FITCHBURG, Mass. (AP) — Falling off a platform onto the third rail at Ruggles Station in Boston almost seven years ago while experiencing a Klonopin blackout may have ultimately saved face transplant recipient James P. Maki's life.
Maki, 62, a U.S. Army veteran, is open today about his life before the partial transplant. He said it is an ugly story of heroin and pill abuse. He was buying two bricks of heroin a day before the accident, he said, each containing 50 bags of heroin, giving two or three bundles away and shooting the rest.
Receiving a partial face transplant in April 2009, after his nose was "blown off," and his face blackened and destroyed below his eyes from a huge jolt of electricity has given him a new start, he says.
Last week, Maki asked the waitress at City Hall Café if he could have the table near the large windows looking out onto Main Street.
But it was not the view with which he was preoccupied. Maki is one of the luckier transplants. He still has vision in his left eye. He can see color and some detail and read large print, but needs bright light to see well, he said. His right eye is almost totally sewn closed.
He said his transplant surgeon, Dr. Bohdan Pomahac, director of plastic surgery transplantation at Brigham and Women's Hospital, closed the eye because he was in pain and so he wouldn't lose it. He can smell, talk, eat and move his face. He is on a very low dose of anti-rejection drugs and does not have side effects.
He has had 25 surgeries since the June 30, 2005, accident. He still needs more dental reconstruction. He got a call last week from his dental surgeon who gave him good news, he said.
"He said he will do the dental work pro bono (for free)," Maki said.
For the two years following the accident before his transplant, he would not go out in public, he said.
"People used to scream when they saw my face," he said. "I felt unhappy that (screaming) was all they could do."
While drinking his cup of coffee, he explained how his heroin use started while he was serving in the Army in Vietnam.
"When I went to Vietnam I used to shoot dice with a guy," Maki explained. "He beat me and beat me, until one day I ended up winning $400. He didn't have it. I told him I wanted it today and that night he brought me a little bag of powder. He said, 'Snort it.' I loved it. It was the perfect escape for me and I kept buying it over there."
He continued using after he got out of the Army. Every day Maki said he would go into town and buy dope.
"It was my priority before eating, sleeping — anything," he said.
His addiction would lead him to "borrow" $250,000 from his adoptive mother before 1980, to hustling friends for money to support it, to jail numerous times, through a number of halfway houses and living on the streets and ultimately to that morning when he overdosed on street-bought Klonopin and suffered severe injuries to his face.
"I used right up until the day I had the accident," he said. "I say I was in a semi-coma for a year-and-a-half after it happened. I don't have any memory until I was in rehab in New Bedford and I came to — meaning I was cognizant. They told me I had lost my nose. I thought they were kidding. It was covered and I didn't look at it. I thought, 'I'm going to have to learn how to live like this.' "
Maki's was the second face transplant in the United States, Dr. Pomahac said, following a woman in Cleveland six months earlier. He was the seventh in the world to undergo face transplant surgery and the first man in the United States.
Maki's mouth was burned inside from the accident, leaving a big hole in his face, he said. Rebuilding three-dimensional bone lined with mucosa that makes up the hard and soft palate is impossible, he said.
"Maki is doing great," Dr. Pomahac said. "He has no issues to speak of. It is better than we hoped for.
"When you replace a missing part it restores a person's humanity," Dr. Pomahac continued. "For someone with no human facial features, it gives them the appearance of looking human, again, to a degree of fidelity not possible without a partial transplant."
Brigham and Women's Hospital is a pioneer in the field. So far, Dr. Pomahac has completed four transplants and each has its own combination of issues.
"They are all kind of like 'Mona Lisas' at this time," he said.
But, the face transplants are paving the way for patients with smaller defects, he said, who are missing features, but do not need an entire transplant.
His next patient is Carmen Tarleton, a woman from New Hampshire who was attacked five years ago by her estranged husband. He burned her with industrial lye, leaving her with extensive burns and horrendous facial injuries, Dr. Pomahac said.
As for Maki, who is staying at the Veteran Homestead in Fitchburg, he said when it is all over, he would like to travel.
His daughter, Jessica M. Maki, working in media relations at Brigham, said her dad's transplant was a fresh start for them.
"After his initial injury, we had to spend a lot of time inside hiding from the 'stares.' It was just easier," Ms. Maki said. "But, now, with his new face, we are able to spend a lot more time together and in public."
She said "little things," like going shopping with her father to buy a dress for her best friend's wedding a few weeks ago while he sat patiently waiting for her as she tried on a dozen dresses, weren't possible before his transplant.
"Of course he looks different — but it's less noticeable to me," she said. "If you held two pictures next to each other, one before the injury and one after the transplant, of course he'd look different. But, he's still the same person, has the same heart, makes the same jokes. His character hasn't changed and he still always looks like the same old dad to me."