G is for ‘Grief’

/ɡriːf/

the emotional suffering an individual feels when something or someone the individual loves is taken away

I’ve never really dwelt that much on my physical appearance.  Or maybe it’s more that I’ve never had much confidence in it.  Certainly never thought of myself for even a moment as pretty or attractive or appealing in the way that Instagram would have you believe is the norm.  I was ill-fated as a child of the 70s – I needed glasses from an early age (those terrible NHS pink-hued beer-glass specs inflicted on 70s kids), developed awful teenage acne and my wonky teeth demanded those rail-track fixed metal braces that refused to let go of remnants of your dinner and earned me the nickname Metal Mickey at school (an all girls’ school, a cruel nest of vipers for those that were different).  I was short (definitely shorter than average at 5 ft 1) and dumpy with the big hips and backside that today look great on a Kardashian, less so on acne-riddled teen from South London in the mid-80s.  In short, I knew I was not dealt a great hand of cards in the looks department, that I was no-one’s dream woman, unless they’d had some particularly ripe cheese that night.  I knew I was lacking the traditional Western markers of beauty, as peddled by magazines, adverts and social media since the dawn of time, so I didn’t really fuss that much about it.  I never really put a huge amount of stock in the value of physical appearance. Of course I would have liked to have been thinner, prettier, taller (who wouldn’t?) but my genetics had determined otherwise and there wasn’t a whole lot I could do about it unless I was prepared to put my body in the hands of a scalpel-wielding plastic surgeon.  Which I wasn’t.  Then.  Ironic that last bit isn’t it?  Didn’t have a choice in the end.

My one saving grace was my hair.   As a child, teen and younger adult I was a copper-coloured redhead (it’s a little more muted and silver-streaked these days but I’m still a redhead at heart). At school this meant that in addition to ‘Metal Mickey’ I accrued the usual nicknames.  ‘Carrot top’.  ‘Duracell’. ‘Ginger nut’.  (BTW, side note on ‘ginger’, please don’t call a redhead a ‘ginger’ thinking it’s acceptable.  As the glorious Tim Minchin sings ‘only another ginger can call a ginger ginger’.) Not much fun at the time, or later when the boys started asking if the ‘carpets match the curtains’, but as I grew up I learnt to appreciate my copper tones.  I learnt to appreciate often being the only redhead in a sea of bland blondes and mousey brunettes (no offence intended).  And on my travels overseas, in SE Asia, Africa, South America etc I was a positive head-turning novelty.  Yes, my hair is about the only bit of me I’ve ever really liked.  And I know I’m a lucky son of a gun that I haven’t had to deal with chemo and the loss of that one part of me that was quite nice.

All this is a very long way round of saying, I never really thought that hard about my boobs.  I held so little stock in my physical appearance that I didn’t really give them a second thought.  They weren’t so massive they were an inconvenience or a literal pain in the back, so they got tucked away inside a range of M&S bras for years, without much attention paid.  I haven’t had children so they haven’t been used for breast-feeding, and although they’ve had some fun over the years in bed, they alone didn’t give me much of a sexual kick (anyone in search of a more potent erogenous zone would be sent further south).

But then you’re confronted with the news that you have to lose a breast.  And you have to face saying goodbye to part of you that has been there since you were born (although only coming to … ahem … prominence in early teens).  A part of you to which you are attached, both literally and emotionally.  I might never have given my breasts a huge amount of dedicated thought but that doesn’t mean that losing one is easy.  As my definition at the top of this post says grief is the emotional suffering you feel when something you have a bond with is taken away.  But how the hell do you grieve for a breast?

How do you grieve for the loss of a body part? An aspect of your intimate anatomy?  There’s no funeral service, no eulogies, no publicly acknowledged period of mourning, no closure. You go to sleep on a hospital trolley with two breasts and wake up with one, or both, absent.  There might be a new breast in place if you’ve opted for a reconstruction but the breasts you knew, stroked, squeezed into ill-fitting lingerie, cursed for being too big, too small, too weirdly shaped, too mismatched, too sore, too jiggly have gone.  Gone into the hospital’s medical furnace or onto glass slides in a pathology lab. The cancer has hopefully gone into that furnace too, but still, it’s a hard way to say goodbye.

In the forums and peer support groups for breast cancer patients, the debates about staying ‘flat’ post-mastectomy or opting for reconstruction are numerous.  For some women, the thought of waking up post-op and looking down to see only a space where once there was a breast is too traumatic a thought to countenance. ‘I couldn’t bear seeing myself flat’ is a common thread.  And when reconstruction surgery is a success, there is much delight (and much sharing of ‘aren’t my new foobs* amazing?’ photographs, which sends Facebooks algorithms into spasms and often results in these beautiful women being sent to FB jail).  Equally, however, some women opt to remain flat after their surgery.  This may be a medical necessity or it may be a deliberate choice, an embracing of the flatter, post-mx body with surgical scar as a symbol of the hard times endured and the difficulties overcome.  Some women use tattoos to cover their mx scars and they are some of the most heart-breakingly beautiful pieces of body art I’ve ever seen, a way to reclaim the body from cancer which has taken so much.  Either way, flat or reconstructed, these women have a strong sense of how they want their bodies to be shaped post-cancer.  No-one wants the scars, the implants, the reconstructed breast, but making a decision about how you look after breast cancer surgery is also about confronting a change a self.

And how do you grieve for this sense of self? Your self-concept? That element of your identity that is tied into your physical body? Because even I, someone who doesn’t place all my sense of value in my physical make-up, has to deal with the fact that post-op I am different.  There is less of me.  Some of me is in a different place from where it used to be.  I am transformed.  I, and the millions of women who face similar surgery, are not less than we were before. But I am not the same physical being I was before the surgery.  That is unalterably true.  And that will always impact on who I am.  I see that difference every day in the mirror, it is inescapable.   My new breast bears a large circular scar (not entirely unlike a tube roundel.  Bit weird). I no longer have a nipple or areola on that breast.  Just a blank expanse of skin, different in colour and texture to that around it. And another scar, pink and vivid, runs hip to hip just above my bikini line.  Oh and I have a new belly button too.  Well, technically the same belly button as my umbilical cord hasn’t moved, but all the skin around it did so there’s a new hole for it to show through. (The new belly button is heart-shaped. Cute in a still slightly scabby post-surgery kinda way.)

But the difference that cancer and surgery have made to my body is mostly only visible to me.  See me in my clothes, even see me in my underwear, and you wouldn’t know such major surgery had taken place.  I’m still the same dumpy, slightly greying redhead I was before.  Except I’m really not.  And how that physical change will alter me emotionally, psychologically, fundamentally is still to be born out.  I’m still in the midst of my grief of losing the old me.

Dealing with a dramatic physical change is never going to be easy, but facing a mastectomy in these complicated gender politics, shifting-sand, #MeToo times is very hard.  Women battle every day not to be reduced to a mere collection of body parts intended for the stimulation and pleasure of another. Page Three has long gone, but magazines, adverts, Instagram filters and voices in the street still suggest that a woman’s sexual identity is tied in to the mammary glands in front of her.  So when one of those glands has to be removed, as women we can’t help but feel that our sexuality, our sense of our sexual self is being threatened.  Even while our feminist brains refute the idea.  It perhaps doesn’t help that in the rooms of breast cancer consultants, plastic surgery department psychologists and cancer counsellors across the land, women are being asked ‘so how do you think your partner will cope with you having to lose a breast?’ or ‘how will you see yourself sexually after a mastectomy?’ or ‘will you be concerned about showing a new partner your post-surgery scars?’.  The emphasis sadly remains on how you might somehow be sexually reduced, in either your own eyes or that of another, by having vital, life-saving surgery on a body part that has no direct sexual function.  Another layer of grief and loss is added to the mix.

I’m afraid I don’t have any answers to the questions I’ve asked about how to grieve for yourself in this awful journey.  Grief is different for everyone and the way through the maelstrom of emotions will lead people in myriad directions.  I suspect, as with the death of a loved one, the grief of what has been lost physically and emotionally will never go away completely, only fade, or at least stop being such a persistent companion.  That new ways to move forward will be found.

It reminds me that when I met with the plastic surgery department’s psychologist prior to my surgery, she told me that she advises all her breast reconstruction patients to look at and touch their changed breasts as soon as possible after surgery.  Because the brain holds a ‘map’ of our anatomy, built up over years of looking at and touching our own bodies.  It’s probably not something most of us think about on a day-to-day basis.  We, of course, touch our own skin frequently – daily bodily functions require it.  And we see ourselves in mirrors or just by looking down.  But we don’t dwell on how we know that that body we’re seeing is ours. Because it’s just how it is, how it’s always been.  Then when you have a mastectomy with a reconstruction suddenly there’s new skin, flesh, scars where the old you used to be.  And your brain doesn’t know this new you yet, hasn’t had time to map it out. So you have to re-educate your brain to accept the new bits.  Touch the skin on your new breast, your new belly button, so that your brain learns this is how it feels, so it creates new neural pathways that allow the brain to recognise what you’re touching is really you.

Grieving for what we lose through cancer is hard.  It’s hard to articulate, hard to convey to others, hard to understand yourself.  But maybe helping your brain to learn the new you can be part of the healing process.

*foobs = fake boobs.  Or, my personal favourite, ‘belly boob’ if you’ve had the DIEP surgery.