The SMITH Diaries Project

Welcome to the Burn Ward

Friday, February 2nd, 2007

By Tish

While many things have occurred in my life that have changed how I think, feel and survive, nothing has had the immediate, easy-to-perceive effect on me as working at the Brooke Army Medical Center (BAMC) in San Antonio, Texas for only two days. At the time, I was sure it was the best thing I had ever done in my life.

It’s difficult to explain, as most things that matter seem to be. I found myself on the phone with my boyfriend the day after my two-day hospital rotation (clinicals) offering a rambling, yet somehow stilted, explanation of working in the BAMC Burn Unit - one of the two best in the country possibly in the world, and a thriving center for burn research. He was surprisingly polite and a good listener, even though reception in the barracks was awful and he was busy. My boyfriend is not the sort to find talking better than working; Considering that it was his final week of school of a rather strange sophomore year, I realize that he must have understood how important it was to me for him to listen to me on the phone for as long as he did.

I would be lying to you if I said burn patients are pleasant people, but it’s fairly obvious why many aren’t: they’re burnt. Plus, they smell pretty bad and are in so much pain that the amount of drugs required to alleviate or relieve their pain leaves many in a constant coma-like state. Nobody except people who are already familiar with their problems wants to look at them, sometimes not even family members.

The only way for most people to survive a major burn is to be tortured in the form of a process called debridement. Here, dead tissue is, in the earlier stages, aggressively removed with brushes, gauze pads, even scissors and knives in order to prevent necrotic (dead) tissue from causing life-threatening infections. Even a simple dressing change - not simple at all and often taking hours - is a form of debridement, as the dressings often pull dead tissue away with them.

My introduction to severely burned patients was when my instructor told me to sit in the Rehabilitation Center. I was surprised at how quickly I got used to looking at people whose healed wounds have contracted to the point that many of their features are no longer recognizable, and who are very frequently missing fingers and parts of arms and legs. A frequent burn deformity was what I liked to think of as “the Claw” - fingers had melted together during the initial injury and were still in the process of being separated, even if it would only help cosmetically. It was also common for the patient to experience difficulty bending elbows or fingers because of severe contracture of the scar tissue - think of it as taking your elbow, bending it and bunching up all the skin on the inside of your elbow. Wouldn’t it be more difficult to straighten your arm? This is because less tissue is available to stretch and adapt. I’d watch physical therapists sit beside the patient and use what appeared to be small buffers with cream or gel on these contractures. I’m still not sure how this helped.

Most of the patients in the BAMC Burn Ward had things far more amazing (and possibly traumatic) done to them than simple debridement. I talked to many patients who had undergone more than 10 surgeries; some have had more than 30, and some 50 due to their extensive, unforgiving injuries.

There was one particularly determined Marine in the ward who had been burned over about 98 percent of his body (I believe the only parts of his body that went unscathed were the very top of his head and possibly his genitals); he had been on the brink of death two or three times since his admission to the ward 15 months prior. He was also a prime example of how a person’s psychological state can affect healing. A nurse told me how once, earlier in his stay, she had taken him out on a walk around their floor of the hospital. The Marine noted a beautiful woman looking out of one of the windows and looked up at the nurse. She knew he wanted to be near her, and his comforts in life were so few she felt there was no way it could hurt to oblige him. She pushed his wheelchair over near the window, maybe five or six feet away from the woman, and walked away to give him some personal space. When the young woman looked over and noticed the Marine, she paused for a moment before she let out an ear-piercing screech and ran away.

I remember the nurse’s face when she got to that part of the story. She conceded that she had been more than a little indignant. “I wanted to hunt her down and slap her in the face,” she confided. “I couldn’t believe that a person could be so cold, especially to somebody as awesome as him. Sometimes I forget how people who aren’t familiar with burn patients react to something so visually traumatic.” She went on to tell me that the Marine had been so hurt by the young woman’s harsh dismissal that he cried intermittently for days, and his previously remarkable recovery declined to the point that he was near death. She said a lot of encouragement was required on the part of the staff - and anyone else who came in contact with him - to bring him back to an emotional state where he could continue his intensely difficult recovery. Even after that, his recovery was no walk in the park.

The Marine underwent numerous surgeries and experimental procedures (BAMC is a burn research center in addition to a ward). One of the most interesting (and difficult) parts of his rehab was a skin repopulation procedure. Cultures of viable skin were made to grow new skin cells. Then, with the Marine suspended a few inches from his bed, the cells were painted over his freshly debrided skin. Remarkably, about 33 percent of these skin cells took - which may not sound like much, but it’s amazing when 98 percent of your skin has been all but destroyed.

I’m self-aware enough to know that I didn’t enjoy working in the Burn Treatment Clinic or visiting the Burn ICU because I love to help people. It’s not that I don’t like to help people, and I think anybody would feel for the patients, what with all they are going through and how much patience they have for the insidiously painful things you are doing to them. For me, the Burn Unit was about the “I can do this” challenge. It’s invigorating. You have the feeling that you are finally doing something. It is not the upper limit of what I want to do with my life, of course - I have newfound respect for nurses and Burn Techs and the like, but I still can’t help to think I can do more than that.

My interests lie in dermatology and cosmetic/reconstructive surgery. I’m not sure which I’m more interested in. Plastic surgery is more glamorous and probably pays more, but it also requires about five more years of school as well as being nice to a bunch of mother-daughter idiots who feel the best way to bond is to get an impromptu nose job. Dermatology sounds a little less exciting, but only slightly, as I’m fairly morbid and skin does all kinds of weird shit, not to mention the family history of the rare skin disorder Darier’s Disease. I know for sure that no matter which route I take, I’ll eventually want my own practice. I loved the hospital, but I also have this (possibly romanticized) idea of what it would be like to have my own my own office, my own small-but-trustworthy staff. I’d try to hire people who have strong personalities, as it seems they connect better with patients.

Of course, that’s not considering the thousands of opportunities to fail along the way. Medical school is hard, it’s expensive. The Army is difficult but inexpensive; they’ll pay for medical school if you meet certain criteria, but then you (supposedly) owe them two years for every year of schooling they paid for. Granted, you won’t go into hundreds of thousands of dollars of debt like your friends, but you’ll also have to hold off on that private practice for a long time to come.

The time I spent at BAMC was a much-needed refresher from four long, hard, fairly unrewarding months of Advanced Individual Training (AIT). My experiences assisting medical professionals and performing minor procedures in the clinical setting gave me a good feeling about my desire to pursue a medical career. It’s too bad that my experience at Fort Benning sort of shat all over that a lot of the time. But most people in the Army understand how that works.

Up Next: Rock of the Marne

5 responses

  1. Tish says:

    Hahaha, I wrote most of that Wikipedia article.


  2. JahFurry says:

    WOW. “as well as being nice to a bunch of mother-daughter idiots who feel the best way to bond is to get an impromptu nose job”
    great chapter. Inspiring and funny.

  3. Katie says:

    How can i get ahold of the author of this?

  4. Ahu says:

    Interesting, I have been working in the burn ward in a tCM hospital in Beijing for a while. You are right, it is a challenge, people do suffer tremendously in there. About the smell, with all the herbal paste on their burns, you could hardly smell the flesh, but rather the intense smell of herbs. Great article. Thanks.

  5. Lamya Marica says:

    Or even use my hand. Lamya Marica.

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