Eyes Without a Face

The sun shone brightly the morning Mrs. K shot her face off.

When the EMTs rang the doorbell, responding to the report of a gunshot at 6:00 that moring, the door wasn't answered immediately. The techs heard a shuffling of feet, a voiceless keening deep in someone's throat, and the woman who had tried to commit suicide twenty minutes earlier opened her door.

The county emergency liaison's report of the incident, written in small, polite capitals, reads clinically, much more so than the frantic notes of the trauma surgeon who took care of Mrs. K after she was transferred to the hospital, sedated and with a tube down her throat: "The subject appeared at the front door of the residence with massive trauma to the subject's face. It appeared the subject suffered a shotgun wound to the face. Upon further invesigation it was revealed that there had been a suicide attempt. Due to the above, it was determined the patient was a danger to herself and to others (and should be taken into custody)."

I first came in contact with Mrs. K's case when our ICU resident came in and mentioned that a senior surgeon was going to place a bedside arterial IV her axilla. Like any other intern circling over someone else's misfortune, I swooped down at the chance to see something I've never seen before.

Mrs. K lay in a typical ICU room: almost wall-to-wall machines with beeping screens translating her physiology into numbers and EKG tracings that I could digest in seconds. Heart rate of 92. Blood pressure 98/40. Oxygen saturation 95% with a respiratory rate of 14 and ventilator settings at 40% O2. She's doing pretty well, I thought, taking in the numbers. Then I looked at the patient.

Loosely draped over her face was an ABD, a kind of absorbent dressing that's a cross between a maxi pad and a diaper. We typically tape them over more absorbent gauze that may or not be moist with blood or saline solution. Only this ABD lay untaped, haphazard, like a tissue that someone had discarded.

As the attending physician fussed in sterile gloves, trying to locate the artery coursing into Mrs. K's armpit, I slid back and asked the nurse.

"What's her story?" Even before she answered I knew there was something wrong with Mrs. K's face. The lie of the dressing wasn't right. Too flat, without the proud arch that should have been her nose. From underneath the corner of her ABD pad, her neck curved seamlessly, bypassing any semblance of a chin. The contours of her face were as still as a lake on a windless winter day.

"Suicide attempt. Gun to the chin." The nurse whispered. "She came in a couple of days ago."

"Is she with it?" How could she still be alive, I thought to myself.

"No, she's pretty sedated."

"Thank God."

I stayed for several minutes, watching Dr. Kensington's attempt to get Mrs. K's flaccid, ample arms into the correct position. The ventilator puffed in impeccable time. Mrs. K smelled of betadine and lemons. The more Dr. Kensington struggled with positioning, the more often my gaze wandered to the sterile curtain covering Mrs. K's face. My morbid curiosity sickened me and I mumbled that I had to leave to continue my work elsewhere.

For several days Mrs. K would not leave me alone. I checked on the hospital computer system and read over her operative reports. She had blown off her mouth, palate, nose, and chin, smashing the fragile bones at the base of her eyes and breaking numerous bones that I didn't even remember existed. Three different teams of surgeons had attempted to reconstruct her, one implanting the seeds of an artificial mouth, which became infected and had to be removed. But she lived, if not kindly.

One thing the operative reports did not tell me was why. This curiosity, the desire to know my patients stories remains the root of my daily musings about career change. I have similar thoughts whenever I'm called upon to "run traumas" (perform an on-the-run physical exam to assess a trauma patient's stability). I don't want ask my gunshot victims, "What is your past medical history - are you taking any medications?" I want to know, "Who shot you? Where did you grow up and how did you get here on this gurney?"

One day, almost surreptitiously, I slipped into Mrs. K's room and looked through the pathos strewn binder that was her chart. I suppose I hoped against all hope that she was loved at home, that this was just a brief psychosis. I hoped that someone cared. But instead, reading through the social work notes, I read that she had a husband and teenage daughter who never visited her, who had to be called long distance when we needed to obtain consent for her repeat surgeries. She had a brother and two sisters, estranged. Multiple suicide attempts.

While I was in her room, the nurse came by and spoke with me as if I were actually taking care of her. "She's doing just fine."

"Is she responding now?"

"Oh, yeah. She understands what's going on. She can squeeze your hand and everything," her nurse said.

I struggled a smile. The ABD still lay, staid, on the lower portion of Mrs. K's face. This time, I could see her eyes, mercifully closed. A flat lip of bloody gauze was where her nose ought to be. My hand reached to undo the tape so I could see the rest. "You're going do to great, Mrs. K. Everything's going to be fine," I lied.

My hand stopped, and I pulled it away. I took off my purple rubber gloves. I didn't need to see her face to begin to understand her story.