Dallas Wiens owes his new life to a dead man. He has become a different person -- inside and, even more so, outside. His grandmother calls it a transformation. "He used to be a real stinker," she says in her small house on the outskirts of Fort Worth, Texas, where embroidered pillows and a row of decorative letters spelling the word "faith" adorn the mantelpiece. The new Dallas Wiens is sitting on a couch beneath the mantelpiece, talking about how he shed his skin, both spiritually and physically.
Fate changed him, he says, adding that: "It takes a tragedy for us to figure out who we really are." Wiens talks about the strength he felt inside, about the hope that never abandoned him and how he saw himself confronted with the choice of becoming "bitter or better."
Though all this may be true, it isn't the actual story. The real story is about external features, about the fact that -- after a horrific accident -- two dozen intrepid doctors in Boston transformed Wiens into a different person by grafting the face of a dead man onto his head.
Forth Worth is one of those hard-to-read provincial cities in the vastness of Middle America, a downtown-less cluster of commercial areas connected to too many expressways.
On the city's outskirts, tourists can watch a dozen longhorn cattle being driven through quaint Wild West sets twice a day, accompanied by would-be cowboys on horseback. Shops on every corner sell embroidered boots, spurs and shot glasses adorned with the flag of Texas. Residents are used to eating a lot of meat and praying often, sometimes at the massive churches lining the streets.
Wiens was working at one of these churches when the accident struck shortly after 6:30 p.m. on Nov. 13, 2008. Wiens, then a 23-year-old construction worker, made a false move while standing on a cherry picker near the back wall of Ridglea Baptist Church. The brick wall has five windows and three openings covered with shutters. Wiens was painting the windowsills white.
In the unpaved alley between the church and a row of adjacent apartment buildings, high-voltage cables encased in black insulation material hang from wooden utility poles, dangerously close to the buildings. When he had finished painting the windowsills, Wiens lowered the cherry picker either into or extremely close to these cables.
The last thing Wiens remembers is his phone ringing. Everything after that, including the bolt of electricity that struck his face, has been obliterated by the shock of the accident.
Eyewitnesses later told him that the high-voltage current traveled directly into his body when a red-hot fireball burst from one of the wires behind the church, severely injuring the entire left side of his torso and his spine, but also striking the front of his head and stripping off his face forever.
Surviving Against the Odds
A rescue helicopter transported Wiens' lifeless body the short distance to Dallas' Parkland Hospital. There, doctors encountered a patient unlike any they had seen before. Where the face should have been, there was nothing but a disquietingly shiny, gaping burn, extending from the forehead to the chin and from one temple to the other. The skin was charred, the nose melted away, the eyes destroyed and the jaw muscles so tightly clenched that the teeth had become hopelessly entangled.
The first operation lasted 36 hours. The doctors managed to keep Wiens alive, and he spent the next three months in a medically induced coma. Over six months, the surgeons and the burn and skin specialists performed 22 operations on him, trying to fend off death even though they had little hope he would survive.
At first, doctors told the family -- Wiens' grandparents, his father and his brothers, David and Daniel -- to expect the worst, and that his chances of survival were very slim. Then, when he contradicted clinical experience by staying alive, they said he would never be able to speak again, that he had permanently lost his sense of smell, and that he would never be able to walk or eat solid food again.
To keep Wiens alive, the doctors had treated his destroyed face and wounded flesh by grafting skin from his thighs and back onto the front of his head, even stretching the transplanted skin across the eye sockets. At that point, Wiens' mouth was nothing but a lopsided, scabbed-over slit, a jagged opening in a hideous face with no eyes or nose, little more than a featureless skull with a grotesque goatee planted crookedly on his chin.
Wiens looked like a figure from a Francis Bacon painting, a mangled creature, a zombie. He would spend almost two years looking like that. As he walked down the street with a blind man's cane, passersby would recoil in horror at the ghastly figure.
Saved by a Daughter's Love
Since he could feel with his fingers what he could no longer see in the mirror, Wiens had an idea of what he looked like. He says he felt like crying when he touched his face for the first time after the accident. But there were no tears.
Wiens was already divorced before the accident. His marriage was over within two years, but it left him with one child. Scarlette was 18 months old when her father lost his face -- too young to think complex thoughts, but old enough to comfort an adult. Most importantly, she wasn't horrified by her father's hideous face. At the hospital, Scarlette immediately recognized her father's hands and was happy to see him, just as any child would be.
When Wiens talks about the scene with Scarlette, emotion creeps into his mumbled voice. It becomes clear that the girl's initial reaction saved him by giving him back what he had lost: an identity. He wasn't just a disfigured monster; he was the father of this child, a girl who recognized him and called him by name. That, says Wiens, was a great moment, and he swore to himself to never give up hope because life could still get better.
At the time, Wiens would have been even more hopeful had he known the latest news from the world of transplantation medicine. Initial successes with the partial face transplantations had been reported since 2005. In the northern French city of Amiens, doctors had performed pioneering surgery when they replaced parts of Isabelle Dinoire's face to repair damage done by her Labrador dog. In a military hospital in the central Chinese city of Xian, sheepherder Li Guoxing received the nose, upper lip and cheeks of a brain-dead donor after he had been mauled by a bear.
In March 2008, eight months before Wiens' accident, Pascal Coler received a completely new face in France to replace one disfigured by tumors. In December 2008, just a few weeks after Wiens' accident, doctors in Cleveland grafted the almost complete face of a donor onto a woman named Connie Culp, who had been shot by her husband outside a bar in Hopedale, Ohio.
In the last five or six years, medicine had seemingly ventured into the last untouched frontier of the human body. Kidneys, lungs, hearts and livers had been exchanged between total strangers for a long time, but not faces. The face was viewed as something different, as part of the soul, as something publicly visible but deeply personal.
Doctors don't tend to discuss such things in philosophical and psychological terms. Instead, they argue over whether they can ethically justify assuming the risks involved with facial transplantation. The problem lies with the medication. For the rest of their lives, transplant recipients must take strong drugs to prevent the body from rejecting the foreign tissue. The drugs suppress the body's immune defenses and have strong side effects, such as skin cancer, diabetes, kidney problems and chronic headaches.
Opponents of face transplants argue that prescribing these kinds of drugs violates medical ethics when it's not a matter of life or death. They say that the face -- unlike the liver or lungs -- is not necessary for survival.
But anyone with the nerves to look at the pre-surgery pictures of the small group of people who have had face transplants will most likely consider such arguments purely theoretical. A person might be able to survive without a face, but not with a life worth living.