Dallas Wiens' face transplantation is destined to become the one that is remembered, not only for the utterly remarkable transformation, but for his touching reunion with his young daughter post surgery. Movingly, she stared at his newly donated face and whispered in his ear "I missed you Daddy."
The father of this young daughter lost his facial features and eyes during an accidental brush against power lines while painting a church in 2008. While his plastic surgeons did a remarkable job covering his skull with numerous skin transfer operations, his face was, well, not really a face at all. To survive that horrific accident was amazing, and having one's sinus, eye sockets, and jaw covered in skin was a miracle in and of itself, but it was not a face. Wiens' little daughter grew up and loved her father regardless, even in his faceless form he was accepted by his little girl and family. Yet, he wanted to become a more public person to help his developing daughter deepen her engagement in the world. He desired to be a more visable presence in her life by offering his public support and companionship without the stares and fears that always follow the facially disfigured.
On May 10, 2011 the Brigham and Women's Hospital released Dallas to return to Texas to resume his life with a new face -- a facial allotransplant more extensive and altering of appearance than any before. In a new series of firsts for surgeon and team Bo Pomahac, Dallas received a full facial replacement, from the crown of the head to the neck region. For the first time, the surgery appeared seamless, scars hidden under his chin and beneath a crown of hair blending into his own hair. For the first time, a non-sighted individual had been given the gift of a face transplant. For the first time, the patent's "reveal" presented a breathtaking transformation, a beautiful replacement of facial features without the usual, and of course insignificant to face transplant recipients, differences of skin tone and texture. To "replace like with like" has always been the mantra of plastic surgeons since the first attempts to surgically repair damaged tissues. Plastic surgeons simply cannot replicate the delicate features of the face, the curves, details found at the edges of the mouth, intricacies of the eyelids, and so forth. Dallas Wiens' operation is the first to replace "like with like" demonstrating the promise of face transplantation to heal the emotional and social wounds associated with loss of face.
"You're handsome Daddy." Wiens' little girl approached him yesterday on camera and "sees" her father, she does not run away, cry, or otherwise fear the father in front of her with a completely different face, the face of another as her father. Even Dallas reported her acceptance of him as her father "amazing." He gently cradles her in his lap rubbing her back and telling her that he missed her so much. One just has to wonder about how we identify each other, is it by face, voice, body posture? How can this little girl feel secure in the lap and arms of her father with another face? Yet, she knows, you can see her amazement, one can sense the healing that the transplantation has offered this family, she is re-falling in love with him in his transformed form.
Face transplantation is still so new and fresh yet you can tell by the post operation photos that the surgical techniques have progressed quickly. While each patient is different in the way they heal and accept the transplanted face, there just seems to be evidence of advances in the procedure itself this time. It appears that less skin tissue was left over in this surgery. Both Connie Culp and James Maki appeared to have excess skin tissue that required tightening a year or so after the transplant. Dallas appears to have tighter skin suggesting that Bo Pomahac may have realized through experience that the need for the excess skin was unnecessary -- perhaps concerns of tissue rejection and excess tissues needed for repair have been somewhat alleviated. Additionally, fears that a non-sighted person would not benefit from the procedure, or that rejection detection would become an additional burden for a non-sighted person, have dissolved.
Indeed, the Boston team is emerging as the real pioneers in exactly the right ways, and from their resolve has emerged growth and healing. In an ironic way, the fame brought onto Connie Culp, James Maki, Dallas Wiens, and the pending Charla Nash surgery, has offered many American's the unique -- at least for Americans -- opportunity to witness, discuss, and observe facial trauma. Thousands of veterans live in hospitals full time, unable to venture outside for very real fears of social rejection and emotional harm. Facial trauma patients have told Bo Pomahac that all they really want is to be restored simple social graces, such as being picked up by a taxi cab. Yesterday, the entire world saw the startling before and after photos of Dallas posted on the front page of CNN and the like. The faceless are now becoming seen, discussed and cheered on. Certainly of the many thousands who would qualify for the miracle of face transplantation, face the challenges of a lack of donorship and medical expertise and expense. And while we cheer the transformation, perhaps the real gift, in the long run, will be like Dallas' little girl who loved her daddy completely before the face transplantation. The real hope is that everyone can be loved, looked at, and accepted. Ultimately and hopefully the long term benefit of face transplantation is that it may offer us the gift of human growth and acceptance.
Showing posts with label Brigham and Women's. Show all posts
Showing posts with label Brigham and Women's. Show all posts
Tuesday, May 10, 2011
Thursday, August 19, 2010
Boston Med -- Bohdan Pomahac
On the final episode of Boston Med surgeon Bohdan Pomahac can be seen conducting the only second face transplantation ever performed in the United States. The series director Terence Wrong films the remarkable surgery and follows Pomahac around Brigham and Women's as a remarkable drama unfolds around them. While Pomahac had prepared for this innovative procedure for many years, it somehow becomes the right moment for a number of firsts to emerge within this historic city already with an amazing array of medical firsts. Within this show alone would occur the first New England face transplantation, the first time a face transplant donor is identified, the first time a donor's wife meets a recipient wearing her husband's face, and the first time two face transplant patients meet -- Isabelle Dinoir and James Maki.
A perfect storm is required and each player in this storm is intriguing and moving. Joseph Helfgot and his family are waiting for a heart to become available and when one does Wrong films the transplant team collecting the organ and bringing it back to the hospital. Like all transplant patients and their families, they are so grateful and feel full of hope. Sadly, Helfgot never wakes from his operation and his family is asked if they would like to donate not only his internal organs, but also his face. Susan Helfgot decides that her husband would want to help continue the tradition of organ donation and agrees for her husband's face to be used to replace another's. James Maki, a Vietnam veteran had gravely injured and lost his nose, lips, cheeks and surrounding bone structure after falling onto the third rail in a Boston subway station approximately 4 years earlier. After 10 operations Maki learned to live without a face, at least without one we could recognize as a face. Taunted by others he lives in isolation with his wife and daughter doing the best they can.
I first met Bo Pomahac after emailing him in the spring of 2008 asking if I could speak with him about face transplantation. I had hoped that I could simply talk with a surgeon who wished to perform the procedure, to learn more about the actual operation, but also just to talk about the topic with someone who understood it and with whom I could engage my thoughts on the subject. Only a handful of research and literature had been published to date and I think at some level I needed to be in the presence of somebody who know a lot about it, believed in it, and found it full of potential. Bo emailed me quickly back saying that it would be fine. In the writing of the book, I began to see some trends in some of these remarkable surgeons, sets of behaviors that would catapult them towards innovation and compassion and one of these traits, I believe, is a sense of openess and generousity.
After Maki's surgery, Dr. Pomahac hands him the mirror to survey his brand new face. Wrong is there to film what might be one of the most captivating scenes ever recorded by film. Just before the mirror is handed to Maki, Pomahac is asked what he thinks might happen. I knew from the medical literature we had discussed that studies had shown that the recipient would not look like their old selves, nor the donor -- that bone structure would play a large role in the way the new face looked. I had however wondered much about this during the writing of our book on the topic. I knew from Sander Gilman's work on identity and the nose, and from the literature on rhinoplasty, that we place a great value and meaning on noses and that a transplanted nose would always be the nose of the donor. I also wondered if the self was an entity that could be captured simply by having a face, maybe any face would complete that gap between the faceless and the faced. As Maki glanced into the mirror he first remarks on his nose, that he indeed has one. He then, after a few seconds of reflection, says that he can see his old self in there. At first the two statements do not seem to blend, he sees this new nose, one that marks the donor (later in the show Susan Helfgot meets Maki and says that she did not see her husband in the face except for his nose) yet he also feels like himself. Bo reflects upon this later and one can sense that he too is moved, that one can replace a face and an entire sense of selfhood in this one amazing act of face transplantation. "What else could one want," he poignantly remarks.
Towards the end of the episode, Bo sits in his house with his children looking at pictures of James Maki explaining how special Jim is as a patient. Yet what I caught was his "World's Greatest Dad" T-Shirt, perhaps a gift from his children that he chose to wear for filming that day. I think that is what makes him stand out, not just because he is now clearly a famed, history making, surgeon who conducted a face transplantation, but because he embodies traits such as the ability to blend sensitivity with celebrity and to balance compassion and conviction with a drive to doing what is right and fair.
A perfect storm is required and each player in this storm is intriguing and moving. Joseph Helfgot and his family are waiting for a heart to become available and when one does Wrong films the transplant team collecting the organ and bringing it back to the hospital. Like all transplant patients and their families, they are so grateful and feel full of hope. Sadly, Helfgot never wakes from his operation and his family is asked if they would like to donate not only his internal organs, but also his face. Susan Helfgot decides that her husband would want to help continue the tradition of organ donation and agrees for her husband's face to be used to replace another's. James Maki, a Vietnam veteran had gravely injured and lost his nose, lips, cheeks and surrounding bone structure after falling onto the third rail in a Boston subway station approximately 4 years earlier. After 10 operations Maki learned to live without a face, at least without one we could recognize as a face. Taunted by others he lives in isolation with his wife and daughter doing the best they can.
I first met Bo Pomahac after emailing him in the spring of 2008 asking if I could speak with him about face transplantation. I had hoped that I could simply talk with a surgeon who wished to perform the procedure, to learn more about the actual operation, but also just to talk about the topic with someone who understood it and with whom I could engage my thoughts on the subject. Only a handful of research and literature had been published to date and I think at some level I needed to be in the presence of somebody who know a lot about it, believed in it, and found it full of potential. Bo emailed me quickly back saying that it would be fine. In the writing of the book, I began to see some trends in some of these remarkable surgeons, sets of behaviors that would catapult them towards innovation and compassion and one of these traits, I believe, is a sense of openess and generousity.
After Maki's surgery, Dr. Pomahac hands him the mirror to survey his brand new face. Wrong is there to film what might be one of the most captivating scenes ever recorded by film. Just before the mirror is handed to Maki, Pomahac is asked what he thinks might happen. I knew from the medical literature we had discussed that studies had shown that the recipient would not look like their old selves, nor the donor -- that bone structure would play a large role in the way the new face looked. I had however wondered much about this during the writing of our book on the topic. I knew from Sander Gilman's work on identity and the nose, and from the literature on rhinoplasty, that we place a great value and meaning on noses and that a transplanted nose would always be the nose of the donor. I also wondered if the self was an entity that could be captured simply by having a face, maybe any face would complete that gap between the faceless and the faced. As Maki glanced into the mirror he first remarks on his nose, that he indeed has one. He then, after a few seconds of reflection, says that he can see his old self in there. At first the two statements do not seem to blend, he sees this new nose, one that marks the donor (later in the show Susan Helfgot meets Maki and says that she did not see her husband in the face except for his nose) yet he also feels like himself. Bo reflects upon this later and one can sense that he too is moved, that one can replace a face and an entire sense of selfhood in this one amazing act of face transplantation. "What else could one want," he poignantly remarks.
Towards the end of the episode, Bo sits in his house with his children looking at pictures of James Maki explaining how special Jim is as a patient. Yet what I caught was his "World's Greatest Dad" T-Shirt, perhaps a gift from his children that he chose to wear for filming that day. I think that is what makes him stand out, not just because he is now clearly a famed, history making, surgeon who conducted a face transplantation, but because he embodies traits such as the ability to blend sensitivity with celebrity and to balance compassion and conviction with a drive to doing what is right and fair.
Subscribe to:
Posts (Atom)