Creative Non-Fiction: Trapped Within

Trapped Within: A Journey through Facial Reconstruction & Identity Reform

Hospital walls always smell the same. That’s something they don’t tell you. They don’t tell you how that same scent will always take you back to that day. Regardless of state, city, or year, that scent will take you back to the moment you found yourself lying on a gurney being wheeled into an unknown room in an unfamiliar place. In a swirl of changes, your mind clings to what it can sense on the most basic level. The feeling of the waffle-knit blanket wrapped around you to make the cold room not so frigid. The taste of ice chips because they are all that has passed through your lips since midnight. The sight of the manila yellow ceiling tiles up above. But above all, the scent. Somehow it manages to smell incredibly clean and still old at the same time. A mixture of antiseptic and years gone by. Its distinctive scent clings to your clammy skin and nervously bouncing eyes. It seeps into the fingertips clinching that waffle-knit blanket as the hands of strangers push you further into the operating room. Now, the room is blinding lights and a space far bigger than you pictured in your dreams the night before. Strangers’ hands are scooping up your frail body, and the blanket is stripped while all you feel is a cold, cold metal table. Latex gloves are snapped and you wonder why everyone is smiling. Your eyes are caught from directly above as a pair of eyes and a masked mouth stop your frantic thoughts. “Hey sweetie,” the eyes say. “I’m gonna need you to start counting backward from ten.” And so you do. You’re determined to reach the end of the countdown and you desperately fight the urge to slip into sleep as a gas starts flowing through the mask you didn’t even notice had been placed over your mouth.

I’ve never been one to call myself claustrophobic. Honestly, I never understood the concept. I like to think of myself as a pretty rational human being, and the fear of a temporarily small space seemed like a solvable problem with an end in sight. But on the morning of June 11, 2014, I felt claustrophobic. My eyes opened to the worried eyebrows of my parents, and my first thought was wondering what everyone was staring at. I started to speak, but my attempt was void as no words came out. I looked to those in front of me in a panic. Why couldn’t I talk? The moment this thought crossed my mind, I began to feel. And what I felt was absolutely nothing. This complete absence of sensation, numbness of my entire face, sent chills through me that I couldn’t even register. My shaking hands reached up towards what I knew was my face from memory, but my body couldn’t feel as my own skull and flesh. I felt gauze. I felt bandages. I felt an oxygen mask. I felt ice packs. I felt skin but there was no way it was my skin. It was too big. My face didn’t extend this far out, right? Slowly, the pieces started to come together in my mind. Everything was swollen. My cheeks. My eyes. My nose. My lips. My tongue. My throat. Everything was far too big and it was pushing me down. Suffocating me. I couldn’t speak and I was trapped behind my own swollen face. There is no claustrophobia like the feeling of being imprisoned in your own body. I noticed for the first time the clipboard set on my lap by my now crying mother. The blank page stared up at me. The anticipation was palpable as my shaking hands began to write. My parents and the doctors all eagerly stared to see what the trapped girl would say. I didn’t hesitate. I only had one question. I penned, “When will this be over?” and waited for anyone to dare give me an answer.

When I was 16 years old I had a double jaw replacement surgery. The resulting year-long recovery was the most challenging and transforming time of my life. For two months my speech was unintelligible. For six weeks I was on an all liquid diet. I lost 15 pounds in a week. At the end of the year, I was left with a new face and a feeling of not fully recognizing the face staring back at me in the mirror. Self-image and appearance are difficult topics for any adolescent girl. My experience with self-image was heightened by years of doctor’s appointments wondering how to “fix” my face. The struggle with confidence continued as my face remained swollen and “incomplete” for an entire year post-op. Double jaw replacement and the resulting psychological and physical repercussions brought a new struggle to find identity and beauty in a new face that was not my own.

The first time this surgery was brought to my attention, I was 14 years old at a yearly well check-up. Seated at Johns Creek Pediatrics, my doctor looked at me and asked when I would be getting braces on my teeth. I shook my head and informed her that I had already had braces in the seventh grade, and her look of confusion took me by surprise. She then pulled my mom outside of the room for a conversation I was not invited to hear. We left the doctor’s office and my mom didn’t speak of anything that had happened. I thought that maybe there had been some mix up, but I didn’t give it much thought. A few weeks later, I found myself seated at an oral facial surgeon’s office.

Dr. Ellis scared me. He was too loud and too bold. His presence intimidated me from the moment he walked into the room. His toothy grin was too eager and he seemed arrogant to my stubborn 15-year-old self. My parents had come with me for a jaw consult, and I couldn’t understand for the life of me why I was seated in this strange man’s office. I like to pinpoint this appointment as the moment when everything changed. Dr. Ellis invited all of the staff and interns into the office, and the next thing I knew there were metal rulers on my face and beady eyes all around. I overheard conversations concerning, “How does her mouth function like that?” and “Can we fix it?” and internally I shut down. To an adolescent teenager, identity is everything and mine was being poked and prodded more than I could handle. I fidgeted with my jeans and kicked my converse back and forth off my seat as strangers commented on the structure of my jaw and face.

Dr. Ellis had a plan. Wisdom teeth out in the next 3 months. Braces on after that. Jaw surgery set for June 11th. No date has ever held more significance to me than that date. Four years later, June 11th still has the ability to stop me in my tracks. I had always been a pretty Type A personality, and control and planning were how I functioned. I need a clear plan and expectations for anything in my life. So when Dr. Ellis looked at me and told me this was all entirely up to my decision, I panicked. I would much rather have my parents tell me this is what was going to happen than let my own anxious mind make a decision that might go wrong. The verdict from the many pokes and prods of the doctors was that my face was a problem. It was a problem of functionality, but I could live with it. My jaw was not right, but I could live in the wrong for the rest of my life if I chose. Dr. Ellis held up a typical jaw model to me and showed how mine differed from the typical. My teeth were not touching anywhere in my mouth except for the very back. My lower jaw, or mandible, was slowly growing downwards, not outwards as most do. This resulted in my lack of a defined jawline and chin. When your teeth only touch in the back of your mouth for 16 years, you tend to adapt. I didn’t know any different. I remember thinking that my teeth just weren’t sharp enough to bite things like pizza. Little did I know, my teeth weren’t even touching. I had the largest open bite possible and for years I adapted and made it work. The surgery would offer functional benefits including my teeth coming together and my lips closing at rest, a luxury I was unaware of. In addition to the functional benefits, Dr. Ellis explained how the reconstruction would cosmetically be more appealing. I now could choose a new and defined jaw line. 

So now I had a choice. Dr. Ellis proposed a double jaw replacement that entailed quite the recovery plan. First things first, braces had to go back on. For a sophomore in high school, this news was devastating. Next, the surgery itself was not for the weak. There was the possibility of being wired shut for weeks if things went wrong in the OR. I would not be speaking for weeks after. I would be on an all liquid diet. I would need at least two months to even think about eating a solid food. The swelling could last from anywhere from one to two years. Though this list was long, these were just the physical repercussions. The psychological effects were the ones to be more concerned with.

Dr. Ellis’s countenance changed as he described to me how I would feel mentally. He told me how many patients struggled with depression and even body dysmorphia post-surgery. One medical study found over 13% of patients undergoing facial surgery presented with Body Dysmorphic Disorder (BDD). In addition, patients who suffered from BDD had a much higher chance statistically of developing depression and anxiety post-op. This was a serious facial change, and while it was more likely that I would like my new face better than the one before, the fact of the matter was that what I knew as “my face” would be changing. His eyes showed sincerity as he described how it can feel to look it the mirror and not recognize the face staring back.

When I think back to that time, I honestly couldn’t say at what moment I made up my mind. In-between the car rides to doctor’s offices and orthodontist appointments, somewhere along the lines the decision was made and I was the next candidate for double jaw replacement. My parents and I realized the benefits far outweighed the repercussions of a life of wondering what might have been different. So I got the braces. I began pre-operative appointments. And I mentally prepared, as best as I could, to become the girl with six titanium plates in her face. 

I like to describe my first days post-op as living like a plant. With the immense level of swelling, I was reduced to my most basic functions. I could not speak or even begin to take care of myself. So I sat. I sat in my hospital bed as my parents syringed liquids down my throat in an effort to keep enough nutrients in me to have my pain killers and antibiotics administered. We would soon learn that this would be one of the more difficult parts of my recovery. With my tongue and throat so swollen in addition to my face, I couldn’t swallow anything. Besides the swelling, everything in my mouth was in a new place and my body didn’t know how to relearn how to swallow. This is where my mom became an incredible asset. No one in my family had really even thought of it before, but my mom was a speech pathologist and she worked with patients who had suffered from strokes and retaught them how to swallow. She soon became my own speech and swallowing coach in addition to my mom and caretaker.

Those first days in the hospital are really a blur to me. I was on a morphine drip and so incredibly weak that any physical movement exhausted me. I remember every day I was required to take one lap down past my room door and back, and it felt like running a marathon. My dad, an orthopedic surgeon, took an unprecedented two days off to sit with me and my mom. I was only supposed to be in the hospital overnight, but due to my immense swelling, my doctor didn’t feel comfortable with me leaving the hospital’s care. I forever have this image of him looking at me and my parents and gesturing with his hands to describe the “bell curve” of swelling. He waved his hands in a steady curve and then jutted his hand out to the right to indicate how my case was so rare. 

After three days in the hospital, my surgeon was confident that I could return home. The reason for the extended time in the hospital was that while in the hospital I could receive water and medications directly into my bloodstream by an IV. When I returned home, it would be on my parents to syringe water and Gatorade down my throat in order to syringe in the medicine after. I will always have the memory of my dad filling up the syringe and looking at me explaining how we only had to get through 100 ccs of liquid before I could take my pain medication. I hated having the liquid syringed down my throat because swallowing was such a foreign concept to my new face, and I could not figure it out. Frustration quickly set in because I knew I was holding myself back from getting pain medication, and that relief was all I could hope for.

Once I was home from the hospital, the reality began to set in. This would now be my life. Falling in and out of sleep pretty much all day. Living from pain medication dose to dose. Watching so many Netflix shows and movies that my eyes were about to fall out. And all the while I was trapped inside my own mind. Unable to talk and unable to truly communicate. I was mute for the first two weeks as the immense swelling did not allow for speech. When I hit week three, my mom began to be able to interpret my strange vocal sounds. She likens it to when I was a baby and my words were unintelligible to all those around her. She became my confidant and my person as she knew how to understand my wants and needs.

Another turning point was my second week post-op appointment with my surgeon. He looked at my mom with disbelief and concern and sternly told her that I had to eat or I would be put back in the hospital with a feeding tube. My mom and I truly hadn’t noticed how significant my weight loss had been. I think we both were so consumed with how large my head was, that we didn’t realize how frail and limp the rest of my body had become. I reluctantly stood on the scale, and to my shock the number was one I had never even seen before. Dr. Ellis informed me I had lost 17 pounds in two weeks and he was incredibly concerned for my vitality. Up unto this point I had been on an entirely liquid diet. Gatorade and thinned out smoothies were all that could pass through the syringe and therefore all that had passed through my lips in the past two weeks. Dr. Ellis sent me home with an assignment to begin soft solid foods. So my mom set out to make me the best mashed potatoes I had ever tasted.

With an upgraded diet to mashed potatoes and eventually even some soft mac and cheese, my weight began to increase and with it, my spirits began to lift. Before the change in diet, I felt depressed for the first time in my life. I remember silently crying at night as I had to sleep upright in my bed with a mountain of pillows propping my face up. I felt defeated and like I was trapped in an eternity that would never end. Looking back, I now liken this to extreme weight loss and resulting fatigue and weakness, but at the time the depression was all-consuming. 

 As I reached a month post-op, my life began to come back to a bit more normal. I still had not left our house except for my mandatory post-op check-ups, but now my mom would let me take a few short minutes to sit outside and feel the sun on my face. This sunlight exposure did wonders for my mood and mentality. As we reached the second month of post-op, a few of my friends were allowed to visit me and bring some much-needed change into our household of routine. By this point, I was getting tired of the monotony, and more than that I was ready to see my new face. I remember each day I would wake up and look at my reflection to see if the amazing change of beauty had occurred overnight.

I think the most revealing part of this entire process was how incredibly insecure I was in my appearance before the surgery. The fact that I wanted to see such a different looking face staring back at me in the mirror revealed how deeply insecure I was with my face to begin with. The doctors reminded me countless times that the swelling would take up to a year and six months to completely dissipate and reveal the new face that had been surgically constructed for me. Yet, I still looked up at my bathroom mirror every morning in eager hopes of seeing someone new and more attractive in my 16-year-old eyes. As time would go on though, I would come to realize that even though the physical change to my face was substantial, it couldn’t change the confidence I had internally. It didn’t matter what my face might look like outwardly, if I didn’t find true value and beauty in who God created me as, then I would never find true contentment in any outer beauty.