About Dr.Pribitkin

About Dr.P - Article on Domestic Violence

Agnes Wilson and grandson Tylor, 3, at home in Swedesboro, following her latest reconstructive surgery in spring. Wilson's late husband shot her in the face with a shotgun 22 years ago. (The Philadelphia Inquirer/William F. Steinmetz)

Agnes Wilson's Ordeal


High school, age 16		1975		1982		1996

Photos show Agnes Wilson before she was shot in 1974 at age 17 and at various stages of recovery afterward. The 1996 photo was taken before her most recent surgery.

By Denise Cowie
Inquirer Staff Writer

Imagine that years ago your husband or boyfriend tormented you by putting out cigarettes in your face. Those scars probably have faded by now. Many people may not even notice. But every time you look in the mirror you can see them and you are reminded.

Would having those scars surgically removed help you to recover emotionally?

Dr. Edmund A. Pribitkin thinks so.

Philadelphia surgeon Edmund A. Pribitkin has operated on Agnes Wilson.

The statistics from the National Coalition and the Pennsylvania Coalition Against Domestic Violence are shocking enough.

* Every nine seconds, a woman in the United States is physically abused by her husband or live-in partner.

*Domestic violence to women ages 15 to 44 is more common than automobile accidents, muggings and rapes combined.

* Nearly half of women who are murdered are killed by their intimate male partners.

* Medical expenses from domestic violence total $3 billion to $5 billion annually.

"Little things make a big difference," says Pribitkin, assistant professor of otolaryngology at Thomas Jefferson University Hospital. But even when abuse victims have medical insurance, it's hard to get coverage for more than major initial reconstructive work, he says. Rarely is "the cosmetic stuff" covered.

Victims of domestic violence sometimes suffer such severe injuries that the scars last a lifetime. Sometimes the physical evidence of battering is less dramatic. Either way, the scars can perpetuate the trauma and low self-esteem.

That's one reason Pribitkin and several hundred other doctors are participating in the National Domestic Violence Project, a nationwide program that provides facial surgery free of charge to victims of domestic violence.

Two years ago this month, the American Academy of Facial Plastic and Reconstructive Surgery, working with the nonprofit National Coalition Against Domestic Violence, launched a 24-hour hotline to reach out to those who need such help.

So far, more than 10,000 calls have been logged to the hotline, resulting in about 1,200 procedures on patients from every state, including a handful in Philadelphia.

Some of the women who have undergone surgery are back in the workforce for the first time in decades, says project spokeswoman Mary Lou DiNardo. "There's so much shame associated with [abuse], particularly if there is a noticeable physical problem, a broken nose or smashed eye socket. . . . Many women have gone into hiding, in a way."

"It really is an enormous gift to battered women to have the scars removed, the physical scars that were a result of the battery," says Rita Smith, executive director of the coalition. "[Without the program,] most of these women cannot afford to have it done."

But behind the statistics are real people who bring home just how horrifying domestic abuse can be.

Agnes Wilson is one of those.

Married at 16 to Robert, her first love, she was well-acquainted with her husband's violent side by the time their daughter Lena was 13 months old. "He'd give you the shirt off his back when he wasn't drinking," says Wilson, who now lives in Swedesboro. "Give him one beer and he was a different person."

In the fall of 1974 she left him, taking Lena to stay at her parents' Franklinville home. But she gave in to his plea to talk things over. On the morning of Nov. 1, she was in the kitchen of their apartment after she had told Robert she wasn't going to change her mind.

"He came into the kitchen with the gun," a 12-gauge shotgun filled with birdshot, she recalled recently, and told her that if he couldn't have her, nobody else would. Although he had threatened her before with a knife, she didn't believe he would actually do this.

"I was fixing Carnation milk when he pulled the trigger," she says. "I had just looked away" - which she thinks may have saved her life. The blast shattered one side of her face and her shoulder, causing massive injuries. While she lay unconscious, he killed himself.

She was only 17.

She spent four months in the Hospital of the University of Pennsylvania, where doctors began rebuilding her face in a series of operations that would continue for almost a decade.

When she could no longer afford the insurance payments, Wilson called it quits on the surgery and tried to come to terms with what had happened. She had to face the fact that in her case, the scars would never disappear.

"Until about age 25 I had a difficult time with it," she says.

Right after it happened, she kept thinking she would wake up one day and everything would be OK. For a while, she tried to cope by partying. Other times, driving down the road, she thought of ending it all by crashing the car. "But I couldn't do that because I had Lena," she says, gesturing at her daughter, grown now and with a toddler of her own.

Eventually, she decided she just had to get on with her life. She married again, but divorced years later. When nobody would hire her as a waitress, "I looked for something that didn't require looks." She got a job at a nuclear plant. When her eyelid wouldn't close properly, she learned to sleep with her finger holding it shut - for 20 years. "You'd be amazed at what you can train your brain to do," she says.

Last fall, Wilson saw a television program that mentioned the Domestic Violence Project.

She called the hotline. Shortly after that, she was talking with Pribitkin at Jefferson.

The idea to help women who'd been physically abused was the answer to a prayer for Dr. Lori Hansen, an Oklahoma City plastic surgeon and one of the doctors credited with getting the National Domestic Violence Project on track.

About six years ago, Hansen and her husband, assistant district attorney Wes Lane, wanted to become involved in some kind of missionary work. Both are Christians and initially thought in terms of underprivileged countries, but Hansen, who is in solo private practice, didn't want to leave her patients for any length of time.

"As we were talking and praying about it, it came to us that we could do something to help others at home," she says. "But I do plastic surgery, and I couldn't think who would need a face-lift."

When she drew up a list of her strengths - plastic and reconstructive surgery, dealing with low self-esteem - she found she had a perfect match with abused women.

Around 1990, working through the city's shelter, she began offering free surgery to victims. ``About 75 percent of injuries are in the head and neck area,'' she says. ``We treat those injuries . . . helping with self-esteem from an appearance point of view.''

A few years later, Hansen, who is on the board of directors of the plastic surgeons academy, mentioned what she was doing to Dr. George Brennan, then its president, who embraced the idea of a national project.

Other surgeons who had been doing similar pro bono work also wanted to see the concept go national, says project spokeswoman DiNardo.

Soon after that, the National Coalition Against Domestic Violence became involved. As the largest national umbrella group, it offered access to more than 2,000 shelters and anti-abuse groups, which in turn helped to evaluate candidates for surgery and to offer counseling.

"The idea was to make it as easy as possible but still meet some criteria to make sure it was battered women [or men] who were getting the help," says the coalition's Smith. (A handful of men have been treated under the program, mostly for injuries from nasal fractures.)

Generally, the battered person must be out of the abusive situation before surgery will be performed, says Pribitkin, a national leader of the project and one of three area surgeons involved since its inception.

"We don't solicit [candidates],'' he adds. ``It's important for us and for them that they be responsible for their own progress.'' They also must have realistic expectations of what can be achieved through surgery.

"It's a real grassroots effort,'' says DiNardo. ``We'd love all our surgeons to be involved."

It's not always easy. Surgeons volunteering in the program, says DiNardo, must get hospitals to donate operating-room time, staffs to donate their services, other doctors or dentists to help free of charge, even line up their own supplies - often donated by surgical-supply firms.

Nevertheless, says Pribitkin, there's been a lot of enthusiasm. ``We're actively looking for more surgeons,'' he adds. With doctors already operating in 44 states, ``our goal for this year is to get all states involved.''

After attending counseling at People Against Spousal Abuse in Woodbury, Agnes Wilson was ready by spring this year for new reconstructive surgery at Jefferson.

With Dr. Marlon Maus, an oculoplastic surgeon at Wills Eye Hospital, Pribitkin worked on her eyelid, which caused tears to collect constantly; and on her nose, which had started to sink in on one side. Using a donated biomaterial called Medpor, they rebuilt her orbital rim - she no longer has to hold her eye closed - and her nose to some extent.

Without the free program, Pribitkin says, ``Agnes' hospital costs would have been well over $10,000.'' Jefferson donated use of all facilities.

Pribitkin plans more surgery soon to improve the function of her eye, and to give her a tip to her nose.

Wilson is grateful to Pribitkin, and agreed to tell her story so that other abuse victims might hear about the program and get help too.

For his part, the doctor is amazed at Wilson's strength of spirit.

"What's really remarkable about her is that she hasn't become completely depressed or disenchanted, and has kept going despite the massive injuries,'' he says.

Life has been upbeat lately for Wilson, a 39-year-old grandmother who rides a Yamaha 750 motorcycle (and vows one day to own a Harley) and adopts all the cats that arrive on her doorstep (13 so far).

She went to truck-driving school in Blackwood last August, and - after finishing the long training run she's on now in the Midwest - she hopes to land a trucking job on the East Coast. If she's lucky, maybe it will even be with an outfit like United Parcel Service, which would keep her close to home.

And on Friday the 13th of December, she plans to marry Hank Clements.

"I'm trying it for the third time,'' she says. ``I want a real wedding this time. I want to get dressed up and have all my friends there to celebrate.''