Long-Term Side Effects of Accutane
Greg Marshall

As soon as the tardy bell dinged, before we’d even pledged allegiance, the joyless gray TV at the back of Mrs. Frederickson’s seventh grade English class flickered on to reveal a logo, a “1” in typewriter font. It didn’t take a genius to see that Channel One—ostensibly a twelve-minute news program for teens—was just a way to smuggle ads into the classroom, a Trojan horse for M&Ms and Clearasil. But what a horse! While other kids furtively finished that day’s homework, I resisted the urge to mouth along with Krystal Greene, whose husky voice and pointy nails made her, in my eyes, if not a national institution then at least super famous. “Hey hey hey, coming at you on this April 9th, you know the drill. Let’s break it down, ya’ll.”

My family had words for my Broadcaster Voice, words like “grating” and “obnoxious.” What did they know? My flat delivery possessed an almost musical quality. This is Channel One News, I said at dinner. In the car. On the way anywhere. This is Channel One News. Channel One. One News. This is Channel One News.

You know the drill. Let’s break it down, ya’ll.

No matter what else was going on in our hectic house, I was speaking into an invisible camera, holding an invisible microphone, pinching one ear shut.

“My sources indicate dinner tonight will be tacos, Krystal.”

“Still no word on what Jessica is naming her new hamster.”

“Debi has apparently decided to dress like a blueberry today.”

What really separated Channel One from the regular news was the chance that I might be on it. For one week a year, Krystal and company surrendered their deep armchairs to teenagers from so-called Channel One schools across the country. One anchor, the baby-faced Tonoccus McClain, had started on Student Produced Week and then been offered a full-time job reading the news for Channel One. It was too much to hope I’d be hired as a thirteen-year-old, but Channel One also aired at Skyline High School, meaning that I had six chances to apply, six years to get myself ready. When Tonoccus looked into the camera at the end of a segment about Student Produced Week and said, “Maybe, just maybe, I’ll be seeing you,” I knew he was talking to me.

There was an obstacle to this dream from the very beginning: acne. My mom liked to say I had the voice and the talent to be on television. What she didn’t say was that I also had the zits that were sure to keep me off it, volcanic, cystic stuff on my chin, under my nose, and between my eyebrows. Some mornings, it wasn’t so bad. Others, it looked like I’d been assaulted with a BB gun. “You just never know, Gregor,” my brother said consolingly. His hair was pulled back in one of my mom’s headbands and he was dabbing cream onto his pimples. The bathroom we shared was piled with scrubs, pills, pads, and peels. “That’s what sucks about it.”

Everyone knew you couldn’t have acne and anchor the news. You couldn’t even do the weather. It pissed me off to think that something hereditary could keep me from making it, that I had to begin my life damaged. Tiffany and Danny had bad skin, but they were bad people. They needed to build character and lay off the Cinnamon Bears. A good kid, a kid who won leadership awards and walked with a limp, like I did, was supposed to be spared run-of-the-mill humiliation. There was enough wrong with me without worrying how I’d look on a given day.

I first remember hearing about Accutane from my older cousins at a family reunion. Accutane was a magic word that came sparkling off the tongue. It was only natural Tiffany would try to go on it. Being the oldest, she had wasted the most years on namby-pamby treatments like amoxicillin and Retin-A that now felt not hopeless but preliminary.

Mom and Dad were relatively lenient. They drew the line at letting their rebellious eldest daughter take a pill that could leave their grandchildren deformed. Because Accutane was known to cause birth defects, our dermatologist, Dr. Tull, insisted his female patients go on contraception, take pregnancy tests, and pledge chastity before he would sign off on treatment. If the illustrations in the brochures he sent home were to be believed, Accutane babies had no ears, little chins, and cone heads. Pharaohs they were, with snub noses and wide-set eyes that even a grandmother would have a hard time loving.

After passing the brochure around the dinner table, Mom tucked it beside her water glass, like a napkin, and said no, case closed. If Tiffany wanted a career in television, that was one thing, but Accutane was an unnecessary risk for a civilian.

“I am a VIRGIN,” Tiffany reminded us. “I am not having sex with anyone.”

“Let’s keep it that way,” Mom said.

Unspoken in this dinnertime back and forth was the fact that we thought of Tiffany as a druggy. We weren’t judging her for skateboarding. We were judging her for smoking pot out of crushed beer cans and sluffing school. And there was the time she dropped acid in eighth grade math. Told she was too sick to finish out the day, she came home and tripped in her room for a few hours before stumbling onto the driveway where Danny was practicing free throws. “You’re the devil!” she cried. “I can see your horns.”

It was a bender she never lived down. “If you think I’m raising some one-eyed freak with gills while you’re out dropping acid, then you’ve been dropping too much acid,” Mom told her.

“I thought it was gum,” Tiffany shrieked before scraping back her chair, stomping up the stairs, whooshing shut her French doors and blasting The Pharcyde. Poor cherry-faced Tiffany. Her room smelled like a kasbah from all the incense. She braided hemp on her wrists and tried to land kick flips in the middle of the street, and still she couldn’t get the neighbor boys to notice her. Compared to a lifetime of being invisible to guys, giving birth to a baby with gills didn’t sound half bad.

Because my brother couldn’t get pregnant, he had an easier time nabbing a prescription than my sister. I was a broken-out eighth grader when Danny started Accutane. At first I was jealous of him, and then flummoxed. The drug was supposed to make his acne worse before making it better, but it just made it worse. His back-ne remained severe, like a map of places he’d visited, each marked with a red pin. Rather than striding around shirtless, he shivered under a blue terrycloth robe, worn free-swinging over his lucky Amateur Athletic Union shorts and a Dream Team shirt washed to colorlessness. It was like he couldn’t put enough layers between himself and the world.

Accutane made Danny aggressive and irritable. The whole house rattled when he started chucking his textbooks around his room. It was like living with a gorilla for six months, always wondering which side of the banana tree he would wake up on and hoping his ailing back would slow him down just enough if he attacked. “He’s coming,” Mom would cry. “Flick the lights!”

My brother’s shoulders ached. His lips were bright and swollen, like he’d undergone a botched elective procedure, and blood poured from his nose anytime he exhaled. Glistening strands of yellow-green bile dribbled from his mouth into the kitchen sink after breakfast. Hissing when anyone turned on the lights, he stumbled around blindly when one of us turned them off. Photosensitivity was one side effect of Accutane, night blindness another.

Just when we thought we might have to board my brother at a zoo, his face cleared. I’m sure it didn’t happen overnight, but that’s how I remember it. A shaky sophomore year became a spectacular junior year. The fro he had been hiding behind fell to a haircutter’s clippers, and so did his terror of girls.

Danny started making funny videos that aired on Skyline’s weekly news show, and he went, in a matter of months, from being the founding member of the Never Been Kissed Club to having Kimmy Oppel, the most desired girl in school, give him mouth-to-mouth in a spoof lifeguarding video. Never mind that his lips were cracked at the corners. He was wearing a shit-eating grin.

“Now that you’re attractive, there’s no excuse for you not to go out there and get a girl pregnant,” Mom said when she saw the tape. She wasn’t joking. “I’m not joking. I’m dead serious. I want grandkids. Just make sure she’s not on Accutane. I don’t want any mutants.”

My brother and his friends lounged around the basement, squirting on lip gloss and itching like addicts. They talked up Accutane like it was a real drug, ecstasy or weed, and not something totally legal that might be picked up from Gordon at Holladay Pharmacy. I may not have been interested in girls, but one thing was apparent: Accutane was about more than attracting the opposite sex. It was key to transforming you into whatever you wanted to be. All I had to do was take a pill and my reports around the gazebo about male pattern baldness and red wine consumption, featuring my dad as my main subject, would be nationally televised.

If the decision were up to my mom, it would have been a no-brainer, but there was a dermatologist to persuade. Dr. Tull considered Accutane the nuclear option and prescribed it as a last resort, stringing you along with minocyclene and “topicals.” Before each appointment, I went at my face with a washcloth and blow dryer until it turned red and blistered, hoping to make my pimples bright enough that he might take pity on me. As an adult, I admire Dr. Tull’s medical restraint. At the time, I resented being forced to hit rock moaning-wastrel bottom. Quiet during appointments, I’d fume in the car afterward. “Moderate? Mom, does this look moderate to you?”

“Don’t pick at your face or it’ll scar,” Mom warned. “And then your life really will be over.”

The Clearasil ads on Channel One were beginning to feel like mockery. You couldn’t dab away the oil with an over-the-counter pad, and trying to cover a breakout with Band Aids only made things worse. An experiment with tinted acne cream in the ninth grade ended five minutes into Peer Leadership Team, my first period, when a popular kid asked if I was wearing makeup.

The only sane person in our house, my dad resisted the idea of me going on an optional medication that was known to cause erectile dysfunction and stunt growth. But how could I trust a man who had grown up washing his face with bar soap?

When Mom and I were on a rampage, Dad would fold his copy of the Tribune and set it on the kitchen table. “I don’t know, you guys. I don’t think your zits are that bad. Maybe you should just take it easy.” Almost in passing, he would mention an article he’d read about a teenager on Accutane who had killed himself. “They say it causes depression.”

“Accutane doesn’t cause depression,” Mom would snap. “Zits cause depression.”

A long battle with non-Hodgkin’s lymphoma and five hypochondriac kids had made Mom an expert at getting Z-Packs, Ambien, Valium, whatever she wanted, really. I’d seen her work a doctor enough times to know a breakdown was useless. Tell a guy like Dr. Tull you felt ugly and he’d blow you off with a compliment. You had to remain stoic, talk symptoms, not states of mind, make him see you as more than a patient, someone with a real future ahead of him.

“He wants to be a talk show host,” Mom said during my next appointment. My hamstrings tensed nervously and my knee jerked, like I was trying to gently dropkick her purse across the exam room. It could be dicey bringing up show business. You never knew how people were going to take it. “Wonderful, that’s just wonderful,” Dr. Tull said, lifting my bangs with his slender silver pen. “Like Jay Leno?”

“Ricki Lake,” Mom said. “He loves Ricki Lake.”

“I haven’t heard of him,” Dr. Tull confessed. Dropping my bangs, he nudged my jaw one way and then another, inspecting my blotched cheeks. “Look, you’re right on the edge. If Accutane is really something you want to try…”

“I think so,” I said, trying to sound reasonable.

Going on Accutane required weekly and then monthly blood work to ascertain that my cholesterol was not out of whack and that my liver wasn’t spelling out save me in enzymes. “Just make sure you don’t eat a Big Mac and fries before you come and see us, Ricki,” Tull advised, snapping off his blue Latex gloves.

From then on, at each visit a nurse tied me off and shoved a needle in my arm. Blood began to flow darkly into a plastic vile, skipping with my heart. I liked to pretend I was donating to the Red Cross. Once tested for triglycerides, these ounces would be pumped into a preemie, and I would be a hero.

The pills came in a booklet covered in no pregnancy warnings. For my daily dose, I had to punch through a tab that pictured the silhouette of a pregnant woman—a very pregnant woman—circled and X-ed out in red like you’d see on a No Smoking sign. It was like an advent calendar for teenagers, but instead of chocolate you got a taste of self-improvement. Years later, my brother admitted to masturbating to that silhouette, fantasizing about getting Kimmy Oppel pregnant.

The side effects started almost right away. Accutane lured out whiteheads and blackheads, nose zits and back zits and zits on my forehead. I could feel them coming on the night before, a premonition that made me cross myself and get out of bed to apply a layer of Cetaphil. My lips began to die on my face and, eventually, mummify. It was like wearing a dehydrated asshole to school every day.

“Like an asshole after a spicy meal,” my brother corrected as we played ping pong one afternoon. “I remember it literally feeling like my lips were going to burn off. I wanted to rip my lips off my face because that seemed less painful than the pain of not having ChapStick.”

The thought was enough to make me reapply.

I wanted to rip my lips off too, but I knew I would need them to be a reporter. If I forgot my ChapStick, I’d make my dad drive the few blocks from his office and park in the fire lane to hand off a tube in the hall outside Honors Biology like he was my drug dealer. Because wasn’t he? Peddling a substance I couldn’t live without. Helping me get my fix. “This ChapStick thing is really becoming an annoying habit,” he would say. “Maybe you should try cigarettes instead.”

Didn’t he understand that my lips were on fire? This wasn’t a subconscious tick, like running my hands through my hair. I had a medical condition. Overcoming bad skin wasn’t a matter of character, hygiene, or diet. It was a matter of science.

“I don’t know, Greggo. Are you sure you’re OK?”

“Do you want me to be a broadcaster?” I would ask, cracking the seal of the lip balm. “Or do you want me to be a druggie like your daughter?”

Sure, Accutane scorched my lips and turned my eyes pink, but it worked. It worked! This is what puts the drug in a class with penicillin and the polio vaccine. Oil glands that had once squirted like oysters ran dry. Barnacles of acne peeled off my chin. Pores palpably shrank. Before I knew it, I had the bisque complexion of a popular kid.

“You’re hot!” Mom whooped, sounding a little too surprised. “You look like a frickin Ken doll.” Sore joints? Blepharitis? Conjunctivitis? Skin so dry it crackled in the breeze, not just flaking off but molting onto my pillow? So what. Waking up to a mask of my face was a talent that would no doubt come in handy if I ever needed to escape from prison. I was shedding old for new. Tonoccus McClain, here I come.

In a world of intractable problems—teen pregnancy, Kosovo, Mrs. Frederickson’s twitch—Accutane was an easy victory, and it made me cocky. I hadn’t been on the pill three months before I started casting about for what else I could improve. My personal motto: change what you can and get plastic surgery on everything else.

Inspired by my local news-ready face, I decided to address my voice. I had collected microphones for most of my teens. Beginning with a simple karaoke accessory, I now had a headset to practice sports commentary, a cordless mic to stage talk shows, and a hands-free clip-on to do musicals, plays, and motivational seminars in my room. I even had a remote-control truck that responded to verbal commands.

Sounding intelligent wasn’t difficult. I had Merriam-Webster’s Word of the Day for that. Now it was time to make my voice sound more … manly. Thanks to puberty, my natural timbre was cracked and deep. It was more about self-control, taking the smile out of my voice. I’d chew the inside of my cheek whenever I forgot myself and raised my hand in geometry to cheep out, “Oh God, wait!”

A self-help book taught me to speak from my gut and hang a string from my bathroom mirror to improve my crooked posture. I started watching Dateline with a hand mirror so I could see myself imitate Stone Phillips.

“You are the weirdest kid ever,” Tiffany would say, and I’d respond by throwing my hands over my head and yipping, “Right!” and “No!” or plugging my nose and going “ba, ba, ba,” to test my nasality.

Proclaiming around the dinner table could only get you so far. I needed practice speaking publicly. The problem was that not enough students at my junior high were interested in debate for us to field a team. It was just Ernie Wang and me. As far as partners went, Ernie was no Krystal Greene. His acne was crusty yellow, Grade II on Dr. Tull’s chart at least. In spite of having his mouth semi-clamped with rubber bands and braces, the kid could spit out two hundred and twenty words a minute and get through nearly an entire rebuttal on a few gulps of air. He had me time him with a stopwatch.

Ernie was in my grade, but he went to Skyline for AP Statistics. In a weird crossing of worlds, he was in my brother’s class. Rather than making fun of Ernie, Danny started calling him E-Money. It irked me, that nickname. Why did Ernie Wang get to be E-Money while I was Gay-gor? Our alliance came to an end when Ernie warned me I sounded too much like a newscaster, apparently unaware that this was a compliment.

Next up on the self-improvement to-do list: hair. I wasn’t just going for the local news, after all, but for Channel One. I had to look cool, effortless, mall-fashionable. Highlights were a start, but for some reason no one at the salon ever touched up the back of my head, leaving me blond in front and dark in back, like a surfer or a mushroom. Alas, experiments started at the salon moved into the shower as I lathered on purple shampoos and followed up with lemon juice and Sun In until my shag was red, orange, and white. “Do your eyebrows, too,” Danny said. “You look like Pete Sampras if he bleached his hair.”

If what Mom liked to say was true, that I had the looks, the voice, and the talent, now all I needed were calf and ass implants to plump up my spastic right side, a nose job, and a chin tuck.

It wasn’t my chin itself that bugged me, which Mom pointed out had a Y-shaped cleft like Leno’s, but the flabby slope between my jaw and Adam’s apple, where my chin became my neck. I couldn’t be bothered to do toe lifts on the stairs or walk on the treadmill in the basement, and the chalky elastic bands and orange Physioball I was supposed to use to do physical therapy at home sat unused in the freezer room. But I flexed my neck with such devotion kids at school started asking if I had Tourrette’s like Mrs. Frederickson.

“If you did half as much for your leg as you do for your neck you probably wouldn’t have a limp,” my brother said.

“Those tight tendons won’t matter when you’re behind an anchor desk,” Mom said, dismissing the notion. “No one is going to be able to see your legs. We should do these first.” She tapped my spotted teeth. I was eight years old when my mom was diagnosed with cancer and some things, like oral hygiene, just sort of slipped through the cracks. I don’t think I brushed my teeth for about two years, this on a diet of three Cokes a day.

Sleeping with trays of Ultradent goo in my mouth, I now woke up with a flu-like tingle in my roots that turned to pain when I drank anything. Orange juice, Coke, and colored liquids of any kind were against the rules during a bleach, but I tried to nudge things along with milk, hoping some of the whiteness would stick. The trouble was that the stains on my enamels brightened in proportion to the rest of my teeth.

“He’s going to be on TV,” Mom told the endodontist, who shaved my front four incisors to horrifying nubs and stuck a set of rubbery temporaries in my mouth. The temporaries never blended in with my surrounding teeth and, as the weeks went by, they turned yellow and started slipping out of my mouth. At an end-of-summer party, they fell out entirely, sinking to the bottom of the diving well. We had to clear the pool and send my sister Jessica in with a pair of goggles.

My permanent veneers arrived days before the start of tenth grade. After I got them embedded in my gums, Mom drove me to Nordstrom for back-to-school clothes. I remember rolling down my window and trying to catch a glimpse of my new smile in the side-view mirror. “They’ll look good once your mouth stops bleeding,” Mom said.

As it turned out, losing my teeth in the pool had been a bad omen. On the first day of high school, during Intro to Journalism, Channel One came on as scheduled, but our teacher, Mrs. Jacobs, playfully whacked the TV with a yardstick until she had depressed the power button. “That thing is just commercials. You’re here to learn, not to buy things,” she said. Putting a knotted finger to her cheek, she resumed going over the Who, What, Where, Why, and How of her syllabus. Just like that, we didn’t watch Channel One anymore. It was a valuable lesson, being told you’re more than just a target demographic for junk food and tampons, but it was a valuable lesson I was not yet ready to learn. The saddest sound I’d ever heard was that of the TV being turned off, Krystal Greene’s hearty hey hey hey, and then the fizz of static.

Mrs. Jacobs must have distrusted TV news in general because later that semester she had us break into small groups to discuss an article by a former anchorman she’d copied out of Newsweek. Written anonymously, the guy’s picture was a silhouette, as if he’d gone into hiding, as if he belonged on the Accutane package. I can’t remember the headline, but the gist was Why I Left Broadcast Journalism.

The kids in my group didn’t care either way, but I felt sorry for him, this disdainful ex-television personality who couldn’t show his face. Being an anchorman didn’t make you a “potted plant” like he claimed. Nor was it such a bad thing to get preferential treatment at restaurants or practice your broadcaster voice at the drive thru. It was fine to be out reporting if you had two good legs, but I liked the idea of an air-conditioned studio, a teleprompter, and a desk to hide my legs behind, like Mom suggested. I wouldn’t have to drag my foot in front of anyone. Maybe if this anchor had gone on Accutane as a kid he wouldn’t have become so bitter. Maybe he would have gotten onto Channel One, like I was about to.

It was just before Christmas when Danny helped me film my audition tape. Mrs. Jacobs excused me from the last fifteen minutes of Journalism and I slipped on the tie Dad had pre-knotted for me and met my brother across the hall, where they shot the morning announcements. Unsatisfied with the occasional stray zit after my initial dose of Accutane, I was back on the medication for an extra three months. That morning, I had punched through the X-ed out pregnant lady and let the capsule rest on my pillowy tongue like a Communion wafer. I was that grateful.

My brother and I had come up with the idea of making my audition like a one-man show. Beginning at the anchor desk, the one that had a mural of an eagle as a backdrop, I sent it out to myself in the field. “With more on the story, here’s Greg.” My brother knew how to use green screens. With his help, we made it look like I was reporting from the Coliseum, courtesy of a jittery frame from Ridley Scott’s Gladiator, and then in front of a busted gate in Jurassic Park. “The power outage is temporary and authorities are telling me everything is under control, Greg,” I said.

The video wasn’t more than a minute or two, but I was proud. It was cheeky and original, showing both effort and a sense of humor. All of my practice around the house might finally pay off.

“You’re probably going to get it,” Danny said as we hung ornaments that year.

Mom leaned into the tree from a stepladder, trying to find the perfect branch for a Popsicle stick angel I’d made in kindergarten. It would make good B-roll for a future news story about my humble origins. “You sure as hell better,” Mom said. “You’ve got the looks, you’ve got the talent, and those teeth were a fortune.”

For weeks after sending in the tape, I’d come home from school and rifle through the mail on the kitchen counter, looking for an envelope with that typewriter “1” stamped in place of a return address. Maybe there would even be a brief note from Tonoccus McClain. My returned audition tape arrived on a bed of junk mail that spring, just in time for Student Produced Week. The rejection slip inside made my foot cramp and my ears start to buzz. It was probably just tinnitus, another symptom of Accutane, but it may as well have been the sound of the air slowly going out of me.

Greg Marshall is a graduate of the Michener Center for Writers. His work has appeared in Electric Literature, Tampa Review, Barely South, and elsewhere. One of his essays was recently named "notable" in Best American Essay 2016. You call follow him on Twitter @gregrmarshall.