The Burn Unit

By Alice Park

The first thing you feel is the heat. Even on a warm, sunny day, the patient rooms and hallways of the burn unit at New York Presbyterian Hospital are heated to 85[degrees] F. For the most severely burned, that's still not warm enough; with so much skin scorched away, the body can no longer keep up the temperature that internal organs need to function.

Within an hour of the second plane crash, a dozen patients--all with life-threatening burns--had been speeded by ambulance to this, the nation's leading burn unit, which by perverse happenstance is located about 100 blocks from Ground Zero. Because burns need immediate, specialized care, the most serious cases bypassed the emergency room and were sent directly to the special unit. By the next day, 25 victims had been admitted.

In the brightly lighted hallways, a sheet of paper taped to the wall inside each room tells the story: on front- and back-view sketches of the human body, doctors have shaded in burned areas and included handwritten calculations of the extent of the damage. In many cases, more than 70% of the body is darkened. "The intense heat and the inability to get away [are what] makes these burns so severe," says Dr. Roger Yurt, director of the unit. One patient, scorched by a fireball of debris, lies almost completely swathed in bandages under a tent of heat shields and blankets. Another, propelled forward by a ruptured steam pipe, is scorched along his back and the back of his legs but was miraculously spared on the entire front of his body--a stark representation of the arbitrary line drawn between health and injury, normality and trauma, life and death.

With so much skin compromised, the top priority for doctors is to keep a patient's body warm and hydrated. In the first 24 hours, the treatment is surprisingly simple: saline fluid--sometimes as much as 8 gal.--to keep up blood volume and stabilize blood pressure, and morphine for pain. Only after a patient is able to maintain normal blood pressure, says Yurt, can surgery begin--a painstaking process in which burned skin is scraped away and substitute sheets grafted in. And even then, only about 20% to 30% of the severely burned will survive.

--By Alice Park