Second Nature: A Love Story

by Jacquelyn Mitchard

  “So you know what that is called, what the girl is doing with her arms?” Hollis asked Eliza.

  “It’s a port de bras,” Eliza said. “A ballet thing.”

  “Did you take ballet lessons?”

  Eliza grimaced. “You haven’t met my mother. I took every lesson. When I came home, I was almost eight. I could barely read Spanish, much less English. It was Bolivian orphan rehab.”

  Hollis smiled and cut her eyes reprovingly at Eliza. They turned back to the screen.

  “I don’t mind rep—retelling it,” Sicily was saying. “It’s just that you can’t consider my reaction out of pro—out of bounds.”

  “I can understand your speech,” Polly said.

  “It’s habit. It’s sort of like your mouth being one of those verbal computer writing devices that puts down ‘dragon’ when you say ‘wagon.’ ”

  Polly smiled. “I don’t consider your reaction out of proportion, Sicily. Everything you thought was solid ground collapsed. After that, the human mind tends to reach for any possible form of relief. The normal response to that kind of devastation is to grab at straws.”

  “That’s a normal reaction.” Sicily sighed. “So I’m normal.”

  “But you went from absolute certainty that you did not want a face transplant to submitting yourself as a candidate. Dr. Cappadora approached you in December. And it’s only April.”

  “It’s my only life,” Sicily said.

  “That sounds rehearsed.”

  “It is! This is the third time I’ve told you.”

  “On the basis of losing your fiancé, you decided you wanted to have a face transplant?” Polly asked.

  Hollis frowned. That made Sicily seem like a girl who was jilted one day and the next day donated all her old furniture and ordered a vanload of new stuff from IKEA.

  Sicily thrust her arms up and out again. She regarded the ceiling as if asking for some kind of celestial guidance. “I was on the verge of having a life with Joey. We were a match. I had an unusual kind of good luck that went bad. Now if I want a life, a mate, children, I have to start over.”

  “Plenty of people—”

  “I know. But I want what I had. That doesn’t make me nuts, just shallow.”

  “This surgery is no guarantee of that outcome.”

  “This face is an almost certain guarantee of the opposite outcome,” Sicily explained. “I’ve not just lost my face or Joey. I lost my family. I’ve had only hard times. I want an easier time.”

  “I’d hardly call a twenty-hour procedure and a lifetime of maintenance drugs …”

  Sicily stood up, crossed the room to the pastoral picture, and wiggled her fingers at it in a covert hello. “You know, I don’t have your knowledge of how the mind works. I do know a great deal about medicine. It’s my job. I know that the drug regimen for anti-rejection is nowhere near as harsh as it was when the first face transplant took place, what, ten, eleven years ago? I know that this is not an easy operation. But it’s founded on basic anatomy. I know that microsurgery is tricky and there is the small chance that the whole face will fail and they’ll end up having to plaster on skin from my butt. But that’s never happened. So much has happened to me, why should that happen too?”

  “Sicily, you know what that’s called. It’s called—”

  “Magical thinking. I know. But there’s no reason it should happen now. It’s happened with a finger. There have been arms that doctors removed. There’s even a guy who had a penis transplant and wanted to have it removed. No one has ever lost a face. The one guy who died—”

  “He failed to follow protocols.”

  Sicily’s eyes were eloquent with reproof. “Way more than that. I know peo—some surgeons who were involved. He was basically a suicide. And, Polly, I’m not being a smart-ass trying to show off.”

  Outside, Hollis Grigsby winced. Sicily was exactly correct.

  The first full-face transplant was a stunning triumph. Lily Blackwood-Thorne—a Londoner who pulled her child to safety from a smashed car—was ambushed by flames when she turned back to help her sister. Everything went so well in part because of pure luck—bad luck and good. Lily Blackwood-Thorne’s older sister, Adele, sustained mortal internal injuries in the same accident and lingered for months on life support. But a fire brigade had put out the flames. Her face was unmarked. Concussed by grief, Adele’s ophthalmologist husband could have opted for a beautiful funeral. Instead, he had asked the golden question: Could anything “be done” to help Lily?

  Even on the morning that Hollis Grigsby scrubbed in at one operating room in St. Charles and Kings’ Hospital to remove Adele’s face—while, in the other room, her hand-chosen team of colleagues prepared Lily’s—she didn’t feel ready. But then, she doubted that she ever would. She would have gone on studying—perhaps forever—the full square foot of tissue that comprised a human face laid flat and the minute miracles of the trigeminal nerve and its branches that led to expression and sensation. She was overly prone to research, always had been. Hollis’s protégé, a crack young maxillofacial surgeon who went by his last name, Livingston (to his dry British chagrin, his given name was, unfortunately, Stanley), had urged her on. Hadn’t she set out to do just this? Wasn’t this the end result of her lifelong work on the hands of burn patients, since hands approximated faces in their complexity of musculature and neurological amplitude? Donor digits and limbs allografted onto burned stumps could restore their ability to caress a child’s face or do a day’s work. But when it came to faces, surgery had so far failed them. Pioneering Spanish, French, and Chinese doctors had successfully transplanted a lower face and a dozen upper halves and quadrants of faces, but the results fell short of what Hollis knew was possible. Patients could close their eyes, chew, spit, arch their eyebrows, but better-than-bad was still not good enough. It was not pleasing.

  Over the years of the quest, Hollis’s obsession with the need and feasibility of such a transplant was not what supported her, but it was what sustained her. Becoming an orthopedic surgeon with a specialty in reconstruction had taken ten years. Her fellowship in microsurgery and the possibilities of transplant tacked on four more. Over the years when she willingly spent hours of her own time and money in the lab, first alone and later with Livingston, she had drawn the suspicion of butchers who wondered at her particular fondness for large batches of pigs’ feet—pigskin texture and vascularity being eerily similar to that of human beings. She spent her days at the University of Wisconsin in Madison replacing hips, legs, and knees, reattaching legs and arms separated from their natural locus by everything from the wheels of a train to a vengeful stepfather. At night, she stood at the microsurgical microscope, which was taller even than she, her head pressed against the binocular headpiece, her hands free to use the instruments suturing the veins or arteries of the animal laid out anesthetized before her, feet working to adjust the focus of the instrument with the unconscious dexterity of a tailor. Her forearms ached. Her lower back burned.

  What was the role of the immune system in determining why some animals healed without any loss of function and minimal scarring? Why did one way of making the tiniest stitches produce a better result than another pattern of sutures? Hollis sewed the skin, photographed, observed, repeated, and reported. The silent hours fell one onto another with the speed of the pages of flip books she and her sisters had played with as children. During her fellowship in London, she moved slowly away from the leg arteries of a dog and a rabbit to the facial skin of a tender piglet or rhesus monkey, drawn back and back again to the vivarium and the cadaver lab, from the living animal to the human being who had disinhabited the body. She had literally worn out cadavers removing and reattaching facial skin—so many reconstructions that she’d left the poor, thin faces of the gallant Oxford dead ragged. Feeling like Burke and Hare, Hollis bought her own cadaver. Night after night she traced the nerves as they wound through the muscles to the brain. Touch, twitch, wrinkle, sneeze. Enlist the frontalis, lower the procerus,
raise the orbicularus oculi. A wink. Again. Hollis was enraptured by the kind of “muscles of emotion” that made a face human.

  “Holly, every face is a face. If you’ve seen one, you’ve seen them all,” said Nathan St. Jerome, Hollis’s best friend at the time, who was now a pricey cosmetic surgeon in Sydney. “You torture that poor woman like you expect to raise her from the dead.”

  “How I feel is, I won’t really understand the one until I’ve seen them all,” Hollis said. “If I have to think about it, I don’t understand it.”

  Perhaps all those nights that Hollis came back to the lab after her sons were asleep informed the relative grace with which her team of six surgeons and twenty nurses laid that eerie one hundred square inches of tissue—translucent as wet linen, fragile and yet so resilient it could withstand a big man’s punch without tearing—across the raw plane of Mrs. Blackwood-Thorne’s exposed musculature. With cameras whirring as the surgeons moved from region to region of the face, support staff documented the microsurgical positioning and attachment of every slicked structure, artery to artery and vein to vein, every nerve to nerve, every rod of muscle in Mrs. Blackwood-Thorne’s face to every corresponding rod in her sister’s face. Because the sisters were so similar, the process was almost like reassembling a human jigsaw puzzle. The moment when the carotid and the jugular that fed and drained the face did their customary job, the vascular “pinking” of the skin, was perhaps the most moving moment of Hollis’s professional life.

  Eight days later, the bandages were removed. Despite the bruising and swelling, Lily Blackwood-Thorne reached up, touched her own cheeks, and shouted, “Adele!” All their lives, people had commented on the resemblance between Lily and Adele.

  Quietly pondering the satisfaction of redeeming at least part of another person’s loss, Hollis forgot how huge this moment would be to the world. The press called the first full-face transplant The Shout Heard ’Round the World. The news might have consumed Hollis with an endless pileup of interviews. Fortunately, Livingston was more gifted with both the press and the physicians who flocked to study the Grigsby–Livingston procedure.

  Eagerly, Hollis received her second candidate, Laurent Girard, an even more heartbreaking saga. Preparing for his family’s annual stalking trip in search of roe deer, Girard shot himself in the face while cleaning his gun. A newly accredited kindergarten teacher, Girard admitted that he didn’t even like shooting but went along for the companionship with his father and brother. Rushed to St. Charles and Kings’, he lay near death for months.

  “I just want to go back to the children,” Girard told Hollis. “And I’ll scare them. They’re so little.” Girard was himself only twenty-three.

  Or so the story went.

  A Canadian with French citizenship living in London, Girard, actually thirty, presented more or less the jacket he wanted the team to see.

  They did not see his hidden history of severe alcoholism or that the gun “accident” was a suicide attempt, his second in five years. Laurent Girard was quite probably a sociopath who charmed them all: Sociopaths were the dread of every surgical team, since they were nearly impossible to tease out and identify. Depression was the norm for the disfigured, and odd quirks of all sorts were expected. But no one could have spotted Laurent Girard unless he’d worn a neon crown. Or so Hollis told six psychiatric interns, when at least two of them considered a change in specialty after the catastrophe. But why? Hollis asked over and over. What was in it for him? A slow death and the added bonus of leaving earnest people with nightmares for life?

  When Girard failed to show for one, then two, and three clinic appointments, word went out to all the contacts he had produced during his family support sessions. Every one was a fake. The kindly mum was a tavernkeeper who thought the poor boy needed a chance. The stalwart older brother, who described his job as a “bit of a minor banker,” was in fact a former actor who’d gone down to drugs and lived in a shelter. There was a bank two doors over.

  Girard finally turned up at a Vancouver hospital, in liver failure, an emaciated walking corpse who died within days.

  Undone, Hollis went back to hands. She refused calls. She turned down the BBC. Hollis was finished with face transplants. Let Livingston do it. If not he, then others.

  Six months later, along came the young girl from a patrician family in Spain. She’d been bike riding with friends when a car plowed into three of the kids. The biking stirrups Aurelia wore for safety somehow got hooked to the car’s bumper, and she was dragged for two hundred yards. Her helmet stayed put, so her brain was unhurt, but her face was destroyed. She was still razor-bright and knew that in sixty seconds she had gone from being the prettiest girl in school to what she called “a thing,” who with bitter sarcasm drove away the friends who rallied around her. Her widowed father left Hollis a dozen messages: “If it is a matter of money, I will pay you anything. Five million pounds. Ten million. Only let my little girl sing and laugh again.”

  She could not ignore Aurelia.

  Nor could she ignore the Irish laborer whose hundred-pound wife had pulled him out of their harvester. “He didn’t have a brilliant face, ever. But I was fond of it,” the wife said.

  So many others could do hands. As Hollis’s mother, Evangeline, reminded her, it was a sin to refuse your own gift. At first, Hollis had done just that. At the age of seventeen, Hollis packed four sturdy boxes with things she could not live without—her favorite pillow, her shawls, her collected Shakespeare, her Bible, big plastic jars of her grandmother’s specially mixed spices, and all her Beatles and Nina Simone CDs. It was the first time she’d gone farther from her own parish than to Baton Rouge. She’d gotten on her first airplane, New Orleans to Edinburgh, and began her undergraduate study on a Rotary scholarship, courtesy of strings yanked none too subtly by one of her mother’s “ladies.” Hollis had meant to major in drama, seeing herself swathed in woolens, striding the Scottish streets mouthing classic lines from memory. Anatomy was only a scholarship elective, chosen in the same spirit as Hollis studied small engines in high school—a thirst to know how things worked. When she ended up repeating “The Carpus consists of the Scaphoid, the Lunate, the Triquetal, the Pisiform, the Hamate, the Capitate, the Trapezoid, and the Trapezium” with more passion than “O hateful hands, to tear such loving words!” Hollis realized that, unawares, she’d fallen in love. Grandmother’s spices and Nina Simone went back into the boxes and flew with Hollis to Madison, Wisconsin, where she began her graduate studies in research anatomy.

  One night during her graduate school years at the University of Wisconsin in Madison, Ralph Mangiotti, the renowned burn surgeon, had come upon Hollis quietly studying his repairs on a young girl whose mother had held first her face then both her hands to the coils of an electric stove. Mangiotti asked what Hollis thought of reconstructive surgery.

  “Well, I think that it is the closest thing on earth we know about salvation,” Hollis said.

  “Why aren’t you doing it?” the doctor had asked.

  At the advanced age of twenty-seven, Hollis entered medical school. Deep in the rigorous program at Madison, Hollis had scant time for any life, never mind a social life. Prospective surgeons on old nighttime soap operas had more sex in a one-hour episode than Hollis had in a semester. Her most significant relationship at that time wasn’t a love affair of the usual kind: It began nearly six years later, when Hollis represented the UW–Madison Burn Center at a conference in London. After Livingston spoke on the dental implications in future of full-face transplant, Hollis waylaid him, voracious for more. Livingston’s wife, Gwen, still told the story of calling Livingston once at midnight after the conference banquet would have been hours over, then five times between one and four in the morning, after which she decided there had been a mishap and began calling the various trauma units, starting with Livingston’s own. She was shocked to hear that her husband was indeed there, unhurt and deep in conversation over tea with a very pretty American, who was not hurt either.
The fellowship post from St. Charles and Kings, Livingston liked to joke, nearly beat Hollis back to Wisconsin. After all the years since, a confirmed and contented expat, and Sidney, her husband, and the boys, when the offer came from Chicago for Hollis to be the one to found the first clinic dedicated entirely to face and limb transplants, she was surprised by the force of her desire to continue to expand the boundaries of this hopeful technology. She was surprised, even more, by the yearning, which ambushed her like an alarm through broken glass, to be home. The boxes made their final trans-Atlantic crossing.

  “Look what she is doing,” Hollis now said to Eliza.

  “These are my facial nerves,” Sicily was telling Polly, placing the thumb and finger of one hand on spots on her cheeks, just below the ears. “They say you can’t remember feelings, but I dream about my great-uncle letting me hold a duckling once and how its feathers felt on my cheek.” She placed both hands over her mouth. “The fifth cranial nerve has upper and lower divisions. Do you have a husband, Polly? Or a boyfriend?”

  Polly Guthrie nodded, and Eliza and Hollis could measure, in the slow tempo of the nod, the psychologist’s perplexity.

  “The fifth facial nerve lets you feel him kiss you. But the seventh facial nerve lets you make that motion with your mouth—what do they say?”

  “Puckering up,” Polly said.

  “That’s it. You can kiss him back. I was thirteen when I got burned. I’d never been kissed,” Sicily said. “I’ve got strong heredity. My grandparents on both sides are well into their eighties and they’re going strong.” Sicily moved her hands down until she cradled the lower portion of the bulbous projection that was her chin. “I want to use the zygomaticus major and risorius muscles, with the help of the buccinator.”

  Polly Guthrie nodded again.

  “I’d give two years of my life to smile.”

  “She knows what she wants,” Hollis said to Eliza. “Let’s transplant this young woman.”