The New Face of Richard Norris

July 28, 2014 12:03 PM

"Since the first face transplant, in 2005, only three American hospitals have performed the procedure. Many of the twenty-eight transplants were partial, sections of the face transplanted from deceased donors. Richard's transplant was a full face and is said to be the most ambitious ever. Rodriguez likens the medically complex procedure to the Apollo moon landing." (previously, previously) [note: contains before and after photos]
posted by trillian (41 comments total)

Rodriguez removed what was left of Richard's disfigured face, dissected down to the skull.

AUGH
posted by showbiz_liz at 12:16 PM on July 28, 2014

While I realize that this is supposed to help overcome severe disfiguration, my first thought was how ... strange and surreal it must be to look at a face that is sort of like yours but not quite and how in some ways at least if you're disfigured it's obvious...

But then I saw the pictures and am absolutely stunned... Downright handsome, IMO. And then I saw the middle (disfigured - well more disfigured, I suppose) and was like - ok, yes, I suppose if I had to choose, I would definitely choose the procedure.

I can't even imagine how awful and painful and how much therapy (physical and mental) one has to deal with in order to go through with this procedure.

I hope this marks the start of a strong recovery for him.
posted by symbioid at 12:17 PM on July 28, 2014 [1 favorite]

I know these operations are risky, and the potential for rejection is devastating, but man, the difference it makes in the patient's life. It's just *really hard* for humans to interact normally without a face. We are so heavily wired for literally, face-to-face communication.
posted by tavella at 12:19 PM on July 28, 2014 [3 favorites]

I am not in that position, thankfully, and yeah, there's a lot to work through emotionally, I'm sure. But a face would feel like any body part to me, like a spleen or a kidney, if I had to receive it. Tissue is tissue is tissue.
posted by agregoli at 12:24 PM on July 28, 2014

I do wonder, though... for the first transplants, it was for people that had large amounts of structure left, so one of the reassuring soundbites for the families of the donor was that it wouldn't look much like the original, because facial structure determined so much of appearance. But with the more recent ones, they are transplanting the structure as well, in this case jaw, teeth, cheekbones, nose. I've got to think there may be some recognition for friends and family of the donor.
posted by tavella at 12:24 PM on July 28, 2014

symboid, I remember a conversation with an online acquaintance, and she talked about how when she was younger she worked in a department store, and one day happened to turn around and was startled by a burn victim, who had basically scarring over a skull for a face. She *still* felt shitty years later because she had involuntarily screamed. She recovered and served him normally, but having to deal with that sort of thing from even well meaning people? And surely worse from crueler ones? Yeah, I think I'd risk death myself.

Also, there's a substantial improvement in physical quality of life. Regaining the ability to chew normal food, plus the nerves eventually grow back, so they can taste and smell again, at least in some cases.
posted by tavella at 12:36 PM on July 28, 2014 [8 favorites]

I've got to think there may be some recognition for friends and family of the donor.

There's a photo of the donor in the article, and to me he looks almost nothing like the post-surgery Richard.
posted by showbiz_liz at 12:36 PM on July 28, 2014 [1 favorite]

The French woman who had the first face transplant was smoking out of her new mouth within days apparently. Can't beat that for fuck-it cool.
posted by colie at 12:43 PM on July 28, 2014 [5 favorites]

There's a photo of the donor in the article, and to me he looks almost nothing like the post-surgery Richard.

And what is weird is that the pre-wounded Richard and the donor look alike!
posted by MisantropicPainforest at 12:44 PM on July 28, 2014 [4 favorites]

Good heavens. That was really well written. I want to have a beer with the writer and talk about her experience with this story, never mind Richard or his mom or Melanie.
posted by ThatCanadianGirl at 12:54 PM on July 28, 2014 [5 favorites]

From the article: Uncontrollable rejection would mean an almost certain death; the only things left of Richard's old face are his eyes and the back of his throat.

This really drove it home how much of the transplant was not just what I would think of as the "tissue" parts but actual infrastructure. It's not a face transplant - it's a partial transplant of the head. And how much this person and others are willing to risk to look and be relatively normal again. It's heartbreaking and yet hopeful - reading this, I keep thinking of acid attack victims.

But I was also struck by the dichotomy of the response of his parents - they were taking tremendous risks, too, in supporting the surgery, but his father seemed much less willing to do so and okay with pre-face transplant Richard while his mother....his mother was a little different. Then by the end of the article, with the smoking and the Wild Turkey syringe incident and the myth vs. the real story....there's some serious armchair psychology one could wade into if one wanted. The turn it took, as it became less about the face and more about the person behind it made me incredibly sad, because his new face isn't going to solve the problems he might have had before the accident. It really makes you think.

Great post.
posted by barchan at 12:56 PM on July 28, 2014 [12 favorites]

Before I open this article, can anyone tell me if the photos within are graphic surgical photos or just photos of the before and after?
posted by elizardbits at 1:06 PM on July 28, 2014 [5 favorites]

Before I open this article, can anyone tell me if the photos within are graphic surgical photos or just photos of the before and after?

There's a drawn illustration of the steps the procedure but no photos or detail of any blood or gore.
posted by ghharr at 1:10 PM on July 28, 2014

There is a diagram of the intra-surgical state of the dude's head which was enough to have me reeling...
posted by colie at 1:11 PM on July 28, 2014

elizardbits, there is a photo of him - quite disfigured - after the initial less-successful surguries. There are no photos of the actual surgery. There is diagram of the surgery.
posted by ThatCanadianGirl at 1:11 PM on July 28, 2014

Ok, the diagram was actually the worst bit.
posted by elizardbits at 1:14 PM on July 28, 2014

The text also includes a graphic written description of both the accident and the surgery, FYI. My imagination was worse than the graphic illustration.
posted by barchan at 1:15 PM on July 28, 2014

I think a consensus is emerging that the bit before where you are disfigured is scary, the bit after where you have a new face is scary in other ways (like rejection drugs and psychological things), but the bit where you are lying there on the operating table with your entire face and jaw and nose removed right back to the throat is kind of unthinkable.

Great article.
posted by colie at 1:19 PM on July 28, 2014

I love that this article goes well beyond the traditional "miracle" narrative. I wonder what Richard thinks of it, though.
posted by bobobox at 1:24 PM on July 28, 2014 [1 favorite]

I hope this marks the start of a strong recovery for him.

Read the rest of the article.

The French woman who had the first face transplant was smoking out of her new mouth within days apparently. Can't beat that for fuck-it cool.

How AWESOME for the dead donor's family!
posted by ethnomethodologist at 1:26 PM on July 28, 2014 [4 favorites]

I work for doctors who might be doing this surgery in the future as it becomes more commonplace (they already do a ton of facial reconstruction work for head and neck oncologic patients), and have spoken with one of the team that did the first face transplant at the Cleveland Clinic (he was here giving a lecture). It's really mind-blowing what we can do.
posted by joannemerriam at 1:50 PM on July 28, 2014 [1 favorite]

The mind-blowing stuff we can do now fixes the face-blowing stuff we did in the past.
posted by MisantropicPainforest at 1:58 PM on July 28, 2014 [3 favorites]

How AWESOME for the dead donor's family!

Eh, I think I'll hold off on judging the postsurgical actions of face transplant recipients until I myself have such incredibly scary and traumatizing surgery.
posted by elizardbits at 1:58 PM on July 28, 2014 [16 favorites]

Which is ideally, obvsly, never.
posted by elizardbits at 1:59 PM on July 28, 2014

I have immense respect for surgeons. I try to imagine wielding a scalpel in a situation like this and I. Can't. Even.
posted by Devils Rancher at 2:39 PM on July 28, 2014

It's really mind-blowing what we can do.


joannemerriam

You are right, of course.

But I also think it's absolutely mind-blowing what patients are capable of enduring. I am in awe at how such complicated, flawed people - like Richard Norris of the OP - find the extraordinary strength to keep on trucking after such surgery (with whiskey and tobacco & whatever else gives him a break or a kick).

As bobobox said above, it's not the usual medical miracle feature at all. But there are many moments of grace & it's amazing journalism.

I am chronically, shamefully squeamish and I am so very glad I read the article & that others advised - correctly - that it was mainly the graphic diagram that required eye blurring.
posted by Jody Tresidder at 2:46 PM on July 28, 2014 [1 favorite]

How the hell is it not required that these patients go to lots of ongoing psychological counseling? I mean, maybe they do, but it definitely was strongly implied by the article that not all is well.
posted by mikeh at 2:49 PM on July 28, 2014

The fact that psychological help is available and even encouraged does not mean it will be accepted by the patient. And Richard's home life was unusual as well. There's really a lot there to be dealt with. Maybe this is what "going well" looks like in this case.
posted by ThatCanadianGirl at 3:14 PM on July 28, 2014 [1 favorite]

I wonder whether he can taste things very much because all I remember about that is he said he doesn't like the taste of Wild Turkey. I also want to know if he gets back to Melanie, and if he can stop self-medicating and using tobacco, and especially if he will find some happiness which seems would be very good for his health and for the others in his life. I hope so. This is a powerful piece of writing.
posted by Anitanola at 3:35 PM on July 28, 2014

I want to have a beer with the writer and talk about her experience with this story, never mind Richard or his mom or Melanie.

Jeanne Marie Laskas is such a great writer, and something about her writing gives me the sense that she's a decent, kind person too.
posted by sallybrown at 3:39 PM on July 28, 2014

but it definitely was strongly implied by the article that not all is well.

Been thinking about this all afternoon. One of the clinical articles the essay quotes is "'Rigorous preoperative psychiatric and psychological selection of patients deemed to be stable, motivated, and compliant by a multidisciplinary team is a crucial determinant of a safe and rapid recovery.' " Later, when the writer mentions her experience, the doctor isn't surprised or worried (I thought he would freak out), and is basically, yeah, it happens, some self-medication is normal.

Given that Richard was chosen because he was deemed "stable, motivated, and compliant" perhaps all is as well as it could be? Or is it the rigorous selection didn't unpack all of his circumstances and the question wasn't whether he was stable enough of the potential candidates but was instead, out of potential candidates, who is the most stable?

To quote again, Researchers in a recent academic survey of the "successful" transplants note a distinct paucity of data on the psychological outcomes for these patients, who, they point out, often suffer from PTSD, alcohol abuse, and opiate dependence as a result of the trauma leading to their initial disfigurement. That's just the trauma leading to the disfigurement - it's not even counting the possible trauma that occurs because of the disfigurement or the trauma of the surgery, and the trauma of post-surgery life.

So how to compare and contrast, even measure, all these different kinds of pain? How do they do so clinically and ethically? How do they measure and compare the data of telling someone you must live your life the way it is versus we can give you a new face but you could die? What do they do, as with Richard, when they have one parent basically saying, I support you the way you are, and the other parent calling the surgeon a savior? Just the ethical dilemmas must be enormous - how could you tell someone who's willing to die for a new chance at life they're too fragile psychologically?

I originally read the article as medical science at its most advanced. But now it's the psychological science that seems the most daunting, and given that quote about "paucity of data" I'm left uneasy perhaps psychology hasn't caught up yet? And that's just the data. That's not counting the strength of human will, the territory of a surgeon's ego, or the need to improve the lives of others when we can, whether it's by experimenting on cadavers or telling a transplant patient he's brave or by saying, yes, we will donate my dead brother's face. The depths and different kinds of knowledge this article touches on are ocean deep.
posted by barchan at 4:06 PM on July 28, 2014 [5 favorites]

NEVER in a thousand years would I think some dumb plot point in a John Woo movie would become a medical reality. I'm just walking in my room back and forth totally amazed at this and congratulations to the doctors and Richard Norris for pulling through all this!
posted by FJT at 4:47 PM on July 28, 2014

some dumb plot point in a John Woo movie

Excuse me but I think you meant the BEST plot point in the BEST John Woo movie kthx
posted by elizardbits at 5:39 PM on July 28, 2014 [3 favorites]

I don't remember any face swapping in Hard Boiled.
posted by fings at 6:13 PM on July 28, 2014 [4 favorites]

colie: "The French woman who had the first face transplant was smoking out of her new mouth within days apparently. Can't beat that for fuck-it cool."

ethnomethodologist: "How AWESOME for the dead donor's family!"

Res ipsa loquitur - the lady was so comforted by the ritual and psychoactives of smoking tobacco that she resumed smoking despite the adverse effect on wound healing and subsequent threat to her life.

I doubt the donor's family had much to say about it - after all, their loved one was still dead either way, and the rate-limiting step in these cases isn't the availability of faces but the availability of a surgical team and postoperative support system capable of rehabilitating the patient. Also, it's France, where smoking isn't demonized as it is in the US.
posted by gingerest at 6:17 PM on July 28, 2014 [2 favorites]

I remember reading about a doctor who operated on a little girl who had Pierre-Robin syndrome (cleft palate and a very small jaw) pretty seriously. The "after" picture looked just like a "normal" little girl. If I were that doctor, I'd be walking two feet above the ground, just having the ability to make such a massive, positive difference to another human being - it'd be superhero-awesome. Bet this doctor was like that. If you could harness the happiness, it'd probably power a city for a month. Here's to more cool people doing cool things for people.
posted by Zack_Replica at 9:14 PM on July 28, 2014

"Hallam's own experience was not particularly encouraging. The new hand freaked him out. One hand his, one hand somebody else's. He couldn't handle it. 'Take if off', he said to his doctors. They refused. He persisted. They refused. So he stopped taking his meds, hid the hand from view so no one could tell what was happening to it. Doctors ended up having to amputate what was left. A mess. How stupid can you get? Hallam, they said, was a psychopath. Physical rejection may be a conundrum, but psychological rejection was the stuff of madmen."

Okay, now I want to punch some Kiwi doctors.
posted by Ivan Fyodorovich at 10:51 PM on July 28, 2014

The thing I am curious about is the lack of movement in his face - is that permanent, or will he over time be able to control the new face?
posted by 5_13_23_42_69_666 at 1:02 AM on July 29, 2014

Isabelle Dinoire, world's first face transplant recipient, not only was indeed smoking but also displayed a sense of humour about the whole thing:

Asked whether she had started smoking again with her "new" lips (as reported last month), Mme Dinoire gave a wry scowl.

"No I haven't started smoking again because I never stopped."

She's a fox.
posted by colie at 2:53 AM on July 29, 2014 [1 favorite]

It's not that the psychology hasn't caught up yet, I'm pretty sure that he could be helped. I think it's that there aren't the same incentives in place to encourage thorough pro bono counseling. I think 'lab rat' is apt. And this story is incredible, but creepy in same way as that part of Robocop 2 where they skip the psych approvals and make new Robocops that malfunction. Except this is also real, making it way more disturbing and sad.

One of the big takeaways for me was him being stuck far from a city, unable to drive and so clearly in need of counseling. The girlfriend they discuss at the end could make a huge quality of life difference for him if she helps him move to a more urban area where he actually could get low-cost or no-cost mental help. Maybe I'm wrong, but when I lived in a small town there was no such thing.

And while I'm rambling, scratch me up as somebody who would not want this procedure even if it meant more significant disfigurement than the subject here. That level of immunosuppression is a big, big deal. I don't even smoke or drink anymore and I wouldn't want that. I've had a taste of it before and it's awful--endlessly worrying. (My husband and I have already discussed this life possibility, beyond "would you still love me" into "which Cobra Commander face covering would you prefer.")
posted by heatvision at 4:52 AM on July 29, 2014

36 hour surgery - that blows my mind; I have total respect for the surgeon, and for Richard, whose body sustained that trauma, and accomplished that healing. He didn't just look damaged before the surgery - he didn't have teeth. It's an amazing accomplishment.
posted by theora55 at 1:13 PM on July 29, 2014