Blood and Guts Read online

  For the staff at East Grinstead, Bill Foxley was another typical case. Most of the skin on his face had been vaporized. It was distorted and ugly. His upper lip was burnt away, and the lower part of his nose had melted. It hung like dripping candle wax, leaving his nostrils flared upwards. His flesh was blistered and glistening, red and raw. His right eye was little more than a slit, blinded by the fire. His left was inflamed. Neither eye had brows or lashes. Worse were his hands. They resembled swollen gnarled stumps, the fingers fused together into a ball of flesh – a coagulated mass of tissue, bone and muscle all melded into one.

  McIndoe's task was to rebuild Foxley's distorted face and do what he could for the airman's horribly damaged hands. Over the next few months Foxley had a series of operations to gradually restore his features. First, the surgeons took a tube of skin from his shoulder to his nose. Three weeks later it hung from his cheek to his nose giving his head the appearance of a jug. Finally, after a further three weeks, they used the tube to rebuild his upper lip. Nine weeks later the waltzing pedicle had done its job: Foxley's face had been successfully rebuilt.

  The results of McIndoe's operations were even more impressive than Gillies' achievements during the First World War. Although Foxley's face was still somewhat distorted, in only a few weeks McIndoe had given him a new nose, lips and glass eye. The surgeons had also managed to separate what was left of his fingers and partly rebuild his hands.

  But McIndoe was more than just a great surgeon; he was also a great psychologist. The patients at East Grinstead did not spend their days lying in bed; they were encouraged to get out and about. After all, most of these men were young and fit. Until their injuries, they had lived life to the full. Indeed, airmen were notorious for their fast living, and keeping them cooped up would do nothing to help them.

  Most of their injuries were external and cosmetic, which meant that they were perfectly capable of moving around. So, with tube pedicles dangling from their faces, they could be found playing football in the grounds, drinking beer in the local pubs or watching films in the town cinema. McIndoe made great efforts to ensure that his patients were integrated as much as possible into the East Grinstead community. He encouraged local people to visit the hospital, and gave talks to explain the work that was done there. As a result of his efforts, the men were received as guests in local homes and were treated with respect in pubs and restaurants.

  The town was proud to play host to the airmen and became part of their therapy – a stepping-stone between the hospital and the wider world. A world where perhaps they would not always be treated so well. During the First World War Gillies had found that, despite his best efforts, his discharged patients met with little public understanding. Their return to Civvy Street had sometimes been brutal. They were haunted by their looks and shunned by society. Many led isolated lives or ended up in dead-end jobs – selling matches or begging. One former patient even found employment as an 'elephant man' in a travelling circus. Many suffered from depression. Some committed suicide.

  McIndoe wanted his patients to be treated as the heroes they were, not freaks to be locked up behind closed doors or laughed at in a circus. He encouraged the wounded men to support each other – to wear their injuries with pride. They called themselves the Guinea Pig Club, produced their own magazine, had a little emblem (a guinea pig with wings) and even their own anthem. This is the first verse:

  We are McIndoe's army, we are his guinea pigs.

  With dermatomes* and pedicles, glass eyes, false teeth and wigs. A night out with the Guinea Pig Club could be a peculiar thing to witness. Their favourite haunt was the Whitehall restaurant in East Grinstead, where the manager, Bill Gardener, became almost as important to their rehabilitation as McIndoe himself. Gardener took a special interest in the men from Ward Three. He drank with them at the bar, but made sure they did not drink too much. He chatted with them, helped them laugh and managed to steer them away from moodiness or depression. Other places in town were similarly accommodating. Seats were reserved for the Guinea Pig Club at the cinema, and they were regular guests at local dances.

  * A dermatome is a surgical instrument used to cut away slices of skin for grafting. In the song, however, it could equally be referring to the slices of skin themselves.

  At any of these places you could see badly disfigured men, some with bandages, most with tubes of flesh hanging from their faces. They would be seen laughing, joking or chatting up the local girls. Some had only stumps for hands and needed help to drink. Their friends would lift the drinks to their lips and assist them later when they needed to go to the lavatory. Often these strange-looking men were accompanied by nurses from the hospital (whom they would also be chatting up). Gradually, the men of the Guinea Pig Club overcame their injuries and regained their dignity. Many of them married local girls, and very often local nurses.

  Word of the hospital spread and soon gained national attention through newspaper and magazine articles. Britain's most popular entertainers came to visit the famous heroes of Ward Three and give performances in the town. Joyce Grenfell and Flanagan and Allen were among the stars to entertain the Guinea Pigs. The hospital was visited by senior politicians and military figures. The local paper reported that the hospital's work 'and the work of their splendid staff was known throughout the world'.

  McIndoe's army was a triumph. The surgeon restored the faces of Allied airmen but, above all, he restored their pride. Bill Foxley is one of those proud survivors and attends the regular reunions of the Guinea Pig Club. Like many of McIndoe's patients, he looks back on his time at East Grinstead with affection. He recalls an occasion when the surgeon took a group of them into London. 'It frightened the life out of people,' he says, 'but that was all part of the game.'

  Between them, Gillies and McIndoe had also restored the reputation of plastic surgery. They had developed new techniques and made tremendous advances in improving the appearance of their disfigured patients. But as 'beauty crank' Gladys Deacon had demonstrated, and as Gillies had discovered with the innkeeper's daughter, you didn't need to be badly injured to seek the advice of a plastic surgeon. There were lots of people who wanted to change their appearance, and for the gifted surgeon a whole new post-war world of opportunity was opening up.

  A WHOLE NEW USE FOR A TUBE PEDICLE

  London, 1946

  * * *

  Harold Gillies had been working as a government consultant during the war, but now he was ready to go back into full-time private practice. The rich and famous came to his house, just off Harley Street, for discreet facelifts, tucks or enhancements. He applied everything he had learnt from battle wounds to the fading faces of Knightsbridge and Mayfair, and was pulling in the equivalent of some £1.3 million a year. Plastic surgery had made his reputation, but cosmetic surgery was making him rich. Now aged almost seventy, he was about to perform an operation that would guarantee him a place in the history books.

  Laura Maude Dillon was born the wrong sex. She spent her life convinced that she should have been a man. She dressed in men's clothing and could pass herself off as a man in the street. But this wasn't enough for Laura; she wanted to be a man. She was determined to transform herself physically into the opposite sex. When she made the decision in the late 1930s this was hardly an easy thing to do.

  First, there were legal and social implications – how on earth would society treat her/him? Would she even be allowed to do it? There were other practical problems too. No surgeon had ever tried to turn a woman into a man before. But Laura was determined, and she managed to persuade a doctor to prescribe testosterone tablets. Her voice and appearance began to change and, during the war, she underwent a double mastectomy to remove her breasts. She was becoming androgynous, but was not yet a man. Finally, Laura was put in touch with Harold Gillies.

  During a series of operations, carried out in the utmost secrecy, Gillies used his tube pedicle technique to build Laura a penis. First, he cut a tube of skin from her side and looped it arou
nd to her crotch. He then filled the tube with a frame of cartilage to give it bulk and structure. Once the blood flow was established, the end of the tube connected to her side was severed and the appendage gradually shaped into a penis. Finally, a rubber tube was connected to her urethra so that she could urinate through the new organ. Thanks to the tube pedicle, Laura became Michael. Gillies had successfully performed the world's first female to male sex change operation.

  Michael's new penis was only cosmetic – he would never be able to achieve an erection, which meant he could never have a full sexual relationship. But being a man made it a lot easier to have a career. Michael enrolled in medical school under his new legal name and eventually qualified as a doctor. He even wrote a book, describing people who were born with the mind of one sex and the body of the other. No one reading the book guessed that he was actually describing himself. In fact, few people would ever have known that Michael was born Laura if it had not been for his aristocratic background.

  Michael's brother was Sir Robert Dillon, the 8th Baronet of Lismullen. In Debrett's guide to the British aristocracy Michael was listed as Sir Robert's heir. However, in the rival publication, Burke's Peerage, Sir Robert's heir was given as Laura. The birth dates of Laura and Michael were the same, and it didn't take long for someone to realize that they were the same person. During research, the editor of Debrett's had come across the amended birth certificate that had transformed Laura into Michael.

  The story broke in 1958 – and what a story it was. A sex scandal involving the aristocracy: what could be better? The world's press were all over it and set about tracking Michael down. They found him on a freighter in Philadelphia, where he was serving as the ship's medical officer. Reporters persuaded the reluctant doctor to give an interview. He certainly looked like a man. He was described as bearded and smoked a pipe. Dillon told the newsmen that he had been born suffering from hypospadias. This is a condition found in males where the opening of the urinary tract is not at the tip of the penis. Dillon had never in fact suffered from hypospadias; physically, he had been born a perfectly healthy girl, but was justifiably unwilling to give the reporters the truth. He said that he had undergone the operations to make him a more complete male.

  He hated the attention and wanted to be left alone. Now the story was out, this seemed unlikely. So, rejected by society, isolated and depressed, Michael fled to India and eventually ended up in a Tibetan monastery, where he became a monk. He devoted the rest of his life to Buddhism and writing. Despite the prejudice he had encountered, he later wrote how he owed his life and happiness to Sir Harold Gillies.

  When Gillies died in 1960 reconstructive surgery still relied on the tube pedicle. But the pedicle – even the waltzing pedicle – had its drawbacks. As it needed to be kept attached to its blood supply, moving tissue around the body took weeks. Patients had to endure straps or contraptions similar to those developed by Tagliacozzi to keep the pedicles in place, and suffer the awkwardness (and embarrassment) of having loops of flesh dangling around their bodies. There had to be a better way. Finally, by the 1970s, surgeons had come up with a solution: the operating microscope.

  Today surgeons can take tissue from anywhere on the body. They use a large microscope positioned over the operating table to connect together minute blood vessels less than two millimetres across. Once the microscope is swung into place, they employ impossibly small needles and minute threads, narrower than a human hair, to make tiny, precise stitches. When Chinese surgeons first attempted microsurgery forty years ago, they unpicked a pair of stockings and used the fine nylon thread. Microsurgery is the same technology that made Clint Hallam's hand transplant possible (see Chapter 3).

  What Gillies and McIndoe did not realize is that the transplanted tissue needs only a single artery and single vein to keep it alive. So even a relatively large swathe of tissue – skin, bone and muscle – taken from, for instance, the leg can be grafted on to a patient's face as long as it is connected by two blood vessels. Rebuilding a patient's jaw can be done in a single operation rather than over a period of months. Operating under the microscope has revolutionized reconstructive surgery and consigned the tube pedicle to history, although pedicles are still occasionally employed when all else fails.

  But even the technology of microsurgery has its limits. As any before-and-after images of reconstructive facial surgery show, there is still a fundamental problem in repairing a face with tissue from other parts of the body. The difficulty is that the skin always looks like the area it has come from. The skin of an arm is different from the skin of a face – it can be darker or hairier – and when it is moved around the body this is all too apparent. Some surgeons believe the only solution is to transplant the skin from someone else's face.

  In 2005 thirty-eight-year-old Isabelle Dinoire received a partial face transplant after being severely mauled by a dog. It was an incredible technical achievement for the French surgical team who carried out the operation, and now some surgeons are planning another huge step forward. They want to abandon traditional reconstructive surgery altogether and carry out a full face transplant. For some victims of facial disfigurement, this might be their only hope.

  The story of Jacqueline Saburido illustrates the point. The bright, pretty twenty-year-old Venezuelan had moved to Austin, Texas, to study English. On the night of 18 September 1999 she was on her way home from a party, sitting in the front passenger seat of a car being driven by another student; three other friends were in the back. It was four in the morning, the road was dark. Suddenly an SUV veered across the carriageway towards them. Its driver was drunk.

  When paramedics reached the scene, the front of the car Jacqui was travelling in was crumpled, the engine ablaze, broken glass across the road. The driver was dead – crushed by the steering wheel. One of the back seat passengers was also dead. The other two were pulled free, but Jacqui was pinned into her seat by the dashboard. She screamed for help as the flames reached higher. The paramedics tried to put out the fire but could do nothing to free her.

  Then the screaming stopped.

  When the firefighters arrived they doused the flames. Jacqui's flesh steamed as they gently turned the water on her body. Her seat had melted, the car interior was blackened by fire. Everyone looking at this awful scene of destruction assumed she was dead. It was a relief really, the screaming had been unbearable. Then Jacqui moved. She was still alive.

  Almost two-thirds of her body was severely burnt. Her face was almost completely destroyed, her hair incinerated, her skin cracked and charred. Her hands had disintegrated into stumps, and she had several fractured bones. No one expected her to live for long. The driver of the SUV walked away from the crash, although he was later convicted and imprisoned for drink-driving.

  With round-the-clock care in a specialist burns unit, Jacqui gradually started to recover. Since September 1999 she has undergone more than fifty operations. Surgeons have done their best to rebuild her face; they even managed to restore an eyelid that had melted in the blaze. But now they've reached the limits of traditional reconstructive surgery and there is little more they can do. Jacqui's face remains terribly disfigured. Her features are crumpled, her neck sagging, her skin a blotchy, crinkled patchwork. She has no hair, eyebrows or lashes. Her nose is flattened and distorted, her nostrils drawn upwards. She has only the remains of a single ear, and her left eye is swollen. Jacqui is still recovering from the events of 1999 and has devoted her life to campaigning against drink-driving.

  After examining cases like Jacqui's, plastic surgeons such as Peter Butler believe that face transplants are the only way forward. Butler is one of Britain's top plastic surgeons and uses imaging techniques to simulate the effects of a face swap. On a computer screen his team can virtually place one face over another. In theory, the technical problems of a face transplant have already been overcome. The surgery is perfectly possible, although the cocktail of drugs to prevent rejection would probably take ten years off a patient's life. Ho
wever, there are big ethical questions over whether it is right to take the face of one person and transplant it on to another. Our faces define us – how would a new face change us? And what about the donor family – how would they react to seeing the face of a loved one on somebody else's body?

  Plastic surgery has come a long way since the brutal operations conducted in early India, or Tagliacozzi's leather corset and pedicle. The real triumph of plastic surgery has not been the cosmetic surgery for the 'beauty cranks' – the botox, the silicone or the facelifts – but the effort that has gone into fixing terribly damaged faces.

  Over the centuries surgery has restored the faces of syphilis victims, soldiers, airmen and the victims of fire or car crashes. Today surgeons can save the lives of even the most badly burnt and injured patients, such as Jacqueline Saburido, but despite all the advances in modern medicine they can only do so much.

  Soon (possibly by the time this book is published) someone in the world will have received the first full-face transplant. You can bet the story will be a sensation. However, advances in tissue engineering will eventually enable surgeons to grow swathes of skin in the lab. They have already been able to grow a human ear on the back of a mouse. One day it might even be possible to construct an entire new face from samples of a patient's own DNA. We can only hope that the technology is used to reconstruct the faces of the victims of conflict or tragedy rather than to boost the vanity of ageing Hollywood stars, Page 3 models or the Gladys Deacons of this world.

  Tagliacozzi's 16th-century jacket-and-strap arrangement. You can see the pedicle linking the patient's upper arm and face.