Jim Wall’s wife didn’t want to shave his head. They don’t have an electric razor at home, and she didn’t want to risk nicking his scalp.

So on a Wednesday morning in mid-July, Wall steps out of his room on the 15th floor of MD Anderson Cancer Center, where the couple is staying for the week, and takes the elevator to the hospital’s sixth-floor salon.

There, he meets Justine Joseph, the licensed cosmetologist who has spent more than a decade running the salon, after arriving in Houston as a Hurricane Katrina evacuee in 2005. Joseph carefully shaves Wall’s head. She listens as he talks about the 15-year-old Weimaraner he and his wife just had to put down, and the amazing Wi-Fi technology in his hearing aids, which Joseph asked him to remove for the haircut.

Wall, who is being treated for lymphoma, first noticed his hair falling out the previous Friday when the first big globs came off in his comb, he tells Joseph. He put up with that for two days before his wife took scissors to it on the back porch.

Losing one’s hair is one of the most symbolic moments in cancer care — a visible signal that someone has become ill. Typically, hair begins to fall out within two weeks of a patient’s first treatment. And at MD Anderson, that’s the moment many patients meet Joseph, the gentle-handed, open-hearted stylist who has worked on an average of 415 clients a month for the past decade, as the only full-time stylist at the hospital’s in-house salon, which is celebrating its 60th anniversary this year.

She knows it’s an emotional moment for many. And over 10 years in the role, Joseph, who is 53, has trained herself to hold in her tears, and bring out client’s smiles.

“I really hated losing my hair,” says Wall, who is 78, as he sits in a black chair, in front of Joseph. “Because for a guy my age, I had great hair.”

He pauses, and for a moment the only sound in the salon is the quiet buzzing of the razor, gliding over his pale head.

“But it will come back, I guess,” he says.

Joseph doesn’t miss a beat. “Yes, it will,” she says.

When Joseph is done, she carefully returns his hearing aids, and asks if he wants a hat.

“I’ll wear this,” he says, picking up the maroon handkerchief he’s stashed on his lap during the haircut. It’s rolled into a makeshift headband, and when he slips it around the crown of his head, and stands up to reveal his full outfit of gym shorts and T-shirt, he looks like he’s off to a pick-up basketball game, even if he is tethered to a rolling IV stand that feeds him a steady drip of chemotherapy for 104-hour long treatment cycles.

“So what do I owe you?” he asks.

“Nothing. Everything is complimentary.”

“Can I give you a tip?”

“Don’t worry about that.”

“Are you sure?” he asks, one hand in his pocket.

“I’m positive,” Joseph tells him. “But you can make a donation in the office if you’d like.”

* * *

When Joseph began styling hair at MD Anderson, she couldn’t make it through a workday without crying. If a patient let a tear drop, hers were just a half-second behind.

“I had it bad when I first started. I really didn’t know if I could do it,” she says during a rare lull between clients. “I don’t think I was helping the situation. I was just crying, because I’d just look at them, and you know. When they cry, I cry.”

That was more than a decade ago. Joseph was among the thousands of evacuees who came to Houston from New Orleans after Hurricane Katrina battered their city.

She was still new in town when she happened to hear a woman talk about her spirituality on the radio. It spoke to Joseph, who called the phone number the woman read on the air at the end of her speech.

It turned out, the woman was a stylist at MD Anderson. Even after a lengthy career as a stylist in New Orleans, Joseph had never heard of a hospital with a hair salon — a rare amenity. But it sounded like the kind of work that could help her find a purpose — and build the foundations of a new life — in Houston.

“I told her I really don’t know how long I’m going to be in Houston, but can I volunteer with you?” Joseph remembers now.

She volunteered for several months. Eventually, she was hired as the salon’s only full-time stylist, aided by several volunteers.

She doesn’t cry any more. Some of that is because of the strength and resolve she’s found through praying for her clients after work every day, and focusing on the positives, like making them feel beautiful and cared for. And some of it is because her clients don’t cry as often as they used to.

“I’ve gotten a whole lot better, and they have gotten a whole lot better,” she says. “I think women are accepting it a lot more. But it’s hard, you know. It’s hard losing your hair, and not knowing when it’s going to grow back, or if it’s going to grow back, and how people are going to look at you. I think most of my patients wonder if their husband is still going to think they’re beautiful. If they’re still going to look at them the same way.”

She does her best to erase that question from each client’s mind by peppering each person with positive reinforcements, and reminders that they’re gorgeous.

As they cycle through the salon throughout Wednesday morning, she takes the time to learn all their names. But she refers to them as Beautiful instead.

“I want them to have the confidence and know that they’re beautiful, no matter how they look on the outside,” she says. “And I think that’s what people really have to start saying to themselves: I’m beautiful.”

That, she thinks, is as helpful as a new haircut, a clean shave, or a loving hair-wash for a patient who’s been confined to her hospital room for days on end. And feeling like she’s helped someone gives Joseph purpose.

Joseph has spent enough time in her life feeling helpless. When Katrina stripped her of her home, and all her worldly possessions. When her father was diagnosed with cancer. When her mother fell and broke her hip two years ago. Miles logged on her car for weekend trips to care for her parents. The long, lonely days when each of them died. Funerals and wakes. Tears and tissues.

“Watching my mama laying in the bed, and I’m right here and I can’t help her, that hurts,” she says. “So just knowing that now I am helping somebody. I’m making them feel good. They may come in sad, but when they leave they’re smiling. That means something.”

It means a lot.

* * *

Joseph works with about two or three clients an hour. Some, like Wall, need a shave. Others need someone to help them shampoo their hair without jeopardizing bandages or wounds.

Shannon Maisano, a 46-year-old mother of four from Louisiana, needs her hair washed after her doctors implanted an Ommaya Reservoir — a plastic device used to deliver her medication to the cerebrospinal fluid around her brain — at the top of her skull. Doctors will use this portal to give Maisano two chemotherapy treatments a week for the next six weeks.

“I didn’t want to wash it myself,” she explains, as she pats around the bandage, rifling her hands through the downy curls that rise up around the gauze. She tips her head back into the black hair-washing sink and closes her eyes as Joseph slips her hands into purple latex gloves and begins spraying warm water on Maisano’s hair.

“How are you doing today, Beautiful?” Joseph asks as she works her hands around her client’s head, eliciting a close-eyed smile from Maisano.

“This is amazing,” Maisano coos. She had no clue about the salon service until her doctors mentioned it to her the night before, after they’d shaved the front of her head for the Ommaya Reservoir, and slicked her scalp with gunk that effectively gelled her hair into bed-head. They told her not to shower for 10 days.

This is Maisano’s second battle with cancer. In 2011, she was diagnosed with breast cancer, which she licked after a year of treatment. In 2017, doctors found new spots in her pelvic area, spine, shoulder, liver and lymph nodes. They diagnosed her with Leptomeningeal Disease, which occurs when cancer is spread through a patient’s spinal fluid. A week before the reservoir was implanted, in early July, she shared her new prognosis with her daughters who are 21, 19 and 13, and her son, who is 10.

The doctors give her two to four months. But that’s not what you tell a 10-year-old.

“With 10-year-olds and 13-year-olds, they think concretely. They’ll remember the day you told them, and think four months from then,” she says.

So when she tucked her son in that night and he asked “When are you going to die?” she told him, “When God tells me to. When God takes me back.”

And then she got to work, praying for a miracle.

When Joseph is done washing Maisano’s hair, she ushers her client to another chair, where she turns a blow drier onto its lowest setting with her left hand. With her right hand, she begins gliding a small round brush through Maisano’s short, dirty-blonde hair, curling it under at the ends.

Her hair is short. And it will fall out soon. But she doesn’t want Joseph to shave it today. She’s saving that moment for when she’s back home with her children. She doesn’t want to surprise them with too many changes all at once, she says.

Joseph asks Maisano about her children. She nods and smiles and laughs at the funny parts. She tells Maisano she has a beautiful smile. And when she’s done rolling the round brush, she offers up head scarves and beanies from the overflowing bins she keeps in the back of the salon. But Maisano says no thank you, and tells Joseph to save them for someone who needs them more.

She walks away with an incandescent smile.

Joseph is smiling too.

“Treating someone nice, it makes them happy. It makes them feel like someone cares about them,” Joseph says. “And it costs nothing. It’s so free.”

maggie.gordon@chron.com

twitter.com/MagEGordon