Burn Unit : Staff and Patients Reach a Painful Accomodation-and, Eventually, a Strongly Affectionate One : By JIM MACAK

After three months in the Southern California Burn Center at the Sherman Oaks Community Hospital, George Mills was more than ready to go home.

Mills, 43, was severely burned June 7 when the gasoline tanker he drove tipped over and exploded. His body, on this last night, still offered ample evidence of the ordeal--large scabs and large slabs of purple skin, newly grafted.

And his mind, Mills said, was still unsettled by the tremendous pain that he had to endure as part of his treatment. The pain was inflicted by the nurses he now hugged goodby.

“Come here, sweetheart,” Mills called to nurse Erika Helms as he wrapped her in his arms and kissed her. “I love you, you know that.”

The affectionate goodby, they both admit, was quite a turnabout from Mills’ first weeks as a patient.

Helms was diplomatic: “George was a little difficult.”

Mills was blunt: “I hated her for what she had to do to me. I freely admit it. . . . The last thing I said to her before she went home was, ‘I hope you get hit by a truck.’ ”

Hostility Not Uncommon

Nurses in the burn center say such hostility isn’t unusual--a patient’s recovery from severe burns frequently becomes more painful, not less, as the days pass. Each time nurses peel away the dressing from an open wound, each time they scrub away dead tissue or prod a patient to stretch newly grafted skin, that patient is hit with stabs of pain that even the most potent painkillers don’t always eclipse.

Nurses are traditionally associated with the alleviation of suffering. But at the burn center, they inflict suffering, said Laura Finlayson, director of education and marketing.

“And unless you’re a sadist,” she said, “it can be a very difficult job.”

The job can take its toll on the nurses as well as patients. Some say it affects their personal lives. A few admit that they had to get away, if only temporarily, as a reprieve from the suffering. But almost all the nurses--after surviving the initial shock of the tasks they perform--end up making a career out of what one patient calls the “dirty work” of the burn center.

Almost all of the 18 full-time nurses have worked at the center for at least five years. Many, like Finlayson, top 15 years. The center also employs five licensed vocational nurses and burn technicians. Nine additional nurses work “on call,” depending on the number of patients.

Even though the job is difficult, Finlayson said, longevity is not unusual because the hours are flexible, extensive training is available, and nurses really have a say in the care and treatment of their patients. Finlayson said the nurses are paid on average $37,000 a year.

“A big problem with nursing in general is that you are never given recognition as a professional,” Finlayson said. At most hospital units, she said, “I don’t care what anyone else says, it’s a long wait before a physician actually treats you as a partner and asks, ‘What do you think?’

“When you work in this unit, it is a team effort. Since I’ve been here, we’ve always had that, and the reason is Dr. Richard Grossman. . . . He does his rounds with the nurses and, if they are not on duty, he calls them on the phone and asks their opinion. . . . And their opinions really count for something.”

A. Richard Grossman founded the burn center at Sherman Oaks Community Hospital in 1970 as a two-bed unit. The center is now equipped with 30 beds and ranks as the largest privately owned facility of its kind in the country, admitting about 350 patients and serving an additional 150 outpatients each year. For those admitted, the length of stay varies greatly. But those with severe burns often end up staying three weeks to a month. Fewer than 1.5% of the patients die because of burn-related causes.

Grossman, a plastic surgeon and medical director for the burn center, said his approach to those “very, very strong women,” as he refers to the nurses, has been crucial in treating burn patients.

‘On the Line’

“The doctor or any other primary physician is only there a few minutes each day. The nurses are there 24 hours. They’re the ones on the line. If they have a suggestion or an idea for a change in therapy and have a good reason behind it, we do it. They would be like residents in any other hospital. They are given responsibility, and they are respected for their profession.” And because of that, he said, they don’t leave.

Susan Camaret has stayed 15 years. As the night charge nurse, her work often stretches from 6 p.m. to 6 a.m. She doesn’t mind the hours. But when it comes to inflicting pain on the patients, Camaret said, the job is no less demanding than it was when she started in 1973.

“There’s no real medication for burn pain; there just isn’t any. Sure, we use morphine, and it helps. But we’re dealing with bare nerve endings, and you just can’t give enough medication to take away that kind of pain.”

For the most part, Camaret said, the nurses talk to patients while dressing the wounds in an attempt to distract them. Nurses also teach breathing techniques, not unlike Lamaze training for pregnant women. Staff psychiatrists are available to help patients cope and, on occasion, to use hypnotism to ease the pain.

Once the patient receives newly grafted skin, another dynamic starts. Nurses must goad the patient to stretch those tender areas. Camaret said it amounts to a daily battle of wits.

“Patients with skin grafts on their arms and hands want to lay them at their sides, elevated on a couple of pillows. They don’t want to move because it hurts to move. But that’s not going to help them heal.

“When it comes time to eat, they say they can’t hold the spoon. We say, ‘Fine,’ and we take some rubber bands and tape and attach that spoon to their hands. ‘If you want to eat,’ we tell them, ‘you will figure out a way to get that spoon from the plate to your face. And, no, we don’t care if you make a mess. We will get you a clean gown. But you will feed yourself. You will get up. You will sit in a chair.’ ”

Camaret acknowledged that burn center nurses do have what some consider a weird sense of humor, even with critically ill patients--but only to keep the patients off guard.

“I think a lot of times, our patients survive solely because they don’t know how sick they are. If, for example, you were really as sick as you felt, you’d probably think the nurse wouldn’t be joking with you, forcing you to sit up in a chair, chit-chatting with your wife. If you were really that sick, you’d probably think the nurse would be taking your blood pressure, checking the cardiac monitor and looking worried and very solemn.

“In a lot of our patients, you have to keep their spirit alive. If you lose that, you’ve lost the battle.”

And, Camaret said, although the nurses have to train themselves not to become too attached to the patients, particularly those undergoing long-term treatment, “every one of us has someone who really gets under our skin.”

For Camaret, it was Rick. She declined to give his last name.

“He was in his mid-30s and sustained an electrical injury. He was trimming his trees up on a ladder. He didn’t have protective gloves on. He clipped a high tension wire. . . . Rick was here 31 days until he died. Both his legs were amputated and one of his arms. We knew in the beginning that his chances were minimal. Still, there was that tremendous fight. He was just so determined to make it.

“He had a 13-year-old son that I became very attached to. The child wanted to see his father, but the family didn’t think that was a good idea because of the way the father looked. But I really felt strongly that this was his dad, and he probably had things to say and really needed to see him. There was a lot of negotiation with the wife and other family members to make this come about. But, in the end, he did get some time with his dad. I think it would have been detrimental for him not to have that chance.”

Camaret said, “Though it’s a sad experience, it’s a rewarding one in many ways because you not only help the patient die in some peace, you help the family deal with this.”

At times, she said, patient rooms at the burn center are turned over to family members who want to stay and sleep and keep watch until the patient dies, no matter how long it takes.

“I just feel that’s the way it should be.”

Nursing supervisor Diana Parker’s small office is covered with snapshots of patients. “My rogues’ gallery,” she said as she reattached two that fell from the wall. Parker was hired in 1973 but left twice, once to travel and once to work elsewhere. She said the job was too much a part of her life, so she kept coming back.

But that doesn’t mean that the work is not stressful and draining.

“What gives me strength,” Parker said, “is that I’ve seen what happens to burn patients who are not well-cared for, who aren’t encouraged to exercise, and they come here, and their skin is frozen to form, and their stay is lengthened by infection. . . .

“You work with patients whose entire lives have been altered forever, and they’ll never forget the horrible incident or this form of hospitalization. And, after dealing with that, it’s hard for some of us to go home and worry about the small things in life.”

Strain on Marriage

Nurse Joanne House doesn’t blame the work at the burn center for her divorce, but she said it did take a toll on her marriage.

“I couldn’t leave everything behind at work. Certain patients or their families affected me, especially the terminal patients. There are very few of those. But with the ones we did have, it was difficult. . . . My husband wanted me to quit. He was upset that I was so upset at times.”

House said she resisted quitting and did grow more adept at keeping her work separate from her home life. But after eight years at the center, she decided that she was ready for a change. She now works full time with Prudential Insurance, arranging home care for patients, and still works at the burn center on weekends twice a month.

“It’s a rough job,” House said. “Sometimes you have to make the patient angry to get them to move, to stretch. I’m used to coddling patients, but here you have to be tough.”

If a patient complains to nurse Brenda Clayton-Farmer that she doesn’t know how painful the treatment is, the nurse has a unique answer: She shows them her scars.

Clayton-Farmer is a former patient at the burn center who suffered second- and third-degree burns over 25% of her body in an auto accident.

Six years ago, she approached a red light and brought her car to a halt. “But the person behind me didn’t. He hit me at 65 miles per hour. My car ignited on impact.”

She remembers the pain during the dressing changes. “It hurt down to your toenails. You don’t think it will ever stop.” And she recalls another difficulty. “I had to keep from internalizing my nursing knowledge as it applied to me. It was hard for me to accept the fact that I was a patient, not a nurse. I kept thinking that I’d get up and help.”

Although she was a licensed vocational nurse at the time she was a patient, Clayton-Farmer didn’t really consider joining the burn center until eight months ago, when she passed state exams to qualify as a registered nurse.

“Once I applied, I knew I could do it. I knew I could make a difference here.”

Clayton-Farmer said Grossman told her that what other nurses learned from a book, she knew from experience. And though she doesn’t broadcast that experience to her patients, she said, she does on occasion tell someone, “I’ve been there. I know it hurts.”

Still, the cycle of pain, struggle and reconciliation continues.

“I’ve done everything for myself all my life, and now I had this nurse whacking my bottom because I couldn’t do certain things,” said Michael Pettit, a 40-year-old electrician from Ventura. “I wanted them to leave me alone. I was tired of being poked and probed and scrubbed.”

Pettit was seared from his skull to his legs when he fell against a distribution panel. After 2 1/2 years of treatment, including a initial monthlong stay, he recently walked away from the burn center after a final operation to remove scar tissue from his head.

Although he fought with the nurses when he first arrived, now he credits them for his recovery. He said several nurses were like mothers to him.

Mills, the severely burned truck driver, said it took him a month to realize that he had to stop fighting nurse Helms and the others at the burn center. He said he finally had a simple revelation: If he didn’t cooperate with the nurses, he wouldn’t heal, and he wouldn’t go home.

“These people who work here, the nurses, the burn technicians, they really carry out the dirty work,” Mills said as he and his wife, Dee, packed some of his belongings into shopping bags to carry out to their car. “They really are the people in the trenches.”