Skin. Deep.

The woman in plastic surgery clinic laughed when we asked if we could take her picture. "I don't think Playboy would be interested in this." Lifting her gown, she revealed the hernia on the right side of her belly: pendulous, firm, the size of a watermellon. It was as if half of her body had decided to become pregnant without the consent of the other half. A stoma bag slumped on one side, but the tape couldn't adhere to the complex topography of her skin and leaked, pungent and brown.

Mrs F's chart told the unfortunate series of events that brought her here: Crohn's disease is a kind of "buy one get three free" illness, with a dozen partner ailments. She'd had five operations that slowly shaved away the length of her intestine. Since 1971, she had a fistula leaking feces from her intestine into her vagina. "They think it'll close any day now," she joked. Three colostomies, and three associated hernias that finally convinced her gastroenterologist that plastics needed to be involved. Her armpits and groin were scarred from multiple bouts with supparating hidradenitis - a kind of acne gone wild that leads to chronic boils and infections. "The worst place is right in my crack", she showed me, running her nailpolished fingers through canteloupe-dimpled cheeks.


The next two patients were traumas. The first, an Iraqi war veteran who hit an IED. He was a smiling teenager, wearing overlarge Starky and Hutch sunglasses. When he took the shades off you saw the path the shrapnel made, tearing off his cheek and right eye and fracturing the bones around his left. Dr L had to make him new tear ducts.

The second man had gotten out on interstate 99 two months ago to change his tire. A car hit him at 65 MPH and dragged him along the siderail for several seconds. The wound in the small of his back was still as big as a legal pad and would need skin grafting.

Mrs. 4 is a petite 40 year old who needs a re-do breast augmentation. After a domestic violence incident, she noticed that her saline implants were leaking. "I want a D-cup," she blurts out when we bring out the prosthetic models. When the attending leaves the room, though, she apologizes. "A C-cup like the first time would be fine." She had her first operation six years ago at the same time as surgery to remove a tumor on her temple. "You, know, it worked. After I got the operation, I didn't care what my head looks like - I just stood in the mirror and looked at my boobs all the time. I was so happy."