Small towns, especially in states with paddy fields do see a lot of cases of lightning-related burn injuries. The surgical team (plastic or general surgery) manages these patients together with the anaesthesiologist, physicians and so on. These patients has dismally low rate of survival due to the massive injuries. Their faces will be charred beyond recognition and their skin in hard, unyielding pieces that might compromise even their breathing.
“In the casualty, the child was seen frothing from his mouth as we quickly intubated him so that he can continue breathing with the aid of a machine. All the important steps were taken to stabilize him in order to allow him a fighting chance of survival. A few long incisions were made on his chest wall so that the thick ‘casing’ of burnt flesh is opened. This is ‘escharotomy’ a life-saving procedure so that the child’s chest wall could expand. Multiple intravenous lines were set-up and a massive transfusion of fluids was initiated to replace the loss of tissue and fluids. Investigations were taken. There are tubes almost in every body orifices as the child was admitted to intensive care for the biggest fight of his life that is just to stay alive as in this case, it does consume a lot of energy.”
One of the most dramatic burn injuries are lightning-related injuries. The patients suffer from multiple organ damages and the protective skin cover is loss. The heart could stop just because of the massive electrical discharges. The kidneys will inevitably fail. Not to mention, the susceptibility to infections as the patient falls prey to multiple bugs within and without himself.
“His parents waited outside the cold corridor, huddled together in nervousness and anxiety. More relatives arrived to accompany them as each took turns to go into the intensive care to visit the little boy, who looked extremely small and fragile. Most of them gasped at the sight as the normally active, playful, cheeky child is now reduced to a mass of dark, charred flesh dependent on machines to be alive.”
Electrical and burn injuries are quite common in Malaysia. Lightning-strikes are rare and dramatic but household burn and scalds are daily occurrences. We see babies, children, adults and grannies with all kinds of accidents involving hot water, oil, petrol, etc. This is just a grim reminder of how badly a person can get burnt.
Grief can be a healing process for many. When it comes to road-traffic accidents, assaults, severe burns and so forth, the sudden escalation of bad news may be unacceptable to many people. Somehow, we doctors face it so much that we run the risk of becoming numb to the emotional upheaval in order to protect ourselves, our mental health. Yet this opportunity and privilege to embrace life at its core, to deftly handle all the highly-charged emotional situations, is part of this art we call medicine.