Tuesday, September 28, 2010

The Saving Brother

I heard the patient's agonizing scream emanate from Room 31 just seconds before Nurse Carla ran up to me. "Dr. Jim," she said, grabbing me by my arm, "I need you in 31 right away." Her face was flushed, her voice edged with concern. Carla, usually calm and collected, had me worried with her nervousness.

As we hurried down the hallway toward the room, we were greeted by yet another gut-wrenching scream. Somebody was hurting. And hurting bad. We hear many types of screams in the ER--demented screams, angry screams, excited screams, drunken screams, etc.--but this primal scream from being in extreme pain was by far the worst.

"What's going on, Carla?" I asked her, intrigued as to what I was going to find when I walked through Room 31's doors.

"Bad burns," she said, "and trust me, your heart's going to drop over this one."

We walked into the room and I was surprised to find an eighteen year-old male patient sitting upright in his cot, completely naked. He was alone and crying. He was thinly-built with shoulder-length blond hair, his face painfully scrunched-up as a result of his despair. His hands were alternating between flailing and holding his genitals. The nauseating smell of burnt skin and hair permeated the room.

I rushed to his side while Carla assumed position on his other side, preparing to start an IV. On a quick, cursory exam, I saw that he had apparent burns to his lower abdomen, his inguinal areas, and his penis and scrotum. Poor kid.

I quickly introduced myself to him. Through abbreviated, gasping words, he told me his name was Matthew.

"Matthew," I said, "we are going to start an IV and give you some pain medication to make you more comfortable, okay?" He nodded his agreement while grimacing from his discomfort. I continued. "After we get you a little more comfortable, we'll talk about what happened. In the meantime, I need to perform a physical exam to see what the extent of your burns are."

Carla had an IV established before I was even done talking. "Morphine?" she asked. "Morphine," I answered, "and lots of it." After giving her some further orders for IV fluid hydration, she hurriedly left the room.

I looked closely at Matthew's head and face. He had no singed nasal hairs, no burnt eyebrows or lashes. I had him spit in a container. His sputum was clear. He had no stridor or difficulty breathing. All good findings to suggest his burns didn't affect his airway. His heart sounds were excellent. His lung sounds were clear. His abdomen, barring the lower skin burns, was soft and without pain. His extremities revealed him to have redness and blistering to the palms of both hands.

Next, as Carla administered the morphine, I focused on his burned privates. His entire penis was red and blistered but, thankfully, the burns were not circumferential. A band of burns that completely encircled the penis would have had potential to cut off the blood-supply to the distal part and that would have been very bad. Matthew's scrotum was also burned, red with significant blistering covering its entire surface. His groin area and proximal thighs on both sides were also a bright, angry red and blister-filled. His anus and rectal area had been spared.

Because of the location of his partial-thickness and potentially full-thickness burns, Matthew needed to be emergently transferred to a burn-unit with his injuries.

After making quick arrangements for his transfer, I returned to Room 31 to find a much more comfortable patient. Several nurses, including Carla, were bent over Matthew tending to his burns.

"Matthew," I said, "do you feel better." Groggy from the pain medications, he smiled a goofy grin at me. "I sure do, Doctor. Thank you."

He then went on to explain to me how he had received his burns. His younger ten year-old brother had been playing with fireworks when Matthew had happened upon him. His younger brother, Matthew continued, was holding an M-80 in his hands, lit, and was trying to slide it down a tube that wasn't wide enough. Matthew, watching with horror, saw the wick of the firework burn down to almost nothing and he decided to act.

"I ran up to my brother, Doctor, and grabbed the tube with the M-80 sticking out of it. I thought it was going to blow up in his face, so I snatched the tube and held it against my belly so it wouldn't hurt him."

As you can probably guess, the M-80 blew while Matthew was pressing it against himself. Although the force of the M-80 missed causing him significant injury, Matthew's clothes caught on fire, resulting in his burns. Matthew was a hero.

"Is your little brother okay?" I asked. "I think so," he answered, "he and my mom should be here soon."

I liked this young man. Here was a respectful, saving brother who risked his manhood, his life actually, to keep his younger brother out of harm's way. I had no doubt that if the exact scenario repeated itself, he would do the same thing.

Within minutes after our discussion, I greeted Matthew's mother and younger brother in the hallway outside of his room. They were both distraught and crying, their tear-stained faces looking expectantly at me for some good news. Especially the younger brother.

I put my arm around his trembling shoulders while I addressed them both. "Matthew is much more comfortable now," I reassured them, "but I have some concerns about how bad his burns may be. We're going to transfer him to the regional burn center so he will get the best available care possible for his burns."

The mother nodded. "Please do whatever you have to do to get Matthew better, Doctor."

I escorted them into Matthew's room, where the younger brother immediately bolted to Matthew's side, hugging him. "It's all my fault," he muttered between his free-flowing tears. "I'm sorry, Matt." The guilty weight of the younger brother was heartbreakingly evident. Matthew, as I knew he would, put his protective arm around his younger brother. "It's alright, bro. I'm just glad that you are okay." Mom came up then, wrapping her arms around both of her sons. Carla and I stepped out to give them some privacy.

We transferred Matthew to the burn unit without incident. Prior to his leaving, we wished him well and told his mother to please keep us posted as to his recovery. We all wanted Matthew to have the best of outcomes.

A few weeks later, waiting in my work mailbox, was an update letter from the receiving burn unit regarding Matthew's condition. I eagerly ripped it open, nervous about the news it contained. Thankfully, it held the best news possible. Matthew hadn't required any skin grafting and, although his burns were significant, they expected a full recovery without any permanent injury or damage.

Sometimes, things turn out just the way you hope they will. Cheers to Matthew.

As always, big thanks for reading. See you Friday...


Rogue Medic said...

Great story.

It is nice to see things work out better than expected.

The aggressive pain management can make a tremendous difference.

Laanykidsmom said...

Wow. I hope my children would protect each other this way. What a sacrificial act by the big brother!

Anonymous said...

A happy ending to an awful accident. At first, I was expecting the cause to be the all-too-common synergistic effects of ETOH, horniness, boredom, and flammable material.

And to think that MY sister still rags on me for a tiny eyebrow scar from an unintentionally badly thrown seashell...in 1966. I was eight, can we let it GO?

Pattie, RN

Leslie said...

Dang it Jim.

When I started reading this post, I was eating a slice of pizza...it is now lying on the plate (where it will stay...unfinished).

When I started this post I was not crying, now however....

I swear your posts need some kind of warning sign "be advised..this blog may cause tears, heartache, or laughter and joy...read/proceed with caution".

Of course, I have been reading your blog long enough to know this...

Katie said...

As soon as I read the word "burn" I subconsciously started rubbing my underarm...



<>< Katie

tracy said...

What an amazing young man. i want to be like him, if i ever "grow up".

Thank you so much, Dr. Jim.

Kate said...

Those screams. I hate them. They make my heart hurt. But that boy's heart is so deep. So, so deep.

Tiffany said...

ouch!!! I cant even imagine that type of pain!! What a self sacrificing, honorable brother matthew is. great post as usual!

CeeCee said...

You needed a happy, respectful teenager story I'll bet. I would think, in the ER, you would see the ones that make bad decisions on so many levels.
Thanks for sharing.

emmy said...

This story had me in tears. I have seen my two boys go at each other to the point of pushing each other through walls, but when one or the other is in real danger it is the other that is there trying to protect. The fierceness of their competition and their love for each other never comes short of amazing me. I'm glad that you were there for Matthew and his brother and that Matthew is doing well.

type1medic said...

Those screams are ones that we in emergency medicine will never forget. I am amazed at this boy's act of selflessness. He is an amazing young man.

911RN said...

This one brought me to tears. As the mother of two boys, I hope mine would be as protective of each other. Great kid, even better brother, sooo glad he had a good outcome.

Jacqueline said...

I like this ending :)

Karen said...

I'm so glad things turned out the way they did. I worked with a 20-something man (lab tech) years ago. He and his not much older brother (a high school teacher) were trying to get rid of tree trunks on their father's land. The lab tech mixed up a potent batch of explosives and in the end, his brother was blinded for life. How guilty he must have felt and how sad.

Wren said...

What a courageous young man. I was so glad to read that he wasn't hurt permanently, Dr. Jim. Great post, and even better since it's true. :o)

SeaSpray said...

What a heroic young man!

They sound like a loving family.

I'm glad he had a good outcome and good for the younger brother too.

Glad you got the win on that one. :)

Anonymous said...

Wow...fabulous story. Matthew is a true hero...it sounds like he comes from a solid family that genuinely cares for each other.


coulrophobic agnostic said...

See, I always wanted a big brother. Sounds like this kid got a great one.

I don't even have a wang and I was cringing reading this. Poor guy, I hope karma is kind to him and he heals up quick.

Next time, though, maybe he should just shout at little bro to drop it!

Anonymous said...

What a touching story. You can also add me to the list of folks who weren't crying when they started reading the post. I'm glad the boy is on the mend and find myself wishing I had a big brother, too.