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A New Life Starts With a New Face

By TChris, Section Innocence Cases
Posted on Sun Jan 04, 2009 at 08:20:16 PM EST
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Ricardo Rachell deserves a break. A shotgun blast to the face left Rachell severely disfigured. Neighborhood kids called him "Scary Man." And then he served six years in prison for a crime he didn't commit. His is the injustice that Houston's new DA talked about in this post.

Who knows if Rachell's facial deformities played a role in his conviction. But such taunts, rejection and deep humiliation often cause those with disfiguring injuries, burns and deformities to live in isolation and depression. Suicide rates are high.

Rachell will be undergoing a series of cosmetic surgeries, thanks to the kindness of Dr. Joseph Agris, who will perform the surgeries at no cost to Rachell. Dr. Agris deserves the public's appreciation for his generosity.

For those of you who like to think about ethics, the linked editorial asks whether face transplants to correct profound disfigurements that are not life-threatening should be considered cosmetic procedures. It's difficult to take issue with the editorial's concluding paragraph.

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    A New Life Starts With a New Face | 26 comments (26 topical)

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    I am all in favor of doing them, when (5.00 / 2) (#1)
    by scribe on Sun Jan 04, 2009 at 09:14:11 PM EST
    it is medically necessary.

    In fact, I believe a face transplamt, to resolve or amerliorate (I doubt anything could ever "cure") severe deformities or damage should be more favored than, say, the heart or liver transplant for an elderly person seeking to add another couple more birthdays.  Or, for that matter, for the person whose own alcohol or drug abuse - done in the face of knowing their respective downsides - has ravaged the organs they were born with.  (As to the latter, I say that even knowing closehand the sufferings such addicts go through - a relative is on the list for a total rebuild after thirty years of drinkin' and druggin'.)

    But, sadly, people - and this has everything to do with human nature and nothing to do with which society one finds themselves in - single out the ugly and disfigured for hatred, ridicule and abuse.  It was not so long ago that the disfigured were considered stupid or retarded in our culture, and hauled out to be killed in cultures only slightly less "advanced".

    Even today, we do the same.  A couple years back I seconded a colleague in a case of a man accused of an attempted sexually-oriented offense.  No one was even touched - there was no allegation of touching.  Years before, the client had taken a shotgun blast to the face, too.  He might well have been innocent - he insisted he was - and it was a purely inchoate offense based only on the classic he said-she said, but there was no way that accusing witness was going to mistake him for anyone else, no way to shake that story.  Given his ugly face, there was no way we could find to make him attractive to the jury or, for that matter, even get him a fair hearing from them.  For that matter, his ugliness made a perfect argument for the prosecution:  he's so ugly he can't get laid so, lonely and frustrated, he turned to [what he was accused of].  I don't remember them making that argument, out loud.  They didn't have to - it was staring the jurors in their faces (so to speak).  

    He refused a good plea and, unsurprisingly, was convicted.  We knocked our brains out for him, but the prejudices against the ugly and disfigured are so strong that he never had a chance.  We may have even told him that, but he didn't want to believe that - he wanted to believe his innocence.  He's got about 8 or 10 more years to think about that....

    I'm fairly certain... (5.00 / 1) (#9)
    by MileHi Hawkeye on Mon Jan 05, 2009 at 03:08:21 PM EST
    ...there isn't a transplant clinic in the whole country that would give an 80 year old a liver or kidney transplant just so they can "add another couple more birthdays".  

    Transplant guidelines (physical, mental, compliance with treatment, support, etc.) are very, very strict--and for a good reason--it is a matter of life or death and not a quality of life procedure. Not to mention the severe shortage of transplant organs available.  

    Is a facial reconstruction/transplant really "medically necessary" since life continues on without one?  Certainly the quality of life for those so affected would in theory, (the jury is still out on the emotional/mental aspects of such surgery) be enhanced, but its not a matter of life or death.

    I'm certainly all for anything that helps the severely deformed live fuller, more productive, happier lives--but let's not confuse life saving with life enhancing.    

    Parent

    I don't like face transplants (none / 0) (#13)
    by Fabian on Mon Jan 05, 2009 at 06:02:00 PM EST
    but I'd agree with them if they were done ONLY to substantially improve function, but not to fix disfigurement.

    It's so risky that I would say do anything and everything else first before considering a transplant.  If the transplant fails, the patient is likely to be off worse than they were before.

    If your arm was damaged but still usable, would you want an arm transplant if the consequence of rejection was losing the arm completely?

    I wonder where this urge to do a face transplant comes from.  Most people who need plastic surgery use their own tissue because it won't be rejected.  


    Parent

    Being worse off... (none / 0) (#18)
    by MileHi Hawkeye on Mon Jan 05, 2009 at 10:52:04 PM EST
    ...is a chance you take every single time you go under the knife.  Sad as it might be, someone has to be the test subject--and I've been in that situation a time or two.  Sometimes it is just the hope of a better life that drives people.  Or as was the case with me, there's just no other direction to go.  

    I tend to see things like face transplants as advancing medical science, even if the surgery itself isn't life saving in the most basic sense.  If they can learn things from this kind of surgery that could be applied to other kinds of transplants--controlling rejection, regenerating tissue, tissue matching and the like--that benefits a lot of people.  


    Parent

    Tissue rejection (none / 0) (#19)
    by Fabian on Tue Jan 06, 2009 at 04:15:56 AM EST
    I haven't seen any advances in that at all.  It's still the same paradigm - squelch the natural immune response which increases the risk of infection.  It takes a life long regimen of drugs to do this.  

    To create or use rejection proof tissue for the best long term solution.

    Parent

    There's been some progress. (none / 0) (#22)
    by MileHi Hawkeye on Tue Jan 06, 2009 at 09:05:13 AM EST
    The anti-rejection treatment that I will be subjected to post-trasnplant isn't quite as bad as what my Dad had to take after his.  The steroids are cut back some, which is good.  

    One of my Doctors was telling me that I might be one of the last to be subjected to the traditional AR therapy.  So, at least there is hope out there.

    And sometimes, you have to hang your hat on that.  Hope for breakthroughs, hope for advances from stem cell research, hope from anywhere you can find it.  

    Parent

    I don't know if you (none / 0) (#4)
    by JamesTX on Sun Jan 04, 2009 at 10:14:03 PM EST
    are familiar with the case, but the only evidence they had was the eye witness ID of the two kids involved. Problem is, when the kids described the assailant (before they had actually seen the suspect), they mentioned nothing about the facial disfigurement. Now, if I were being asked to describe what Rachell looked like to a police officer, I can't imagine I would not mention the facial disfigurement. If I were a police officer interviewing such a victim, I certainly can't imagine not asking if there was anything unusual or unique about the assailant's appearance. Zero. Zip. Nada. Not a peep about anything wrong with the face before the the kids actually saw the defendant. And the ID was it. It was all the evidence they had. Nothing else.

    This story is the story of what is wrong with criminal justice in Texas. It is disgusting. It is depressing. It has to change.

    Parent

    Well, in the case I worked on (none / 0) (#6)
    by scribe on Mon Jan 05, 2009 at 08:39:15 AM EST
    the accusing witness (AW) made an ID, describing The Ugly Man and his vehicle in pretty direct (and, unfortunately) accurate detail, including the fact and nature of disfigurement.  And AW did it in a videotaped session (a non-obvious camera recording the session) using non-suggestive interrogation.  Textbook professional police work, unfortunately for the defendant.  It was not similar to the case you describe, in those regards.

    The core problem I had with the case I worked on was that the alleged criminality was an alleged attempt - something wholly inchoate.  It is in those situations that the ugly or disfigured stand to lose all the time, because people are quite willing to believe the worst about them merely based upon the ugliness or disfigured nature of their appearance.

    Parent

    Psychological and sociological (none / 0) (#8)
    by JamesTX on Mon Jan 05, 2009 at 01:42:02 PM EST
    research has established the powerful effects of physical attractiveness quite unequivocally. Yes, attractiveness is the elephant in the living room in all social interaction. In fact, it often turns out to explain more of the variation in the way a person is treated than any other variable, although everyone naturally denies that it enters into their decisions. It is a halo type effect, meaning that people infer a person's inner qualities based on outer appearance.

    I have a close friend who grew up with a facial deformity. Luckily for him, he had a successful plastic surgery as a young adult. It was amazing what it did for him, and we were always overwhelmed at how deeply and universally appearance effects social outcomes. I was never what is considered "attractive" in our culture. That is, I'm never going to be an underwear model! But I didn't have a serious deformity. My friend and I always discussed how these things affect people's careers, and our predictions were almost always correct. There is a myth that it only applies to women. It is, in fact, probably more important for men. Attractiveness is almost the most important thing, even when other things are not equal. It overrides many more important personal qualities. And you are correct that people with low levels of attractiveness are seen as being "sexually and romantically desperate", helpless, and thus more likely to have perverse motives. It is really frustrating and demeaning.

    As you have said, it is amazing that something which good science has established to have such obvious powerful effects is not controlled for in legal proceedings. There is a tendency for people to avoid overt discussion on the issue of serious deformity when the person is present (our tendency is to try to pretend it doesn't exist). At the same time, as you said, it is having powerful effects in their minds. If the issue of the defendant's appearance is relevant to the case, and the issue is being discussed, then there may be circumstances where it is better if the person is not in the room. That way, this powerful determinate can be discussed and made objective without the force of the avoidance tendency.

    Parent

    Height too. (5.00 / 1) (#10)
    by sarcastic unnamed one on Mon Jan 05, 2009 at 03:21:07 PM EST
    The taller you are the better.

    Parent
    A friend of mine (5.00 / 1) (#12)
    by sallywally on Mon Jan 05, 2009 at 03:39:59 PM EST
    in her mid-fifties lost about 120 pounds (half her weight)and was left with tremendous amounts of skin that didn't un-stretch to fit her new smaller size. Her face looks like a bloodhound and she says her old huge stomach, now a large amount of "empty" flesh, hangs down to her knees - she has to use a girdle to get along, night and day.

    No insurance will cover this, though, saying it's "cosmetic," and by some standards I guess it is. But what a shame to live with grotesqueries like this.

    I think it's a subset of the disfigurement problem. Hatred and judgment against fat people.

    Been there, done that. (none / 0) (#14)
    by Fabian on Mon Jan 05, 2009 at 06:11:44 PM EST
    My second pregnancy literally split me open inside.  I had (have) stretch marks from pelvis to a few inches below my sternum and literally from side to side.  My rapidly expanding uterus stressed my body so much that even the muscle wall gave way.  

    Imagine six pack abs.  Now imagine six pack abs with a six inch split along that central seam, with intestines sliding in and out.  Yummy.

    Insurance covered putting me back together again - but they didn't pay for the surgeon removing the excess skin and fat.  That's "cosmetic".  Recovering function they would pay for.  Cleaning up the mess on the outside was my problem.

    Parent

    Unconscionable IMO. n/t (none / 0) (#15)
    by sallywally on Mon Jan 05, 2009 at 08:37:01 PM EST


    Parent
    Oh, how I wish (none / 0) (#20)
    by Fabian on Tue Jan 06, 2009 at 07:48:34 AM EST
    I had thought to do a photo journal of that pregnancy.  It would have been worth it if it had scared the h3ll out of a few women who think that pregnancy is no big deal.  My abdomen was a fascinating study in stretch marks from the faint, barely visible ones on the edges to the cruel ones colored black from the broken blood vessels radiating out from the from the black blob that was my navel.

    A sci fi special effect was one way I described it. It's not a exaggeration either.  My mother was talking about me to a co-worker.  "No, you don't understand.  She really IS huge!".  I was too busy hoping everything went well (high risk pregnancy) to ask if all of this was normal.  

    Parent

    Fabian, I can't speak for other women (none / 0) (#21)
    by vml68 on Tue Jan 06, 2009 at 08:20:36 AM EST
    but you have definitely scared the hell out of me! I am a bit fearful of pregnancy as it is and you just added a new dimension to that. Thanks... :-)!

    P.S.- IIRC, you mentioned that you are quite small in stature. Did that have anything to do with what happened?

    Parent

    I think it was genetic (none / 0) (#24)
    by Fabian on Tue Jan 06, 2009 at 11:27:30 AM EST
    the official term for what happened was polyhydramnios - an excess of amniotic fluid.  Often this can indicate something wrong with the fetus but we checked him out as thoroughly as possible and nothing showed up.  Now, if this causes a problem, you can insert a needle and draw off some fluid as many times as needed - buuuut this doesn't address the cause of the problem and it is invasive.  Do you really want to risk introducing infection?

    My maternal great aunt may have had the same problem just by looking at some photos of her, but anyone who may have known is dead.  

    There are far more common problems that can happen than the two that happened to me.  Mine were so rare that the first baffled the entire staff of the practice.  The second was a hernia, but if you look for hernia & pregnancy, you'll find others, but not this particular one.  It's associated with extreme obesity, not pregnancy.

    I did a lot of research for me and for a friend who was very high risk.  We both had some unusual complications and both of us never really knew what the causes were.  You'd think that because pregnancy is so common, that it would be well studied.  It's not so.

    I would encourage anyone who is planning to get pregnant to read up on pregnancy complications and fertility problems.  It took my friend the loss of her first baby (she didn't realize she was pregnant!) and and one miscarriage before they found an effective treatment to allow her to carry to term.  Even then she delivered early due to pre-eclampsia.

    Two notes:
    What happened to me was in reality something similar to what happens to many pregnant women.  The tissue that tore is meant to stretch.  Ideally, it shrinks back to pre-pregnancy condition afterward.  Only it doesn't always do that.  Sometimes it remains stretched and it's connective tissue, not muscle.  Exercise doesn't affect it.  So there is a specific "cosmetic" surgery to fix that.  This can be done as minimally invasive surgery.

    I was satisfied with the care I received.  I just realized that most women go into child bearing very ignorant.  No one makes a point of teaching us about these things and we assume everything will be fine.  The reality is that 1 in 5 pregnancies will suffer a complication. [link]  Reported miscarriages are almost as common.  It's a risky business.

    Doctors aren't perfect but at least mine was honest.  When I asked how we could prevent what happened with my first child (bled out in utero, almost stillborn) they admitted they did not know what exactly had happened or how to prevent it.  (BTW - all my searching on the internet never found another incidence of that.  Incredibly rare.) They declared me High Risk and watched the pregnancy closely.

    Pregnancy may be a natural part of life but it's not something to be taken lightly.  I'm glad women don't usually suffer the trauma I did, but I think they should educate themselves and prepare themselves.  Why do we offer LaMaze classes but not Common Complications of Fertility, Pregnancy and Childbirth?  Shouldn't women know these things?

    Parent

    It must have been a scary time for you. (none / 0) (#25)
    by vml68 on Tue Jan 06, 2009 at 12:14:06 PM EST
    And I know what you mean about education for women regarding fertility, pregnancy,etc. I have been reading up on the subjects since I would like to have a child in the near future and was surprised by how little I knew (aside from the basic mechanical aspects of it... :-))

    Parent
    First pregnancy (none / 0) (#26)
    by Fabian on Tue Jan 06, 2009 at 03:02:30 PM EST
    nine months of blissful ignorance.  Second pregnancy - lots of anxiety.  My primary thought was "healthy baby".  Everything else didn't really matter.  My friend had it worse, plus her problem was placental dysfunction which meant that no stage of the pregnancy was safe.  She had to go on medication from the first positive home test.

    Plus all the women I knew who had fertility problems - fortunately they were treatable.  And the one women who very likely had a fertility problem but didn't realize that miscarriages can be a sign of hormonal insufficiency.  (If you have two miscarriages, you should get thoroughly checked out before you try to conceive again.)

    Parent

    Monsters Are Scary (none / 0) (#2)
    by squeaky on Sun Jan 04, 2009 at 09:23:06 PM EST
    I remember seeing a guy pretty regularly on the west side hwy south around the 125th st exit. He looked like he was horribly burned, or something. Mostly black face with white sploches. I figured that the most he could expect in terms of human contact was speeding cars going by. I never saw him during traffic jams, only at 30+ mph.

    He was super scary looking, but fascinating at the same time, a freak. A facial transplant would have obviously normalized the guy. Most of us get scared by grotesque faces for some reason. Insurance should pay.

    Dr. Joseph Agris (none / 0) (#3)
    by JamesTX on Sun Jan 04, 2009 at 09:57:13 PM EST
    is my new hero. Here is a citizen of Texas who deserves recognition. Mostly, doctoring in Texas is just about being rich and powerful. I am thinking Agris would make a good State Senator, perhaps replacing that fascist doctor they have in the Senate from East Texas. The government of the State of Texas is a sorry excuse for humanity as evidence by what they did to this man. If they were human, every last one of them would be on their knees begging his forgiveness. Its good to know we still have some prominent citizens who have the capacity for moral reasoning. It would be better if we could get them into the government.

    Can't agree (5.00 / 1) (#7)
    by sj on Mon Jan 05, 2009 at 09:36:14 AM EST
    Why take some one from what he is born to do (surgery) and put him in something that doesn't use his talents at all (government)?

    That's even worse than the hitting the peter principle because the hierarchy isn't even there.

    Understand the longing for ethical government, though.

    Parent

    Agreed. (none / 0) (#17)
    by JamesTX on Mon Jan 05, 2009 at 09:12:18 PM EST
    That was actually sarcasm.

    Parent
    Somehow missed that :) (none / 0) (#23)
    by sj on Tue Jan 06, 2009 at 09:21:45 AM EST


    Parent
    FWIW (5.00 / 1) (#11)
    by txpublicdefender on Mon Jan 05, 2009 at 03:35:12 PM EST
    For what it's worth, I'm pretty sure it was his local representative that contacted the doctor in the first place about helping this man.

    This case is a classic example of prosecutors pursuing a case that they had to KNOW was unjust, and of a jury ignoring the clear evidence establishing reasonable doubt right before their eyes.  The only evidence against this man was the eyewitness ID of the victim and his friend.  This man has a very clear facial deformity.  It's not something you would even miss in the dark.  It is major and obvious and the first thing that anyone would notice upon seeing him, and probably would never be able to forget.  And yet, neither boy mentioned anything unusual about the face of the assailant when they gave their initial descriptions of the perpetrator.  And still, the jury convicted the man.

    The prosecutor who prosecuted the case should have his or her head examined.  The jurors should be barred from all future jury service for gross incompetence.  

    Parent

    If the prosecutor (5.00 / 1) (#16)
    by JamesTX on Mon Jan 05, 2009 at 08:49:10 PM EST
    knew he was innocent of this crime, which he/she almost surely had to, then I think disbarment might be the most important response -- the most important thing for us to do in order to reaffirm our humanity and our respect for the social contract. We most definitely have a law enforcement/prosecution problem. That isn't an question for argument. Any progressive living here knows it. It is well documented, and more evidence pours in every day. But those people are in charge because someone put them there. Ultimately, we have a citizen problem. Those of us who live here all know exactly what that jury did and why they did it. We live and work with these kind of people every day. They are part of a culture which has so thoroughly accepted a philosophy of authoritarianism that they resent their ethical duty to supervise and restrain that authority. They served their disgusting political god at this man's expense. They are so damned averse to disagreement with authority and power that they simply defer to authority without question. To them, deference to authority is the highest moral value. They have by collective choice adopted the type of moral reasoning which researchers have identified as characteristic of children under eight years old, and closer to those under three or four. For them, right and wrong are solely defined by the authority and power of police and prosecutors. They are sheep -- unusually arrogant and self-righteous sheep, at that.

    My family has history here. It can be traced back to shortly after statehood. We are not transplants. My speech shows it. Even after years of effort, my accent is hard on the ears. That is how I am familiar with the actual heart and soul of the authentic cultural roots of Texas. Texas never was the image that we have been made into by the conservative movement and the movie industry of the 1950s and 60s. Unfortunately, we are now acting out that Hollywood "Wyatt Earpo" image largely due to newcomers -- people who have moved here within the last couple of generations seeking their childhood fantasies from TeeVee -- summary hangings, cowboy justice, harshness, brutality, intolerance and such (all disguised as good old clean conservative religion). They are the ones with the Stetsons on the dash and the scowls on their faces. They think they are so damned cool. They make me sick.

    Those people bring shame. My grandfather wore a Stetson. He wasn't full of hate. He was, despite his faults, a good man. A fair man. He knew there was a right and a wrong which was defined by something independent of authority. He had the moral reasoning capacity of an adult, even if he was ignorant and uneducated, and wrong about some things. He may have been as much of a racist and sexist as anyone of his time, but there is no doubt he would be disgusted by what happened to Rachell. He would be disgusted by the cheap television facsimiles into which his traditions and his culture have been transformed. He would be sad. He would be angry. He would be insulted and demeaned.

    You can see this has deeply effected me. I am beginning to think I want to move away from here. This state has always been a significant part of my identity. I always had great hopes that we could recover from the likes of Bush and the mobs who follow him. I am beginning to think not. I am beginning to think...this place is evil. I don't want the blood on my hands. I don't want the people like Rachell, sitting in those white rooms with the symbolic cross of George Bush's fake god on the door, finding my name on the list when they ponder who...who is doing this to them.

    I may sound like a mental case, but this event is not something to be taken lightly. It is a symptom of a social order which has gone terribly wrong. I don't know if I can participate in this social order anymore. I don't know that I can overlook this. I think I want to leave.

    Parent

    I'm just in awe of medical progress (none / 0) (#5)
    by Cream City on Sun Jan 04, 2009 at 10:22:52 PM EST
    in transplants -- and grateful.  I'm a prime candidate for needing a kidney transplant eventually, having lived half a century with only one (lost one as a side effect of polio).  

    At the time, without transplants then, the prognosis was that I wouldn't live past 30.  But within a decade, successful kidney transplants and so much more progress in nephrology changed that and much more for me and many others.

    So I got a new lease on life despite an "invisible disability" -- why not others with these horrible disfigurements?  I simply don't understand the resistance to the results of great researchers.  

    Bless them all for advances they have made not only for me but also for others, including one of my children with a different disability -- one that led many people in the past to restricted lives owing to stupid laws and thus to isolation, suicide, etc., as I know from the sad life of a family member in a previous generation with the same condition, now so easily controlled by meds.  If a pill could fix Mr. Rachell's face, would we question it?  Of course not. . . .

    A New Life Starts With a New Face | 26 comments (26 topical)

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