Book Review

Autobiography of a Face

N Engl J Med 1995; 333:949October 5, 1995

Article

Autobiography of a Face
By Lucy Grealy. 223 pp. Boston, Houghton Mifflin, 1995. $19.95. ISBN: 0-395-65780-6

Although physicians understand how a patient's definition of self and identity may be bound to the face, in Autobiography of a Face, Lucy Grealy writes about this topic from a unique and sobering perspective. At the age of 9, she underwent a partial mandibulectomy for Ewing's sarcoma, followed by 2¹/2 years of chemotherapy and radiation treatments. In her book, written when she was in her 20s, Grealy describes the daily burden of physical and emotional pain she bears and explores how this helped define her persona.

Whether trying to eat after chemotherapy or withstand the jeers of boys in junior high school, Grealy struggled every day to maintain her dignity and self-awareness. She captures how a physician can so easily instill hope or destroy confidence. Her description of failed nasal intubation is alarming. Neither nostril was patent, “so they decided to go straight through my mouth. This required prying my mouth open and keeping it open, which hurt like hell, but worse was that at each attempt to pass the tube, my airway was temporarily blocked and I couldn't breathe, which put me into a panic.” Grealy does not fault the medical establishment. Rather, her graceful and articulate prose describing a physician's routine reminds us of the sensitivity we must exercise in caring for patients. She has hope and faith in her physicians, who offer her a microvascular free-flap reconstruction. Grealy writes:

Maybe life was going to be all right after all. . . . What would it be like to walk down the street and be able to trust that no one would say anything nasty to me? My only clues were from Halloween and from the winter, when I could wrap up the lower half of my face in a scarf and talk to people who had no idea that my beauty was a lie, a trick that would be exposed the minute I had to take off the scarf.

Unfortunately, the flap reabsorbed, leaving Grealy thinking: “I felt like such a fool. I'd been walking around with a secret notion of promised beauty, and here was the reality.”

As surgeons we like to believe we understand how our craft can affect a person's identity; as physicians we like to believe we understand the psychology of self-definition and self-perception; and as human beings we like to believe we understand how our words can comfort and can even soften the blows from disease and treatments. Grealy, however, forces us to look through her eyes and see her face. We are not as gentle as we would like to think.

Grealy describes how her self-awareness and identity evolved. As doctors, we can only benefit from her candid thoughts and better understand how our words and actions help mold patients' perceptions of themselves. Finally, after arriving at a cosmetic solution, Grealy asks: “Where was all that relief and freedom that I thought came with beauty?” It is only after Grealy scrutinizes her inner self — that is, her personality, beliefs, and emotions — that the importance of her appearance fades and her true beauty is revealed.

Ross I.S. Zbar, M.D.
University of Iowa, Iowa City, IA 52242