Reprinted by permission of Gary McCoy Copyright 2008

 

LYMPHEDEMA AND THE PRINCESS

With lymphedema, it sometimes seems there are no answers, only mysteries. Has it always been that way? Or were there answers once, ideas that might have been known long ago but are lost to us now, perhaps forever?

 

In a strange little book by Cornelius Stetter called "The Secret Medicine of the Pharaohs," there is a brief reference to the depiction of pathologic medical conditions in Egyptian art and hieroglyphics. He mentions one figure in particular among the thousands of relief sculptures on the South-facing façade of Queen Hatasu's temple at Deir el-Bahari, carved into the limestone wall nearly 3500 years ago.

Here the ancient artists have recorded the celebrated voyage of the Egyptian Queen to the neighboring country of Punt, in what is now coastal Somalia. She is greeted by the Prince of Punt and his wife, the Princess Ati, whom Stetter believes to be suffering from a serious disease condition: lymphedema. "Bags of flesh hang from her arms and thighs," he tells us, "and only the joints of her hands and ankles are visible." It's a description that sounds depressingly familiar.

 

Lymphedema can have many causes. In the Western world of today the most common cause is the destruction of lymph nodes and vessels due to cancer surgery and radiation. Though not an especially rare side effect of cancer treatment, it is little understood by the medical community, much less by the public. For that reason each new diagnosis has the impact of a complete surprise. The doctor is puzzled. The life-long process of keeping the swelling under control is delayed while a specially trained therapist is located and the insurance company informed, through appeals and grievances, of the treatment required for a disease they claim they never heard of.

 

Ati must have struggled with her doctors, too. In the austere view of the early Egyptians, it was the enjoyment of meals that was the source of human grief. Eating with pleasure resulted in poorly digested food, a toxic potion called "pain and slime" that flooded the body with illnesses of all kinds. With that in mind, preventive medicine in Ati's day involved the routine use of laxatives, emetics, and enemas. To these early doctors, Ati's medical condition would have seemed the result of too many meals, too richly enjoyed. But could they seriously have considered her guilty of enjoying her food? In her deformed and desperate condition, we wonder, was she capable of enjoying anything at all?

 

Like our doctors today who too often fail to diagnose lymphedema and offer little treatment and less support, we can imagine Ati's doctors considering her condition and pursing their lips in frustration. The prescription? Enemas probably, and emetics to vomit up the "pain and slime" responsible for her disfigurement. All of which must have been about as distressing as our rituals of therapy and garments. And still, nearly 4000 years later, we have no cures, no miracles – only the daily coping.

 

Having read Stetter's sorry description of Ati, we launched a hunt for a picture of the wall sculpture. We googled Deir el-Bahari, and in moments discovered the complete text of an 1891 publication on Egyptology and, amazingly, a drawing of the very relief we were looking for. There they stand, all these centuries later: the Prince of Punt presenting rich gifts to the visiting monarch, and beside him his remarkably ungainly wife, the Princess Ati.

In the traditional perspective of ancient Egyptian art, they stand with their feet and faces in profile and their torsos facing outward toward the viewer. But unlike the typically slim and shapeless limbs in other paintings and sculptures, Ati's flesh hangs in lumpy folds from her arms and legs. In procession behind her are her two sons, her daughter, a few retainers and the so-called "Great Ass," the beast appointed to carry Ati's unmanageable weight wherever she might wish to go.

 

Poor Ati. We expect slouched shoulders, lowered eyes, all the signs of humiliation we understand to be part of our condition. But to our wonder, she is not a pitiful figure at all, as she presents herself unabashedly before the glorious Queen Hatasu, acknowledged daughter of the Sun. Ati stands erect and proud, performing her princessly duties with no shadow of self-consciousness. That, as much as the dramatic folds of her flab, is what must have caught the artist's eye. It has certainly caught ours.

There is no hiding lymphedema. Either your limbs bulge like Ati's, or you begin the unending routine of daily self-massage, fussy skin care, and wrapping in layered bandages or conspicuous compression garments night and day. But for Ati, it seems, there's nothing about it she wishes to hide. She's a princess, after all. Chin up, no holding back, she takes her rightful place in the royal procession without a qualm.

 

If Ati could see us now, she would no doubt be surprised by the rhythmic massage and the mummy-like bandages that we call our lymphedema treatment, and amazed at the reduction in swelling that these methods produce. But it's clear from these few pictures we have of her that she'd be even more baffled by our efforts to camouflage our deformed arms and hands, the all-too-common attitude of shame that makes us shrink in the face of our vulnerability.

 

Maybe Ati's doctors had no answers for her, but Ati herself had an idea that gave her a quality of life we can only envy. In spite of everything – the "bags of flesh", the "Great Ass," and the nosy limestone-carving paparazzi of her day – Ati knew she was a princess, inside and out. Hopefully that lesson, carved in the limestone of Queen Hatasu's temple, isn't entirely lost on us today.