Burn center employees face demanding tasks

(JSonline.com) Even those who have spent years working in intensive care units and emergency departments – people often confronted with pain and suffering that few of us ever experience or witness – have a certain amount of awe for the doctors, nurses, therapists, psychologists and others who work with burn patients.

Few injuries are more horrific, and few patients face more agonizing or longer recoveries, than those with severe burns.

Only a small segment of the people in health care is drawn to working with burn patients. Those who are often spend decades in the highly specialized field. And the care they provide with intense and delicate patience brings its own rewards.

“Seeing a person rebuild their life is a joy,” said Lynn Vice, a psychologist who has worked for 30 years at Columbia St. Mary’s Regional Burn Center.

The health system’s burn center opened in 1959 and is the fourth oldest in the country. It initially was funded by what is now We Energies, after a worker was severely burned in an accident.

Today, the center treats 200 to 225 patients a year. Roughly half of them will have the most severe, or third-degree, burns. Some will be in the burn unit for more than six months. Many will spend years recovering from their physical and psychological wounds. A few never do.

No patients require more complex and intensive care than burn victims, said Darlene Sargent, director of critical care at Columbia St. Mary’s Hospital Milwaukee.

Depending on the severity of the burns, a patient’s care can cost from $25,000 to $121,000 for the first month alone. For some patients, the total cost will exceed $500,000.

Those with the most severe burns may spend their first month or longer heavily sedated to help them escape the indescribable pain.

“When they wake up, they don’t believe they have been there for a month,” said Anthony Linn, a surgeon and medical director of the burn center. “The families feel like they have been there for a year.”

Linn still can remember cases from 20 years ago.

“Burned skin has a smell,” he said, “and it is a smell you will never forget.”

Linn and the other three surgeons who work with burn patients begin replacing the charred skin with skin grafts or a temporary artificial skin after three or four days, generally limiting each surgery to about 10% of a patient’s body and performing surgery every one to two weeks until all of the skin has been removed.

That is only the beginning of the ordeal.

More surgeries may follow, first to restore movement and function because the patient’s skin loses its elasticity, later to lessen the scarring. Patients may need 24 quarts of water a day because fluid seeps through their wounds. And they will require the constant care of nurses and an array of therapists.

Changing a patient’s dressing – fine mesh gauze permeated with a cream – can take a nurse and a patient care assistant four hours and must be done twice a day.

It also must be done in full gowns to reduce the risk of infection and often in rooms that are kept at 90 degrees because the most severely burned patients lose their ability to regulate their body temperature.

The nurses will care for patients for months, and they develop bonds unlike any other in health care.

“You cry with patients,” said Sherie Siemann, who has worked with burn patients for 11 years. “You get excited with them when they reach certain accomplishments.”

The nursing requires critical care and rehabilitation skills. But it also requires compassion and patience.

“They will sit with patients and hold their hands,” Linn said.

“They know the kind of pain we are going through,” said Bill Ester, who had third-degree burns on 60% of his body after a tanker he was driving rolled over and burst into flames 18 years ago. “They are angels.”

Team care

But from its first days, the center has focused on providing team care, in which doctors and nurses as well as physical, occupational and respiratory therapists work together.

Speech therapists, a psychologist, a nutritionist, patient care assistants, even someone from housekeeping, which is responsible for infection control, were added later.

“The burn unit is almost like a family,” said Vice, the psychologist. “I’ve known some of the nurses for most of my life.”

Sara Harwood, a physical therapist, said the specialized care required by burn patients requires a team, and the many roles are equally important.

Harwood has worked at the burn center since graduating in the early 1990s.

“I feel I really can make a difference in the lives of the patients,” she said.

But she and others acknowledge that the work is not for everyone. Harwood has seen students training at the hospital faint. And working with patients in intense pain is a challenge.

Patients may require therapy for as long as a year. Patients with severely burned arms, for example, must learn to feed themselves, to tie their shoelaces, to button their clothes.

“It’s a life-altering experience,” Harwood said.

The emotional recovery can be as difficult as the physical recovery.

Post-traumatic stress disorder, depression and anxiety are common, Vice said.

Some patients will have flashbacks. Others may experience guilt if they believe they caused the accident. And throughout this time, they are struggling with their physical impairments and scars.

“There is just a multitude of issues,” she said.

Support group

Ester experienced many of those issues.

“I had no clue what I was really up against when I started that whole process,” he said.

He thought that in a year he would have regained his life and the accident would be just a bad memory.

“But at six months, I realized I was not even close to where I was,” he said, “and that I may never be.”

He still was in severe pain and couldn’t even bend his fingers.

“I was close to suicidal,” Ester said. “I hit the wall at six months. Just hit the wall.”

Around this time, he got a call from a nurse at the burn center who asked if he wanted to put together a support group for burn survivors. He knew he needed to talk to someone.

He remembers meeting a 10-year survivor at the first meeting.

“I treated that 10-year survivor like God,” he said.

Two years after his accident, Ester, who has a love of mountain climbing, was standing on top of Mount Rainier. And now burn survivors ask him how he recovered.

“So it’s come full circle,” he said.

Watching people go through their journey is a privilege, Vice said.

“They remind me what the human spirit really is capable of,” she said.