MARCH 2007 – NO. 13
In burn surgery, a lot goes missing
The man came by air, south from the Colorado border. He was alert, asking for morphine and his wife. They wheeled him directly from the helipad, under the roar of the blades, down the hall to the tub room.
The tub room is always first. It's 200 gallons, stainless steel, 98.6 degrees, antiseptic, with wisps of steam rising, and a block and tackle above it. After a while, everyone lying in the rooms beyond comes to fear it. They keep the morphine in a locked chest nearby, in dozens of cold vials, and refill the chest every week.
Over two years I had seen many people lowered into that water by the pulley, old men and children, babies and young women, all naked, held in the arms of the nurses as they floated there, their eyes dreamy from the needle, trying to be still as the bandages soaked through and were pulled away. And when they were done, wrapped in gauze again, the surface of the water was alive with dead skin, like white cellophane, as the tub drained. Then a nurse would climb in with bleach, wipe the metal bottom with a sponge, gather up the skin with the glove of her free hand, and squeeze the water out of it.
But he didn't know yet what it was like, and was calm as we lowered him in, peeled off the bandages. Sixty percent of his body, from the nipples down, a mass of blisters and white.
In the burn unit, pain is a good thing. It means the tissue is alive, that it will come back again. Blisters are fine, they are hope. But then there is the dead gray, like an eye, and when you touch it, when you push hard, there is no reaction in the face, no further blanch beneath the finger. This is a third-degree burn, which sears the nerves, and it is the kind that kills you. Though Mr. Stone was only 50, and strong, we knew right away that it would be a near thing.
"It was a box canyon," he said, as he lay there in the water. "We thought we were somewhere else." He shook his head, looking at the ceiling. They had banked in, flying down the center, the walls pouring by on either side. They had rounded a bend, and suddenly saw it. The end of the canyon, rising a thousand feet above them, all red sandstone, coming up through the windshield. There was no room to turn, no time to climb out. And so they waited, throttle back, flaps down, drifting to the streambed and the trees at the base of the canyon wall.
"All I remember after that," he said, "was the fire." Dr. Whistler smiled and left the room.
Dr. Whistler was a tall man, thin, with curly brown hair going gray, and small gold-rimmed glasses. He looked intelligent and kin, and he was widely read. He had a degree in philosophy from Harvard, and he made sure we knew it. On rounds, he would decorate his remarks with literary quotations: Li Po, or Shakespeare. Once I called him on it.
"Quoting Hamlet, Dr. Whistler?"
"Act?" he shot back, assessing me.
"I don't know."
"Three," he said, with a little smile, before turning off down the hall. "Act three." He loved burns.
Day five was the first harvest day, and Dr. Whistler was ready. He stood in the room in his gown, razors waiting, and folded his arms as Mr. Stone rolled in. He'd made it this far alive. We'd poured a river of fluids into him now, and he was a lucky man.
Burn surgery is simple. You take a straight razor to the burns and shave down through them until you are in live tissue, and blood rises, in a hundred tiny points, from the flat surface of the wound. You want a bed of severed capillaries, where blood can rise to the grafts.
But you also need good skin to graft, and Mr. Stone didn't have much left. We started with his shoulders, and his round, untouched back. This was my job.
I used an electric razor. There is some technique to it: finding the proper angle, the necessary flick of the wrist at the end of the streak. But when you do it right there is a curious pleasure there, the skin rising, curling up like a slice of cheese from the blade. When you're done you have a rectangular sheet of split skin about two inches wide and four inches long. When you do it right it is translucent.
But you also leave a mark, a matching bloody rectangle on the shoulder, a sign. And you have to let it heal, to let the skin grow back, before you can take it again. Mr. Stone didn't have enough good skin to cover all his burns, and so we waited, did this many times, the skin healing, machined away, coming back again. The labor of weeks.
The skin was precious, and we got the most out of it. We fed the sheets through the hole-puncher, and what emerged was like a fishnet stocking. It could be stretched now, like bad rubber, and this was what we used to cover him. We simply stapled it down to the bleeding bed, wrapped it tightly, hoped it would take.
"It's like slaughtering a hog," Dr. Whistler said happily. And it was true. It was hot, bloody work, the thermostat turned up all the way to keep Mr. Stone warm, since the air on his exposed tissue acted like a fan through a wet sheet. He could die of cold, and we had to be quick.
"Sorry, piggy," Dr. Whistler said, looking around to see if anyone caught the reference. Then he shook his head. "William Golding," he said, "Lord of the Flies."
When he was awake, Mr. Stone read Flying magazine in his room. "Don't tell my wife," he said, before tucking it away under his pillow. '
"Are you really going to fly again?"
"It was just bad luck, stupidity," he replied, "If I'd been a little more careful with the map it never would have happened. I've learned my lesson."
"You just have to be certain, that's all. You just have to know exactly where you are, and where you're going."
But Mr. Stone was in the burn unit, and he was going to the tub room.
I imagined what he must have felt, the cliff coming up like an acquaintance, deadly and quiet, and how the cockpit suddenly filled with details – dust on the yoke, an empty coffee cup. And then the fire, rising. Looking at him, he seemed miraculous, like a visitor to the world. And here he was, leafing calmly through the magazine. "Bonanza!" the cover read, and in the photograph the plane turned away gently over the green land.
"What's the most poisonous snake in the world?" Dr. Whistler demanded, peering at us through his small round glasses.
"The green mamba?"
"No," he said, triumphant. "That's on land. The most poisonous snake in the world is the fire snake. It's a sea snake."
He tapped the bridge of his nose, and I wondered why he knew that, and why he had displayed that knowledge.
Mr. Stone's wife was 20 years his junior, and she wanted a child. She stood by her husband's bed as he lay uncovered, his torso and legs, his genitals: all bluish-red leathery ridges, where the grafts grew. She held his hand, and she met with Dr. Whistler in private. The next day it was news. "He's going to try and reproduce," Dr. Whistler said gleefully on rounds, rocking back and forth on the balls of his feet.
On it went, the weeks flowing to months, Mr. Stone skinned and reskinned in the hot room as Dr. Whistler stood there with his razor, wiping it briskly on his gown, cheerful, until his chest and belly were a mass of red streaks and threads of tissue, his forehead damp in the heat, his bright, alert eyes peppering us with questions and stories. He loved his work, you could see it, he loved the razor in his hand and the heat, the faint coppery odor of blood.
He'd just read an article in The New Yorker, and it had drawn him in. The pilots were in their seats, he said, with nuclear bombs armed and ready. The Pakistanis, poised for the Indian cities, Delhi and Calcutta. Fire like you've never seen. One telephone call.
"I am become death, destroyer of worlds," Dr. Whistler said, stretching. "Source?"
"J. Robert Oppenheimer," I replied, "after the Trinity site test."
"Right," he snapped. "And his source?"
"The Bhagavad Gita."
"Right again. And which god was he quoting?"
"Shiva," I replied. "He was quoting Shiva."
Dr. Whistler looked at me for a long moment, then nodded. He seemed lost in thought, as if for an instant he'd forgotten where he was. But then he was back.
"Good," he said, looking down to where Mr. Stone's skinned feet lay waiting. "This should do it."
From The Blood of Strangers by Frank Huyler, © 1999 by the Regents of the University of California. Reprinted by arrangement with the University of California Press.
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