F is for Facing Your Public

If “all the world’s a stage, and all the men and women merely players” (William Shakespeare), then Cancer has to be one of the more challenging roles in the canon. It’s like auditioning for a cosy rom-com and finding yourself cast in a wartime epic. This is a role heavy with expectation: the mere mention of the C-word is enough to elicit a grimace, and there are few words in the English language more loaded with fear and emotion. We all have a preconceived notion of who the Cancer Patient is, and when you find yourself on the other side of the diagnosis you cannot escape the sense – real or imagined, but certainly perpetuated by the media – that you are now categorised as a ‘victim’ of a tremendous misfortune, cursed with trial and tribulation, weakness and woe. Don’t get me wrong, this is one of the more disastrous events to befall me – to paraphrase Lady Bracknell, to get cancer once may be regarded as misfortune; to get it twice looks like carelessness – but I simply don’t recognise myself in that characterisation, and I’ll wager most other cancer patients wouldn’t either. That’s surely the reason why many people choose not to ‘go public’ with their experience – Jackie Collins being the latest and greatest example – and it’s an option I seriously considered but had to rapidly reject; even the most basic pretence is far too complicated for my straight-talking northern sensibilities. Instead, I reluctantly accepted the mantle of a role that no-one wants to play, but many of us must embrace.

Backstage Nerves

Facing the world after finding out you have cancer is like stepping out on stage without having had time to read the script. In the blink of a diagnosis you suddenly find yourself under the spotlight, categorised as a Person With Cancer, along with everything that represents to everyone that you know.

Cancer is the ultimate confidence killer. It is the arch nemesis that has turned your world upside down and your body into something that you no longer trust. All that was certain has suddenly become tentative, and your faith in the most basic assumptions about who you are, and what is ‘supposed’ to happen has been shaken to its core. However unprepared you feel, somehow you have to find a way to overcome the confidence crisis, re-enter the real world, and adjust to the role that has been thrust upon you. And that’s before you even start to get to grips with the physical impacts. Treatment is going to leave you temporarily altered and permanently transformed – and not in a “wow, what an amazing makeover” way; certainly not for a woman in her prime. “Does my bum look big in this?” is now so far down the list of potential issues it no longer registers (Answer: Of course it does. No one can eat this much smashed avocado without developing a ‘shapely’ behind). The pre-performance checklist you need to run through before embarking on any public engagement is now altogether more tedious:

Question: “Is it completely obvious that I’ve only got one boob right now?”
Answer: Probably. Try a different top, and then see what you can do with a strategically positioned scarf.

Question: “Do I look like a sick person, or can I pass for ‘pale and interesting’?”
Answer: Possibly, but slap on some more bronzer just to be safe; better Priscilla Queen of the Desert than Marley’s Ghost.

Question: “Have I actually got time for any of this?”
Answer: Absolutely not. You’ve just missed your cue.

Breast cancer patients don’t have the monopoly on body image issues. I imagine that much of it is similar to the body shock of pregnancy and childbirth, or the natural stages of aging. The difference is the speed and strength of the assault on all fronts, and the fact that some of it is irreversible. You could easily argue that in the grand scheme of life and death, none of this really matters, and it’s just my vanity speaking. Of course it is. But it’s also so much more than that. My personal philosophy is that the more I look like myself, the more I will feel like myself, and the more people will treat me like myself, all of which can only combine to whip up a virtuous cyclone of pure and undiluted ME-ness which will blow any concept of victimhood clean out of the sky, and vanquish the corrosive little voices of shame and insecurity that cancer creates.

Sometimes I wonder
Where I’ve been
Who I am, do I fit in?
Make-believing is hard alone
Out here, on my own

– Irene Cara, Fame

Costume

There is something supremely satisfying about looking the best that you possibly can when your life has gone to hell in a handbasket. I think of it as the Velvet Curtain Philosophy after the iconic scene in my beloved Gone With The Wind when Scarlett, desperate to pay the taxes due on Tara, horrified by the toll that hunger and poverty and hard work have exacted on her looks, and too proud (and foolish) to ask Rhett Butler for a loan in her ragged dress, creates the most stupendous costume from the only fabric she has left – her mother’s dining room curtains – so he will not suspect her diminished circumstances and she can charm him into marrying her (this is not, I will concede, Scarlett’s finest hour). Her calloused and work-worn hands give her away in the end – just as if you look closely enough you can clearly see the tell-tale signs of a body in cancer treatment – but it is the beautiful dress that gives her back her identity, and the courage to go and execute her hare-brained scheme in the first place.

He had never known such gallantry as the gallantry of Scarlett O’Hara going forth to conquer the world in her mother’s velvet curtains and the tail feathers of a rooster – Margaret Mitchell, Gone With The Wind

Hair and Make Up

Fortunately Scarlett was not suffering from cancer, and therefore didn’t have losing her Southern belle ringlets to contend with (though I am certain Vivien Leigh would have looked equally beautiful bald). Since biblical times hair has signified strength, vitality, and even superhuman powers. It’s the one thing we wear every single day; it’s not just the icing on the cake, but the signature of our trademark style. Imagine James Dean without his cooler than cool quiff, Robert Redford without his magnificent strawberry blonde mop, Farrah without her Fawcett Flick, Audrey without her pretty pixie, or Marilyn without her blonde bombshell bob. It’s no surprise then that the first question many chemotherapy patients ask is “will I lose my hair?” It certainly was one of my overriding concerns. Sickness? Fine; Nerve damage? Yes, OK; Hair loss? Rapidly developed into a full scale obsession. Literally HOURS spent googling images of bald celebrities, tying elaborate bandanas with my (wholly inappropriate) winter scarves, and wandering back and forth in front of the mirror in a shower cap to get comfortable with what I might look like bald (technically known as ‘improvisation’ and ‘getting into character’). And, of course, I purchased the eye wateringly expensive wig in the superstitious hope that it would act as a talisman against me ever actually needing it. At the time of writing the Cameron (as in Diaz; a sassy super blonde bob which is significantly more stylish than my actual hair) is still boxed up in the cupboard. This is thanks entirely to my hair hero Glenn Paxman, and his brother Neil who developed the Paxman Scalp Cooling System when Glenn’s wife was receiving chemotherapy for breast cancer. That was 18 years ago, and today the ‘cold cap’ is available to chemotherapy patients throughout the UK to mitigate against the horrible side effect of hair loss.

Here comes the science bit…

The ‘cold cap’ is exactly what it says – an ice cold hat that cools the scalp from 36⁰C to a frosty 22⁰C, so blood supply is reduced and the activity in the cells is slower, which reduces the amount of chemotherapy drugs that reach the hair follicles. It’s a beautifully elegant solution to a vexing problem, theoretically at least. In practice the ice hat is anything but elegant; a neoprene skull cap that must be clamped to the scalp before, during and after treatment, for anything between 1 and 5 hours depending on the chemotherapy regime. There is cold, and then there is the Cold Cap. This is your face in the bitter wind howling down Michigan Avenue on a January day. This is Dennis Quaid battling sub-zero temperatures to rescue Jake Gyllenhaal in a post ice-age Day After Tomorrow. This is Han Solo frozen in carbonite…

Actually, in reality, it’s nowhere near as punishing as it sounds – the ‘brain freeze’ pain subsides after 15-20 minutes, and you quickly acclimatise as a thin layer of ice forms over your scalp, but it is the very definition of ‘no pain, no gain’.

Cumulatively I’ve clocked up 62 hours under the cold cap so far – which must surely entitle me to some kind of silver tier loyalty status – and only twice have I had to resist the urge to scream at the nurse to get this Godforsaken instrument of torture the hell away from my head while yanking the plug out of the socket and staging a very public actor’s hissy fit. On both occasions I have waited that split second long enough to consider the consequences, and swiftly concluded that no matter how much pain I am in right this second, it is absolutely preferable to the complete hassle I will be faced with if I have to faff around with a hat/scarf/wig every time I want to leave the house, or go bald and invite the sympathy stares of strangers. This is a long running production, and I’d personally prefer not spend the better part of each day in Hair and Make Up before I can venture out in public. I’ve learnt a lot about myself during this experience, and theses are the lengths that vanity and sheer laziness will drive me to.

The cold cap isn’t for everyone; it doesn’t work with all regimes, and it doesn’t completely prevent hair loss. This isn’t hair that just stepped out of a salon; this is weak and fragile hair that requires very careful handling, so you essentially trade baldness for one 6 month long bad hair day. I have experienced my share of ‘thinning’ and I doff my cold cap to any chemo patient who is brave enough to go gracefully bald – there is simply nothing that prepares you for the moment when you innocently put your fingers to your hair and it comes away in droves. If mine all goes in the end, it goes, and I’ll suck it up like any other side effect and turn it into an excuse to do more shopping, but for me it has been worth the investment to look in the mirror and see the woman I recognise – because I’m worth it. Besides, everyone knows that the Academy looks kindly on those willing to go to physical extremes in pursuit of an authentic performance: courageously eating doughnuts to portray an unfortunately overweight person; courageously not eating doughnuts to portray an unfortunately emaciated person. Sometimes one simply has to suffer for one’s art.

My Interpretation

Facing your public as a Cancer Patient isn’t about artifice or putting on a falsely brave face. It’s merely about finding your own way of interpreting the role, and trying not to let the rest of the world typecast you into something – or someone – that you’re not. Just as every cancer is unique, so is everybody’s way of dealing with it. Physically we can resort to every trick in the wardrobe department to create an illusion, but the character you see before you is the very essence of real.

Cancer alters you – just like any major trial or upheaval in life – but it doesn’t make you fundamentally different. You don’t overnight turn into a cancer cliché, or some desperate Gloria Swanson figure barricaded in your deserted house in a turban, deliriously reminiscing about your glory days and railing against your fate. It doesn’t take over your personality or become the only thing that matters. I may have cancer but I still care passionately about all the things I cared about before; what’s going on with my family, friends, work and colleagues; what’s going on in the world; whether Idris Elba is officially the most attractive man on the planet, and how Downton Abbey will end.

To my mind it is less about ‘change’ and more a process of distillation. Like the creation of a fine Scottish whisky, living through cancer is essentially a compressed maturing process that dispenses with the peripherals and concentrates your character more towards the traits that were always at its core. And what you get – who you become – depends very much on what the cask and grain was made from in the first place, be it sweet and mellow, or bitter and dry. Personally I’ve always been more ‘Shiny Happy People’ than ‘Everybody Hurts’, more pragmatic than romantic, so those tendencies were bound to be magnified through this experience. This is my interpretation of being a Cancer Patient, and the intensely stubborn and single-minded part of me can’t help but seek to shun the stereotype.

An All Star Cast

If all the world’s a stage, then there are no mere players. We’re all the heroes of our own dramas; we’re all the guest stars in someone else’s story. I wouldn’t be the Cancer Diva that I am without spending all this time talking about myself – these are my Breast Monologues – but it’s actually not all about me. This is an ensemble production and there is a large company keeping the show on the road. Family and friends are the co-stars who provide the dressing room pep talks, support you at your petulant worst, brilliant best and everything in between, close ranks around you when you need to regroup, and bolster you with the confidence you need to step out onto the stage. They recognise, as I do, that cancer is merely a subplot – albeit a pivotal one – in a much richer and more interesting story, and whilst this Act happens to be more absorbing and gruelling than others, it doesn’t stop me playing my supporting role in all their lives. Just because I have cancer doesn’t mean I have lost perspective on life in all its ordinary glory. Just because I have cancer doesn’t mean I can’t play Hermione to their Harry, Shazza to their Bridget, or Morecambe to their Wise. Cancer is not a defining attribute – it’s just a thing that happens. Whoever we are – singleton, grandparent, husband or mother, sister, brother or significant other – sometimes it can be hard not to get swept away and swallowed up by the stereotypes society has created for us, but we always reserve the right to redefine the role on our own terms. And whatever setbacks we encounter as we tread the uncertain boards of life, we must simply pick ourselves up, dust ourselves down and go on the with show, because that is the stuff that star quality is made of.

There’s no people like show people, they smile when they are low
Even with a turkey that you know will fold, you may be stranded out in the cold
Still you wouldn’t change it for a sack o’ gold
Let’s go on with the show!

– Irving Berlin, Annie Get Your Gun

Links

https://www.breastcancercare.org.uk/get-involved/campaign-us/body-image-breast-cancer

http://www.macmillan.org.uk/information-and-support/coping/changes-to-appearance-and-body-image