‘A TOUGH GUY’

Todd Robinson’s third surgery had sharpened the outlines of the peril his burns posed. When burns kill, it is often a delayed reaction, as infection outraces the surgeons’ ability to cut away compromised flesh.

After the operation, Dr. Richard Grossman sat in the cafeteria at Sherman Oaks Hospital chewing crushed ice and speculating on Todd’s chances. “When you have burn cases like this, you have all hopes of them surviving--and then you watch them die over three or four weeks,” he said. “It’s devastating. He may not be a survivor. We’ll know if his heart starts giving signs of failing or his lungs start to get congested.”

The next day, Saturday, March 1, Todd had a high fever, a distant reflection of his body’s war to live.

He was in pain from his burns and the deep surgical cuts, and couldn’t sustain an easygoing demeanor. When friends visited, he did not look at them, or respond to what they said.

Todd had been in the burn center for 10 days since the pipe at Jersey Maid dairy had burst and scalded him with hot water. He had undergone a trilogy of hard surgeries, and felt worse after each. Where, he wondered, was progress?

Making his rounds that morning at the burn center named for his father, Dr. Peter Grossman examined Todd. The surgeon emerged from Todd’s room looking relieved.

“He’s really hurtin’,” Grossman said, “but his vital signs are doing great. A tough guy.”

Todd, it appeared, was weathering the crisis.

“It looks like we’ve got most of the necrotic tissue,” Grossman said. “We can start to think, not of keeping things from getting worse, but of him starting to get better.”

*

Successful skin transplantation is a melding of the residual life forces in the graft and the fervor of the recipient area to heal itself.

When a graft is placed on a wound that has been surgically cleared of burned tissue, the transplanted skin absorbs plasma from blood at the site, which keeps it from drying out. Clotting blood produces a sticky layer of elastic filaments called fibrin that helps keep out infection and binds the graft to the wound.

Meanwhile, blood vessel connective tissue, known as granulation tissue, begins to form in buds on the wound’s surface. These grow into the graft and form capillaries, reestablishing blood flow. The graft turns from pallid to pink and, over time, to some version of normal skin tone.

In the case of third-degree burns--which destroy the dermis, the deepest layer of skin and the source of its functionality and beauty--nerve fibers from surrounding healthy tissue begin searching out and growing into nerve sheaths in the graft. Sensation gradually returns; the grafted area becomes sensitive to pain, then to light touch, then to temperature.

Meanwhile, new top-layer skin cells begin to grow laterally into the graft area from peripheral unburned areas. These new cells gradually replace the cells of the graft, which eventually slough off as all topmost skin cells normally do.

The grafts surgeons generally use are thin, and do not contain hair follicles or sweat or oil glands. In the case of third-degree burns, these dermis-based elements no longer exist in the wound bed either. Thus, areas that have been deeply burned typically do not sweat, self-lubricate or grow hair after they have healed.

Scar tissue begins to appear quickly. It is composed primarily of collagen, the tough, fibrous protein that is the body’s principal structural material. In its panic to close a wound, the body deposits collagen at the site profusely and in haphazard patterns.

Skin grafts signal to the body that the wounds have been covered, and slow the production of collagen. Over time, ordinary mechanical forces at the wound site realign the chaotically deposited collagen into more useful patterns. Still, scar tissue never achieves the flexibility or elasticity of normal skin, and may continue to grow for as long as two years after a wound has been closed.

In deep burns, brute collagen essentially takes the place of the destroyed dermis over time.

Grossman Burn Center surgeon Michel Brones cites an analogy. Imagine the skin, he says, as a 10-story building that has burned to the ground. New top-layer skin cells eventually provide three new inhabitable upper stories. Scar tissue provides the seven lower stories, but those stories are uninhabitable.

*

When Dr. Richard Grossman leaned over Todd Robinson’s chest a few days after his third surgery, he smelled an ammonia-like odor, a sign that pseudomonas bacteria were having a festival in the dead tissue there.

So, on Tuesday, March 4, almost two weeks after Todd’s accident, the surgeons cut again, this time on his chest and flanks, areas left alone during the previous surgery.

None of the cadaver skin applied the previous Friday had taken, so it was plucked off. The doctors scraped the recipient areas till they bled afresh, and draped them in new cadaver skin, hopeful that sufficient additional granulation tissue would develop to bond some of the new homografts to the wounds.

Over the next three weeks, Todd underwent a fifth, a sixth and a seventh surgery. Each time, the surgeons found less to cut. Each time, a greater percentage of the cadaver skin had taken, and less needed replacing.

To Todd, distracted by pain and his body’s inability to regulate its own temperature, the surgical progress the doctors spoke of was a comfortless abstraction.

His dressing changes were especially painful. Twice each day, nurses and aides wheeled him to the hydrotherapy room, wet him, and cut away the old dressings. Then they bathed him, salved him with antibiotics, and re-dressed him. Each visit to hydrotherapy lasted more than an hour.

But if the dressing changes were a trial, Todd’s daily trips to the hyperbaric oxygen chamber were welcome respite from nurses and visitors. For 90 minutes, twice a day, he lay in one of the sealed glass chambers and watched videos or listened to music or slept while his ravaged tissues received healing doses of concentrated oxygen.

Intermittently with the surgeries, psychiatrist Clinton Tempereau led Todd through more relivings of his accident. Each time he recited the facts, Todd felt less of the terror.

*

On Saturday, March 8, Todd sat in a wheelchair at an umbrella table on the burn center’s front patio. The painkillers in his system, the warmth of the air, the swell and ebb of traffic on Van Nuys Boulevard, all these lulled him. He drifted back and forth between mindfulness and shallow napping.

Covered in white blankets and a head towel to shield him from the sun, he looked like a comedy-show version of a Bedouin chieftain, except for the red baseball cap that crowned him.

Todd pondered his burns and what they might mean for the remainder of his life. He was only 32.

“Thinking about scarring does bother me, of course,” he said. “You know, I’m worried about it, but it doesn’t matter. I just want to get better, and whatever happens, happens. What I’m more concerned about is, how much of my abilities can I get back?”

Todd grew up without a father, and learned his prodigious mechanical skills on his own. At various jobs he had learned to work on cars. He learned construction, machining and millwright mechanics.

“I believe I’m one of the best at Jersey Maid, as far as engineer capability,” he said. “There’s some of us that they give special assignments to. The harder assignments--rewiring a machine, or converting it from relay logic to controller logic. And usually I’m just a good trouble-shooter when something goes down.”

Proud as he was of his mechanical competence, however, he defined his physical vitality in terms of his water-skiing skills. In his best performance on a tournament slalom course, he cleared two of the six buoys at the top speed of 36 mph, at the end of a tow rope that was “28 off”--28 feet shorter than a standard 75-foot rope. The shortness of the tow rope is a measure of a skier’s agility and control. With the world record at 41 off, Todd was in the upper reaches of amateur skiers.

In fact, he said, water skiing leaped to mind even as the scalding contents of the broken pipe were blasting him down the ladder at Jersey Maid, bathing him in pain and panic. He remembered thinking, “You’re not gonna make that water ski tournament that’s coming up in a couple of weeks . . . “

Shortly after he was hospitalized, a new white Pro-Tec ski-jumping helmet arrived at his home. Todd had ordered it before the accident, and Lori brought it to the burn center, thinking it would cheer him.

At first, Todd refused to look at it. It was an emblem of all he stood to lose.

But Lori kept it in his room, on the head of a large teddy bear, and over time its symbolism changed. It came to stand for everything Todd hoped to regain. It came to stand for the restored man himself, bounding over the wake of a 300-horsepower Chevy marine V-8 again, lithe and focused and in command, sunlight inflaming the spray from his skis.

*

The triangle above his bed resembles one at the end of a tow rope, and Todd grasps it and eases himself into a sitting position. He tries to keep the backs of his calves off the sheets because the wide scarlet strips where autografts were taken hurt so much.

Physical therapist Margaret Traxler helps him swivel so his legs hang over the side of the bed. She slippers his feet, and tilts him to standing behind the aluminum walker.

For the first time since Todd strode toward the ladder at Jersey Maid, he is going to take a walk.

He begins. His steps are slow and nip but six inches of floor apiece. He is bent from the waist and bowed from the neck. Because of his confinement in bed, his hip extensors are too weak to hold him erect. The stiffness from bed rest and the pain from his surgeries make it difficult for him to move his thighs, keep his elbows down, bend his knees.

His various IV tethers have been disconnected. A thin headband holds in place the colorful plastic ports of the three-channel catheter in his jugular vein. They bob like decorations.

“Unbelievable . . . he looks real good. . . . You’re on your way, Todd,” the women at the nursing station tell him as he motivates by. They have no illusions about the degree of difficulty of what they see.

Todd returns to his bed. He has walked a circuit of about 60 feet.

“Excellent. Fantastic. That was just about the right distance,” Traxler says as she helps him sit and pivot to a reclining position.

Todd’s voice is weak. “Maybe a little too far for the first time,” he says.

*

As the days of his hospitalization mounted into weeks and his surgeries accumulated, anger and frustration began to flow beneath Todd’s resolve.

Although he complained only rarely and mildly to the nurses, he sometimes dissolved into tears in front of Lori and his mother. His left thigh especially refused to heal; it had become the focal point of his pain.

On March 21, more than a month after he was admitted, he barely managed to complete a shuffle around his usual circuit.

A new digestive problem, not uncommon for someone who’d had a stomach tube in him as long as Todd had, gave him pain in his abdomen and lower back, complicating the chorus of suffering from his surgeries and unhealed wounds.

“I can’t even [expletive] walk,” he sobbed, as the physical therapist helped him back into bed.

Lori dabbed his eyes with a Kleenex.

Yet his healing was gathering momentum. At his seventh surgery, four days later, the map of his injury showed a nearly unbroken territory of mended-looking baby pink. Newly adhered homograft formed tidy white patches of netting against it. Only here and there, notably on his thighs, remained small scraps of brown cadaver skin that hadn’t taken.

In the last days of March, his tethers were removed, first the bladder catheter, then the stomach tube, then the jugular catheter. For the first time, Todd was able to sit in a shower and change his own dressings. Only the recalcitrant left thigh continued to bleed.

Dr. Richard Grossman examined him in the hydrotherapy room on March 31.

“Well,” the surgeon said, laying a hand on Todd’s healed chest, “I’ve had enough practice cutting. I don’t really think I need any more. I’m ready to send you home toward the end of this week.”

Wednesday: After the homecoming, a setback.

To retrieve this series on the Internet, go to: http://ziira.shop/burn/

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About This Serial (Ventura County Edition)

The Grossman Burn Center at Sherman Oaks Hospital is the region’s preeminent burn ward, serving Ventura County as well as Los Angeles County and other areas. “After the Burn: One Man’s Struggle for Life” is a four-part serial detailing the center’s efforts to help a man injured in an industrial accident.