I am told that my bald head is very pretty. It is smooth and sculpted, the basic oval shape planed at interesting angles on both sides of the front dome. I know this, along with a bunch of other odd facts, because six months of chemotherapy for breast cancer removed every strand of hair from my body.
The head hair went first, in great clumps, a few weeks after my first dose in December 2007. I told a friend, “It’s bloody cold up there!” He laughed, and pointed to his own bald head: “Now you know what we have to put up with.”
Covering up is fiddly. Wigs itch like crazy, and go askew, and the hair can look too obedient. I catch glimpses of this in shop windows. What passed as normal and nice in front of the hallway mirror suddenly looks “wiggy”. With a headscarf, it is hard to maintain temperature control: a covering comfortable for indoors is not warm enough for the winter air. In the summer, if you expose your scalp to the sun, you are risking a new form of cancer and if you cover up, you risk boiling your brains. Sometimes I stayed at home, just to avoid the effort of presenting my head to the world.
The eyebrows and eyelashes were gone by Easter. Forewarned, I went to Selfridges cosmetics hall to buy an eyebrow pencil, but this turned out to be difficult. I learned that eyebrows are now very “big” in make-up fashion, and the pencil has been eclipsed by waxes, powders and washes, brushed over the existing hair for dramatic effect. I tried to indicate my problem to a young sales assistant but her self-absorbed eye didn’t take in my scarf and bare temples. So I spelled it out: “The thing is, I need something to use instead of eyebrows, not on top of them.” “Instead?” Her face was a grimace of incomprehension. I felt ridiculously upset, and ran to the ladies to wash my red eyes.
I learned some people deliberately remove their eyebrow hair, favouring art over nature. A visitor from the US brought me a pack of “Perfection Stencils” – they came in four styles: Delicate, Elegant, Glamorous and Classic – and a matching compact of wax and eyebrow powder. I preferred to go freehand with a pencil, sourced at last.
The absence of eyelashes was a much bigger shock. I felt very exposed to the world, and the world exposed to me. When I cried, my tears splattered and leaked in all directions.
The last chemo dose came at the end of May. Two months later, my head was covered in short fuzz and the eyebrows showed a 5 o’clock shadow. In the heat, through sheer physical desperation, I went around a museum exhibition completely wigless and hatless for the first time. People were terribly polite: no one stared or pointed. Confidence boosted, I started to bare my head in more of London’s public places, and met the same polite indifference.
During chemo I became very self-conscious about my right hand, which was permanently bruised. Every three weeks, nurses took a blood sample to check the cell count, and then the next day, inserted a cannula to deliver the drugs. Sometimes the first try didn’t succeed, so there were three or four attempts, each one leaving a sore, purple mark. The cannula is a piece of plastic plumbing, sitting on top of a hollow surgical needle. This is inserted into the vein, to allow doctors and nurses to attach and detach drips at will. Sometimes, I was expected to wear one for long periods – for example, when there was a long delay while the chemo mix was prepared, or during any hospitalisation. For me it had its own special horror, beyond the pain of insertion. There is something about wandering around with a port into your body’s interior that makes you feel harpooned, pinned down and marked with a capital P for Patient. Conversely, this instant access seems to make medical people very happy; it takes very little excuse for a cannula to be prescribed.
One of the chemo drugs, Taxotere, made my fingers and toes numb and the nails discoloured. “Oh yes, you might lose a few fingernails,” the oncologist observed. Each nail now has at the top an area of white, where the nail is pulling free of the skin, a band of mottled brown, a band of normal pink skin and a wide pale stripe across the bottom. The whole surface is stippled and crooked. Two months from the last dose, it is still hard to use my fingers. They feel unreliable, as if I am being erased from the tips upwards. It bothers me out of all proportion to the relative seriousness of this problem, compared to my general predicament.
Like anyone with a serious illness, I must manage other people’s anxieties as well as my own. Chemotherapy is odd in that you actually get worse every day, not better. For breast cancer it also often takes place before surgery, not afterwards, so the tumour remains in place during the long wait. This always surprises people, and upsets their strong need to see the afflicted friend or colleague as someone who, having been given a diagnosis and treatment, is therefore getting better. They wish a swift recovery, but there is no recovery going on. This must wait not only for the end of chemo, but also the surgery and, often, radiotherapy. If all goes well, treatment takes 10 months. If it doesn’t – for example, if chemo is delayed by adverse reactions, or if the first surgical operation is unsuccessful in removing all diseased tissue – it can drag on for considerably longer.
Even when the trajectory of treatment is completed, recovery is, properly speaking, a recovery from the treatment alone, rather than the main illness. Chemo makes the hair fall out, and then the hair grows back again: this is good for morale, but it says nothing about the progress of the cancer itself. One must wait two or more years to know if all traces of the disease have been eradicated. And even then, there is no certainty. Once one has had cancer, one is never entirely free from risk of a recurrence. The doctors talk only in terms of minimising the risk.
When surgery finally comes, it is a relief. But none of the options is exactly nice. Reconstruction options following mastectomy include the L-flap, which moves back muscle around to the front, and the rectus free flap, which uses tissue from the abdomen. If the tumour is small enough, and in the right place, one is offered what is elegantly called “breast conservation”. This ranges from a small incision directly into the affected area to the much more ambitious “central block technique”. In this operation, the original breast tissue, skin and nipple are retained, but underneath the surface it goes through a major trauma of reorganisation.
The afternoon before surgery, the invisible is briefly made visible when surgeons visit women in the ward and mark them up with black felt tips pens. Dotted lines for the surgeon’s knife, and X marks the tumour spot; a helpful “L” or “R” (for left or right), to make sure they don’t take the wrong one.
Throughout the months of treatment, people habitually say that I look very well. It is hard to know if this is true in an absolute sense or only by comparison with their expectations: cancer and chemo are dread words that evoke dread images. For the patient, however, one’s notion of “dread” and “good” changes radically. Now, “good news” consists of learning that the tumour tested strongly for hormone receptors, because that means the doctors can throw in an extra treatment. On diagnosis, a year earlier, the response was: “Tumour? I have a freaking tumour?!”
Susan Greenberg is a senior lecturer in creative writing at Roehampton University. She is a founding member of the International Association for Literary Journalism Studies (www.ialjs.org) and a contributor to Prospect