Riding Shotgun: A Gift of Flesh

Rebuilding a face, shaking up our ideas about identity.

The perfect gift: a basket of assorted bath products, a box of Swiss chocolates, a face.

Yeah, a face — merry Christmas, happy Chanukah, have a very merry solstice. Say what you will about the French, they know their wine, they know their art, and they know their presents.

Last month, a surgical team in Amiens performed the world’s first face transplant, a procedure that’s been possible for years but never attempted. A woman who was mauled by her dog had the lower half of her face, from the bridge of her nose to the bottom of her chin, replaced with donated tissue from a brain-dead woman from Lille. We’re not talking about a Face/Off scenario with doctors peeling off the flesh like a Halloween mask, exchanging identities in some post-modern Shakespearean tragicomedy. It was probably one-fifth of what we would consider the “face.” A few paltry ounces of muscle and skin.

But like many extravagant gifts, there are some complaints. Oh, none from Isabelle Dinoire, the woman on whom the surgery was performed. The first thing she said after coming out of surgery was a polite “Thank you” to her physicians.

Much of the hubbub centers on the claims that Ms. Dinoire was in the middle of a suicide attempt when her dog clawed and bit and chewed away part of her face. She had taken two sleeping pills; was she just hoping for a good night’s rest, or was she hoping to die? British tabloids say one thing. Her physicians say another. The doctor seemed convinced that she was psychologically stable enough for the procedure and has adamantly said so.

But the controversy remains, and I doubt the continuing attention has anything to do with Ms. Dinoire’s mental state. If this were a liver, do you think we’d care? If it were a heart, even — that most vital of vitals? No, of course not.

But a face. And not even a face: lips, a few inches of nose, the skin of the chin. A fraction of face.

Psychologically stable or not, the real question that was asked, even before her mental state came into question, was whether Ms. Dinoire would be able to live the rest of her life looking in a mirror and seeing part of somebody else’s face.

The eyes are the windows to the soul. The face, their frame. A moving, twitching, smiling, highly nuanced puppet of your emotions, your thoughts, your feelings. You think of yourself, you think of your face. You think of others, you think of their faces. A photo ID doesn’t have a picture of your hand, or of your leg, but of your face.

You equate your face with identification, with identity. And how much of your identity do you link directly to your face? And in a world where you can receive a new face when yours is damaged or lost, how does that affect your identity?

What will Ms. Dinoire think when she looks in the mirror and sees the one-fifth graft of flesh and skin from someone in the grave? A happier thought, I think, than if she were looking at a gaping wound, a lipless mouth, a hole where her nose used to be, and the cold, white bone of her jaw sliding up and down across the tissue of her cheek when she talked.

Was she ready for it? I think the real question is this: Were we ready for it? Are we ready to change our idea of identity? Are we ready for a world where the flesh that’s lost can be replaced or regrown? Where our bodies — so long the seat of being — can be augmented and repaired using living parts not our own, parts that were once a part of someone else? It’s a much easier pill to swallow when those parts are buried deep inside, pumping away in private. But for all to see?

Maybe we’d be more comfortable in a world where, when a hand or a foot or a face is lost, it remains lost; where the only replacements are steel or wood or plastic; where my flesh is my flesh, and your flesh is your flesh, and the body is as sacred as the soul. It’s easier, after all, to fix our identity to our body. The soul, the mind, is much harder to grasp.

And what happens when the first brain transplant is performed? What happens to our idea of identity then?

Just a question. A thought. My present to you. Joyeuses fĂȘtes. Happy holidays.

Article © 2005 by Steve Spotswood