Monday, November 19, 2012

"Worlds of Unknowing"

I recently read Lucy Grealy's Autobiography of a Face (1994).

Actually, I thought it was on my Classics Club list, but as it turns out, it's not. Oh well.

It's an extremely interesting--and yes, somewhat depressing--read. In 1973, at the age of nine, Grealy was diagnosed with Ewing's sarcoma, a rare form of bone cancer that typically afflicts children.

Over the next two years, she would undergo an aggressive course of radiation and chemotherapy (5 days a week) and a series of surgeries that eventually removed over a third of her jaw on the right side of her face.

And before you think, "Oh, but they can do wonderful things with reconstructive surgery...," stop. This was the mid-1970's. Chemotherapy was relatively new. Microsurgery was in its infancy.

Most people don't realize that reconstructive surgery on radiated bone and tissue is extremely complicated. Even if the body doesn't reject the graft, the radiated tissue has a tendency to simply "absorb" the graft over time.

In Grealy's case, she would undergo the pain and complications of a surgery involving extensive bone grafts designed to reconstruct her missing jaw (the bone was removed from her hip, which typically left her lame), only to watch as her jawline slowly disappeared again anyway.

And then they would try again.

Initially, when presented with the idea of reconstructive surgery, Grealy was told that the only option was a technique called "pedestaling." Because microsurgery was a relatively new field, the primary issue in reconstructive grafts in the early- to- mid-1980's was the problem of creating a sufficient blood supply to the graft itself.

To achieve this, "pedestals" were used: part of the graft was left attached to its original site and then slowly moved to its final destination. Grealy's description of the procedure is both explicit and horrifying:
In the first operation, two parallel incisions would be made in my stomach. The strip of skin between these incisions would be lifted up and rolled into a sort of tube with both ends still attached to my stomach, resembling a kind of handle: this was the pedestal. The two incisions would be sewn together down its side, like a seam. Six weeks later, one end of the handle would be cut from my stomach and attached to my wrist, so that my hand would be sewn to my stomach for six weeks. Then the end of the tube that was still attached to my stomach would be severed and sewn to my face, so that now my hand would be attached to my face. Six weeks after that, my hand would be cut loose and the pedestal, or flap, as they called it, would be nestled completely into the gap created by my missing jaw. This would be only the first pedestal: the whole process would take several, plus additional operations to carve everything into a rcognizable shape, over a period of about ten years altogether. (154)
Ultimately, Grealy found a microsurgeon, so she never had to undergo the pedestal procedure described above.

What I think Grealy manages to convey throughout her narrative--beyond the mind-boggling description of a sequence of operations that sound like the stuff of science fiction--is a sense of how the regular experience of this kind of perception of and relationship to one's body shapes one's sense of oneself.

Grealy was fifteen when the pedestal procedure was suggested.

In interviews and at public readings, Grealy expressed dismay at the extent to which she was often defined solely in terms of the content of her story. She was a writer. She wanted her story to be read on the basis of its literary merit, not simply as a tale of her "triumph" over cancer.

Autobiography of a Face is thus about identity and physicality, but it is not solely about the role that the body--or, more specifically, the face-- plays in the construction of identity.

As the world looks at Grealy's childhood face and stares or cringes, and as Grealy herself attempts to come to terms with whether or not to look at her own face and its implications, her narrative account meditates on all of the other ways we understand the trajectory of life's direction and its significance.

For instance, Grealy describes how her cancer diagnosis first unfolded. It's a malignancy with few symptoms, and Grealy never actually realized she had it.

One day, she was playing dodge-ball and collided with a classmate. By the next morning, her jaw had swelled and she couldn't open her mouth. Initially, they simply thought she had fractured her jaw.

Grealy reflects on the sheer coincidence of this discovery of a life-threatening condition:
It's impossible for me not to revisit this twenty-year-old playground scene and wonder why I didn't go right when I should have gone left, or alternatively, see my movements as inexorable. If the cancer was already there, it would have been discovered eventually, though probably too late. Or perhaps that knock set in motion a chain of physical events that created an opportunity for the cancer to grow which it might not otherwise have found. Sometimes it is as difficult to know what the past holds as it is to know the future, and just as an answer to a riddle seems so obvious once it is revealed, it seems curious to me now that I passed through all those early moments with no idea of their weight. (27-28)
These are the moments of sheer beauty in Grealy's text, I think: the points at which she pauses, poised on the threshold of discovery, to reflect on what she characterizes as the "worlds of unknowing" that we all inhabit on a daily basis.

Hospitalized for yet another surgery, she shares a room with a teen who dove off a two-story building into his friend's pool. As Grealy observes, "Michael, at the age of seventeen, was permanently paralyzed, all because of a stupid trick that took him ten seconds to perform":
When I got home, I thought of Michael again and again. Did he ever reimagine himself standing on that roof or try to remember what it was like to not know his fate for just one split second longer? If he didn't, I did it for him. I'd close my eyes to feel the height, see the bright blue of the pool winking below me, bend my legs, and feel the pull in my calves as I jumped up and then down, falling from one world of unknowing into the next one of perpetual regret. (175)
Lucy Grealy died of a heroin overdose in New York City in December of 2002.

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Ralph Waldo Emerson once wrote, "Life is short, but there is always time for courtesy."