On the Bookshelf: 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.
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?
No. I'm not a squeamish person. There's a smell, a lot of people think it's kind of revolting. And the patients' skin was very black and very red, black because silver nitrate, which is used to prevent infection, turns everything black. But none of that upset me. I was fascinated from the beginning, right from when I first went into the OR.
Speaking of the OR, you write that it's kept very hot and wet to keep the burn patients' temperature normal and their tissues from drying out. What's it like to work in there, capped and gowned?
It must be really hard. The temperature and humidity are both kept in the high 90s. The surgeons drink a lot of water. I was very amused to see what they're chugging is bottles of sterile water, the water they use to flush wounds. And a nurse comes around with a plastic bag filled with ice and lays it on the neck of everybody in turn. They also take breaks, although there's always somebody in authority there. It's especially hard for the anesthesiologist. He can't walk around like the surgeons can--he's stuck in his spot behind the patient. So he takes a lot of breaks, leaves his resident in charge.
Two of the burn unit nurses you highlight are men--is the proportion of male to female nurses more tilted toward males in this unit?
It's true across burn units. Apparently the burn and emergency medicine services have a higher proportion of male nurses. It's a little bit testosterone driven, and also, with burns, there's a lot of physical work. You do a lot of lifting of inert bodies. And I have to admit, those two guys were so interesting. Everything out of their mouths was amazing.
Have you ever been burned?
Funny you should ask. Never, until three weeks ago, when I burned myself badly--not hospital badly, but pretty bad. It was eye-opening, realizing how stupid I was. I was making my morning coffee. I put hot milk in my espresso. The phone rang, and by the time I came back, the coffee had cooled off. So I put the coffee in the microwave, but I set it for 3 minutes rather than 1 minute because I wasn't paying attention. When I took it out, it just exploded, it was superheated. It was a second-degree burn. It hurt like hell. Did I seek medical attention? No. Why? I think because I was embarrassed. That was so stupid. I should have called 911 and let the EMT say, lady, how did you do that? The moral is not to make your coffee before you've had your coffee.