RAF

[Brad Fox]

The RAF

By Dr. Paul Brand

 

In forty years of surgery I have encountered my share of human drama, but nothing has surpassed my early experiences as a sur­gical student during the German bombings of London in World War II. Daily, squadrons of ugly, fat Luftwaffe bombers filled the sky, their engines growling like unbroken thunder, their bomb bays belching out cargoes of destruction.

To this day, when I hear the undulating pitch of a siren that approximates the air-raid warning in London, adrenaline floods my body, resurrecting the fear and tension.

During one period, the Luftwaffe attacked our city on fifty­-seven consecutive nights, with the raids lasting as long as eight hours without pause. Fifteen hundred planes came each night, in waves of 250. In those dark days, we could not help believing that everything we cherished-our freedom, our nation, our families, our civilization-would be buried in the wasteland created by those hated bombers. Only one thing gave us hope: the courage of Royal Air Force pilots who rose in the skies each day to battle the Germans.

We could watch the aerial confrontations from the ground. RAF Hurricanes and Spitfires, tiny and maneuverable, looked like mosquitoes pestering the huge German bombers. Although their cause seemed futile, and more than half of their own fighters were soon shot down, the RAF pilots never gave up.  Each day they sent a few more of the dreaded bombers cartwheeling in flames toward the earth, and all of us spectators cheered loudly.  Eventually, Germany could not sustain further losses from the increasingly accurate fighter pilots and Hitler called off the raids.  London slept again.

I cannot possibly exaggerate the adoration that Londoners gave to those brave RAF pilots. Winston Churchill, if anything, under­stated our gratitude when he said, "Never in the history of human conflict has so much been owed by so many to so few."

I doubt whether a more adulated (praised) group of young men has ever lived. They were the cream of England, the brightest, healthiest, most confi­dent and dedicated, and often the handsomest men in the entire country. When they walked the streets in their decorated uniforms, the population treated them as gods. All eyes turned their way. Young boys ran up to touch them and to stare at close range. All girls envied the few who were fortunate enough to walk beside a man in Air Force blue.

 

I came to know some of these young men, though in far less idyllic (happy) circumstances. The Hurricane, agile and effective as it was, had one fatal design flaw. The single propeller engine was mounted in front, a scant foot or so from the cockpit, and fuel lines snaked alongside the cockpit toward the engine.  In a direct hit, the cockpit would erupt in an inferno of flames.

The pilot could eject, but in the one or two seconds it took him to find the lever, heat would melt off every feature of his face: his nose, his eyelids, his lips, often his cheeks. I met the RAF heroes swathed in bandages as they began the torturous series of surgeries required to refashion their faces. I helped treat the damaged hands and feet of the downed airmen, even as a team of plastic surgeons went to work on their burned faces.

Sir Archibald McIndoe and his plastic surgeons performed mir­acles of reconstruction, inventing many new procedures along the way. For facial work they usually used skin grafts from the abdomen and chest. In the days before microvascular surgery (tying small blood vessels together), full thicknesses of skin and fat could not simply be sliced away from one part of the body and stitched onto another. Swatches of skin had to be coaxed away, with one end remaining attached to the old blood supply while the other was connected to the graft site until new vessels grew to nourish it. Often surgeons used a two-stage process, temporarily attaching one end of the patient's abdominal skin flap to an arm until a blood supply developed on the arm. They then cut the flap of skin from the abdomen so that it dangled only from the arm, and sewed the loose end to the forehead or cheek or nose. Eventually a blood supply would develop on the facial graft site and the skin could be cut free from its temporary host, the arm.

As a result of these complex techniques, bizarre sights flour­ished in the wards: arms growing out of heads, a long tube of skin extending from a nasal cavity like an elephant trunk, eyelids made of skin flaps so thick they could not open. An airman commonly endured twenty to forty such surgical procedures before being ready for dismissal.

Throughout the tedious progression of surgeries, morale remained surprisingly high among the pilots, who were fully aware of their patriotic contribution. Wonderful nurses did their best to create an atmosphere of cheerfulness and warmth. The pilots dis­counted the pain and teased each other about their elephant-man features. They were ideal patients.  But gradually, as the last few weeks of recuperation drew to a close, a change would set in. We noticed that many of the pilots kept asking for minor alterations: a nose flap tucked in just a bit, mouth turned up some at the corner, a slight thinning down of the right eyelid. Soon the realization dawned on all of us, including the patients, that they were simply stalling. They could not face the world outside.

Despite the miracles wrought by Dr. McIndoe with his marvelous techniques, each face had changed irreparably. No surgeon could possibly restore the protean range of expression of a handsome young face. Although technically a good piece of work, the new face was essentially a scar. You cannot appreciate the flexible, nearly diaphanous(membrane-like) delicacy of the eyelid until you try to fashion one out of coarser skin from the abdomen. That bulgy, stiff tissue will pro­tect the eye adequately, but without beauty.

I especially remember an RAF pilot named Peter Foster, who described to me his mounting anxiety as the release day approached. Your fears and concerns, he said, come to a focus in the mirror. For some months you use the mirror daily, as an objec­tive measuring device, to scrutinize the progress your surgeons have made. You study scar tissue, the odd wrinkling of the skin, the thickness of lips and shape of the nose. From this survey, you ask for certain adjustments to improve appearance, and the doc­tors tell you whether your request is reasonable.

But nearer the day of release, your view of the mirror changes. Now, as you gaze at the reflection of a new face, not the one you were born with but an inferior imitation, you try to see yourself as strangers will see you. In the hospital you have been an object of pride, supported by the camaraderie of your friends and the min­istrations of the staff. On the outside, you will be a freak. Fear creeps in. Will any girl dare to marry that face? Will anyone give it a job?  At that critical moment, concluded Foster, as each airman con­templated the new image of himself as viewed by the rest of the world, one factor alone mattered: the response of family and inti­mate friends. The surgeons' relative success in remaking the face, counted for little. The future hinged on the reactions of family members to the news that the surgeons had done all they could and the face before them would never improve. Did the airman sense loving acceptance or recoiling hesitance?

These distinctly different reactions cleaved (separated) the airmen into two groups in as dramatic a demarcation (line) as I have ever seen. Psychol­ogists followed their progress. In one group were some whose girl friends and wives could not accept the new faces. These women, who once had idolized their heroic lovers, quietly stole away or filed for divorce. Airmen who encountered this reaction changed in personality. They stayed indoors, refusing to venture outside except at night, and looked for some kind of work to do at home. In contrast, those whose wives and girlfriends stuck by them went on to tremendous success - they were, after all, the elite of Eng­land. Many became executives and professionals, leaders of their communities.

Peter Foster gratefully admitted belonging to the fortunate group. His own girlfriend assured him that nothing had changed but a few millimeters' thickness of skin. She loved him, not his facial membrane, she said. The two got married just before Peter left the hospital.

Naturally, Peter encountered painful rejection from some. Many adults quickly looked away when he approached. Children, cruel in their honesty, made faces, laughed, and mocked him.

Peter wanted to cry out, "Inside I am the same person you knew before! Don't you recognize me?" Instead, he learned to turn toward his wife. "She became my mirror. She gave me a new image of myself," he said with appreciation. "Even now, regardless of how I feel, when I look at her she gives me a warm, loving smile.  That tells me I am OK."

Years after I worked with the airmen, I read a profoundly dis­turbing article entitled "The Quasimodo Complex" in the British Journal of Plastic Surgery. In it, two physicians reported on their study of 11,000 prison inmates who had committed serious crimes. They carefully documented a trend that I will summarize with one overall comparison. In the normal adult population, 20.2 percent of all people may be said to have surgically correctable facial deformities (protruding ears, mis­shapen noses, receding chins, acne scars, birthmarks, eye deformi­ties). But research revealed that among the 11,000 offenders fully 60 percent showed such characteristics.

The authors, who named the phenomenon after Quasimodo, Victor Hugo's "hunchback of Notre Dame," ended the article with some disquieting (uncomfortable) questions. Had these criminals encountered hostility and rejection from classmates in grammar school and high school because of their deformities? Could the cruel japery (teasing) of other children have pushed them toward the state of emotional imbal­ance that ultimately led to criminal acts?

The authors went on to propose a program of corrective plas­tic surgery for prison inmate volunteers.  If the surface appearance had made society reject these people and possibly push them toward crime, they reasoned, perhaps changing that surface appear­ance would help rehabilitate them by changing their self-image.

Whether a murderer on death row or a crack pilot in the RAF, a person forms a self-image based largely on what kind of image other people mirror back.  The report on the Quasimodo complex reduces to statistics a truth that haunts every burn victim, handicapped person, and lep­rosy patient. We humans give inordinate (inappropriate) regard to the physical body, or shell, that we live in. It takes a rare person indeed, some­one like Peter Foster's wife, to look through that shell and acknowl­edge a person’s inherent human worth.

 

Reference

 

Yancey, Philip, 2004.  In the Likeness of God.  Grand Rapids, MI, Zondervan Press.  Reprinted by permission of the author, March 10, 2011.