Fenton explained the whole procedure to me. First he would insert a tissue expander, to be followed by a vascularized bone graft. Because the bone graft would have its own blood supply, the chances of it being reabsorbed were minimal. The procedure would take at least six months to finish; I knew enough about plastic surgery by then to know this probably meant a year. Telling him I'd think about it, I boarded the train back to London. In the dining car I encountered yet another pack of drunken men more than willing to judge my looks for me.
I was frightened that none of Fenton's proposed operations would work, that I would only be letting myself in again for that familiar disappointment. But, again but, how could I pass up the possibility that it might work, that at long last I might finally fix my face, fix my life, my soul? And thanks to my Irish passport and socialized medicine, the operations would be free. Remembering the drunken but nonetheless cruel comments of those men on the train, I called up the doctor and told him yes.
An empty balloon was inserted under the skin on the right side of my face and then slowly blown up by daily injections of a few milliliters of saline salution into a special port beside my ear. The objective was to slowly stretch out the skin, much the way a pregnancy stretches the belly, so that there would be enough of my own skin to pull down and cover the bone graft. The whole process took about three months, and I spent the entire time in the hospital. All in all, I had a great time.
The others on the ward took it upon themselves to teach me about Scotland. The dialect was almost impenetrable at first, but I wasn't half bad at understanding it by the time I left. Certain patients became my good friends, and after they were released, they took me for day trips to the beautiful countryside surrounding the city. The landscape brought up long-distant memories of Ireland. One of the doctors, a German woman named Eva, commiserated with me on our shared foreignness and invited me home with her sometimes after work to enjoy a good meal, which made me feel special, not like just another patient.
I was happy to be in the hospital, relieved not to have to go out into the world looking this way. My face transformed on a daily basis into something father monstrous. It was beginning to look as if a big balloon had been put in my face. I knew my appearance was strange, but there were other people on the ward with tissue expanders, people worse off than myself, and I never felt the need to explain or apologize or feel ashamed of my appearance. Since physically I was capable of taking care of myself, and medically there was no need for me to be an inpatient, it did not escape my attention that I was being treated like a sick person simply because I did not look like other people.
The big day finally came, and in what turned out to be an almost thirteen-hour operation, due to some minor unforeseen difficulties, the tissue expander was removed and the graft from my hip put in. I was severely disoriented when I woke up, a feeling exacerbated by the morphine they were giving me. The morphine didn't actually lessen the pain; rather, it diminished my scope of awareness. As I kept waking and sinking back under, I was overtaken by a brutal paranoia, convinced that because I had chosen to do this to myself, I deserved everything I got. Such long operations are rare, and I don't think the staff was aware of this side effect. I was a complete wreck, and no one knew how to reassure me. It wasn't until Susie came up from London a couple of days later to visit me that the paranoia began to wear off. I don't think I'd ever been so happy to see someone in all my life.
Because of the bone taken from my hip, I was very lame for a long time. I tried not to think about the results. There were more revision operations to come, and I patiently waited for each of them. After a few, my face was beginning to look acceptable to me; the new graft was solid and didn't seem to be in jeopardy. But then something unexpected happened: the original bone on the left side of my jaw, which had also been heavily irradiated, was starting to shrink, probably spurred by the stress of such a large operation. The doctor proposed putting a tissue expander in on the left side, followed by yet another free flap.
I could not imagine going through it again, and just as I'd done all my life, I searched and searched for a way to make it okay, make it bearable, for a way to do it. I lay awake all night on the train back to London. I realized then that I had no obligation to improve my situation, that I didn't have to explain or understand my life, that I could simply let it happen. By the time the train pulled into King's Cross Station I felt able to bear it yet again, not entirely sure what other choice I had.
I moved to Scotland, partly to be near the hospital and partly because I wanted more independence. Eligible for social security benefits, I was able to get my own, albeit very cold, flat overlooking a bridge under which whores congregated at night.
When I arrived at the hospital to set up a date to have the tissue expander inserted, I was informed that I would spend only three or four days there after the initial procedure. Almost in a whisper, I asked if I would be staying in the hospital for the three months of expansion time. No—instead I was to come in every day to the outpatient ward. Horrified by this prospect, I left there speechless. I would have to live and move about in the outside world for three months with a giant balloon stuck in my face. In the few days before I went into the hospital I spent a great deal of time drinking alone, both in bars and at home. I even picked up a man, a sweet and handsome man, probably every bit as lonely as I was. Lying next to him after it was over, I remember thinking I was fooling him, that he didn't have any idea who, or what, he was really with.
I went into the hospital, had the operation, and went home at the end of the week. The only things that gave me any comfort during the months I lived with my face gradually ballooning out were my writing and my reading. I wrote for hours and hours each day and lost myself reading everything from Kafka to Jackie Collins. I'd usually walk to the hospital, even though it was several miles, because I didn't want to get on the bus and feel trapped that way. Luckily it was also cold, so I could wrap my whole head in a scarf. As the tissue expander grew and grew, this became harder to do. I stopped going out except to the hospital and to the little store around the corner from me to buy food. I knew the people who worked there, and I kept wondering when they were going to ask what was wrong. I assumed they thought I had some massive tumor and were afraid to ask.
Finally I couldn't stand the polite silence any longer. I blurted out my whole life story to the man behind the counter. I was holding a glass bottle of milk, letting the whole saga stream out of me, when the bells tied to the door jangled. The man who walked in was completely covered with tattoos. I stopped in midsentence and stared at him. He stopped in midstride and stared at me. There was a puma reaching across his cheek toward his nose, which had some kind of tree on it, the trunk of it running along the bridge, then flowering up on his forehead. He hadn't even one inch of naturally colored skin: his ears, neck, and hands were covered with lush jungle scenes and half-naked women with seashells covering their breasts.
I don't know why, but I felt immensely sorry for him. We finally broke our mutual stares, I paid for my milk, he bought a pack of cigarettes, and we walked out together, turning different ways at the corner. In the same way that imagining living in Cambodia had helped me as a child, I walked the streets of my dark little Scottish city by the sea and knew without doubt that I was living in a story Kafka would have been proud to write.
The one good thing about a tissue expander is that you look so bad with it in that no matter what you look like when it's finally removed, it has to be better. I had the graft and some revision operations, and by that summer, yes, even I had to admit I looked better. But I didn't look like me. Something was wrong: was this the face I had waited for through eighteen years and almost thirty operations? I couldn't make what I saw in the mirror correspond to the person I thought I was. It wasn't only that I continued to feel ugly; I simply could not conceive of the image as belonging to me. I had known this feeling before, but that had been when my face was "unfinished," when I still had a large gap where my
jaw should have been. I'd been through twelve operations in the three years I'd been living in Scotland: Fenton was running out of things to do to me. There were still some minor operations, but for the most part it was over. Was this it? How could this be? Even as people confirmed that this was now my face, even as people congratulated me, I felt I was being mistaken for someone else. The person in the mirror was an imposter—why couldn't anyone else see this?
The only solution I could think of was to stop looking. It wasn't easy. I'd never suspected just how omnipresent our own images are. I became an expert on the reflected image, its numerous tricks and wiles, how it can spring up at you at any moment from a glass tabletop, a well-polished door handle, a darkened window, a pair of sunglasses, a restaurant's otherwise magnificent brass-plated coffee machine sitting innocently by the cash register. I perfected the technique of brushing my teeth without a mirror, grew my hair in such a way that it would require only a quick, simple brush, and wore clothes that were easily put on, with no complex layers or lines that might require even a minor visual adjustment. I did this for almost a year.
The journey back to my face was a long one. Between operations, thanks to some unexpected money inherited from my grandmother, I traveled around Europe. I kept writing. I returned to Berlin and sat in the same cafes as before, but now without my image, without the framework of when my face gets fixed, then I'll start living. I felt there was something empty about me. I didn't tell anyone, not my sister, not my closest friends, that I had stopped looking in mirrors. I found that I could stare straight through a mirror, allowing none of the reflection to get back to me.
Unlike some stroke victims, who are physically unable to name the person in the mirror as themselves, my trick of the eye was the result of my lifelong refusal to learn how to name the person in the mirror. My face had been changing for so long that I had never had time to become acquainted with it, to develop anything other than an ephemeral relationship with it. It was easy for me to ascribe to physical beauty certain qualities that I thought I simply had to wait for. It was easier to think that I was still not beautiful enough or lovable enough than to admit that perhaps these qualities did not really belong to this thing I thought was called beauty after all.
Without another operation to hang all my hopes on, I was completely on my own. And now something inside me started to miss me. A part of me, one that had always been there, organically knew I was whole. It was as if this part had known it was necessary to wait so long, to wait until the impatient din around it had quieted down, until the other internal voices had grown exhausted and hoarse before it could begin to speak, before I would begin to listen.
One evening near the end of my long separation from the mirror, I was sitting in a cafe talking to a man I found quite attractive when I suddenly wondered what I looked like to him. What was he actually seeing in me? I asked myself this old question, and startlingly, for the first time in my life, I had no ready answer. I had not looked in a mirror for so long that I had no idea what I objectively looked like. I studied the man as he spoke; for all those years I'd handed my ugliness over to people and seen only the different ways it was reflected back to me. As reluctant as I was to admit it now, the only indication in my companion's behavior was positive.
And then I experienced a moment of the freedom I'd been practicing for behind my Halloween mask all those years ago. As a child I had expected my liberation to come from getting a new face to put on, but now I saw it came from shedding something, shedding my image.
I used to think truth was eternal, that once I knew, once I saw, it would be with me forever, a constant by which everything else could be measured. I know now that this isn't so, that most truths are inherently unretainable, that we have to work hard all our lives to remember the most basic things. Society is no help. It tells us again and again that we can most be ourselves by acting and looking like someone else, only to leave our original faces behind to turn into ghosts that will inevitably resent and haunt us. As I sat there in the cafe, it suddenly occurred to me that it is no mistake when sometimes in films and literature the dead know they are dead only after being offered that most irrefutable proof: they can no longer see themselves in the mirror.
Feeling the warmth of the cup against my palm, I felt this small observation as a great revelation. I wanted to tell the man I was with about it, but he was involved in his own thoughts and I did not want to interrupt him, so instead I looked with curiosity at the window behind him, its night-silvered glass reflecting the entire cafe, to see if I could, now, recognize myself.
Acknowledgments
I would like to thank the Bunting Institute of Radcliffe College, the Corporation of Yaddo, and the Fine Arts Work Center in Provincetown.
Lucy Grealy, Autobiography of a Face
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