Agreeing to get Mayo Clinic’s first face transplant won’t undo his decision. But now he has a second chance for a normal life.
- “A Little Nervous” About Mayo Clinic’s First Face Transplant
- “Far Exceeded My Expectations”
Guys do stupid things. I should know, since I am one. Some of us, eventually, learn a little wisdom.
Everett “Red” Knowles was 12 when he decided to hop a freight train on his way home. That was May 23, 1962.
Red doesn’t know what happened right after he grabbed a passing freight car. The next thing he remembered is being at the bottom of a slope. Doctors figure, from the way his arm was avlused (torn off) at the shoulder, that he hit a bridge abutment.1
Red got up and walked away, holding on to his arm, still inside his shirt sleeve. Folks working in the area helped him get to a police ambulance, which carried him across the Charles River to a Boston, Massachusetts, emergency room.
He and Dr. Ronald Malt, Massachusetts General Hospital’s 30-year-old chief surgical resident, achieved a measure of fame that year.
Red’s arm was kept on ice until surgeons could start work reattaching it. Doctors had reattached blood vessels, nerves, muscles, bones, and other tissues, before: but never an entire limb.
Dr. Malt’s team reconnected Red’s bone, muscles, skin, and blood vessels first. I’m not entirely sure why they waited until September to reattach the nerves. I gather that they figured letting the arm heal a bit before working on the wiring was a good idea.
A few weeks later, Red was feeling severe pain in his right arm: which was good news, under the circumstances. A year or so later, Red was playing baseball again: as a lefty.
As an adult, folks called Everett Knowles “Eddie.” For a while he made a living lifting sides of beef. He drove trucks, taxis, and school vans; did volunteer work; and died last year.
Someone called him “a good friend and a pretty good mechanic.”2 I think that’s a good way to be remembered.
It still is, for that matter.
But is is the right thing to do? After all, some painfully-religious folks had conniptions over smallpox inoculations. Also lightning rods. I’ve talked about that before. (October 16, 2016; August 21, 2016)
But extreme medical procedures aren’t required. Not if they would be overly hard to endure, dangerous, “extraordinary, or disproportionate to the expected outcome.” (Catechism, 2278)
What’s “extraordinary” has changed over the millennia. Quite a bit of that change happened since I was a child.
Putting good health at the tip of my priority list, idolizing physical perfection, is not a good idea. Putting anything or anyone where God belongs is a bad idea, and I shouldn’t do it. (Catechism, 2112–2114, 2289)
I don’t think reattaching a 12-year-old’s arm was a bad decision. Maybe it’s an ‘extreme medical procedure,’ but the expected outcome was extreme, too: four working limbs, not three, for someone who could reasonably be expected to live for decades.
I’ll be talking about a face transplant done at Mayo Clinic. The patient had lived about a decade without most of his face, thanks to an unsuccessful suicide attempt. The donor tried to kill himself, too: and succeeded.
Suicide is a bad idea. (October 14, 2016)
That said, I must not assume that suicide is an automatic ticket to Hell. The Church prays for folks who have taken their own lives. (Catechism, 2283)
Suicide is a personal topic for me. My first suicidal impulse came in my teens, a woman who was very dear to me killed herself, and that’s another topic, for another post.
That was about 32 centuries back now: around the time Hattusa fell. My civilization’s records for the era are a trifle sketchy. That’s understandable, since the Late Bronze Age collapse happened then, and that’s yet another topic. (November 29, 2016)
Where was I? Vishpala, Hattusa, replacement parts. Right.
Herodotus wrote about Hegesistratus of Elis. Apparently he cut off part of his foot to escape Spartans. Hegesistratus , that is. Later, he “made himself a foot of wood.” (“The Histories,” 9.37, Herodotus) That was about two dozen centuries back now.
The Capua Leg was buried with someone about 300 BC. It was destroyed during World War II, but there’s a replica in London’s Science Museum.
The oldest prosthetic we’ve found so far is Tabaketenmut’s wooden toe. She was buried in the Theban necropolis in 800 BC, give or take a century or so. Testing with a replica showed that it would have let Tabaketenmut walk while wearing Egyptian sandals.
- “The ancient origins of prosthetic medicine”
Jacqueline Finch, The Lancet (February 12, 2011)
Basic research leading to artificial heart pacemakers started in 1889.
That’s when John Alexander MacWilliam noticed that “strong galvanic and faradic currents” could make a human heart beat: or stop it, and the human, permanently. More research was needed, obviously.
Arne Larsson received the first (working) artificial pacemaker in 1958. Melanoma killed him a little over 43 years later. Heart-lung machines have a similar history; but they’re still too big to fit inside someone. We have a few artificial heart prototypes, though.
Scientists grew a working mouse thymus inside another mouse recently. That research, published in 2014, is promising. But we’re still a very long way from growing human organs suitable for transplantation.3
Like I said, being healthy and staying healthy is okay: within reason. But are organ transplants “within reason?”
Heart-lung machines and pacemakers weren’t invented until well after the Gospels were written, so our Lord didn’t mention them specifically.
We were, however, told that love supports “the whole law and the prophets.”
If I take Jesus seriously, and I do, I will love God, love my neighbor, see everybody as my neighbor, and treat others as I’d like to be treated. (Matthew 5:43–44, 7:12, 22:36–40, Mark 12:28–31; Luke 6:31, 10:25–27, 29–37; Catechism, 1789)
Organ transplants are okay if expected benefits outweigh the risks. Donating organs after death “…is a noble and meritorious act….” On the other hand, killing someone and breaking them down for parts is a bad idea. (Catechism, 2296)
Simple? I think the answer is yes: and no.
“Mayo Clinic announces first facial transplant surgery”
Jay Olstad, KARE (February 17, 2017)
“For the past 10 years, 32-year-old Andy Sandness has been faced with the worst mistake he’s ever made.
“He was 21, battling depression and so he decided to shoot himself in the face. He says he immediately regretted it.
“‘I was stupid. I made the wrong choice and I’m paying for it for the rest of my life.’
“A decade later, the eastern Wyoming man got a second chance at a new life.
“‘I’m here, a little excited, happy. A little nervous,’ he told the Mayo Clinic’s videographer right before the surgery….”
I should think he’d be “a little nervous.” Upwards of 20 face transplants have been done since the first one, in 2005,4 but it’s still a very new procedure.
Face “replants” are a bit older.
Sandeep Kaur was nine when her hair got caught in a thresher, tearing off her face. Her mother saw the accident and got her daughter to a hospital, carrying both pieces of the girl’s face in a plastic bag.
That was in 1994. Abraham Thomas, a very skilled microsurgeon, reconnected the pieces. Sandeep recovered, with some scarring and muscle damage. As of 2004, she was learning to be a nurse.
The first partial face transplant, in 2005, was successful, at least for a while.
Isabelle Dinoire’s Labrador retriever had bitten off part of her face, probably while trying to revive her. She’d taken an unusually large dose of sleeping pills, for reasons that vary according to who’s talking.5
The donor, another woman who may or may not have committed suicide, was brain-dead when part of her face was removed. I hope so, at least.
We have inconsistent accounts of Dinoire’s and the donor’s cause of unconsciousness and death. I suspect that’s because suicide is an uncomfortable topic. As I said before, I think it’s a bad idea. If nothing else, it seems to make messes worse.
Anyway, Isabelle Dinoire’s 2005 surgery was successful, in the sense that drugs kept her body from rejecting the transplant. At least for a while. She apparently lost use of her lips during the winter of 2015-2016, and died the next April.
I don’t know what the procedure’s legal status is in America, but at least one person thought it was “experimental” and debatably ethical a few years back:
- “On face transplantation: Ethical slippage and quiet death in experimental biomedicine”
Samuel Taylor-Alexander, abstract, Anthropology Today, via Wiley Online Library (January 30, 2013)
That author’s concern for “the relationship between nationalism and medical advancement” is a can of worms I’ll leave for someone else.
This YouTube video is from Mayo Clinic:
- “Mayo Clinic’s First Face Transplant: The Patient”
Mayo Clinic, 5:08; via YouTube (February 17, 2017)
As Dr. Samir Mardini said, most of Andy’s upper and lower jaws were missing, along with his nose. There wasn’t much left to reconstruct.
The good news was that surgeons could patch and stitch what was left of his lower face into a small mouth and single nostril. The not-so-good news was that he looked — odd.
Some, not many, men have chosen a life far from other folks. Most of us prefer living among other people.
I think Andy summarized it nicely: “It would be nice to have – to settle down, have a wife and kids.”
“2 tragedies intersected to give this man a face transplant — and the story that unfolded is powerful”
Lydia Ramsey, Business Insider (February 17, 2017)
“In June, the Mayo Clinic performed its first face transplant.
“The medical feat, which is still a relatively uncommon procedure, was punctuated by the heartbreaking stories of two young men under very similar circumstances — one ending with a damaged face, the other in a death.
“Here’s how the decade-long story unfolded….”
Folks apparently are learning that “depression,” major depressive disorder, is a disorder: not an unwillingness to be peppy. I remember when we were on a similar learning curve with epilepsy, and that’s yet again another topic. Topics.6
I haven’t read why Calen “Rudy” Ross decided to kill himself. He’s the other young man Lydia Ramsey mentioned.
Rudy apparently had no obvious reason to commit suicide. He was 21, healthy, recently married, with a child on the way.7
My hat’s off to his widow. She was 19, eight months pregnant, and handled the additional decision-making with what I think is admirable reason, foresight, and resolve.
Her husband’s driver’s license had the ‘organ donor’ option checked. A few discussions later, she, LifeSource, and Mayo Clinic, were working to honor Rudy’s wish.
“…Months earlier, both he [Sandness] and Lilly Ross had expressed interest in learning about each other. She particularly wanted him to know about her husband, an adventurous, spontaneous guy.
“Last fall, she wrote to Sandness and the five others who received her husband’s organs. She described Ross, her high school sweetheart, as a ‘giving person’ who loved hunting, trapping and being with his dog, Grit. ‘I am filled with great joy knowing that he was able to give a little of himself to ensure a better quality of life for someone else,’ she wrote.
“As for the face transplant, she thought of her baby son when she agreed to it. ‘The reason that I decided to … go through with it was so that I can later down the road show Leonard what his dad had done to help somebody,’…”
(Associated Press/syracuse.com, LifeSource)
I don’t think the organ and face donations make Rudy’s suicide “okay.” I do think Lilly made a good decision, under extremely difficult circumstances.
We’re even told that psychological factors make a difference. (Catechism, 2282)
I can’t reasonably say that suicide or any other bad idea is okay.
But recognizing that an action is a “grave offense” is one thing. Judging the person who commits the act is something I must leave to God. My job, part of it, is responding with charity and justice. (Catechism, 1861, 1928–1942, 2197–2246, 2401)
Happily, my connection with Rudy, Lilly, Leonard, Andy, and all, is quite remote. At the moment, my concern is mostly making sense in this post.
“…The moment Sandness realized his face finally looked normal came three months after the procedure. He was in an elevator, and a little boy glanced up at him without being startled, something that had never happened before the surgery.
“In the time since the procedure, Sandness has also regained the ability to smell, breathe, and eat as he could before the transplant. For now, he’s enjoying being able to blend into the crowd….”
(Lydia Ramsey, Business Insider)
Doctors at Mayo Clinic needed to be reasonably sure that Sandness knew the risks involved with this procedure, and could live with the consequences:
“…Sandness had to undergo a rigorous psychiatric and social work evaluation to address, among other things, a key question: Should this surgery be performed on someone who’d attempted suicide?
“Several factors were in his favor: His resilience and motivation, a strong support network of family and friends, a long-standing rapport with Mardini and a gap of several years since the shooting. Doctors also noted others with self-inflicted injuries, such as excessive drinkers, have received liver transplants.
“‘I don’t think there’s anybody who doesn’t deserve a second chance,’ Mardini says….”
(CBS News (February 17, 2017))
Since I take Jesus seriously, and have read Matthew 18:21–35, I won’t argue against second chances. I’ve talked about mercy, forgiveness, and getting a grip, before. (December 4, 2016; November 21, 2016)
Transplants from one person to another trigger an immune response, unless the donor and recipient are twins. Our immune system is pretty good at attacking critters in our body that don’t have our genes.
That’s a good thing; when bacteria, viruses, or parasites get past our skin. When the non-identical code is in a transplanted organ, it’s not so good.
That’s why folks with transplanted parts take immunosuppressive drugs for the rest of their lives. The drugs have various unpleasant side effects, but not taking them means the new kidney, heart, or whatever, stops working.
Having an offline immune system isn’t good, either, which is why balancing benefits and risks is so important.
“A ‘miracle’ face transplant gives young man a new life”
Sharon Cohen, Associated Press, STAT News (February 17, 2017)
“He’d been waiting for this day, and when his doctor handed him the mirror, Andy Sandness stared at his image and absorbed the enormity of the moment: He had a new face, one that had belonged to another man.
“His father and his brother, joined by several doctors and nurses at Mayo Clinic, watched as he studied his swollen features. He was just starting to heal from one of the rarest surgeries in the world — a face transplant, the first at the medical center. He had the nose, cheeks, mouth, lips, jaw, chin, even the teeth of his donor. Resting in his hospital bed, he still couldn’t speak clearly, but he had something to say.
“He scrawled four words in a spiral notebook:
“‘Far exceeded my expectations,’ he wrote, handing it to Dr. Samir Mardini, who read the message to the group.
“‘You don’t know how happy that makes us feel,’ Mardini said, his voice husky with emotion as he looked at the patient-turned-friend he had first met nearly a decade earlier….”
The transplant operation kept two operating rooms, about 60 surgeons, nurses, anesthesiologists, and other folks busy for 56 hours.
They didn’t stay awake through the whole thing. STAT News says that individuals would take four-hour breaks along the way.
- “Mayo Clinic’s First Face Transplant: The Patient”
Mayo Clinic, 5:08; via YouTube (February 17, 2017)
- “Mayo Clinic’s First Face Transplant: The Surgery”
Mayo Clinic, 7:18; via YouTube (February 17, 2017)
One of the really tricky, or maybe tedious, parts of the process was testing the nerve branches to see which should be connected.
Neural ‘wiring’ in the human face is nowhere near as simple as that picture makes it look. Doctors tested the circuits by applying electric current to nerves and watching what happened.8
We’ve come a long way since Luigi Galvani learned how to make a dead frog’s legs jerk, and that’s still another topic.
“…He’s thrilled to smell again, breathe normally, and be eating foods that were off-limits for a decade: apples, steak, and pizza that he shared with his doctors.
“His transformation isn’t just visible. After the shooting, he says, when he dreamed, he still had his old face. Now, his new face appears in his dreams.
“Sandness, now 31, plans to return to Wyoming, work as an electrician and, he hopes, marry and have a family someday.
“For now, he savors his anonymity. Recently, he attended a Minnesota Wild game. He bought some popcorn. He watched some hockey. He didn’t see any stares or hear any whispers.
“He was, as he says, ‘just another face in the crowd.’ Just thinking about that makes him smile.”
(Sharon Cohen, Associated Press, STAT News)
Being able to eat an apple and not scare children is nice. So, I think, is raising a family.
I’m glad that Sandness has a second chance.
More about life, death, and decisions:
- “Brain Implants and Rewired Monkeys”
(November 18, 2016)
- “Different Sorts of ‘Dead’”
(November 11, 2016)
- “Alchemy, Science, Life, and Health”
(October 16, 2016)
- “Elastic Brains and New Tech”
(October 14, 2016)
- “Polio, Zika, and Using Our Brains”
(August 21, 2016)
- “The Boy Who Lost His Arm — and Got It Back”
Joan Steen, Popular Science, p 71ff., via popsci.com/archive (November 1962)
- “Wellesley loses Everett (‘Eddie’) Knowles, RDF volunteer, medical miracle”
Deborah Brown, The Swellesley Report (October 25, 2016)
- “Somerville boy makes medical history”
Paul Maisano, Op-Ed, The Somerville Times (April 7, 2013)
- “May 23, 1962: Give That Kid a Hand!”
Randy Alfred, Wired (May 23, 2011)
- “Ronald Malt”
Pearce Wright, Obituary, The Lancet (November 9, 2002)
- ‘The First Thing I’m Gonna Do Is Start Exercising Arm’
Winona Daily News, via newspaperarchive.com (June 17, 1962)
- Artificial cardiac pacemaker
- Artificial heart
- Artificial heart valve
- Cardiopulmonary bypass
- Hip replacement
- Organ transplantation
- Regenerative medicine
- Wake Forest Institute for Regenerative Medicine
- MRC Centre for Regenerative Medicine
- Wake Forest
- “Whole organ ‘grown’ in world first”
James Gallagher, BBC News (August 24, 2014)
- “Will we ever grow replacement hands?”
James Gallagher, BBC News (Marcy 21, 2012)
- Human Craniomaxillofacial Allotransplantation | A Face Transplant Research Study
Comprehensive Transplant Center, Johns Hopkins Medicine
- “First face transplant patient, Isabelle Dinoire, dies at 49”
Azadeh Ansari, Sandrine Amiel, CNN (September 7, 2016)
- “Face transplant recipient overwhelmed by result”
BBC News (February 18, 2017)
- “2 tragedies intersected to give this man a face transplant — and the story that unfolded is powerful”
Lydia Ramsey, Business Insider (February 17, 2017)
- “Twin tragedies give survivor a new face and second chance at a normal life”
Associated Press, syracuse.com (February 17, 2017)