About Face

Half asleep, she reached up and touched a chin, her chin, which she couldn’t feel six months earlier, when it was just newly her chin. This chin, this jawline, the cool tip of this nose still amazed and shocked her. Almost every morning when she awoke, she still wondered if the whole crazy thing had just been a terrible dream. When she looked in the mirror later, and she was still rather reluctant to do this, she was, even now, shocked to find a face she didn’t quite recognise. This must be, she thought, what an amnesiac went through, when trying to recover memory, or some sense of a personal history.

At night she was still visited by the horrible ordeal she had gone through some eighteen months earlier; the growl, so resonant, so piercingly loud, it seemed to emanate from her own throat, but that was where her own muffled screams came from. The warm, pungent, salty drool into her gagging mouth, the ferocious eyes which she registered only briefly; the unbelievably sharp teeth. The heavy paws, pinning her to the ground; her flailing, helpless arms and legs; the warm urine of despair as she wondered if this was how she was going to end.

Later, as she drifted in and out of consciousness in hospital, she became aware of heavy bandaging on a face she could barely feel. She had managed to raise and look at her bandaged right hand. The index finger appeared to be splinted, and this puzzled her somewhat. She learned later that even the tip of her finger had been severed and, it turned out, successfully reattached. Her face was a different matter. She became more and more aware of sober bedside conferences where she picked out the grim words “necrotic tissue”, and began to wonder whether it was worth all the effort and her lengthy confinement. Her mother and sister put in a lot of time at her bedside, smiling, telling her news and gossip that she was unable to respond to. There was little that could interest her anyway. No mention was ever made of her attack, or how the horrible beast had been disposed of. It was awful to be fed through tubes. She did have a sense of taste—her tongue had been unaffected by the attack but the only taste in her mouth remained a somewhat salty, bloody one.

Three months after the attack she was discharged into the care of her mother, who managed bravely to look her daughter in the eye, but she could not hide the grief her daughter’s mutilated face caused her.

“Maryanne, my darling, there is every hope that surgery can help your face. Doctor Jensen has promised you that there are a number of options he will offer you within six months.”

Maryanne turned away sadly, knowing she could barely articulate, with her lipless mouth, the doubt and despair she felt. She never stepped outside the house. If she could have, she would have smiled at the thought of going outside wearing a veil like a Muslim woman, with only her frank blue eyes showing over the top. Even so, she couldn’t have made herself properly understood. Her mother and her sister, the only two people, apart from the medical professionals, who were allowed to have anything to do with her, could mostly understand the sounds she uttered, amplified by mimed gestures.

She began to keep a journal, and the process of writing down everything as frankly as she could gave her considerable comfort. She was cheered by the fact that she could soon write about matters other than her horrific experience, that she could gradually focus on matters outside herself. She studied old family photo albums, began to read newspapers and magazines, and after a while, began reading books again. Not so much novels, as she had once done, but history and biography.

When she had first come to live with her mother, she spent a lot of time escaping into sleep, despite its haunted dreams. One time she heard her sister’s agitated voice exclaim, “I don’t know how she can stand …” She was obviously silenced by her mother, and their footsteps retreated to the more distant kitchen. There were other whispered, desperate snatches of conversation, and sometimes she could hear her mother’s fervent sotto voce prayer.

After six months of not looking at herself in the mirror if she could possibly help it, and learning to speak rather more clearly, there was a fateful phone call from Doctor Jensen’s surgery. She was asked to come in for a consult to discuss what were, for her, rather dubious options. Doctor Jensen explained that the tissue of Maryanne’s lower face had absolutely no give in it, something she was only too keenly aware of. She only really had tight, warped skin over bone. He and his colleagues were proposing to offer her a completely new procedure. He hesitated and looked away from her briefly, carefully choosing his words. She had heard of organ transplants, hadn’t she, and of the rather more controversial limb transplants. Maryanne gasped through her tight, lipless mouth, and one expressive, questioning eyebrow shot up.

“Yes, we are seriously considering a lower face transplant.”

He spoke solemnly, deliberately, and then turned to his computer screen which faced both of them. “This is your face before the, er, event … and this is one generic possibility.”

All manner of thoughts crowded in on Maryanne. Could she bear the prospect of a normal face, albeit someone else’s? She was reasonably sure no such procedure, or perhaps very few, had ever been undertaken, and if it had, it had probably failed and never been reported on. She considered the reprise of a long period of pain, intubation, being rendered mute again, and finally, the distinct possibility of tissue rejection. But, if successful, wouldn’t it mean a whole lot of publicity, which she would loathe, and the medical profession would ride on the success of?

Doctor Jensen saw her look closely at the computer image and, for a while, didn’t interrupt her train of thought. Then he said quietly, “We believe we have reached a stage of expertise where there is a reasonable chance of success, say about eighty per cent. And this would hold out a promise for a whole lot of other people …”

“What about the twenty per cent chance of failure? I’m not just a lab rat,” Maryanne said bluntly. She thought, but could not get herself to say, and what about the donor? That would be a young woman who has just died, wouldn’t it, with a good tissue match. Her thoughts rushed on, but she did not, could not, articulate them. And what about how long it would take, the pain, the anti-rejection drugs?

Doctor Jensen could see that Maryanne was quite agitated, and tried to calm her with assurances that the donor would be a willing one, and the prospects for a reasonable, normal life were within her grasp. He advised her to go away and think about it, and he promised to get in touch if any suitable donor came up, and see how she felt about going ahead.

Maryanne said nothing to her mother during the drive home, and her mother did not feel like belabouring her with questions. That evening when Allie dropped in after work, they all sat down together at the table and Maryanne produced the computer print-outs of the “before” and proposed “after” pictures. They all studied them in silence for a while, and then, to lighten them up, Allie said, “What if the donor turns out to be a nice looking young man? Would you end up having to shave?”

They couldn’t help bursting into giggles. “What if it’s a pretty dark-skinned girl?” Maryanne mused. “I’d be two-tone! Or two faced!” After another brief giggle they became sober and silent.

“Do you think you might give it a go, darling?” Mrs Cavanagh asked quietly.

They all studied the pictures for a while, until Maryanne said softly, “Yes, I think I will. After all, I’ve had a lot of experience with pain, and if those medicos think it’s worth a try, I’ll go for it.”

During the following weeks Maryanne’s mind was crowded with ideas and concerns. She thought wryly of an old movie about a concert pianist who’d had the hands of an executed criminal transplanted after an accident, and then became a sinister murderer himself. Just how much did the personality of the donor impinge on the recipient? She looked up the anecdotal and quasi-scientific evidence on the net, She remembered the John Travolta thriller she had seen a few years before, Face/Off, and resisted the temptation to hire it and watch it once more. She began to think of the prospect of a transplant as a challenge she could rise to.

She was thirty-five, so considered herself still flexible enough, after what she’d been through, to take it on the chin. Hah! She had survived a marriage break-up and was curiously glad there had been no children. She resolved to be her own child, and nurture herself through the whole thing. Her mother and sister were right behind her and clearly made every effort to be positive.

It was still a shock to get the phone call. A twenty-eight-year-old woman, with no immediate family and with her driver’s licence endorsed with the consent to be an organ donor, had perished in an unspecified accident. She appeared to be a good tissue match, and the process of harvesting organs for various recipients would soon be under way.

Maryanne packed quietly and hardly a word was spoken as the three women drove to the hospital. Maryanne tried to calm her rapid heartbeat by silently reciting every prayer she remembered from her Catholic childhood. The prayers were more like mantras than direct appeals for help. She was sure her mother, in the driver’s seat beside her, was saying much more heartfelt prayers.

Doctor Jensen and the team of surgeons assured them that the chances of success were excellent, and should they need to, they had the fall-back of using some of Maryanne’s own thigh tissue to rebuild some semblance of facial muscle.

Once again the semi-consciousness, the dull pain, the heavy bandaging, the intubation, the bipping monitors … Maryanne’s breathing needed to be assisted because the transplan