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A Face, to Face the World
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The first full-face transplant, performed on Frenchwoman Isabelle Dinoire, was unnervingly beautiful, even to her.

The third successful operation, in the United States, was unnervingly odd.

The last one, which was last May, on a blind young father who’d been in a bad farming accident (there is never a good one) showed what the future of this surgery may be.

Every story begins with a question.

The question I asked myself nearly two years ago, when I began my newest novel was this: How will the 200th full-face transplant look? And will there ever be one?

The answer is the story behind my tenth adult book, Second Nature: A Love Story, out this month.

It is the story of Sicily Coyne, a young woman who gets a second chance a dozen years after her face was horribly disfigured in a chapel fire that also killed her firefighter father. After a full-face transplant, Sicily is transformed, and so is her life. But that is only the beginning of the story. Enormous research went into finding out what could go right with this procedure and what could go wrong.

A great deal can go right, and often, even a mediocre result is a miracle, when this procedure is necessary. There is great need, especially for the victims of severe trauma and burns. Although the effect often is cosmetically astounding, and psychologically uplifting, this surgery is never done for cosmetic reasons. A face transplant can let eyes open or close, let someone breathe or eat or sleep without complex devices.

And while this brave new medical advance is indeed painstaking, is not rocket science or even brain surgery. Everyone has a jaw, in much the same place. Everyone has an eye socket, in much the same place. So why hasn’t that 200th surgery happened, if there is the means and the need? Why is this story set in a presumptive near future, about ten years from now?

Think about it.

We may consider the heart the seat of human emotion. The heart flutters and hurts, and, usually, when we’re describing a psychological circumstance, we’re really describing a physical feeling of anxiety or dread or grief.

Yet, the heart is not the most intimate part of the body. In fact, people give birth on TV or show the footage to friends. The most intimate part of the body is the face. We consider it, along with the eyes, the mask and mirror of the being.

Thirty or forty years is a long time, but not, for example, a long life. Yet it was that long ago, when I was a kid, that the idea of taking a heart from a person whose body would never get better, and putting it in the chest of a person whose heart was truly broken, by disease or heredity, was weird science.

Now, it happens literally every day, in every major city.

It is customary when the anguish of brain death comes unbidden to good people, for the family to give up a loved husband or wife or child’s heart, lungs, kidneys, corneas, and even other parts of the body – a hand, a foot, a finger, so-called “soft tissue.”

A face is something else.

At least, it’s something else, to us.

            I think that the reason that there are not more face transplants is that there are not more people willing to donate a face.

            Burying someone you love without his or her face is a thought that stops the most emotionally robust person. For some reason, that idea raises moral, ethical and emotional issues like nothing else does. We attach an almost mythic meaning to faces. Even Dinoire said that her face would never “really” be her own. She went further and said that it would never “be me.” Yet, that’s a way of thinking. It’s not a fact. Botox, in moderation, is becoming. It also becomes you. So do defined muscles, when you exercise. When we think of faces, we think in magical terms that aren’t truly justified by 200 square inches of skin. If that skin were a belly or a backside, it wouldn’t carry so much mythical freight. Those thoughts stand in the way, today, of something that could change lives in a powerful, poignant way, with no harm done.

One of my best friends died in December, after four years in a persistent vegetative coma. She was only 44 years old, and she could never have gotten better. Still, her family would have recoiled from the suggestion that her gorgeous face give hope and presence to another person mangled by fate, although she, herself, one of the most hardheaded and soft-hearted people I have ever known, would have welcomed that opportunity.

            In time to come, I think more people will welcome the chance to do such durable, profound good, to give a person back to the world in a unique way, a restoration in the fullest sense. It’s a new take on biological destiny, a forward way to think of what we bequeath to the world when all else is lost, the very essence of our better nature.

            What this story is about are all those possibilities, the good, the awful, the sublime. I hope you read it, and I hope it make you cry and laugh, but also think.