SOURCE: "Staring Pain in the Face," London Review of Books, March, 1995, p. 16.

[In the following review, Robbins asserts that in Autobiography of a Face Lucy Grealy "has created a beautifully written re-creation of and meditation on her illness and treatment, growing up, love, and the years spent being her face."]

At the age of nine, Lucy Grealy learned she had Ewing's sarcoma. An operation removed the tumor along with half of her jaw, and was followed by two years of radiation treatment and two and a half years of chemotherapy. Her chances of survival were around five percent.

I had my own preconceptions of what Lucy Grealy's account of her illness and its effect on her life would be. Eleven years ago I could have been sitting with Grealy's mother in the hospital. My daughter wasn't ill—she had been hit by a car just before her eleventh birthday. For thirteen days she was in a coma; she had a broken leg, cracks in her pelvis, bruised nerves in her neck that paralyzed her left arm. Now she is completely recovered. She graduated from college this year, has a job, her own apartment. The pain of those weeks in the hospital and years of recovery has never really been assimilated. But I confront that pain as a parent, who is supposed to protect her child from such destinies as car accidents or serious illness. Lucy Grealy confronts that pain from the perspective of the child, and the poet she has become, and has created a beautifully written re-creation of and meditation on her illness and treatment, growing up, love, and the years spent being her face.

Grealy and her twin sister were the youngest of five children of an Irish broadcast journalist. The family emigrated to the United States when Grealy was four. Despite her father's initial success on network television, the family always had money problems, her mother suffered from depression and fits of anger, and her oldest brother eventually was diagnosed as a schizophrenic. When Grealy was sixteen, her father died of pancreatitis. Despite these elements of "dysfunctional" family, Grealy's account of her cancer, the treatment and the years of operations to "fix" her face never slips into melodrama. Indeed, her lucid evocation of events many would want to forget illuminates far more than her own reality.

Grealy tells two stories, of her illness and her appearance, and it is the latter one that will no doubt touch most readers. What teenage American girl, after all, hasn't thought at some moment that she was ugly? But Grealy's experience was on a different level; people really did stare, classmates were extremely cruel. To survive, Grealy developed a series of defenses, which she elucidates in fine detail.

Grealy was still a child and proud of her "tomboy heritage" when the cancer struck, and at first she ignored the changes in her appearance from surgery and treatment. But eventually her appearance became her defining nature: "This singularity of meaning—I was my face, I was ugliness—though sometimes unbearable, also offered a possible point of escape … the one immediately recognizable place to point to when asked what was wrong with my life."

Her mother gave her a sailor hat to cover the baldness from chemotherapy, and she clung to it as a barrier against people's stares. She had already felt a chasm open up between herself and her family, when her mother's Orthodox Jewish colleagues at a nursing home had offered her discarded wigs. At first the wigs had been a family joke with everyone, but when Grealy and her mother went to a custom wigmaker—and Grealy realized her mother might actually spend scarce money for one—she was appalled. Grealy thought the wigs made her look ridiculous, was amazed that her mother didn't think so too, and equally amazed that she didn't know Grealy's true feelings.

When her hair grew back, she almost unconsciously adopted a posture in which it hung down to cover her face. At first she met the teasing of other children with sarcastic retorts of her own; but as time went on, and especially when she reached junior high and high school, she tried to overcome the insults and teasing, primarily from boys, by training herself to believe that true beauty had nothing to do with looks, or by trying to forgive her taunters:

I thought that if I could do this, the pain they caused would be extinguished. Though I had genuine glimpses of what charity and transcendence meant, I was shooting for nothing less than sainthood; often, after my daily meeting with them, I only ended up hating myself instead.

She still had girlfriends, whom she now thought of as from her life "Before"—as well as friends she met on the children's ward at the hospital, in the life she labeled "After." Answering the questions of her friends from Before was in part an exercise in storytelling, even as she believed "they'd never understand what it was really like." Among her friends at the hospital, however, she and they could "redefine for each other what it was like to be sick."

When her doctors began talking about reconstructive surgery, she felt relief—"Maybe this wasn't my actual face at all but the face of some interloper … and my 'real' face, the one I was meant to have all along, was within reach"—followed by perplexity:

I had put a great deal of effort into accepting that my life would be without love and beauty in order to be comforted by Love and Beauty. Did my eager willingness to grasp the idea of "fixing" my face somehow invalidate all those years of toil?

Only at Halloween, when she could cover her face with a mask along with everyone else, did she feel the freedom she believed others felt all the time. But the years of reconstructive surgery raised and dashed hopes so many times that when she finally had a face others considered hers, she felt empty, "without the framework of when my face gets fixed, then I'll start living." It took her almost a year to learn to see herself, both literally and figuratively, and her insights into learning to treat herself better are flashes of intuition we can all use.

What most moved me, however, were Grealy's confrontations with illness, hospitals, pain and their reverberations on her relationships with others. At first she was excited by the attention and medical trappings. Her favorite television shows were Emergency! and Medical Center, and her first two operations rescued her from unfinished homework assignments. Later, hospital stays were times when she felt cared for, though at the same time ashamed—"Was there something wrong with me that I should find such comfort in being taken care of so? Did it mean I liked having operations and thus that I deserved them?"

She describes the hierarchy among hospitalized children: "The truly sick were at the top, but of course being too sick worked against you as you couldn't enjoy the status." She remembers her confusion on realizing that the almost three years of chemotherapy and radiation treatment were done: "As hard as it was to admit this to myself, I was afraid of it ending, of everything changing. I wouldn't be special anymore; no one would love me." At the same time, she resisted others' pity and felt intense embarrassment when, at her elementary school graduation, the vice-principal praised her bravery.

Coping with pain became one way Grealy tried to build up her self-esteem.

It gave me pleasure to think that the boys who teased me openly at school and the adults who stared at me covertly elsewhere would never be able to stand this pain…. My whole body was tense and my stomach upside down, but I was convinced that because I did not admit these things, did not display them for others to see, it meant I had a chance at really being brave….

But what really helped her through adolescence was horses. She loved animals and at fourteen got a job at a stable. Caring for the horses made her feel cared for; the animals didn't care what she looked like, only what she did for them.

In one episode Grealy shows how a child takes a parent's remark and turns it into an axiom of life. After her first chemotherapy session, when she cried before the injection, her mother tried to reassure her that crying was only from fear, she shouldn't be afraid, there was no need to cry. At nine, Grealy only partly understood. As she reflects now:

My mother didn't know how to conquer what I was afraid of, nor could she even begin to tell me how to do it for myself. Instead, out of her own fear, she offered her own philosophy, which meant in this instance that I should conquer the fear by not crying…. I resolved to never cry again.

It was a resolve she could not meet, and she hated herself for not being strong enough. Some months later, when she noticed her mother's eyes filled with tears, she understood for the first time that her mother "was suffering not just because of, but also for, me."

Her relationship with her father seems simpler yet more poignant. Her mother's presence forced Grealy to take her into account as she suffered through the treatment sessions. But when her father took her, he couldn't bring himself to stay, thus leaving her at least "free to respond as I chose."

Grealy's writing is so marvelous that the gaps in her story are well hidden. The relationship with her twin, Sarah, for example, is barely touched on: Grealy doesn't even say whether she is an identical twin, and we're left to wonder whether Sarah had the face Grealy thought was her own "real" face. We hardly know how her siblings reacted to her illness—though she makes it clear that her family doesn't talk easily about emotions—or how much they might have contributed, even unwittingly, to her sense of ugliness or isolation. That it was her older sister, Susie, who put her in touch with the surgeon who finally succeeded in remaking her face might indicate both effort to help and concern about appearance.

But in the end these gaps do not damage Grealy's story so much as they illuminate it. Illness of this sort is isolating, no matter how much people love you or try, however ineffectually, to help. Grealy's descriptions of her attempts to confront that isolation also testify to isolation's numbing aspects. Her father's fatal illness was brief and came just months after the horse she loved died—yet grief at her father's death didn't seem to hit her until more than a year later. As she attempted to reconstruct his presence, the few details she could remember served only to underscore how little she knew him.

Grealy's memoir of living through and growing up with hardship is full of moments that both warned and chilled me. Illness—or injury—reveals how impotent parents are to protect their children, and also how difficult it is for parents or children to understand each other. If I were Grealy's mother, I would be immensely proud of her for writing this marvelous book; yet I probably couldn't bear to read it myself.