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SCIENCE
Tearful meeting for pair forever linked by face transplant

ROCHESTER, Minn. — Standing in a stately Mayo Clinic library, Lilly Ross reached out and touched the face of a stranger, prodding the rosy cheeks and eyeing the hairless gap in a chin she once had known so well.

"That's why he always grew it so long, so he could try to mesh it together on the chin," she told Andy Sandness, as he shut his eyes and braced for the tickle of her touch on new nerve endings in the face that had been her husband's.

Sixteen months after transplant surgery gave Sandness the face that had belonged to Calen "Rudy" Ross, he met the woman who had agreed to donate her high school sweetheart's visage to a man who lived nearly a decade without one.

The two came together last month in a meeting arranged by the Mayo Clinic, the same place where Sandness underwent a 56-hour surgery that was the clinic's first such transplant. With her toddler Leonard in tow, Ross strode toward Sandness, tears welling in her eyes as they tightly embraced.

Ross had fretted before the meeting, fearful of the certain reminders of her husband, who took his own life. But her stress quickly melted away — without Calen's eyes, forehead or strong cheeks, Sandness didn't look like him, she told herself.

Instead, she saw a man whose life had changed through her husband's gift, newly confident after 10 years of hiding from mirrors and staring eyes.

"It made me proud," Ross said of the 32-year-old Sandness. "The way Rudy saw himself ... he didn't see himself like that."

Sandness and Calen Ross lived lives full of hunting, fishing and exploring the outdoors before their struggles consumed them, 10 years and hundreds of miles apart.

Sandness put a rifle below his chin in late 2006 in his native Wyoming and pulled the trigger, destroying most of his face. Ross shot himself and died in southwestern Minnesota a decade later.

By then, Sandness had receded from contact with the outside world, ashamed of his injuries — surgeries to rebuild his face had left him a quarter-sized mouth, and his prosthetic nose frequently fell off.

Hope first came in 2012 when the Mayo Clinic started exploring a face transplant program and again in early 2016 when he was wait-listed for the procedure.

Ross already had agreed to donate her husband's lungs, kidneys and other organs to patients. Then LifeSource, a Midwestern nonprofit organization that facilitates organ and tissue donations, broached the idea of a donation for a man awaiting a face transplant at the clinic.

Ross and Sandness' ages, blood type, skin color and facial structure were such a near-perfect match that Sandness' surgeon, Dr. Samir Mardini, said the two men could have been cousins.

Ross consented, despite her hesitation about someday seeing her husband's face on a stranger. Eight months pregnant at the time, she said one reason to go forward was that she wanted the couple's child to one day understand what his father did to help others.

More than a year after a surgery that took a team of more than 60 medical professionals, Sandness is finding a groove in everyday life while still treasuring the simple tasks he lost for 10 years, such as chewing a piece of pizza.

He's been promoted in his work as an oilfield electrician and is expanding his world while still prizing the anonymity that comes with a normal face.

"I wouldn't go out in public. I hated going into bigger cities," he said. "And now I'm just really spreading my wings and doing the things I missed out on — going out to restaurants and eating, going dancing."

Life with a transplanted face takes work, every day. Sandness is on a daily regimen of anti-rejection medication. He's constantly working to retrain his nerves to operate in sync with his new face, giving himself facial massages and striving to improve his speech by running through the alphabet while driving or showering.

"I wanted to show you that your gift will not be wasted," Sandness told Ross.

Mardini and the rest of Sandness' medical team have delighted in seeing their patient and friend open up since the procedure, going out of his way to talk with strangers whose gaze he once hid from.

"It turns out Andy is not as much of an introvert as we thought," Mardini said. "He's enjoying these times, where he's missed out on 10 years of his life."

Ross and Sandness say they feel like family now. They plan to forge a stronger connection, and Sandness said he'll contribute to a trust fund for Leonard's education.

On the day of their meeting, the boy stared curiously at Sandness at first. But later, he walked over and waved to be picked up. Sandness happily obliged.

For Ross, just meeting Sandness felt like a huge release — a way to get past a year filled with grieving, funeral planning, childbirth and gut-wrenching decisions about organ donations.

"Meeting Andy, it has finally given me closure," she said, her voice choking as it trailed off. "Everything happened so fast."


WASHINGTON
Tax split poses big challenge

WASHINGTON — The House and Senate tax overhaul plans are broadly similar, but crucial differences are creating headaches for Republican leaders determined to keep myriad interest groups and factions of the GOP satisfied. And then there's the ambitious timetable they've set of finishing in time to get legislation to President Donald Trump by Christmas.

The most politically challenging decisions involve dealing with popular and widely used tax deductions, structuring tax cuts for business and balancing personal income tax rates between middle-class families and the rich.

All of these decisions come against a generous — but firm — 10-year, $1.5 trillion cap on the measure's cost to the federal deficit. Both House and Senate have adopted accounting gimmicks to squeeze tax cuts that appear larger down to fit that restraint.

Trump's enormously expensive demand for a cut in the corporate tax rate to 20 percent — from the current 35 percent — is a big complication, as is unrest among House Republicans hailing from affluent suburban districts who are upset over the proposed loss of the deduction for state income taxes.

Here's a rundown on the major differences between the House and Senate bills:

INDIVIDUAL TAX RATES

The Senate measure keeps the current number of personal income tax brackets, seven, though it changes the rates to 10, 12, 22.5, 25, 32.5, 35 and 38.5 percent. That last top bracket for the wealthiest earners carries a higher rate of 39.6 percent under current law.

The House bill goes further toward simplifying the tax system. It shrinks the number of brackets from seven to four, with rates of 12, 25, 35 and 39.6 percent.

Lots of numbers here for congressional negotiators to play with, to move up or down.

The inheritance tax on multimillion dollar estates, called the estate tax, is an especially hot-button issue. Democrats point to the proposed GOP changes as proof that the Republicans are out to help wealthy people like Trump and his family.

Currently, when someone dies, the person inheriting the estate must pay taxes on its value above $5.5 million for individuals, $11 million for couples. The House bill initially doubles those limits and then repeals the whole tax after 2023. The Senate version doubles those exemption amounts — but doesn't repeal the tax.

To repeal or not to repeal? That may be the class-warfare question.

DEDUCTIONS

The Senate bill would eliminate a taxpayer's ability to deduct state income taxes and local property taxes. But the final bill may have to closely track a House compromise that provides a property tax deduction of up to $10,000 or else risk a revolt from GOP lawmakers from New York, New Jersey, and California.

The Senate bill preserves popular individual tax breaks for large medical expenses, mortgage interest, electric vehicles and college costs that were targeted by the House. The House limits deductibility of mortgage interest to the first $500,000 of a loan, riling the real estate and housing industries, and eliminates a deduction for medical expenses that's often taken by families facing crippling nursing home costs.