Sixteen-year-old Mark McDonough woke up early the morning of Aug. 3, 1976. His room was like an oven. An orange glow crept up the stairwell.

He heard the crackling downstairs in his family's colonial in the Cleveland suburb of Fairview Park, Ohio. As smoke filled the upstairs hallway, Mark rousted three of his sleeping brothers. Tim, Patrick and Dan climbed out second-story windows. Mark, the oldest, stayed behind.

His mother, Dorothy, and youngest brother, Toby, were still inside.

Mark went for his mother's bedroom. But smoke drove him into a bathroom, gasping for air. He thought he could go through the window and reach a sun deck off the master bedroom, where his mother slept.

Mark punched the bathroom window but was unable to move it.

He sucked in the fresh air from the outside and dashed for his life. Blinded by smoke, he tumbled down the steps. He reached for the front door. The knob turned, but the door was swelled shut by the heat.

Mark got down low and raced through flames to a door leading to the garage. Firefighters found him lying in front of it. He was unconscious, in the fetal position. The skin on his arms and hands was gone. More than 60 percent of his body was burned.

The house that Dorothy and her husband, Thornton, designed was destroyed. Thornton was in San Francisco on business when he got the call at his hotel.

Mark awoke in the ambulance in agony. As it sped to the hospital, Mark thought, "Oh, God, please take me."

Today, McDonough is a plastic surgeon who is glad to be asked about the thick, waffled skin on his arms. When a horribly burned patient turns attention to McDonough's disfigurement, it's a good sign.

"It's a barometer I have that tells me they're getting better," he says as he rushes down a hallway for surgery at Vanderbilt University Medical Center in Nashville, Tenn. "In the first couple of weeks, they don't even notice. They finally get out of themselves."

McDonough, 41, is fit and tan, bursting with chatter as he moves through a typically long day of advanced training on the leafy Vanderbilt campus. He is entering the last year of a fellowship in plastic surgery. His voice is husky from the ventilation tubes that kept him alive. His body is a mosaic of skin grafts. Groin skin covers the inside of his fingers. Layers of skin were peeled from his thighs and buttocks and transplanted like sod on his arms, hands and lower legs. He has had more than 30 surgeries.

Before McDonough decided to become a surgeon himself, he was a physical therapist. He used his experiences as a patient to help others. For eight years he had his own physical therapy practice in Florida.

But he grew tired of doctors telling him what was best for patients. At age 30, McDonough decided he wanted to call the shots. He entered Case Western Reserve University School of Medicine.

He now performs some of the same surgeries that he endured. He talks to fire victims in ways only he can.

Some hit closer to home than others. When he was training in Tampa, Fla., he tended to a badly burned 7-year-old boy whose mother set fire to their trailer. When the boy regained consciousness, he pleaded with McDonough to let him die.

"You know at that moment he's in touch with pain that is incomprehensible," McDonough says. "Later, I went out to the parking lot and puked my guts out."

His motivation is his own experience as the kid on the table. But his sense of purpose did not come easily. In the aftermath of the fire, McDonough had to decide whether the physical and emotional devastation would defeat him or make him stronger.

His brother Tony died in the fire. His mother died of smoke inhalation, after spending two days on life support. McDonough spent every waking moment praying to join her. Ten days after the fire, he nearly got his wish.

McDonough was finally stable enough for surgery to remove the dead skin. The process is called debridement, similar to shaving cheese. Surgeons would temporarily graft pig skin in place of the dead. Pig skin protects the tissue and tells doctors if the burn area is ready for grafting with the patient's own skin.

But McDonough's injuries and the trauma of surgery were too much. His body's stress response produced so much digestive acid that it tore a hole in his gut.

This was one of the most feared complications of burns. McDonough was losing blood. Doctors stopped the debridement and slit him down the middle to remove part of his stomach. That's when his heart stopped.

"I became completely aware of the fact I was going down," he recalled. The pain stopped for the first time since the fire. He was bathed in warmth and light. He felt the presence of Toby and his mom.

"All of a sudden, I understood. All the pain I was experiencing was a necessary part of life," he says. "I understood there is a reason for this. But I'm not going to join my mother and brother. I'm going to live."

His heart was shocked back to life.

After he awoke from surgery, McDonough, heavily bandaged and barely able to talk, told Thornton McDonough what happened. "Do you believe you can die and live again?" he whispered to his dad.

It was Friday, Aug. 13. Every Friday the 13th since, Thornton McDonough calls his son to wish him a happy birthday.

McDonough says the experience proved to him that there is a God. And that the tragedy was part of a bigger plan. Even if he couldn't understand it.

A spiritual awakening began. It would help McDonough through difficult years ahead.

He spent three months in the burn unit at Metropolitan General Hospital, now MetroHealth Medical Center. No amount of morphine could relieve the pain. Stripping layers of healthy skin for grafting hurt more than the burns. Once a day -- sometimes once a shift -- he would be submerged in a tank of water to cleanse the wounds. The cold was unbearable.

With two-thirds of his stomach gone, Mark dropped to 90 pounds. It was a month before he could get out of bed. He had to learn to balance again to walk. His hands were a crumpled mass of scar tissue. It would be two years before he could straighten his fingers.

Dr. Richard Fratianne, the burn unit founder and director, helped McDonough understand what was still possible. He told McDonough that doctors, nurses and occupational therapists could help restore his functional ability. But the future was Mark's to decide.

"Winners see the bottle as half-full. The losers see it as half-empty. Only you can control your feelings," Fratianne told him.

McDonough was taken with Fratianne's strong spiritual beliefs and persistent encouragement. The two developed a bond that has endured. Years later, in medical school, McDonough was invited to scrub for surgery alongside his mentor.

McDonough chokes with emotion at the thought.

"It hits me. I'm in the operating room with this guy who's as close to God as you can be. He saved my life."

Slowly, he began to rebuild his life. After missing his junior year in high school, he edged back into society. He gradually shed fears of being stared at.

Today, McDonough puts his injuries out there with unwavering confidence. He jumps up during an interview and drops his pants to show his scarred thighs. He casually flips off his clog to show a patient with severe ankle burns the repair job on his heel.

Such displays reflect remarkable strength, says Fratianne. At the same time, McDonough isn't invulnerable to stares at the beach. People abruptly look away.

But kids sometimes ask. McDonough lowers himself to their level and tells them: "I was in a house fire, and I didn't get out. If you're in a fire, you have to get out."

He and his wife, Joan, have three boys. On their first date, he told Joan about his near-death experience. "I absolutely believe he would not have made it were it not for that," she says. "It's given him the perseverance he has."

He has pushed through other setbacks. McDonough had a stroke on the 19th anniversary of his mother's death. He recovered fully. His medical training was interrupted in 1994 by burn complications that required three surgeries on his heel. Last year, his residency program at the University of South Florida lost accreditation and closed, forcing him into a desperate search for another medical school. That's when he landed at Vanderbilt.

Some might say the fire victim-turned-burn doctor was divinely scripted. McDonough isn't so sure.

"I think (God) and I each had a say in that," he says. "He gave me the freedom to choose, and I felt obligated to do something with it."