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Fear and Trembling on the Tip of Your Tongue

ISSUE:  Winter 2019

Illustration by Kate Lacour

Who looks in your mouth? Nobody. That cozy little cavern is designed for darkness and privacy. When the mouth is open, we glimpse occasional bits of action in what is technically called the vestibule, and are struck by the intimacy of what we have seen. Hence the wonderful passage by Vladimir Nabokov in which one character glances at his companion and notes “her tense tongue in the red penumbra of her mouth and the flash of her teeth before her hand shot up to her mouth to stop her soul from escaping.” Perhaps the mouth is the seat of the soul. It is in any case the antechamber to the interior and largely hidden. The lips, with their hint of marzipan puffiness, are an exception. We forget that they are simply a continuation of what is inside: a pinkish membrane that functions as a protective lining and lawn sprinkler. The lips are a tiny demonstration of how it would feel to be turned inside out.

Actually, there is somebody who looks in your mouth. That person is the dentist—the professional who makes almost everybody afraid, possibly because he looks where he’s not supposed to. Earlier this year, my dentist was completing his examination. My teeth were fine, he told me, but he was alarmed by two white sores on the right side of my tongue. He poked the sores with a rubber-gloved fingertip. He took pictures, all of them brightly lit and gory-looking, as if he were the Weegee of dental photography.

“I think you better get that biopsied immediately,” he said. 

“Why?” I didn’t like the direction of this conversation. “What’s wrong?”

My dentist is a studious man. He explained that when it came to cells, stasis was a good thing. What we didn’t want was cells that morphed, mutated, moved around. Essentially, change was the enemy, and the cells on the right side of my tongue were changing. That was alarming. His concern was oral cancer. 

I felt a chill. Not metaphorically—no, an actual sensation of cold passed through my body, perhaps a premonitory shiver at the thought of being dead. I had no reason to assume I was dying, of course. Oral cancer is not necessarily fatal, and I wasn’t even in the primary risk group, which consists of males who smoke heavily or chew tobacco. But the chill persisted as my dentist led me to the front desk and booked me an appointment with an oral surgeon.

Now I had two days to worry. Two days to learn about what cancer does to the mouth. The images on my laptop were awful, the tormented flesh a kind of antipornography. I was frightened. But I was disturbed, too, to think that my tongue was the culprit. The tongue is the instrument of speech, of taste, of sexual pleasure, its pulsing papillae the bearers of so many happy sensations. It is the great enabler of experience. It is, too, one of the very few muscles not anchored at both ends—a flouter of mechanical principles, a free spirit that sometimes seems like a separate being. Perhaps it’s the tongue that is the seat of the soul. 

On the appointed day, I met my girlfriend, Nina, at the surgeon’s office on Park Avenue. He turned out to be a big, bluff, life-affirming sort of guy named Lustman. He invited me to sit in the exam chair, with its hydraulic-powered backrest and aluminum-alloy frame. The chair was the center of attention, the room’s reason for being. He glanced at the email from my dentist, then asked me to open my mouth.

The moment had come. Doctor Lustman trained a bright light on my mouth, then bent over and peered inside, his eyes magnified by the spelunker’s goggles he was wearing. This was business as usual for him. The intimacy must have long since worn off—it was probably like glancing into a root cellar.

He asked his assistant to pull my tongue out, so he could study the sores at closer range. She did so, and nobody took note of the slight Looney Tunes vibe, the tongue extended like a window shade. “That doesn’t look very sinister to me,” he said. 

“Wonderful,” I said.

“But we better take it off. I still want a biopsy.”

This had to be good news. He had peered into so many mouths, seen so much oral-cavity carnage—if he thought I had cancer, he would tell me. When I asked what was causing the sores, though, he hedged. “I can tell you one thing,” he said. “Your tongue is too big for your mouth.”

I wasn’t sure how to take this. I had always thought my tongue was the right size: It fit in my mouth, after all. I couldn’t tell if his statement was a diagnosis or simply a scientific fun fact, the sort of thing you might find printed on the inside of a personalized Snapple cap. In any case, he didn’t elaborate. I felt an extraordinary awareness of my tongue—its fleshy amplitude and tragic confinement—as Doctor Lustman wheeled over his laser apparatus with its gleaming wand. 

As a first step, the assistant gave me a pair of pink glasses, either to shield my eyes from flying debris or to keep the laser from boring a hole in my head if Doctor Lustman sneezed. I winced as the doctor injected my tongue with an anesthetic, then left the room. Nina tried to cheer me up. “You’re being brave,” she said, to little avail. I remained a melancholy creature, sprawled on my fancy chair and regarding the world through rose-colored spectacles. The numbness crept across my mouth. I prayed for a total cessation of feeling, scolded myself for being afraid, grew drowsy, and suddenly Doctor Lustman and his faithful assistant were back. Nina made a hasty exit as they began firing up the laser.

It was noisy. It was bright. I kept my eyes closed, for the most part, while the assistant yanked on an interesting length of tissue that seemed to belong to another person. What I smelled, after a while, was burning flesh. Of course it was burning: The doctor was cutting off a strip of my tongue, about a centimeter long, with a concentrated beam of light.

“I bet you’re hungry for barbecue,” he said. This must have been a standard bit of levity, saved for the moment when the patient began turning white. I tried to laugh.

Now the sound-and-light show ended. Examining his handiwork, Doctor Lustman told me he was going to stitch up my tongue. This was another procedure I didn’t want to visualize: I kept my eyes screwed shut while he fiddled with the needle and thread. Then it was over. The doctor left the room, the assistant packed the right side of my mouth with gauze. She said: “Want to see it?”

“Why not?” I said, through a mouthful of gauze and blood.

She showed me a tiny vial, with the tissue floating in some kind of preservative. There went the bad cells, the ones that insisted on changing. It didn’t look like a piece of my tongue, let alone a fragment of the soul’s dwelling. It certainly didn’t look like something that could kill me. “Say goodbye to your old friend,” she said.

There is a long history of the tongue as an indicator of general health. This accounts for the custom of sticking out your tongue at the doctor’s office, which has been going on for centuries. Yet a handful of Victorian medical men went a step further, arguing that the tongue was a kind of diagnostic Rosetta Stone, allowing you to decode all the body’s ills. 

One of these doctors, Benjamin Ridge, called the tongue a “map of the empire of disease.” Ridge was a Member of the Royal College of Surgeons who outlined his theory in a book called Glossology, first published in 1844. He apparently felt himself embattled. In the preface, Ridge recalls sharing his theories with a fellow physician, who soon after advised him to give up his “new-fangled notions, as they were erroneous and speculative, without a shadow of truth or usefulness in them.” Undaunted, Ridge pressed on, arguing that each section of the tongue testified to the health of a particular physiological system. How, for example, could an organ so intimately related to speech not tell us something important about the other relevant organs? If the tongue “is in such close spiritual connexion with the lungs and brain,” he wrote, “it must have a more palpable material union with those parts.”

It was the material union that fascinated Ridge. He was arguing that the tongue was literally one with the body. It was the ultimate oracle of being, its intelligence gathered from a network of nerves, muscles, and blood vessels. It could tell you everything. This is, of course, a very mechanistic view of the body. It suggests an artifact of the Industrial Age—and indeed, in 1855, Ridge and a fellow tinkerer were granted a patent for improving the operation of steam boilers. 

Ridge’s theory of lingual supremacy failed to enter the mainstream. Yet he never abandoned it. Almost twenty years after the appearance of Glossology, he published another book, Ourselves, Our Food, and Our Physic, in which he took to the warpath again. This volume was nominally a self-help manual. Ridge promised to identify the habits that led to ill health and offer “direct hygienic remedies and diet.” But he returned to his argument that the tongue was the ultimate diagnostic tool and clearinghouse for the entire body. “No books on medicine or physiology, or anything ever taught in the schools,” he lamented, “have ever noticed or pointed out these great laws.” The failure to heed his wisdom, Ridge suggested, would be a catastrophe for public health. Nobody listened. When he died, his obituary in an obscure medical journal noted little aside from his authorship of Glossology and some confusion as to where exactly he had obtained his medical degree.

Yet here I was, more than a century later, something of a confirmed glossologist. I, too, was waiting for my tongue to tell me everything—to settle my fate. I returned home from the surgery in a cab with Nina. A fresh roll of gauze had been stuffed into my mouth. The anesthetic was still working its wonders, so there was no pain. I felt suave and rejuvenated as I stepped out of the cab and greeted the doorman. The plan was for me to stay in bed and recover.

Eventually I did feel some pain. For that there was Percocet. I had also been advised to avoid sharp, crunchy, spicy foods of any kind. For that there was applesauce and Jell-O, which made me feel like a senior citizen. I had no doubt that the hole in my tongue would heal. The mouth is remarkably adept at damage control, the saliva itself boasting a miracle compound called histatin, which speeds up the closure of lacerations. That’s right: Licking your wounds is not merely a cliché but a sensible form of self-care. Yet I was still anxious about the biopsy, which would take a few days to process. I sensed a kind of psychic dishevelment, a deeper disturbance, in no way proportionate to the tiny sliver of tissue floating in the vial.

The fact was that I had recently turned sixty. I had avoided that fact by fleeing with Nina to Mexico City, where I celebrated my birthday by eating ant eggs and powdered gold and something brought from the kitchen in a smoking glass vessel halfway between a bong and an alchemist’s retort. I pointedly declined the suggestion that we visit the ruins at Teotihuacán that same day. The symbolism bothered me. We went the day after, and the symbolism still bothered me. Nobody knew exactly who had built the wide boulevards, the colorful colonnades, the two giant pyramids, at whose summits we found a noisy crowd eating Pringles and taking selfies. Back and forth we strolled on the Avenue of the Dead, which felt endless. The place was a monument to oblivion—to forgetting, and to being forgotten—and it made me feel almost as old as the surgical gash in my tongue was now making me feel.

I didn’t want to see the Frankenstein-style stitches. I made myself look in the mirror: not bad. I gargled saltwater religiously, as I had been advised, and kept up my diet of pablum. One day passed, and then another, and another, and I heard nothing about the biopsy. I wasn’t supposed to worry. Doctor Lustman had pronounced his magical incantation, he saw nothing sinister, I would be fine. No news was not bad news. But anxiety, fear, depression—they delight in a vacuum. I was coping with all three by the time I flew to California, a week after the surgery.

California is where nothing changes. There are no seasons, no meaningful cycle of frost and heat, death and resurrection, only the beautiful sunshine. Everything is perpetual: the golden light, the sweet scent of jasmine, even the sea otters reclining like pashas on their beds of golden kelp.

This is, I know, an Easterner’s fantasia. Just five months earlier, in fact, large portions of the state had been on fire. Yet I felt that fantasia strongly as the plane banked over Sacramento, surrounded by its crazy geometry of cultivation: rice, tomatoes, almonds, mandarins, everything in abundance. My friend Dave picked me up at the airport and we set off for his house in Davis. Above us was the California sky, impressively blue and vertical and somehow belittling of what lay beneath it: The low buildings and packed dirt and bustling humans were reduced to footnotes. Also, there was the Grateful Dead on the car stereo, a concert from 1989, when Jerry Garcia still walked the Earth.

I had known Dave since college. He seemed, as we nodded our heads to a dawdling version of “Sugaree,” to be in excellent shape. He was tanned, hairy-armed, handsomely bearded. I was struck by his vigor; a few of my other contemporaries weren’t faring so well. There were aches, pains, elective procedures. An old friend had experienced a minor stroke shortly before my tongue surgery. He was supposed to recover completely—indeed, he had never struck me as impaired in any way. Still, he worried that something had been lost, that he was limping along with a kind of ghostly deficit that he couldn’t even describe.

But Dave was thriving, and that was good. He was an advertisement for immortality. “I cut all red meat out of my diet,” he told me. In his Prius with its powerful sound system, we made swift progress from Sacramento to Davis. The two poodles greeted us ecstatically at the door. His wife, Pam, showed me to the guest room, whose walls were painted pink. “That might have been a mistake,” she said. “It looks like the inside of an organ.” She didn’t specify which organ, but I immediately thought of the mouth.

Dave and Pam knew about the biopsy. They knew that a pathologist was bent over a faraway microscope at that very moment, determining my fate. They encouraged me to relax, and I did. In the mornings I walked the dogs with Dave, identifying with the older of the two, who had Addison’s disease (“Just like JFK”) and a deliberate manner. We watched TV, strolled around downtown Davis, visited the dispensary.

One night the three of us drove to a Mexican restaurant, getting lost amid the alien corn and irrigation canals. There were two different GPS systems going and they disagreed about how we should get there. So did Dave and Pam. What followed was some low-level conjugal friction plus the Greek chorus of robot voices fighting over the appropriate exit. We eventually arrived, ordered food and drinks, and took up the issue of God’s existence.

“There’s something,” Pam said. “Not God, not an old man with a beard, but a mysterious force of some kind.” She had a pink drink and it was clearly taking the edge off after our tense drive. 

“I recognize that the universe is mysterious,” I said. “So I kind of agree.”

Dave had no use for a conventional God, or for gods in general. He was agnostic. Pam was a lapsed Catholic, for that matter, but she couldn’t quite shut the door on the uncanny, the inexplicable. Neither could I. At certain moments I was confident that something was being communicated to me—not words but feelings, sensations, a slant of light or a phantom touch on the skin. For these things there was no glossary.

The food arrived and at once my tongue began to hurt. The wound, whose stitches had finally dissolved, felt like it was lighting up inside my mouth.

“Shit,” I said. “I was supposed to avoid spicy food.”

“Take out the peppers,” Dave said. “The seeds too. Little bastards.”

We drove home in the dark. “Terrapin Station” was on the stereo. There was some talk about Burning Man, where Pam and Dave went every year, sometimes waiting forever in their camper to gain access to the scorched environs of the Black Rock Desert. “It was eight hours last time,” Dave said. The place made him ecstatic. It was an autonomous republic of dust, tie-dye, mushrooms, communal showers—where time seemed to stand still, where nobody was born and nobody died. (Actually, a man was found dead in his truck during the 2018 event, but that was a fluke.) 

The drive back was faster. There was less traffic, and no lofty sky to make you feel awed and insignificant. The cloud cover hid the stars—something vague was up there, but who knew what?

It was now Saturday, nine days since the biopsy. Life-and-death information was seldom communicated on the weekend. Back at the house, I retreated to my pink room and got in bed. The lights were out. I recalled that many years before, one of my relatives had discovered a lump in her breast. It was malignant, and instantly removed, but she had undergone radiation therapy, and I joined her one day in the treatment room. It was dark. The bright red crisscrossing rays sought out and found their target. I said some comforting words, but we didn’t talk much, not wanting to mess with the magic in the room, which killed one thing and spared another. 

The next day was a big day. As undergraduates, Dave and I had played together in a band, which in our collegiate waggishness we called Wealth of Nations. That was the name of Dave’s current band, too, and he had excitedly informed them that the original lead guitarist was in town. I felt like a woolly mammoth released from the ice—like something resurrected. They came over on Sunday night and we set up in the garage. With its posters and Vox amps and colored lights, it was a consummate man cave. Also a time capsule: The objects, the artifacts, the songs we played dated from several decades before. We were breathing the air of 1972. The only thing that had aged was us.

We were all in our sixties. Several of us looked like God: an old man with a beard. There was a civic planner, an ER doctor, two college professors, a therapist. Of course we resembled a Viagra commercial, making a big, virile noise and hopping around on one foot. Well, I didn’t hop around. I sat on a low stool with a borrowed guitar and tried to keep up, because I was out of practice. 

What did we play? There was “Willin’” and “One Way Out” and “The Word” and “Shakedown Street” and one of those Grateful Dead numbers with so many chords and bridges and harmonic cul-de-sacs that I stopped playing for a minute and looked at my fingers, which were developing blisters. It was loud in the garage. The poodles were listening. I couldn’t figure out whether the experience was making me feel young or old. I was doing almost exactly what I had done in college—when I was a slimmer, shaggier, more innocent version of myself, whose very atoms had been replaced so many times by now that he should have been a virtual stranger to me. Yet we were the same. I was playing the identical phrases, the bluesy licks and sweet-tempered runs up and down the major scale. I had learned nothing. Nothing would ever change.

I departed a day later. The layover was in Salt Lake City, and I steeled myself to call Doctor Lustman. It had been eleven days since the biopsy. There was no reason to hide bad news from a patient, but the silence seemed glaring. How hard could it be to examine my cells and note the telltale signs, the irregular shapes and the dark, DNA-crammed nuclei?

The airport was bright, spacious, with views of the snow-dusted Wasatch Range in the distance, a better place to learn your fate than the claustrophobic terminals in New York City. I sat down in the food court. All around me were human beings, the sleek and the slovenly, the tall and the dumpy, the angry introvert and the compulsive smiler. They were in transit. Their relationship to me was accidental. I dialed Lustman’s number and waited.

The receptionist answered. I explained my mission and was put on hold. No smooth jazz, no Vivaldi, just silence. As I waited in my plastic chair, everything echoed in the atrium of the food court and I was frightened again. The last call came for one flight or another: Houston, Miami.

“I’m sorry,” Doctor Lustman said, getting on the line. “I just came back from vacation. Meant to call you earlier.”

“Thank you,” I said.

“The news is good,” he said. “What we wanted to hear. No cancer.”

“So what is it?” I was suddenly suspicious of good news. “If it’s not cancer.”

“Lichen planus,” he said. “It’s on the inside of your cheeks, too. Nothing to worry about. I can give you an ointment if it ever bothers you again.”

This minor inflammatory disorder had been mentioned by my dentist, then forgotten—at least by me—once the scarier outcomes were raised. The name comes from the lacy striations it sometimes leaves on the inside of the cheeks, which resemble lichens. Well, that sounded less forbidding, didn’t it? Doctor Lustman added that it was noncontagious and often asymptomatic: In other words, you might not even know you had it.

“Thank you,” I said again. I sent Nina a euphoric text. I felt as if I had just been turned inside out, but in a good way. I studied my fellow travelers—such a beautiful phrase—and found them extraordinary, like Yeats with his book and visionary teacup, convinced that he “was blessed and could bless.” This was surely a form of love, oceanic and undiscriminating. Or gratitude. Or the suspension of dread, as the amygdala, the almond-shaped fear factory deep in the brain, started ratcheting down. I could feel it on my skin, and in my veins—as Yeats said, my body of a sudden blazed. It lasted twenty minutes for him. For me, it wore off quicker, and then I approached the Jetway, and was whisked over the mountains toward home.

There was a follow-up visit to Doctor Lustman a few days later. He looked in my mouth, with its secret garden of striations, and declared that I was healing nicely. My tongue was intact. It was still the imp of speech and love, of sweetness and swallowing, and I could stop worrying about the fragility of being.

Except that I couldn’t. Shortly after my return from California, one friend awakened in the night with chest pains and radiating discomfort in his shoulder and arm—classic signs of a heart attack, although he was soon diagnosed with atrial fibrillation and put to rights with a handful of pills. Another friend died, after fighting leukemia for almost a decade. He had bounced back from so many physiological trials and tribulations that we had come to regard him as indestructible, which was a soothing illusion: If he was, why not us?

All of this made me think of oblivion—of simply vanishing. It’s what we seem to do. Take Benjamin Ridge, the author of Glossology. He is little more than a scattering of facts. He was married to a woman named Eliza. He shared the cover of The Lancet with Sir Erasmus Wilson, who first described lichen planus, in 1848. He went bankrupt in 1856. He died in 1889, and what is most poignant about the obituary I mentioned earlier is this phrase: “All inquiries that have been initiated regarding Dr. Ridge’s antecedents have been fruitless.”

You might argue that the editorial staff of Medico-Chirurgical Transactions didn’t try hard enough: The man certainly had a mother, a father, a fugitive past. Yet the sad suggestion is there, that the poor doctor had been erased fore and aft, that he came from nowhere and proceeded to nothingness.

On the other hand, I read his book. I pored through old documents, looking for his paper trail. Most of all, I was stirred by his theories—by his sublime notion of the tongue, which has been shared by Chinese physicians for many centuries. In 1341, one such practitioner, Du Qingbi, wrote that sickness infiltrated the mouth by entering “the space which is half exterior, half interior.” So even then, the mouth was seen as a halfway house, a purgatorial palace. And the tongue was there to tell what you most urgently needed to know. Which was what? How many years were left to you? The inner workings of your heart? The state of the soul, that small, pale, vagrant thing whose address was unknown? There is so much we wish to be told. 


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