Life in a burn unit
A bad burn inflicts terrible devastation. Beyond scorching portions of the victim's body into a blackened crust called eschar, the burn wrecks it from the inside:
- Chemicals in inhaled smoke strip away the protective mucous lining of the windpipe.
- Carbon monoxide generated by the flames displaces life-giving oxygen carried throughout the body by hemoglobin in the red cells.
- The immune system goes wild, pumping out toxins as it goes about its business of destroying incinerated tissue.
- Massive quantities of fluid leak out of the bloodstream, blowing up the victim like a watery balloon and leaving behind a thickened sludge that the oxygen-deprived heart strains to pump.
Buy Amid the destruction, medical writer Barbara Ravage found a book. Burn Unit: Saving Lives After the Flames is part science, part history, and part an account of 18 months she spent at Massachusetts General Hospital, home to one of the country's 125 advanced burn centers. There a team of doctors, nurses, and other caregivers labor in relative obscurity to undo damage caused by fire, boiling liquids, chemicals, and electricity.
What's different about working in a burn unit?
Medical people outside the burn units feel it's not a desirable place to work. There's no money in it--a lot of the time surgeons only get Medicaid payments. They're on call to a degree even a heart surgeon isn't. The stories are the saddest you've ever heard. There's no prestige. There's also this feeling about burn patients among doctors and nurses outside the burn unit that why bother with them anyway--they'll be disabled and marginalized when they're discharged.
How can they say such a thing?
It's true that a lot of burn patients are psychotic. Of the four ICU beds, anytime I was there there were three who were either suicide attempts or homeless people burned under the kind of circumstance that a psychotic personality finds themselves in. And now you have all these people coming in because of a fire or explosion in a methamphetamine lab. Outside the unit you hear, well, they were doing something bad, and they got what they deserved. Of course, you never, ever hear that from anybody in the burn unit.
Why would anyone choose to work in a burn unit?
The teamwork is extraordinary. The kind of posturing you see elsewhere doesn't exist. Everybody's opinion is of great value. I watched surgeons listening to what a physical therapist had to say and really paying attention. There just isn't any of the attitude you see in other services. And, this is so corny, but when you save a life under those circumstances, you've done something worthwhile.
Is this a subject that's too intense for some people?
Some of my own family have told me, oh, thank you for giving me a copy of the book, but I can't possibly read it. I wish they would. The book is really about everyday heroism, and history, and science.
How about you--was it hard for you to look at burn patients or watch them being treated, especially during the debridement sessions when dead skin is scraped away?
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