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For six years, Sandra Caira ran the wig salon at a breast cancer clinic in Toronto, helping women replace the hair they had lost during treatment. Then, she became a client

Sandra Caira was a practical registered nurse before she took a job at the salon at Sunnybrook Hospital, located within the hospital’s breast-cancer clinic.

Sandra Caira was a practical registered nurse before she took a job at the salon at Sunnybrook Hospital, located within the hospital’s breast-cancer clinic.

JENNIFER ROBERTS/For The Globe and Mail

Sandra Caira runs a straightening iron through the honey-brown hair of a display wig as she waits for her next client. The door to her salon, located in a breast-cancer clinic on the sixth floor of a hospital, is open, giving Caira a full view of the women on their way to and from their health appointments.

This is the first place some will go after learning they have cancer. Under the expressionless gaze of bewigged mannequin heads, Caira fits these women with wigs from a multitude of boxes stacked neatly on the shelves. She snips the wigs to match her clients' own hairstyles. She listens to their fears and frustrations, keeping a box of tissues within easy reach in front of the soft-lit mirror. She calls them "My dear." And when she's satisfied, she sees them leave, looking and feeling a little more upbeat, a little more like a healthier version of themselves.

Caira knows first-hand how looking well can dramatically make a person feel better. Seven years ago, at the age of 43, she underwent a double mastectomy after discovering a cancerous lump in her right breast. The "big 'C' word " felt like a death sentence. She planned her own funeral. She bought greeting cards, which she filled out and signed for her daughter, who was 12 years old at the time. There was a 16th-birthday card, a high-school graduation card, a marriage card.

Her wigs pulled her out of her despair, giving her the strength and motivation to get on with her life instead of dwelling on death.

"My wigs got me through deep, deep dark places," she says.

Caira, a former nurse, had been working for the Continental Hair salon at Toronto's Sunnybrook Hospital for six years before she was diagnosed with cancer. Even though she had encountered countless women who'd lost their hair due to cancer treatment, she didn't want to believe it would happen to her.

It was a Thursday when her hair began to fall out. It started with a tingly sensation in her scalp. Caira had taken a shower that morning, and when she ran a pick through her hair, she noticed more of it came out than usual.

By the afternoon, "you could just put your hands in like this," she says, running her fingers through her long, brown hair, "and just pull it out." Like pulling out tufts of candy floss. By Sunday, about 75 per cent of her waist-long, eighties-style poofy mane was gone.

Caira found it easier to cope with the loss of her two breasts than the loss of her hair. After all, she explains, you can disguise a flattened chest with prosthetic breasts and a new bra. But hair?

"My hair was a huge part of personally myself, my identity."

Every morning, Caira teased and hairsprayed it into her signature volumnous style. She still doesn't step out in public unless her hair and eye makeup are done. Even when she's Sea-Dooing or snowmobiling at her cottage, she always makes sure her hair is styled and goes back inside to blow it dry whenever it gets wet. "That's just me."

At the University of the West of England's Centre for Appearance Research, professor Diana Harcourt specializes in studying how cancer-related changes in patients' appearance, mainly breast reconstruction and hair loss, affect their well-being.

Hair loss, she says, can be an extremely harrowing experience for many patients, and some even describe it as the hardest part of their cancer treatment. For many, hair is a symbol of who they are, how they present themselves to the rest of the world.

"How we look is a fundamental part of who we are," Harcourt explains. "And if that's changed in circumstances which you didn't want to happen – you didn't choose to make that change – that can be really, really distressing and upsetting."

Harcourt, a professor of appearance and health psychology and co-director of the Centre for Appearance Research, adds that when patients lose their hair, their diagnosis is made public, as others automatically associate their lack of hair with cancer. "It feels like it can be a loss of privacy as well," she says.

Of course, not all patients are affected in the same way. But, she says, "What you can't assume is because somebody had short hair, for example, beforehand, it wouldn't be upsetting for them. Or you can't also assume that it's not an issue for men as well."

The psychosocial impact is far from a frivolous matter, since hair loss can seriously affect patients' quality of life, she says, noting it's important to ensure patients feel it is appropriate for them to discuss their concerns about losing their hair.

Hair loss can dampen their confidence, reduce their willingness to engage in social situations and affect their relationships with their family and friends. And these consequences can last long after they've finished their cancer treatment, she says, as cancer survivors wait for their hair to regrow or come to terms with hair that's grown back looking very different in colour and texture.

Devastated as her hair fell out by the fistful, Caira asked a colleague to set her up with two wigs made of human hair, cut and styled to look exactly like her own. She wore one from morning till night for a little more than two years, taking it off and placing on her nightstand when she got ready for bed. Her daughter only saw her once without a wig during that time. Her husband only saw her three times without hair.

Treatment left her drained and nauseated. She couldn't stomach the smell of perfumes or foods. Once, during a visit to the shopping mall, she caught a whiff of the smells coming from the food court and barely contained her gagging in time to make it to the nearest garbage bin.

Without any hair, her image in the mirror reflected how sick she felt, she says. But when she had a wig on and filled in her eyebrows with a cosmetic pencil, she could avoid any pitying looks from others. She felt stronger. She could get on with her day. "It was more me."

It can be difficult, though, for others to understand how distressing hair loss can be. Case in point: Caira recalls an awkward encounter in her shop a few years ago, when a man expressed reluctance to buy his wife a $20 cloth cap to cover her head, never mind a wig, which starts at around $450 for those made of synthetic hair.

"She was sitting on my chair and she was just bawling and crying," Caira says. "I didn't know what to do, what to say, because I'm just Sandra. I'm just a person selling wigs."

Eventually, she gently asked the man to step outside so she could have a word with his wife. She then called up her boss and fixed the woman up with a discounted synthetic wig.

"For next to nothing," she says.

"Is it vain?" she shrugs. "It's part of our identity."

Caira was a registered practical nurse for 14 years before she got into the wig business. The long hours and emotional toll of working at a retirement home left her feeling burned out. She was browsing the Internet one day, mulling the idea of finding a part-time nursing job at Sunnybrook Hospital, when an image of the late Emma Suba, a founder and matriarch of the family-run Continental Hair salon popped up on her computer screen.

Caira phoned the company, which has had a location at Sunnybrook since 1998, and went in for a job interview the next day. She was hired immediately.

Thirteen years later, this modest shop, the size and muted grey of a hospital examination room, is her one-woman operation. She's the manager, not owner, but it may as well be hers. "My baby," she calls it.

Since her own experience with cancer, her job has become something of a personal mission. It's not about making sales; Caira doesn't earn commission. Rather, she says, "I just want to make ladies strong."

At noon, there's a soft knock at the salon door, and Paris Cyrus peeks in.

"Oh-la-la, girl! You look beautiful," Caira exclaims, as she gives Cyrus a hug. "Let's see. How do you feel? Sore?"

Cyrus recently had her fifth surgery. Since being diagnosed with breast cancer in 2013, she has become both Caira's client and friend.

As she settles into the salon chair, Cyrus recalls there were days while going through therapy when she didn't want to get out of bed. She might have stayed there, cocooned with her pain and her grief, she says, had it not been for her long, straight, black wig. With it on, she would occasionally venture to the Starbucks near her house, where she could people-watch and regain a sense of normalcy.

"If I wasn't able to get this?" Cyrus says, teasing a few strands over her forehead. "I don't know what I would've [done]."

With no family in Canada and a social network that dissolved as fair-weather friends disappeared, Cyrus felt painfully alone. But her regular visits to Caira's salon always made her feel better. She describes Caira as her "guardian angel."

"She always cried with me. I just needed somebody to feel the way I feel," Cyrus says, her voice breaking. "I think this is some sort of comfort zone for us, for all the women. I tell Sandra, 'We all need you.'"

Cyrus is one of only two clients Caira keeps in contact with outside of work. Caira says she must keep her work and private life separate, otherwise she'd find herself overwhelmed. She's a Virgo after all, she says, prone to caring too deeply. "I need to turn the caring part off sometimes because I carry it home."

At 4 p.m., Caira turns off the salon radio and closes up shop. She gets behind the wheel of her Dodge Caliber. On the 30-minute commute home, she prays for all the women who pass her salon door.

There's a prayer for the lady who is undergoing cancer treatment at the same time as her adult son. A prayer for the new mother who found out she has cancer just months after giving birth. A prayer for the young woman with the beautiful long red hair, who was anguished at the thought of about losing it all during therapy. A prayer for her friend Paris Cyrus. There are too many.

What it's like…to lose your hair to cancer

Paris Cyrus lives in Toronto. She recently had her fifth surgery. Below is her story, as told to Wency Leung.

Sandra Caira, left, styles the wig of Paris Cyrus at the Continental Hair salon in October, 2015. Since being diagnosed with breast cancer in 2013, Cyrus has become both Caira’s client and friend.

Sandra Caira, left, styles the wig of Paris Cyrus at the Continental Hair salon in October, 2015. Since being diagnosed with breast cancer in 2013, Cyrus has become both Caira’s client and friend.

JENNIFER ROBERTS/For The Globe and Mail

Losing my hair was the saddest, most painful chapter of my life. As a woman, I think the hair and the breasts are the most important part of our looks because it shows our femininity. So every time, looking at myself in the mirror, it was just very sad. Very, very sad. There was lots of crying, depression.

You have no hair, no eyelashes, no eyebrows. You look like a different person. And you're asking "why?" and "how?" "Is this real?" I thought I was dreaming.

I was diagnosed with breast cancer in 2013. When I saw my oncologist, they explained I'd be losing my hair the second week after starting therapy. At the time, my hair was curly and I had it down to my shoulders. They said it would be better to go and shave it because it's very scary when you start losing a bunch of hair.

So, I went to a salon by my home, not any place special, and I asked the guy there to shave it. Not completely shaved; it was a No. 1 grade, I think, so, very short. I didn't have anyone to go with me. As he did it, the tears were coming down.

It was cold out and I wore a hat to come home. Slowly, every time I took a shower, more hair would fall out as I went through my treatment.

I grew up in Europe, when you go out even to buy bread, you dress up. So, how I looked was very, very important to me.

People say it's not a big deal, but it's a huge deal. They'd say, "You're going to be okay. You're strong." But I'd say, "I don't want to hear that I'm strong. I don't need you to tell me that I'm strong." Some people would say, "I feel sorry." But I don't want you to feel sorry for me because I feel sorry enough for myself.

When I got fitted for a wig at the salon at Sunnybrook hospital, I felt sad. I felt embarrassed. I don't know why, I just didn't want anybody seeing me like that. But I told Sandra, the salon manager, "I want it black. I want it straight. I want it long."

She said, "That's my girl. She knows what she wants."

When she put it on, after she gave it a wash and a haircut, I felt so much better. It made me go out a little bit because otherwise, I was home all day, every day. Going through what I went through, it makes you just want to lie down. You're vomiting. You're in pain. You have mouth sores. You have all these things going on. You don't want to go anywhere. But after getting a wig, toward the end of each treatment session, I felt I really wanted to go have a coffee at least. I'd put on my makeup, I'd put on my wig and I'd put on my beautiful dresses. It was the old Paris.

I'm so used to the wig now that I don't go out with my own hair. I really love it. I always try to look at the positive and I'll make a joke of it. I say, "Okay, I lost my hair, but thank God I did not have to pay for a full-body wax." But it's not funny, I mean, it's really, really sad.