Doctor: We’re chasing the smoke but we’re not putting out the fire

Doctor: We’re chasing the smoke but we’re not putting out the fire

Posted: Thursday, August 5, 2010 11:07 pm
By: John Brannon, Staff Reporter

By JOHN BRANNON
Staff Reporter
Puzzling indeed are the words from a trauma surgeon who treats burn victims in Nashville.
“We get several repeat customers,” said Dr. Jeffrey Guy, director of the Burn Center at Vanderbilt University Medical Center.
In his 11 years as director, Guy and a staff of about 80 have treated hundreds of patients brought in with second- and third-degree burns. “We get the worst of the worst,” he said.
Most are referred to the center because of severe burns sustained in an auto accident, a house fire or other unfortunate circumstance.
The 29-bed facility receives referrals from throughout Tennessee and from portions of Mississippi, Arkansas, Alabama and Kentucky. It is one of the nation’s largest burn care facilities.
The only other burn care center in Tennessee is a seven-bed facility at Regional Medical Center (The Med) in Memphis.
Long road back
For patients with severe burns, the healing process is usually long and painful. As you might imagine, some recover, some don’t. Those who do recover get on with their lives as best they can. The odds against their being in another accident and burned again are undoubtedly astronomical.
Yet it happens.
Who are they?
Who are these “repeat customers” that Dr. Guy mentions?
They are cooks of another kind — those who mix, or “cook,” a variety of household items to produce a deadly and potent stimulant called methamphetamine — “meth” — for personal use and/or sale on the street.
Their clandestine workshops — “meth labs” — are places where untrained minds and unskilled hands mix volatile chemicals, some of which are anhydrous ammonia, red phosphorous, starter fluid, hydrochloric acid, drain cleaner and lithium metal.
Sometimes their backwoods chemistry has an unexpected and premature ending. What they get is not meth, but a sudden explosion and subsequent fire. Thus do meth lab “cooks” get killed or severely burned. If they can cling to life long enough to get to a hospital and thence to a burn care facility, they stand a good chance of recovery.
On the rise
At this writing, a third of the 29 beds at Vanderbilt’s Burn Center and the seven beds at The Med’s burn care facility are occupied by victims of meth lab explosions.
“We’ve seen an increase (in meth lab explosion victims) the last 18 months,” Guy said. “We’re seeing a lot of the new one-pot method they call ‘shake and bake.’ Just last week we got two really large meth burn (patients) and another two with over 60 percent (burns).”
Lesson not learned
You’d think the painful experience of being severely burned — the road to recovery takes as long as six months — would dissuade a meth cook from ever messing with that stuff again. But such is not the case.
Guy has several horror stories about the hold meth has on the souls of its makers.
“TBI called me last week about a patient of mine who had 65- and 70-percent burns on his body,” Guy said. “We spent months putting him back together. He leaves the hospital and within two weeks he’s cooking meth again.
“Two years ago we had a patient who had bad meth burns. It was his second hospitalization. He actually died in the hospital. We coded him, got him back. He goes to one of my residents and says, ‘Gee, Doc, I got a problem with my sinuses. You think you can give me something for my sinuses?’
“He was trying to get us to write him a prescription for the (cold medicine  — pseudo-ephedrine) so he could make meth.”
Children, too
Some of the patients the Burn Center receives are children who are burned in explosions and fires in meth labs in their homes. Dr. Guy has a poignant and sad story about a little girl, age 11.
“There’s a handful of these children who come through every year,” he said. “Probably the most memorable story is this one about a little girl from the Chattanooga area. It was a traditional meth lab, not the one-pot method. They had the building encased in plastic to keep fumes in the building.
“When the building caught fire, the plastic just melted. She came to us  entombed in plastic, like a cocoon. We had to chisel through the plastic just to get tubes in her for her to breathe. And we had to slowly chisel the melted plastic off her burnt body. She had a very difficult time of it. She’s gotten her life together, but this was a child. She’s horribly scarred, emotionally and physically.
“There are things that adults do, and they’ve got children in a meth lab. The lab may not explode, the child may not get hurt. But there’s certainly illegal activity, and we come across those children in a variety of circumstances.
“Of all the kids we see, about 20 percent of them are victims of child abuse.”
A cancer
Guy said that for all the Burn Center does in treating patients whose burns are meth-related, “we’re just putting bandaids on gunshot wounds.”
The larger problem is drug addiction and associated mental illnesses. And the much-hyped health care reform bill does nothing to address the problem.
As far as fighting the onslaught of meth labs and distribution of meth, “we are dealing with the physical manifestations of a cancer.”
He said that in his line of work, he’s like the blind man who can see just one part of an elephant, “and the one part I see is pretty bad.”
“I see the most graphic part of it, and it makes the toenails curl,” he said. “They are blown to pieces and have burns over 70 to 80 percent of the body.
“The reality of it is, for each patient we have here, there are probably 100 or 200  out there having their lives devastated by that drug. They may not be in a hospital, but their relationships are falling apart, their children are being neglected, or they are losing their jobs and getting behind on their bills.
“There are probably 100 or 200 of their stories for each story I have here. We are chasing down the smoke, but not putting out the fire.
“It sounds gloomy. I’m just a doctor. I’m not a legislator or a judge.”
What to do?
Guy has some strong words for what needs to be done about the meth epidemic and those “repeat customers.”
“The thing that will eventually change their lives is if they actually get incarcerated,” he said. “I keep seeing them until they blow themselves up or get killed. The only thing that gets them pointed in the right direction is incarceration.”
John Brannon may be contacted by e-mail at jbrannon@ucmessenger.com.
Published in The Messenger 8.5.10

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