Turning Heads: A Much‐Needed Project in Empathy

As the cover photograph of the 2006 book Turning Heads: Portraits of Grace, Inspiration, and Possibilities,1 the glamourous shot of a 40-year-old woman with cancer paid homage to an 1814 painting of a reclining nude by French artist Jean-Auguste-Dominique Ingrés. For women with cancer, the hair loss that accompanies chemotherapy can be a daily reminder of the disease and a physical transformation that strips away their self-image. After she was diagnosed with stage II breast cancer, film director and producer Jackson Hunsicker compiled and edited the book to help spur an “attitude adjustment” about how patients, their loved ones, and the rest of us perceive the disease and tend to shrink away from it. Turning Heads also taught a powerful lesson in empathy that inspired the creation of a nonprofit, the Turning Heads Project, to continue Hunsicker's work of allowing women with cancer to feel empowered, seen, and celebrated. “The whole idea was to give people self-confidence and show them that they don't have to become invisible because they're bald,” says project cofounder Debbie Miller, herself a lymphoma and sarcoma survivor from Palm Desert, California. After Miller was diagnosed with non-Hodgkin lymphoma in 2010 and underwent chemotherapy, she received the Turning Heads book as a gift from David B. Kaminsky, MD, her friend and pathologist at the time (now the executive vice president of the United States and Canadian Academy of Pathology and CytoSource's physician editor). Miller recalls how moved she was by the photographs showing women from so many walks of life—on the divan or on a motorcycle, with a surfboard or in a ballgown, radiant or introspective, with family or alone. They were living. Miller even spotted a black and white photograph of an artist that had been taken by another friend, photographer Michael Childers. “It totally changed my perception of what it means to be bald and to lose your hair while going through chemo,” she says. For his portrait of artist Pam Clerihan, then aged 58 years, Childers photographed her hugging herself and looking off to the side with her mouth set in a line of determination and her eyes sparkling with emotion. In the book, Clerihan wrote that she had thrown a party and invited everyone she knew to witness her hairdresser shaving her head. “After the party, from that moment on, there wasn't any, ‘Oh-look-at-her’ look. We all lost my hair together,” she wrote. In his own written reflection, Childers remembered how Clerihan relaxed throughout the photo shoot until she began to silently weep. Finally, it was okay for her to let go and allow herself to be fragile, he wrote. “Then it dawned on me, sometimes you have to be strong to cry.” Looking back upon the women he photographed for Turning Heads, Childers recalls being moved by their power and trying to capture their dignity. “I found that with their hair gone, there was an incredible shift of emphasis to their eyes,” he says. “The eyes truly are the windows to the soul.” After reading the book, Miller told another close friend, Stacy Jacob, that her only regret was not being in it herself. So, Jacob dusted off some photography equipment that she had in her garage, Miller brought over some clothes, jewelry, and makeup, and they did their own photo shoot to create a keepsake book with inspirational quotes. At the hoot, Jacob started a playlist that she had made just for the occasion, and on came “Pretty Woman” by Roy Orbison. In one of the photographs, Miller is up to her shoulders in a pool, wearing makeup and large hoop earrings and facing the camera with a confident smile (see the opening photo). The 2 women decided that they wanted to give the same experience to others and received permission from Hunsicker to found the nonprofit Turning Heads Project, which launched out of their living rooms in May 2010. Over the next decade, Miller and Jacob styled, pampered, photographed, and presented keepsake books to approximately 80 patients with cancer who were referred by word of mouth or by chemotherapy nurses and psychologists in the area. Reading what other people have gone through definitely helps because then you feel you're not alone. You're not the only one going through it. –Turning Heads Project cofounder Debbie Miller Kathryn Pollak, PhD, a professor of population health sciences who teaches empathy to medical providers at Duke University School of Medicine in Durham, North Carolina, says that patients who are undergoing chemotherapy tend to underreport their actual emotions during conversations with their physicians to avoid missing any treatment rounds. Recognizing and responding to emotion can be difficult for people in general, Dr. Pollak says, but emotions dealing with hair loss from chemotherapy are especially stressful for women because the hair loss alerts everyone else to the fact that they have cancer. “I don't think that oncologists quite grasp how big of a deal baldness is for patients,” she says. Projects such as Turning Heads are fantastic resources for combatting shame and stigma and for giving women the sense that they are being heard emotionally and do not have to go through it alone, Dr. Pollak says. Even so, she worries that some physicians may misinterpret the self-empowerment as a sign that the cancer treatment and hair loss are not truly traumatic. To them, Dr. Pollak says, “I would say that losing hair is a really big deal. But there are some women who are dealing with it, not resigning themselves to shame and to being out of control.” Clerihan died in November 2010, a decade after Childers took her photograph and 6 months after Miller and Jacob started their foundation. Hunsicker lost her own fight in December 2017. After fending off her lymphoma, Miller was diagnosed with sarcoma in 2015 and lost her right leg below the knee. Eleven months later, her husband died. Then, however, Miller fell in love with a man who had lost his own wife; they celebrated their second wedding anniversary in March 2020. Jacob went on to start her own photography business, thanks in part to her own experience with the nonprofit project. Miller does not try to hide her prosthetic leg when she is out and about. “Now that I do have what some people consider a handicap—I don't consider it that—I proudly wear my prosthetic everywhere with a short skirt or shorts because I'm bionic and I'm terrific,” she says with a laugh. The Turning Heads Project is currently on hiatus as Miller and Jacob move forward with their lives, but other women around the world are posting their own photographs and videos on social media and patient support websites. In one video, a Brazilian mother whose daughter has cancer shaves her daughter's head and then begins to lop off her own hair as her daughter gasps and cries; afterward, the bald mother and daughter pose together with broad smiles. The touching act of solidarity has been viewed millions of times on Twitter and YouTube. In an image that still appears on the Turning Heads Project homepage, a woman's face is framed by her outstretched hands and the cloud of glitter she is blowing toward the camera. The riotous, shimmering universe of pink and green stars and specks of color seems to envelope the entire space. The model, Heather, had been battling ovarian cancer for 6 years when she heard about the project from a chemotherapy infusion center. For the fi nale of her 2012 photo shoot, she wanted to pay homage to her favorite song, “Glitter in the Air,” by Pink. She certainly did, recalls Miller with a laugh, remembering that Jacob's living room was covered in it. “Her husband told us that she had never thought she was beautiful until she saw the pictures we took of her,” Miller says. At Heather's memorial service in 2013, the images of her were featured prominently: blowing glitter, laughing in a garden, smiling gently as her husband kisses her bald head. Unflinching. That was Heather's word, and she held it up proudly in one of her photographs, smiling and looking straight at the camera. Don't look away, her eyes say. I won't.

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