Anna and Joe Gruttadauria were awakened three hours after the fire by one of their daughter Pam’s co-workers at the Holiday Inn, calling to see if she was all right. They checked Pam’s room, only to find her bed empty. She had not come home.
Pam’s parents turned on the TV, saw news reports about the fire, then drove to the Crowne Plaza Hotel where Red Cross volunteers were setting up a support center. At 6:30 in the morning, the distraught parents were told there was no “Pam Gruttadauria” on a list of known survivors. They began to call area hospitals, describing Pam as five feet tall, with dark hair. When they spoke with Massachusetts General Hospital, their hopes were dashed. The hospital’s two remaining Jane Does were both about five feet, four inches tall.
By mid-Saturday, the second day after the fire, only one of Mass. General’s Jane Does remained nameless. When the Gruttadaurias called the hospital again that day, they were asked for a more detailed description of their daughter. This time, Anna described acne scars on Pam’s upper chest and a chipped front tooth. The “unknown woman in room 14” also had a chipped tooth.
Sometimes when people are seriously burned, the massive swelling of their bodies makes height measurement difficult. Aided by Anna Gruttadauria’s additional description, MGH staff remeasured their unidentified female patient. Taking into account her body’s swelling, the terribly burned woman was closer to five feet. Buoyed by this news, the Gruttadaurias sped to Boston, hopeful that their daughter might still be alive.
Upon arrival at Massachusetts General Hospital, Anna and Joe Gruttadauria were introduced to Dr. Lawrence Park, the hospital’s emergency room psychiatrist. He explained to them that the girl in room 14 was very badly burned, and they would not be able to see her face or hands, which were swathed in bandages. But someone would have to try to identify her.
Anna didn’t hesitate. Donning sterile gown, gloves, and a mask, she stepped into the room and looked at the patient’s terribly swollen feet. Her daughter had one toe that overlapped the one next to it. So did this patient. Pam had red acne scars on her upper chest. As did the poor girl in the bed. And the unconscious burn victim, suspended amid a network of tubes, wires, and monitors, had a single chipped tooth visible above the breathing tube that passed from the respirator into her lungs.
“This is Pam,” said Anna.
A mother knows.
Several regional burn centers and general hospitals cared for victims of the Station fire. Rhode Island Hospital’s burn unit alone performed more than forty skin-graft surgeries in the two months following the fire. The University of Massachusetts Medical Center, Massachusetts General Hospital, and Shriners Hospital in Boston also cared for critically burned Station fire victims. (This was the first time in the history of the Boston Shriners Hospital that it treated adults, rather than children.) The best hospital care, however, was no guarantee of patient survival, as four succumbed in the days and weeks following the fire. One was Kelly Vieira, the wife of Station stage door bouncer Scott Vieira.
Several fortunate coincidences favored Rhode Island Hospital that fateful night. Three surgeons on its staff had trained at the Army Burn Center in San Antonio, Texas. Their experience would prove invaluable. Also, the Station fire occurred at 11 p.m., right at the hospital’s shift change, resulting in twice the normal number of nurses being available to remain and stabilize emergency admissions. Additionally, because of a renovation then under way at Rhode Island Hospital, new, barely finished space was available to immediately house the influx of patients. A twenty-one-bed burn ICU was created on the spot, along with a thirty-four-bed step-down unit.
Three weeks after the fire, thirty Station survivors remained confined to four hospitals, with twelve of those patients still listed in critical condition. Among them were bodybuilder Joe Kinan, reptile fancier Gina Gauvin, and hotel breakfast manager Pam Gruttadauria. Their struggles for survival would test each patient, their caregivers, and their families to the limit.
Care of critically burned patients is not for the faint of heart. It is a high calling among surgeons, requiring not only technical proficiency, but also an encyclopedic knowledge of human physiology. They must understand the body’s need for nutrition as it operates in overdrive to overcome horrendous traumatic insult. They must implicitly understand the precarious balance to be struck while treating the body’s massive loss of fluids. They must be constantly vigilant for bacterial or fungal infections that threaten burn victims all too often.
Burn specialists well know that every treatment they administer imposes its own burden on the critically ill patient. Every surgery stresses an already weakened body. Every antibiotic, in large enough doses, can be toxic to kidneys or liver. No treatment is without risk. But treat they must, if the patient is to stand any chance of survival.
And many interventions are painful. There is no escaping the fact that lifesaving treatments for burn victims can themselves be excruciating. Physicians, aides, and therapists must steel themselves to the often painful nature of their treatments, understanding that they are necessary to the paramount objectives of burn care.
As explained by Colleen Ryan, MD, codirector of the Sumner Redstone Burn Center at Massachusetts General Hospital, the three objectives of critical burn care are, in order of priority, “First, survival; then, function; then, cosmetics.” In other words, critically ill patients must be saved. Once survival has been reasonably assured, procedures can be undertaken to enhance bodily functions. Finally, once a patient’s level of functioning has been maximized, further interventions may be considered to enhance a victim’s appearance.
For Pam Gruttadauria, Gina Gauvin, and Joe Kinan, weeks, even months, passed before doctors could worry about anything but their survival. All suffered second-, third-, and fourth-degree burns over more than 50 percent of their bodies. All had leathery eschar encircling torsos or limbs, requiring escharotomies (incising of the burned skin to allow it to split, so that deeper tissues are not compressed by swelling). Still deeper burns required fasciotomies (incising the fascia that divides muscle compartments, to allow swollen muscle tissue to expand). For some, the deepest burns would even necessitate limb amputations.
Critically burned patients are maintained in a chemically induced coma during initial treatment, which may last weeks, or even months. Their respiration supported by a ventilator, burn victims often “lose” months of their lives, later awakening to a very different reality. If they are lucky.
Skin that has suffered third-degree burn cannot be left in place, lest it become a breeding ground for infection. It must be removed within a few days of injury by cutting, called debridement. Charred skin is cut away, revealing fat, muscle, or even bone, depending upon the depth and location of the burn. In order to prevent fluid loss and infection, the debrided site must be covered with some kind of graft. When patients cannot immediately spare sufficient healthy skin of their own, debrided areas are temporarily covered with cadaver skin or a collagen-based product called “artificial skin.”
Such measures are only stopgaps. Eventually, all debrided areas must be grafted with the patient’s own skin. But how can patients with few unburned areas of their body spare sufficient skin to graft everywhere else? The answer lies in the wonders of split-thickness grafting and the skin’s own regenerative powers.
When Gina Gauvin’s doctors at UMass. Medical Center sought to permanently cover debrided areas of third-degree burn, they took an electric reciprocating blade, called a dermatome, to her few areas of healthy skin. It produced strips of skin graft thick enough to survive if nourished by new blood supply, but thin enough that tissue remaining at the donor sites would later heal, forming new, re-harvestable skin. Each strip of graft material was then passed through a mesher, which produced a latticework pattern in the grafts, allowing it to be stretched to three times its original area. The meshed grafts were then stapled to debrided areas, where it was hoped they would develop their own vascular supply and fill in the interstices among their latticewor
k — without infection causing the grafts to slough off.
The process was repeated, time and again, for each of the critically ill Station fire victims. Temporary graft material was removed, the patient’s own skin harvested, meshed, and stapled in place over previously debrided areas. Once a donor site healed sufficiently, it was used for another split-thickness graft — and so on, until all debrided areas were eventually covered, and the mesh grafts consolidated into solid skin, of sorts. It would lack hair, nerve endings, and sweat glands, but would have to suffice for the body’s protective envelope.
Patients underwent daily dressing changes and spray debridement of dead skin — a process so painful that it caused even deeply sedated patients to grimace. All fought off infections over the weeks and months — some successfully, some not.
On Gina Gauvin’s admission to UMass. Medical Center, doctors gave her less than a 50 percent chance of survival. Four days after the fire, they removed the dead skin on her scalp, back, arms, hands, and fingers, replacing it with artificial skin or temporary cadaver graft. Throughout the rest of February, March, and April, Gina underwent skin grafting and other surgical procedures, about twice a week. Her doctors had no choice but to remove hopelessly burned structures — most of her left ear, her right pinky, and two thirds of the other fingers on her right hand. Fortunately, Gina, whose hobby was painting, was left-handed.
By the last week of March, however, Gina’s luck was running low. A combined fungal and bacterial infection had taken over her left hand, threatening her overall survival. If the infection spread from that hand to the rest of her body, she would die.
It’s said in the King James Bible, “Wherefore, if thy hand or thy foot offend thee, cut them off.” Gauvin’s surgeon, Dr. Janice Lalikos, knew that her patient was in exactly that terrible situation; not through temptation, as contemplated by the scripture, but due to infection. The doctor would have preferred to consult with a conscious Gina (she was still heavily sedated), but after obtaining consent from her sister, Dr. Lalikos reluctantly amputated the artist’s dominant left hand.
Joe Kinan, the amateur body-builder and formal-wear salesman from Canton, Massachusetts, was among the most seriously injured Station fire victims at Massachusetts General Hospital. Initially treated across the street at the Shriners Hospital, he was transferred to Mass. General once its burn unit, which had been full to capacity, could accommodate him. Kinan remained in critical condition longer than any other Station fire patient, grievously burned on his head, upper body, and hands. His ears, one eye, his nose, and lips were gone, burned off in the inferno. Doctors eventually grafted skin over where his eye had been, believing there was no point in even attempting prosthesis. His sight in the remaining eye was only partial. Doctors had to amputate most of his fingers, leaving him with opposable pincer stubs on one hand only. Amazingly, once Kinan emerged from months in a medically induced coma, he embraced life with a positive attitude that stunned his caregivers, offering encouragement to other patients in the burn ward. Several recalled passing Kinan on a gurney in the hospital and thinking, “My God, Joe’s so much worse off than me, and yet he’s asking me how I’m doing!”
Sometimes, when in the presence of angels, one can only marvel.
During the two and a half months that Pam Gruttadauria was at Massachusetts General Hospital, her parents visited her every day. They would speak to her, hopeful that she could hear their voices through her deep sedation. Sometimes they thought that she reacted to spoken words. Anna and Joe Gruttadauria clung to that belief in the face of Pam’s devastating injuries. Their daughter had no hands. Or eyelids. Or nose. The burns to 100 percent of her face had destroyed not just the skin, but also the underlying muscles that provide shape and expression. Would she want to live that way? Her parents could not help but wonder.
But Joe and Anna also believed that God had saved Pam for a reason. They had to believe it, in order to make some sense of her suffering. Even if Pam survived, though, she would face years of painful treatments and lifetime disability. The Gruttadaurias knew it was in God’s hands. As it had always been.
In late April, some ten weeks after the fire, Pam’s condition began to decline. Infection was overwhelming her organs. Her blood pressure could not be maintained. Pam’s kidneys and liver were failing. “I think Pam’s tired,” Joe Gruttadauria told his wife. “She’s fought a good battle, but she’s tired.” When Pam’s doctors told the Gruttadaurias that nothing more could be done for their daughter, Joe and Anna agreed to discontinue her respirator and kidney machine. They were comforted by the doctors’ assurances that Pam would feel no pain.
Anna and Joe remained at their daughter’s bedside while she continued to breathe shallowly, disconnected from the respirator. After about three hours, Pam peacefully yielded up her spirit. That night, Pam Gruttadauria, age thirty-three, became the Station fire’s hundredth, and final, fatality.
It would be years before many of the most seriously burned Station fire victims could concern themselves with the third priority of burn care, cosmetic appearance. For them, surgeries to release function-impairing scar contractures would long take precedence over aesthetics.
For others who may have a played a role in the Station tragedy, however, priorities were not so constrained.
On May 24, 2006, Jack Russell appeared on an episode of TV’s entertainment tabloid Extra. The “news hook” for the story was Russell’s showing off the results of his recent face-lift:
Voiceover: “He’s the lead singer for the ’80s metal band Great White, but for Jack Russell, the past three years have not been great. His life unraveled when a Rhode Island nightclub caught fire during a concert and . . . one hundred lives were lost. . . .
Russell: “My drinking really, really started getting really bad after that.”
Voiceover: “The forty-five-year-old checked into rehab. Now, he’s nine months clean and sober and ready for a fresh start.”
Russell: “I’m feeling so good inside. I look in the mirror and it just doesn’t represent how I feel inside, so I, you know, I thought it was time for a change.”
Voiceover: “That change? A face-lift.”
[Graphic: “$30,000–$45,000”] . . .
Voiceover: “Four weeks later, check out the results! Before and after. Jack got the subtle, not-overdone look he wanted. His eyes, more refreshed. Jowls gone, and no more turkey neck!”
Russell: “Most of my friends go, ‘Have you lost weight?’ and I’m like, ‘Well, yeah, about ten pounds in the face,’ you know?” [laughs]
Three thousand miles to the east, Joe Kinan began his day. It was difficult for him to line up his new prosthetic ears with the magnets that had been implanted under his grafted skin to hold them in place. But he managed.
After all, as the ex-formal-wear salesman’s girlfriend observed, “This just happens to be the suit he is wearing right now.”
CHAPTER 25
RISKY BUSINESS
IN MOST STATES, THE PLAINTIFFS’ TRIAL BAR is home to a handful of respected practitioners with extensive trial experience, rigorous analytical skills, and absolutely titanic egos. Rhode Island is no exception. As often as not, these individuals have practiced together in the past and, after going their separate ways, spend the rest of their professional lives trying to prove that they are far and away superior to their former colleagues. Some do this by campaigning for every available office within the organized bar; others, by seeking as much publicity for their cases as possible; and others, by earning a reputation as the meanest dog on the block. Rhode Island has all three types (plus a few hybrids). And it was inevitable that they would be drawn like moths to the Station fire’s flames.
The victims of the Station fire were, for the most part, blue-collar, biker-bar types; many were only marginally employed, and many were single parents. Substantial savings, or even first-rate health insurance, was the exception, rather than the norm, for this group. Loss or incapacity of a breadwinner meant devastation for ma
ny a Station victim’s household.
Whatever may have been their station before The Station, however, all injured persons had in common that they were blameless victims of negligence and greed on the part of multiple perpetrators. The fire victims were dearly in need, and deserving of compensation, and the civil justice system was their only chance for recompense. The response of Rhode Island’s plaintiffs’ bar to this pressing need displayed both the best and worst of their profession.
In the United States (in contrast to the other countries whose legal systems derive, like ours, from English jurisprudence), attorneys are allowed to represent plaintiffs on a “contingent fee” basis — in other words, they are not paid by the hour, but as a percentage (in most cases, a third) of what they recover for their clients. If they lose, they are paid nothing for their years of work. Riskier still, contingent-fee attorneys customarily advance all expenses of the litigation, which, in a case like the Station fire, can run into the millions.
Originally disfavored by courts and legal ethicists, contingent fees are now legal and ethical in all states, because they provide a “key to the courthouse” for persons who could never afford to pay hourly attorneys’ fees. A logical outgrowth of American entrepreneurial spirit and disdain for elitism, the “American Rule” not only allows contingent fee litigation, but eschews feeshifting to the losing party (in the UK and other Commonwealth countries, the losing party in civil litigation must pay the other side’s attorney’s fees, in addition to his own — a risk that simply cannot be borne by many private individuals). The result in the United States is that grievously injured persons, who could hardly afford hourly attorneys’ fees, much less their adversaries’ legal fees, can have their day in court if they find an attorney willing to champion their cause.
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