flabby and my skin was a wreck and i was feeling generally not so great about myself, and you know what? maybe I don’t want a crooked nose for the rest of my life. is that so wrong? does that make me inexcusably vain or just a little bit normal? 


i took self-photos in the mirror from every angle and uploaded them to Microsoft Paint, using the drawing tool to rudimentarily shave the bump off my profile, trying to get an idea of what i might look like following surgery; my homemade “after” pic. i showed my mom and she thought it looked pretty good. satisfied, i thought, why not? It’s just an appointment, let’s see what he has to say, and if insurance will cover it maybe i’ll go for it. i have the time now before I fly to New York to present on capitalism, commodities and culture at that grad student conference, and it would heal in time for me to still surf Negra and Witch’s Rock in May when I’ll be tour guiding another surf course. the timing’s perfect, especially since Dr. A assured me last time i was there that it would only be swollen for a week. i could do that.


“but we can’t lie,” he said, still scribbling notes on the page. “if they find out i fabricated anything on the report, they’ll take away my license and i’ll never be able to practice again.” wait, really? are we on Grey’s Anatomy or is this the real world where doctors don’t care who pays them as long as they get paid. shit, now it’s never going to work. i start gathering my things ready to bolt. i was banking on an experienced plastic surgeon in his sixties knowing a thing or two about working the system, maybe fudging the dates a few weeks to help a patient out, not freaking out about committing serious insurance fraud. no dice, i start saying things like “oh of course, and i would never ask you to LIE; I completely respect your ethics as a medical professional and I don’t want to lie either, and it’s not a lie really, you see, for the past few weeks i’ve been getting these strange sinus headaches after I get out of the water and it’s just…”


“okay, here’s what we can do,” ah yes, there he is, work with me my brother. “go to the insurance office downstairs and explain your accident to them: you were at a New Year’s party and someone hit your nose and tweaked it a little bit and it started bleeding but you thought it was fine so you didn’t do anything about it at the time, but now a few months later you are having trouble breathing and i, as your doctor, ordered x-rays since your septum is most likely broken…” i stop him mid-sentence, knowing his plan is foiled, but still very impressed with his creativity: “when you looked at the x-rays i got in Colombia the first time i was here you said my septum isn’t broken, so won’t they see that when they look at the x-ray report?” “oh,” he says, scratching his pen over the words ‘New Year’s party’. i reminded him that it was a surfing accident; we didn’t have to white-lie about how it happened, just about when. he writes me an order for a new set of x-rays, and changes his notes to include surfing in the description, assuring me that he’ll tell his secretary to erase my visit in November from record in case the insurance company checks into it. 'FIRST VISIT', he jots down at the top of his barely legible page with my name on it.


he’s already standing up ready to usher me out. i remember this from last time and knew i’d have to get feisty to have him answer some actual questions about the invasive procedure i was considering subjecting myself to, let alone look at or touch my nose before i went under the knife anesthetized in a few days’ time. “could you tell me a little bit about the surgery, like what you would be doing to my nose?” “oh yes, i’d break your nose to make it straight again, remove that bump from there and lift the tip a little bit”. oh god, anything but the tip. that’s what I was afraid of, an upward sloping nose tip, my worst nightmare. you might as well take my entire Eastern European Jewish identity, chop me up, mush my pieces together and put me in a cookie-cutter mold, give me blond hair and blue eyes and call me Christie. “do you really have to lift the tip? like what i really want is just my old nose back, like what it looked like before i broke it, pretty much the same nose, just straight again.” he didn’t know what to do with me. “you mean you still want that bump?” yes, i still want the fucking bump, i want the same nose i had before my surfboard smashed it into a million pieces in the middle of the Pacific ocean a three hour boat ride away from anything resembling civilization, buckets of blood and a fountain of tears pouring down my face.


now he’s showing me his sales catalogue: binders full of noses showcasing his work over the years. “see, look at her witch nose before and how beautiful she looks afterwards. they used to to call her a witch! she has beautiful eyes, but before surgery all anyone could look at was that horrific nose. this is what we would do with your nose, just remove that bump and lift the tip, just a millimeter; see how much better that looks now?” in some of the cases, i agreed with him and the women did look better and brighter in their after photos. But for some of them, i just felt sad that they would go through such a painful process to try and look a little more like what society tells us is beautiful, shaving off their bumps that once gave them character and told a story about their heritage and ethnic identity, trading them in for the image of cultural homogenization that we call 'pretty'. 


i think that’s why this whole process of considering fixing my nose has freaked me out so much. when you have what’s considered an ‘ethnic’ nose, it takes on a personality of its own and becomes such a part of who you are that thinking about changing it becomes an identity crisis. you’ve most likely experienced an evolving lifelong relationship with your nose: first you hate it because it’s huge and the girls in the fashion magazines all have cute button noses and you wish you looked more like that and you start plotting with your girlfriends about getting drunk and smashing your nose with a frying pan so it looks like an accident and then you’d have to get it fixed; then a few years later you learn to accept that, yeah, you might have a giant schnoz, but you’re still a beautiful person in spite of it, especially since true beauty is on the inside, right?; and then finally, into your twenties, you look in the mirror and you actually feel beautiful because now you’re proud of your big Jewish nose because it makes you different and you actually celebrate it because it connects you to your ancestors and all of that history, and to think about changing that would mean losing that connection; in essence, losing a big part of yourself.  


i’m fighting tears again as he flips through the pages of noses, continuing his sales pitch on where he was educated and how he has forty years’ experience and was the director of plastic surgery at the fancy private hospital, as if all that is going to make me feel better about shedding a piece of who i am. i know he’s the best for the job, which is why i came back; if i’m actually going to do this, of course i want the best. but i’m also reminded of why i ran out of there the first time; the whole business transaction feel of a salesman surgeon selling perfect little noses to whomever will pay for them. and after i had called him months ago to tell him i was going to wait and think about it more, his response still lingers in my ears: “if you were my daughter, i would tell you to do it right away; now you’re going to have a crooked little nose that’s harder to fix later.” “thanks for your medical opinion,” i had said, feeling the whip of his words in the pit of my stomach as I hung up. crooked little nose.


“but, you know, it’s your decision,” he says, playing a little reverse 'i don't need you' psychology on me. “think about it and let me know. you know you will look better afterwards with a straight nose, so if you decide to do it, give me a call and we can schedule it for early next week before i leave for Semana Santa.” i thank him for his time and book the procedure tentatively for this upcoming Tuesday, of course pending insurance approval and my committed change of heart. “we’ll be in touch,” Dr. A’s secretary says, smiling; the “don’t call us, we’ll call you” of the plastic surgery industry. 


i fill out the required paperwork and get the x-ray report the insurance company needs to be sure my surgery isn’t just cosmetic, in which case they wouldn’t have to cover it. “so what if you’re in an accident and you chop off your ear somehow? insurance doesn't cover that because your eardrum still works fine without the fleshy part of your ear?” i ask the pubescent insurance rep in the hospital lobby. “i know, it’s a strange policy,” he responds emotionless; it’s not his first time hearing a commentary like that from a smartass like me. i figure the traces of fracture from four months ago would appear all but healed on today’s x-ray, so insurance paying for it was going to be a total longshot. they’d decide it was an elective procedure for cosmetic purposes only and put it in the ‘no’ pile. my crooked bump was safe; i exhaled relief as i walked out the automatic doors into the parking lot.


i hadn't paid much mind to the words on the x-ray report before leaving the hospital since my Spanish vocab doesn’t yet include technical medical terminology. when I got home later that evening, i typed the short paragraph into google translate and gazed in shock at the words on the screen:


Observed deviated septum to the left, along with right inferior turbinate hypertrophy; evident traces of fracture lines in the nasal bones at the middle third section, drawing attention to the loss of bone density at the distal end of the fracture. Moderate depression of bone structure. No soft tissue augmentation observed.  


DEVIATED SEPTUM TO THE LEFT?!? WHAT!? i’m no MD but i’m pretty sure that’s a medical issue requiring a medical procedure to correct. i stare eyes-wide into digital nowhereland and trace my displaced nasal bones between my thumb and index finger. shit. does this mean it's bye-bye bump forever?