Why face transplant research is important – and, more power to Oscar!

The Times carried a moving interview yesterday with the surgeon, Dr Joan Pere Barret, who carried out the world’s first full face transplant a year ago on ‘Oscar’. Some might say it was a pity it was not with Oscar himself but I fully respect his desire for privacy as he comes to terms with his completely new face – and all the risks associated.

Oscar’s injuries were from an accidental gun shot and if you look at the internet images of the damage, you can understand why “(for 6 years) he never went out because he was worried about people laughing at him” according to his surgeon.

The face transplant has undoubtedly given him a new lease of life in functional and aesthetic terms and you can understand why he decided its benefits outweighed the risks that the transplant may be rejected or that the heavy lifelong immuno-suppressant regime might have horrible side-effects or reduce his capacity to fight off infection or cancer and so reduce his life expectancy.

As more of these important transplants are proposed and conducted, I found myself reflecting on two aspects of this man’s case:

First about the similarity between the gunshot wounds that Oscar and another transplant patient, Connie Culp have endured and those of the first patients of modern-day facial reconstructive surgery, those injured in the trenches of the First World War.

Another book in the genre exploring those days, following Marc Dugain’s The Officer’s Ward (also a fine film), Pat Barker’s Life Class and The Crimson Portrait by Jody Shields, came out this week by Louisa Young called My Dear, I Wanted To Tell You. It takes the reader to the now extinct hospital, St Mary’s Sidcup where Harold Gillies performed so many facial surgeries.

But the second point is that many of those real men and women like the Italian guy with gunshot wounds I shared a ward with back in the 70s were supported and enabled, despite their less-than-perfect surgical repairs, to face their worlds again.

It grieves me to read that Oscar spent 6 years in isolation. I passionately believe that he – and many other patients worldwide who may be waiting for transplants (or not) – should be offered immediate help to enable them to emerge from that isolation – or better, never to go into it in the first place.

And, indeed, despite his new ‘improved’ appearance, Oscar (and the others) will still need help (I suspect) to learn how to manage (the fear of) the reactions of other people to him in all sorts of social encounters, small and big.

This is one reason why psycho-social professionals should be present as core and essential members in all clinical teams dealing with patients who experience facial conditions that affect their appearance be it after trauma, cancer, warfare, stroke, birth conditions or any other cause, even what might be thought of as ‘quite minor’ (but rarely is to the person whose face is affected). It is also where the cognitive and behavioural approach pioneered by Changing Faces and now in play in many hospitals is so crucial.

I described that approach in brief at the end of my blog on 16.3.11 but, to come back to Oscar, I would want him to have now – and to have had before – a social skills mentor who could help him understand how others are likely to experience meeting him and to devise and practise how he will – pro-actively and robustly – handle such reactions in the future.

More power to you, Oscar!

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