The Setback

The most perfect moment in cinema history occurs two-thirds of the way into the timeless classic, Dumb and Dumber.

Amid a playful montage, one of our lead idiots takes things waaaaaay too far when snow gets thrown on him, and suddenly, we have this masterpiece.

Perfection.

Eat shit, Scorcese.

It works as an intro to this update because, like poor Lauren Holley in the clip above, sometimes you get a little more than you bargained for in terms of a hit to the face. You’re in a good mood, feeling all right about things and then WHAM, right in the kisser.

It’s a nice way to say that, unfortunately, the last surgery did not go well. Actually, that’s not quite right. More accurate is to say that the time in between surgeries did not go well — did not go well at all — and so we have what our warm and usually-confident surgeon titled, a “significant setback.”

How significant? Well, while I had walked out of my previous procedure with a pretty good starter-nose (it had a triangular shape, it had two holes for nostrils, guys — all the good stuff), by the time I was headed in for the June surgery to refine that little guy, it had, in effect, completely collapsed.

The nostril holes were still there, yes, but other than that it had totally flattened itself, drooping down towards my lip like a wet bag of oatmeal.

I had thought it was just some things moving around inside and could be set back to rights quickly, but the news was worse than we predicted. In reality, everything inside my (now former) new nose, had dissolved. It was gone.

Corrupted and ailing, it had essentially lost the will to live and decayed, and melted away in just a few weeks once the process started. Three surgeries worth of cartilage, a lining that I had grown in my head since the previous July, all of it gave the sign of the cross and drifted away quietly. It was all removed.

Why? Sigh. The surgeon doesn’t know. He doesn’t like to say it, but he doesn’t know. Could have been bad blood flow, he said. I might have caught an infection, but what kind of infection, he didn’t know. The point is that it got ill, lost its blood supply and suffered “resorption,” which is the term for this failure.

*Note: I talked to another reconstruction surgeon recently who said that (lest I ever just catch a break and do something common) resorption is stupidly infrequent, and there’s really no telling why it happens. So, I’m still managing to catch all the wrong breaks. Consistency!

It’s always a surprise waking up from these things; blinking back to consciousness in a dim little hallway of beds separated by curtains, trying to figure out what hurts and how much. I had gone in expecting just some tweaks and improvements; maybe a refined nostril and a re-attached central bit of skin, which on the outside is not called a septum, it’s called a “columella.”

Rebecca was right there when I came around. I don’t remember what I asked, but she handled it well.

“Are you sure you want to know?” she asked back. It was the same phrase and tone she’d responded with after the original excision, when I woke up and asked her how much of my nose they had taken.

To her credit, she told me both times. Actually she’s developing quite a talent for handling tough questions — including taking a call from the surgeon in the O.R., during the frigging surgery, when Kofi, bloody up to the elbows one can assume, had a nurse hold a phone up to his face on speaker so he could ask her where to take the new lining from, after delivering the news the old one was gone, and he had to harvest a new one.

He gave her a choice: should he take a section of skin out of my forearm, or take out more of my forehead? I don’t envy her the position, it’s not easy being thrust onto a call and unexpectedly asked for such a decision under pressure, but it was the right one.

At issue was lining — a layer to go inside my new nose, Round 2. This is a layer that has to be harvested, then incubated somewhere so it can re-establish a blood supply on it’s own in a new place, before eventual movement to the nose, a process called ‘lamination.’

In the original process, we did this by taking lining from my thigh and placing it in my forehead, under what would become the eventual ‘flap’ that forms the outer skin to this day. But now Kofi needed a new one, and to get it he performed a really hard-to-picture bit of skin-weaving.

As best as I can explain it, here’s what he did: carving into my forehead again, he took a long length of skin, maybe an inch wide, from my right eyebrow to my hairline, and flopped it over. He then ran it underneath the current flap, a little like folding the arms of a pretzel, but without half-twisting it, as he had done the original. To secure it in place, he pulled it through the left-side nostril and sutured it there at the end with stitches.

The effect, by design, is that the two raw surfaces of the flaps are now in contact underneath the original one — and that is where the new lining is currently laminating. It’s a little graphic, but just hold on, it gets worse.

The new flap, without the half-twist, is now just a section of exposed flesh kind of drooping over my right eye before disappearing into my “nose” and popping out again at the bottom. He’d created, in effect, a second pedicle, which is two more than any person would really ever want.

And my head, oh man my forehead. Good god what a mess. When I first got home from the hospital, it looked like someone taped a grenade to it, pulled the pin and walked away. Where before maybe a third of it was exposed tissue from the original flap, now much more of it is open, and this time the wound was deeper, wider, higher. It was, in a word, disturbing.

There are… not a lot of things to prepare you for looking at your own skull. Not a lot of things you go through day-to-day that give you practice at it, help ease that experience a little. But then there you are, standing in your bathroom again, removing a soaked bandage and holding your breath a little about what’s underneath.

And what you see is… well, it’s gore. There is blood and raw tissue, and in the middle, two distinct sections of pinkish-white surface area, each maybe a couple of inches square. It’s bone. And not only do you have to see it and reckon with it — you have to rub frigging ointment on it. You have to touch it. You have to re-bandage it.

Honestly, it’s more than a little bit infuriating and baffling (baffuriating?) what a hospital will send you home with to take care of yourself. Inexplicable and, to a point, inexcusable. What the fuck do I know about taking care of my own exposed skull? Especially when no one even tells me it’s under there, waiting beneath the bandage when they wheel me out the door, and I find out only when I stand in the bathroom with Rebecca and peel back a viscous piece of Xeroform to find it staring back.

How the hell is it the best version of care to send me, doped up and armed only with some vague directions and a printed outpatient packet, home to try to fill a hole in my forehead with some Aquaphor and a set of wooden tongue depressors that I buy off of Amazon under the heading, “Craft Ice Cream Sticks?”

It seems like a ridiculous notion. A failure, however minor, of the medical system. They just send you out like, “Ok, see you asshole! Good luck with whatever you find under that bandage! Email us if you have questions, we’ll get back to you in a week or so! Bye!”

But ok, whatever. Could be worse. We’re coping. We move on.

Now finally to the nose, such as it is. What does it look like? Well since there is no longer any structure there, the only thing holding the flaps up is a plastic tube with the approximate diameter of a quarter. Because the new flap comes through the left nostril, the tube pokes out to the right, and the effect is that it looks like the nose is kind of melting off to one side, drooping and strange. Alas, we are partway back to hole-in-the-face territory, but this time with some plastic and flesh to mask the Void, which is helpful. It’s more weird now than disturbing.

I had a hard time deciding this time whether to append a photo, and in the end, I don’t think I will. Facebook spreads the images far and wide, to people I may not know well or have never perhaps met in the flesh. It also sends them to people I do know well, but who I don’t care to have a lasting image of the weirdness.

So we’ll go with this — how most people see me in public: like a guy who looks like he just got in a bad bike accident and has something weird going on between his eyes that you can’t quite work out.

As for what’s next, it’s a time of mild apprehension. With nothing to keep it holding its shape, we worry now that the remaining skin will shrink too far, too fast — and become unusable before I can get back into the OR. The problem is Dr. Boahene’s patient load — he has so many people he tries to take care of that he can’t get me in to a procedure any sooner than the end of August, almost six weeks from now. And that’s a problem — the ideal window for this procedure is like 6–8 weeks total, any shorter and the blood vessels won’t have grown enough, any longer and the shrinking skin becomes an issue.

But because of the patient load, by the time I hit my next scheduled operation, it will have been 11 weeks.

Now, Dr. Boahene assures me that he won’t let the shrinking get to a critical point, that he’ll operate after hours if need be, but it’s not a comforting proposition — I can barely get the guy to take a five-minute look at the nose, and he’s just going to schedule an extracurricular surgery some night? I don’t buy it.

So we wait. We track progress. We re-bandage the forehead every couple of days, take care of the chest incision that still plagues me, because cartilage is still poking out there too. We do saline rinses and try to keep the tube from falling out. We grind on.

I don’t mean to sound morose. These days, a little over a month after the setback, I actually feel pretty good, and I’m mostly channeling the first week’s disappointment. So much time and discomfort, wasted. Just, tossed away into a bin. All the healing and pain from pulling cartilage out of my chest — fruitless. And we have to do it all again.

We’re basically back to where we were in January, with a giant new head wound and a fresh new flap, a plan to add some molds and structure and try to get the thing to take hold. A looming surgery to get more chest cartilage, maybe some from my ear, if necessary.

But I’m all right, you know? I’m all right. Thanks for everyone’s support and good thoughts along the way — it goes a long ways, and I’m grateful for it. For now, we’ll see what develops. Kofi said there’s a possibility we could still be on track to have most of a nose by year’s end.

I’d put those odds at about one in a million, but…