Alice Lowe: Jim, as I recall, The Twisting Path was one of your earlier efforts when we started reading and reviewing each other’s work last year, and you took it through a number of incarnations before the final version now published in r.kv.r.y. Given the nature of the story, I imagine it was difficult to write, and I wonder how you approached it, what obstacles you encountered in telling your story, and how you overcame them. Because I know that you’ve turned some of your life stories into fiction, did you ever consider writing this as fiction in order to give yourself more latitude with the facts?

Jim Brega: Well, going back to the real origins of this story, I’d have to start with the daily blog I was writing in 2009 and 2010 to document the experience of being diagnosed with and treated for prostate cancer. Friends kept encouraging me to use some of the material from the blog in my creative writing. That idea was very challenging for me because the blog material was extremely emotional and raw, full of anger and complaining, not “literary” at all. (For example, part of the testimony I uploaded was a post-op photo of my abdomen, with PowerPoint arrows indicating surgical incision points.) The experience of receiving my diagnosis was actually the least traumatic one in the whole process, so I decided to start with that. The second half of “The Twisting Path” was my first attempt to deal with the material. If you remember, it originally stood alone and was titled “Spring Fever;” I thought it might be a flash piece. But I wasn’t able to put the part that came before the diagnosis out of my mind, so I ended up writing about the biopsy as a “prequel.”

AL: Interesting—I would have imagined that the diagnosis would be enormously traumatic, even shattering. Hopes dashed. But as I read your piece, I understand that you’re saying that by the time you got the diagnosis, you’d already gone through the stages of grief, as it were. That by agreeing to the biopsy, you would “start down the twisting path … that could lead from this room to others like it.… in an accelerating rush to the final tumble.”

JB: “Hopes dashed—“ I can see how most people might think of the diagnosis that way; that would be logical. But I, like the narrator in the story, have watched the wasting away of “a lover, then one parent, then the other,” which changes my expectations of disease. I tend to face potentially bad outcomes by imagining from the beginning the worst that could happen and devising a contingency plan for that possibility. I guess that could be considered a mental rehearsal of the stages of grief. Once the plan’s in place I allow myself a little hope that things will go a different way. So, in the story, deciding to go ahead with the biopsy was the first step on “the twisting path.” If the biopsy had been negative, I would have been all done: no harm, no foul. But I had already imagined that it would be positive, to steel myself against the diagnosis; when the call came it was just a confirmation that I had to take the next step. It took nine months, but eventually I reached the end of that section of my “path” when I made the decision to have surgery. So far the evidence is that I was cured. Earlier you asked whether I considered writing this piece as fiction. While I was writing it I didn’t feel the need to stick to the strict “facts” of the experience (as I remember them), because what was most important to me was to try to capture the feelings that are inherent in situations like this one: fear, loss of control and individuality, distrust of what I think of as the “medical- industrial complex,” etc. I also wanted to write about those moments in our lives when we know we are making a life-altering decision from which there can be no turning back, and are confused about what to do. I struggled with that part of the story—if you remember, it once had a whole (made up) section about a dream in which I visualized the options metaphorically. The dream sequence really didn’t seem authentic; fortunately, through working on the story in our circle, that part was cut. Interestingly, it wasn’t until I had reached a point where I felt the piece was “finished” that I realized I’d inadvertently incorporated into the story an experience from another minor medical procedure I’d gone through during the same period. So, without getting into the fiction vs. creative non-fiction controversy that’s raging in the literary world right now, I’d have to say that I approached and wrote the story not as a reporter but as someone who had gone through a confusing and emotional experience and wanted to convey to readers what it felt like. At the same time, I didn’t feel the need to expand or embellish the experience to make my point. And in spite of my lack of attention to the issue, I think the essay would pass a fact check.

AL: I was glad when you decided to take out the dream sequence, because your experience, as you wrote it, is so intense that the dream seemed both unnecessary and distracting. But I also recall it being a vivid piece of writing—maybe you’ll find another use for it! That fiction-nonfiction controversy has been like a bag of potato chips—once I dip in I can’t stay out of it. I agree that we’re wise to stay out of it, but I think you’ve very succinctly stated the ideal intent of a personal essay—that of capturing and conveying the emotional experience yet still passing the fact check.

JB: Speaking of conveying an emotional experience, I wanted to ask you about a passage from your essay, My Moving Cage, which was published in the July 2011 issue of r.kv.r.y. In describing your first experience with a panic attack that occurred while driving across the Coronado bridge, you wrote, “It was as if there were hands on the steering wheel covering my own, an evil entity who wanted to take the car over the side. I clenched the wheel in a vise-like grip to keep from making a sharp turn to the right, through the restraining wall and into the dark swishing water below. I was sweaty and clammy. Dizzy, hyperventilating.” Your description is very vivid; it almost feels like a description of being possessed. Although you write about trying to avoid the road structures that trigger this panic, you actually have had to confront them many times. Even though the feeling returns full strength near the end of your essay, did repeating the experience affect your ability to recall what the original incident felt like? Do you think your discovery of similar episodes described in the work of Joan Didion, Susan Cheever, and other writers influences the way you remember or even experience your own?

AL: “Possessed” describes it well—the crux of my phobia was the feeling that I wasn’t in control of not just the car but of myself, my own actions. Feeling possessed, out of control, is of course transpiring in my head, but at the same time I was fully conscious of the physical, tangible things that were happening to my body and in my responses, and that’s what I felt I needed to convey in my essay for readers to absorb, to make them squirm a little. The same way I felt when you described the biopsy in such detail! Unfortunately for me, avoiding the Coronado Bridge doesn’t get me completely off the hook—I’ve had a few relapses, which I’ve learned to accept, and so even now I can attest to the accuracy of my description of the original incident. I think that discovering that my malady had an identity, and reading the descriptions set forth so powerfully by the likes of Joan Didion and Ruth Reichl—I know and fear the Bay Bridge, I’m right there with them in their panic—was validating and reassuring. I hadn’t lost my mind. Not only was I not alone, I was in highly esteemed company.

JB: As you mentioned, you also researched your symptoms and discovered that they characterized a recognized phobia: hodophobia, “fear of travel by road.” When I recently re- read your essay I realized that it hadn’t occurred to me to wonder whether what I went through had ever been classified as a phobia. As I started researching the question, right away I was able to come up with iatrophobia, “fear of doctors,” but that didn’t seem to cover it. Nosophobia is “fear of a specific disease;” but, again, my anxiety was more general. There are two terms for a fear of needles; also too specific. Then I came across tomophobia—“fear of an invasive medical procedure.” Jackpot! A description of a patient with this phobia describes his “…intensely irrational and unavoidable fear of putting himself in the hands of others…. Moreover, the fear of losing control of his body through loss of consciousness or compromise of physical integrity during an operation or surgical intervention was reported….” The importance given the fear of losing control, in all the various meanings of that phrase, really resonates, and may be an element that connects our two experiences.

AL: And we’ve both written personal essays to transmit emotional states to readers!, One of the things I find striking about The Twisting Path is its form and pace. You start off in a narrative, descriptive mode; it’s first person, your observations and internal deliberations. Then, once you’re in the exam room, your story gradually transitions and becomes more dialogue driven, which to me accentuates the immediacy and the awfulness in excruciating detail of what you were going through. And then, bam, you’re on the phone getting the diagnosis. And then you draw back into the slower narrative of your thinking and your acceptance of what you’d anticipated: “It’s to be the twisting path, then.” Marvelous! As one writer to another, was that according to plan or did it evolve that way?

JB: I’d have to say half planned, half evolved. Having written the second half of the story first, I knew that the narrator was going to end up essentially alone in a wide-open natural environment. As a contrast, I wanted the atmosphere in the first half of the to be intimate, claustrophobic even: three characters in a tiny room. There are three sense /images that make the connection between the two parts: the smell of blood (which indicates danger or fear), an image of a twisting path (the uncertain course of medical decision-making), and a line of dominoes falling (fate set in motion by a human hand). But the only element of the three that was originally written into both halves was the reference to the smell of blood. The image of the twisting path was invented while I was struggling with the now-deleted dreams, and the row of dominoes was added to both parts much later. Since you noted the “excruciating detail” of the autopsy, I wanted to mention that I intended the dialogue in the biopsy room to be a bit humorous, though I’m not sure whether I achieved that. I’m a great fan of the ability of writers like Augusten Burroughs to tell horrifying stories in a way that makes the reader laugh. My sense of humor is very dry—some have compared its texture to that of dust—but from a certain point of view I think that what happens to people who are suddenly thrust into medical environments is kind of horrible/funny (or horribly funny). People become stupid, confused, uncertain, unable to carry on a simple conversation or follow a clear instruction. They suffer the worst humiliations without complaint. But the humor in the situation exposes their humanity, their vulnerability. They find “truth;” it’s beautiful, really. The phone conversation in the essay’s second half is hardly a conversation at all; if you notice, the narrator utters only three words aloud: “No, no questions.” Yet he’s obviously still engaged in a vigorous inner monologue. I purposely set this conversation in a spot where he could observe and appreciate the early signs of spring in the landscape around him. He confronts the irony in the lushness of the Earth, an Earth that’s coming alive just as he is forced to confront mortality. The atmosphere becomes more sinister as he imagines the ground opening up beneath his feet as if to swallow him. There’s an implication that he may have spent many hours admiring his view, but is suddenly seeing it in a new way because of the news he’s receiving. At this point the /images of a twisting path and a row of dominoes from the first part of the story are repeated as a coda.

AL: You mentioned admiring Augusten Burrough’s ability to tell horrific stories with humor. What other writers do you admire?

JB: I enjoy reading almost anything, and cultivate the serendipity of having something wonderful come into my hands un-looked-for. Often I allow the two-dollar bookshelf at my local used bookstore to suggest something to me. That’s where I recently scored a copy of Joan Didion’s collection of essays Slouching Toward Bethlehem, which was delightful. I also found a copy of Alice McDermott’s Charming Billy, and of Martin Duberman’s memoir, Waiting to Land. I’m in the middle of an anthology in which I discovered Saul Bellow’s short story, “A Silver Dish,” which blew me away with its perfection. But on any given day you’d be as likely to find me reading Karen Armstrong’s A History of God, though perhaps a bit more slowly than the other things I’ve mentioned. I think the last thing I bought on my Kindle was To The Lighthouse. So, my reading list, to the extent I have one, is very diverse.

AL: What are you working on now?

JB: Right now I’m spending some time re-working a few completed stories that have not been able to find homes in a journal. I’m also twenty thousand words into a story that might or might not become a novel at some point. And I’m reading as research some “boys’ book” fiction series that were published early in the twentieth century, looking for inspiration for a potential Young Adult book. Those who are interested can follow me on my blog at jimbrega.com.

AL: Well, thanks for inviting me to participate in this conversation!

JB: Thank you! I really appreciate it.

Alice Lowe is a freelance writer in San Diego, California. Her creative nonfiction has appeared this year or is forthcoming in Prime Number, Phoebe, Jenny, Tiny Lights, City Works, Writer’s Ink, Skive, Raven Chronicles, and Killing the Angel. Her essay, My Moving Cage, was published in the Summer 2011 issue of r.kv.r.y. In addition, she was the winner of a 2011 essay contest at Writing It Real. She has published essays and reviews on the life and work of Virginia Woolf, including a monograph, “Beyond the Icon: Virginia Woolf in Contemporary Fiction.” Alice blogs at www.aliceloweblogs.wordpress.com.