Jim Maki doesn't remember falling off a Boston subway platform -- but in that instant his face, and life as he knew it, was gone.
Four years later, Maki would get an astonishing second chance. He would receive another man's features thanks to a groundbreaking face transplant surgery and one woman's generosity to honor the man she loved.
But the procedure came with enormous risks. At the time, Maki would become only the second person ever to receive a face transplant in the U.S., so the surgical team would be heading into uncharted waters.
Watch the exclusive behind-the-scenes of Maki's face transplant on "Boston Med" tonight at 10 p.m.
Burn center director Dr. Bohdan "Bo" Pomahac was on call on June 30, 2005, when Maki was admitted to the intensive care unit of Brigham and Woman's Hospital. Maki had accidentally fallen face first onto an electrified subway rail.
"The tissues basically got vaporized. It was literally like how you would create a crater in the middle of the face," Pomahac said.
Maki suffered third-degree burns and had lost his nose, cheeks, teeth, part of his mouth, muscle, bone and nerves, in addition to damaging his arm and one of his eyes. In all his years as a plastic surgeon, Pomahac never had seen a facial injury so severe. He knew the lost tissues were irreplaceable, so "patients like him are doomed."
"It was difficult for him to speak, eat or drink," Pomahac said. "I don't think that any one of us can quite imagine what it is like living without a face. ... If you're horribly disfigured, and you can't really express yourself when you speak, it's a bad combination. You are just at the mercy of people and their judgment."
The Man Without a Face
Unable to endure the stares, insults and, sometimes, physical assaults, Maki became recluse, preferring to stay in his home outside of Boston.
"I've had young kids come up to me and ask if I was real," Maki recalled. "It was uncomfortable. ... They usually stay away from me."
Over the years, Pomahac performed multiple procedures on Maki's face, but felt helpless that he couldn't do more. So after several extensive medical and psychological evaluations, Maki became listed as a face transplant candidate in February 2009. Now, all that was needed was a donor.
A Strange Request: Donating a Face
A child of Holocaust survivors, Joseph Helfgot, grew up dirt-poor, but would go on to become a university professor, a radio talk show host and, eventually, a successful Hollywood businessman. He had no idea his long list of achievements would also include "life saver."
Helfgot suffered from heart problems his whole life, but his condition became worse after he entered his 50s. When he was wheeled into surgery at Brigham and Woman's Hospital for a heart transplant in April 2009, he had a stroke on the operating table and was declared brain dead.
"It happened so fast I couldn't really believe it, and I just flashed back to the night before when Joseph and I had this conversation," said Helfgot's widow, Susan Whitman. "'If anything happens to me,' Joseph said, 'I really want you to remember that I'm an organ donor and I want you to do it.' "
Whitman and her family prepared to donate Helfgot's liver, kidneys and his transplanted heart.
But the New England Donor Bank had another request it had not asked many people before.
"I just remember thinking, how can you take somebody's face off of them?" Whitman said.
But Whitman and her family realized, "After somebody just died and gave you a heart, how could you say no?"
Maki was taken into the operating room four days later.
The Face Transplant Surgery
Dr. Pomahac likened the night of Maki's face transplant operation to a big concert as he coordinated and directed how best to perform the surgery. Multiple specialists had to be consulted or brought in -- surgeons, anesthesiologists, immunotherapists, nurses, residents, physical therapists and technicians.
A face transplant is an incredibly risky procedure. Aside from the dangers of the surgery itself, there is the possibility that the donor blood vessels will not connect well with the recipient's tissue and the patient's body could reject the face. Even if all goes well, Maki will have to take medications to fight off rejection and infection for the rest of his life.
"This is nothing like, you know, science fiction, [the movie] 'Face-Off' sort of thing. It's nothing like that at all," said Dr. Julian Pribaz, one of the plastic surgeons who operated on Maki. "This is real life."
Having only previously practiced on cadavers, Pomahac and his team tried to prepare as best they could as they headed into the unknown. At the time, only one other face transplant had ever been done in the U.S., and at 1 a.m., April 9, 2009, the second face transplant in the nation began.
Two operating room teams, one for the donor and one for the recipient, started simultaneously, identifying all the muscles and nerves.
After about seven hours, the facial parts of the donor were packed into an ice cooler and carried across the hallway to Maki's operating room, where Pomahac and Pribaz began to marry the tissues and vessels together under a microscope.
The entire surgery would not end until 4 p.m. the following day.
Maki Sees, Touches His New Face for the First Time
Maki woke up groggy in the intensive care unit. His daughter Jessica Maki, a senior at Northeastern University, and his wife, Cynthia Maki, came to see him and were elated over his new face.
"Compared to the no-face he had before, I mean, it's amazing," Jessica Maki said. "It surprisingly looks more like him than I thought it would."
She admitted it had been hard to go out in public with her father.
"Life without a face is not a life," she said. "It's just emotionally and psychologically and physically, you can't participate in life. As superficial as that may sound, definitely, it will be much easier with a face."
Maki, too, was delighted with the results.
"I've got a nose," he told Pomahac. "I can see myself in this picture."
He thanked his surgeon for a job well done.
To date, a dozen face transplants have been performed, some involving more facial tissue than others, in France, Spain, the U.S. and China. Maki knew his new outlook on life was possible because of those who paved the way before him.
Isabelle Dinoire from France became the successful first face transplant recipient in 2005 after she was mauled by her dog. About a month after his surgery, Maki got the chance to meet her when she was visiting the U.S.
Using a translator, Maki told Dinoire, "I'm glad to see you went through it all right. I'm in the process of trying to do that now."
Maki was about to get another emotional visit. On the morning of May 19, 2009, Susan Whitman arranged to meet the man who now had her husband's face.
"I want to know. I'm excited for him. I want to say congratulations," said Whitman. "Of course, I'm nervous."
Watch the exclusive full story on "Boston Med" tonight at 10 p.m.