Hi Friends.

It has been a quiet call night so far. Any of you in medicine know that we are afraid of using the all-destructive "Q" word. Any mention of the fact that there hasn't been a deluge of new patients is simply inviting the trauma gods to instantly send a busload of cracked up hemophiliacs your way. So I have thrown all caution to the wind by starting this letter with a sentence containing the word quiet.

This morning, I operated on the girl who had been scalded on Christmas Day. She certainly wasn't the first burn I had seen, and I have seen this pattern of burn hundreds of times back in the US. Her father told us that she had been in the kitchen when it happened. Many of the homes around our base are one or two room dwellings. There is a common room where the cooking is done. Often the stove is unprotected, and some even cook indoors over a small fire. The family had a small stove, and there was a kettle of burning water on it. The little girl, backed into the stove, and knocked the kettle onto herself.

Her burns weren't deep, but I am sure that they felt raw. It's a fact that full-thickness burns, that kill the skin all the way through to the fat, hurt less in the beginning because the pain nerves have been destroyed. A partial thickness burn stings, because the nerves are still alive. When she arrived, she was cleaned in the ER with a little bit of sedative to calm her.

I arrived this morning just before the first cases in the OR were about to start. I saw the girl's number on the schedule. Our trauma czar had visited her the night before. She was having a lot of pain whenever the nurses cleaned her wounds, and he wanted her to have her burns cleaned in the operating room. That way, she could be knocked out and not feel it at all. The anesthetist brought the girl to the room and medicated her. After her breathing was regulated and she lay still, we removed all of her dressings. I took several of the stiff brushes that we use to clean our hands before surgery, and soaked them in warm water. We each took an area, and began scrubbing her burns. The bristles removed the thin yellow slime that had started to develop over her burns. After that was gone, we scrubbed deeper, bringing small pinpoints of blood to the injured skin. This rough treatment was to be sure that the skin was alive and also to remove any dead material that bacteria could feast on. It made me cringe to imagine how it would have felt if she was awake. When her shoulders were done, we turned her over on her stomach and cleaned the burn on her back the same way.

After washing and drying her skin, I applied a temporary artificial skin over her burns. I had ordered it a month ago for a burned boy who had died. We all had struggled to keep him alive. His infection became too much and had spread through his body. He was too far gone to benefit from the high-tech artificial skin, but it would help this girl. I stapled it in place and wrapped her body in gauze. After the gauze covered her chest and arms like a mummy, I stretched an elastic netting over her torso to hold the wappings on. Then we let her wake up. She showed us she was alive with a strong yell. We gave her some pain medicine, but what she was really yelling for was her Dad. We reunited them in the intensive care unit, and she calmed some. The best part about the artificial skin is that it will stay on her for a week or two. We don't have to subject her to painful dressing changes and washings every day.

The other surgeons and I loitered around the PLX, like firemen waiting for a fire. As my day to go home to M. glimmers like a star low on the horizon, I am getting antsy to leave. I think that I'm a little more touchy than usual. It was tougher today to control my outbursts on my political opinions and frustrations with the slow pace of progress. I wasn't alone in harboring a strong opinion. Like sharks to chum, my surgeon friends all chimed into the discussion with opinions that covered the full spectrum. If only we were Congress, the war would have been solved today!

As the evening wore on, we received a few patients from other bases. Two men came to us who had sustained sports injuries bad enough for them to need evacuation out of the country. Amazing! Both were in some discomfort. We medicated them to ease their pain, and got them ready for the next flight out.

Hope to talk to you again soon!

Chris