Refined by Fire

by Brian Birdwell

  He was starting to heal—even though it was a long, slow process. On October 1, I saw his unbandaged fingers for the first time since his surgeries. They looked like real fingers again.

  By October 4 he was completely off the ventilator and breathing on his own. He received a plug for his trach and was able to talk to me now. It was exciting to hear that beautiful voice again. I was hoping his first words would be “I love you.” Instead, they were “I’m tired.”

  After twenty-six days in the Burn Unit’s ICU, Amy, one of Brian’s physical therapists, announced that Brian was ready to be moved to step-down care. I was excited and scared at the same time. ICU was like a safe little cocoon; it had been our safety zone. What would we experience in step-down?

  Thirteen

  Moving to Step-Down

  * * *

  Journal 10/8/01

  Well, this is the day. Mike is his nurse today. Day 27: The day we move from ICU 4H6 to 3E32. It’s exciting but scary. . . . Mike and I busily began packing up all Brian’s things and getting everything ready to go to step-down care. Lord, I’m scared and nervous about this move. Guide us through this process. Give me a peace that passes all understanding.

  * * *

  Mel

  On the morning of October 8, Brian went to the physical therapy gym on the Burn Unit rehabilitation floor, in step-down care. While he was gone, I received word that we were moving out of ICU. I was busily packing Brian’s belongings when the nurse manager approached me and gave me a lecture about how different step-down would be from ICU. “Step-down is about Brian doing everything for himself,” she said.

  I thought, Man, these people are in serious need of compassion!

  Brian finished therapy, got settled into his new room in step-down, and promptly began choking. He desperately needed suction to have the mucus cleared from his throat and lungs. We were ignored.

  This is going to stink, I thought, dreading the upcoming weeks. This was such a huge shock and difference in the level of care.

  ICU was great because his personal nurse was right outside his door. No matter what he needed, that person would take immediate care of him. In step-down the nurses each had four patients, so nobody was the number-one priority. Brian was no longer going to have his needs met instantly.

  Fifteen minutes later I walked down the hall to find somebody to help Brian. The nurses had been helping their other patients. I finally found someone to help him. While he was being suctioned, I waited out in the hallway, pacing and praying. Dale Turner, the nurse practitioner, approached me and asked if I was all right.

  “No, really I’m not,” I said and started to cry. “I am so scared about Brian being down here. It was so much easier in the ICU. And this is the unknown.”

  “Well,” Dale said in a compassionate tone that told me she’d given this speech many times before, “in my twenty-five years of working here, we’ve never had a patient die in step-down care. If he were still critical and near death, Dr. Jordan would not have allowed him to leave ICU. So practically speaking, he’s going to be okay down here.” I found her words reassuring because I thought, Okay, I guess he isn’t critical anymore. But I still had to pray for God to give me strength and patience in dealing with the staff.

  The next several days were trying for us. We had to readjust to new staff, new surroundings, new routines, new pain.

  One of his physical therapists coldly informed me that Brian wasn’t doing his facial exercises enough and that his face was going to scar because of it. Brian overheard her and became frightened. But being a soldier, he decided to step up to the challenge. He informed me that he intended to work extra hard in rehab.

  During this time another patient’s father stopped by and told Brian that he’d definitely face medical retirement. That was exactly what Brian didn’t need to hear. After the man left, I closed the door, and we had our first cry together. It was devastating to see my tough guy, soldier husband sobbing. Fortunately, that night the staff permitted me to sleep in a recliner in Brian’s room. I didn’t feel comfortable leaving him alone with those worries swirling around in his head.

  Brian

  Wake up, breakfast, medication, physical therapy, lunch, nap, medication, physical therapy, dinner, medication, shower, dressing change, medication, sleep.

  Then start all over again.

  Day in and day out, it was the same routine.

  I had surgery again two days after I moved to step-down care. Dr. Jeng put Integra on my arms, which is a synthethic material that would teach my skin buds how to act like dermis. He didn’t anticipate any more surgeries for a while unless I caught another infection.

  I grew more excited each day watching the seeding and skin buds grow from the grafting.

  My bandages were still changed twice a day. But no more tank! Now I took showers. I sat in the stall while a nurse squeezed a sudsy washcloth filled with antibacterial solution on me. She scrubbed some of the areas that weren’t burned. But for the donor sites and areas that still had no skin, the nurse just carefully let the soapy solution ooze from the rag onto me. Then she’d rinse me, help me stand, and dry me. The cleaning still stung—but it was paradise compared to the debriding sessions in the tank.

  I was still dependent on others for simple tasks such as bathing or shaving. At times that was frustrating, because I wanted to do things for myself.

  I established a rule. Visiting hours began at eight in the morning, and I informed Mel that when the clock struck eight, she was to be in my room, “standing tall!” She laughed and said, “Gladly!” I wanted her to be near me as much as possible.

  On October 11, the one-month anniversary, there was a memorial service at the Pentagon. Colonel Rota escorted a group of family members from the hospital. I was relieved when Mel said she would rather stay with me to watch it on television. We watched the President say a few words, and I saw the ghastly façade of the wrecked Pentagon’s west side, the side where I had faced death. The scene brought back all the wretched memories of that morning, and Mel and I sat and cried together. After the service was over, I confessed to Mel, “Sometimes I wish I hadn’t survived because of everything I’m putting you through.”

  Mel

  When Brian confided that to me, I tried to reassure him that it was a privilege to care for him and that my love for him was deeper than ever. That evening I returned to my hotel room and wrote in my journal:

  To you, Brian, when someday you read this: It was heartbreaking to see you agonizing over how this is affecting me. You are the most amazing man I have ever known. You are strong, loyal, kind, respectful, and genuinely sensitive. The depth of my love for you is immeasureable. You are the most precious gift God has ever given, and it is a privilege to be your wife. I love you.

  I knew I couldn’t say those things without crying. So I wrote them.

  The next day I walked into his room and knew immediately from the strange, familiar, putrid smell that his infection had returned.

  During our devotional time together I looked up all the references to suffering in my Bible’s concordance. We came to 1 Peter 5:10, which said, “After you have suffered for a little while, the God of all grace, who called you to His eternal glory in Christ, will Himself perfect, confirm, strengthen and establish you.” After I read that, we both stopped and looked at each other. I couldn’t believe this verse summed up our experience. This was a huge moment for us spiritually. I stood up and wrote out the verse on Brian’s dry erase board that hung on one of his walls. We needed to read that verse every day.

  After our study I prayed,

  Lord, I know you are going to be glorified through this tragedy and you’ve used Brian to touch many lives. I know you will use him and his story in a mighty way to glorify you. What a privilege you have given him to be able to have such a powerful testimony in sharing Christ boldly. And while we look forward to our future together, I pray that you would heal him of this infection, that you would relieve his pain, and that you woul
d bring him comfort as we walk through this suffering.

  Brian

  Back to surgery. The staph infection was back with a vengeance. It covered my entire arms, forehead, and ears.

  During surgery, Dr. Jeng applied Acticoat to my forehead, ears, and arms. Acticoat is a gauze wrap that contains silver ion and other nutrients to help the healing. He also applied Xeriform, the mineral oil wrap, and medicated creams.

  The night nurse was responsible for keeping the Acticoat wet because the water would help my body absorb the silver ion and other nutrients into my skin. After the nurse moistened the gauze, she would place chucks over my arms. These chucks were plastic-backed covers to ensure that the rest of my body remained dry while my arms stayed wet and cold.

  Normally before showers and bandage changes I’d receive two milligrams of Dilaudid for the pain. After the showers and bandage changes I received two more milligrams of Dilaudid.

  Several days after the surgery, it was time to remove the Acticoat. Minnie, one of the nurses, administered the shot of pain medication directly into my IV, walked me to the shower, and began to clean and remove the dressings. Everything came off without a problem—until she got to my forehead. She started to peel off the Acticoat . . . but my face came with it. It was stuck.

  She tried to remove it gently, but it was so intensely painful that I started to tremble, then shake violently. She removed a quarter of the Acticoat, then stopped. My forehead was bleeding, and the blood was running down my face.

  She ran to the nurses’ station and asked a resident physician for permission to give me another two milligrams of Dilaudid. She administered it directly into the IV and waited for it to take effect.

  I would have given anything not to have her remove any more, but I knew that was impossible. I told Minnie I was ready to try again.

  She started to pull it again. But chunks of skin and tissue continued to peel off. I was still bleeding, and the Dilaudid wasn’t helping! I started to shake violently again, and my tears mixed with my blood and streamed down my face. Minnie started to cry and ran to get the resident.

  She returned to the shower with one of the residents, who took one look at me and gave the okay for another two milligrams of Dilaudid. I would have six milligrams running through me, a dosage close to making me unconscious enough for surgery.

  Minnie waited for a few moments and began again. She was still crying and extremely distressed over what she was doing to me. While I no longer shook violently, I still trembled. I still felt the pain of her peeling off my forehead.

  When the Acticoat was removed, Minnie gave me my bath. She tried to wash the area with a cloth. Then she wrapped cotton around my head, and dressed my arms and the other burned areas. We walked back to my room, where she helped me lie down on my bed.

  I don’t know if the Acticoat initially helped the infection. But in those moments of peeling it off, whatever good Dr. Jeng thought the Acticoat would do, it had just done twice as much damage. My face was now one big gaping wound, and the staph infection would get worse. Now it would move into my eyes.

  Mel

  The next morning a hospital visit to the ophthalmologist confirmed that Brian had an eye infection. The ophthalmologist was concerned that the staph would damage tissue around Brian’s eyeball. He prescribed liquid antibiotic drops, which seemed to help. I tried to aid the nurses when I could, since they were so busy with all their patients. So I swabbed Brian’s eyes to clear the fluid and clean the mucus around them.

  The worst part of the infection was on his forehead. Brian’s face had only second-degree burns. But because of the infection, Dr. Jordan treated it as a third-degree burn. So Brian went back into surgery. Dr. Jordan shaved off Brian’s forehead, basically peeling it to kill the infection. Then he grafted Brian’s forehead, using cadaver skin just to close the wound.

  When he came out of surgery, Dr. Jordan told me, “He cannot under any circumstance touch that graft.”

  The one night he was forbidden to touch his forehead was the night he decided he had to lay his arm there and potentially ruin the graft.

  It was like wrestling a wild beast that night. I sat beside his bed, and every time he moved, I wrestled his arms down. Because he was so drugged, he didn’t understand why I was being cruel and not allowing him to do what he wanted! The next night they brought in a sitter who watched him all night to make sure he kept his arms away from his forehead. The following night the nurses strapped down his arms. They placed Velcro on his bandages, then on the side of the bed. He was angry. “This is not a good plan!” he kept saying.

  He played the woe-is-me part so well the nurses finally accommodated him. After three nights of not being able to touch his forehead, they removed the straps and allowed him to touch it. By that point, it didn’t matter; the critical part was past.

  Several days later Nancy Fox, the social worker, approached me, concerned about my well-being. “I think you’re bordering on a mental breakdown,” she told me.

  I wasn’t sure how to respond. I thought about several incidents that had happened just within the last few weeks and realized she was right; the stress was taking its toll on me.

  I remembered the night the nurse gave Brian Ambien to help him sleep. She was supposed to give him five milligrams and gave him ten instead. In the middle of the night he was still awake and tried to reach one of the nurses. But he couldn’t find the call button, which they had placed at his feet. For some unknown reason, he decided to get out of bed. Because he was so medicated, he couldn’t get his balance and crashed onto the floor.

  Then earlier in the week Debbie Vance had spoken with me about Matt. She was worried because he wasn’t eating and had stopped applying himself in school. So I called and spoke with him. He admitted it was hard for him to focus. He was homesick and worried about Brian.

  Then there was the incident with Brian, in which a nurse tried to teach him to eat with a prosthetic that Amy, one of his physical therapists, had made him. It was so painful and frustrating for him that he eventually threw down the prosthetic and dove his face into his Jell-O.

  Then I thought about the day Dr. Jordan decided to cast Brian’s arm to try to straighten it. He would straighten Brian’s arm, cast it, and then a couple days later, cut out a wedge and straighten it more. While it would be painful, it would help his flexibility.

  Because Dr. Jordan decided on the cast during surgery, when Brian recovered from the anesthesia, he took one look at the cast and went berserk.

  He kept yelling wildly, “Why is there a cast on my arm? They broke my arm!”

  I tried to calm him without much success. A resident physician, Dr. Phil Ragland, was in Brian’s room and couldn’t understand what Brian was yelling because the plug in his trach, which helped him talk, wasn’t in.

  I tried to explain that Brian thought his arm was broken.

  “What?” the resident said, looking distressed.

  “Because of the cast, Brian thinks his arm is broken.”

  Finally Dr. Ragland understood and said, “Brian, no. Your arm’s not broken. Everything is fine. The cast is to straighten your arm.”

  With all the medication in Brian’s system, he was like a wild man. We couldn’t get him to calm down and listen so he could understand. So they gave him medication to knock him out.

  While waiting for the medication to take effect, Brian kept screaming and thrashing. I tried to talk to him, rubbing his feet to calm him down.

  Finally Brian was able to understand that his arm wasn’t broken. He calmed down, then drifted off to sleep.

  I began to shake and cry.

  Another extremely stressful event was the anthrax scare, which panicked me because they’d discovered anthrax at our main DC post office. A Kansas City reporter had written an article about Brian being a huge Kansas City Chiefs fan. In the article he’d encouraged readers to write to Brian. We were inundated with letters! It was wonderful for Brian—the outpouring of love and support from people
all over the country. But I became fearful of touching the bags and bags of mail, afraid one of them would have anthrax on it. I obsessed over the anthrax. While I knew my thoughts were ridiculous, I couldn’t change my thinking.

  Then, when Matt was spending the night at the hospital hotel, he threw up all night. I started to cry, afraid Matt had anthrax. I was becoming hysterical and knew I had to do something to calm down. When Brian went into surgery, I drove to Walter Reed Medical Center to see an Army physician. I explained my symptoms: a cough, heaviness in my chest, night sweats, panic attacks, and my unusual exposure to large volumes of mail. The physician thought I should be tested for anthrax and started me on antibiotics as a precaution.

  A few days later I received word that the anthrax test was negative. I was relieved.

  Brian

  Physical therapy was the bane of my existence. There were times in step-down when the nurses would have to administer so much pain medication to help me through physical therapy (PT) that I would mentally float. There were other times when I left PT in tears, begging for God to let me die.

  Because grafted skin has no flexibility, I had to work my body to force it to bend, stretch, move, and grip. Otherwise it would scar and become so stiff that I could be paralyzed.

  The nurses would inject me with a shot of Dilaudid before I went to PT because the therapists were going to work my range of motion and “crank” on me, bending me the way my skin and joints should bend. I compared it to trying to bend a cracker without breaking it. It was taking leather and turning it back into skin again.

  During my sessions I started with a paraffin wax treatment to warm up and loosen my skin and muscles and to soften the scar tissue. The therapist would wrap my hands with coban tape, then put the paraffin on me. While I knew it was hot, I couldn’t determine how hot since I’d lost my sense of temperature with my skin.