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.
A Chance Born of Optimism
Jeffrey Janis, the doctor treating Wiens in Texas, recognized the possibility that he could be only the second or third patient in medical history -- and the first in the United States -- to receive a completely new face. Janis, a respected plastic surgeon, helped save Wiens' life immediately after the accident. Like any ambitious doctor in the United States, he attends every medical conference he can. At one symposium, Janis listened to a presentation by Bohdan Pomahac, the director of the Burn Center at Brigham and Women's Hospital, in Boston.
Pomahac, a native of the Czech Republic, reported on the initial experiences with partial face transplants. But, more importantly, Pomahac had access to a generous research budget that would enable him to fund at least half a dozen transplants. The US Department of Defense has awarded him a $3.5 million (€2.5 million) grant to conduct further research on facial surgery, which could also benefit wounded soldiers.
Janis first told Pomahac the unfortunate story of Dallas Wiens at the conference. When Pomahac saw Wiens for the first time, he almost rejected him as a candidate. Pomahac had seen few faces in his career as badly damaged as Wiens'.
Nevertheless, Pomahac had his team take a closer look at Wiens, analyzing his tissue, his blood vessels and his nerves. They made 3-D images of his head, a model of his damaged skull and models of the missing bone segments that would have to be taken from a donor at a later date.
They also spoke with Wiens who -- contrary to his doctors' predictions -- had learned how to speak again. Indeed, it is quite possible that Wiens' positive attitude, his characteristically Texan optimism and his unbroken faith in all kinds of things ultimately convinced the team in Boston to accept him as a candidate. Wiens was fearless.
He wanted his chance, and he would get it.
15 Hours of Surgery
Boston is sacred ground for doctors the world over. Harvard Medical School is surrounded by several major hospitals and famous research centers that together cover the area of a small city. In one of the buildings, the "Ether Dome," the first operation performed with ether anesthesia took place in 1846, and on Dec. 23, 1954 Joseph Murray, who would later receive the Nobel Prize in physiology or medicine, performed the first successful human kidney transplant between identical twin brothers.
In the early days, organ transplantation was a grim guessing game. Few patients survived the procedures, or they died because overdoses of X-ray radiation had overly weakened their immune defenses. The equipment, the computers and the analytical technology with which humans can now be dissected down to the cell level simply didn't exist at that time.
By comparison, when it was lying on the operating table at Brigham in March 2011, Wiens' body was like an open book. Only two people before him, one in Spain and one in France, had received complete donor faces, and now it was his turn.
The video of the 15-hour operation, edited down to a few minutes, makes the procedure seem much less complex than it actually was. It shows a group of doctors standing quietly around the table, wearing extremely powerful loupe systems on their heads. There is also a blue refrigerated box with a white lid. It presumably held the donor face preserved in a sterile plastic bag placed inside another bag filled with water that was, in turn, surrounded by ice.
The Complexities of a Transplant
The basic goal of the operation was to remove the face from the dead person along with all underlying tissue, nerves and blood vessels, to tie off all their ends or seal them with an electric scalpel, and to connect this mask to the recipient's jugular vein and carotid artery. "Once blood circulation has been established," says Stefan Tullius, head of the transplant surgery division at Brigham, "you have a little time."
Tullius flips open anatomy textbooks to explain the whole thing. A native of the western German town of Bad Kreuznach, Tullius received his medical degree in Frankfurt. He worked at Berlin's Virchow Hospital for 12 years, and he has transplanted thousands of organs over the years, including kidneys, livers and pancreases. Tullius has been working in Boston since 2005. He runs his own research laboratory, performs surgeries at Brigham and teaches at Harvard Medical School. When Wiens was wheeled into the operating room, Tullius was also standing at the operating table as part of the pack surrounding Pomahac, the chief surgeon.
Hundreds of tiny blood vessels and nerves in a face have to be connected, Tullius explains, "which is why everything takes so long." The larger nerve fibers, barely as thick as a hair, are sewn together with tiny needles and thread, "which isn't really a problem nowadays." The fact that the donor face lies firmly attached to the recipient's head is partly the result of many muscle strands having been connected, says Tullius, "and the recipient's blood vessels and nerves sprout in."
They sprout in?
"They branch out into the new tissue," Tullius explains. "And the skin is also sewn together. At any rate, nothing falls off."
Medically Pioneering, Philosophically Challenging
Tullius talks about the pressure doctors face when they venture into new territory in the operating room. He is aware that such radical interventions into the human face are pushing the boundaries of medicine.
Tullius has two children. His son was six when a program about a partial face transplant he had a hand in was shown on television. Before that, Tullius says his son had not been particularly interested in his work -- the kidneys and the pancreases and all that.
But when Tullius's son heard that this operation had to do with the face, he asked his father: "And what about the person who donated the face?" Tullius suddenly found himself having to talk to his son about death. "When it comes to the face," he says, "questions about recipients and donors, and about life and death, are different, more urgent. It's just the way it is."
Indeed, astonishing, incomprehensible things happen in the human body when body parts and organs are transplanted. Tullius describes one patient who received a transplant of the lower face in Boston. After the surgery, the patient's skin would turn bright red every four weeks. Doctors initially interpreted this as the first sign of a rejection reaction. But then they learned that the donor had had a skin disease known as rosacea that the transplant recipient "inherited" from the donor. "There are many things we still don't understand," says Tullius.
He does a lot of research with laboratory mice, and he often encounters philosophical questions in the process. What is age? What is youth? And what defines life?
Making the Face His Own
Such questions also come up when meeting with Dallas Wiens in his grandparents' small house on the outskirts of Fort Worth. No one knows anything about the donor because his family insisted on anonymity. His face sits on Wiens' head like a latex Halloween mask, but that's only the first impression. It soon becomes apparent that this mask reveals the rudiments of facial expression, and that a few muscles are moving beneath the skin. This is expected to improve over time as the nerves continue to "sprout."
Speaking to Wiens and focusing on his face, one can almost forget that something isn't right. Especially when wearing sunglasses, Wiens looks like a stroke patient, an emotionless poker player or a cynical police officer in a TV series. On the whole, and especially in comparison with the hideous face he had for two years following the accident, Wiens looks almost normal.
The right corner of his mouth droops a bit, though this is less noticeable when he lets his beard grow. Hair even grows on his head. "I just got a haircut," Wiens says, with his happy, infectious smile.
In fact, hair is an interesting aspect of this story. The donor was obviously older and heavier than Wiens, and he had gray hair. But the hair is no longer gray. Within a few weeks, Wiens incorporated the donor's hair into his own body, and his youth and hormones somehow reversed the graying process. Now, instead of the donor's gray hair, Wiens has dark brown, almost black hair. "It's my hair," says Wiens, as he runs his hand through it with a dramatic flourish. "It's my head," he adds, "and my face."
Wiens laughs a lot and is pleasant company. He speaks quickly and mumbles a lot because his mouth still isn't doing everything the way it's supposed to. But, despite everything his doctors predicted, he can still speak again. He is walking, even though everyone said that he would never walk again. He has even regained his sense of smell.
In fact, this last improvement came at a relatively early stage in his ordeal. When the tubes were pulled out of his nose at Brigham and Women's Hospital, Wiens was able to smell the hospital meal -- which was lasagna that day -- with the donor's nose, his new nose. He describes it as "the most wonderful smell I've ever encountered." Soon thereafter, he was able to feel the touch of his daughter's hands on his face -- and her tiny kisses. Wiens has been a happy man ever since.
The Miracle of Life
Still, the new face also causes Wiens much irritation. You can see it best when he stands, walks or gesticulates. Indeed, his head and his body seem somehow incongruous or at odds with each other. But the doctors say this is normal and will improve, that he will eventually make the face his own, and that he will look 60 percent like himself and 40 percent like the donor. It might sound like some Frankenstein or science fiction tale. But, in the end, it is merely a test of the limits of our imagination.
When Wiens removes his sunglasses for a moment, there is no longer anything disconcerting about him. Instead, his face is shattered and harrowing. His right eyelid is shut, as if the entire right side of his face were still asleep, and white portions of his left eye are visible.
It is a touching sight, one that banishes thoughts of monsters and reminds you instead of the miracle of life. It reveals that a human being is sitting there, a very special human being.