Tuesday, March 13, 2012

Escharotomy.. When you realise that you are not naked as long as you are in your skin!

[Eschar is a thick leathery tissue which replace the skin in deep burns patients. Removing eschar is a time consuming pain staking process. Its practically cutting the leathery thing off from rest of tissue. Some times done under general anaesthesia, sometimes sedation and sometimes in our uncivilised setting, "vocal anaesthesia"]
 Burns patients are one particularly frustrating group of patents. For many reason their survival is poor. Anything more than 20% has extremely high mortality, either by fluid loss in early days or late onset infections. Fire to me is fieriest thing on earth. I dont know how people can even imagine about setting onelself on fire. And still an unbeleivable number of people resort to self immolation to "prove their point". Almost every time when a female with burns come, the history will be invariably an "exploded kerosene stove" and for males, a tipped off lamp or attempting to burn wastes. Frequency of stove explosion is so high that you may start thinking if they are making stoves with explosives.
Almost always the patients and bystanders reach a good rapport with the Burns ICU staff in a few days and true history unviels. Sometimes the reality will be more stranger than those soap operas in TV channels. The one who made me write this blog is in our ward now, a 39 year old mother of 3 kids. Did her escharotomy yesterday. She has 55% deep burns extending and now her specimen showed presence of extremely resistant bacteria sensitive only to Imipenam, a drug costing 2000 Rs per day! The history was as usual exploded stove. She had no female bystander and was brought by a guy somewhere in mid 20s. As days passed, the real history surfaced. She left her home husband and kids 2 years ago to live with this guy who is working as a video editor.Neither of families care. Kids are in orphanage. She havent met them for the last 2 years. And as she developed some difference of opinion with him, she was just trying to scare him by trying to burn herself. She never thought the fire would catch up!
 For males its a different story. Its usually the alcohol that does work. Though most of them prefer to pour it on their spouses, some try it on themselves too. To make the matters worse they start having withdrawal symptoms on day 2! One intersting guy came with history of tipped of lamp. 2 weeks in to admission, the eschar came off. This guy used to drink spirits and abuse his wife and kids every day. One fine day his 10yr old son lost his temper and threw the kerosene lamp on his dad. The story was covered up and the guy went home despite his 40% burns. I always think about that boy. I wonder how much he might have suffered and what he will grow to become. I have sutured stab wound on a 16 yr old who works for "quotation" gang and perhaps they need more guys. Ofcourse everyone knows that world we live in is a dangerous place. Still we try to beleive that the soaps and serials are fiction. But as they say Sometimes reality is stranger than Fiction.

As the eschar falls off, the reality is revealed. Then you realise that you are not naked when you are in your skin.

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