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There was a long period of time, almost a year, during which I never looked in a mirror. It wasn?t easy, for I?d never suspected just how omnipresent are our own images. I began by merely avoiding mirrors, but by the end of the year I found myself with an acute knowledge of the reflected image, its numerous tricks and wiles, how it can spring up at any moment: a glass tabletop, a well-polished door handle, a darkened window, a pair of sunglasses, a restaurant?s otherwise magnificent brass-plated coffee machine sitting innocently by the cash register.

Lucy Grealy: There was a long period of time, almost a year, during which I never looked in a mirror. It wasn?t easy, for I?d never suspected just how omnipresent are our own images. I began by merely avoiding mirrors, but by the end of the year I found myself with an acute knowledge of the reflected image, its numerous tricks and wiles, how it can spring up at any moment: a glass tabletop, a well-polished door handle, a darkened window, a pair of sunglasses, a restaurant?s otherwise magnificent brass-plated coffee machine sitting innocently by the cash register.

The Face of Pain

Lucy Grealy, whose 1994 memoir, “Autobiography of a Face,” was a fearless account of growing up with a disfigurement caused by cancer, died Dec. 18, 2002, in New York City. She was 39. She had accidentally taken an overdose of heroin. Her life had been hard, but she had also experienced more joy than many.

Her fiercely honest account of this tortured existence and what it was like for her to be “ugly” in a society obsessed with physical beauty captured national attention. For a time she was the toast of talk shows and literary circles. However, she suffered from depression. She had been staying at the home of friends at the time of her death.

Born Lucinda Margaret Grealy (pronounced GRAY-lee) in Dublin, Ireland, she was one of five children. Her father, Desmond, helped found RTE, the Irish national broadcasting network, before he moved the family to Spring Valley, N.Y., when Lucy was 4.

Grealy was diagnosed with Ewing’s sarcoma, a rare and often lethal form of cancer that began as a dental cyst. Starting when she was 9, Grealy had chemotherapy and radiation treatments as often as five times each week for five years. It dissolved nearly half of her jaw bone.

Grealy wrote of her nine-year-old self facing cancer, ?Every day I?d have some test, and it never occurred to me to ask what was going on, what the tests were for, what the results were.? We all get caught up in systematic processes, like medical diagnoses or job searches, and neglect to stop to think about what?s really going on and what the results will mean in the long run. We?re swept along by a lot of life?s goings-on.

Over the next 15 years she had 30 surgeries, hoping each time to restore her once-pretty face. Most of the operations were failures.

Grealy’s memoir about the long years leading up to her imperfect face launched a book tour and a spate of articles about her. Interviewers invariably described her large, bright eyes as expressing a type of wisdom formed by pain.

In the book, Lucy detailed her quest to reclaim her jaw, disfigured by cancer. Suddenly, she was the toast of literary New York, beloved for her quick wit and wild streak, saluted for her grit. But her endless surgeries left her so weak, impoverished, and dependent on drugs that even her dearest friends couldn?t save her.

Well before the publication of Autobiography Of A Face, Lucy had become friends with another writer,?Ann Patchett. Ann was hugely patient with Lucy, who could be infuriatingly disorganised and irresponsible. She was able, it seemed, to accept Lucy’s constant need of approbation and affection, even when Lucy herself ignored, and even scorned, those needs in others. Ann was a good friend. Lucy’s life became harder, with endless reconstructive surgeries, frustration at her inability to recreate the crystalline beauty of Autobiography, and a loneliness she attributed to being “ugly”. Ann supported her throughout, with company, money, food and love.

I?knew Lucy Grealy for several years before she knew me, and now that she?s dead, I think of all the years I will know her again in this one-sided way, me thinking of her. We started college together in 1981. Even at Sarah Lawrence, a school full of models and actresses and millionaire daughters of industry, everyone knew Lucy and everyone knew her story: childhood cancer, endless reconstruction. She was the campus mascot, the favorite pet in her dirty jeans and oversize Irish sweaters. She kept her head tipped down so that her long dark-blonde hair fell over her face to hide the fact that much of her lower jaw was missing. It was her work-study job to run the film series on Friday and Saturday nights, and before she would turn the projector on, it was up to her to walk in front of the screen and explain that in accordance with the New York State fire marshal, there were exits located at either side of the theater. Only she couldn?t say it, because the crowd of students cheered her so wildly, screaming and applauding and chanting her name, ?LOO-cee, LOO-cee, LOO-cee!? She would wrap her arms around her head and twist from side to side, mortified, loving it. Her little body, the body of an underfed 11-year-old, was visibly shaking inside her giant sweater. Finally, her embarrassment reached such proportions that the audience settled down. She had to speak her lines. ?In accordance with the New York State fire marshal,? she would begin. She was shouting, but her voice was smaller than the tiny frame it came from. It could not be heard past the third row.

I watched this show almost every weekend. It was as great a part of the evening?s entertainment as seeing?Jules et Jim. Being shy myself, I did not come to shout her name until my junior year. By then she would wave to the audience as they screamed for her. She would bow from the waist. She had cut off her hair so that we could see her face clearly. It was always changing, swollen after a surgery or sinking in on itself after a surgery had failed. There was the year that she walked with a cane and someone told me it was because they had taken a chunk of her hip to graft into her jaw.

Everyone knew that Lucy was the poet. I wrote short stories. I thought we were not so far apart, but when I waved to her in passing or said hello in the cafeteria, she would look at me blankly for a minute and then look away as if we had never met. Lucy Grealy was much too cool for the likes of me, a girl from Tennessee who did not go to clubs in the city.

I graduated from college early and went home to Nashville, where I put my liberal-arts education to use as a line cook in a restaurant. Soon after I received my letter of acceptance from the M.F.A. program at the University of Iowa, I got a letter from Lucy. Her handwriting was small and oddly scrawny. She said that when our mutual friend Jonathan Wilks had first told her that I had gotten into Iowa, she was disappointed because she wanted to be the only Sarah Lawrence person to be admitted. But then he had also told her that I was going out early to find an apartment, and if this was the case would I find one for her as well? She was having a surgery over the summer and wouldn?t be able to go and look. She reminded me that she was on a very limited budget.

It never occurred to me to tell her no. Lucy had the pull of celebrity, and while she had always ignored me, I was flattered to be asked for help. Besides, she would be the only person I knew in Iowa. I borrowed my mother?s car and drove up in the early part of summer and quickly found that there was not a single apartment Lucy could afford, nor was there a single apartment I could afford. There were very few that we could have managed if we pooled our resources, and so I rented half of a very ugly green duplex on Governor Street for $375 a month. When I got home, I wrote and told Lucy that we would be roommates.

I rented the smallest U-Haul truck available, and my stepsister, Tina, and I drove to the Midwest with the few things I culled from my family?s basement: a single bed mattress and box spring, a chair, a coffee table, a tiny bureau, a few pots and pans. We watched as the hills of Tennessee flattened out and the trees gave way to fields until finally we were driving on a tabletop covered in corn, the highway making a neat cut through the middle. It was late August and scorching hot. We were sticky from sweat and all the candy we had eaten on the way. We pulled up to the house on Governor Street and found the front door open wide. The place was completely empty and the linoleum floor was wet with Pine-Sol. I stood at the threshold, not entirely sure about just walking in. I called her name from the door. ?Lucy??

She shot out from the back bedroom with a howl, was through the living room and up into my arms, leaping up onto me, her arms locked around my neck, her legs wrapped around my waist, 95 pounds that felt no more than 30. She was crying into my hair, squeezing her legs tighter. It was not a greeting as much as it was a claim: She was staking out this spot on my chest as her own, and I was to hold her for as long as she wanted to stay.

?What happened?? I said, and I put my arms around her back. There was never such a little back, and I felt it heave and sob. I had thought something horrible, only something truly outside my understanding of bad things, could drive this girl into my arms.

She pulled back to look at me. She kissed me and smiled and cried again. ?I?m so glad you?re here,? she said.

I do not remember our love unfolding, that we got to know each other and in time became friends. I only remember that I walked through the door and it was there, huge and permanent and first. I felt I had been chosen by Lucy, and I was thrilled. I was 21 years old and very strong. She had a habit of pitching herself into my arms like a softball without any notice. She liked to be carried.

?Dearest anvil,? she would write to me six years later, ?dearest deposed president of some now defunct but lovingly remembered country, dearest to me, I can find no suitable words of affection for you, words that will contain the whole of your wonderfulness to me. You will have to make due with being my favorite bagel, my favorite blue awning above some great little caf? where the coffee is strong but milky and had real texture to it.?

Lucy had gone to the local auction her first night in town, and there she had met a man who was handsome and twice her age. He had given her a ride in his sports car and then taken her home and made love to her. Years later in her memoir,?Autobiography of a Face, she called the man Jude, not because she was afraid he would sue her but because she didn?t want to give him the pleasure of seeing his name in lieved to have finally ditched the burden of her virginity, but what was the point of having sex with a man if you didn?t have a girlfriend to tell the details to? For three days, she had waited in our duplex for me to arrive. She hadn?t had the money to connect the phone service.

For two people who didn?t know each other, Lucy and I had a lot in common: not only friends and classes from college and a vaguely stunned feeling about having found ourselves in the Midwest but also about four hours? experience with men between us. We had both made it through high school without a single date. We had both had our first kiss from the same boy in college (a sainted and tender soul who must have made it his business to kiss the girls who would otherwise have graduated unkissed). Lucy had infinitely more flair than I did. She had danced in New York?s finest transvestite clubs, where she was once again regarded as a sort of lovable mascot. She had had adventures that were, if not sexual, at least sexy. And now she was having sex.

Lucy continued off and on with Jude for the two years we were in school. She came home early most mornings looking rumpled and calm. In those days, she had a four-by-four gauze pad folded and taped to the side of her jaw that she wore constantly. I never saw what was under it, though I pointedly asked her to let me see several times. I became so used to it that after a while, I thought of it as part of her face. She would pour a cup of coffee and sit down across from me at the table.

?Bondage,? she would begin patiently, ?is not about a desire to be dominated.?

And so began our sexual education, with Lucy attending the demonstrations at night and me reading off her notes in the morning. I would make her a bowl of Cream of Wheat while she talked about pornography, fetish, and whatever had happened the night before. We talked about books. We shared our copies of Nabokov and Garc?a M?rquez. Lucy was always the more ambitious reader. I stayed with fiction, while she went through philosophy and film criticism and heavy art-history books she lugged home from the library. Lucy?s particular genius was the ability to take the disparate subjects she read about and find the ways that each one informed the other. We talked about classes and poetry and politics and sex. But the core of our love was based in the little home we had together. I cooked what we referred to as Lucy-Food, a steady diet of things that did not have to be chewed, soft lasagna and half-done pancakes. After meals, we danced in the kitchen. Lucy was a brilliant dancer, and I was tireless in my efforts to imitate her.

We would dance for hours, dance until our feet ached from the linoleum floor, at which point Lucy would go and get in the tub (Lucy, skinny, was always freezing and could most often be found in the bath). I would sit on the edge and smoke cigarettes and we would talk about our bodies. Most people thought that Lucy?s story was in her face, a history in the irregular line of her jaw, but it was in her entire body. It had been systematically carved apart for its resources over the years: The skin and muscle taken from her back had left wide swaths of scar tissue; delicate, snaky scars wrapped around her legs because some surgeon had needed an extra vein; one hip had been mined for bone grafts and had left a spiky stalagmite peak that pushed threateningly against the ropey pink skin. In the future, they would take her lower ribs and a bone from her leg and the soft tissue from her stomach and pour them all into her jaw, where they would gradually melt away into nothing. But while she was tortured by her relationship with her face and talked about its being ugly, she had a real fondness for her body. Every scar was a badge of honor. She had a lack of physical modesty common to many people who had spent that much time naked in hospitals.

Outside of the moments we were together in the green house on Governor Street, Iowa City wasn?t such a wonderland for either of us. Jude proved to be more insane than the sex was worth. In retrospect, we should have seen this coming, but we had no experience to judge him against. I had made an equally poor choice of partners, but at least I now had something to add to the discussions over breakfast. Instead of giving us the companionship we had hoped for, the men made us lonelier, a feeling that was especially hard for Lucy, who had spent so much of her childhood in the isolation of illness.

Years later, I thought about the loneliness of Iowa and how it wasn?t so bad when we had each other to come home to. She wrote to me, ?Lately I?ve been completely obsessed with loneliness: it colors everything I see these past few weeks. It?s okay to be lonely, I know that, but I don?t like the way it?s become the thing by which I measure everything else. I can?t seem to try to not be lonely: it only seems to happen accidentally, like this afternoon. I?ve started several letters to you, even finished a few, and even got one into a stamped envelope, but they were all so whiney, so pathetic, I just couldn?t bring myself to post them. I?m not too sure this one will make it, but I?ll try. In the others I kept trying to explain why I was lonely and pathetic, but maybe I should just simply skip that, announce it in a single sentence, then get on with the letter. I?m lonely and pathetic. There it is.?

On the cold mornings that we were both home, Lucy would get up in the dark early hours and come into my room. ?Scoot over,? she?d say, and I would press up against the wall beside my single bed and she would crawl in beside me and wrap her arms around my waist. ?Someday we?ll look back on all of this and we won?t even believe we were here,? she?d whisper. ?We?ll say, ?Do you remember when we used to live in Iowa?? ?

I?d smile, warm, already falling back to sleep, telling her: ?We?ll say, ?That happened during the Iowa years.? ?

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Lucy Grealy

None of this is to say that I was Lucy?s only friend, or the only person she could really talk to, or the person with whom she had had some kind of fundamental breakthrough in intimacy. The truth was that Lucy had a genius for friendship. At any given moment, she could think of 50 different people she could call for coffee. There were at least a dozen people who would have taken her in and taken care of her for years at a time. She loved her friends, and we all loved her passionately. She was able to offer up the deepest part of herself over and over again to people she liked, and in return, we were willing to do anything for her. ?There are a lot of people who think they?re my best friend,? Lucy liked to tell me. ?But you actually are my best friend.? I always imagined she said it to a lot of people, but it didn?t matter. That was her gift: herself, her intimacy. After we left Iowa, I would always feel a tremendous sense of relief whenever we were together again, as if I was now finally able to speak my own language after having to stumble through for so long in awkward French. Again and again in her letters, she spoke of how we should plan to go away to another country, replicate the Iowa years of our life. I made a mistake not taking her up on it.

Lucy tried constantly to find and fully participate in any joy that was available to her, but still she was pulled into blistering bouts of depression. Her grief about feeling ugly and her desire to be loved in a way that would be huge enough to meet her needs would regularly roll her into a little ball and paralyze her. She would cry for hours and then for days. I had grown up bearing witness to depression, but Lucy?s darkness terrified me, in large part because it made such perfect sense. No matter how anyone argued for the virtues of her talent and her friendships, the many jewels of her life, there was no denying the fact that what she had been through and what was still ahead of her seemed insurmountable. She would tell me she wanted to go out to the cornfields wearing a light jacket at night, drink a bottle of whiskey, and lie down in the snow. I would pull her into my lap and hold her and kiss her hair.

I came to understand early on that I could not worry about Lucy, that it was just too enormous for me to manage and that worrying about her would swamp me. It happened one night while we sat in a sports bar drinking, waiting out a terrible rainstorm before we could walk home. We had just gone to see an especially stupid romantic comedy, and now she was crying, saying she was always going to be alone and that she couldn?t stand it anymore. I was stunned by the rawness of her pain. I decided then that I would take all the hours of my life that could so easily be spent worrying and instead try to help her. I would do anything I could.

Lucy stayed on in Iowa for a while after I went back to Tennessee. I brought home the man I had been dating in school, thinking that marrying him might solve our innumerable problems. Lucy went to London and stayed with her sister, Suellen. Suellen read an article about a plastic surgeon in Aberdeen, Scotland, who was doing pioneering work in facial reconstruction. Lucy went to meet with Oliver Fenton, and it was agreed that she was an excellent candidate for the procedure, which would take about three months. When I got divorced a year later, she was still there.

?Got home from the hospital today to find my Saint Lucy medal waiting for me,? she wrote from Aberdeen. ?I have always wanted one of those. Thanks: it?s just so amazing to me how good you can make me feel, more than anyone else (sounds like a pop song, I know).

?My eye is still swollen, not so bad as Friday, but it?s still a real problem aesthetic-wise. Monday Mr. Fenton came round and said there wasn?t anything he could do, that I was stuck with the problem, that maybe it would get better, maybe it wouldn?t, and in the meantime I had to decide did I want anymore surgery as that would surely make it worse. He was so flippant about it; so short and curt, as if he were telling me anything other than that all of this had been a total flop. It really upset me, what he had to tell me and the way he told me. I spent the night crying uncontrollably, all the nurses trying to console me. Finally the head nursing sister came and talked to me and she said she?d let him know how upset I was. The next day he was supposed to come talk to me, but in the end he didn?t have time, so now I?m supposed to go back on Monday. I just don?t know, Ann, I just don?t know. Sometimes I feel real calm and wise and accepting and other times I?m totally on the edge. When I wear the guise of alienated poet I do okay, everything seems if not actually good, then at least placable. When I try and wear the guise of a woman, it?s a disaster.?

I was living out my own disaster on a smaller scale: I was 25, divorced, out of a job, and back home. My stepfather, knowing that the best chance I had of getting over things was being with Lucy, bought me a ticket to Scotland.

Lucy had two tissue expanders in Aberdeen, first on the right side and later on the left. The expander is a process of surgically placing a balloon under the skin and then injecting a small amount of saline solution into it every day so that the skin is stretched and then can be used in surgery. When she came to meet me at the airport, she looked like she had a tire of flesh stitched beneath her face. Her face, normally faulted for being too small, her jaw an unfinished ledge that simply dropped off into nothing, was now huge. When she saw me, she was already crying, the weight of so much time being alone over now for a little while. She climbed into my arms there at the gate and I held her.

Aberdeen was largely a rig town, which meant the men worked three weeks off-shore on the oil rigs and then came into town for a week, fat with cash and wanting to stay as drunk as possible. It was a brutal place for tissue expanders. Lucy was chased, harassed, and teased with a viciousness she had not endured since junior high school. She told me she would sometimes run out of food and be too terrified to go to the store around the corner. But together we spent our nights in Caf? Drummond and our days in a restaurant called the Nile. Her room at the time was a kind of YMCA dorm, six girls each with a tiny bedroom sharing a kitchen and a living room. When we put up my cot, there wasn?t an inch of remaining floor space. For both of us, those weeks together were the happiest we had that year.

One night, coming home late in the freezing damp wind after a couple of drinks at Drummond, I was struck by the terrible mess I had made of my life. Walking up the street in the darkness, I complained to Lucy: I was divorced, I?d quit my teaching job to get away from my husband, I was broke, I felt impossibly far away from writing.

?Oh, you?ll be fine,? she said lightly, wanting to move ahead to another topic. I stopped. ?I?ll be fine? That?s it? I?ve wrecked my life, come to Scotland, and all you have to say is that I?ll be fine?? I had spent plenty of time on her sadness, and now I wanted a minute for my own.

Lucy looped her arm through mine and pulled me forward. ?It?s true,? she said, leaning her head on my shoulder. ?It?s your blessing and your curse. You?re always going to be fine.?

Lucy worried as much about whether she would be a writer as about being alone: ?I?m still racking my brains to figure out where I went wrong. I am very negative about ever getting any sort of luck in writing or love or anything at all. It?s not just luck, I know I have to make it happen, but in the end you can?t force someone to publish your work or accept your love,? she wrote. She worked hard on her writing, and when she finally got out of Scotland after three years, she had won a Bunting fellowship at Radcliffe College. There she wrote an essay for?Harper?s?about her face, the thing she had been hoping to transcend. The essay led to a book contract; another long fellowship at the Fine Arts Work Center in Provincetown; and finally, in 1994, the publication of?Autobiography of a Face.

I?ve never known a writer who hated to write quite as much as Lucy did. On any given day, you could find her at the Governor Bradford in Provincetown, having a drink and shooting pool, talking about how awful it was to live under the pressure of a book that was due. At the same time, there has never been a writer who took more pleasure in her success. Lucy?s true destiny, it turns out, was to spend her afternoons doing photo shoots at fashion magazines, stay out late at every fashionable dinner party, and then get up early for a spot on the?Todayshow. She was comfortable and eloquent with Charlie Rose and Lenny Lopate and CNN. She was everywhere. She got a good-size loft on Mercer Street in Soho. The supermodels called out to her as they all tripped home on the cobblestone streets in the early hours of the morning, ?Hey, Lucy! Hello!? But she only nodded slightly and turned away, seeming too cool for the likes of them.

I had learned early on in our friendship why it was that Lucy never talked to me in college: She had no idea who I was. Everyone knew her name, remembered her story, and spoke to her. She had long ago given up on keeping a world of strangers straight. She put absolutely no effort into remembering people, so that it was quite possible to talk to her on ten different occasions and still have her say at some point, ?Have we met before??

Those were the very best days. The world was in agreement that her book was brilliant and that the author was both heroic and fascinating. Lucy never liked being alone, and the more famous she was, the more people there were to press up against her. She did not have the true love she wanted, but she had plenty of sex and a couple of guys who were very steady in her life. She stopped trying to be a writer for a while and let herself be what she most wanted to be: an interesting thinker. No matter how you try to dress it up, writing is a solitary act. Lucy was a brilliant conversationalist, and in a sense she did her best writing while talking to other people. Now her world was filled with smart people to talk to.

I was at the Bunting Institute the year Lucy?s book came out, finishing up my second novel. We took the train back and forth between New York and Boston and had the money to talk on the phone every day. But Lucy?s money ran out long before her celebrity. She seemed to have a nearly magnetic pull toward poverty. The more that came her way, the faster she managed to blow through it. Lucy gave money to friends, bought a horse, went to Istanbul. She threw me a book party when that second book was finished. I once found more than $50,000 in checks stuck to the front of her refrigerator with a magnet. ?I never get to the bank,? she said.

?But why on the refrigerator??

?I just found the check from the Whiting. I thought it would be safe there where I could see it.? Lucy had won the Whiting Award that year to the tune of $30,000. The check for the first half of the prize had gone missing for more than a month, and she was dreading having to ask them for another.

Lucy owed the world a fortune: student loans, back taxes, unpaid hospital bills. She screened her calls to avoid collection agencies. Once, years after her success, when she was having an especially bad bout of depression, she stopped opening her mail for months. She simply dumped it in a giant Hefty bag by her front door. The bigger the bag became, the more depressed she got. I told her to carry the bag to a mailing store and have them send it to me, which she did. The piles of bills, up to fifteen notices for the same request, covered my floor. I forged her name on overdue contracts and paid off everything I could manage, which left out the student loans and federal taxes.

With the success of her first book, everyone wanted a chance at her second, but coming back inside and being alone at her desk seemed even more unbearable now that everyone in the city wanted her company. When she ran out of money, she started teaching. She moved around from Sarah Lawrence to Amherst to Bennington to the New School. She taught private workshops at home, thinking that the Gordon Lish approach would be the most lucrative. But the place she could have made money, the writing, continued to be unbearable. She always owed some magazine an essay. She went to the MacDowell colony for eight weeks one summer to write a twenty-page book proposal and came back empty-handed. She told me she was playing too much pool. She told me from the pay phone that she had managed to have sex with someone on the pool table after the other residents had gone to bed.

Most years, I sent Lucy a plane ticket to come to Nashville for either Thanksgiving or Christmas. She was family. My mother and I would go out the day before her arrival to buy the Lucy-Food, Cream of Wheat and mousse-p?t?, vegetable terrines, chocolate pudding, Brie. My mother would make Lucy?s favorite: mashed-potato casserole. Lucy had yet to get the lower teeth that she had been promised in Scotland and had been promised in countless surgeries before that. There wasn?t enough bone in her lower jaw to sink an implant into.

In the hopes of getting enough bone in her lower jaw, of filling out her chin, and, most important, of being able to put her lips together, she decided to embark on yet another harrowing round of surgeries. She had taken a swallowing study and found that because she could not make an oral seal, approximately 15 percent of what she ate and drank went into her lungs. She was constantly choking and went in and out of bouts of pneumonia. By this time, she had cobbled together all of her essays into the book?As Seen on TV: Provocations, but there had been very little money in the project for her. She had decided to write a novel, which was now overdue at Doubleday. She had taken a large advance on twenty pages, and what she owed, either the money or the work, haunted her.

?Finish the book,? I said. ?Then start the surgeries.?

But she refused. She said she couldn?t put it off any longer. She said that life, real life, would start after the surgeries were finished. She had said it so many times before that I thought surely she was joking, but she wasn?t.

In the summer of 2000, I was 36 and Lucy had just turned 37. She had the fibula taken out of her leg and put beside what was left of her jawbone. I came up to New York to help take care of her. She had the surgery on Thursday, June 29, and at noon the next day it seemed that all of New York vacated to go the beach for what would become the longest Fourth of July holiday in history. The hospital seemed to be manned entirely by two nurses and half a dozen 12-year-old plastic-surgery residents who had begun their rotation July 1. ?It shouldn?t hurt at all to walk,? one of the handsome boy doctors told Lucy as she wept with pain. ?The fibula isn?t a weight-bearing bone.? Someone needed to be with her all the time. She couldn?t turn her head to the side or lift herself up to vomit, and so we waited beside her with the suction tube. I came in the morning at six and stayed until Lucy?s friend Lucie Brock-Broido came at 6 p.m. to stay through the night, and in between a whole host of friends came to help, Sophie and Joy and Ben and Andy and so many people I had never met before. Lucy asked for what she needed and expressed her gratitude with great dignity. She was a brilliant patient.

?I?m in my element,? she would say weakly as I held her up to give her a sip of water. ?This is what I was trained for.?

When it was finally time to go home, I loaded her in a taxi with the luggage, plants, stuffed animals, a cane, and a walker. When we got back to her apartment, I carried her down the long halls of the National Arts Club, where she was living at the time. Even if she had had the energy, her leg was still too painful to make it more than three hobbling steps. For the next couple of days, I carried her through the streets of New York to various doctors? appointments. I found it was easy to hail a cab with a girl in your arms.

The idea behind the fibula surgery, as I understood it, was to put the bone in her jaw, wait for it to heal, then install a series of external bolts on her face that would be tightened over time, melding the old bone and the new bone together. The bolts would stay for six months and then be removed, after which there would be some smaller, shaping surgeries. Lucy worked hard on psyching herself up for the bolts. We talked about it constantly. ?I?ll finish the novel when I have bolts in my face,? she said. ?That will keep me home.? But when she went into surgery to have the bolts installed, they found that the native bone was too weak to support them. After an hour on the table they closed her up.

The only thing worse than having bolts in your face is not having them. Lucy?s leg hurt all the time, and now she felt she had brought it all on herself, as if she had willfully undertaken a surgical folly. She fell into a vicious depression, and when she cried, she talked about how she felt ashamed for what she had done. She was addicted by then to a whole host of painkillers that she was still taking from the fibula surgery, and then those painkillers bled over into heroin. She started cutting herself. Her psychiatrist, in whom she had placed an inordinate amount of faith, dismissed her as a patient. It was like watching the disintegration of a cliff that you suddenly realize had nothing beneath it all along. Everything in Lucy crumbled in on her. Then she took too much of what she had lying around her apartment and wound up back in a different hospital.

Lucie Brock-Broido rode with her in the ambulance and got her admitted to the psychiatric ward at three in the morning. They put Lucy in a hospital gown and left her in the emergency room until two o?clock the next day, saying they would get to her, at which point she talked a nurse into giving her back her clothes and went home. The next day, she saw a new psychiatrist, who said she would have to return to the ward or be released to a friend. She was sent to Nashville.

She got off the plane looking like a twig. What she was suffering from was beyond me to fix, so I did what I knew how to do for Lucy: I made her happy for a little while. I made her all the food she liked and got her massages and pedicures. I took her to bad movies and bought her everything that was not nailed down. I rented a canoe for the day, and out on the Harpeth River we smoked cigarettes and talked about the plot of her novel while we floated, watching as snakes swam silently past the aluminum sides of our small boat. I wanted her to move to Nashville. I had a nice guest room now and thought she should stay until she got on her feet. It would be like the old days. I would do all the dishes. We would dance in the kitchen and I would sit on the edge of the tub if she wanted to spend hours in the bath. It could be like it was. It could be some version of what it was. But once she felt stronger, happier, she wanted to go home. She had a teaching job, she had her friends, she loved New York. Besides, the doctors had promised her another surgery that they really thought would work.

There was another surgery. She wanted me to be there in recovery when she woke up. It was eleven o?clock at night before she came down to the floor. They had shortened the bone in her upper jaw this time and cut the scar tissue in her neck to give her a greater range of motion and taken a soft-tissue graft from her stomach to fill out the side of her face. I took the elevator to a floor marked no visitors and went into doors bearing the same directive. I stood in a huge room of beds turned in every direction. It was like a dream I am still having. I couldn?t find her. ?Lucy Grealy,? I said to the nurse.

?Are you family??

I told her the truth: She was my sister. The nurse pointed to the bed I was standing right in front of and still I couldn?t find her. She looked like someone had beaten her with a tire iron. Her head was an enormous pumpkin, every feature stretched into someone else. There was blood running out of both sides of her mouth and down her neck, blood running out of her nose. The skin over her eyes had been pulled into shimmering translucence, and her breasts were bare. I was crying then, and I stood beside her and held my hand on her forehead the way she liked. When the nurse told me that I had to go right now, I asked her if maybe, when there was a minute, she could hold her hand on Lucy?s forehead. It made her feel better. I went out into the hallway and sat on the floor beside a gurney and cried. Not the way I would cry, but the way she would cry. I cried myself senseless.

There were a whole host of new pain-killers after that, including a bottle of 80 OxyContin that Lucy later confessed to grinding up and snorting. Once they were gone, the heroin that had been flirting with her all year moved in and stayed. There were still lovely times after that. I can remember them. But I told her I could not see her through the heroin. It made me insane, even more than I could have guessed was possible. After sitting beside her through so much pain that came to her beyond her control, I could not abide the pain she went out looking for.

?I will leave you over this,? I told her in the Park Avenue Cafe. ?After all these years, I will end our friendship.?

She leaned across the table and kissed me. ?You are my angel,? she said. ?I so appreciate you saying this. It really helps me.?

?But I?m serious.?

?I know,? she said.

I was serious. I told her every time she picked it up again. ?Don?t turn away from me yet,? she said. ?Promise me you?ll still take my phone calls.?

I never stopped taking her calls, calls from pay phones in various tiled hallways, calls later from Sophie?s or Stephen?s, where she would go to stay after the hospitals, calls from rehab. I never stopped seeing her, even though I planned to, even when I would be so angry with her. Recently, we were talking about this in the middle of the night. I was standing in my backyard with the cordless phone, looking at the moon. In the middle of all the talk about fresh starts and new jobs, we started talking about Nabokov, and then we were talking about the night sky, the different sides we saw from New York and Tennessee, and then about the metaphysical process of sight. ?Who will I talk to?? I said. ?If you keep going like this, who will there be for me to talk to??

?I?ll get over this,? she said. ?We?ll look back and call these the heroin years. We?ll say, ?Do you remember when Lucy was a heroin addict?? ?

?For some strange reason birds keep crashing into my window,? she wrote to me from Aberdeen in 1990. ?The second one just bonked into it while I was sitting here, and two did yesterday also. Maybe it?s an omen (didn?t I write a poem with birds crashing into windows once?) I remember it now: it was a bad omen in the poem. Do you ever have premonitions? I have black empty ones all the time, not of a bad future, but of no future. It scares me a great deal, I can?t describe it, but it feels so certain. I like to think it is only my imagination, a result of my depression.?

I got the call from her internist, who was a friend of Lucy?s. He had been planning a trip to Tennessee and so had my number in his cell phone. Like all such calls, it came after I was asleep, so that for a while after I hung up, I had the chance to wonder if I had been dreaming. It is remarkable for me to remember now that I had thought it would be possible to walk away from her, that she might have gone on living, but without me. I know now I never would have had the strength of my convictions. I am living in a world without Lucy. I have no choice about that. If she were alive and I had the choice, I wouldn?t have been able to last without her for a day.

Ann Patchett

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