Angels on Call

In the burn center at Saint Barnabas, caregivers meet trauma with skill and compassion.

Dr. Hani Mansour, director of the Burn Center at Saint Barnabas Hospital in Livingston, examines Ken Kuiken, severely burned in an industrial accident.
Photo by Colin Archer.

Burn nurse Mary Szatkowski had barely reported to work last August when the call came from an emergency dispatcher: Two boys extensively burned after igniting a container of gasoline were being airlifted from Monmouth County to her hospital, Saint Barnabas Medical Center in Livingston. Routine patient assignments for the night had already been made, but now, in a heartbeat, everything changed. The tempo in the second-floor burn intensive care unit quickened as the medical team prepared to assess and treat the incoming patients. Szatkowski, 44, would care for the more gravely burned of the two. She moved quickly and efficiently through the flurry of preparations required. If she was rattled, it did not show.

Sometimes, under similar circumstances, Szatkowski waits outside at the helipad when a new patient comes in. Preliminary information about victims is often sketchy, and she is not always sure what she is facing until the door of the helicopter opens. But on this night she did not meet her patient until he was wheeled into the unit’s hydrotherapy room, where burns are immediately cleaned and dressed. The boy was on a ventilator, medicated, and unable to communicate, but Szatkowski introduced herself as always. “My name is Mary, and I’ll be your nurse,” she said. “You’re in the hospital. You’re safe. We’re taking care of you.”

By early morning, the boy was in his room. Szatkowski had comforted his parents and explained the daunting challenges ahead. It was time to head home to Morris County and sleep. She listened to news and music on the drive, but her attention wandered. “The events of the past evening always whiz through your head,” she says. “You think, ‘Did I make all the right points? Did I do everything possible for my patient?’”

When she awoke, her mind was still in the burn unit. “I called the day nurse to see how he was,” she says. The news was encouraging. “He was critical, but his vital signs were stable. He was hanging in there.”

The Burn Center at Saint Barnabas, New Jersey’s only certified burn center, is a busy place, with a twelve-bed intensive care unit and an eighteen-bed step down unit for less critical patients. Last year it treated 375 people, ranging from infants to the elderly. Of those admitted to its ICU, roughly half were suffering from flame burns, with or without smoke inha–lation. One in five had scald burns. The rest had injuries resulting from contact with a hot object, chemical or electrical burns, or skin loss related to disease.

While house fires, crashes, and explosions account for many of the burn center’s cases, everyday activities—stripping a wood floor, attempting to repair a home boiler, spilling hot liquids, bathtub injuries, and using chemicals to destroy a beehive—can also land people in the burn center. Most of the time, the patients have been accidentally harmed, but not always. Sometimes young children are intentionally burned. And on rare occasions, individuals set themselves on fire.

The burn center’s 65-member multi-disciplinary team is a proud and unusually tight group, and a number of staff members have worked together for decades. They are surrounded by bottomless pain and suffering, dreadful sights and smells, and patients with complex needs. Yet they love their work. Szatkowski, an eight-year veteran of the night shift who, since nursing school, never wanted to do anything but nurse burn patients, feels grateful for the opportunity.

“There’s an intensity to the work,” she says. “It’s the nurturing, but it’s also the critical thinking. It can be very draining and frightening. Things can change in an instant, especially with children. It can be so sad. But there can be uplifting moments, too. It’s so great when they open their eyes for the first time. Or stand. Or start to walk.”

Burns are a particularly traumatic injury for patients and their families, says Hani Mansour, the Beirut-born surgeon who has headed the burn center since 1981.

“People can accept when someone has cancer, a heart attack,” says Mansour. “It’s part of the natural process of living. Being burned is an accident, something very sudden. You go from being healthy to being devastated, with the fear of disfigurement and the fear of death. It devastates the whole social setup, too. Suddenly a spouse is married to someone who is not the person who was there the day before.”

Mansour, 63, received his medical degree in Lebanon in 1973 and came to the United States the next year. After completing a general surgery residency in Baltimore, he served as a staff surgeon at the U.S. Army Institute of Surgical Research Burn Unit at Brooke Army Medical Center in San Antonio, Texas. He arrived at Saint Barnabas in 1981, planning to apply his expertise for a year and then go. His goal was to develop a burn center in Lebanon.

“I found a very basic unit,” he says. “The surgeons who were here had no experience in burn cases, but I saw a very young and enthusiastic group of people who wanted to do better. They needed someone who knew how to treat burns.”

He taught and guided the staff and promoted the center, which soon expanded from its basement quarters. After two years, Mansour hired a second burn surgeon, then a third and a fourth. Today, nearly 30 years later, he remains. But he still dreams of establishing a burn center in Lebanon, where he recently bought an apartment.

Former patients and their families say Mansour and his colleagues are a breed apart from other doctors.
“They are not your typical doctors with that God complex,” says Doreen Kuiken of Surf City, whose husband, Kenneth, a 48-year-old union electrician, was burned in a horrendous workplace accident in Jersey City earlier this year. “They spoke to you with such compassion. They were never stern. They never talked down to me. When they explained what was happening with Kenny and I would break down, they would wait until I finished crying. They are amazing, just absolutely angels.”

Kuiken’s ordeal began late on the evening of May 15. He was upgrading a service panel in the basement of a high-rise office building near the Grove Street PATH station downtown. Just as he was finishing up, someone restored power—too soon. Kuiken was hit with a blinding electrical flash.

The next thing he knew, he was crawling along the floor on his knees and elbows. He could feel the flesh falling off his hands. His shirt had disintegrated, and one pants leg had been blown off. He was in excruciating pain but kept dragging himself forward, seeking a safe place. One of his coworkers used a fire extinguisher on the flames. Someone held him down, and he felt himself going into shock. Somebody else loaded him on a gurney. An ambulance took Kuiken to a local emergency room, where doctors ordered him airlifted to Livingston. On the way to the helicopter, he briefly revived when a wave of cold air hit his face.

“Oh my God, he’s still awake,” he heard someone say. Then he sank into unconsciousness again.

At Saint Barnabas, he was placed in a medically induced coma. The coma, which paralyzed him and spared him what would have been unbearable pain, lasted six weeks. He was severely burned on his left side and both hands, more than 51 percent of his body. During this period he had four skin grafts—skin taken from the right side of his body was used to cover his left leg, left arm, the left side of his torso, and both hands. (To graft skin, surgeons shave off a layer of healthy skin from a part of the body that is generally hidden. If only a thin slice of outer-layer skin is needed, the donor site will heal by itself. A full-thickness graft, required for deeper tissue loss, must be surgically closed. Early complications at the graft site can include bleeding and infection.)

For Kuiken, crisis followed crisis; his heart would race, and his kidneys failed, requiring dialysis. While in a coma, he appeared to sleep. “I can tell you I have no memory of this time, but I had the weirdest dream, like I was in a hospital bed and I kept getting shots to keep me immobile,” he said shortly after coming home.
After the coma drugs were withdrawn, it took him two weeks to fully awaken. When his head cleared enough for him to assess his situation, a tube in his throat prevented him from speaking. His hands looked strange and discolored. Worse, he could not lift them. He got scared. “Did I have a stroke?” Kuiken mouthed. The memory of what actually happened returned later, in a flood. When two patches of grafted skin failed, he needed a fifth surgery. After recovering from that, he was sent to a rehabilitation center. Finally, he went home. He had been gone three months.

Kuiken, a muscular former lifeguard, had lost 50 pounds. To minimize scarring, he wore a compression garment 23 hours a day and will continue to do so for one year. He required occupational and physical therapy three times a week. He has a brace for his left leg, which he will wear until he regains use of his foot. His hands really hurt, and he had no feeling below his knuckles. Tasks of ordinary living were exhausting, but he did not spare himself. When his wife bought supplies for a restaurant he owns with his parents and she manages, he went along for the ride and pitched in. Now, if he feels like having ice cream, he walks across the street to get it. He looks forward, not back. He expects a full recovery. And he wants to go back to work as an electrician. Kuiken had always been a determined guy, but he owes some of his confidence to the people who nursed him through the nightmare.

“You know what?” he says. “I never knew how close [to death] I was until the last day I was in the hospital. Dr. Mansour came up to me and said, ‘You’re my miracle. You’re very special. Most people would not have survived this.’ ”

Survival of burn patients is directly related to the percentage of body surface damaged or destroyed by second- or third-degree burns. But numerous advances during the past 50 years —including topical antibiotics to prevent infection, optimal nutrition, early surgeries, cultured skin, and technology for ventilator support—have dramatically improved the odds. Cosmetic surgery results have also improved.

Skin that has been damaged or destroyed must be removed and then replaced by grafting healthy skin or covering it with artificial skin. The best skin grafts come from a patient’s own unburned skin. If there is not enough of it to go around, specialized labs can take a piece the size of a postage stamp and grow it into a sheet large enough to cover a square foot in a matter of weeks. While the patient waits, skin from a cadaver provides the best temporary cover. “There is also artificial skin, but I don’t like it,” Mansour says.

Some 4,000 Americans die of burns every year, but three-fourths of those deaths occur at the scene or during hospital transport, according to the American Burn Association. (The association and the American College of Surgeons Committee on Trauma are responsible for verifying Saint Barnabas as a burn center.) Of the estimated 25,000 or so patients admitted yearly to specialized burn centers between 1995 and 2005, 94.4 percent survived, the association reports. The mortality rate at Saint Barnabas’s burn center during that period was 5.59, virtually the same as the national figure.

“Mortality is dropping. There are more happy endings than sad,” Mansour says. “The greatest mortality is from smoke inhalation, which can lead to lung failure. We cannot do lung transplants, unfortunately. Maybe some day.”

Burn treatment requires the services of many professionals besides doctors and nurses. Respiratory therapists, nutritional experts, occupational therapists, physical therapists, and social workers also play important roles in repairing patients’ bodies and lives. But none have a harder job than the nurses and burn technicians who cleanse patients’ burns in the hydrotherapy room, using shower hoses to wash away dead tissue, debris, and, sometimes, blood. Patients in the tank room, as it is known, are heavily sedated, but it is still an intensely painful process. And not just for them.

“The tank room can be the most difficult part of being here, for patients and staff,” says Peggy Dimler, the burn center’s clinical manager.

“I’m not a yeller or screamer, but they almost got me to cry a couple of times,” says Joe Kolodziej, a patient burned over 25 percent of his body in an explosion last April. Like all patients, he went to the tank room every day during his stay. That meant 28 visits, an experience he likened to having someone wash off “the worst sunburn you can imagine with sandpaper.” One time he needed two doses of morphine.

“The tank room is clearly the worst part of being at Saint Barnabas, and yet the people who work there are the finest human beings you will ever meet,” he says. “I think of these people and can’t help but get choked up. They were just very kind.”

Kolodziej, 48, a councilman in Clifton, was at his business helping load a machine part into a customer’s box truck when the accident occurred. According to reports from fire officials, the truck was carrying a tank of acetylene that apparently fell over and began to leak when the driver backed into the loading dock. When his partner opened the truck from the rear, the invisible gas spilled out. The pilot light for the building furnace was about 12 feet away. Kolodziej saw a narrow flame shoot out and arc into a ball of fire. “The flame got sucked into the truck, then exploded,” he says. “That’s when I turned and ran out of the building. I was fortunate enough to have the good sense to close my eyes and hold my breath.”

He doesn’t remember hearing an explosion, which was powerful enough to rattle windows three blocks away and be heard a mile away. What he does recall sounded like an animal inhaling. Then he felt as if he were being squeezed and pushed. The squeezing sensation, he believes now, was the flame burning his skin. The push was the explosion. “In terms of feeling initial heat or pain, I didn’t feel any,” he says. “Maybe it was the adrenaline.”

Kolodziej and the man who had been loading the truck ran to the aid of the driver, the last to exit the building. Then he called 911. He knew he was hurt, but had no idea how badly. His arms looked red and near his ankles—he had been wearing a T-shirt and shorts—he could see some peeling skin. He paced and walked around until a deputy fire chief he knew put his hands on his shoulders and told him to relax, that he would be going to the hospital soon.

Ambulances transported the injured men to Saint Barnabas. The two men from the truck were strapped into gurneys. Kolodziej sat down on a jumpseat, and an attendant gingerly belted him in. Of the three, he would remain at the burn center the longest. One of his arms had second-degree burns; the other had second- and third-degree burns. He had third- and fourth-degree burns 360 degrees around both legs from his knees to his ankles.

Kolodziej walked into the emergency room. He called his wife to say he had been in a little accident at work. His wedding band started to feel tight—with very large burns fluid can accumulate everywhere in the body—so he removed it. “I’d only been married a year and a half. I didn’t want them cutting this off,” he says. When he reached the burn unit, he was examined and taken to the tank room. Kolodziej realized he would be there a while, but still didn’t fathom how badly he’d been hurt.

“The staff was cool, calm, collected, reassuring. There was no sense of urgency, no chaos,” he says. They told his wife it was day-to-day. By the middle of the second week his arms were healing nicely, but his legs likely needed skin grafts. They took skin from his left thigh and wrapped it around both lower legs. The grafts took, and, a month after being admitted, he was ready to go home. Doctors said full recovery would take eight to eighteen months.

The moment was sweet. Kolodziej followed his doctors’ instructions to the letter. He went to physical therapy. He exercised, taking short walks in the park in the evening—burn parents are advised to stay out of the sun—and flexing his ankles to counteract stiffness from scarring. He got out on the golf course as soon as he felt able. He was happy to get his life back.

For some patients, particularly in cases of extreme disfigurement, it can be difficult to maintain a positive attitude, but the vast majority of patients go on with their lives and thrive, Mansour says.

That would include Joe Kolodziej. “I’m a grateful man,” he says. “Do my legs hurt? Yes. They do. Are there things I can’t do with my wife, like taking vacations and going kayaking? Yes. It’s frustrating. But I cheated death and I’m here.”

Mary Jo Patterson is a frequent contributor.

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