40 years later, bonds, pain persist at Saint Elizabeth burn unit

40 years later, bonds, pain persist at Saint Elizabeth burn unit

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Her pajamas ignited.

Their grain elevator exploded.

The vacuum cleaner torched her and the carpet.

A fireball shot out of his convertible’s engine and into his face.

She tipped the stove pot.

Different burns at different times all brought them to the burn unit at Saint Elizabeth Regional Medical Center, which opened 40 years ago Tuesday and has transformed the looks and lives of thousands of patients since.

* * *

Under the August lights in Wisner, more than 5,000 people watched Matt Kreikemeier and his truck’s 2,500-horsepower alcohol-fueled engine catch fire during the Thunder by the River truck pull.

The truck’s hitch tore off the back just after the green flag dropped. With it went the kill switch, sending Kreikemeier careening down the dirt track on a blazing 30 mph, 10-second hell ride.

The 50-year-old Snyder farmer finally stopped the truck and rolled out.

An ambulance ride followed by at least two helicopter trips brought him to Saint Elizabeth Regional Medical Center in Lincoln, the beginnings of a long, slow journey to heal the burns his flame-resistant jumpsuit couldn’t squelch that night.

* * *

Before December 1973, Kreikemeier would have had to go to Denver, Tulsa or St. Louis, because Nebraska and much of the surrounding area had no specialized place to treat burns.

Saint Elizabeth changed all that when it opened its four-bed Burn and Trauma Center on Christmas Eve.

The now 16-bed in-patient unit admitted more than 1,900 burn patients like Kreikemeier between 2000 and 2012, according to hospital records. They’ve come from the far reaches of Nebraska, Wyoming, Colorado, South Dakota, Iowa and Kansas with burns from car accidents, chemical fires, grain bin explosions, steam burns and scalds.

Through the years, medical care — burn care especially — has advanced by leaps and bounds, burn unit staff say. But painful healing, long stays and patient-nurse bonds have remained a constant.

“You have to realize that when this burn unit started Mr. Kreikemeier ... probably would have died,” said Dr. David Voigt, co-medical director for the center.

Roger Bonin, Lincoln Fire and Rescue’s paramedic services division chief, said having the burn unit in Lincoln saves emergency crews stops and gets burn victims to specialty care quicker.

“The people in this area probably don’t know how fortunate they are to have this resource in their area ... if they need it.”

Today, Kreikemeier and patients like him can survive massive burns due, in part, to advances including these:

* Better infection control because of improvements in antibiotic and antifungal treatment.

* Artificial skin products that allow doctors to get burned skin off faster and delay or decrease skin grafting.

* Respirator technology improvements for patients with smoke-inhalation injuries.

* * *

Years ago, a patient’s chances of dying equaled his or her age plus the size of the burns, Voigt said. That’s called a burn score.

Kreikemeier, who had third-degree burns over 65 percent of his body, had a score of 115.

Now, about half of patients survive with scores of 135.

The Saint Elizabeth unit’s mortality rate hovers about 15 percentage points above the national average, which Burn and Trauma Center Director Christi Chaves attributes to its policy of turning no patient away. The center admits half a dozen patients with big burns like Kreikemeier’s annually.

Nationwide, fewer people suffer burns today, Voigt said. The trend is attributed to improved fire education, detection and better fire and rescue services.

Still, burn treatment remains a type of care that tests the mettle of its patients and nurses, who never promise to make the pain go away.

* * *

Leonard “Bud” Kohl, 91, remembers the recipe for the most painful experience of his life: a quart of Clorox and 5 gallons of water.

He soaked in a tub filled with that solution in 1978, a rag clenched in his teeth his only defense against the pain.

Back then, the Crete mail carrier walked nine miles every day and farmed in his free time.

“I was still pretty damn tough,” he said. “Although sometimes I wished I was dead.”

Kohl, then 56, thinks he would have died if a Crete physician hadn’t sent him up the road to Lincoln moments after he was hurt.

* * *

July 18, 1978.

Bud and Mary Ann Kohl went for an evening spin around Crete in his dark blue ‘73 Cougar convertible. Just across the railroad tracks, near North Main and 17th Street, the car died.

Not much of a mechanic, he leaned on some advice a friend had given him on dealing with the car’s recurring problem: He popped the hood and poured no more than a tablespoon of gas into the carburetor.

“What the hell was he doing?” his wife recalls thinking.

The plan backfired. Flames shot into his face and set his polyester shirt ablaze, singeing what little light brown hair he had.

He ran instead of rolled, trying to rip that burning shirt from his body. When it was over, second- and third-degree burns ran from his belly button on up.

In the four months Bud Kohl spent in the burn unit, he made at least one hundred trips to the tub room.

“The tub was every day the same amount,” he said. “They scrubbed until the skin was growing.

“I hated it. I hated it.”

* * *

Today the white-walled tub room contains no tub. The tubs had goose-neck drains that trapped bacteria, which spread among patients, Voigt said.

Now, across from a black “Welcome to the Burn Center” sign in the hallway, the room holds a metal bed called a shower cart that's parked just below hoses hanging from the ceiling.

But it's called the tub room, and nurses still scrub patients' raw skin with Dial soap and water to stave off infection.

They might pull off any second-degree burns or, if need be, scrape off dead flesh with a Norsen debrider — a tool that looks like a curved butter knife.

Third-degree burns, where tissue may be dead down to muscle or bone, require surgery.

Next, nurses hose off the patients with tap water, washing burn remnants down the drain. Then they redress the wounds.

“I think sometimes you just have to tell the patients, ‘I’m really sorry I’m going to have to be the Wicked Witch for a little bit, and we have to do this,’” said staff nurse Ester Rathjen. “‘But in a month, you’ll be grateful we did — that you had this five minutes of pain.’”

Today’s patients have help managing the pain thanks to a better understanding of narcotics, Burn and Trauma Director Chaves said.

Many won’t remember some of the early sessions, which can last 2 1/2 hours, but they may have a dream-like recollections of the tub room.

“I had one patient tell me that his dream was someone put him in an ambulance and took him to a filling station and beat him with hoses,” Voigt said.

The room is hot — at or above 98.6 degrees — to keep patients comfortable. But nurses often leave to change sweat-drenched clothes during a session.

Even weeks into their recovery, when sessions there are much shorter, patients get anxious at the thought of the tub room, Chaves said.

To help distract them, a radio plays requests, and the unit will soon have an iPad with a waterproof sleeve.

Still, time in the tub room drags on, Kreikemeier said.

“It’s like watching a steer get fat. It takes forever.”

* * *

In other parts of Saint Elizabeth, patients generally check out after three or four days, Chaves said.

But burn unit stays can be as long as 18 months.

In that time, nurses get to know families — down to nieces and nephews, what sports they’re in, who recently got married.

Rathjen grew so close to a patient admitted in 2006 she went to his “I’m Glad I Survived” party. Each year, he brings a thank-you cake to the unit on the anniversary of his burn.

When patients die, burn unit nurses often go to their funerals.

“You work so very hard on this patient,” said retired nurse Linda Terrano, “and not to have the outcome be good was hard.

“Sometimes you would stand there and support the family with tears running down your face because we’re human too.”

Even when the patient survives, the work is stressful.

Terrano used to escape by going home and hopping on her John Deere to mow.

Rathjen, who lives in David City, pops in a book on tape on the way home.

“Sometimes you cry,” she said. “It’s a good place to do it.”

The nurses see patients through milestones: walking again, eating on their own. They watch the patients progress and their kids grow up, but sometimes burn complications and infection can return with a vengeance.

Rathjen recalls the man who survived his burns only to have a stroke.

“I will never forget discontinuing life support with his wife laying next to him,” she said.

“And you go through several layers. You think, ‘What are his kids going to do? What is his wife going to do?’”

Terrano remembers the evening in the 1970s she stood in the doorway of a patient’s room as her children massaged their mother’s toes — the only place on her body they could touch — as they sang her favorite Christmas carols in her final moments.

“This is not a job that people come to and think, ‘I don’t know what I want to do so I’m going to go work in the burn unit,’” Chaves said, adding that two staffers recently left because they couldn’t handle the stress.

But the work is rewarding too.

The unit’s green scrapbooks holds dozens of cards that single out staff.

One in particular stands out.

“Thanks to all of you,” the card reads.

Then the former patient writes “for using your medical knowledge to help me live one more enjoyable year on earth.”

* * *

On a November Wednesday, Kreikemeier sits in his chair, his legs bandaged from ankle to mid-thigh, his right arm in an airplane splint and his right hand covered by a beige compression glove.

Slowly, he takes a sip of coffee.

“I never thought I’d drink coffee through a straw,” he says.

He’s bad at remembering names, but he tries to stay positive by joking with the nurses, chiding one he thinks is too young to be married.

He puts a positive spin on the new skin on his burned forehead: no wrinkles.

“You have to stay in the right frame of mind,” he says. “Days get long if you don’t.”

Earlier this month, Kreikemeier checked out of Saint Elizabeth and into Madonna Rehabilitation Hospital. He will check in with the burn unit’s outpatient doctors every once in a while.

His goals are simple: Get back home for a day or two to work on taxes and perhaps, one day, compete in a truck pull again.

Bud Kohl learned in 1978 that fire is hell. But the nurses and doctors helped him through, and so did his wife, Mary Anne, who visited him every day.

Four months after the worst day of his life, he walked out the door on his own.

“I was tickled to death, I guess, and thankful to the Lord that I was still alive,” he said.

Reach Riley Johnson at 402-473-7306 or rjohnson@journalstar.com.

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