Face

It was a ritual Biko and I had performed thousands of times over the last five years, so I had no reason to think that December evening would be any different. We had just returned home from a walk when he nudged my knee with his long snout and flopped to the floor, legs akimbo, his white, furry belly turned to the ceiling. Scratch my tummy, please. Since I had first met him as a sad-eyed Basset Hound puppy, Biko had been hard to resist, with his floppy, chocolate brown ears that trailed on the ground and tripped him up, his oversized front paws like fluffy slippers, and his constant need for love and attention.

He had come into my life around the time I had started working as a freelance journalist in Mexico City. I was spending long hours on my own in front of a computer, so having him around was good company and taking him for walks was one way to guarantee I got out of the house each day. Even when he grew to around fifty pounds, he would still try to climb onto my stomach while I was watching TV, like he had done as a puppy, trying to get as physically close to me as possible. His comedic looks and cuddling ways were two of his biggest selling points.

Now Biko was five years old and I crouched down to give him a tickle, balancing on the balls of my feet in the hallway of my one-bedroom apartment. We had moved to New York in August 2010 so I could go back to school, and it took him a while to get over the flight from Mexico. He had been off his food and lethargic—doggie depression, the vet said—for the first two weeks. But four months later, we were settling in nicely, the two of us. I found his sweet spot and gave it a good scratch, eliciting a wildly pumping foot in response.

One minute he was flat on his back groaning with pleasure, and the next I noticed a tiny sneer around his nose. Not even a fully formed growl, but a wrinkle so small I wasn’t even sure I’d seen it.

“Did you just growl at me, Beeks?” I teased.

The words were barely out of my mouth when his stocky frame came flying toward my face and knocked me backwards to the floor. His teeth were bared in a tight grimace and he was snarling in a voice of wild fury I had never heard before. He seemed to be powered by a savage, primal rage. I still can’t quite reconstruct how it happened so quickly, how he went from prone to airborne in a split second, how a dog with a long, heavy body and short legs could flip and fly in one smooth movement, gaining such speed and trajectory that I never stood a chance of raising my arm in time to shield my face.

I felt a soft tearing sensation, like slow ripping through silk. Then hot blood gushed from my mouth, pumping out in heavy spurts, ruby blotches seeping into my white fleece. I watched it fascinated, horrified, paralyzed.

He lunged again. This time my right arm went up and he sank his teeth into my wrist. I kicked hard into his soft belly with one foot and propelled myself into a standing position with the other. He beat a temporary retreat, his hackles raised and his body still arched into attack mode, trembling with the low warning hum of a growl. “Oh Biko, you’ve really done it now,” I said. I actually said that to him.

Two things flashed across my mind. I needed to get out and I needed to find help. Fast. I had a clear path to the front door behind me, and on the way out I grabbed a black towel from the bathroom and pressed it to my throbbing mouth to staunch the blood. There was blood everywhere—in my mouth, on my clothes, my face, my hands, the floor, the sink, the bathroom door. I left smudged red fingerprints in a trail behind me as I fumbled for my cell phone and keys and fled the apartment, slamming the door behind me. I heard Biko belatedly race down the hallway and fling himself bodily against the barrier I had just put between us. And then I began knocking on doors.

First, I tried the other two apartments on the first floor, and then two more on the second floor. It was the fourth door that opened. “Please help me, please call 911,” I begged the young woman who stood in the doorway, my voice muffled by blood and towel. “My dog just attacked me.”

Four paramedics from the fire department—FDNY stretched in white capital letters across the back of their navy blue shirts—arrived within ten minutes. One of them took my blood pressure and another gave me a wad of fresh white gauze to press to the wound.Then they helped me downstairs to a waiting ambulance. The driver radioed through to his command center: “Where’s the best hospital to take a patient with a facial injury who probably needs plastics?” “Bellevue,” came the reply.

Even though I heard what he said, the severity of my injury still hadn’t sunk in. I really wasn’t in any pain, so it didn’t seem like it could be all that serious. I didn’t realize then that I was most likely suffering from psychological shock—a condition also known as acute stress response, which often follows a traumatic experience and is characterized by disorientation, numbness and emotional detachment. Adrenaline must have been coursing through my system, keeping me upright and relatively compos mentis. I kept asking the paramedic sitting with me if I would need stitches. He didn’t answer.

37 yo F BIBA [brought in by ambulance] after sustaining dog bite. Patient was at home playing with dog on the floor and dog bit her — removing a large amount of soft tissue from lip and cheek. Right oral commissure – loss of circumferential tissue – 1/3 of upper and lower lip (upper >lower ) – jagged edges.

Bellevue Emergency Room at around 9pm: It was busy, but not crazy busy. I’d watched those medical dramas on TV, so I knew this was probably relatively quiet. I was propped up on a bed and an orderly trundled me around, looking for an empty space to stash me and take my details. For a short while, I was parked in a corridor between two guys who were handcuffed to their beds. I observed this with an idle curiosity that seems preternaturally calm in retrospect. Another man, shoeless and dressed in a dirty coat, argued with the ER admitting nurse about some pills she was refusing to hand over.

It had been close to an hour since the attack and I still hadn’t stopped bleeding. They found me a space behind a curtain, cut off my bloodstained fleece with a pair of scissors, and dressed me in a flimsy hospital gown. They gave me a tetanus shot and inserted an IV filled with antibiotics into my arm. They asked me if Biko was up to date on his rabies shots—he was. And if I had insurance—I did. The ER doctor, a tall Asian man with black, spiky hair and a very white coat, was pleasant but harried. He tried to wrap a bandage diagonally over the top of my head and under my chin to hold the gauze in place, but it wasn’t tight enough and it kept slipping over my eye like a pirate’s patch. Blood was flooding, bitter, viscous, and metallic, into my mouth and down my throat. The doctor told me not to swallow it or I might throw up. I asked him what he proposed I do with it instead. Someone handed me a yellow plastic bowl and I spat bloody splotches into it, dark crimson on ochre, like a gory Van Gogh palette.

A blonde Ear, Nose & Throat (ENT) resident dressed in blue scrubs came to see me once, twice, three times. She was brisk, in a reasonably sympathetic way, and probably a few years younger than me, I decided. She kept taking pictures of the wound with her cell phone and sending them to her attending to consult on the best course of action. These were to be the first of many photos of my injury—photos I wish had never been taken, visual evidence I long to erase from existence because that way there’d be no proof (aside from me) that it had ever happened. I seemed to have left my cell phone in my neighbor’s apartment, or the ambulance, or lost it somewhere along the way; so I asked the doctor if she could email my father, who was due to fly into New York from London the next day for a visit, and tell him where I was.

By midnight they were ready to wheel me up to the operating room. “We’ll irrigate the wound, disinfect it, and stitch it up,” the resident explained to me. “But we won’t do any reconstruction tonight. It’s best to let the wound heal first before we tackle that.”

I reached up for the first time then to touch the place where my lip should have been. It had finally stopped bleeding, and I felt the edges of a jagged outline that lay above my teeth and stretched into my right cheek. “Oh God, he’s really taken a chunk out of me, hasn’t he?”

From: Kaufman, Laura*
To: Fitzgerald, Niall
Subject: Tara Fitzgerald

Mr. Fitzgerald,
Your daughter was brought into Bellevue Hospital earlier this evening after being bitten by her dog. She sustained a large injury to her face, primarily to her lip. We took her to the operating room, washed out the wound and closed it. The injury will need further surgery in the future. She asked me to pass this information on to you as she does not have her cell phone. We are doing our best to take care of Tara.

Laura Kaufman MD

I came out of the anaesthetic too fast. As I jerked into consciousness, I was blinded by the huge fluorescent lights shining overhead and began struggling to breathe. Something was stuck in my throat and I thrashed and kicked out in panic, trying to suck some oxygen into my lungs. Four or five people leaned over me and pinned me to the operating table. One of them extracted the thick tube and I gasped for air. My throat felt raw and scratched, my face fragile and swollen. Then I remembered where I was, and I began to cry. They wheeled me down to the recovery ward and I slipped into a fitful sleep in the dark, chilly hospital room, wondering if anyone outside knew yet what had happened to me.

I woke up in another room with a bandage on my face and my tongue glued to the roof of my mouth, longing for liquid of some kind. The duty nurse brought me a mini can of ginger ale and I stuck in a straw and sucked. Nothing happened. I tried again. Still nothing. Because I couldn’t fully close my mouth, or “seal off the oral cavity” in medical terms, I had no suction capacity. It finally hit home. I really did have a hole in my face.

That first day after the attack I also discovered I had lost the ability to say certain plosive consonants—like ‘b’ and ‘p.’ Try saying them without letting your lips touch. ‘Book’ becomes ‘ook’ and ‘pain’ becomes ‘ain.’

It was several hours before I ventured into the bathroom and came face to face with a mirror. The first thing I noticed was that my normally straight blond hair had gone curly. And I don’t mean a little bit wavy, but full-on 1980s tight poodle-perm curly, even my bangs. It looked so ridiculous I had to giggle. Maybe the distraction was a good thing. That day I couldn’t really look at the wound, except through the tiny gap in the bandage that covered half my mouth and part of my right cheek. The doctors told me I could go without the bandage if I wanted, but I didn’t want to see the rest. And I certainly didn’t want anyone else to see the rest.

Later that afternoon, after my dad had touched down at JFK, he came to the hospital and began to do what he does best. He’s used to running a multinational business, and he’s a fixer, an organizer of people and things. He reached out to anyone and everyone he had ever known in the medical profession in New York to get recommendations for plastic surgeons, because soon I would have to have another operation to begin the reconstruction of my mouth. He tracked down a local vet and went with her to my apartment to retrieve Biko, who apparently came running to the door, tail wagging and excited to see people, wondering why he had been left on his own for so long. The vet took him to her animal hospital for safekeeping. I still didn’t understand what could have happened to him, why he would have turned on me like that.

After two nights at Bellevue, my father took me to the hotel where he and his wife Ingrid were staying. I had been planning to fly home to the UK for Christmas that week, but the doctors said the risk of infection was too high to get on a plane, and anyway the last thing I wanted was to be out in public for any sustained period of time. In the days leading up to Christmas, Dad made phone calls while Ingrid did what I knew he would never have been able to bring himself to do. She helped me clean the wound each day, so I wouldn’t have to look at it, and she washed my hair, which soon returned to its normal state after a good shampooing.

That week is mostly a blur. I took the occasional phone call that usually ended in tears and wrote emails I don’t remember. I slept and watched trashy TV—staring greedily at people’s undamaged faces—and avoided the world. After two or three days I started to change the bandage myself and examine the wound in the mirror. I was able to look at it in isolation with an almost objective horrified fascination, as if it weren’t part of my own face. I could see the jagged edge that left my teeth exposed, the gaping gash of a mouth, and the crude tear into my cheek. But the only way I could look at my whole face was to focus on certain features one by one, or see it in profile. As long as I didn’t see the wound as part of my face, I could deal with it.

Well-meaning people, who had heard about the attack and called or emailed to express sympathy, often told me I was lucky, that it could have been my eyes or my throat. He could have killed you, they said. Oh lucky, lucky me. They enraged me. Sometimes I wanted to punch them right in the face. I knew they were trying to help. But this is not what lucky looks like.

I stayed in the hotel room as much as I could, and on the few occasions I did venture outside I wrapped a scarf around my face. I found myself unable to look people in the eyes when I spoke to them, afraid of their reactions. I kept returning to the idea that as human beings our face is the seat of our identity, the way we present ourselves to the world. It’s how we recognize people and how we carry out much of our communication with each other. We judge people’s reactions to ourselves by their facial expressions, and we are more likely to trust those expressions than we are the words coming out of someone’s mouth. I guess this is why people sometimes find it hard to look at or speak to those who have serious facial disfigurements. They cannot read their expressions or “understand” them.

The English language is full of idioms that use the word ‘face’ to mean one’s identity, one’s pride, one’s real self, one’s appearance: Face to face. Two-faced. In your face. Face value. To save face. Face the music. To have egg on your face. A slap in the face. Put on a brave face. Not just a pretty face. A face only a mother could love.

What does it mean when your face is no longer the face you recognize?

As an adolescent, after struggling with a bout of teenage acne, and on into my early twenties I had always been somewhat self-conscious about my looks. I had never considered myself to be beautiful, but on a good day I would have said I was pretty, in a girl-next-door kind of way. I have quite finely structured symmetrical features, decent cheekbones, and large blue eyes. In the past, I had often been complimented on my smile. Now I would have to learn to live with a different face, a different identity.

My father and I went to see a string of plastic surgeons, each of whom took photo after photo of my face, like sets of mugshots—front on, profile, mouth at rest, yawning, smiling—and then explained how he would tackle the reconstruction. It would not be a simple task. The corner of the mouth, or commissure, is one of those miracles of natural design. The muscles in the cheeks pull together to form a perfect acute angle so that the mouth can seal shut, allowing us to do all sorts of important things like eating, drinking, and saying ‘book’ when necessary. Those corners are anchoring the muscles in your cheeks. They are part of the warp and weft of your face. Take them away and the whole thing collapses. Surgeons call it the integrity of the mouth.

The commissure is very hard to re-create artificially after it has been damaged. And mine was completely gone.

I wanted to make the right choice, pick the right surgeon. But the weight of the decision overwhelmed me. I panicked, I locked myself away, I raged and I screamed. Then I researched and I read, I asked questions and demanded answers and follow-up appointments. Trauma takes away your control, and seeking knowledge is one way of reclaiming that control. I thought if I could reduce the process to an intellectual exercise and somehow understand it, then I could take it in hand and own it. And maybe that way my emotions wouldn’t take over. Because it felt like if they did, they might never stop.

My father and Ingrid headed back to London for Christmas and I spent four days over the holidays staying with family friends, mostly shut in a room, reading or sleeping. With a bandage covering half my mouth, eating or drinking was a messy, awkward business and I avoided doing it in front of anyone. The only time the bandage came off was at night, when I was sure no one could see.

My mom arrived from the UK in late December, rented a short-let apartment in the city and moved me into it. By that time, we had narrowed the choice of surgeon down to Dr. S, mostly because he came recommended by someone Dad trusted implicitly. But I was still wavering. Mom and I went back to see him three times during the last week of 2010, each time with more questions than the last. At first I was unsure of his quiet manner and unwillingness to promise too much. He told us of the difficulty of re-building a true commissure, and of the chance that it might end up as a rounded corner instead of an acute angle. Images swam into my mind of a grotesquely made-up, red clown’s mouth with its curved edges. He explained that in order to close up the hole in my cheek I would have to lose some length and therefore symmetry on the right side of my mouth. But ensuring a seamless close would also avoid the risk of drooling in the future. Jesus Christ, I hadn’t even thought of that.

On the upside, my relatively wide mouth and full lips would be a plus. More to work with, Dr. S said. In the end it was his patience and his willingness to field all my questions—including the all-important “Are you sure you can do this?”—that won me over. At our last pre-surgery appointment he came straight from the operating room, still dressed in green scrubs, fresh off doing a liposuction procedure. “Always makes me hungry,” he said. That made me laugh.

In the run-up to the operation, I read up on facial defects and started to understand Dr. S’s reticence to promise miracles. With a hereditary or congenital facial defect, the expectation is that each operation will be an improvement for the patient. After all, the patient was born that way, so you are starting with a lower frame of reference. With an acquired defect such as mine, you may see some improvement after an operation, but it will always fall short of the wished-for goal of looking exactly as you did before. Accepting that this will never happen is the hardest part of the process. Plastic surgeons can do amazing work, but they also have to manage expectations.

We scheduled the surgery for January 6th, but there was something else I needed to deal with first. Biko had been at the animal hospital for two weeks when the vet gently suggested I needed to make some sort of decision. I remembered how a few years earlier, during a particularly violent thunderstorm in Mexico City, I had been curled up on the sofa reading a book when I felt two large paws reach up onto the seat beside me. I could feel Biko’s body trembling in fear against my leg. Normally I didn’t let him on the sofa, but that time I made an exception. Back legs scrabbled up behind front ones and he huddled beside me, gradually creeping his way on to my lap. He was scared and I was there to protect him. I was supposed to be there to protect him, from thunderstorms and everything else.

I will probably never know what really happened to him, but the vet had two possible theories. She said the most likely explanation for a previously loving and gentle dog turning on his owner was either a neurological disorder referred to as Sudden Rage Syndrome, which is thought to trigger unpredictable rage blackouts in some dogs, or perhaps an advanced brain tumor. Either way, she was not optimistic. I took a sort of bleak comfort from the fact that Biko was just sick and hadn’t intended to do what he’d done. I asked the vet if there were any viable alternatives to euthanasia, which is what she was suggesting. I was horrified by the idea, and also a little frightened of the possibility that my decision might be coming from a vengeful place. I didn’t hate him, but I did feel betrayed by him. How could I kill my own dog?

I combed the Internet in search of other solutions. The vet told me a dog with a biting history—especially one who had attacked his owner—was unlikely to be adopted. She said there were a handful of animal sanctuaries that might take him in, but he would most likely remain locked up and with little human contact. I toyed with the idea of taking him back under certain conditions—I could keep myself at a distance from him, I could muzzle him, or even de-fang him (have all his teeth removed). None of them seemed like viable options.

The truth is I hadn’t told the whole story. It wasn’t the first time Biko had bitten me. The week before the December 15th attack he had also turned on me out of nowhere while I was petting him, grazing the inside of my wrist with his teeth. I had played it down as a bit of a joke at the time, but it wasn’t really very funny. I didn’t want to admit to myself that he was capable of such behavior, but now I was scared to be around him.

By New Year’s Eve I was emotionally wrung out from researching surgeons, researching options for my dog, mourning Biko and mourning myself. I was easily sleeping sixteen hours a day and I couldn’t concentrate on anything for more than five minutes at a time. Having to make another decision was the last thing I needed, but I had no choice. No one else could do this for me.

I called the vet and said I was ready. She told me it would better if I didn’t come to the hospital to say goodbye. “Either he’ll be completely normal and you’ll doubt your decision, or he’ll try to turn on you again and I don’t think you want to risk that,” she said. I didn’t argue. There was something comforting about being told what to do. “One last thing, you have to actually say the words Tara, so there’s no chance of making a mistake.”

Dear Tara,

After a long walk around the block during which he smelled many smells and greeted many dogs, Biko enjoyed a tasty meal of beef soup and peas. Then, surrounded by the staff who had loved him and cared for him over the last two weeks, he was sedated and gently put to sleep.
Please know you made the right decision.

Yours,

Nancy McDonald

In the following months I cried more for him than I ever cried for myself.

The day of my second surgery, a Thursday, Mom and I arrived at New York Presbyterian Hospital at 6am. I was scheduled for the first surgery of the day and Dr. S. came in to say hello before they took me into the operating room. Then the anaesthesiologist paid me a visit and I told her about waking up with the tube down my throat. She said this time I would be under a milder dose of general anaesthetic that meant I would be sedated, but not completely knocked out. This is known as a “twilight state,” where the patient is relaxed and sleepy, but still responsive and able to follow simple directions. The patient should have no memory of the surgery and the time directly following it. Also, the anaesthetic would be administered by several thin tubes going up my nose and not one terrifyingly fat one thrust down my throat, as the surgeon would need the area clear to work on my mouth.

Several hours later, Dr. S found my mother in the waiting room and showed her photographs of the surgery on his digital camera. “You looked so funny,” Mom said to me afterwards. “Just a little face sticking out of a hole in a green sheet.” I never saw those photos, nor do I want to. But I did ask him later what, exactly, he had done.

He explained that he had closed up the large defect in my cheek by pulling together the layers of the external skin, the middle muscle layer, and the inner oral mucosa (the lining of the oral cavity). Then, in order to recreate the acute angle of the right oral commissure, he elevated the remaining oral mucosa, closed it onto itself to fill the missing lip area, and advanced the surrounding skin and muscle as separate layers.

“Once I had gained enough length to close the cheek defect, I elevated some of the remaining lip tissue along the edge defect on the lower lip and turned it up towards the edge of the remaining lip tissue on the upper lip, thus closing the lips,” he wrote to me. “In order to recreate the acute angle of the commissure, I inset the muscle layer into the lips at a distance that matched the other side. The rest was securing things carefully in place with very small sutures.”

Translation: I had a working mouth again. Unfortunately that was also when the searing pains in the right side of my pulled-together, swelled-to-bursting, stitched-up face kicked in. Ice packs, frequent doses of Percocet, and mindless television only helped a little. I also had a rising nausea in the pit of my stomach that only ginger ale and red jello seemed to temporarily assuage. I had to sleep propped upright to try to bring the swelling down, and I concentrated on deep breathing all night to quell the nausea. I willed myself not to throw up and risk tearing apart the doctor’s handiwork.

After the second surgery I had a new food-and-drink-related problem. I no longer had a wide-open gash that things could fall out of, but now my mouth wouldn’t open very far and I had to be careful chewing, as the inside of my right cheek was pressed hard against my teeth. Foods that required me to stretch my mouth—sandwiches, cupcakes, apples—were impossible to navigate. I had to break them down into smaller constituent parts to eat them, chop cubes, cut slices, remove layers. It was messy, time consuming, and frustrating, so I stopped bothering. I ate protein-rich soups, scrambled eggs, and rice with boiled vegetables. Soft, bland foods.

Less than a week later we were back in Dr. S’s consulting room. He leaned over, peered at me through the magnifying loupes attached to his glasses, and began clipping my stitches open and pulling them free with a pair of tweezers. I lost count after twenty, when a burning, localised pain took over, and I squeezed my eyes tight shut and let tears roll down my cheeks and on to the sickly pale brown leather of his reclining chair. That number did not include the stitches inside my mouth that I could flick repeatedly with my tongue and that would eventually dissolve over time.

After the stitches came out I saw a dramatic and thrilling difference—my mouth worked and I didn’t look freakishly deformed. I was briefly elated. Then, gradually, disillusionment set in. I started to notice the asymmetry; I felt the numbness and hardness of the scar tissue. I realized I would really never look the same again, and soon other people would see that too. I had been closeted away for the last month, only seeing family and one or two close friends. But I couldn’t hide from the real world forever. It was time to put on that proverbial brave face.

Dr. S told me I could go back to living a normal life, do whatever I liked. He advised me to start stretching my mouth—laugh and smile and yawn—in order to increase the range of movement. But I was nervous that if I laughed too hard or yawned too wide then all his intricate stitching might start to unravel, peeling back the layers to reveal what really lay beneath. Teeth, scars, blood, a gaping maw where my mouth used to be. I could still trace the outlines of the injury with my tongue. I could never forget it was there or what it looked like. Sometimes, on a particularly cold day, the scar would tighten up and feel as if it were about to shrink away from the edges.

It’s almost impossible to cover up a facial injury or choose not to have people see it. Rationally, I know I’m more aware of it than other people are, but that doesn’t make me any less self-conscious. Imagine the feeling when you have your wisdom teeth removed. It’s hard to speak clearly and your face feels like it has swelled to four times its normal size. Then imagine feeling like that all the time. A friend’s husband, who is a psychiatrist, told me that while I see the injury as close to eighty percent of my face, most other people probably perceive it as around two percent. He may be right, but it doesn’t change what I see in the mirror.

I began to find it hard to accept compliments gracefully. When people, even those who knew nothing about the attack, told me I looked beautiful, I didn’t believe them. My mouth, my smile is asymmetric now; one side is shorter than the other, one side has uneven lips. There is a small white scar curving up from the edge of my top lip and another reaching out into my right cheek. I notice other people’s mouths all the time. I note symmetry and asymmetry obsessively. If symmetry equals perfection therefore beauty, as so many women’s magazines and quasi-scientific studies would have us believe, then by default does asymmetry equal imperfection, therefore ugliness?

In mid-January 2011, a month after the attack, I returned to my own apartment. We’d had a cleaning service come in and get rid of the evidence, but I came across two brightly coloured dishcloths, crusty with old blood, that had been stashed in a plastic bag and forgotten inside a cupboard. They looked like replicas of the blood spatter patterns you see in forensics crime shows on TV. I wondered if a CSI team would be able to tell what had happened to me from this collection of dark brown circles and blobs?

It was also around that time that I started seeing a therapist who specialized in dealing with Post Traumatic Stress Disorder (PTSD), a common consequence of violent experiences such as my own. I continued to piece together my memories of the attack like shards of a broken mirror, with the full picture never quite coming into focus. I didn’t want to be defined by my injury, but I also recognized that it couldn’t be entirely forgotten or passed over either. Life goes on, but life must, necessarily, be different. An unexpected traumatic event robs you of your sense of safety in the world. Mortality is suddenly that bit closer to the surface, and danger lurks around every corner.

My trauma therapist warned me that heightened anxiety, panic attacks, flashbacks, and violent dreams were often products of PTSD. That first night back at home I tossed and turned for hours before dropping off. I was on high alert and every tiny noise or movement had my heart racing and my muscles tensed. The violent dreams that began then continued to plague me for some months afterwards.

I dream I’m in a CVS pharmacy with my mother and we are buying vitamins and Band-Aids and toilet paper. Ordinary stuff. She is waiting in line to pay and I go to look for shampoo. As I’m walking back towards her, I see a faceless man standing behind her bring out a long, thin blade and draw it noiselessly across her throat. She falls to the floor, convulsing in a pool of blood, and he walks away. I scream and scream, but no sound comes out.

It’s more than two years now since the evening my face changed forever. And I don’t think about it every day any more. I’ve had four surgeries so far. Dr. S described the last two operations as “tweaking,” in other words no major reconstructive work. And I keep wondering: how much surgery is enough? I want an end to the operations, but that would also mean accepting the way I look now is here to stay. The reconstruction will never be a hundred percent, because it can’t be. I still avoid having my photo taken, except for when I am forced to at the doctor’s office. I’d rather that a permanent visual reminder of my lopsided smile didn’t exist.

However, my passport is due to expire in September 2014, and then I’ll have no choice but to face the camera again. When that happens, the face I have now will officially be my new identity, whether I accept it or not.

I often think about that disconnect I feel between my face and my identity, especially when I meet people who didn’t know me before the accident. There’s a part of me that hopes maybe they won’t even notice my scars and my asymmetrical mouth, that I can be “normal” to them, whatever that means.

But another part secretly wants them to ask me about it, so I have an excuse to explain that I didn’t always look this way. That, at least on the outside, I used to be someone else.

*Some of the names of medical personnel have been changed.