Burn Unit
Saving Lives After the Flames
By Barbara Ravage
DA CAPO; 320 PAGES; $26
"Unutterably sad." Those are the words Barbara Ravage uses to
describe the stories of the many burn victims she encountered
during her research for "Burn Unit," a thorough look at an
unsung medical specialty devoted to a particularly aggrieved
class of patients.
"Burn patients are exposed to a degree that should be seen
only by their caregivers and, in certain circumstances, their
closest family and friends," writes Ravage. And yet here she
has chosen to expose them in a different way, a way that seems
to have more to do with hope than with sadness.
There are an estimated 139 burn units in the country, and
Ravage, the author of several other health-oriented titles,
knew little of such facilities before beginning her research.
But it's clear that years later, she's come to believe that
treatment in a burn unit is essential for gravely burned
patients, who need the care not just of doctors and nurses but
also of "the respiratory, physical, and occupational
therapists, the dietitians and speech pathologists, the
patient care and laboratory technicians, the social workers,
psychologists, and pastoral and other counselors with the
training and skills needed to reconstruct lives damaged by
fire."
Ravage's narrative, which she consistently wraps around
solid science, begins in 1942, when a fire tore through a
Boston nightclub called the Cocoanut Grove, killing nearly 500
people. Firefighters arriving at the scene found almost 200
bodies directly behind the club's main entrance -- clubgoers
who had died in the midst of a desperate attempt to escape.
Many of those who didn't die were severely burned; 171 burn
victims were brought to Boston City and Massachusetts General
hospitals, and these patients became subjects in "the most
comprehensive clinical trial in the annals of burn treatment."
Today, more than 1 million Americans are burned every year,
with an estimated 45,000 requiring hospitalization. Luckily,
medical science has kept pace with the volume of patients, and
60-plus years after Cocoanut Grove, Massachusetts General
boasts a state-of-the-art burn unit that Ravage characterizes
as one of the best in the country. In "Burn Unit'' Ravage has
chosen to focus on two patients who were treated at Mass
General in recent years, and she follows their long journey
from injury to eventual recovery.
The case of Dan O'Shea, and Ravage's retelling of it, is
particularly painful and evocative. O'Shea was burned in a
blaze in his studio apartment, most likely due to a cigarette
that smoldered in an ashtray while he slept off a night of
heavy drinking. Upon his admittance to Mass General, this
31-year- old party boy who'd once prided himself on his good
looks "wore his skin like a tattered shirt, a patchwork of red
and white, black and brown covering his arms and torso." Notes
dictated by the surgeon on call at the time refer to O'Shea's
airway as "paved with soot," and Ravage writes that when his
parents first saw him, "[h]is head was huge, his face bright
red, and his eyes wild. He rose up from the table he was lying
on and reached out his arms, beseeching them."
Ravage paints an equally vivid portrait of the burn unit
staff. We meet the affable, straight-shooting surgeon, the
respiratory therapist who moonlights as a DJ, the social
worker whose colleagues describe her as "the Columbo of the
burn service." High praise is bestowed on John Burke, formerly
the unit's medical director, who took the burn team "from
screen doors to bacteria-controlled nursing units" and
invented Integra, the first artificial skin substitute. Ravage
also devotes significant space to the debate over artificial
skin, concluding that "the wow factor is huge, but science is
still a long way from giving nature a run for the money."
Still, over the past 100 years, science has made undeniable
progress in the treatment of burns -- progress so significant
that it has given rise to ethical issues regarding burn
recovery and a patient's right to die. Today 95 percent of
burn patients can be saved -- even those with burns covering
almost every inch of their bodies. Mike Wilson, a burn unit
nurse with a long history at Mass General, puts the dilemma
this way: "We can keep people alive here with 90 and 95
percent burns. The key is that we don't often enough ask the
question 'Should we?' as opposed to 'Can we?' "
Wilson's passion on this issue -- he goes on to complain,
"Leave it to the United States to take the communication out
of death. Until you die..." --
reveals the extent to which burn unit professionals concern
themselves with the soul and spirit of their patients as much
as with the body. Many of those burned the worst will never
remember their time in these units. But, Ravage writes, "the
policy is to assume they might, so the nurses speak to them,
calling out as though across a vast divide, ever aware that
there is a person inside that mummy wrap, someone's father or
sister or husband or child is lying in that bed." •
Blair Campbell is a San Francisco writer.
