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“If there are complications,” he continues, “we have to treat them aggressively. It takes a lot of skill and judgment. The woman would be conscious but heavily sedated, so I can assure her family that she is not suffering.” Dr. Fratianne is pleased to report, “In the last eight years, we have not lost a child from a burn, regardless of the size of the burn. Under age sixty-five, for patients without serious co-morbid diseases, our survival rate for large burns approaches ninety percent. That’s so dramatically different from fifty years ago, when a young adult had a fifty percent chance of survival for burns on fifty percent of his body. Now, almost all patients can survive.” The inpatient stay averages one day for every percent burn. Ninety days, for instance, for a ninety-percent burn. The price is staggering—about $3,500 a day. To manage costs and better assist patients, the center pioneered ambulatory care in 1991. If a patient does not need IV resuscitation or intravenous antibiotics, a person with burns on up to twenty-five percent of his or her body can be treated at Metro’s Burn Ambulatory Clinic and have dressings changed daily by nurses. The clinic serves more than 500 patients a month. The cost of a clinic visit equals only about two to three percent of a day’s admission, Dr. Fratianne notes. While, as Dr. Fratianne says, “all this complex medical stuff” heals the physical scars, he and his T.E.A.M. approach the delicate mission of healing the mental, emotional, and spiritual–or “internal”–scars. “The rehabilitation of the patient begins on the day of injury. Burns occur from the outside in, and healing occurs from the inside out. Patients can survive a burn, but they cannot be cured of their burns, because the scars are permanent. When the body image changes so dramatically, there’s a loss of self-esteem,” he says, “and for many patients, this becomes a crossroads in their lives.”   Appropriately, the burn center is decorated with
pictures of its symbol, the butterfly, a creature that has to entomb
itself and then reemerge. “With burn victims,” Dr. Fratianne says, “the
old person has to die, because he or she is never going to look like that
again. A new person can arise, and when that happens, we witness the
transcendent spirit of the human being.”“When a patient is totally burned,” Ms. Yurko adds, “their face is gone, their hair is gone. I don’t look at the scars. I look at their eyes. I can see the pain, the terror, and the need.” Says Dr. Fratianne, “One of the most important things I tell the patient is, ‘I will never abandon you. Now, I didn’t say that I will fix every problem; I can’t do that, but I will be here.’” He and the staff create an environment that is supportive and open in order to build trust and help the patient overcome his or her present crisis. Most burn patients realize that they also need psychological support while they are in the hospital. Most can be encouraged to attend weekly therapy sessions led by members of the Adult Burn Survivors Support Group. Dr. Fratianne acknowledges that survivors “are the most believable. They can relate to new patients in a way that I can’t.” He believes burn survivors benefit from support once they leave the hospital, too. Burn patients often remember the date of their injury, “just like it’s a birthday,” Ms. Yurko says.
Children are encouraged to attend the four-day Camp Phoenix, sponsored by local firefighters and Aluminum Cans for Burned Children, in August and February at Camp Christopher, in Bath, Ohio. “The sight of 50 to 60 children swimming together, with all their scars exposed, is awesome,” Dr. Fratianne says. Ms. Yurko tells of a teenage girl, burned twelve years ago, who attended an image enhancement session at the last camp. “She learned how to apply makeup to help blend the scars so that you could hardly see them anymore. She was astounded. It changed her outlook on things.” |
 Of the thousands of burn patients helped by Dr. Fratianne and the MetroHealth T.E.A.M., at least one turned to a career in medicine. At age sixteen, Mark McDonough was burned in a house fire that killed his mother and brother. He awoke on August 3, 1976, in the burn center, after sustaining burns on sixty percent of his body. He was a patient there for "three months and two days. I went back in thirteen to fourteen times for different reconstructive procedures, the last one in 1994." The Fairview Park, Ohio, native says of Dr. Fratianne, "There are two types of health-care professionals dealing with burns that I perceived as a patient: the easygoing, encouraging, and nurturing type; and the type that can give tough love, that’s not afraid to say here’s where you are and here’s what you’ve got to do. Frat plays both of those roles well." Dr. Fratianne helped him change his whole outlook. "He has always been encouraging, a great moral supporter, an overall great human being as well as physician and spiritual adviser," Dr. McDonough says. Dr. Fratianne served as the godfather to Dr. McDonough’s wife when she converted from Episcopalian to Catholic. In high school, Dr. McDonough was interested in fine arts, but after his injury he turned toward medicine and science. He did undergraduate work at Ohio University and Ohio State University, then studied physical therapy at Cleveland State University. He practiced for eight years at burn units in Ohio and Florida, then started medical school at Case Western Reserve at age thirty, earning a degree in 1994. Dr. McDonough, now 41, has completed a four-year program in surgery and is now finishing a three-year plastic-surgery residency at Vanderbilt University. "My own experience as a patient stimulated my interest in rehab," he says. "It was the caring people, the love and support that I got as a burn patient that was the genesis of my interest in becoming a clinician. Once burn patients know I’ve been through it, too, they are more willing to talk, and I’m able to give them some strength in that sense." "Wherever my career in plastic surgery takes me, I hope that part of it is doing burn care." -SSR |
