Caring for Cary
It takes special knowledge and equipment to treat a burn victim. And it takes special skill and understanding to treat a child. When the burn victim is a child, expertise must rise to the very highest level—like that found at Bridgeport Hospital.
It's been nine months since it happened, but Newtown resident Neal DeYoung's eyes still well up whenever he thinks about Halloween 2004.
That night Neal and his wife, Suzy, went trick-or-treating with their three children: daughter Quincy, age 11, and sons Cary, seven, and Barrett, six. "I was dressed as a Black Rider from ‘The Lord of the Rings,'" Cary explains. The family ended the night with a stop at a neighbor's house. There, Cary's sleeve somehow caught fire. In one brief moment, the DeYoungs' lives changed.
"I smelled smoke. I looked down at my hand and I saw fire," Cary remembers. "I was in shock." Neal and Suzy, waiting in the car a few yards away, heard screams and saw flames. "We ran," Suzy says.
The flames were quickly put out. Within minutes, damp towels were applied to Cary's burned hand and neck, and an ambulance was on its way. Within half an hour, Cary and his parents were in the Emergency Department (ED) at Bridgeport Hospital.
Why Bridgeport Hospital, half an hour away from Newtown? Because the emergency medical technicians and the DeYoungs agreed that Cary needed an expert burn team to care for his injuries—and Bridgeport Hospital has the only dedicated Burn Center between New York and Boston.
In Bridgeport Hospital's ED, Cary's condition was swiftly evaluated. Although the most severe burns (third- and fourth-degree) were on his left hand, Chief of Surgery Nabil Atweh, MD, was more concerned about Cary's neck and chin, which were also severely burned. Facial burns are often accompanied by damage to the airway caused by breathing in heated air and soot, and by swelling. Many burn deaths are caused, not by the burns themselves, but by airway damage.
Philip Fidler, MD, Medical Director of the Andrew J. and Henrietta Panettieri Burn Center, conferred with the DeYoungs and pediatric intensivist Mary Lou Gaeta, MD, and decided that Cary needed a breathing tube to keep his airway open. "I hated it," Cary says—but the tube, delivering oxygen to his lungs, may have saved his life.
Attention also focused on Cary's hand. Burned tissues tend to swell, and burned skin, or eschar, does not stretch, so there was a danger that as his hand swelled, the unyielding skin would compress blood vessels, cutting off circulation to the fingers. So one of the first steps the Burn Team took was an escharotomy—incisions on the top and sides of his hand to release the tight skin, freeing his vessels to transport blood to the hand.
After his initial evaluation and treatment in the ED, Cary went to the P.T. Barnum Pediatric Center, where the entire staff is especially dedicated to the care of sick or injured children. Dr. Gaeta, who is also Medical Director of the Center, took the lead in working with the Burn Team to help Cary recover.
There's a strong partnership between the two Centers: The Burn Center staff focused on Cary's burns while keeping the whole patient in mind; and the Pediatric Intensive Care Unit (ICU)—the only one in Fairfield County— focused on the whole patient while keeping his burns in mind—a delicate balance of multidisciplinary skills.
Critical care nurses in the Pediatric ICU monitored Cary's fluids, pain medication, protein levels and nutrition, and kept a sharp eye out for any signs of infection. After Cary was stabilized, he was moved to the regular Pediatric Center.
Because so much protein is lost in the fluid that weeps from burns, nutrition is critical. Dietitians were part of Cary's team, making sure he received the needed nutrients. For a few days, while he was unable to swallow, Cary was fed through a tube. Then he received nutrients through an intravenous line, and finally, toward the end of his stay, by mouth. His first choice for solid food? Pizza, of course!
The goals in treating Cary's burns were to save as much tissue as possible; to make sure that Cary's scars would not prevent him from breathing, speaking, swallowing, or moving his head; and to ensure that his appearance would be very close to normal. To accomplish these goals, the Burn Team used a series of sophisticated techniques to promote healing and preserve skin:
- Artificial skin. A tissue-thin layer containing human skin cells was applied, almost like a bandage, to protect Cary's tissues from infection, prevent fluid loss and provide an opportunity for his own skin to heal as much as it could.
- Living skin substitutes. These live skin substitutes, some from the skin of animals and some from organ donors, temporarily kept Cary's wounds from growing larger and deeper, and promoted further healing.
- Grafts of Cary's own skin (autologous grafts). Once healing was under way, the Burn Team could assess which areas required autologous skin grafts. Dr. Fidler and plastic surgeon Harvey Bluestein, MD, used very thin layers of Cary's healthy skin to permanently cover these areas.
Throughout this time, both the Pediatric Center and the Burn Center teams always remembered that Cary was a little boy, not just a burn patient. His parents helped in this goal. "We decorated his room with cards, posters, banners—it looked like a candy store," says Suzy DeYoung. Either Neal or Suzy stayed with Cary every night, and one memorable night his little brother, Barrett, had a sleepover in Cary's room. And although Cary's dressing changes were usually done in the Pediatric Center, they were never done in that room. It remained a place of refuge for Cary.
Cary's doctors and nurses were careful to earn and keep his trust. During his month-long stay, close relationships developed between the DeYoungs and the Burn and Pediatric teams. (In Dr. Fidler's office, a model of Harry Potter on his Turbo 2000 hangs from a thread over the desk—a gift from Cary.)
Today, nearly a year after he was burned, Cary still wears an elastic glove on his hand and a transparent plastic mask over his chin and throat, in order to prevent the scars from thickening into lumps. A mask and glove like Cary's are very visible. So it's easy to understand why burns, more than any other type of injury, have long-term effects, not just physically, but socially and emotionally.
To help Cary's friends understand what had happened to him, and why he needed to wear these special garments, several members of his Burn Team and his Pediatric Center Team visited Cary's school to talk to his schoolmates about burns and burn treatments. This made the transition back to school much easier for Cary.
Cary still has regular checkups with Dr. Fidler, and frequent physical therapy sessions to make sure his neck and fingers remain flexible. Although he'll always have some scars, he has healed remarkably well considering the extent of his injuries. He notices the smell of smoke "a mile away," his mother says.
Yet he remains an energetic, talkative, likeable little boy. And that is in large part because of the care he received at Bridgeport Hospital.