It was a question that, in the beginning, struck me as rude and intrusive. But it passes the time. Besides, they never question why you ask; the right to dignity is something most have long since surrendered.
“So how’d you get burned?” I slipped the pressure cuff over his emaciated upper arm, willing my fingers not to recoil from the slick, lifeless sheet of skin that covered it.
“Walking home from my friend’s house. Some guys lit me on fire.”
I looked up at him. He had warm, brown eyes too large for his sunken face. It was hard to guess his age, maybe 15, maybe 20. A kid, anyway. “Were you out drinking?”
“Nah, playing video games at my buddy’s house. I was walking home when these gang members saw me, thought I was in a rival gang or some shit. They poured gas on me and lit a match.”
“Hmm,” I murmured, trying to look nonchalant while my stomach flipped. He knew better, this boy who had suffered second and third degree burns over 60 percent of his body, was permanently disfigured, and would spend many years undergoing painful surgeries. He pressed an unnaturally smooth, cold hand on my forearm, and grinned. “I know man, it sucks. But check it out. The state? They said they’d pay for my college education.”
It’s a story I thought I’d never tell. At a burn unit, the way to cope is to leave the stories there. Bring nothing home, and take nothing in with you. But I’m lousy at my job. Each baby I hold could be my own, sheets of skin peeling off, rivers of blood pouring down her legs. They scream when they see someone in scrubs approach; I have to pry them away from their mothers.
My daughter is 17 months old. Her bright, dark eyes tell stories. Her mouth is a kiss. Before she was born, I counted by years. I’d worked in the hospital about a year. I’d moved to Colorado around three years ago. Then Sarah came, and I began counting by weeks. Sarah’s one week old; it’s time for her 1st well-baby check. Sarah’s three weeks old, the cord should be falling off. Sarah’s six weeks old, and she just smiled for the first time. When she was seven weeks old I returned to work, and everyone became the enemy, intruders that stood between me and my daughter. I hated them: their petty complaints about traffic, their useless dramas. Their world continued unaffected while my heart keened in my chest, wracked with guilt at abandoning my infant, not two months old and in a stranger’s care. If I had a decent job, I thought, I could have stayed home another month, or returned part-time, something. What else would my lack of education cost her? I needed a better job, a future. I applied to a fast-track nursing program, and three months later received an acceptance letter. The program was intense, full time. I would have to work graveyards and sleep when I could. The only opening was in the Burn Unit.
“You won’t make it,” my co-workers said. “It’s brutal, awful. Highest turnaround in the hospital.” I put in for a transfer. After the first night, I printed out a nine-month calendar and circled the final day of school, the day I would come to see not as the beginning of my nursing career, but as the end of my time in the Burn Unit. And then I began counting by the day.
* * *
A man is slumped down in a tub filled with bloody water. I’m kneeling at the edge, holding a hand swollen twice its size, thick and bloated, the way I imagine a corpse would be. He may as well be a corpse. He is burned over 65% of his body, including most of his face, spends his days alternating between the “tub room” and sedated in bed.
Using an instrument that resembles a scalpel, I begin to pick at the edges of dead skin on the man’s palm. “Uhnnn,” he protests, but can barely open his eyes. His head rolls back. He is sedated to the point of unconsciousness. Although nothing can kill the pain completely, at least the Versed will wipe out his memory. The nurse pushes more of it through the catheter dangling from his arm, then frowns at me.
“What are you doing?”
“Debriding his hand.”
“Do it faster.”
I press harder, scraping the blade against the man’s flesh, chiseling away the necrotic tissue that falls away in clumps that sink in the water. Bursts of blood appear, like those fast-motion frames of blooming roses.
“Good,” the nurse says. “Better.” She picks up her own debrider and begins to carve away his face. His cheek is white and slick and she slices it like she’s giving him a shave. The man jerks and his throat whistles in what he probably thinks is a scream and I know that the dead skin has to come off so the new skin can grow and I know that the blood means life and should be beautiful like roses and I know without lopping off pieces of the man’s flesh he’ll have to endure more surgery and that the surgery is worse, I know, I know, but my arm is numb and I can’t cut that hard. I can’t.
The nurse looms over me; she grabs the man’s hand and slashes down with blunt force. The skin I’d been picking at peels away like the skin of an apple. It slides into the tub. The nurse lets his hand drop back in the water and glares at me.
“You’d better learn to work faster. The IV meds have a short half-life, you know what that means, right? You’re in nursing school, right? Now get his wounds dressed.”
I punch a hole in the plastic over the drain and the water and blood gurgle away. I drape clean wet towels over the man and, using the mechanical lift, position him in a chair. Section by section I remove the towels and replace them with gauze slathered with medicated cream. I love the smell of this cream, a smooth clean smell like its name: Silvadene. At the end of each shift, I steal away to an empty room, turn the radio on and prepare dressings for the next shift. I open a jar of Silvadene and over a sterile field I scoop out the cold cream and spread layers onto thin sheets of gauze. It’s like frosting a cake. I hum along to the radio and imagine I’m anywhere else.
When the man is dressed I get him back in bed and return to the empty tub room. I gather the plastic lining heavy with chunks of skin, and throw it away. I carefully sanitize the tub for my next patient, a girl of nine, whose flowing princess costume touched a candle flame and embraced her in fire.
* * *
My daughter is sleeping in my arms, her mouth open. I lean in and inhale the warm rush of sweet air and my stomach seizes. I slip my arm out from under her and roll away, swinging my legs over the side of the bed and curling over my knees. What am I doing in nursing school? I will fail completely. I squeeze my eyes shut and the vision blurs, the trapped vision of the nurse glaring at me.
What are you doing? she asks.
Gathering myself, I slip from the room and go outside. I light a cigarette even though I quit years ago. I stare at the sliver of moon but what I see is a silvery edge of fabric catching fire and the gleam of a metal blade and the slender arc of my daughter’s eyes and I know I’m not equipped to deal with this much pain.
Once when I was filling in as a receptionist in the emergency room, a woman burst through the doors and ran to the counter.
“My daughter was in an accident, my daughter, can you tell me what’s happening, please, my daughter, car accident …”
I stared open-mouthed, until someone nudged me and whispered, “Trauma Two, the 5-year-old.”
I closed my mouth and stared at the woman. Her daughter was dead. I knew this, but I couldn’t tell her. That was the doctor’s job, and I told her instead to have a seat and he would be right with her. Her gaze calmed a little, and she walked toward a vending machine that dispensed watery lattes and cappuccinos. I knew she was thinking, if my child was dead, surely they would just tell me.
The minutes ticked by and she sat and held her shitty cup of coffee without drinking it and I watched a thin drizzle of foam slide down her cup and melt into her jeans. I wondered how anyone could want to work in the emergency room, or be a first responder. I couldn’t wait to get back to the lab where the traumas were faceless: tubes of blood labeled with anonymous-sounding names or pieces of tissue dropped into specimen cups and wrapped in biohazard bags.
Papery clouds cross the moon and I squeeze the end of my cigarette, twisting the embers away. They glow down to ash on the concrete and I rinse off the patio, toss the butt over the wall. Inside, I scrub away the stink of smoke and change clothes and crawl into bed. There’s so little time to sleep, but when I sleep and then wake it’s time to say goodbye again and go to class. So I watch her until I can’t keep my eyes open anymore and I drift away on a silent apology for the weakness that I once thought was a strength—this crippling sense of love.
* * *
A burn takes 48 hours to fully reveal itself; it works under the surface in an inevitable journey with unknown affects, like a choice that’s been made. The nerves that sense pain are in the second layer of skin, so the deeper burns that destroy this layer are less painful than the shallow burns that leave the nerves intact. I wonder, what is the optimal ratio of distance? If I had to choose, would I choose pain or numbness?
Tonight on my way back from a coffee break I see a girl alone in the waiting room. She smiles at me, and I smile back. Most of the techs hate her; she’s difficult, she’s demanding, she refuses to let anyone debride her daughter unless she’s present, something discouraged so the child won’t associate trauma with the parents. A few nights before, I had bathed her daughter for the first time, filling a shallow pink basin with warm water and sitting the toddler inside. Next to the basin I’d lined a shelf with bottles of soap bubbles and brightly colored wands. Her mother blew bubbles through the wands while I soaked and peeled her daughter’s skin, and when the girl cried her mother tickled her tummy until the cries turned to laughter. We discovered our babies were the same age, had the same light-up princess shoes and loved Elmo with the same obsessive attachment. The mother apologized for insisting on being in the tub room, and I assured her if it was my daughter nothing could keep me away.
But tonight the mother had sent her husband instead, and looking at her I feel the weight of her heart in my chest. She had been cooking spaghetti, had turned to drain the boiling water, and tripped over the toddler she had just seen across the room.
“I couldn’t go in tonight,” she explains, looking straight ahead.
“It’s never going to be over for her.”
“It’ll get better.”
I take a sip of coffee and, to fill the silence, ask her if she has other babies.
“She’s the only one.” Her eyes are bright but she doesn’t cry when she tells me she isn’t having more children. She can’t be more than 25. I think of the children whose parents had purposely scalded them, I think of the three year old who last week had four of his toes removed and refuses to look at his feet. His mother has never been in to see him.
“I hope you change your mind,” I say. “You’re a good mom.”
She smiles again and I walk back through the double doors, thinking maybe if her daughter is still in the bath I can blow bubbles at her and hear her laughter. Maybe the sound will bring me closer to home, to my girl, and distance is what gets you through the nights.