365 Days (26 page)

The corpsman found a small, unburnt area near the elbow and plunged the needle into the skin. David, watching him, visibly relaxed. He turned his head on the board and looked at Edwards.

“We can help you grow new skin, stop your infections, graft you—if it comes to that. But it will all be for nothing if you leave here with all your joints tied down by scar tissue. If you don’t exercise and keep the scar tissue and new skin over your joints loose and flexible it will tie ’em down like iron. All that new skin and scar that will be forming has a tendency to contract with time. If you don’t keep it loose, you’ll leave here as much a cripple as if someone had shot off your arms and legs. Your hands aren’t that bad, David. We’ll start today with them.”

“But I can’t hold a fork.”

“We’ll put wooden blocks on them, and as you get used to handling one size, we’ll make the blocks smaller. Understood?”

“Yes, sir.”

“You married, David?” Edwards asked.

“No.”

The corpsman, pulling off a piece of skin, left an area red and oozing. David, stretched out and relaxed in the water, his head bobbing a bit, didn’t even notice.

“Engaged?”

“Yes, sir.”

“Would you like me to write her for you?”

David closed his eyes. “No, sir, I don’t think so.”

“All right. I’ll check on you later.”

When he got back to the office he found Johnson working at his desk.

“Coffee?” Johnson asked.

“No, thanks.”

“We’re getting three more today. Colonel Volpe called. Apparently you said you’d be too busy to take two VIP’s around.”

“That’s right, I’m no goddam press agent. You show ’em around.”

That evening, despite the fact that Johnson was on call, Edwards went back to the ward. All the patients had been settled in for the night. The ward master was in the treatment room, cutting adhesive tape into twelve-inch strips.

“What’s new, White?”

“Nothing, Doc, really. Same old thing.”

“How’s Jensen doing?”

White put his scissors back into his pocket. “He’s doing all right. We drew two blood cultures on him this evening and sent a titer off for moniliasis. He had some difficulty using the blocks, but he got a few bites down; seems as if the sulfamyelon is bothering him—stinging him. You never know who it’s going to bother.”

“And the three new ones?”

“They’re OK,” White said. “Hardly burned at all. Don’t even know why they came here.”

“It’s the Army’s idea,” Edwards said, and giving him a parting pat, walked out into the unit. David was on a Stryker frame halfway down the ward, lying on his stomach. White sulfamyelon cream was smeared all over his burned back, buttocks, and legs.

“How’s it going?”

“Fine, sir.”

“The ward master told me that you did all right at supper.”

“Yes, sir.”

Later that evening, one of David’s blood cultures began to grow out Pseudomonas arinosa. The bacteriology lab called the ward, and the ward master called Edwards. He told the ward master to restart David’s IV and put him of 200 mg of polymyxin every four hours.

The next morning, after rounds, Johnson got him alone. “About Jensen’s polymyxin,” he said. “Do you think his kidneys are good enough to handle that big dose?”

“What would you suggest?” Edwards asked.

“You could destroy his kidneys with that much polymyxin.”

“I could save him too.”

“If he’s going to die,” Johnson said, “he’s going to die. He’s 80-percent burned, and his blood culture is already growing out pseudomonas.”

“I know. That’s the great thing I learned from my trip back to America. His death is expected. It is expected since there are 80 percent burns, and it is expected that 80 percent will become septic. The whole thing is expected. You’re supposed to get burned in Nam; you’re supposed to get your legs blown off; you’re supposed to get your chopper shot down; you’re supposed to get killed. It’s just not something that happens. It’s expected.”

When Edwards came back to the ward, he found David lying on his back, and the corpsman was smearing on the last of the sulfamyelon, spreading it over David’s charred stomach as if it were butter.

“This stuff stings, honest, Doc,” David said. “It just keeps stinging.”

“I know,” Edwards said. “It does that sometimes, but it will get better with time. You sort of build up a tolerance to it. The point is that you need it now. It keeps your skin from getting infected and gives the new skin a chance to grow. Believe it or not, sulfamyelon is one of the major breakthroughs in the treatment of burns.”

“Can’t I have something for the stinging?”

“No, David, I’m sorry.”

That evening, down in the hospital bacteriology lab, his second blood culture started growing out another patch of pure Pseudomonas.

When Edwards came to work up the new admissions the next day, he stopped by to see David. Unable to lift his head, he was fitted with prismatic lenses so he could see around him without having to lift his head. Someone had hooked a book rack onto the frame, but there was nothing on it. He was just lying there with the glasses on, staring at the ceiling.

“I asked the therapist for a mirror today,” he said before Edwards had a chance to say hello.

“What did she say?”

“She didn’t say anything.”

“This is not the time for mirrors,” Edwards said. “When things start healing up, I’ll get you one. Don’t worry, David, we’ve had guys here a lot worse off than you. They all healed. It took a while, but they did.”

That afternoon they got in two more burns from Nam. One was from Laos. At least that’s what the soldier said; his records read Vietnam.

In the evening, Edwards brought David a book. He found him on his stomach again, and he put the book on the night table next to the frame.

“How does the skin grow back?” David asked, speaking to the floor. The day before he had mentioned that there were sixteen different colors in the floor tiles. “I mean, where’s it gonna come from?”

“From you.”

“Yeah?” David said. “How?”

Edwards pulled up a chair. “You have enough, you don’t really need very much,” he explained. “The skin grows back from the areas around the hair follicles; the follicles go down pretty deep, down into the area below the skin. Below the burns the new skin grows out from the lining of these follicles, like grass out of a valley. These linings are like nature’s reserves. The new skin just keeps growing out from them, creeping over the burned area, until all these little growing areas come together.”

“Why am I going to have to be grafted then?” David asked sullenly.

Edwards sensed the despair in his question. “Sometimes,” he said, trying to sound reasonable, “if the burns are too deep, deep enough to destroy the follicles, then there is no skin to grow back, so we have to graft.”

“Where are you going to get the skin for that?”

“From your friends, David,” Edwards said gently, “from your friends.”

The morning culture again grew out Pseudomonas. That afternoon they took David to the operating room and covered his legs and part of his stomach with cadaver skin. When Edwards visited him again that evening, he complained that his head hurt and that the sulfamyelon was stinging even more.

“What will you do when you get home?” Edwards asked.

David was sullen. “School, I guess.”

“You’ve got to be more positive than that,” Edwards said coaxingly.

“I was positive before I got burned.”

“I’m telling you, you’re going to be OK.”

“I didn’t even see it,” David said reproachfully. “I was just walking. I wasn’t even point. I swear to God, I didn’t even hear it. Can you believe that?” he said loudly. “I couldn’t even goddamn hear it.”

Within three days the cadaver grafts failed, refused to take, and Edwards had to order it pulled off, like the rest of the dying skin. David, lying in the water, saw him as soon as he walked into the treatment room.

“I’m handling it, dammit,” he said belligerently. “Just leave me alone, will you? Just goddamn leave me alone.”

That evening David ignored his presence.

“I saw you with some letters this afternoon,” Edwards said, noting that the whitish scar tissue under David’s chin had a pale greenish cast to it. “Nice handwriting. Your girl?”

“No, my family.”

“What did they say?”

“It’s in the drawer.”

Edwards opened the drawer of the nightstand next to the frame. It was a rather bright letter, careful, measuredly written, filled with support and concern. There was a section about Carol, how much she loved David and how happy she was that he was finally out of the fighting.

“Did you answer?” Edwards asked.

“I didn’t know how.”

“They know you’re burned,” Edwards refolded the letter. “It seems to me they’re holding up quite well. The least you could do is help them out.”

David slowly turned his head. His eyes, hollow holes, stared coldly and defiantly at Edwards. “I’ve been throwing up all day. I can’t keep anything down.”

“Yes,” Edwards said calmly, putting the letter back in the drawer. “I know.”

“I’m not going to make it, am I? No, no, don’t interrupt. I know I’m not. That stuff you keep putting into my IV bottle—the only other guys who get it are the ones on respirators. I know,” he said, almost triumphantly. “I’ve checked on the way to the whirlpool. I know.” It was all there in his eyes—the pain, the suffering, the loss of belief.

It caught Edwards off guard. “I told you about the pain, didn’t I?” he said angrily. “Have I bull-shitted you yet? Look, if you were going to die, I’d let you know. Right? I’d give you the chance to tie things up, understand?” A certain distance entered David’s stare, a vague confusion that was more pathetic than his glaring hopelessness.

Edwards got up. “Now, dammit,” he said, “I want you to think of an answer to that letter. I’ll be back in the morning and I want an answer. Is that clear?”

Depressed and angry, he left the ward. Outside he passed groups of patients from the other wards, some standing around talking, others doing nothing, or being pushed around in wheelchairs by their buddies. Johnson was right, he thought. David would die. He was probably, all things considered, dead the moment the round hit the rucksack.

Edwards went back to his room and sat there on the edge of his bed. There was really nothing left to do. Almost unconsciously he got up and walked wearily over to his desk, pulled open a drawer, and took out a folder that contained a passage he had once read. It had struck him so forcibly at the time he had made a Xerox copy of it.

...the dying experience is extremely traumatic to the young adult, to his family and the treating staff. The meaning of dying is appreciated by the young adult, but the reality of personal death is not accepted. He lusts for life, he now has the full emotional capability to sense the personal depth of meaning in death. As he strives for self-sufficiency and for independence, he can appreciate clearly the total passivity and the absolute dependency of the dying experience. In the solitude of death, the young child or the mature adult can turn to another for comfort without feeling childish or dependent. The newly emancipated, self-sufficient young adult may have too much personal pride to allow himself to accept the support and the understanding he so desperately needs as he moves toward death. The specific emotional reaction of the newly mature young man to the prospect of personal death is RAGE. He feels that life is completely within his grasp so that death above all else is the great ravisher and destroyer. These mature young men who have worked, trained and striven to reach self-confidence and self-sufficiency now appreciate what they can do and what they can enjoy and that suddenly it will all end. They are so ready to live, to them death is a brutal, personal attack, an unforgivable insult, a totally unacceptable event. The intensity of his natural understandable rage at this process of dying may cause an accentuation of physical pain. Normal bitterness may be expressed by lack of cooperation or even by open antagonism. The dying young adult may alienate himself from his family. If the physician and the treatment staff can understand this natural rage that they see in the young adult about to die, they may be able to help him cope with his emotional reaction in a fashion that does not disrupt the necessary treatment. The young physician himself responds with the normal rage reaction of the young dying adult. He sees death as a destroyer that must be fought with every means possible. This normal, youthful rage may lead the physician to assault the dying patient with all kinds of treatment procedures in an attempt to keep death away. The task of the physician is not to comprehend the incomprehensible, but to make the natural work of death and the mourning the most meaningful and most productive for the people with which he deals.

The phone woke him a little past three in the morning.

“Major!”

“Yeah.” Edwards fumbled across the night table for the lamp switch.

“This is Sergeant Cramer. Jensen’s temperature just spiked to 105.”

“OK,” Edwards said, switching on the light and sitting up. He cleared his throat. “I’ll be right over.” Even as he was hanging up, he was reaching under the bed for his shoes.

The ward master met him at the entrance to the unit and followed him hurriedly down the ward.

“He’s becoming disoriented.”

“What about the cultures?” Edwards asked quickly. “Still Pseudomonas?”

“No, this morning’s grew out Klebsiella.”

David was lying on the frame. All the covers were off, and he was trembling.

“106,” the medic said, reading the stool-smeared thermometer.

“Better add some kanamycin and Keflin to the Chloromycetin. How’s the blood pressure?”

“Stable.”

“How much kanamycin and Keflin?” Cramer asked.

“A lot, a lot. Just get it!”

Cramer looked at him and quickly left to get the antibiotics.

“David, David,” Edwards leaned over the frame. “David!”

Slowly he opened his eyes, but there was no light in them, no gleam.

“Listen,” Edwards said, lowering his voice. “I’m going to have to put you on a cooling blanket; it’s not going to be comfortable, but your temperature...”