It was toward the end of her 15-day stay in the hospital, and Helen Gonzalez had not yet seen the entirety of her new body. At age 21, a car crash sent her flying through the windshield. Surgeons managed to save her right arm, badly sliced by the glass, but her left arm was amputated above the elbow.
In her hospital room, she had glanced down a few times to see the residual limb. However, it wasn’t until happenstance brought her in front of a floor-to-ceiling mirror in the entryway to the physical therapy department. “It’s like a dress. You don’t really know what it is going to look like until you get to that dressing room,” says Gonzalez, of the experience that sent her crying back to her room. “It makes all the difference, that mirror.”
Gonzalez, 48 and a senior executive assistant in Houston, has spent more of her life without her left arm than with it, yet her voice still quivers with emotion as she talked me through her mirror moment.
For two decades, stories like Gonzalez’s have driven Wyona Freysteinson, an associate professor of nursing at the Texas Woman’s University, to study mirrors and how patients interact with them following a body-altering accident or surgery, such as a mastectomy. Much of that niche research has centered on the first glimpse for patients and how healthcare professionals can turn that moment from traumatic to therapeutic.
“Right now, [patients] are being wheeled into elevators with mirrors and seeing themselves for the first time in a lobby on the way to the physical therapist,” says Freysteinson. “Really, all healthcare professionals should be thinking about this.”
It’s fair to say Freysteinson is near-obsessed with mirrors. A collection in her office of about 40 antique mirrors is evidence of that. It’s a fascination was fueled, in part, by an experience as a 16-year-old working in a nursing home. One evening, an elderly woman, weighing about 80 pounds and her body distorted from arthritis, requested a mirror. Freysteinson froze. “She is going to look at herself and immediately die because she is the ugliest thing I have seen in my entire life,” thought Freysteinson’s younger self. Instead, the opposite happened. As the woman looked at the reflection, tracing her finger over her features, “pain left her face and she looked at peace,” she says.
“Really, all healthcare professionals should be thinking about this.”
After that, Freysteinson was never without a small compact mirror during her early years as a nurse. If a patient had a breast removed or burns had wreaked havoc on a body, she would use her mirror to gently introduce them to their new body. As she moved into academia, she couldn’t help but study mirrors.
Freysteinson’s most recent study, published in the Rehabilitation Nursing Journal, detailed the experience of amputees and mirrors (her other studies have looked at mastectomy and terminal ill patients, as well as those with dementia). The study found that mirrors are crucial for checking the alignment of a prosthesis and the health of a residual limb. At the same time, amputees are reminded of the limb once there.
The study laid out how participants felt their first mirror viewing experience should have been, not what it was. They recommended it should not be left to chance. Rather, a mirror needs to be offered along with the option to view themselves privately or with a healthcare professional who is trained and ready to support the patient. “I think that we are really medically driven and when it comes to taking care of the psychological… that aspect of looking at [self] in the mirror is not part of that right now,” says Freysteinson.
Tamar Burr, 34, has undergone two amputations on her left leg due to a rare birth defect. The first time Burr viewed her body following the initial below-knee amputation was “in front of everyone in the whole therapy department,” she says. “I remember having such a rush of emotions, thinking ‘This is not something you want to do in public.'”
“I remember having such a rush of emotions, thinking ‘This is not something you want to do in public.'”
In between the amputations, Burr attended a study with Freysteinson, where she talked with other amputees about body image and experience looking in mirrors. By the time of Burr’s second amputation, an above-knee, she decided not to wait to look in the mirror and did it with her supportive prosthetist alongside her. “I knew how to utilize the mirror this time, to inspect the incision, but also to look at myself for the first time,” she says. “It helped a lot because it was support that I hadn’t had before.”
Freysteinson’s research hasn’t stuck with everyone, though. “For the entire time that I have studied this, people have looked at me as though I have two heads,” she says. Once, a doctor who performed mastectomies remarked to her that women “can just freakin’ look down at their chest and see that their breast is gone,” Freysteinson recalls. Perhaps doesn’t help that humans have a complicated history with mirrors; they have, at times, been associated them with vanity or evil spirits. The wicked queen from Snow White and the folklore of speaking “Bloody Mary” at a mirror to conjure up spirits are some examples.
And perhaps not all patients benefit from a grandiose first look in a mirror. Tracie Zenis, 45, had part of both breasts removed. The post-surgery reveal was gradual, as she went about the practicalities of changing dressings and dealing with drains, which are inserted tubes to speed up healing. “You don’t care what you see in the mirror,” says Zenis. “Plus, you’re just glad to get rid of the cancer,” she adds. For her, the thought of pausing for a first look in the mirror felt manufactured. But as Zenis pointed out, what she saw wasn’t the final result. She had breast reconstruction surgery 12 months later. Amputees, burn victims, and some mastectomy patients are often looking at their forever bodies.
For Freysteinson, her end goal is to educate other healthcare professionals on why they should take time to offer patients a mirror. “It should not be something that we hide from, duck from, avoid in restaurants, close our eyes in elevators,” she says. “I mean, it is just a mirror.”
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