I Was a Burn Victim
As told to an “Awake!” staff writer
THAT November morning had the makings for one of those gorgeous New York autumn days. But for me it was to turn into a nightmare.
As usual I left our Long Island home early for work. I operated a small floor-maintenance business, with my brother-in-law as a part-time helper. This day our job was on a summer home near Westhampton; the owners wanted it converted to a year-around residence. Since we would be using a highly volatile solvent to remove a polyurethane coating from the stone floor, we had turned off the heating a few days before. However, unknown to us, just the day before, someone came and hooked up the gas stove and lit the pilot light.
We were well along with the job when, suddenly, I looked up and saw this wall of flame hurtling toward us. It knocked my brother-in-law through a doorway into a bathroom. This prevented him from receiving serious burns. But it turned out much worse for me.
The room suddenly became a mass of flames, sealing off all exits. I had the presence of mind to hold my breath, protecting my lungs, and to leap through a glass window. My right biceps was cut severely, which later was to complicate my battle to stay alive. Remarkably, the flames had not set my clothes afire, but the flash of severe heat baked my exposed flesh.
Feeling no pain, I immediately began looking for my brother-in-law. I feared he might still be trapped in the house. But then several neighbors, who had heard the explosion, rushed to the scene. Two of these were nurses who pleaded with me to lie down and rest, but I was concerned for my partner. What a relief it was when I saw him coming around the corner of the house! It wasn’t until then that I realized that part of my lower legs, arms and face were severely burned.
Shortly, another neighbor, who was a doctor, arrived and helped control the bleeding from my arm. An ambulance came and rushed me to the Riverhead hospital. Doctors immediately began efforts to stop the bleeding and succeeded in temporarily halting it. But what could they do for the burns I received? This hospital did not have facilities to treat severe burn cases, so a private ambulance was called. It transferred me to the specially equipped burn care unit at the Nassau County Medical Center, some 50 miles (80 km) away.
During the trip I began to feel a great hunger and an unquenchable thirst. Doctors later explained that this was due to the tremendous loss of body fluids, since much of my skin, which normally holds the fluids in, had been destroyed. On arriving at Nassau County Medical Center I was rushed to the special area set aside for severe burn cases. I was sedated to prevent pain, although up to that time I had felt very little discomfort. At first, a burn victim may not appear seriously injured or feel pain, but this can be deceiving.
Assessing the Damage
Recently, it interested me to read that a certain hospital has been giving severely burned patients “a choice between quiet death and drawn-out treatment.” The doctors there, after assessing the damage, may tell a patient: “To our knowledge, no one in the past of your age and with your size of burn has ever survived this injury.”
Two sisters, aged 68 and 70, who had been burned badly in a car accident, were told this. Yet one of them said: “I feel so good. Wouldn’t I be hurting horribly if I were going to die?” Not necessarily, at least not in the beginning. The sisters accepted the doctor’s assessment of their injuries, and treatment was withheld. The sisters’ beds were put close together and they discussed funeral arrangements and other matters. Both died by the next day.
Many in the medical profession object to this approach, feeling that withholding treatment, no matter how serious the injury, is unethical. They point to recent cases where very severely burned persons have been saved. A 36-year-old woman in Shanghai, China, for example, recovered last year after receiving deep burns over 94 percent of her body. A generation ago rarely did a person survive if he suffered such burns over as much as a third of his body.
My wounds were not quite that extensive. The doctors said that 26 percent of my body had received second- and third-degree burns, and my condition was complicated by the badly cut arm. The American Burn Association defines as severely burned any person with second- and third-degree burns over 20 percent of his body. But what about first-degree burns?
I had always thought that these were the worst. But not so. First-degree burns are less serious, affecting only the outer layers of skin. Yet they can be very painful. Most severe burn cases, including my own, involve all three types.
In second-degree burns the inner layers of skin are damaged and the capillaries are injured. Fluid leaks out, causing blisters, and, if these are broken, the wound weeps. New skin, however, can eventually be formed to repair the damage. But in third-degree burns the full thickness of the skin is destroyed beyond regeneration, including nerve endings that register pain. The only way the body by itself has to close the wound is to draw the adjoining skin together over the gap.
In time, my pain became agonizing. The doctors said this was good, although, as the sufferer, I can say the blessing was well disguised. Their reasoning was that the pain indicated that most of my wounds were deep second-degree burns and not third-degree burns, which ruin the skin beyond repair.
I kept wondering how my body was going to heal. Would I have use of my arms? Would there be huge scars on the burned areas, particularly my face?
Treating My Burns
For a week I was in intensive care, and was kept under sedation. For the first few days my arms were suspended above to prevent my turning over in bed and damaging them further. The skin of my face was burned off. I’m black, but all pigmentation was gone. A friend remarked: “It just proves that color is only skin deep.”
I could tell by the looks on the faces of visiting friends, including my wife, that they were shocked by my appearance. Wisely, there are no mirrors in the patients’ rooms. It’s disheartening enough to look at your charred arms and hands and other body parts.
Infection is a major threat to burn victims. Even today it is the cause of half the fatalities in a burn center. So hospital personnel wear gowns, face masks, hair and shoe covers. And if they leave the area they put on new sterilized coverings when they return. Visitors are screened to make sure that they have no illnesses, not even a simple cold, and similar attire is provided for them. The burn area is slightly pressurized, so when doors are opened the filtered air escapes and no air comes in from other parts of the hospital.
But the particular challenge has been to control the bacteria that are in the burn wound itself. Antibiotics taken internally usually are not effective, since the capillaries that might carry them to the burn site have been destroyed. So, to prevent infection, my arms were wrapped in bandages that were soaked in a dilute solution of silver nitrate, or in a saline solution. Three times a day these bandages were removed as they dried out, and new ones were put on.
Removing the bandages was pure agony. This was especially so after the first week, when I was taken off pain-killing drugs to prevent possible addiction. The scabs and tissue, with which the body automatically covers deep burns, would come off painfully with the bandages. And when the air touched the open wounds, oh, how it would hurt!
Then the nurses would clean the wounds of the remaining eschar, as these scabs and tissue are called. Since bacteria can grow in or beneath the eschar, it was considered important to remove it. When patients are at all able to get up and around, three times a day they go to the shower where their wounds are cleaned with a sponge.
After about three weeks, there was a welcome change in treatment. The nurses began to cover my arms with thin pigskin grafts. There was no pain as damp, cool strips of pigskin were laid on my wounds. Three times a day these grafts were checked and the ones that did not adhere were removed. The wounds were then cleaned again, and another strip of pigskin was put on. When grafts would “take,” they remained intact for a few days. Then they would slough off, as the body rejected them. But in their place the beginnings of new skin growth could at times be seen. This was really encouraging.
This pigskin treatment lasted only about two weeks. They then returned to using bandages soaked in a saline solution. Also, on some wounds they rubbed, with a gloved hand, an antibiotic cream called Silvadene. At times it seemed to me as though they were experimenting to see what treatment would work best. But I was slowly recovering, and didn’t develop any infection.
Treating the Whole Person
When a person loses much of his skin, fluids and essential body ingredients seep out, often in tremendous amounts. Several gallonsa of liquids may have to be infused during the first 24 hours to restore losses. I was encouraged to drink large amounts. Still, during the first week after being burned, I lost some 30 pounds (14 kg).
A few years ago, after a few weeks, many burn victims were dying of pneumonia or some wasting illness. Eventually it was discovered that the basic cause of their death was malnutrition. So, to provide for burn victims’ unique nutritional needs, doctors today may pump a nutritious potion directly into the patient’s stomach. In addition, they are encouraged to eat as much as they can.
Besides being urged to eat huge regular meals, I was told to drink quartsb of a nutritious concoction of thick cream and eggs. As soon as one container was empty, another was provided. The high-protein diet on which I was put included 8,000 to 9,000 food calories a day, nearly four times what the average person eats.
Having been in excellent health at the time of the accident, and only 27 years of age, I was able to recover my weight and strength, thus avoiding any complications. In fact, when I left the hospital on December 19, I weighed 30 pounds (14 kg) more than before my accident on November 8.
My face began healing nicely, with full pigmentation eventually returning. The scarring on my face has progressively improved, until now it is hardly noticeable. But my hands and arms, which were burned the worst, have required attention right up to the present.
In a severe burn there is shrinkage of muscle and tissue, and the contractions stiffen the joints. In the morning I couldn’t bend my hands or fingers at all. They needed to be manipulated to work out the stiffness. In the past, failure to provide this therapy for burn patients resulted in permanent disability.
So each day Darcy, the physical therapist, would come around. She was a former lieutenant in the armed forces, whom I judged to be in her mid-20s. She would manipulate each finger knuckle, wrist, elbow or whatever body part needed loosening up. It was excruciating! Especially during the first few weeks when the scabs were forming! As she broke the fingers or wrist free, the scabs bled.
We knew of Darcy’s approach by the screams of the patients as she progressed from room to room. But, really, if it hadn’t been for her, we would have ended up invalids. I decided that if I had to be hurt, I would do it myself. Early in the morning I began manipulating my own joints. When Darcy reached me at about 1 p.m., I was able to perform the movements that she asked for, and she went on. As a result of maintaining this painful therapy, I have almost regained normal use of my fingers, hands and arms.
An important part of rehabilitation is combatting depression. It was the biggest problem for me. The torturous pain of seemingly unending daily treatments can be almost beyond endurance. What makes it so hard is that progress is so slow, taking months, for some patients even years.
The ability to do things physically may be limited. Even sleeping is difficult, as one is often awakened when turning onto an injured part. For the first few days nurses fed me. But then they devised an attachment to the bandages to slip a utensil into so I could feed myself. Often, though, I just put my face in the plate to eat. I couldn’t even turn the pages of a book to read.
Also contributing to depression is concern about scarring—what you’ll look like. I know I was worried. I’ll admit that on occasion I was very low, and cried. Even the strongest patients became depressed. One told me: “I hate to face another day.”
Yet, a positive mental attitude is important to recovery. I am reminded of the case of Judith Byrd. She had been in a rear-end Pinto automobile accident in which the gas tank blew up; the newspapers last year reported that the Byrd family finally won a financial settlement from the rent-a-car and car-manufacturing companies involved. Well, after I had been in the burn center a couple of weeks, Judith was brought in with burns over about 55 percent of her body.
Some days afterward, one of the doctors told me: “All her vital signs are good. She should live, but she doesn’t seem to have the will.” Her face had been badly disfigured, and her hands needed to be amputated. I talked to Judith some, and my family and I got to know her relatives. We were sorry when Judith died three months later. As one prominent doctor said, he had never seen a seriously ill patient recover who lost the will to live.
Understandably, burn patients may be inclined to give up. So their need of encouragement, I believe, cannot be overemphasized. I know that the hundreds of cards and visits I received from my Christian brothers and sisters really helped me. Recognizing the need, the Nassau Burn Center has started a Burn Alumni Supportive Association. Arrangements are made for recovered patients like myself to visit the Center and encourage those going through the same agonizing treatment the visitors had successfully completed.
To Graft or Not
The doctors wanted to give me skin grafts. The pigskin grafts that I had received earlier were actually more like bandages. The only permanent grafts are those from a person’s own body—even grafts from other humans will eventually be rejected.
I noted the problems of other patients with grafts of their own skin. Often there was discouragement when their grafts didn’t take. And there was the pain they experienced in having skin stripped from unburned areas of their bodies, and the time it took for these new wounds to heal. I wanted to see if my body eventually would repair the yet uncovered wounds in my arms. As time progressed, amazingly more and more skin began to grow in my open wounds.
When I refused skin grafts, it was decided to move me to another part of the hospital. I requested to be sent home, where my wife could care for me. She did an outstanding job, all of this in addition to caring for our children and her household chores. For months I still had a lot of pain, but gradually the wounds began to close.
A few weeks after I got out of the hospital, my arms were measured for special form-fitting elastic garments that are worn over burned areas. For a time I wore these elastic sleeves 24 hours a day, and I still wear them at night. They exert constant force on the wounds, and this has smoothed out the skin and eliminated much of the ugly scarring. Eight months after the accident, I was able to get back to work.
Burns are a much greater threat than most persons realize. In the following article you will learn about a very effective treatment for them.
a One gallon = 3.8 L.
b One quart = .9 L.
[Blurb on page 17]
“I looked up and saw this wall of flame hurtling toward us. It knocked my brother-in-law through a doorway.”
[Blurb on page 19]
“We knew of Darcy’s approach by the screams of the patients as she progressed from room to room.”