COMMENTARY
Issam Makhoul , MD
Black and White
At age 45 , Mrs . S . saw the first white spots on her arms and legs . She ignored them in the beginning ; however , when they did not go away and started spreading to larger areas of her skin , she talked to her doctor . He looked undisturbed by her skin and said , “ Do not worry , this is vitiligo ,” and stopped . She asked , “ Is it going to go back to normal ?” Without looking at her again he said , “ Rarely does it happen ; at least I have never seen it .”
Over three years , her skin underwent a radical transformation from black to white . As this process was happening , her family and friends started withdrawing from her . Only her husband and children were sympathetic to her , to a point . One time she was stepping out of the bathroom into the hallway in the darkness of the night with only the moon rays from the nearby window lighted the hallway , when her husband , surprised by her presence , was startled . He collected himself and apologized to her . This was the prelude of many similar occurrences with other family members and friends .
In the beginning , she wore long pants , dark stockings , long skirts , and long sleeves to cover her whiteness . She felt ashamed . The last straw was when her face turned white . Cosmetic creams and makeup helped for a while , but it was so difficult to make it work any longer . She had to reveal her new face to the world . Now , it was her turn to be startled when looking in the mirror at herself every morning . She cried for days on end . Her doctor diagnosed her with depression and gave her a pill for it .
Years have passed by . Her completely white skin was “ beautiful – pure , smooth and clear .” For whatever reason , she also lost all hair on her body with the exception of her head . Every time she allowed some skin to be seen , she received praises from strangers in the stores or at the beauty salon . Little by little , she went back to wearing normal clothing that allowed her legs and arms to be seen . Slowly , she regained confidence . She would say jokingly to her family , “ I am the first blackwhite woman , and I am proud of it .” She would also think without daring say it to anybody else , “ What would I say of somebody who was born black and feels white or vice versa ?” or “ What would I say of the boy who feels he is a girl or the girl who feels she is a boy ?” Sometimes , her imagination would take her even farther , “ What would I think of somebody who thinks that they are an elephant or a tree or a dog ?” She knew that in the last cases people were likely sick but she was not sure about the other ones .
At age 60 , she was diagnosed with breast cancer . I saw her after her surgery . I walked into the room , introduced myself and was also surprised – only for a second – by the difference between her color and that of the rest of her family . After she told me her story , we agreed on a plan and started her on chemotherapy . As we proceeded with the treatment , she began noticing black spots on her face . I know from my experience with other black people that chemotherapy causes increased pigmentation on the palms and soles , and sometimes in the mouth and on the face . This effect is transient . It usually goes away a year later . After we completed chemotherapy , she asked me hesitantly , “ Do you think I may be black again ?” Her question caught me off guard . “ Are you not happy where you are now ? I thought you were .” She answered with a melancholic voice , “ Yes , but I had to give up my identity .” And after a moment of silence , “ If this were to happen , I mean , if I can become black again because of the cancer , I would consider cancer the best present that God has given me .”
After satisfying their physiological and safety needs , individuals focus on social relationships and belonging , esteem , and self-actualization . Central to these needs is the development of a clear and strong sense of identity . Diseases impact patients ’ identities in many ways . I never thought of cancer as a “ present .” As I hear some patients acknowledge how cancer was the wake-up call that they needed to change their life ’ s direction , I realize the power of the human spirit to turn adversity into success and salvation when provided with a nurturing environment . I do not know if Mrs . S . will ever be black again , but I am sure that her new identity was not able to erase her original one , probably because of the continued hidden bias against her . Her strong spirit helped her create a new identity despite social rejection and opened her eyes to understanding other people who were struggling to define theirs . How many patients have had a broken identity from disease and were unable to find a new one because there was nobody there to listen and accept them and give them a helping hand ?
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NUMBER 12 JUNE 2018 • 269