Healing the Whole Patient
In the spring of 2014, Joseph Adam Mason was working an ordinary day when the unthinkable happened: a line broke off an insulator on the power pole he was working on, hitting his wrist
and sending 15,000 volts of electricity through his right arm and out his back.
“My vest melted to my back, my left arm had second degree burns,” Mason said. “My right arm and my back had third degree burns. My heart stopped for a little over a minute.”
The freak accident turned Mason into one of the 40,000 people who are admitted to hospitals for burn injuries each year. Though Mason was living in Mississippi at the time, his injuries were severe enough to send him to the Blocker Burn Unit in the John Sealy Hospital at The University of Texas Medical Branch at Galveston (UTMB), recognized as having the highest survival rate for major burn injuries in the country.
The Blocker Burn Unit was named for Truman G. Blocker Jr., M.D., a surgeon widely renowned for treating burn victims. Blocker held numerous positions at UTMB, from professor to dean, and was the institution’s first president. After treating victims of the 1947 explosion of a freight ship in Texas City, which killed over 600 and wounded thousands, Blocker championed UTMB as a leading center for burn treatment, research and education.
Today, the Blocker Burn Unit contains a six-bed intensive care unit that is uniquely outfitted for burn victims.
“If you are burned and you come to UTMB, you’ll be sent directly here for care—there’s no waiting in the emergency room,” said Jason Sheaffer, nurse manager of the Blocker Burn Unit. “For the nurses who work here, this is the only thing they do—take care of burn patients.”
Rooms in the unit are kept at a much higher temperature than normal hospital rooms to prevent hypothermia in patients, many of whom have lost significant amounts of skin, hampering their body’s ability to regulate temperature. Each room is also equipped with plumbing and drainage systems that enable patients to be washed right in the center of the room. Regular, thorough cleaning of wounds is vital for burn patients.
For patients like Mason who are admitted to the Blocker Burn Unit, wound cleaning and debridement, or the removal of dead and damaged skin, begins as soon as they arrive. New patients visit the tub room, which consists of several shallow, metal tub tables.
“They’re examined by a doctor and their treatment plan is made right here on the spot. If they require emergency procedures, we will do those right here. That would be everything from central line placement to escharotomies,” Sheaffer said. “After they’ve been here for a few days, they will start coming to the tub room daily for washing and wound care.”
Tub room treatment is provided by specialized nurses whose entire job revolves around tub room wound care.
“The bond between the tub room nurses and patients is really strong. It takes a great deal of trust between a nurse and a patient to get them through what is a very difficult experience,” Sheaffer said. “It takes a lot of training and experience and compassion to do this job.”
Training and education are central to Blocker Burn Unit operations. Most trainee nurses and physicians receive very little burn-specific experience, both in the classroom and in the field. Students at UTMB, however, benefit from being so close to a highly regarded burn treatment center. Surgical residents rotate through the unit for a month at a time. Plastic surgery residents return for additional training. The unit offers fellowships for physicians who have completed their residencies and are interested in additional specialized burn treatment training. Nurses also receive most of their training in-house.
“We have a long, six-month orientation process for new grads where they will come in and begin their training in the tub room for several weeks,” Sheaffer said. “Then they transition to the ICU where they learn ICU and burn care before moving into an independent role.”
Jong O. Lee, M.D., surgeon at the Blocker Burn Unit and Shriners Hospitals for Children-Galveston, and a professor of surgery at UTMB, began his career at UTMB in 2001 as a fellow in the unit. Lee said he did not have any exposure to burn treatment until his third year of residency, when he was sent to a burn center in Fort Wayne, Indiana.
“I really enjoyed the experience, and getting to take care of adults and kids,” Lee said. “When you take care of general surgery patients, you see them before surgery, they come in and have the surgery, and you might see them once after. Then they go home and that’s it. For burns, it’s a bit more prolonged relationship and I enjoy that.”
Lee also expressed the importance of teamwork in the unit.
“We emphasize a multidisciplinary approach to patient care,” he said. “We have doctors, nurses, physical therapists, social workers, a dietician, respiratory therapists. Everyone contributes.”
A typical day for Lee and the other physicians on the unit begins with rounds at Shriners at 7:00 a.m. The same physicians serve both Shriners, which treats pediatric burn patients, and the Blocker Burn Unit, though the nursing staff differs. During rounds at Shriners, a large team, including attending physicians, fellows, residents, medical students and nurses, discusses each patient. Then the doctors head over to the Blocker unit to visit patients there, review what happened overnight and plan the day’s agenda. After rounds, physicians head to surgeries at Shriners or UTMB. Afternoons are generally dedicated to patient care and bedside procedures.
Generally, Lee said, patients spend at least one day in the unit per percent burned. A patient burned over 20 percent of his body, for example, might spend about 20 days in the hospital. Admission time also depends on other factors, such as the severity of the burns, whether first-, second-, or third-degree.
Unfortunately for Mason, complications have prolonged his time in the Blocker Burn Unit. After his accident in the spring of 2014, Mason remained in the unit for about six months. Following his initial stay, he was in and out for routine checkups and additional surgeries, until his wounds became infected and he had to be readmitted.
His experience is not unusual—burn wounds are highly susceptible to infection. Despite the setbacks, Mason calls his time as a patient in the Blocker Burn Unit “a good experience.”
“The doctors are spectacular here and have done a wonderful job trying to save my arm—and we’re still trying,” he said. “They have a good crew here and they take care of me. I’ve gotten to be quite a family member here.”