On Tuesday morning, I met with Dr. Bessey. He is a surgeon
at the Burn Center along with Dr. Yurt and Dr. Gallagher. We talked about my
research for a while before deciding that the topic of ‘wound healing’ should
be my focus for the summer. He got me involved immediately by showing me all
the patients and introducing me to the staff members.
I helped some of the nurses and technicians in the ‘tank’,
where the burn wounds were scrubbed and cleaned to remove dead skin, puss, and
other debris. Though I helped out briefly with infants, I’ve been working with
adult patients mostly. Since all patients go through tank sessions, I got to
observe all the patients and their progress in recovery. I saw many interesting
cases and I’ll share a few here. I met two patients who had 2nd
degree burns on their feet. Their injury would not have been so serious but
they have diabetes and didn’t feel their feet burning. Dr. Bessey explained
that diabetes leads to poor circulation, as well as microvascular disorders, so
their wounds do not heal very quickly, if at all, which then increases the
chances of infection. I saw several minor patients, one of whom was a 4-month-old
little girl. She had 2nd degree burns on the lower parts of her
body, with some parts that experienced 3rd degree burns. There was a
distinct line separating the burn and normal tissues, which Dr. Bessey said in
many cases is due to being intentionally dipped into hot water. The mother has
previous conditions of mental illness. Either way, the girl had to be wrapped
with creamy bandage lined with silver sulfadiazine, a topical antibacterial
cream that inhibits the growth of bacteria and yeast. People sometimes use
silver nitrate solution instead. She will need surgery on the 3rd
degree burns since they don’t heal on their own.
Final patient was a new admission, who had burns so bad that
all the attendings and residents came to see him. According to him, he fell
asleep while smoking a cigarette and dropped it on his T-shirt. He said the
fire was in direct contact with his skin for 2-3 minutes before he was able to
take the shirt off. He has a history of alcoholism and smokes a pack of
cigarettes a day. He experienced direct flame burns on his left side and the
inside of his left arm. Dr. Bessey explained that the ‘cherry red’ parts are
worse burns than the pink, while the white patches indicate complete skin burn.
The patient didn’t feel anything when we touched the white patches because the
burn had damaged his pain receptors.
We scrubbed off much of the debris, cleaned him off of soot (from the
smoke) and dressed him with silver sulfadiazine and ace bandages. He was
shaking from pain even with a lot of medicine.
Today I observed Dr. Bessey performing surgeries in the OR. The
patient experienced burns on his entire back and the inside of his right arm,
where he was feeling the most pain. The back was healing well, showing signs of
pigmentation (purple dots). His arm, on the other hand, seemed to be healing
much more slowly, if healing at all. Dr. Bessey and his surgical technician
used what looked like a large vegetable peeler to take thin skin sections from
the patient’s thigh. The skin was then perforated to look like a Band-Aid.
Blood oozing from the injury site can prevent skin autografts from attaching.
Therefore, perforations must be made to allow the blood to leave. Stapling the
skin onto the injury site and wrapping up the arm completed the skin autograft.
Dr. Bessey is also introducing me to the multidisciplinary
aspect of patient care. In a meeting that takes place weekly, doctors, nurses,
technicians and social workers all met to discuss each of the patients and
their needs for quick recovery from their injury or surgery. They discussed
whether the patients needed physical therapy, social workers, etc. I realized
there is much more to working at a hospital than diagnosis and treatment.
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