If the balloon burst, Matt would suffer a major stroke.
Doctors debated which surgery to do first - shore up the artery with a stent, or realign the face.
If they did the face first, the aneurysm might burst.
If they did the stent first, he'd need blood thinners, which would delay his facial repair by six weeks. The jaw would heal out of alignment, forcing complicated, painful surgery later on.
Matt figured his doctors would do the right thing.
"These were the same doctors who'd been saving my life for weeks," he said. "I had a lot of trust in them."
Doctors fixed Matt's face first, in a five-hour operation.
"Seeing Matt lying there afterward, with the swelling and trauma from yet another round of having his face reworked, really brought home the severity of his injuries and what he's been through," Matt's dad, a managing director at Vanguard, e-mailed friend and Vanguard chairman Jack Brennan.
The surgeons put in a stent three days later, on Nov. 21. Matt went back to the ICU.
"We're no longer optimistic about getting out of here by Thanksgiving, but that's okay," Mike Miller e-mailed Brennan. "We're incredibly grateful to be where we are, and to have made the progress that we've made. So makes no difference where we are - we'll have much to celebrate."
With Thanksgiving six days away, doctors tested and found no nerve conductivity in the top half of the left side of Matt's face.
The nerve was either traumatized or severed.
If severed, the window to repair it would close in days. And repair was still a long shot, not without its own risks.
But without the nerve, Matt would never be able to smile, eat, or speak normally.
For the first time, Matt took a good look in a mirror.
"I look fine, Mom," he wrote, his jaw still wired shut.
"Well, your smile is a bit off," she replied, with loving understatement.
"Isn't my smile fine?" he asked Emily.
"Well, not really," she said. "It's OK, though."
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