Blood and Guts (28 page)

Most of their injuries were external and cosmetic, which meant
that they were perfectly capable of moving around. So, with tube
pedicles dangling from their faces, they could be found playing
football in the grounds, drinking beer in the local pubs or watching
films in the town cinema. McIndoe made great efforts to ensure that
his patients were integrated as much as possible into the East
Grinstead community. He encouraged local people to visit the
hospital, and gave talks to explain the work that was done there. As
a result of his efforts, the men were received as guests in local homes
and were treated with respect in pubs and restaurants.

The town was proud to play host to the airmen and became part
of their therapy – a stepping-stone between the hospital and the
wider world. A world where perhaps they would not always be
treated so well. During the First World War Gillies had found that,
despite his best efforts, his discharged patients met with little public
understanding. Their return to Civvy Street had sometimes been
brutal. They were haunted by their looks and shunned by society.
Many led isolated lives or ended up in dead-end jobs – selling
matches or begging. One former patient even found employment as
an 'elephant man' in a travelling circus. Many suffered from depression.
Some committed suicide.

McIndoe wanted his patients to be treated as the heroes they
were, not freaks to be locked up behind closed doors or laughed
at in a circus. He encouraged the wounded men to support each
other – to wear their injuries with pride. They called themselves
the Guinea Pig Club, produced their own magazine, had a little
emblem (a guinea pig with wings) and even their own anthem. This
is the first verse:

We are McIndoe's army, we are his guinea pigs.

With dermatomes
^*
and pedicles, glass eyes, false teeth and wigs.
A night out with the Guinea Pig Club could be a peculiar thing to
witness. Their favourite haunt was the Whitehall restaurant in East
Grinstead, where the manager, Bill Gardener, became almost as
important to their rehabilitation as McIndoe himself. Gardener
took a special interest in the men from Ward Three. He drank with
them at the bar, but made sure they did not drink too much. He
chatted with them, helped them laugh and managed to steer them
away from moodiness or depression. Other places in town were similarly
accommodating. Seats were reserved for the Guinea Pig Club
at the cinema, and they were regular guests at local dances.

^*
A dermatome is a surgical instrument used to cut away slices of skin for grafting. In the
song, however, it could equally be referring to the slices of skin themselves.

At any of these places you could see badly disfigured men, some
with bandages, most with tubes of flesh hanging from their faces.
They would be seen laughing, joking or chatting up the local girls.
Some had only stumps for hands and needed help to drink. Their
friends would lift the drinks to their lips and assist them later when
they needed to go to the lavatory. Often these strange-looking men
were accompanied by nurses from the hospital (whom they would
also be chatting up). Gradually, the men of the Guinea Pig Club
overcame their injuries and regained their dignity. Many of them
married local girls, and very often local nurses.

Word of the hospital spread and soon gained national attention
through newspaper and magazine articles. Britain's most popular
entertainers came to visit the famous heroes of Ward Three and give
performances in the town. Joyce Grenfell and Flanagan and Allen
were among the stars to entertain the Guinea Pigs. The hospital was
visited by senior politicians and military figures. The local paper
reported that the hospital's work 'and the work of their splendid
staff was known throughout the world'.

McIndoe's army was a triumph. The surgeon restored the
faces of Allied airmen but, above all, he restored their pride. Bill
Foxley is one of those proud survivors and attends the regular
reunions of the Guinea Pig Club. Like many of McIndoe's patients,
he looks back on his time at East Grinstead with affection. He
recalls an occasion when the surgeon took a group of them into
London. 'It frightened the life out of people,' he says, 'but that was
all part of the game.'

Between them, Gillies and McIndoe had also restored the reputation
of plastic surgery. They had developed new techniques and
made tremendous advances in improving the appearance of their
disfigured patients. But as 'beauty crank' Gladys Deacon had
demonstrated, and as Gillies had discovered with the innkeeper's
daughter, you didn't need to be badly injured to seek the advice of
a plastic surgeon. There were lots of people who wanted to change
their appearance, and for the gifted surgeon a whole new post-war
world of opportunity was opening up.

London, 1946

Harold Gillies had been working as a government consultant during
the war, but now he was ready to go back into full-time private
practice. The rich and famous came to his house, just off Harley
Street, for discreet facelifts, tucks or enhancements. He applied
everything he had learnt from battle wounds to the fading faces
of Knightsbridge and Mayfair, and was pulling in the equivalent
of some £1.3 million a year. Plastic surgery had made his reputation,
but cosmetic surgery was making him rich. Now aged almost seventy,
he was about to perform an operation that would guarantee him a
place in the history books.

Laura Maude Dillon was born the wrong sex. She spent her
life convinced that she should have been a man. She dressed in
men's clothing and could pass herself off as a man in the street. But
this wasn't enough for Laura; she wanted to
be
a man. She was
determined to transform herself physically into the opposite sex.
When she made the decision in the late 1930s this was hardly an
easy thing to do.

First, there were legal and social implications – how on earth
would society treat her/him? Would she even be allowed to do it?
There were other practical problems too. No surgeon had ever tried
to turn a woman into a man before. But Laura was determined, and
she managed to persuade a doctor to prescribe testosterone tablets.
Her voice and appearance began to change and, during the war, she
underwent a double mastectomy to remove her breasts. She was
becoming androgynous, but was not yet a man. Finally, Laura was
put in touch with Harold Gillies.

During a series of operations, carried out in the utmost
secrecy, Gillies used his tube pedicle technique to build Laura a
penis. First, he cut a tube of skin from her side and looped it
around to her crotch. He then filled the tube with a frame of
cartilage to give it bulk and structure. Once the blood flow was
established, the end of the tube connected to her side was severed
and the appendage gradually shaped into a penis. Finally, a rubber
tube was connected to her urethra so that she could urinate
through the new organ. Thanks to the tube pedicle, Laura became
Michael. Gillies had successfully performed the world's first female
to male sex change operation.

Michael's new penis was only cosmetic – he would never be able
to achieve an erection, which meant he could never have a full
sexual relationship. But being a man made it a lot easier to have a
career. Michael enrolled in medical school under his new legal
name and eventually qualified as a doctor. He even wrote a book,
describing people who were born with the mind of one sex and
the body of the other. No one reading the book guessed that he
was actually describing himself. In fact, few people would ever
have known that Michael was born Laura if it had not been for his
aristocratic background.

Michael's brother was Sir Robert Dillon, the 8th Baronet of
Lismullen. In
Debrett's
guide to the British aristocracy Michael was
listed as Sir Robert's heir. However, in the rival publication,
Burke's
Peerage
, Sir Robert's heir was given as Laura. The birth dates of
Laura and Michael were the same, and it didn't take long for someone
to realize that they were the same person. During research, the
editor of
Debrett's
had come across the amended birth certificate that
had transformed Laura into Michael.

The story broke in 1958 – and what a story it was. A sex scandal
involving the aristocracy: what could be better? The world's press
were all over it and set about tracking Michael down. They found
him on a freighter in Philadelphia, where he was serving as the
ship's medical officer. Reporters persuaded the reluctant doctor to
give an interview. He certainly looked like a man. He was described
as bearded and smoked a pipe. Dillon told the newsmen that he had
been born suffering from hypospadias. This is a condition found in
males where the opening of the urinary tract is not at the tip of the
penis. Dillon had never in fact suffered from hypospadias; physically,
he had been born a perfectly healthy girl, but was justifiably
unwilling to give the reporters the truth. He said that he had undergone
the operations to make him a more complete male.

He hated the attention and wanted to be left alone. Now the
story was out, this seemed unlikely. So, rejected by society, isolated
and depressed, Michael fled to India and eventually ended up in a
Tibetan monastery, where he became a monk. He devoted the rest
of his life to Buddhism and writing. Despite the prejudice he had
encountered, he later wrote how he owed his life and happiness to
Sir Harold Gillies.

When Gillies died in 1960 reconstructive surgery still relied on
the tube pedicle. But the pedicle – even the waltzing pedicle – had
its drawbacks. As it needed to be kept attached to its blood supply,
moving tissue around the body took weeks. Patients had to endure
straps or contraptions similar to those developed by Tagliacozzi to
keep the pedicles in place, and suffer the awkwardness (and embarrassment)
of having loops of flesh dangling around their bodies.
There had to be a better way. Finally, by the 1970s, surgeons had
come up with a solution: the operating microscope.

Today surgeons can take tissue from anywhere on the body.
They use a large microscope positioned over the operating table to
connect together minute blood vessels less than two millimetres
across. Once the microscope is swung into place, they employ
impossibly small needles and minute threads, narrower than a
human hair, to make tiny, precise stitches. When Chinese surgeons
first attempted microsurgery forty years ago, they unpicked a pair of
stockings and used the fine nylon thread. Microsurgery is the same
technology that made Clint Hallam's hand transplant possible (see
Chapter 3).

What Gillies and McIndoe did not realize is that the transplanted
tissue needs only a single artery and single vein to keep it
alive. So even a relatively large swathe of tissue – skin, bone and
muscle – taken from, for instance, the leg can be grafted on to a
patient's face as long as it is connected by two blood vessels.
Rebuilding a patient's jaw can be done in a single operation rather
than over a period of months. Operating under the microscope has
revolutionized reconstructive surgery and consigned the tube pedicle
to history, although pedicles are still occasionally employed
when all else fails.

But even the technology of microsurgery has its limits. As any
before-and-after images of reconstructive facial surgery show, there
is still a fundamental problem in repairing a face with tissue from
other parts of the body. The difficulty is that the skin always looks
like the area it has come from. The skin of an arm is different from
the skin of a face – it can be darker or hairier – and when it is moved
around the body this is all too apparent. Some surgeons believe the
only solution is to transplant the skin from someone else's face.

In 2005 thirty-eight-year-old Isabelle Dinoire received a partial
face transplant after being severely mauled by a dog. It was an
incredible technical achievement for the French surgical team
who carried out the operation, and now some surgeons are
planning another huge step forward. They want to abandon traditional
reconstructive surgery altogether and carry out a
full face
transplant. For some victims of facial disfigurement, this might be
their only hope.

The story of Jacqueline Saburido illustrates the point. The
bright, pretty twenty-year-old Venezuelan had moved to Austin,
Texas, to study English. On the night of 18 September 1999 she
was on her way home from a party, sitting in the front passenger
seat of a car being driven by another student; three other friends
were in the back. It was four in the morning, the road was dark.
Suddenly an SUV veered across the carriageway towards them. Its
driver was drunk.

When paramedics reached the scene, the front of the car
Jacqui was travelling in was crumpled, the engine ablaze, broken
glass across the road. The driver was dead – crushed by the
steering wheel. One of the back seat passengers was also dead.
The other two were pulled free, but Jacqui was pinned into her seat
by the dashboard. She screamed for help as the flames reached
higher. The paramedics tried to put out the fire but could do nothing
to free her.

Then the screaming stopped.

When the firefighters arrived they doused the flames. Jacqui's
flesh steamed as they gently turned the water on her body. Her
seat had melted, the car interior was blackened by fire. Everyone
looking at this awful scene of destruction assumed she was dead. It
was a relief really, the screaming had been unbearable. Then Jacqui
moved. She was still alive.

Almost two-thirds of her body was severely burnt. Her face was
almost completely destroyed, her hair incinerated, her skin cracked
and charred. Her hands had disintegrated into stumps, and she had
several fractured bones. No one expected her to live for long. The
driver of the SUV walked away from the crash, although he was later
convicted and imprisoned for drink-driving.