By Nicki Serquinia, Special to In Life
"Losing a breast was nothing compared to this," she says.
I pick up a strand of the young woman’s hair, slide my fingers down the length of it, past her shoulders, through the thick, neatly trimmed ends. A third of it comes away in my hand, like threads unraveling.
She is my first client since deciding to "specialize in cancer patients," but it isn’t the first time I’ve felt the sensation of hair falling away like dandelion fluff. Four years earlier, in 1988, I also lost my hair due to chemotherapy.
It wasn’t until my friend, the late Mary Ann Waters, was diagnosed with breast cancer in 1992 that I decided to start seeing cancer patients as part of my hairdressing practice.
When Mary Ann called to tell me of her diagnosis, we made a date to go wig shopping together. But when I came to pick her up, she confessed that she had gotten nervous and gone without me. "What do you think?" she asked, as she pulled her new wig from a brown paper bag. I stopped in midbreath, trying to decide if I should be honest or upbeat and supportive.
Mary Ann was 52 years old, an English teacher at West Valley High School and an accomplished poet. I had been cutting her chestnut hair in a classic short bob. The wig was off-black, curly, and would have been better suited on one of the Marx Brothers. With much diplomacy, I said, "I think we can do better on the wig."
We went back to the store, exchanged the wig for a short layered style in her color, then proceeded back to my house. As I cut her rapidly thinning hair down to about two inches, I looked at her reflection in the mirror and said, "Isn’t it nice to know that the person cutting off all your hair knows what this feels like?"
"You have no idea," she said. I got out my scarves, showed her how to tie them, and I knew I wanted combine my hairdressing experience with my cancer experience to assist women with this process.
When my first client sees her hair in my hand and bursts into tears, I question my decision. Unsure of what to do next, I turn the chair away from the mirror and sit down facing her.
"I’m sorry," she says, wiping her eyes with a Kleenex. "I’ve been told I have cancer. I’ve lost a breast. And I haven’t cried through any of it—until now. The breast is easy to cover up, you know? But this… how am I supposed to deal with this?"
She has luscious hair, a blend of at least 15 colors, all natural, ranging from pale blond to rust, cinnamon, gold, copper, and even a few strands of mahogany.
It’s thick and straight, so shiny that in full sunlight on a summer day, you’d have to squint to look at it. She doesn’t need to tell me that she has always been know as "the woman with beautiful hair," that a major part of her identity, what has set her apart since childhood, is her hair.
Even so, I find it shocking that she considers temporary hair loss more devastating than having her breast amputated.
In 30 years of hairdressing, I have seen all kinds of people with all kinds of attitudes about their hair. Since I began seeing cancer patients, my biggest surprise has been how many women echo my first client’s sentiments.
Hair evokes tremendous emotion in our culture, and baldness even more. I once had a call from a man who was going to decide whether his wife would have chemotherapy "based on how the wigs looked." Some women have refused chemo, choosing to die rather than lose their hair.
And some women shave their head before they begin treatment as a way to feel in control when so much of their life is out of control.
I’ll never forget the woman who, after coming in and picking out a wig to match her natural blond hair, went home and cut her hair about 2 inches long and dyed it bright fuchsia. Both the cut and the color were patchy and uneven, giving her a "caught in the eggbeater" look.
"Everybody hates it," she told me, "but this way, I figure nobody will feel sorry for me when it falls out."
A young woman, not yet 21 with metastasized cancer of unknown origin, comes to see me after 3 weeks in the hospital. I watch from my kitchen window as a car drops her off and pulls away.
Standing alone at the end of my driveway, she’s pallid and gaunt, teetering slightly. She is wearing a fanny-pack that dispenses medication every few minutes. I walk out to meet her and see foot-long waves of hair hanging off her shoulders. A nest of matted hair the size of a football rests between her shoulder blades.
She tells me that she has not washed or combed her hair for 3 weeks, hoping if she didn’t put any stress on it, it wouldn’t come out. I run a pick through a strand of hair, and more than half of it ends up in my hand. She winces, though it doesn’t hurt physically.
"My boyfriend is coming up from California this weekend, and I’d like to have some hair left," she says, as if I can arrange that for her. And seeing how badly she wants it, I convince myself that I can.
I describe a cute, wispy haircut about 2 and a half inches long. She reluctantly agrees to let me wash her hair. "Just be really careful, okay?"
I lay her back in the shampoo sink, run warm water over her hair, then gently massage her scalp with sweet orange shampoo. My heart starts to pound as most of her hair slips from her follicles and mats about 4 inches from her head. The only thing I can do is cut out the mats, then even it up as she cries.
I wasn’t happy about losing my hair, but in the week before my surgery, my abdomen went from normal size to looking as if I were six months pregnant. My lungs filled with fluid and my temperature hovered around 103.
I was acutely aware that in the olden days, or if I lived on the proverbial desert island, I would have just plain died, probably within the week. Then, when I found out I had ovarian cancer, I realized that not too many years ago, there was no chemotherapy and no treatment for my cancer. I felt immensely grateful to have chemotherapy available to me and accepted the hair loss as part of the process that would make me well.
But often with breast cancer, the symptoms are less dramatic. The tumor may appear only on a gray film over a lighted screen in the doctor’s office. The patient feels fine and sees chemotherapy as an invasive poison rather than a gift. She may feel betrayed by her body for secretly growing cells that could kill her. And betrayed again when her hair gets caught in the crossfire of the treatment that can save her.
With recent advancements in nausea medications, lumpectomies and reconstructive surgery, some of the trauma can be minimized, but the hair loss makes it undeniably real, dramatic and public.
I didn’t mind being bald in front of my friends, but I didn’t go bareheaded in public. It takes a lot of energy to be stared at and I didn’t have any to spare.
Three and a half months after my hair started growing back, my hair barely covered my head and I retired my favorite scarf. My girlfriends wanted to take me out to celebrate. We went to a busy downtown lounge on a Friday night. I was self conscious at first, with my head uncovered in public for the first time in 9 months.
We found a table and within minutes a woman rushed over and told me how cute my hair was and asked where I had it done. I thanked her, more grateful than she would ever know, and gave her my business card.
My friends and I chuckled, then got down to the business of catching up on each others’ lives. Before long, a couple of men gravitated toward our table, beer bottles in hand. After several unsuccessful attempts at small talk, one of them tried one more time to be clever by asking, "So what else do you do besides hang out at Hayden Lake with the Aryans?"
Luckily, I was on my second margarita at the time. I grabbed his collar, pulled him close and said, "I just got done having cancer. My hair’s coming back and I think I look damn good."
He stammered an apology, then soon left the bar. Though I was proud of myself, it could just as easily have crushed me on a different day.
After completing chemotherapy and radiation, my friend Mary Ann underwent high-dose chemotherapy at the University of Washington Medical Center. With high-dose treatment, the patient receives chemotherapy every day for five days, then stays in the hospital for four weeks while her blood builds back up.
All the patients on the unit are bald. People with hair—visitors and staff—become the minority.
What I discovered as a visitor was the incredible beauty of bald women. It was like visiting the set of a science fiction movie, "Planet of the Bald." A planet of beautiful, doe-eyed warrior women in loose fitting cotton gowns, hairless heads, and a beauty in their faces that could only come from a blend of courage, fear, vulnerability and hope.
I was dumbstruck to think that perhaps I too, had looked so beautiful and powerful.
Over the next few years, as I saw 3-10 new cancer patients a month, I realized something far more complex than vanity is at the heart of the trauma of hair loss.
Often, women feel guilty for getting sick in the first place and putting their family through such stress. They feel as though they must protect them from the sight of their bare head, the constant reminder that they have a life-threatening illness.
Women are often afraid that their small children or grandchildren will be frightened by them. Or that their husband and older children would be embarrassed if anyone at the soccer game were to suspect they were wearing a wig.
One patient brought her adult daughter along to cast a vote in the wig selection but made her leave the room each time I removed one wig and replaced it with another. Several mothers have told me their teenaged sons "couldn’t take it", if they were to see their mother bald.
So they keep their head covered at all times, lest they make someone else uncomfortable. And heaven forbid someone might think they were looking for sympathy.
For years I struggled to find the just-right word to define this experience that is, for some women, more emotionally painful than losing a breast. As I listened to and observed women in various stages of acceptance and devastation, one word finally emerged: shame.
And isn’t baldness the ultimate nakedness? In the movies, isn’t it always the buffoon or evil one who loses his or her wig at the climatic moment, revealing their true, hairless, impotent self?
If it’s a comedy, we laugh on cue. In a drama, it’s the moment of truth. We feel compassion for the character and relief that our own false faces and vulnerabilities are safely hidden away.
It has been 12 years since I had cancer and nine years since I began including cancer patients in my practice. Things have changed in that time.
A couple of years ago, I saw a bald woman in the mall, and one in a restaurant. Most recently, I was waited on by a bright and beautiful young woman at a beauty supply house who hadn’t a hair, or anything else, on her head.
Though they undoubtedly felt empowered by their decision, and I applaud them for their courage, most of us don’t want to make a bold statement while having dinner or buying a sweater.
"Fighting for your life," has become synonymous with having cancer. That can feel pretty overwhelming on days when driving to the grocery store is a triumph, and the last thing you want is to be stared at, or even congratulated for your courage.
Most of us want to blend in, and we feel better with the softness and comfort that a wig, hat or scarf provides. Mary Ann said she preferred a wig “for negotiating a crowd.” And there is the practical consideration of staying warm.
So, to all my sisters who have or will experience cancer and hair loss: It doesn’t matter why you got sick, so don’t waste an ounce of energy trying to figure it out. Focus instead on getting well, and on all the things that are going right in your life.
It’s an amazing paradox that we often find our strength when we are most vulnerable, our greatest gifts in what looks like a tragedy.
And whether or not you choose to wear a wig, know that your beauty and strength lie not in your hair, but in your spirit.