So what does it mean?

“The body has memory.  The physical carriage hauls more than its weight.  The body is the threshold across which each objectionable call passes into consciousness — all the unintimidated, unblinking, and unflappable resilience does not erase the moments lived through, even as we are eternally stupid or everlastingly optimistic.”  Claudia Rankine, poetess

Finding Dr. von Heimburg’s document about my burn history was a stunner.  For months after, I racked my feeble brain, wondering how that document could have appeared in a basement box I’d long since forgotten. Just how did a critical document I had never seen before GET in that box?  Even more incredible was its likely fate — it was headed for the garbage had my god-sent friend Gloria not mysteriously saved it from extinction.

To my my way thinking, it was a miracle document.

After paying it due homage and digesting the very fact of its existence, I began to wonder what exactly it meant. First, in terms of my very survival as a pediatric burn patient. Second, in the memories it filled in and the gaps it left.

I turned to Dr. Robert Lehman, a noted St. Louis surgeon.  “Bob, can you help me interpret this report?” I asked, as I looked at its menu of debridement, dressing changes and skin grafting. “Oh, this was serious,” he replied with a knowing tilt of the head.  It was a classic Dr. Bob gesture.

The most medieval of the menu is, of course, debridement, a surgical procedure using forceps, scissors and other implements (of torture, I might add) to remove dead (or what they perhaps lovingly refer to as ‘necrotic’) tissue.  Skins grafts are then transplanted to the debrided site.  In reflex, I rubbed my thighs thinking about that — my thighs and rear end are my donor skin sites and still carry the precision scars of the scalpel, which cut perfect rectangles of skin from them.  Thinking about it made me queasy.

I asked then what was possibly the more interesting question, “Reading this, how do you assess my survival rate at the time?”

Of course, in the interim, I’d looked up the various measures of burn survival, like the R-Baux score which measures mortality in adult burn victims or the P-Baux score which measures mortality in pediatric cases.  These various measures include some combination of the percent of body surface burned + the patient’s age and often including a smoke inhalation component as well as sepsis status. It’s all sort of compellingly macabre and all, according to Dr. Bob, irrelevant for me.  In his pleasantly dead-pan manner he said, “I think, that at the time you were burned, the thinking was burn plus age.  Looks like there’s all sorts of analysis being done today that would never have applied back then.  I should say that the new analyses weren’t done then.”  Hmmm.

This is understandable.  Not only am I old (!) but at the time I was burned, 911 was not even in existence.  It was something of a cowboy world for burn care.  There were no burn units, no Baux scores, no longitudinal studies.  I didn’t even get to the hospital by ambulance.  By all accounts, my parents drove me to the hospital, hours after the accident.  That was standard operating procedure in the day.

Taking Dr. von Heimburg’s report, my survival score was 12% total body surface area burned (TBSA) + age of 2 = 14% mortality.  To me, those were fighting chances.  And then, there was always contradictory information out there — “In the 1960’s, the likelihood of survival was only 50% in children with burns covering 35 – 44% of the total body surface area (TBSA), and few patients with burn sizes exceeding 45% TBSA survived.  The average length of stay for the acutely burned child was 103 days,” writes Dr. David Herndon of Shriners Hospitals for Children.

It made me think about my length of stay — somewhere past the 60 day mark — as well as my other doctor, Dr. Thomas Lynn. There were no records available from him.  He died young, a stroke or heart attack according to his daughter and my high school friend Julie. Within two years of my accident, he was gone and I was referred to plastic surgeon Harold Hoops.  By the time I developed interest in finding records, Dr. Lynn’s clinic was long since closed, the records destroyed.

So here were the gaps again.  Confirmation on nine procedures.  But the story I remember put the count at about 20.  Dr. von Heimburg listed only one skin graft.  Looking at my leg, I know there were others. I see the cuts and feel the ridges It had to be the handiwork of Dr. Lynn, whose records are gone forever.  “The body has memory,” Claudia Rankine says. I know it to be true.

 

 

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