PRINTA toddler's trauma
Third-degree burns put the life of a 2-year-old
Courtesy of Thomas and Tara Hutchens
December 18, 2008 | 12:00 a.m. CST
The George David Peak Memorial Burn Center contains 14 private intensive care rooms. A car crash victim lies
bandaged beyond recognition in one bed. The dripping fluid in her IV is the only movement in the room. A house-fire victim occupies room two. The majority of his body was burned, and his hands are beyond repair. His fingers likely will be amputated. A third unit accommodates a teenage boy. His entire backside was scalded during a bonfire gone wrong. His doctors worry whether his young body will be able to overcome the shock of the third-degree burns.
You might think the largest burn center in Missouri would be in St. Louis or Kansas City, but the George David Peak Memorial Burn Center in Columbia holds that title.
The program can best be characterized by its well-qualified staff and state-of-the-art facility. Built in August 2007, the center features 14 private intensive care rooms staffed by three burn surgeons and a team of nurses. They see 25 to 35 clinic patients on a daily basis, and about a third of those patients are new.
According to Program Director Dr. James Kraatz, the reason Columbia is home to such a large program, besides its central location in the state, is that the staff demonstrated a willingness and dedication to its growth. The staff’s expertise also comes in handy with surgical infections and complex wounds other than burns.
A lot of training is involved: surgery residency, a surgical critical care fellowship and then a fellowship caring for burn victims. The nurses must handle complex wound care that is not taught in any class. Essentially, they must apprentice while on the job.
Kraatz says that there are only about 120 burn facilities in the United States. Among those, only 15 to 20 are open all of the time and can meet the definition of a burn center with the proper staffing and facility. “Some hospitals are trying to make a name for themselves as a trauma hospital and only offer burn service as a sideline,” Kraatz says. They are often too busy to accept patients.
Kraatz says that though there is some capacity within St. Louis or Kansas City hospitals for burn treatment, the nearest center of this size is in Chicago. Luckily, Columbians won’t have to travel that far.
“If you’ve got a burn, you can come to us,” Kraatz says.
--Julie Heidbreder
Julienne Hutchens, 2, before she was badly burned on Oct. 15, 2007.
Julienne under the care of the burn unit staff at the University Hospital.
The OR of the MU Hospital burn unit.
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Thirteen months ago, Julienne Hutchens was among those in the burn unit fighting for her life. She was 2 years old. The morning of Oct. 15, 2007, was partly cloudy and warm in Bethel, a small farming town in Shelby County. Julienne’s mother, Tara, helped her daughter pull on toddler-sized jean shorts and a T-shirt that read “My Daddy Said I Can.” They went about their daily routine in Heartland Community, a ministry-based neighborhood that cares for troubled teenagers, where Tara is a middle-school science teacher and youth instructor for a girls’ dormitory. Around 5 p.m., Tara began preparing dinner with Julienne beside her. They were anticipating the arrival of Julienne’s aunt and uncle, who were joining the Hutchens family for fried chicken and mashed potatoes. Tara peeled the potatoes and dropped them gently into a large bowl filled with water. She placed the pot in the microwave and set the timer. Minutes later, the water was impatiently bubbling and steaming, the potatoes ready to be drained into a colander. Tara picked up the pot and turned toward the sink, where Julienne sat on a barstool, washing her hands. Julienne’s eager eyes watched the spuds below the surface of the scorching water. As Tara moved to the right of her daughter, her balance faltered, and the heavy container slipped out of her hands.
The boiling water spilled all over Julienne and ran down the little girl’s face and clothes. Julienne screamed in pain. Tara instinctively began splashing cold water over her daughter, but the shrieks grew louder and more excruciating. Tara thought removing the wet clothes would help Julienne cool off faster. She peeled the T-shirt off over Julienne’s head. Julienne’s skin came off with it. About that time, Tara’s brother-in-law and his wife arrived at the Hutchens’ home. Seeing his niece bleeding from eyebrow to knee, R.T. Hutchens called 911 and Julienne’s grandparents, who lived close by. R.T. also alerted Wendell Nickerson, a neighborhood doctor, who arrived at the scene before the paramedics. He arranged for an emergency helicopter to come
immediately from nearby Shelbina to Heartland’s landing pad, located five blocks away. Julienne was still screaming when the ambulance pulled up in front of the house. The little girl received an injection of morphine and was sped away to the landing pad.
Julienne was lifted to Columbia’s University Hospital; her parents traveled close behind. Tara had notified Julienne’s father, Thomas. Charles Sharpe, a pastor and founder of Heartland Community, flew the frantic parents in his private jet to Columbia Airport. A journey that could have taken two hours by car was reduced to less than half that time. “I knew she was in pain, but I didn’t understand what it really meant or what it was going to do to my life,” Tara recalls about the first few hours after the accident. Inside the George David Peak Memorial Care Center, the Hutchenses met Dr. Nicholas Meyer, who informed them that the average hospital stay in the burn unit is one day per percentage of the body burned. Julienne had second- and third-degree burns on 40 percent of her body. “The natural history of burns over 20 – 30 percent is that they’re fatal,” reports Dr. James Kraatz, director of the George David Peak Memorial Burn and Wound Center and assistant professor of surgery at MU’s School of Medicine.
With Julienne deeply drugged and in the hands of the hospital staff, Tara and Thomas began to consider the long-term implications of the accident, should their daughter even make it through the night alive. They were told that the worst-case scenario could involve nearly two months in the hospital, six months of inpatient rehabilitation and additional outpatient therapy. The couple began making arrangements with their employers
and also with friends and family regarding their two boys, 7-year-old Jonathan and 8-year-old Jordan. Tara figured she would be absent from work for at least the next year. Julienne’s room in the burn unit became Tara’s home. Thomas balanced his time between the hospital and taking care of their boys at home in Bethel, but Tara never left. She sat faithfully by her daughter’s side, almost as permanent a fixture as the ventilator, dialysis machine or infrared heater above Julienne’s bed. Julienne’s days, frequently interrupted by doctors,
nurses and therapists, were mostly vast stretches of nothingness made hazy by the same heavy painkillers that made life bearable. Dependent on others for food, bathing, using the bathroom and most other tasks, Julienne survived because of the people surrounding her. “A burn accident does not just inspire a relationship between a doctor and a patient,” Kraatz says. “You really have to involve a multidisciplinary team from the get go. There are a lot of people who are going to have stakes in how a patient is cared for.”
Endocrinologist Dr. Michael Gardner was one such person. Nurses paged Gardner every hour for a week to keep track of Julienne’s blood sugar levels in order to gauge stress on her body. Her levels swung wildly from 20 to 300 milligrams per deciliter (normal is between 70 and 150 mg/dl). “They paged him, and he would always call back to get the blood sugar,” Tara explains. “Around the clock, 24 hours a day, for over a week, he wanted to know what her blood sugar was. That really touched us. For him to put that kind of time in, it was just amazing.”
Julienne’s bandages were changed once a day, an hour-long process that involved sedating the 2-year-old and scraping off her dead skin. Nurses popped the bubbles on Julienne’s blistering arms, legs and chest. The supine skin was cut away or peeled off. A gray pad called Mepelex was applied at the end of the process to draw out excess moisture and promote skin regrowth. Julienne was asleep during these procedures and therefore experienced no pain. Nurse Paul Linneman was present for each bandage change — even on his days off. During those times, other nurses washed Julienne’s hair, which often became severely matted because the little girl sweated so much from continuously being kept under a heater. Burn patients are typically kept very warm so they can use their energy to heal rather than to heat their bodies. Nurses frequently read to Julienne after their shifts ended and brought her toys and books. Although she had a feeding tube, she was encouraged to eat real food toward the end of her stay, and some nurses brought her yogurt. Julienne was fond of one nurse, Jessica, whose long blond hair reminded Julienne of her preschool teacher.
Meyer kept watch over Julienne as well. He decided after a week that skin grafts were necessary across the child’s chest, shoulders and upper thighs. Skin grafts involve placing new skin over a burn to permanently replace damaged or missing skin. Third-degree burns usually require such surgery to cover wounds and prevent infection or loss of fluid. Grafts also minimize excessive scar tissue. Julienne’s surgery was performed in the burn unit’s operating room — the hospital’s largest OR, featuring temperature and humidity controls, a sterile warm water source and portable equipment. “The operating room is designed with state-of-the-art technology for treating patients with burns and wounds,” Kraatz says.
Prior to surgery, a burn must be debrided, a process comparable to sanding the injury. Because burns are rough wounds, not clean breaks in the skin, those rough edges must be cut away and filed down to expose healthy tissue and make a flat and even surface for the new skin.
Julienne’s surgery was successful. Splints on her arms and legs kept the new skin from shifting. “She had places on her hips that also needed to be grafted,” Tara says. “But then she wouldn’t have been able to move at all, so instead they cut those spots out and stitched them up so that she would at least be able to move her hips a little bit.” As soon as Julienne was out of the splints and able to move, she progressed rapidly, albeit awkwardly, with her wounds still healing. “She didn’t have the prodding that adults usually have to get
moving; she wanted to do things,” Tara explains. “The places that needed stretching were easy to stretch. For example, her shoulders, all we had to do was make her reach for us. Even coloring with crayons stretched her hands.”
Eventually Julienne could stand alone, enduring the horrible, burning sensation as blood rushed down to the damaged areas of her thighs. Nearly two weeks after her accident, she was managing slow and painful baby steps. After 17 days in University Hospital, Julienne was released. Her young body healed rapidly, and she was out much sooner than her parents had expected. Tara recalls: “As soon as she was able to move, she progressed really quickly. When they released her, she didn’t have to have any therapy.” Doctors instructed Tara to dress Julienne in a compression garment for a year; the binding cloth would improve her circulation and help reduce scarring.
Julienne’s slight scars — and the occasional nightmare — are the only reminders of her accident to date. The most significant mark is on her neck; there is other scarring covered by her clothes. Julienne is fortunate that her face healed remarkably well. “I can see [the burn mark] whenever she’s crying and her face turns red,”
Tara says. “But if you didn’t know, you wouldn’t notice.”
Even if the scars were noticeable, it’s not important, says Linda Hansen, executive director of Burns Recovered Support Group. “Our skin is the wrapping paper of our body,” Hansen says. “The gift is always on the inside. When we get a present, what the hell do we do with it? We tear off the paper, and we throw it away! What we want is the gift, and that’s on the inside.” BRSG is headquartered in St. Louis and meets monthly at University Hospital to help burn survivors in Columbia and the surrounding area cope on the emotional road to full recovery.
Kraatz shares a similar view of his patients in noting that a burn survivor never comes through an accident a worse person for the experience. “It probably has something to do with perspective,” he mentions. “If you go through something that’s that much of a life change, you’re standing on a platform looking down on the world. The little stuff just can’t bother you much anymore.
"It’s not something, fortunately, that’s really part of our societal culture,” he continues. “It’s not common. Everybody has a relative who’s got cancer or had a heart attack or something like that, so there’s a way we deal with that as a society. When we talk about burn injuries, both as a burn survivor and a burn provider, the overwhelming response you get from somebody is either, ‘I don’t know how you went through that,’ or ‘I don’t know how you do that for a living.’”
Fortunately there are people who treat burn patients for a living, and many of those individuals work in Columbia. Doctors, nurses and therapists who are skilled in their field and in the art of patience make life possible and even improved for patients such as Julienne. They are not only professionals; they often become friends with patients and their families. This year, three nurses from University Hospital drove two hours to visit Julienne and Tara. The little girl was shy at first, but after a few minutes, she opened up and was eager
to share a bit of her world with the nurses who had so lovingly taken her into theirs. The trio from University Hospital enjoyed a steak dinner and a musical show at Heartland Community before heading back to Columbia. Tara watched them drive away. “The staff at the University Burn Unit was incredible,” she remembers. “Without them, our stay would have been so much harder than it already was. They deserve a lot of praise for the sacrifice that they make for their patients.” V
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