Chrissy Steltz holds her 2-month-old son, Geoffrey Dilger Jr., in her Milwaukie apartment.
If her six-hour surgery goes as planned, Chrissy Steltz will wake up able to breathe through a nasal airway for the first time in more than 10 years.
She won't yet have a nose -- just a rectangular opening where the nose should be. But it's a start.
An accidental shotgun blast at close range when she was 16 blew away much of Steltz's face, including her eyes, cheeks, nose and upper jaw. The first page of her 725-page medical record at Legacy Emanuel Hospital & Medical Center in 1999 gives a stark summary, under Reason for Admission: "Most of face gone."
The surgery begins a new medical effort to give Steltz a new face. It will take months, possibly a year. The ultimate goal is to fashion a realistic silicone mask -- with glass eyes, fake lashes and lids, a breathing nose and cheeks -- that Steltz will wear over her ruined face.
That prosthesis will snap into place, attached to eight titanium dental implants that doctors will drill into her facial bones in three months. She plans to wear the prosthesis most of the time, removing it for daily cleaning. In public, she'll also wear tinted glasses, to camouflage the inability of her eyes to move.
The rare total mid-face reconstruction is a collaboration of teams led by Dr. Eric Dierks, a Portland maxillofacial surgeon who specializes in treating trauma and cancer patients, and Larry Over, a Eugene dentist and prosthodontist.
The prosthesis will replace the black nylon sleep shade Steltz wears now to cover her vacant eye sockets, missing nose and heavily scarred face. But that won't come until next year.
First, Dierks must cut a hole in the skin graft where her nose used to be.
The sideways, point-blank blast from a 12-gauge shotgun entered just below her right eye and exited her left temple.
It was March 21, 1999, a Sunday evening. About a dozen teenagers had gathered to party in the Southeast Portland apartment where Steltz lived with her boyfriend. She was an A-minus student at Franklin High School. Her mother let her move in with the boyfriend as long as she kept her grades up.
One of the teenagers found the shotgun under a couch in the laundry room. He was fooling around when it went off.
"Everybody was drinking," Steltz says.
Police investigators called the shooting accidental. The 18-year-old who fired the gun was sentenced to 27 months in prison for second-degree assault. Steltz's boyfriend, also 18, was given probation for theft of 15 guns, including the one that nearly killed her.
She spent six weeks in the hospital, mostly in the intensive care unit -- on a respirator, her jaws wired shut, a feeding tube in her abdomen. She had more than a dozen surgeries. The record of her in-hospital medications runs 129 pages. She remembers nothing from the first 38 days.
"From her upper lip to the hairline was blown away," says Dr. Mark Buehler, an orthopedic surgeon who treated her. "Her nose was gone, her cheeks were gone, her eyes were gone.
"There was nothing there."
Chrissy Steltz, who will undergo the first of three surgeries today to repair her face, does the dishes in her apartment with some help from Rebecca Derscheid, her brother's girlfriend.
The Legacy Emanuel trauma team's priority was to make sure she didn't bleed to death, then stabilize her and close the gaping wound. They used pieces of the fibula, the slender shin bone, as well as metal plates, to make new cheekbones and "bridge" the middle of her face, which they covered with a large "paddle" of skin from her leg.
"It's almost like a jigsaw puzzle inside my head," says Steltz, now 26.
View full sizeRandy L. Rasmussen/The OregonianDr. Eric Dierks will be performing today's surgery to begin building a new face for Chrissy Steltz.The first she remembers is waking up disoriented five weeks later. She didn't realize she was in the hospital or that she'd been shot or even, at first, that she was blind.
Now she refers straight forwardly to the "unfortunate chain of events that changed my life." She says "when I went blind," rather than "when I got shot."
In the decade since, she has settled into what passes for normalcy in the life of a blind woman who wears a black mask. She learned Braille. She worked briefly in a legal office, answering phones, but mostly as a daytime caregiver for her younger sister, Shyanne. She lives in a two-bedroom apartment in Milwaukie with her partner of seven years, Geoffrey Dilger, who also is blind, and their 2-month-old son, Geoffrey Jr.
Aside from her traumatic injury, Steltz is healthy. The only prescription drug she takes is for headaches. Her short-term memory occasionally plays tricks on her. Her jaws don't open fully, so she can't eat a sandwich without squishing it first. She has no sense of smell. Her voice, paradoxically, will sound less nasal once she has a nose to breathe through.
The only time she can see, Steltz says, is when she dreams.
What she misses most about having sight is the independence and spontaneity. "You can't just randomly take a beach drive," she says. "Nothing is random.
"I had a driver's license for four months and 11 days, and I loved driving."
Steltz has never seen her 10-year-old sister, born four months after the shooting.
"I miss not being able to visually see my sister or my son or my significant other," she says.
Having an infant son provides an extra incentive to get her face rebuilt. She wants little Geoff to know Mom with something besides a deformed face.
"I look at him like I would if he could see my eyes," Steltz says. But instead of eye contact, he gets what she calls "sleep-shade contact." Even if it's a year before she starts wearing her new face, "he'll grow up knowing me that way."
For a patient such as Steltz, the line between cosmetic and functional need blurs.
Steltz is on the Oregon Health Plan, the state's Medicaid program for disabled, blind and low-income residents. That plan probably won't cover most of the cost of her facial reconstruction, including the prosthesis, because it is considered cosmetic.
Surgeon Dierks and prosthodontist Over agreed to absorb the uncovered costs. Zimmer Dental Inc. will donate the implants, which run about $2,100 apiece.
Breathing through her nose as well as her mouth, Dierks says, will help improve Steltz's sleep, keep her sinuses from drying out and prevent sleep apnea -- interruptions of breathing -- as she ages.
"It's not like I hit an age where, say, I got wrinkles and want to go have some laser surgery done," she says. "This is something that just needs to be done so I can walk around and actually feel comfortable with everybody else in public.
"I would like to look like what I used to look like." The last time she saw herself in a mirror, she was 16.
View full sizeRandy L. Rasmussen/The OregonianChrissy Steltz, who will undergo the first of three surgeries today to repair her face, does the dishes in her apartment with some help from Rebecca Derscheid, her brother's girlfriend.Steltz's face will be rebuilt in three phases.
Today, Dierks will make an N-shaped incision in the middle of her face, creating two flaps of skin. One will fold in to form the "roof" and the other the "floor" of her new nasal passageway. The opening must be larger than normal, because scar tissue will shrink it over time.
Dierks also will straighten and trim the piece of leg bone that bridges her face from cheekbone to cheekbone and cut away other scar tissue.
In about three months, after that surgery heals, he will set eight dental implants into Steltz's face -- to secure the prosthesis that Over will assemble. It takes at least four months for the implants to fuse with the bone.
Then they'll fit the prosthesis to her face.
"We want to make it comfortable and durable enough so she can put on what is basically, for us, a Halloween mask, and wear that all day long," Dierks says.
The team of surgeons and nurses in the operating room at Emanuel today "will probably not see a case quite like this again," Dierks says. In his 25-year surgical career, he has performed hundreds of facial reconstructions but "nothing this big."
Still, it's not a face transplant. When doctors at the Cleveland Clinic performed the first face transplant in the United States last December, they removed a face and its blood supply from a brain-dead donor and grafted it onto a 46-year-old woman. Like Steltz, the woman had been horribly disfigured by a shotgun blast, but the injury also left her in severe pain and unable to speak clearly or swallow easily.
Steltz's injury is not life-threatening. A face transplant would entail much higher risk -- and expense -- than her prosthesis. It would require her to take anti-rejection drugs for the rest of her life, at a cost of more than $1,000 a month. Suppressing her immunity would expose her to further risk of infection and disease.
"A face transplant would still not give her seeing eyes, nor would it give her mobile eyelids and lashes," Dierks says. "There's no way we can return that to her." The prosthesis will look "as good, and debatably better, than a face transplant," he says, even though it won't move.
The best possible outcome after the elaborate handiwork on her face would be for no one except Steltz to notice.
"Hopefully," Dierks says, "a year from now, Chrissy will be able to go to Kmart or Fred Meyer and not have people crane their necks -- (and think) 'What happened to you, lady?'
"I don't think she'll get those stares and comments."
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