Barbara Ravage - Burn Unit

A word about my method. Massachusetts General Hospital and the people who work there were unfailingly generous with time, information, and access, far beyond anything I could have expected. Nonetheless, the protection of patient privacy and confidentiality always took priority, by law as well as my personal ethics. A severe burn is a devastating event for both patient and family. Patients in the burn unit are either unconscious or fully absorbed in the painful process of recovering from their wounds, and they may not be asked to speak about their ordeal while they are in the midst of it. Their families are living through the most anguished time of their lives, and although some consider it acceptable for strangers to intrude upon the anxious and the grieving with cameras, tape recorders, and notebooks, I was unwilling to do so. Instead, I was lucky enough to be introduced to two former burn patients and their families who agreed to share their memories of the experience and to allow burn unit staff to speak to me about their care. I had lengthy interviews with Tom and Nancy Parent, and with the patient I call Dan OShea and his parents, here named Jack and Peggy. I spent many hours over the course of more than a year on Bigelow 13, the floor that houses the burn unit at Mass General. I stood alongside nurses at bedside, attended clinic, sat in on informal chats and formal conferences, joined rounds, spoke with attendings, residents, therapists, patient care associates, and other support personnel, and watched them at their work. I witnessed a number of surgeries during a series of hours-long visits to the OR, and toured the Emergency Department at Mass General, the Hyperbaric Medicine Center at Massachusetts Eye and Ear Infirmary, and in the course of a single very long day, every department and floor of the Shriners Hospital for Children in Boston. I had the enormous privilege of spending several hours with John F. Burke, MD, whose contributions to modern burn care are legion. Over the course of two meetings, this raconteur extraordinaire treated me to a minicourse in the history of burns and his not insignificant role in it. I made two visits once before and once after September 11, 2001to the Cornell Burn Unit at New York-Presbyterian Hospital, where the few surviving burn victims of the attack on the World Trade Center were cared for. I also attended workshops and educational programs at the annual meeting of the American Burn Association for two years running, where I learned from burn care professionals at institutions throughout the country.

The names, words, and actions of all the burn care professionals used in this book are real; thoughts attributed to them are based on what they told me. The same is true of Tom and Nancy Parent and, except for their names, which I have changed at their request, of the OSheas. Other patients whose treatment I describe are composites. In order to comply with the federal Health Insurance Portability and Accountability Act (HIPAA), which governs patient privacy, I have changed the names and identifying details of the patients, in some instances combining case histories in the interest of presenting a comprehensive picture of the course of burn treatment in the most economical way possible. The details of their care, however, accurately reflect what I saw for myself or was told about by people who work with burn victims and survivors.

Burn patients are exposed to a degree that should be seen only by their caregivers and, in certain circumstances, their closest family and friends; their stories are, by and large, unutterably sad. My method reflects the wish to allow a glimpse behind the curtain to those who have never been in a burn unit without breaching the privacy of those who did not or could not give their consent.