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UTMB Burn Unit Specializes in Saving Lives
The music in the tub room where patients are bathed is the patient's choice. But this time, Colleen James said, she found it somewhat inappropriate.
“Johnny Cash? Ring of Fire – in a burn unit?” said Ms. James, nurse manager of the Blocker Burn Unit at The University of Texas Medical Branch in Galveston. “I was so upset -- the patient and the whole staff were just howling and laughing at me.
“You have to have humor here,” Ms. James said firmly. “Lots of it.”
At Blocker, they do have lots of humor – and ongoing research, teamwork, experience, commitment and sheer stubbornness. Otherwise, they wouldn't be saving the lives they are saving.
Twenty years ago, patients with burns over half their bodies usually did not survive. Today, Blocker boasts the highest survival rates in the nation for patients with major burns – which are defined as covering more than 80 percent of a patient's body. The UTMB burn unit was the first burn center in the country to be certified by both the American College of Surgeons and the American Burn Association in 1996.
Specializing in treatment of heat-related, chemical and radiation burns, the Blocker Center is especially responsive to large industrial accidents such as the March explosion at a BP refinery in Texas City. Twenty-three of that accident's most severely injured victims were brought to Galveston that day by ambulance or helicopter. Like them, most of Blocker's patients are Texans, although some come from surrounding states, Mexico , the Caribbean and even Saudi Arabia .
“With big burns, so many other parts of the body are affected,” said Colleen James. “The burns involve your immune system, your circulatory system, your major organs. Your metabolism gets revved up – like you just ran a marathon. It's not just a matter of taking care of your skin. We also have to deal with infection, blood pressure and heart rate.”
Patients who are burned over more than half their bodies will usually spend two to three months at Blocker, Ms. James said. There, they will be treated by a team of specialists, including physicians, nurses, nutritionists, psychologists, occupational and physical therapists, and pastoral caretakers.
In 2004, the burn unit treated 212 inpatients, with outpatient clinic visits rising to 2,500. Three faculty burn surgeons are now on staff, with another scheduled to arrive in August. Bed capacity in the adult unit is usually six, but can be expanded to other intensive care units, if necessary.
Recent developments in treatment include Biobrane, a new kind of dressing that doesn't have to be changed. Without repeated and painful changes in dressing required, patients can go home earlier. As the burn heals, the dressing peels away. In the past decade, the burn unit has learned to treat pediatric burn patients' pain more aggressively with painkillers. Antidepressants have also proven effective in the 10% to 12% of childhood burn survivors who suffer flashbacks to their injuries.
“Burn care is physically and emotionally draining work,” Ms. James said. “Most of the patients who come here have catastrophic injuries, and lots of times, their families are angry about the situation.
“It's a lot that we're asking of them – that they trust us, perfect strangers, with their loved one's life. But we do ask that. We do ask our patients and their families to unconditionally trust us.”
This trust doesn't only include a patient's immediate care. It also applies to deeper questions about a burn patient's long-term survival. As more patients with major burns are surviving, questions have been raised about the quality of life of those who live the rest of their years with disfigured faces and bodies.
At Shriners Burns Hospital , which is across the street from the Blocker Center on the UTMB campus and shares its staff of physicians to treat pediatric burn patients, Walter J. Meyer, III has answered many of those questions.
Meyer, a UTMB pediatrician and child psychiatrist, recently conducted a study of 100 young adults who suffered major burns when they were children. Now in their early 20s, these former patients had all been burned over more than 40 percent of their bodies.
“What I was impressed with was how normal they are,” Meyer said. “They were doing what other young adults in our society were doing. Their concerns were with jobs, relationships, marriage and college. They did have an increased incidence of psychiatric diagnoses – with more anxiety disorders, phobias and social anxieties.
“But they still get up and go to work every day.”
With more than 40 percent burns on their bodies, these young people will be visibly distinguishable for the rest of their lives, Meyer said. “But their behaviors are normal,” he said. “They're not in more trouble. Their IQs are normal, even a little on the high side. Their educational level is similar to others of their age.
“Males, in particular, are normal. The females were a little more withdrawn and aggressive. When you take into account our society's emphasis on beauty for women, you can understand that.”
Meyer attributes these patients' relative well-being to what he considers children's natural tendency to look to the future and not focus on what has been lost.
At both the Blocker Burn Unit and Shriners Burns Hospital , patients' severe burns are initially shocking to see. You want to look away, but you don't. After a while, you become used to it.
The extraordinary, you see, has become the ordinary. Patients with burns over most of their bodies are being saved. They are surviving to lead productive lives. They are listening to Johnny Cash as they are bathed. If you listen long enough, you might hum along.
— Ruth Pennebaker
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