The bullet was a pernicious thief. To get a measure of what it stole from Katie, hold your hands up to your face, palms out, your thumbs touching beneath your chin and your index fingers touching between your eyebrows. Your hands are framing the part of Katie's face she lost. Gone were part of her forehead; her nose and sinuses; her mouth, except for the corners of her lips; and much of her mandible and maxilla, the bones that make up the jaws and front of the face. Her eyes remained, but they were askew and badly damaged.
This is how Katie arrived more than five weeks later at the clinic, which was founded in Cleveland, Ohio, in 1921 by four doctors, three of whom had served together during World War I and had come home inspired by the military model of teamwork among specialists. In Memphis, Tennessee, where Katie was first operated on, doctors had saved her life against all odds, but their attempt to cover the gaping wound with a tissue graft from her abdomen hadn't worked.
Brian Gastman, the first clinic doctor to see Katie, lifted her onto a gurney and wondered if she would make it. She was so tiny. Just 105 pounds. Even if she survived, he wasn't sure she would have enough tissue for all the reconstructive work he needed to do. "It was not great," he said. "Her brain was basically exposed, and I mean, we're talking seizures and infections and all kinds of problems. Forget the face transplant; we're talking about just being alive."
In his 27 years of training and practice, Gastman said, this was one of the worst face traumas he'd ever encountered. Beyond the wound to her face, she had traumatic brain injury from the bullet's concussive force to her frontal lobe, optic nerve, and pituitary gland. The damage to her pituitary threw her hormones and sodium levels out of whack, which can be deadly. Taking charge of Katie's care, Gastman organized a multidisciplinary team of 15 specialists to address all her issues, from endocrinology to psychiatry.