How a Transplanted Face Transformed a Young Woman’s Life [NSFW]
August 15, 2018 7:59 PM   Subscribe

National Geographic: At 18, Katie Stubblefield lost her face. At 21, she became the youngest person in the U.S. to undergo the still experimental surgery. Follow her incredible story. [CW: Extremely graphic images and descriptions of facial injuries and reconstruction; suicide; overdose]
posted by reductiondesign (33 comments total) 33 users marked this as a favorite
 
This is almost unbelievable. I hope it all works out well. A close friend of mine has incrementally lost about half her face to cancer over the last 15 years; her courage to just live and work in a gawking world of judgment is both inspiring and humbling. I hope Katie continues to find that same courage.
posted by Rumple at 8:17 PM on August 15, 2018 [14 favorites]


Thank you for sharing this. For those of you who have watched the whole video and have seen all the various related articles, why is it that Katie's face is now so swollen compared to what it looked like when it was being sewn on during surgery? Is it due to muscles/bone grafts?
posted by Hermione Granger at 8:26 PM on August 15, 2018 [1 favorite]


Wow, this was so fascinating. I stayed up an hour past my bedtime to read it and I haven't even yet delved into the supplemental material (something to look forward to tomorrow). Thanks for posting it!
posted by Neely O'Hara at 9:16 PM on August 15, 2018


Why is it that Katie's face is now so swollen compared to what it looked like when it was being sewn on during surgery?

posted by Hermione Granger


The swelling is soft tissue. They made a lot of cuts so they created a lot of dead ends and a lot of scar tissue. They attached the major blood vessels, but the minor ones, teeny capillaries had to try and attach themselves, and often they couldn't because the scar tissue was too dense, or because they weren't growing next to a matching teeny capillary. They no doubt attached as many larger lymph vessels as they could, but could only do big ones. So the interstial fluid has trouble draining, and that in turn creates more scar tissue. Fluid that gets trapped is called a seroma when there is pocket of it between tissues, and it often gets surrounded by fibrous tissue before it absorbs, so that there is thickening. And the fluid in a seroma can turn into a gel instead of getting reabsorbed.

I don't know precisely why there is swelling in her case but these are factors that could be involved.

I wanted to be an organ donor, from as early as I when I first heard it could be a thing. I filled out the form back when you had to ask for forms to fill out instead of having a box to tick when you renew your medicare card. I can't be an organ donor now, so I would like to be one of the cadavers that the doctors got to practice the procedure on.
posted by Jane the Brown at 9:20 PM on August 15, 2018 [37 favorites]


Super interesting that a side effect of the opioid epidemic is the increase in organs.
posted by k8t at 9:21 PM on August 15, 2018 [8 favorites]


Thanks for this.
posted by Johnny Wallflower at 9:41 PM on August 15, 2018


thank you for sharing this.
posted by nikaspark at 11:15 PM on August 15, 2018


Yeah, that was a hard read. Some of the photography is really good, though, for instance this picture (no gore).
posted by Harald74 at 12:56 AM on August 16, 2018 [4 favorites]


What I understood from the article is that the transplant included bone from the donor - upper jaw, some lower jaw, cheekbones and sinuses - and her face was just bigger. In the photo where the surgical team are looking at the face before transplant that's why it doesn't lie flat.
posted by glasseyes at 12:57 AM on August 16, 2018


why is it that Katie's face is now so swollen compared to what it looked like when it was being sewn on during surgery? Is it due to muscles/bone grafts?
In addition to Jane the Brown's answer, they intentionally left some of the skin and tissue of her original face in case of rejection, plus they did do substantial muscle/bone grafts - most of her lower face is from the donor.

In this picture from the side you can see how long the jaw effectively was post transplant.

The focus is on restoring functionality. She will continue to have revision surgeries to improve function and cosmetics. She's already had major revision work done 14 months after the surgery, including a 'facelift' to remove excess skin, and shortening the jaw, but the latest pictures are from only 8 months post transplant.
posted by Absolutely No You-Know-What at 3:45 AM on August 16, 2018 [4 favorites]


I want to question the notion of tagging this as NSFW/graphic (both here and at the start of the article). There are OR photos (and post-op photos with visible sutures) and that's something that some people are going to want to scroll past fast (me) or means they need to pass on the article entirely, so let's say that. There's this implication that Katie's face is gory (pre- or post-transplant) and that's both objectively false and an implicit judgement about who is "supposed" to be seen.
posted by hoyland at 4:18 AM on August 16, 2018 [18 favorites]


From the article, on the discussion surrounding face transplants:

Ethicists weighed in, many arguing that face transplants, like hand transplants, were not lifesaving and would expose patients to too many severe risks just to make their lives easier.

I was taking college bioethics at the time of the first face transplant (woman mauled by her dog), and I vividly remember these discussions. There was this overwhelming moral judgment that face transplants were inappropriate, were crossing a line, that by changing a person's visible appearance, we were somehow changing their personhood. Absolutely zero empathy for people in Katie's situation, or people who have lost their face to cancer, or car accidents. I'm not talking about the moral judgment of college students, either; we read legit articles by legit trained well-known ethicists who were like "This could possibly be used for cosmetic reasons/exposes the patient to the risk of graft-vs-host disease, so it should be banned." At the time I was pretty meek and had a tendency to defer to authority (both no longer the case, I'm pleased to say) so I felt pretty conflicted about being the lone dissenter in seminar.

Also, the idea that face transplants, or even hand transplants, are not necessary because they are not life-saving, is flat out boneheaded. By that criteria, a kidney transplant isn't life-saving either (theoretically, you could be on dialysis forever); neither is a heart transplant (ditto ditto LVAD ditto). The idea that a hand, or a face, is somehow extraneous to life is so bizarre as to be laughable.
posted by basalganglia at 4:45 AM on August 16, 2018 [24 favorites]


Powerful and heartbreaking. I've met the photographer, Lynn Johnson and she is an amazing woman herself. I can barely look at those pictures, I can't imaging shooting them and processing them.
posted by octothorpe at 5:08 AM on August 16, 2018 [2 favorites]


Ever since I read this, I have not been able to get past the question of the loaded hunting rifle just lying around and not locked up. Why! Why so utterly careless. This is exactly why you have a gun case or cabinet, this is why you UNLOAD YOUR RIFLE WHEN YOU ARE NOT ACTUALLY ACTIVELY OUT HUNTING. One moment of peaking fraught despair on the part of a depressed young person under extreme pressure does not have to do this much damage.
posted by theatro at 5:51 AM on August 16, 2018 [54 favorites]


Ever since I read this, I have not been able to get past the question of the loaded hunting rifle just lying around and not locked up. Why! Why so utterly careless. This is exactly why you have a gun case or cabinet, this is why you UNLOAD YOUR RIFLE WHEN YOU ARE NOT ACTUALLY ACTIVELY OUT HUNTING. One moment of peaking fraught despair on the part of a depressed young person under extreme pressure does not have to do this much damage.

Gun ownership rates and suicide rates are correlated. "In states where guns were prevalent, rates of suicide were higher. Where gun ownership was less common, suicide rates were also lower ... Most attempters act on impulse, in moments of panic or despair. Once the acute feelings ease, 90 percent do not go on to die by suicide.”
posted by entropone at 6:07 AM on August 16, 2018 [25 favorites]


This is fascinating — thanks for posting it.

You have to wonder how this changed the family dynamic, since thanks to the brother's reckless actions, Katie is going to need special care, most likely for the rest of her life. How has that affected the relationships among the family? And what happens when her parents get sick and need care themselves, or when they die? Is her brother going to step up and care for her himself, or provide the funds that will be necessary for her care?
posted by holborne at 6:40 AM on August 16, 2018


I personally found the disembodied face photo disturbing. I appreciated the content warning.
posted by heatvision at 6:55 AM on August 16, 2018 [10 favorites]


I've been seeing teasers for this story for a while, and we get National Geographic so I'm expecting it in the mailbox any day now. Such a hard story to read, and terribly sad to comprehend. This is almost definitely not the point of the story, but I wonder how this could have gone differently had this young woman not had quick, impulsive access to a firearm. Not to loop _everything_ back to that, but I can't help but think it.

Thanks for posting this. I really hope she and her family can heal a little.
posted by littlerobothead at 6:57 AM on August 16, 2018 [3 favorites]


This is very interesting. I'm still reading, but I wanted to stop and digest and say thanks for posting.

Even apart from the face transplant, Katie got a tonne of specialized care to save her life and partially reconstruct her face and deal with her brain damage, etc. etc. What would have happened to Katie in the days after she shot herself if she had not had health insurance? Would they have done all the same things but bankrupted the family? Or would she have been at a lesser hospital where such things weren't available and would have died and people would have just said there was no way to save her given the extent of her injuries? Or?
posted by If only I had a penguin... at 7:18 AM on August 16, 2018 [6 favorites]


I wonder how this could have gone differently had this young woman not had quick, impulsive access to a firearm

It's a really important question to ask. While the national conversation on gun control mostly centers on mass shootings, the vast majority of gun deaths in America are suicides.
posted by Jpfed at 7:27 AM on August 16, 2018 [12 favorites]


Ever since I read this, I have not been able to get past the question of the loaded hunting rifle just lying around and not locked up.
Oh, theatro, than you for writing this. I had the same thought, but you put it into words so well (and without the cursing and invective had i tried to write it myself).
posted by notsnot at 7:30 AM on August 16, 2018 [5 favorites]


I saw this this morning and found it incredibly moving. I am thrilled for Katie that she gets this chance, in awe of the surgical skill involved and the dedication of the caregivers, and profoundly stirred by the grandmother's generosity in choosing to arrange the donation of her granddaughter's face. There is so much to be held onto here, in a time when casual cruelty seems to be the default mode of everyday life.

And yet, and yet. I guess like many of you, I couldn't help but read past the text we were being offered to the panoply of American sorrows that seep through its interstices. The desperation involved in Katie's choice to end her life. Her easy access to a loaded weapon. The casually infuriating, completely expected line about "trusting in their faith in God" (which I saw coming as soon as I read the father's "Oh, gosh,"). The overdose of a young woman that led to the availability of the donor face, and the opiate epidemic behind that. The Department of Defense's interest in underwriting this surgery, so as to learn how to repair the future generations of yet-to-be-maimed young soldiers who are even now toddling around their kindergartens. All of it is a fabric of horror and loss and denial and unending grief, barely acknowledged except in passing allusion. And that — in the end, that's what did me in emotionally, despite all the hope and goodness also visible in Katie's story.
posted by adamgreenfield at 7:39 AM on August 16, 2018 [100 favorites]


First impression, first thought -- I'm surprised they put all of that effort into helping her when she got there with a suicide attempt. If you're an alcoholic you're not going to get a liver transplant if there's others in line ahead of you and that's just common sense. Anyways, she is never, ever going to be a gorgeous young woman again and that could tend toward depression. She does have close family, those ppl are closed around her like a splint wrapped around a shattered arm. So that's good.

~~~~~

I ran my arm through a storm window, It was banging and clattering in a late autumn day, then once It came back HARD and I put my hand up to stop it and I missed the wood part of the door and poked my hand through that glass. My palm of my hand was numb for a long, long time, as though nerves slowly came back together. Years. That is what this woman is faced with, but on a much larger sense; instead of my hand to deal with, and all the way down into my finger, she's got to deal with that in her entire face, as those nerves grow back together. If the do.

~~~~~

I tend to really, really love doctors. They've got all these smarts and they're able to pull them out and use them over long hours and and under immense pressure, it's all just part of the job, part of who they are. a part of what they are. Docs have saved my life, my sisters life, my fathers life (though he died in the end of course but he didn't die from when he got hit by that car). And docs are fun, in my experience of them anyways, they can of course get imperious and finger-wavy about stuff but mostly I've not run into that. I had to fire one recently because she wanted to "play doctor" and fuck around with a medical regimen that's been working perfectly since 2003. Sorry doc, you're a wackjob. Bye bye, see you on the flip/flop."

Anyways. A great read, tremendous imagery This is an A+ post.
posted by dancestoblue at 7:52 AM on August 16, 2018 [1 favorite]


Would they have done all the same things but bankrupted the family?

Basically, this one. Once she arrived at the hospital she arrived at, the hospital and the doctors were obligated by law and the Hippocratic oath to do everything to save her, cost be damned - at the moment. The bills would have arrived and if the family couldn't pay, the lawsuits would start.
posted by cooker girl at 7:54 AM on August 16, 2018 [1 favorite]


I'm surprised they put all of that effort into helping her when she got there with a suicide attempt. If you're an alcoholic you're not going to get a liver transplant if there's others in line ahead of you and that's just common sense.

TFA explains this - the DoD is basically funding this because shes the closest they are going to get to a facial trauma victim from war (despite having folks come back from afghanistan who chose not to attempt the procedure).
posted by Exceptional_Hubris at 7:56 AM on August 16, 2018 [5 favorites]


. . . I couldn't help but read past the text we were being offered to the panoply of American sorrows that seep through its interstices.

Absolutely. The idea of Adrea's grandmother considering that Adrea would have wanted to be Katie anyway -- that she would rather have had that loving family than her own -- and the sight of her face laid out like L'Inconnue de la Seine.

In Mary Roach's book Stiff, Roach quotes a medical student who remembered her first cadaver limb because it still wore pink nail polish. It had belonged to someone, someone who cared for her appearance, who opened the little bottle and screwed the top back on. Adria's selfie, her feather earrings, her simple Y necklace, reminded me of that.

I wonder what Anna Coleman Ladd could have done for Katie. A mask wouldn't have been enough, but it could have eased her suffering for a while.
posted by Countess Elena at 8:00 AM on August 16, 2018 [4 favorites]


Super interesting that a side effect of the opioid epidemic is the increase in organs.

I talked with the head of an organ bank a couple years ago in Massachusetts, and she said the same thing. Haven't gotten to this article yet, so perhaps I'm repeating what's said there... The organs from people who die of overdoses are usually in much better shape than any other donated organs. They come from young people who died relatively quickly and without physical trauma. The drugs that kill them also might only damage a single organ or none, so the rest are all in relatively great shape. These organs are as close to brand new as you can get in an adult size.
posted by msbrauer at 8:59 AM on August 16, 2018 [2 favorites]


I have to echo the thought that if not for the easily accessible loaded rifle, Katie's suffering could have been prevented. I don't know for sure what her family's political views are, but considering their involvement in (I assume) Protestant Christianity and general religiosity, I imagine they're likely to be conservative, and I don't know how they personally square the pro-gun/"all problems come down to personal responsibility" ideology with Katie's actions. I would have liked to know more about how the brother felt about his role, yet I would also not be surprised in the least to hear that the family sees absolutely no conflict between having guns everywhere all the time and Katie's easily preventable tragedy because God's will or some thought-terminating handwave. It's clear they don't blame Katie for what she did, but the fact that the mom calls it an "accident" just erases everyone's agency.

It's also so sad that Adrea had such different outcomes. I have to wonder about how it is that the Stubblefields get so much compassion and material support from the community while Adrea and her family seem to have been left to their own devices. Another way this story is such an encapsulation of America today is the gaps visible between who is deemed "deserving" of help and who isn't.
posted by Kitty Stardust at 9:26 AM on August 16, 2018 [11 favorites]


Adrea

Thank you. I couldn't remember her name when I posted my comment above. Her name was Adrea.
posted by adamgreenfield at 10:59 AM on August 16, 2018 [1 favorite]


By that criteria, a kidney transplant isn't life-saving either (theoretically, you could be on dialysis forever); neither is a heart transplant (ditto ditto LVAD ditto).

Not really. Average lifespan on dialysis is 5-10 years, per the NKF. There are people who have been able to keep it up for decades, but there's a serious increased risk of death on dialysis compared to a kidney transplant. And LVADs are only a replacement for transplants for patients with certain kinds of heart damage.

In comparison, any of the face transplant patients could be expected to live normal lifespans without it, and if the transplant fails they may no longer have enough tissue left to recover even the pre-transplant quality of life. And given these are not covered by insurance, they would not necessarily be able to have a second transplant. It's a genuine concern.

I think quality of life is as important as quantity, and it is very hard to live life without a face, so I am fine with the operations, but it's not just blind negativity that leads some people to question face transplants.
posted by tavella at 11:14 AM on August 16, 2018 [3 favorites]


. . . I couldn't help but read past the text we were being offered to the panoply of American sorrows that seep through its interstices.

Sorrows are not confined to America. It's called life . Lots of madness around. Lots of sadness, if you choose to look at it that way. It's up to you.
posted by Modest House at 11:25 AM on August 16, 2018 [1 favorite]


Sorrows are not confined to America. It's called life . Lots of madness around. Lots of sadness, if you choose to look at it that way. It's up to you.

I'm sure there are other places on Earth cursèd enough to host each of the particular sorrows of endemic gun violence, epidemic opiate abuse, performative religiosity in the absence of any meaningful personal responsibility, and a generation-long war, but it seems to me that the combination thereof is a peculiarly American thing. If you choose to look at it that way.
posted by adamgreenfield at 11:45 AM on August 16, 2018 [29 favorites]


It may be considered ethically dubious to replace the face someone lost to trauma because it is only cosmetic, but it is not considered ethically dubious to replace the breasts that someone lost to a mastectomy required as a treatment for cancer, even though the "breasts" are non functional tissue bulges. They will even make a pair of new breasts in the patients size preference, so that some previous A or B cups go up to a C. I can't even...
posted by Jane the Brown at 8:04 AM on August 26, 2018 [1 favorite]


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