By Siegel, Karen Hall
A winter morning, 2003: Stirring oatmeal, letting Al Roker’s banter distract from my sister-in-law’s fresh death and my faraway sick mother’s plight, I abruptly glanced over my left shoulder to locate an unfamiliar noise. Wide, high flames were the disturbance- rising from that shoulder and resembling a cartoonist’s hell-sleeve caught fire? no cloth burns that fast. . . . Snapping off the oatmeal burner, I dove from the kitchen and rolled. Rolling, I struggled to untie the belt of my blazing kimono, but bows can turn to knots when you’re rolling. Pace common wisdom, rolling didn’t work. Fire towered above me; my task was to wrestle down this tiger. Or die-my son, my loves, I can’t never see them again. . . . Still, I made one minuscule pause: sitting straight up, I mouthed the word “help” knowing none could be forthcoming-husband out of town, door triple-locked from inside. Even if I wasted time screaming, by the time anyone rounded up the super and he came and broke down the door I’d be literally toast. No, it was show time, inferno just a piece of cake, smother its oxygen, fast.
I rolled near the Murphy bed I’d slept on and yanked my favorite blanket from that. Hoping it wouldn’t be ruined, I swaddled it around myself and finally stifled the flames. When I unwrapped the blanket my kimono was gone except for a charred piece hanging from the knot. A gift from a traveler to Japan, it must have been their blackestmarket flammable cloth. (Of course, I shouldn’t have been cooking in any robe with droopy sleeves. That part was a little ignominious for a one-time scientist with good lab technique.) My bra right underneath, sanctioned by the U.S.A., wasn’t even slightly scorched!
First Aid Second
Forgetting all that, I rushed to the bathroom to check in the mirror: Flushed face intact, though brows and lashes slightly singed. Hair a bit jaggedly shorter, nothing a trim couldn’t fix. Finally I surveyed my back and left arm, which both looked alarmingly red. But nothing particularly hurt, so I figured I was probably home free-meaning no doctors. I sauntered back to the living room and looked out at the Empire State Building, thinking as I did each post-Towers morning, We’re both still here. I checked that the rug and the floor weren’t burnt and didn’t see much damage to my blanket. Back in the kitchen I finally heard the weather before shutting off the TV. Then I telephoned my husband.
“Call 911,” he choked. “Right now.” I thought, okay, it couldn’t hurt to have some medics come over and apply the right ointment and so forth. Within minutes of my 911 call-during which I’d pointedly emphasized that the fire was out-a large party of firemen, police, and medical people flocked into the apartment. I sat, bemused, on my bed as someone wet my back with water and firelighters scouted all around. The super stood expressionless, watching from the hall; he’d grown up in Saigon.
Then I learned that I wasn ‘t home free. In concert, my visitors readied me for what they avowed was the world’s most spectacular burn unit, as if it were someplace I’d really enjoy. I doubted the need for all this drama and was peeved because a cop wouldn’t let me lock my own door or even carry my purse. Being borne on a stretcher through the lobby was a low point even though the doormen stayed cool.
Irrationally I thought, / killed a raging tiger and didn’t let this building burn down, and suddenly Fm forced to be passive? Where were you people when it mattered? Outside, I was inserted in an ambulance in which sat a man, but I have no further memory of the journey.
The Tank
After an hour or so of ER flurry, some burn-unit folks removed me to The Tank, a large room containing several single-bed-sized metal rectangles fitted with hoses and drains. I loved the name-The Tank sounded like something out of a prison movie. Cheerfully I mentioned this, causing a couple of nurses to exchange is-she-psychotic glances. I quickly gleaned that the mental status of a lady who sets herself on fire is automatically suspect. (Statistically, I later learned, I should have been poor and/or drunk.) As I sat in one of the rectangles, the head burn surgeon and his efficient minions scraped and washed and calculated that 17 percent of my body surface was burned, much of it third-degree (meaning that both the thin epidermis and the thicker dermis beneath it were history, with zero chance of recovery). What remained was some infection-prone dead stuff called eschar.
It was obvious they planned to admit me. Of course I could simply have retrieved my precious purse and walked out. But then I’d probably die of infection or wind up somewhat deformed, so I figured I’d have to play along. Worried about work, I asked when I could go home: two weeks, minimum-depending on whether I’d need skin grafts. SKIN GRAFTS? HOLY SHIT! At that, I finally grasped that for a while I’d need to cede control. And that the only way to traverse that “while” would be to watch, indifferently, whatever happened. To just let it be a movie.
What happened was that each morning for ten days I was doped with morphine and taken to The Tank, there to be scraped and washed by a very kindly crew. (Scraped, because eschar tends to break up on its own, so some could be readily removed.) Often other rectangles were occupied, too, and privacy was incomplete. But there was no Tank camaraderie. In fact, the room brought to mind a graveyard with inhabitants posing on their stones. And there was no camaraderie on the intensive-care burn floor where I roomed. Strolling around it, I saw that patients were in no shape to chat. Screams of burnt babies sometimes pierced the normal nursing bustle.
At each Tanking, a resident burn doctor would arrive to check whether any of my third-degree burns had shifted down to second, which they never had. (Sometimes what at first looks like third turns out not to be.) Then, because infection is a major bane of burns, I would be anointed with a soothing infection-fighter, silver sulfadiazine, and tightly bandaged back up. Each night one or two people would scrape and re-anoint me as I sat on my bed. The night personnel were constantly changing, as were their official qualifications. One woman who had the air of recruitment off the street was such a bandaging ace that she must have worked with mummies in a previous life.
One night, an RN, possibly somehow impaired, accidentally stuck herself with a needle she’d just used on me and rushed off nervously. Next morning, the jollies! burn nurse popped in and asked me to sign permission for an HIV test, which I readily did so his colleague would have peace of mind. I never got that night nurse again-and never got my test result. I didn’t ask about it, because I suspected that her fellow nurses kept the mishap off the record. She’d been the nurse I liked best.
Watching, Watching
Things hummed along. Family and friends visited and called. My horrified blind mother managed to call, but not dead Eileen. I kept imagining how Eileen, just sixteen when we long ago swore “real” sisterhood, would find a way to make me screech with laughter about my predicament. A year or two earlier, during a still-optimistic radiation session she’d wailed to her technician, “I’m too cute to die!” and he agreed. It was funny, yet it summed up the subjective crux of the human condition. For two or three seconds per day I pondered the hoary psychoanalytic dictum that “there are no accidents.” Was my near self-immolation a way to exorcise survivor guilt, or was it merely carelessness? Either way it felt part of an ineluctable script, so I just kept watching the movie.
My husband brought my computer and papers and often lugged in restaurant food and wine. The hospital rations seemed less healthful than you’d expect in this era of Big Nutrition, yet I had to eat a lot in order to get enough protein, which leaks out fast through the eschar. (If you lose too much protein, your immune system sputters and your “metabolic profile” gets deranged.) Thus a bossy dietitian insisted that I down several cans of protein drink per day, and the staff kept count of the empties.
So, as I sat at a table next to my bed, translating medical journal articles into “patient information” and tossing back protein drinks, things didn’t seem half bad. Occasionally I went to a therapy space, where I obligingly stretched my burnt arm. The women there urged me to join a burnt-people discussion group huddled in a corner of the room, whose ambulatory members seemed culled from a step-down burn floor. Hello, my name is Karen and although I feel infinite pity for all beings burnt or un-burnt, talking to you won’t mitigate a thing. . . . No thanks, no time. Work deadlines.
Two women doing an academic study asked if they could interview me. For nearly an hour they kept digging for symptoms of posttraumatic stress disorder, which I simply didn’t have. They left looking disappointed. But this wasn’t the worst thing that ever happened to me, and in the cavalcade of human woe it was peanuts.
After several days of this doable routine, the burn surgeon himself arrived at my Tank session and informed me that I would shortly be getting skin grafts. This was heartening, because the buzz was that you got to go home soon after grafting.
Frankenstein Time
First they slice off any eschar. Then they peel skin off your thighs (or other un-burnt spots), stick it on a stretching machine, and staple it over the wounds. This requires general anesthesia and lots of morphine later. What hadn’t been adequately impressed on me was that before going home I would have to spend five days almost totally immobilized, flat on my back with a splint that kept my left arm extended like a wing. The Frankenstein grafts needed this undisturbed time to “take”-to stop being thighs and start being neck, back, and arm. Grafts do that very quickly, albeit far from simply. Most critically, adventurous blood vessels in the wound beds start worming up into the grafts-delivering them second life-and many other processes get rolling. So, five days of little but watching. I tried to view it as a morphined-up mental vacation; luckily I’d finished my work and emailed it in. And at least I was done with The Tank (except for one last post-immobilization visit, when they hosed off a trillion staples). Immobilization
One night during the immobilization, a young, new-seeming nurse, who kept complaining that he hadn’t intended to come in to work because of some contretemps with his girlfriend, suddenly announced that I needed a blood transfusion. Although I’d had two during surgery, now I was slightly anemic. For an hour or more he struggled with the transfusion apparatus, all the while scowling and complaining about not having stayed at home. The bag of blood languished on a visitor’s chair. After conferring with a colleague he finally hooked things up, but somehow the hooking up entailed my head being a lot nearer the floor than were my thickly bandaged thighs. I mused that if gravity trumped heartbeats, someone else’s blood would start pooling in my head.
I was fascinated: Generally I don’t expect much empathy from the public, including the nursing sector. We’re each stuck at the center of our private universes-romantic glitches, health concerns, dinner, kids … to say nothing of rollings in the fathomless unconscious. Or, our minds might be compared to atoms that have tremendous forces keeping their nuclei intact, but not necessarily many bonding electrons in their outer orbits. Anyway, for that upside-down stretch of hours I was as objectified as a crummy-model car in for bothersome repairs.
A censorious day nurse disliked me. I got the feeling that it was something like “Yeah, Miss Thing sets herself on fire and I’m supposed to care, what with toddlers and firemen to treat.” That could have been projection, though; I constantly thought it myself.
Once, despite my button calls and voice messages, this unfriendly nurse left me alone-immobilized-for several hours. When she did bring my medications, way late, I saw that one dose was seriously wrong. Through the bedside message system I succeeded in speaking to the charge nurse, who finally came in with the miscreant in tow. When I showed the damning evidence, the charge nurse frowned and said she’d discuss it with the younger woman later, but I doubt there was much dressing down. Some weeks later, a friend who’d been a nurse in the sixties told me that in those days a wrong dose meant instant dismissal. But a nursing shortage, long-sought upgrades in training and respect, and, I’m sure, some variant of politically correct workplace “rights” have changed all that. (Say, what’s that statistic? Each year one hundred thousand U.S. patients perish due to hospital mistakes?)
Home!
Nearly three weeks after my arrival, abruptly I was told to go home, be out before fast-approaching noon. As I hurriedly threw clothes over my bandages, I received instruction screeds, prescriptions for painkillers, and appointments for physical therapy. Once home, I stayed in bed for a day, allowing my husband to pamper me, then decided to get over it.
Ha! I did not imagine that nearly five years later-today-I would still be dealing with itchy, swollen red scars. The main game in skin transplantation (providing it “takes” instead of falling off) is battling the hypertrophie scars that tend to form, especially on the edges of the grafts. You could say that collagen-the main structural component of skin-is appalled at finding itself in a new neighborhood, and its production typically goes wild. But instead of arranging itself in its usual orderly way, the insulted collagen forms thick raised whorls.
Days after leaving the hospital, I was back in an outpatient clinic being fitted for a custom-made pressure shirt. This was a tight black spandex and nylon affair with one short sleeve and one long. Pressure is supposed to inhibit collagen production and thus the flowering of scars. I dubbed it my Spiderwoman suit. It featured circular cutouts for breasts, allowing me to wear the right-sized bra on top; this added to the cartoon effect. My physical therapist was always shaping thick pink silicone things to stick under the shirt, to increase local pressures over problem sites. And I also wore large sheets of translucent silicone next to my flesh. Silicone is supposed to help with scars; I can’t say if it did or did not. All this junk needed washing every day, as did the pressure suit. Thus I actually needed two suits, which perplexed my insurance no end.
I never minded the suit, which curtailed itching and narrowed my waist, except that it posed a sartorial challenge. While it wasn’t a problem under T shirts, it was hard to dress up with this unlovely black thing zippered to my throat. Sometimes I unzipped it a few inches and folded the edges under to get away with slightly lower necklines. In any case, I wore it night and day for exactly two years. Just once, when my husband’s son was nominated for a Tony, I sallied forth to Radio City Hall sans Spiderwoman suit in a normal dress with a wrap casually thrown around it. Less than two hours into the show we had to rush home-without the suit, the scars swelled up mightily and itched. Anyway, before we left he lost out to Billy Joel.
Scars and Stripes Forever
My physical therapist, an exuberant Russian emigre, explained that hypertrophic scars take six months to one year to “mature.” (Not the same as “heal”; the grafts themselves heal quite quickly, like most other surgical wounds, and their scars are not open sores.) By the end of a year, latest, she said, I’d have flat, flesh- colored scars that wouldn’t hurt or itch. So for six months I was fairly patient, although daily in unexpected pain. Maybe burnt nerves were springing back to life or fresh ones were taking their place. Whatever the reason, I often needed opioids like Percocet.
The burn surgeon, leery of prescribing these addictive drugs, referred me to a pain-management clinic, but I didn’t want any more appointments. I simply got the drugs from my doctor. With them and the help of my husband I got through those six months. Every day he massaged the scars, and often he took me to movies. Movies, and only movies, afforded a pain-free, itch-free two hours, although more than once after the show we had to bolt from a restaurant mid-meal because I was suddenly dizzy with pain. Several times I lost it, and my husband would rock me as I violently sobbed.
Yet during those six months (and the following years) I pretty much lived my normal life. Sure, I sometimes dashed to bathrooms for lotion or pills, which hardly disturbed a noisy party. Even close friends tended to assume my burn was “over.” For reasons lost to history, I’d learned as a child not to show psychic discomfort.
The pain attacks abruptly stopped, but at six months and still at one year the scars remained “immature” – not flat and flesh- colored. At two years, almost the very same story. At that point, the burn surgeon deemed that the pressure shirt wasn’t helping. Since discarding it, I’ve stuck to soft clothes, nothing ribbed or scratchy.
In the first post-Spiderwoman years I tried all kinds of ways to appease the angry scars. Acupuncture-for fifteen weeks -didn’t do a thing. My dermatologist injected steroids to no effect. She then tried a laser treatment said to work on scars, but mine were recalcitrant. Long her patient, I mentioned that the fire had an interesting upside: I’d read about some expensive new beauty treatment that used radiant heat to tighten the skin. I joked that I’d opted for do-it-yourself – that the fire left my face noticeably “refreshed!” I thought she’d like that, but she gave me that blank- faced mental-status look. (For that matter, the tiger must have kissed me, because it etched a small scar along my bottom lip, making it more fashionably full.)
Every six months I checked in with the burn surgeon, who did nothing but look, then at year three he dismissed me.
Now
The scars still need lotion a couple of times a day, but they no longer play a grievous role. Obviously I can’t parade around in clothes that bare my back without shocking the populace, and anyway skin grafts should never see the sun. The back scars stay stubbornly red, although now and then a small spot might blanch. I no longer wait for any big change because it seems like a chronic disease. In fact, the scars itch and swell if I’m tense or upset, perfectly consonant with the latest thinking in “psychodermatology.”
On the bright side, my arm is totally “matured.” However, thanks to that skin-stretching machine the surgeon employed, the matured grafts boast a faintly checkered pattern. So my pale arm, when bent, resembles an outsized raw chicken leg. It’s not the most dashing buccaneer scar, but by now I almost like it.
As everyone (including me) declared from day one of this adventure, I was lucky. Most people whose clothes catch on serious fire either die or are tragically disfigured. I’m endlessly grateful for this peculiar stroke of luck. Yet younger Eileen-never very lucky outside charm and good looks-died of cancer thirty-one days before my event. And my mother followed her to the land of shades after more gruesome elder years. A friend from first grade suffered and died, and two uncles bit the dust. Nearly four thousand Americans perished in Iraq, and what with flood, craze, and germs the world kept going to hell. None of that was aberration, we know it in our guts. So what’s “luck”? Doubtless there are blips of relative luck, but as far as I can see every single human’s in the same leaky boat. All we can do is cheerfully watch it sink.
Karen Hall Siegel is a writer and translator living in New York City.
Copyright Antioch Review, Incorporated Spring 2008
(c) 2008 Antioch Review, The. Provided by ProQuest Information and Learning. All rights Reserved.
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