Flashback

One week after his scalding, a weakened Todd Robinson is lying in the Grossman Burn Center’s intensive care unit. His wife, Lori, sits at one side.

Dr. Clinton Tempereau, the burn center’s psychiatrist, sits at the other. He is there to start excising from Todd’s psyche the equivalent of the burned tissue the surgeons have been cutting from his body, before it can breed catastrophe.

Tempereau: Todd has a little bit of hand exposed, which you’re encouraged to hold, Lori, because this is a hand-holding situation.

This is a deliberate, programmed, calculated flashback, but with you in charge, Todd. I’m going, with your permission, to do this again and again. What you’ll find is, about the fourth or fifth time it’ll begin to get a little old hat. By the seventh or eighth time it’ll be boring to both of us. And you can let it go.

Todd: OK. All right, well, they call me out there and I climb up this seven- or eight-foot ladder with my tool pouch and I take the cover off this limit switch that’s mounted on the shaft of this valve, and I can see right away that it’s out of adjustment. So I adjust it. A very simple adjustment. Took two minutes to adjust it.

Tempereau: So now what are you doing?

Todd: OK, so now I’m putting the cover back on, and I start to look down and I see that water’s leaking out of this cap . . . and I immediately just start to climb down when the cap blew off--just like that.

Tempereau: Can you see that?

Todd: Yeah, it’s hitting me. It’s hitting me in the abdomen. The water’s blowing at my abs really hard, and I’m just screaming. And finally I just jumped down. Because, I guess, for a second you don’t realize it’s hot.

And then I got to the ground and I landed on my stomach, and the water now is pouring on my back.

Tempereau: Can you feel it?

Todd: Yeah. Now I’m standing up and I’m trying to pull my clothes off and I’m screaming, and I’m just in pain everywhere. I’m just pulling my clothes, and I look down and I can see my chest is all white.

Tempereau: Can you see that in your mind’s eye? What do you look like?

Todd: It’s patchy white, and skin’s just rolling off my arm. So I just start pulling my clothes off and I’m yelling, “Call 911! Somebody call 911!”

I got a T-shirt on and my work shirt, and I pulled those off and I could see that I was just blistering, and everything was stuck to me.

I’m burning. I’m in so much pain. I’m in so much pain, grabbing at my clothes. I still have my shirt and I’m grabbing at it, trying to stop the pain . . .

(They pause.)

Tempereau: Have you noticed when Dr. Grossman comes in, he does all this touchy-touchy stuff?

Todd: I like it.

Tempereau: It feels so good, doesn’t it? And you stop and think, when you see a little kid who’s been hurt, or an animal that’s been hurt, what do you do? The first thing you do is touch them, and they stop crying.

And one of Lori’s functions, since she’s basically a designated member of the burn team, is to do just that.

Todd: I need this. I love this. I would be happy all day if somebody’d just hold my hand.

*

Nothing consoles the weeping burned body quite so well as the skin of the dead. It staunches the evaporation of fluids and the squandering of calories. It soothes riled nerve endings and is a shoulder to the door against invading microbes.

Nearly all burn centers use cadaver skin as a temporary covering, since the body eventually rejects it as foreign. After wounds are completely cut clean of burned tissue, they are grafted with sections of a patient’s own undamaged skin--called autografts--as permanent cover.

A special problem exists, however, with vastly burned patients like Todd Robinson, who are increasingly rare. Of the nearly 400 patients who pass through Sherman Oaks Hospital’s Grossman Burn Center in a year, no more than 10 have injuries as extensive as Todd’s. Nationally, deaths and serious injury from burns have declined for decades, thanks to public awareness campaigns.

The special problem facing Todd and others like him is that they lack enough unburned sites from which autografts can be obtained. Skin may be taken from the same site more than once, but only after the donor area has had about two weeks to regenerate. This means widely spaced multiple surgeries and longer burn-center stays, which, at as much as $5,000 a day, are among the most expensive hospitalizations.

One answer--tried elsewhere but refined by, and now unique to, the Grossman Burn Center--is to use less costly cadaver skin, in conjunction with low doses of the anti-rejection drug cyclosporine, to achieve permanent covering.

Dr. Richard Grossman’s method also includes having patients spend time daily in hyperbaric chambers--sealed, human-size glass capsules into which pure oxygen is pumped to an atmospheric pressure equivalent to 33 feet under water. This force-feeding of oxygen, to levels 10 times normal, promotes graft adherence and speeds the healing of donor sites.

In the long run, Grossman maintains, his method shortens patients’ hospital stays and exposure to infection. Cyclosporine is discontinued when a patient’s wounds have healed, and Grossman says biopsies of these healed areas a year later indicate that they are indistinguishable genetically from a patient’s own skin.

Grossman, who has built his center into the largest and most famous west of the Mississippi, says every burn center director “has his own ‘this-works-for-me.’ The proof is in the pudding. Because of what we do, there are about 80 people walking around that should not be walking around. This works for us.”

*

A little after 6 a.m. on the last day of February, nine days after his accident, Todd was wheeled into the operating room for his critical third surgery.

His blood pressure was low, indicating that he might be headed for septic shock from his unhealed wounds. Grossman was resolved that the surgeons would begin grafting to try to stem the tide. That meant they must cut even more deeply than before, as deeply as they dared, to be as sure as possible that they were making viable beds for permanent grafts.

They planned to take what skin they could from Todd’s scalp and calves and graft it onto priority areas, especially his dominant right hand and arm. Then they would put fresh cadaver skin on the rest and start Todd on cyclosporine.

The cutting began at 6:15. For 2 hours and 40 minutes, the quartet of surgeons swung their Weck and Watson knives. Red blossomed on their blue surgical gowns and pooled in depressions in the surgical sheeting. Scarlet footprints accumulated like crazed dance steps on the linoleum floor.

Anesthesiologist Rick Zeiger watched the amount of packed red blood cells he was administering rise to two units, then three. It was a lucky thing so many of Todd’s friends and relatives had donated blood; surgery as performed at the Grossman Burn Center requires lavish supplies of it.

With a dermatome, a device that resembles an electric cheese slicer, Grossman began removing thin strips of skin, about three inches wide and of varying lengths, from Todd’s calves. Six times he leaned his weight into the task, and six times the dermatome snarled, leaving raw red in its wake.

Surgeon Matt Young puffed Todd’s shaved scalp with injections of saline solution to give the dermatome a smoother ride. Grossman took six more grafts there.

The autografts were placed on plastic carriers and put through a meshing machine so they could be expanded to as much as three times their original area. Snipping them minutely to avoid waste, two surgeons shaped the net-like grafts on the backs of Todd’s hands, his right forearm and a small part of his left forearm.

Meanwhile, the cutting continued on his ravaged thighs.

“I’m almost done with four units,” Zeiger announced. “I think this is going to be a sixer.”

The surgeons were falling behind their expectations. They’d had to cut the left thigh all the way to its yellow subcutaneous fat.

Then Grossman turned to the penis. “It’s all third-degrees,” he said. “It’s such a rare area to be so horribly burned like this.”

By now Zeiger was calling for a seventh unit of blood, and the surgeons had yet to address the broad burn on Todd’s chest. They were approaching the point where they would be spilling what Zeiger was putting in. They wondered, should they cut the chest today?

“Your call,” Grossman told the anesthesiologist.

Zeiger thought for a moment. “I would say not.”

Surgeon Peter Grossman, Richard’s son, finished cutting on the upper right arm. He shook his head. “This guy’s in real bad shape,” he said. “He could die from this burn.”

*

Todd’s burn exploded Lori’s life, scattering it like so much debris. The sight of her husband in his ICU bed, cocooned in bandages and helpless; the uncomprehending fears of their son Cody and the need to arrange and rearrange for his care; the onslaught of concerned friends to whom she played brave hostess while terror howled inside her--all these carved her strength as surely as the surgical knives carved Todd’s flesh.

Sometimes, out of others’ sight, she wept herself dry. At night, alone with baby Dylan in the apartment the burn center keeps for families of critical patients, she lay awake. What if Todd died? What if he made it home but was so disfigured she couldn’t conceal her repulsion?

His bulky dressings became a kind of metaphor for all she couldn’t understand or foresee. What was under those dressings?

As the days passed, she managed to herd the shifting details of her family’s displaced life into something resembling a routine. She began screening visitors to conserve Todd’s strength and her own.

Her employer, Remax/Beach Cities Realty, continued to pay her salary while she attended to Todd. She stayed with him all day and all evening, soothing him at his worst moments in an empathetic sing-song, waiting nearby in the company of her thoughts during his long surgeries.

When she could, she sneaked looks at the admission photographs in Todd’s bulky hospital chart. She listened intently to the doctors, and began to peek through the openings in Todd’s dressings to divine for herself what his wounds might portend.

She came to see she was her husband’s principal link to his real life. She was resolutely upbeat in his presence.

After a long day at his bedside, she’d kiss Todd good night before leaving for the apartment.

“Don’t you give up,” she’d instruct him.

“I won’t,” he’d say.

She’d begun to sleep nights.

*

Tuesday: Todd Robinson faces more surgeries and tries to fight off new infections.

To retrieve this series on the Internet, go to: https://www.latimes.com/