Four years ago today I was diagnosed with cancer. What did that mean to me then? I don’t know now that I am so far away, across an ocean in many ways, from where I stood on that day. On that day, I nodded and cried.

“You’ll only have one shot at this,” Dr. Edmunds implored. His oral surgery office sat up on the bank overlooking High Street, the same office where I’d had my wisdom teeth out more than three decades earlier. I hadn’t been into this office in between except to have the biopsy performed two weeks earlier.

“Go to Boston if you can. Go someplace where they can do the scans themselves. Don’t get a scan at one place and leave with a disc to take to another place.” But that is exactly what my insurance would require me to do. They would not pay for any scans conducted in Boston or ordered by my oncologist. I thanked Dr. Edmunds for his caring. I could see it was difficult for him to give me this news, that he’d hoped it had been something different, maybe an autoimmune condition like he’d mentioned at our first visit in the Northampton office. “This may be two different things,” he’d said then. But now his voice was urgent. He wanted to make sure that I switched gears quickly and gave it my best shot. Forget about my clients, forget about my daughter’s school fundraiser and my son’s SAT prep. Forget about all the favors and support for friends I emitted like air from my lungs. Forget about every other priority and focus on one thing, staying alive.

There were 21 days between my diagnosis and my surgery. When I first called the surgeon Dr. Edmunds had recommended I was told it would be five weeks to get in, however while I was on the phone an appointment for the next day became available. I took it. I just needed a referral from primary care. I called and got through, lucky because this was one of their half-days and it was almost noon. The nurse told me they couldn’t write me a referral since I hadn’t been in to see them for cancer. I informed her that I had come in more than six months earlier, on March 22nd. I remembered because it was the day after my birthday. She reviewed the note.

“Oh here it is. Patient is concerned about oral cancer. Dentist is unconcerned,” she read into the phone.

I got the referral.

The next day I went to Boston. My surgery was scheduled for the following month but moved up twice, bumping other patients whose diagnoses were not life-threatening, not cancer. Each day my tongue surveyed the tumor’s growth, feeling it spread across the roof of my mouth. They didn’t want it to cross the midline. Every millimeter meant more of the jaw and palate devoured and subsequently more teeth lost. I remember running my tongue over the tumor and trying to wrap my mind around a surgery they had told me was too complicated to explain.

I couldn’t see from there to here anymore than I can stand on the shores of New England and gaze across the Atlantic to take in the old world. I had a dream the night before my final pre-op visit. In the dream I was an old woman. I was in my seventies rather than forty-nine. Everyone else had stayed the same age, only I had grown older. In my waking hours I cried. I understood. I would be changed, unable to return to that version of myself. Me as I knew me would be lost at sea and this weathered, weakened, aged version would emerge on a distant coast, tasked with finding her way back home.

I was mostly unafraid of dying on the table, something my mother always worried about. I’m glad she wasn’t with me in the pre-op appointment to hear the lengthy list of things that could go wrong. The list I signed in acknowledgement was at least three pages. I might lose my eyesight or my hand, might have paralysis of my face, loss of feeling in my hand, my arm or my neck. I might lose my hearing in one ear. It went on.

The one that really struck me was that they might have to cut my face in half from the top of my head to the bottom of my chin. They went over this in detail because without knowing the size or position of the cancer they couldn’t know ahead of surgery if they would be able to get it through my open neck and mouth. In retrospect, I feel strongly they should have pushed for a PET scan. If they did cut through the midline of my face, they would cut in a zigzag pattern, because that would make it easier to reattach everything. They explained that it would be easier to lift the two sides of my face off and then put them back together. This made sense from my experience of carving pumpkins. I wouldn’t carve a pumpkin that year. I would be in the ICU recovering from surgery until the second week of November.

So much was lost, but not the gem, the true bounty, the bulk of what we all had our eyes on, our hearts throbbing for. Life. My life. All of the losses, my jaw and teeth, my appearance, my enunciation. These make the confetti chopped and tossed in the celebration. I see myself walking through it, that confetti falling like rain, catching in my hair, highlighting my asymmetrical smile.

“Do you miss the teeth?” a new dentist, a prosthodontist, asked me this morning. It wasn’t until a few hours before the appointment that I realized I had scheduled the appointment for the anniversary of my cancer diagnosis. This was not really where I wanted to be on this day, but it was the time slot they had open. And it was fine.

I know they ask if I miss the teeth to see if I would like some sort of device fashioned, however it always strikes me as odd. I miss my jaw and to some degree my lymph nodes. I miss my departed salivary gland like a lost family member. They took some scalenes and a hunk of my sternocleidomastoid. They detached one point of the temporalis and took the hyoid bone. I had to relearn how to move my chin from side to side by practicing in a mirror. I practiced lots of things in a mirror and now I think it is all pretty subtle, at least to those on the outside of my skin. For me, it’s all still noticeable and it adds up to the version of me I saw in the dream, older, different.

Things change. That’s what my uncle said to me at my aunt’s funeral. That was before cancer when I was that younger me. I felt foolish crying in front of him. He had lost his wife. She was only my aunt. “Things change,” he said. How could he be so calm? That’s what it’s like to be younger and not know.

Even now there is so much I don’t know and you don’t know. What would it be like to think of this not knowing as youth? As innocence? Oh, how we might like to hold fast to the taut skin, rosy cheeks and wide eyes of not knowing. A tiny rescue in the sea of loss.