The Woman Who Had a Face Transplant
Carmen Tarleton survived a brutal attack from her estranged husband, but her painful journey was just beginning.
You cannot cry.
Not yet, not here. You need to concentrate. You need to be strong. As Kesstan “Kess” Blandin sat in the family waiting room outside the Intensive Care Burn Unit on the seventh floor of Boston’s Brigham and Women’s Hospital, she leaned forward in her chair to listen to Dr. James Watkins, her sister’s surgeon.
She knew she needed to hear every word.
The soft-spoken trauma surgeon did his best to choose his words carefully but the facts were grim. “Carmen was attacked and burned over 80 percent of her body with industrial lye,” he told Kess, her mother, and her brother, who sat with her in the ICU’s waiting room. “Hers is one of the most severe burn cases I have ever seen.”
As the burn unit’s nurses and hospital orderlies hurried by, Dr. Watkins continued. Carmen had been blinded in both eyes. The lye, a caustic chemical that is poisonous and corrosive, had burned off her eyelids, her left ear and part of her nose. It had eaten away most of her face.
The family was speechless. None could fully comprehend what Dr. Watkins was telling them. Much of it was too horrific. Suddenly, Kess half rose from her seat and asked, “Do I need to go in there and say goodbye to my sister? Is this what you are saying?”
The veteran surgeon answered softly, “The chances of her surviving are not very high.”
Just a day earlier, on June 10, 2007, Carmen Blandin Tarleton, a 39-year-old nurse and mother of two girls, Liza, 14, and Hannah 12, had been sound asleep in her home in Vermont. Around 2:30 a.m. she was awakened by a loud crash that shook the sturdy white house. It’s an earthquake! she thought as she got up to investigate. Groggy, she opened her bedroom door and saw a man dressed all in black in her living room. Terrified, she told him, “Take whatever you want!”
But the figure lunged at her. In a flash she recognized it was her estranged second husband, Herb Rodgers. He punched her hard in the face, knocking her to the floor. “Herb!” she screamed as she fell down. “It’s me, Carmen! What are you doing?”
He grabbed the baseball bat he had brought with him and began beating her with it. She raised her left arm to block the blows and heard it crack. Pain shot through her body like an electric shock. Rodgers kept beating her until she was unconscious.
He tied her hands behind her back and dragged her into another bedroom where she regained consciousness long enough to yell to her daughters, “Call the police!” Rodgers again beat her mercilessly with the bat. She was helpless. He grabbed her throat and choked her. She lost consciousness.
Moments later, Carmen awoke. She was lying in a battered heap on the floor and looked up to see Rodgers return with a dish detergent bottle in his hand. As he squeezed its contents over her, she thought, He’s going to set me on fire! Somehow she managed to shout through her pain, “Please!”
Rodgers squirted the clear thick gel all over Carmen, into her eyes, onto her face, hair, arms, chest, legs and back. It was industrial-strength lye and immediately began burning off her skin, turning her fair complexion to mottled dark brown, then black, as it etched its way through tissue and into her bones. Her skin, on fire, soon felt like it was burning from the inside out.
Then, a loud shout from outside the house: “This is the Vermont State Police! Come out with your hands up!”
Rodgers surrendered and was handcuffed.
Carmen was in agony, begging her daughters to help her into the tub and shower her with cold water. An ambulance soon rushed her to a nearby hospital and she was then transferred to Brigham and Women’s Hospital, two hours away in Boston.
She was blind, battered, and terribly disfigured, but still alive. Barely.
Before Kess, Joan and Donny could see Carmen in her ICU Burn Unit room, they had to put on gowns, hairnets, masks and gloves. Burn victims, because they have lost their skin that normally protects us from infections, are especially vulnerable. Of the patients that survive a burn, anywhere from one-half to three-quarters later die from infection. As a precaution, Carmen’s room, like some others in the hospital’s ICU Burn Unit, was pressurized to minimize the infiltration of outside infectious particles.
Carmen’s medical team had told the family that she had been placed in a medically induced coma by powerful drugs known as amnesiacs. She could be in a coma for up to four months while she underwent skin grafts and other surgeries. However, her doctors had temporarily ‘lightened’ her dosage in the hope that she might be able to respond to her visiting family.
Kess walked into Carmen’s room, followed by her mother, then her brother. They saw a small woman lying still in the hospital bed. She had a tracheostomy with a tube down her throat. She was hooked up to a ventilator that was breathing for her and was tethered to a bank of blinking and whirring high-tech monitors. She was bundled like a mummy in white bandages except for her horribly swollen face and her hands. Her face was so disfigured and blackened it was unrecognizable; it was as if her skin had been flayed off.
Joan was horrified but also confused. She told Donny, “This isn’t Carmen.” We’ve got the wrong room, she thought. Where’s Carmen?
It wasn’t until Kess recognized Carmen’s hands, which had not been burned, and her crooked front tooth that she realized this was her sister. She felt like she’d been punched in the solar plexus.
Kess took a deep breath, walked to the right side of the bed and gently took Carmen’s left hand in hers. Then she bent down and whispered into her one remaining ear, “Carmen, it’s Kess and Mom and Donny.” She paused a moment and added, “We are here for you.”
Kess felt her sister grab her hand and saw her legs begin to move. She blinked back tears and looked at her mother and brother, who were now also talking to Carmen.
Somehow, she thought as she held Carmen’s hand even tighter, we will all get through this.
Snow White. That’s how Kess began thinking of her sister as she watched her lying in her hospital bed, ‘asleep’ in a deep medically induced coma. Kess had moved into an apartment in Boston to be near Carmen and had visited her every day since first seeing her a month ago.
Against all odds, Carmen had survived, lying motionless and unaware of the team of surgeons and nurses that monitored her vital signs, dressed and cleaned her wounds, and wheeled her into surgery for 38 skin graft operations.
During her daily visits, Kess would talk and read to her sister. Although she knew there was little chance Carmen could hear anything, it helped her pass the time. And, she thought, perhaps the words could somehow seep into her consciousness.
She read widely, from Buddhist writings and poetry to the hundreds of cards and letters people sent. From a collection of the poet Rainer Maria Rilke, she read:
Extinguish my eyes, I’ll go on seeing you.
Seal my ears, I’ll go on hearing you.
And without feet I can make my way to you.
Without a mouth I can swear your name.
Break off my arms, I’ll take hold of you with my heart as with a hand.
Stop my heart, and my brain will start to beat.
And if you consume my brain with fire,
I’ll feel you burn in every drop of my blood.
One month into her coma, Carmen’s blood pressure dropped dangerously low and wouldn’t respond to medication. Her doctors called in Joan and Kess to explain that there was ‘a good chance’ Carmen wouldn’t make it.
“You don’t know Carmen,” Joan told the doctors. She recalled how Carmen ‘had to be the best’ at everything she had tried; from learning the piano, to playing tennis to skiing. “She’s always been a competitor and a fighter,” said her mother, “and she has two daughters to live for.”
Near the end of September, more than three months after she had been attacked, Carmen ‘woke up’ from her coma. She had defied all the odds. Still blind, but sensing that her sister was with her, she called out to Kess, “I know I’ve been gone awhile. What is it, July?”
“It’s September 23rd, Carm,” said Kess.
As she listened to her sister’s voice, she recalled a powerful dream she’d had when she was unconscious. In it the word ‘LIFE’ flashed on a large screen followed by the words, ‘IS’ and ‘A’ and ‘CHOICE.’
“Life is a choice,” she had repeated in her dream.
Carmen was back. But her journey, full of new choices, twists, and turns, was just beginning.
The pain was excruciating. Carmen had been back living in her Vermont home for several months and had to have her dressings changed every two days—a painful endurance test that lasted about two hours. Kess tried her best to gingerly remove Carmen’s bandages but the open wounds, especially those on her head and back that had not yet healed, were ultra-sensitive. Carmen couldn’t help but scream in the shower when any water touched her open wounds or when a dressing pulled off bits of tender raw skin.
Remembering her own nursing days and how difficult it had been to cope with patients in such pain, she tried her best to stay silent. She especially didn’t want her daughters or her mother, who were all living with her, to hear her screams.
Joan couldn’t bear to see her daughter suffer. When Carmen screamed as Kess changed her dressings, she’d retreat to the garage, out of earshot, for a cigarette and a cry.
The pain was searing; sometimes it felt as if someone were burning her alive. “I’m so sorry, Kess,” Carmen said as she broke down in tears during one session. “But the pain is just so horrible.”
There were also little victories. Carmen began seeing a therapist. After several months at home, she had the courage to walk into the bedroom where Herb had beaten her. He was now in jail, awaiting trial. A year after her attack she received a corneal transplant and with it the hope that she would finally be freed from her prison of blindness.
She agreed to an interview with the Associated Press, the world’s largest news-gathering organization. When friends and strangers told her they had been inspired by her story, she wondered if she should keep telling it.
“Maybe I can help people,” she told her mother. “The better I feel, the happier people seem to get.” Letters poured in from around the world. Neighbors brought her cooked dinners. Someone sent her a check for $1,000. She remembered something her father had told her eight years earlier: “I never wanted to change the world but I know you do.” Maybe she had found her calling.
Excited that a local television station was about to broadcast a report on Carmen, the family gathered in her living room to watch the evening news. The news anchor introduced the segment and added, “Warning. These images are graphic and may be disturbing to some viewers. Viewer discretion is advised.”
Carmen felt as if she’d been violated again. “Oh my God! They are talking about me,” she shouted. Then, quieter, she asked, “They’re talking about me?”
Neither Carmen’s daughters, Kess, nor her mother said anything. But Carmen was devastated. As Joan had seen her do so often, she lightly touched her face, feeling rough scar tissue, her damaged nose and lips, her missing ear. How horrible do I look? wondered Carmen.
The next day she asked her mother, “What do I look like?”
Joan hesitated then said, “I can’t put it into words.”
Kess was a little more forthcoming. “Well, Carm. You’re scarred. I don’t know what else to say.”
On a bus into Boston for one of her regular weekly checkups, skin grafts, or other procedures at Brigham and Women’s Hospital, Kess was leading Carmen by the arm down the aisle to use the restroom. Suddenly a four or five-year old girl sitting at the rear with her father began crying when she saw Carmen.
“Daddy, Daddy!” the small girl whimpered. “Make him go away. He’s scaring me.”
Although she could not see the girl, Carmen spoke in her direction: “It’s okay, honey. You don’t have to be scared. I’m a mommy.”
A moment later Kess told her, “Carm, never mind, she can’t hear you.”
“What do you mean?” asked Carmen.
“Her father has moved her out of the way.”
Although her first corneal transplant had failed, Carmen had the same operation in her right eye. Less than two weeks later, nearly two years after her attack, she was brushing her teeth when she noticed the sink’s gleaming silver faucet. “No! It’s impossible,” she told herself. “I can see!”
She had been praying to be able to see again, to look at her daughters, Kess, her mother. Finally, her prison doors had swung open. She could see Hannah’s graceful smile, Liza’s wavy hair and Kess’s deep brown eyes. “You are so beautiful,” she told each of them.
It was time to answer the question she had agonized over: “What do I look like?” When she was alone she went into her bathroom and locked the door. She raised a small hand mirror to her face. As she looked at the disfigured, scarred face that stared back at her, she moaned softly, “Oh God. Where am I? Where is Carmen?” She thought of the little girl on the bus, the television news warning, her family’s hesitancy to tell her what she looked like, and broke down crying.
As if fate hadn’t been harsh enough, she lost her regained eyesight after only four months. She was blind again. Doctors said there was hope they could restore some sight in her left eye, but the right was too damaged. She sank into a deep depression. As she wrote, “Every time I heard my kids laugh, I ached to see their smiles. A car horn reminded me that I would never again drive to the grocery store, let alone drop my girls off at college one day. The litany of lost things was endless.”
For months, Carmen was lost in despair. Then, while listening to a self-help book, she heard a message about forgiveness. Forgiveness isn’t something we do for others, noted one writer, we do it for ourselves. It was as if a curtain had lifted. Carmen realized that hating Herb for what he had done would only continue to damage her. He had been sentenced to 30-70 years in prison; this was no longer about him. More importantly, forgiveness was a powerful message that she could speak about to others.
She thought back to her dream where she had seen the sign, “Life is a choice.” And she remembered her father telling her he knew she had always wanted to change the world. She could start on her own small corner of the world.
Carmen began speaking to Rotary Clubs, churches, women’s groups; almost anyone who asked. She summoned up the courage to appear on The Doctors, a television show about medical issues. The more she spread her message, the more comfortable she felt with herself. One day, while she was shopping for a new cellphone with Joan, a little boy broke off from his mother’s grip and ran over to Carmen.
“What’s wrong with your face?” he asked her.
Carmen, still blind, bent down and told him, “I was burned, honey.”
“Oh. Does it hurt?”
“Sometimes,” said Carmen.
He smiled at her and said, “Well, I hope you get better.”
She began collecting her thoughts for a book. Thanks to another corneal transplant, she regained limited vision in her left eye. Though still technically blind, she could now use a magnifier to read.
Almost every week she and Kess would take the bus to Boston for consultations, more skin graft surgeries and treatments for infections. During the three years since her attack she had undergone more than 50 operations. She was still in almost constant pain, and took a cocktail of drugs to lessen the horrible burning sensation.
In December 2011, Carmen’s lead plastic surgeon and head of the burn center and plastic surgery transplantation at Brigham and Women’s Hospital, Dr. Bohdan Pomahac, called with a proposition. Would she, he asked, be interested in being considered for a full-face transplant? As he spoke, Carmen lightly ran her fingers over her scarred face, pausing to feel her caved-in nose and her battered lips that never closed properly and left her drooling constantly.
“You’d have eyelids, a full nose, and your quality of life would improve,” said Dr. Pomahac.
There would be months of testing and psychological consultations, he explained. And of course, there could be no guarantee a donor could be found. He said that because Carmen had had so many operations that required large blood transfusions, her bodily defenses might not be strong enough to fight off the rejection that normally occurs with transplants.
“I just want you to think about it, Carmen,” said the skilled surgeon, who had just completed one of the world’s few full face transplants on a Texas man. “I know it’s a lot to grasp.”
A new face, thought Carmen after hanging up. I could smile again. Maybe I could even kiss someone!
After scores of physical and psychological exams, Carmen was approved for a full facial transplant. However it wasn’t until 11:30 p.m. on February 13, 2013, more than a year after Dr. Pomahac had first asked her if she would consider a transplant, that she got the call she had been waiting for.
“Carmen, I know you have been waiting a long time,” said Dr. Pomahac, “but we may have a donor.”
Carmen cradled her cellphone to her one good ear and listened as the surgeon continued, “But we have a couple of issues.” He explained that the donor was about nine years older than Carmen and there may be some rejection. If Carmen’s body rejected the donor face completely, it would have to be removed and surgeons would have to reconstruct Carmen’s face. It was a major risk but as the surgeon, whose first name in Czech means “gift given by God,” explained, “We may not find a better match.”
At 5 o’clock the next morning, Carmen was wheeled into the Brigham and Women’s Hospital operating room where more than 30 surgeons, nurses, technicians and attendants awaited her.
Five hours earlier Pomahac and a second team of surgeons at University of Massachusetts Medical Center had begun carefully removing the face from a woman who had died just a day earlier from a stroke. They stripped away the donor’s skin, taking care to painstakingly dissect the tiny arteries, veins, muscles, nerves, fat, and bones Carmen would need. Once they had removed the face, they flushed the blood out of it and replaced it with cold preserving solution. It then looked like a lifeless gray, ashen mask. They packed it on ice and rushed it via an ambulance to Brigham and Women’s Hospital, 39 miles away.
While Dr. Pomahac had been removing the donor face, a team of surgeons had been readying Carmen for the transplant. Guided by 3-D diagrams of Carmen’s facial structure, they gingerly stripped her face of damaged skin, muscle, and nerves to make way for the new tissue.
It would take almost 15 hours for Dr. Pomahac and his team to complete Carmen’s face transplant. Using high-powered microscopes, surgeons delicately connected the nerves, blood vessels, and muscles of the donor face to Carmen’s. It was exacting work, and the surgeons made hundreds of tiny, precise stitches under their microscopes.
Because face transplants demand so much concentration, there’s rarely any chatter among the surgeons, nurses, or technicians in the operating theater, with one exception: Moments after Pomahac and his team positioned the donor face over Carmen’s face and stitched together the external carotid artery on the right side of the face and a facial artery on the left, there was an audible gasp from some members of the operating team.
Several of the team muttered, “Wow!” as they watched Carmen’s new face gradually change color from ashen grey to bright pink, starting from its right side to the nose, then to the left cheek and finally up to the forehead as the blood flowed into it. As Pomohac would later explain, “It is a profound moment. The face literally comes alive before our eyes.”
Ten weeks after her surgery Carmen was ready to reveal her new face to the world at a press conference with Dr. Pomohac and his medical team. But first there was someone she had to meet. Ever since she awoke from surgery she had frequently “talked” to her new face, thanking her mystery donor and her family for their generous, life-changing gift.
Because donations are usually made anonymously, Carmen never expected to know whose face she had received. But tonight in the library of Brigham and Women’s Hospital, she would meet the daughter of that donor. What could she say to her, she wondered. How could she ever thank the family?
Marinda Righter, 30, who had offered her mother Cheryl Denelli-Righter’s face for donation, was equally nervous. Organ donation officials had told her she would likely not recognize her mother’s face if she met Carmen. They explained it would have changed greatly after it was attached to Carmen’s bone structure. Still, she thought as she prepared to meet Carmen, Can I handle this?
Even before she entered the hospital library, when she saw Carmen through a window, Marinda recognized the face of the 56-year-old mother she had lost to a sudden, massive stroke less than three months ago. Overcome with emotion, she rushed into the room and hugged Carmen. Both women started crying.
Brushing back her tears and still hugging Carmen, Marinda looked closer at her face and noticed her mother’s freckles and the two small age spots she used to jokingly complain about.
“Can I touch your face?” she asked Carmen and then lightly ran her hand over her freckles.
“And I have this little mole right here,” said Carmen, pointing to her cheek.
“Oh my God,” said Marinda, “Yes. I know that mole!”
The next day at the press conference, Marinda turned to Carmen and said, “I get to feel my mother’s skin again. I get to see my mother’s freckles. And through you, I get to see my mother live on. This is truly a blessing.”
“Blessings” are something Carmen Tarleton talks about frequently these days. Ever since her book Overcome: Burned, Blinded and Blessed was published, she has devoted her life to spreading her message of forgiveness and perseverance. Sitting in her small Thetford, Vermont apartment that looks out on lush green, cow-dotted pastures and wearing a T-shirt that boldly proclaims Vulnerability is Sexy, she explains: “I am blessed because I’ve overcome challenges in my life and I’ve moved on. I want to be an example to people that horrible things may happen to you, but you can get beyond them and come to a new place in your life.”
She pauses, and after a small chuckle adds, “You know, it’s like that dream I had years ago: ‘Life is a choice.’ And I chose life.”
After more than 55 surgeries, Carmen’s medical prognosis is good. Her face transplant has dramatically lessened her pain, yet she must still take more than a dozen different medicines daily, including powerful immunosuppressants to stave off rejection. Although she is still legally blind, the sight in her left eye is good enough that she can read with the help of a magnifier. Each month she gains more feeling and control in her face, and her speech steadily improves. She lives close to her sister Kess, her mother Joan and her two children, Liza and Hannah, who now attend college. And Carmen has a new man in her life, music teacher Sheldon Stein, whom she met a few months before the transplant. Carmen’s website is www.overcomebook.com.