Refined by Fire

by Brian Birdwell

  As difficult and as painful as everything had been for me physically up to this point, that pain was nothing compared to the finality of losing my coworkers. The emotional ache was much deeper. It reached way down into my soul and ripped a part of me that I knew would never quite be whole again.

  Mel

  Colonel TW Williams, the other military aide in Brian’s department, visited Brian. Brian had been concerned about Colonel Williams. Even though Williams had been running errands the morning of September 11, Brian didn’t know if he had returned to their office while Brian went to the restroom, right before the attack. Brian was relieved when he learned Colonel Williams had never reentered that section of the building.

  Before we entered Brian’s room, TW pulled me aside and handed me something. I looked down at his hand. It was Brian’s wedding ring. As soon as TW handed it to me, I put it on and wore it next to my wedding ring. I decided I would return it to Brian after he was discharged from the hospital.

  I wasn’t aware of the exchange Brian and John Collison had with the ring or the significance of the way it was removed because John had never mentioned it. His visit had been too emotional. But I knew that John had received Brian’s ring at some point; I just wasn’t sure when.

  On September 20 Brian slept most of the day. He had surgery at 2 p.m. Dr. Jeng told me afterward he did some very aggressive scrubbing and told the staff to “frost him like a cake.” In other words, Dr. Jeng ordered them to pile on the Silvadene, an antimicrobial ointment that they lathered over his burns before they dressed him with bandages.

  Brian had a raging infection and fever. He also developed a heart arrhythmia and a racing heart rate. The staff began to monitor him closely and considered increasing the medication, Lopresser, to slow down his heart rate. They were concerned about getting his rate back under control. The problem was that because burns can shut down your internal organs, they can also shut down your heart. So from that point forward every day they did an EKG on him. The arrhythmia never presented itself again, but the rapid heart rate did. I was so scared—it felt as if everything was happening at once. And nothing was under our control.

  Later that afternoon I received a call from Dave Davis, who worked for the office of Kay Bailey Hutchinson (U.S. senator from Texas), asking if I’d like to attend the President’s address to the Joint Session of Congress that evening. I talked to Brian about it, and he encouraged me to go. So Colonel Dane Rota, my right-hand man, drove me to Hecht’s, a local clothing store, to buy an appropriate suit and shoes to wear. I’ve never shopped so quickly in my life. I walked into the store and fifteen minutes later came out with an outfit in tow! I rushed to the hotel to shower and get ready. But while I was in the shower, I started to hyperventilate and had a massive panic attack. I couldn’t breathe and became dizzy. I thought I was having a heart attack. I became overwhelmed with fears that there would be an attack on the Capitol building that night. What would happen to Matt? I worried. I stood in the shower and cried and prayed frantically. I just couldn’t get any peace about going.

  I quickly got out of the shower and called Dave back, explaining the situation as calmly as I could. He was very kind. I think he really did understand my fears. So I put on my jeans and T-shirt again and walked back to Brian’s room. We watched the speech together on TV.

  In Psalm 27:7-8, King David writes,

  Hear, O LORD, when I cry with my voice,

  and be gracious to me and answer me.

  When You said, “Seek My face,” my heart

  said to You, “Your face, O LORD, I shall seek.”

  As I sat in Brian’s room that night and watched the President, I thought about those verses and claimed them as my own. They were God’s personal promise to us—that he would carry Brian and me through this. I needed to keep my focus on God, and he would handle all the other things.

  After the President’s speech, I opened my Bible and began to read Philippians 4:13 to Brian: “I can do all things through Him who strengthens me.” It was another verse I would cling to in the days to come.

  Nine

  Aftereffects

  * * *

  Journal 9/19/01

  The staff is upping Brian’s antibiotics and amnesia medication to help him forget his pain. He was totally out of it. He couldn’t stay awake for anything. That’s a good thing. He needs the rest.

  * * *

  Mel

  Every day it felt like I was riding a roller coaster. Brian still wasn’t able to speak because of the trach. But he mouthed lots of words. He blew me kisses and told me I was his queen. Those were the high times.

  The low times were extremely low. The doctors were having trouble containing his staph infection. Burns are highly susceptible to infections, which can take root in the dead tissue and eat away at the body. There are two kinds of staph infection—regular staph and hospital staph. Hospital staph is the worst kind because it perpetuates itself and becomes extremely resistant to antibiotics.

  Brian had hospital staph. They kept trying to treat his infection with massive doses of antibiotics, but nothing would kill it.

  Every time I walked into his room, the smell of the infection would just about knock me over. It was a distinctive and sickening odor.

  The infection covered all of the burned areas on his body with green pus. It was eating away at his face and ears. It was even in his eyes.

  Plus Brian’s arms were still festering. Dr. Jeng had to perform another extreme surgery in which they put him under anesthesia and scrubbed him. Dr. Jeng told me they were going to use a bleachlike solution to kill the infection; it was essentially the equivalent of scrubbing Clorox on his arms.

  They also used a diluted bleach-type substance to soak his bandages in before they dressed his wounds, hoping that would cure the infection. That was so incredibly painful for him that they had to double his pain medication. I prayed fervently that God would ease his pain.

  When after a week and a half that treatment still didn’t kill it, Dr. Jeng entered Brian’s ICU room to speak with me.

  “Okay, here’s the plan,” he began—but to me he sounded a little too excited. “We’re doing maggots.”

  I stared at him blankly for a moment, letting his words sink in.

  “I’ve already spoken to Brian, and he agreed,” he continued. “But he wanted me to tell you because he didn’t think he could really explain.”

  “We’re doing maggots—on purpose?”

  “Yep. The nurses prefer to call them sterile larvae, since they feel the word maggots is too harsh. But let’s not sugarcoat it; they’re maggots.”

  I swallowed hard. “Why?”

  “The maggots eat the dead tissue and leave the good, healthy stuff. They do a better job of removing the bad stuff than we can. Brian’s infection is at the point where we have to take extreme measures.”

  Then as if to comfort me, he said, “We can have them shipped overnight to arrive by 10 a.m. tomorrow morning. They will be on him for three days. We place them in clear, long plastic bags, then put the bags over Brian’s arms with this brown goo.”

  “Will that take care of the infection?” I asked.

  “It should,” he responded.

  By that point I thought, Okay. Whatever it takes to get Brian well, let’s do it. If you want me to go pick the maggots off a dead animal on the side of the road, I’ll do that. I’ll get whatever he needs to have.

  When the maggots, or sterile larvae, arrived, I thought I would gag. Combined with the stench from the infection and the green pus, only the sight of these ugly little creatures could have been worse. The nurses put Brian’s arms in a bag of brownish, maggot-filled juice. And as the maggots ate, you could see chunks of pus-looking gunk with bits and pieces of muscle tissue floating in the bag. It was ghastly.

  For three days Brian and I watched the maggots eat to their fill and grow. Brian could even feel them wiggle around on his arm. Fortunately they didn’t cause him pain—and they worked. Those lit
tle divinely created creatures worked wonders. Somehow God created those maggots to know exactly what tissue is dead and what’s not—right down to the cell level. For Dr. Jordan or Dr. Jeng not to use them and to debride Brian to get rid of the infection using a surgical instrument, would have been the equivalent of gutting him like a fish. For every piece of dead tissue they took out, they would take ten times as much good tissue. The maggots did a better, more precise job than what a surgeon could do with his scalpel.

  Brian

  At night the nurse closed the curtain to my room, and I was supposed to sleep. But I could see this yellow light through the curtain. I lay there for hours every night with the bed propped up, since they wouldn’t allow me to lie flat because of air constrictions. I would stare at that light, not interacting with anybody, just counting the seconds and minutes.

  I felt like a prisoner. My only surroundings were my room, the tank, and the nurses’ station that I shuffled laps around. For twenty-six days, the time I spent in the ICU was all I knew.

  On September 10, I jogged four and a half miles—from my Pentagon office, over a Potomac River footbridge, to the Teddy Roosevelt island, and back. I weighed 168 pounds. I was in the best physical condition of my life, and I felt great.

  Two days later even standing up was a challenge. The first time the nurses asked me to walk, two steps exhausted me.

  I was so swollen from the fluid building around the burns that I weighed more than 200 pounds.

  Each day in the ICU was essentially the same. It was a day-by-day, hour-by-hour observation. I experienced daily debriding, tank sessions, redressing of my wounds, and physical therapy.

  Every four hours the nurse administered my pain medication—which usually wore off after two to three hours. It was torturous to have to wait for my next dosage. They had to give me serious dosages of pain killers for everything—because everything they did caused tremendous pain above and beyond the initial pain from the burns.

  I was on several different medications. For the pain they gave me Dilaudid, a morphine derivative. I was on Adavan (an antianxiety medication), Diprivan (a sedative), and Versed (an amnesia drug), to help me forget. Benadryl was to help me sleep and to stop the itching once I started to heal. Everything was administered through my IV. But the quantities of Dilaudid they had to administer were unbelievably high since it only dulled the pain but never completely relieved it.

  In the mornings after the nurses administered the medication, it was time to remove my bandages. The bandages had to stay moist continually so they wouldn’t stick to my skinless body.

  The nurses cut the bandages and unwrapped me. Many times even though the dressings were wet, the pieces of gauze stuck and would have to be pulled off the muscle or tissue, revealing an oozing, pus-filled wound.

  Once that work was completed, I was placed on a gurney totally naked except for a light blanket. The nurses pushed my gurney around the nurses’ central station and into a room with a giant whirlpool—the tank.

  They placed me on a board made of hard rubber, strapped me to it so I wouldn’t fall off, then dipped me in the tank. The tank was filled with a warm water-chlorine-iodine mixture. Once I was submerged, they either cut away any nonviable tissue, or they scrubbed it off. They took towels and washed every burned area to clean it and to remove the dead tissue. It was like dousing an open wound with alcohol—and it was my entire body. After they finished the scrubbing, they lifted the board and rinsed me.

  I couldn’t move. I could only watch them scrub my arms and legs. I was a captive, and all I could do was pray for them to hurry and get me to surgery as quickly as possible. I kept thinking, Get it over with. Get it over with. Hurry. From the tank, they would often take me directly into surgery. That was the best part because the anesthesiologist would conk me out—the only time I was pain-free.

  Because of the amnesia medication, I don’t remember much. The amnesia drugs didn’t relieve the agony, they just helped me not to remember it. Sometimes they didn’t up the dosage enough—and I remembered everything. I remember very clearly at least five times in that dreadful tank. It hurt getting out of bed. It hurt getting on the gurney. It hurt being rolled to the room and then placed inside the water. Then came the intense sting, like little needles pricking every inch of my body.

  Once I was wet, the nurses began to debride me. It felt as if they were using steel wool washcloths—on top of the stinging. They were wiping a washrag over open wounds where, in some cases, it was directly on straight muscle. It was absolutely agonizing.

  One day it was so bad I didn’t think I was going to survive. I begged them to give me more pain medication, but they wouldn’t because I was going into surgery right after the tank session, and they were afraid the amount of medication would compromise the anesthesia. Finally Dr. Jeng came in and told me they couldn’t give me any more pain medication. It was Dr. Jeng’s way of saying, “Suck it up.” It just broke my heart. I felt as if I was drowning, barely holding to the life preserver, and they ripped it from me.

  Those memories terrified me. The moment when I would see the nurses roll in the gurney, I would tremble with the knowledge of what was coming next. Many days I would beg, “Just let me lie here and die. Please!”

  I remember distinctly another day when I was really worried about a tank session coming up. The day before, my night nurse, Michelle Howard, had given me some sort of amnesia medication just as they were bringing in the gurney to take me to the tank. They placed the gurney beside my bed, and I knew what was coming. It was like telling a convicted criminal, “Sit in the chair. We’re going to juice you.” But I didn’t remember much after that. The next thing I knew, I woke up back in bed. It was as if they were saying, “Oh yeah, your tank session is done.”

  But the next day I had a different nurse because I was going in the tank at a different time. She didn’t give me the same drug Michelle had given me. I told her adamantly, “You’ve got to give me that same drug again.”

  She answered, “No, we can’t do that.”

  I was in hell. I remember vividly everything about that tank session. It wasn’t only the pain of what they were doing to me physically; it was the mental torture and anguish of knowing they could do better than what they were doing. I thought, I know you can give me this drug. I’m not having surgery after this. You did it to me just two days ago. Now why won’t you give it to me again?

  The amount of time I spent daily in the tank was about fifteen minutes. But to get to and from the tank was an hour.

  The nurses changed my bandages twice daily. I visited the tank once a day unless I’d had surgery. In which case I didn’t go to the tank for five days afterward.

  On the days I didn’t have surgery, after the tank session, they returned me to my room and rebandaged me. First, they placed Silvadene on my body to act as a cooling and soothing agent—although not much for me was cool and soothing. They put the Silvadene, a white topical ointment, on a large rectangular bandage, then wrapped it around the burn area. They started with my arms and curled it like gauze. Then they wrapped the bandages on my fingers. Finally they turned me over and put them on my back. After they placed all the bandages, they wrapped this jacket-type article on and safety-pinned it together to keep the dressings in place.

  After a skin graft surgery, they would apply a yellow petroleum-like ointment wrapping called Xeriform. It contains a special substance that keeps the graft lubricated so it doesn’t stick to its covering.

  They changed the Silvadene twice a day. The Xeriform was removed after three days. They tried to do the bandage changes around ten in the morning and then again at ten at night.

  The dressing changes and the debriding in the tank took almost three hours daily.

  Then there were the surgeries. I was in surgery almost every day it seemed. I didn’t mind that; actually, I looked forward to those times since that was the only time I was relieved of pain. Yet even in my sleep I felt the slicing and throbbing.

&n
bsp; The surgeries were for debridements, excisions, and to graft new skin onto my body.

  The heat that’s generated from a burn literally cooks the water out of the skin. The skin goes from being a flexible living thing to something more like a tanned leather belt.

  There are three layers of skin: the epidermis, the dermis, and the hypodermis. With a first-degree burn, the top layer, the epidermis, has been burned away. A second-degree burn means the dermis and the epidermis have been burned away. With first- and second-degree burns the third layer of skin is still there, as well as the hair follicles, oil glands, sweat glands, and temperature sensors. Everything is still resident inside your third layer of skin, the deepest layer—including the skin pigment. With a third-degree burn, every layer of skin is gone. It’s called a full thickness burn, meaning that skin is completely gone. And what’s directly exposed is muscle.

  A third-degree burn cannot regenerate skin. So the third-degree burn must be closed by skin grafts. They prefer to take skin from other parts of your body that hasn’t been burned. Otherwise, they have to grow tissue in a lab, import it from other burn centers, or use cadavers or pig skin.

  They used all of the above on me. My arms and forehead had to have pig and cadaver skin as temporary grafts until my infections were under control enough to use my own skin. Fortunately, since my stomach and upper thighs escaped unscathed, they were able to use that skin as a donor site.

  I was burned over 60 percent of my body, with more than 40 percent third-degree burns. That’s a lot of skin grafts.

  My arms were complete third-degree burn losses. Everything was gone. If a burn is circular, in which a small portion of it is third-degree, the second-degree and first-degree burn area around it could eventually grow laterally and cover that area. But because I had such a large area that was third-degree burns, my arms had to be completely grafted.

  My stomach served as the donor site for my fingers, elbows, and face. For my arms, Dr. Jeng used my upper thighs.