MIAMI, Fla. -- Sometime soon, a physician is likely to sit at the bedside of Ronald Poppo and explain to the homeless Miami man what much of the world already knows — that his face is gone and he will never again look the way he thinks he does.
Yet even as the 65-year-old learns what happened to him 12 days ago when a deranged stranger gouged out one of his eyes and chewed off his forehead, nose, an eyelid and his lips, Poppo may struggle to grasp the implications of the attack, experts say.
"What they all say is, 'I've become a monster,'" said Daniel Alam, a plastic surgeon at Cleveland Clinic who helped transplant a face onto a Connecticut woman mauled by a pet chimpanzee in 2009. "Because without a face, others cannot see them as human. The world cannot relate to them ever again. That's where depression comes in. And he will be a victim of that."
Poppo is likely several weeks from a full understanding of what has happened, say doctors. Although none of the physicians surveyed are involved in Poppo's care, they have all dealt with similar cases.
"In that initial conversation, I let them know this is a horribly disfiguring injury, but luckily you're alive," said Eduardo Rodriguez, an expert in facial reconstruction and chief of plastic surgery at the University of Maryland Medical Center in Baltimore. "And I let them know they have a long road ahead—surgery for years, 20 to 30 operations."
Rodriguez, who has offered to consult in this case, said Poppo is not a likely candidate for a facial transplant. "We're hoping this guy can go back to his normal life, or his homeless life," said Rodriguez. "If he can eat OK, preserve the vision in one eye…"
From what he has seen from photos and heard from other physicians, Rodriguez said Poppo's injuries are among the worst he has heard of.
In cases such as these, he said, "it is impossible to make them look normal. It is more important to give them a sense of hope.''
The cost of rehabilitating Poppo, who has lived on the street for at least 30 years, will be enormous. Blane Shatkin, a plastic surgeon at Memorial Hospital Pembroke, said surgical fees and hospital charges at the end of a year could total $1 million. "It's a big price tag," he said.
Poppo may also need many hours of psychological counseling or other medical treatment to deal with addiction or substance abuse.
Who will pay? Taxpayers.
"The fact is, a civil society has a certain moral obligations to its citizens," said Kenneth Goodman, director of the Bioethics Program at the University of Miami's Miller School of Medicine. "What that means is that in Miami-Dade County, you try to give same level of care to indigents as to anyone else."
Poppo was attacked May 26 when a naked Rudy Eugene, 31, pummeled him on the MacArthur Causeway and then spent 20 minutes gnawing on the helpless man's face. Eugene, a former Hollywood resident, was stopped only when a Miami police officer shot him dead.
Although there has been speculation that Eugene may have been on drugs, no autopsy results have been made available.
Ed O'Dell, a spokesman for Jackson Memorial Hospital, said that without consent, "We are not able to give any information on any aspect of the case.''
Poppo does have relatives. A 44-year-old New Jersey woman, Janice Poppo Dibello, told reporters she last saw her father when she was 2. An ex-wife and two siblings have also surfaced, but it is unknown if they will be involved in his recovery.
"This case is so unique and unusual, and what he has to deal with is so overwhelming," said Maria Elena Villar, a professor of health communication at Miami's Florida International University.
"He is disfigured, and he will probably have trouble walking around the way he did before. So he's going to need a lot of support services. Usually that would involve the family, but he is probably not going to have that."
Once a promising student at a prestigious New York City high school, Poppo was divorced in 1970, relatives said, and disappeared soon afterwards. His daughter told reporters she thought he was dead.
Since finding his way to South Florida decades ago, he has been shot and wounded and arrested more than two dozen times, mostly for drinking and vagrancy.
Some experts say it is possible that having his face ripped off might not be the worst thing ever to befall a man who has lived half his life on the streets.
"It may seem horrific — the thought of cannibalism is — but he may have experienced things he perceives as worse betrayals," said Gwendolyn Quinn, a health psychologist who studies how doctors deliver bad news to terminal patients at Tampa's Moffitt Cancer Center.
When giving Poppo the bad news, physicians experienced in such severe cases emphasize the need for honesty and compassion.
"I would discuss the circumstances leading up to the event honestly, in the same way you would deliver bad news about cancer, or tell a loved one someone has passed away," said Robert Hasty, a professor of internal
medicineat Nova Southeastern University's College of Osteopathic Medicine. "Make sure they understand the implications."
But there is unlikely to be a cinematic reveal when the bandages are peeled away and Poppo looks for the first time at a visage he's never before seen — his face.
"It is best not to have a single dramatic moment, but to allow for a process of understanding to occur, after days and months," said Chad Perlyn, chief of plastic surgery at FIU's medical school.
When the relationship between patient and doctor is secure, said Perlyn, "then you may show him the injuries on a diagram or model. Let the patient be your guide."
Staff researcher Barbara Hijek contributed to this report.