Thursday, July 31, 2008

Burn, baby, burn

“The strong wind howled in fury as the heavy storm reigned in disdain. Thunder and lightning flashed across the dark skies as people sought cover under sturdy buildings. A group of little boys who were playing football in the field ran for any form of shelter but one of them was too slow and providence had it that he would be struck by lightning. Among the group of children, he was singled out by Fate. A few thousand watts of electricity flowed through his body. The initial agony was mercifully quick as the child collapsed from the sheer heat. As the path of electricity zapped through his body, all the cells along the way were literally ‘fried’ by the high temperature.”

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.
“1 week has passed by. The child grew almost emaciated over time. His fever has never settled. The armamentarium of expensive antibiotics couldn’t seem to halt the progression of the massive infection. One by one, his organs failed him. By the second week, the doctors faced the grim, unpleasant prospect of announcing the unevitable…that the child might be taken off life support due to the hopeless situation. The entire family came to the meeting with sober faces and downcast facies as a somber atmosphere descended upon the meeting room. Breaking bad news can be the most difficult, heart-wrenching communication in a doctor’s life. Before long, the whole family came to accept the situation and the child passed on in peace after a few short years on earth.”

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.

By the way, a few friends have asked me about the relevance of the photographs that i put in my blog as it's usually not related to the topic i m speaking about. the only reason is that my topics are usually kinda grim and I need to insert some hopeful, happy pictures to balance up the article.

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