Minneapolis writer Jack El-Hai tackles the story of Mayo’s first face transplant

To give an idea of the scope and difficulty of Jack El-Hai’s new book: He usually does three or four revisions. This one was more like 10 or 12.

“It was a hard book to write,” said El-Hai of “Face in the Mirror,” which covers nearly 20 years — from 2006, when a Wyoming man named Andy Sandness shot himself in the head and immediately regretted it, to today, when he’s a Minnesota resident and the recipient (in 2016) of the first-ever face transplant at Mayo Clinic.

The difficulty had to do with the many folks who needed to be happy with the book. It’s not just El-Hai and his readers, the people he has aimed to please with previous works such as “The Lobotomist” and “The Nazi and the Psychiatrist.” It’s also the clinic, which commissioned the book, medical professionals who were part of the historic operation, Sandness and Dr. Samir Mardini, who led the surgical team and was eager to have his most important work documented.

Getting the medical details right was also tricky, said El-Hai, 66. The transplant involved a team of more than 50, performing an operation that took a staggering 57 hours. That part of “Face in the Mirror,” at about the halfway point of its 230 pages, is riveting. It feels like we’re there as the team problem-solves its way out of difficult situations during a procedure that is more complex than movies such as “Face/Off” have led us to believe.

El-Hai’s reconstruction of those scenes began with 80,000 pages of material documenting Sandness’ journey. The thumb drive full of documents starts when Sandness reached Mayo in 2006 — a gunshot having damaged his eyes and destroyed his nose, jaw, mouth and most of his teeth — through surgeries over the next several months (which gave him a reconstructed face with a prosthetic nose and tiny mouth), through the transplant in 2016, to the present.

“It was all the work that has been done on him, his whole medical history, starting with when he shot himself,” said El-Hai, over a chai latte in downtown Minneapolis. “The information about the face transplant was great. I also had done interviews with many of the staff in that surgical suite during that long weekend. So it was putting that all together, knowing the operation would be at the heart of the book. I was aware I had to make that as strong as I could.”

That it took 2½ days of surgery suggests the complexity of the face transplant. But El-Hai goes deep to show us the difficulty of finding a face donor (who not only had to be of compatible coloring and age, but also had to have medical details similar to Sandness’) and the complexity of the operation itself. It involved connecting multiple nerves from Sandness to the donor face, figuring out all the things a face needs to do (such as the drainage of tears and connections between a nose and mouth) and keeping the patient stable throughout.

The writer was struck by that complexity but even more so by the transplant’s planning. (Mayo wouldn’t reveal the cost of the operations, which were funded by the clinic as well as a donor; El-Hai assumes it’s in the millions.)

“All of the weekends they practiced on cadavers, determining whether Andy was a suitable patient, both medically and psychologically — that was extensive and I had no idea that happened,” said El-Hai. “Part of the psychology was determining that he wouldn’t try to take his own life again, of course, but also that he was responsible enough — to take his medications [for the rest of his life], to not eat shellfish, stay out of the sun, that kind of thing."

Sandness, of course, was sedated for the surgery, but El-Hai said the extraordinary patient was quite forthcoming in interviews. A private person, Sandness had enthusiasm for the book that waxed and waned. (In “Face,” he says that he craves anonymity and, since Sandness now has children, El-Hai suspects he worries about what they’ll think if they ever read the book.) But El-Hai, who lists Sandness first in his acknowledgments, said he was a big help.

“What was surprisingly easy to get — I was amazed — was Andy’s recollections," said El-Hai. “He recalled things that happened after he shot himself because he was still conscious, or maybe going in and out. But he certainly remembered details. He remembered wanting to apologize to his mother, but being unable to speak.”

Working on “Face” made El-Hai, who thinks of it as a book about second chances, realize that he’d like to write more happy endings like what Sandness experienced.

But first he has a few unhappy endings: The Rami Malek/Russell Crowe movie version of his “Nazi” book, now called “Nuremberg,” is due later this year. (Coincidentally, El-Hai’s cousin, Minneapolis-based orchestrator Robert Elhai, ended up working on the score.) Now, El-Hai is at work on “The Case of the Autographed Corpse,” about an Apache man convicted of murder and “Perry Mason” creator Erle Stanley Gardner, who helped get him paroled.

One thing all of these projects have in common is a factor usually true of El-Hai’s writing: dual protagonists, whose differences create compelling contrasts and conflicts. That’s something he’s likely to bring to future work, books that could represent both a shift in direction and a reconnection to his past.

“I have a database on my laptop of story ideas, fiction and nonfiction. Right now, there are 3,000 ideas in there and probably 10-20% are fiction,” said El-Hai, whose career began with stories published in literary magazines. “I’m never going to get to the vast majority of those, but I do want to get to more of those fictional story ideas.”

Perhaps some of them will have happy endings?

Families can find mental health information and resources for crisis care on NAMI Minnesota’s website, namimn.org. If you or someone you know is struggling with suicidal thoughts, call the 988 Suicide and Crisis Lifeline by dialing 988. You can also text HOME to 741741 to connect with a Crisis Text Line counselor.

Face in the Mirror

By: Jack El-Hai

Publisher: Mayo Clinic Press, 330 pages.