Inside the Book

 

Contents
Author's Note  
Introduction  
   
PROLOGUE
A Life on Fire
CHAPTER 1 Saturday Night at the Cocoanut Grove
CHAPTER 2 A Riot in the Body
CHAPTER 3 The General
CHAPTER 4 The Very Young, the Very Old, the Drunk, and the Stupid
CHAPTER 5 Bigelow 13
CHAPTER 6 In the Hyperbaric Chamber
CHAPTER 7 At the Bedside
CHAPTER 8 Gasping for Breath
CHAPTER 9 The Scourge and the Silver Standard
CHAPTER 10 Cutting Off the Dead
CHAPTER 11 Healing
CHAPTER 12 New Skin
CHAPTER 13 Burned to Death
CHAPTER 14 A New Life
   
Notes  
Acknowledgments  
Index  

from the
Introduction

Over 1 million Americans are burned every year, more than half of them children. An untold number of burns never come to the attention of a medical caregiver. They are treated with first aid at home, if they are treated at all. Others are tended to in a doctor’s office, clinic, or hospital emergency room, and the patients sent home to heal. But each year, an estimated 45,000 people are burned seriously enough to require hospitalization and one tenth that number dies.

It is a common enough story. You read about it in the paper or see it on the evening news. Someone is trapped in a burning building and does not survive the trip to the emergency room. A gas tank explodes in a three-car pileup and some of the occupants burn to death while others are thrown free of the wreckage. A child is accidentally scalded when a pot of boiling water is upset on the kitchen stove. One hundred young people out for a good time are incinerated when fireworks set off an inferno in a rock and roll roadhouse. Fire and heat injury cripple and kill people every day, but unless our own lives are directly affected, few of us know what actually happens to burn victims—both those who die and those who survive.


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“Burns have a personality of their own,” a nurse once told me. “They are visually and emotionally overwhelming.” And they present the professionals who treat them and the researchers who study them with challenges unrivaled in the annals of medicine. Mass casualties like those at the World Trade Center haunt us; large numbers of badly burned survivors like those who escaped the Station fire inspire our pity. But in the end, every fire victim is an individual, a singular life to be mourned or saved. Whether it is a crime or an accident, a case of negligence or ignorance, a natural disaster or an act of war, there will always be fires and people will always get burned. There will always be a need to develop better burn treatment and a deeper understanding of how burns kill.


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The history of burn treatment is one of chance discoveries, fruitful collaborations, and key people being in the right place at the right time. State-of-the-art burn treatment is the result of that history and those scientific discoveries. It is also the result of a unique community of healers. Across the entire spectrum of burn care can be found people who are exemplars of selfless, compassionate dedication to the patients and families they serve. This book is a tribute to the entire burn care community, past and present. It is a tale of hope and heroism, of lives lost and lives saved, of medicine at its very best. At a time when so many of us have lost faith in the medical profession, it offers a glimpse at a different world: a Level I burn center where nothing is more important than saving lives, and the history and science behind the everyday drama that is played out there. This is a book about good healers and good medicine, of selfless crusaders, teamwork, and passionate, patient-centered care.


Prologue
A Life on Fire

Sometime in the early hours of the morning, the narrow entrance to Dan O’Shea’s basement studio apartment began to fill with smoke. Most likely a cigarette had been left smoldering in an overflowing ashtray. No one knows for sure. Nor does anyone know when the acrid smoke began to seep into Dan’s consciousness as he lay on the other side of the door, sleeping off another alcoholic Friday night. At some point, a smoke alarm went off, alerting other residents of the South Boston townhouse, one of whom dialed 911 before fleeing the building.

Perhaps it was the alarm rather than the smoke that finally penetrated Dan’s stupor.

Stumbling in the darkness, he did exactly what you are not supposed to do. As he opened the door leading to the windowless vestibule, a fireball engulfed him, flinging him backward into the room, his face buried in the futon mattress, his back exposed to the flames.

That is how the firefighters found him.

They got to the scene quickly, but it was some time before they were able to get inside. The street entrance to Dan’s apartment was a wall of flames, the windows were covered by metal gates. By the time they reached him, he was unconscious and barely breathing.

An ambulance was dispatched at 4:39 a.m. and pulled up outside the townhouse four minutes later. By 4:47, its sirens were blaring as it sped through the darkened streets toward Massachusetts General Hospital.

Inside the ambulance, the paramedics wasted no time starting the life support ABCs: airway, breathing, circulation. When Dan was found, his breathing was agonal. That is medic-speak for the last gasps of a dying person. An oxygen mask had been clamped over his face the moment he was rescued, but his chest was not moving. Experience told them that anyone found unconscious in a smoky fire needs more than a face mask to get oxygen to his lungs. Using a laryngoscope to peer down Dan’s throat, one of the paramedics could see that the soot-blackened airway had already begun to swell. He inserted a plastic tube into Dan’s mouth and down his windpipe to a level below his Adam’s apple. The half-inch diameter endotracheal tube would prevent further swelling from closing his throat entirely and suffocating him. With the ET tube in place, the medic started pumping 100 percent oxygen with a hand-operated air mask bag unit (AMBU). By mimicking the rhythm and force of normal breathing with the AMBU, he could keep Dan’s lungs operating until they reached the hospital and a mechanical ventilator could take over.

At the same time, the other paramedic hung a bag of saline solution on a hook in the ceiling and started an IV line in the bend of Dan’s left elbow. The salt water flowing into his veins was all that stood between him and fatal burn shock.


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In a leafy suburb twenty miles away, Jack O’Shea was up early, as usual. He flipped on the radio at his bedside and got the WBZ time check: 4:55. Then came the news bulletin: A fire in South Boston...a single victim, male, rescued and taken to Mass General.

Jack bounded out of bed and headed downstairs. The newscaster had given the East Fifth Street address, but he could never remember the exact house number where his youngest son lived. He figured he should check the book Peggy kept by the kitchen phone before getting her all worried for no reason. He was halfway down the stairs when the phone rang. It was the building owner calling to say there had been a fire and Dan was on his way to the hospital.

Awakening to every parent’s nightmare, Peggy O’Shea threw on some clothes and finger-combed her short blond hair. By the time she got downstairs, Jack was already pulling the car out of the garage. She slid in beside her husband, mouthing a silent prayer as he backed out of the driveway. In a few hours, the roads would be filled with Saturday shoppers, but in the predawn quiet they were able to cover the distance in less than a half hour.