Published February 21, 2009
STAMFORD, Conn. – Her hands looked like they were wrecked by a machine. Her hair was yanked out and her eyes were severely damaged. In fact, her face and scalp injuries were so extensive that all the blood obscured whatever parts were left.
Two of the first medical workers to treat the woman mauled by a chimpanzee in Connecticut this week described her nightmarish injuries Thursday as she was transferred to the Cleveland hospital that performed the nation's first face transplant.
One of the workers, Bill Ackley, told The Associated Press it was a "miracle" that three days after the attack Charla Nash would be taken to the Cleveland Clinic, which specializes in reconstructive surgery.
"It was amazing to us she had these type of injuries and they were survivable," Ackley said.
Medical workers found Nash, completely unrecognizable, face down Monday in friend Sandra Herold's driveway. The first police officers on the scene couldn't tell if the body was male or female, and warned dispatchers that the victim's face was ripped away.
Nash's attacker, a 14-year-old, 200-pound chimpanzee named Travis, had already been shot by police but was still roaming nearby, temporarily out of sight.
"This was a beast taken out of his element and put into our world," Ackley said. "What he did was essentially what they do in the jungle."
Ackley, a captain with Stamford's emergency medical services, and medic Matt Groves were among the first to tend to Nash. Police formed a perimeter around them with their guns drawn in case the chimp came back.
Blood was everywhere. Groves confirmed she was alive by checking her breathing.
"You ready?" Groves said. "One, two three."
The medics rolled Nash onto a stretcher and strapped her in. They stanched the bleeding with gauze.
Nash's hands were horribly disfigured, but still attached to her wrists.
"I would liken it to a machine-type accident," Ackley said. "She had some crushing injuries to her hands and some tearing injuries to her hands."
Her head injuries "involved her entire face and scalp," Ackley said. Nash's eyes were injured, but Ackley would not say how extensively. Her hair had been ripped out.
"She just had disfiguring injuries," he said. "Her nose was still there. There was some disfigurement. She did have injuries to her mouth that caused quite a bit of bleeding. It was very difficult to determine where everything was because of the blood."
Nash did not talk, but was conscious. She was able to respond to requests to move her foot.
No one talked, but Ackley couldn't help wondering as he worked if Travis would return. He had seen the chimp around town and knew how big he was.
Travis didn't come back. Fatally shot by a police officer, he retreated to Herold's home and died. Why he attacked remains a mystery.
Medics rushed Nash to Stamford Hospital, where four teams of surgeons operated for more than seven hours to stabilize the 55-year-old Stamford resident. She was transferred Thursday to the Cleveland Clinic, which two months ago performed the first face transplant in the U.S.
Eileen Sheil, spokeswoman for the Cleveland facility, said Nash is being seen by a head and neck surgeon and likely will be treated through a team approach involving many specialists.
Sheil said she didn't know if a transplant will be considered. "Priority one is to stabilize her."
Nash's transfer to Cleveland likely is because of the clinic's expertise in facial reconstruction—not because doctors are considering a transplant right away, a leading surgeon said.
"This is a difficult time for the patient and she will need to adjust to it first. All the other options should be discussed first" before something as radical and risky as a transplant is considered, said Dr. Bohdan Pomahac, a reconstructive surgeon at Harvard-affiliated Brigham and Women's Hospital in Boston.
Brigham also has approved plans to offer face transplants, and Pomahac said he has tried to contact doctors involved in Nash's care but has not reached any yet.
"Often things sort of sound worse than they really are," he said. If any of Nash's face was salvaged, "a lot of the tissues can be returned to where they came from," or repaired with traditional skin grafts or flaps.
In December, surgeons at the Cleveland Clinic completed the nation's first facial transplant, of an unidentified woman who suffered a traumatic injury several years ago. The injury left her with no nose, palate, or way to eat or breathe normally.
In a 22-hour procedure, 80 percent of her face was replaced with bone, muscles, nerves, skin and blood vessels from another woman who had just died.
It was the fourth partial face transplant in the world, though the others were not as extensive. Nor were any done as emergency operations, said Dr. W. P. Andrew Lee, chief of plastic surgery at the University of Pittsburgh.
"It would be unusual" to perform one so soon for Nash, he said.
To consider it, doctors must make sure she is medically stable, that alternatives have been carefully considered, and that she truly had given informed consent, because a transplant requires taking anti-rejection drugs lifelong, Lee said.
That could conceivably be done in a matter of weeks, but "to find a suitable donor with matching skin color and size and other features, that's a practical limitation," he said.
Cleveland doctors have said it took several months to find a suitable donor for the face transplant Dr. Maria Siemionow performed in December. Siemionow is out of the country at a conference.