As healers, we don't have the luxury of having a bad day

It was an unusually cold night, even for December. The emergency room was quiet -- few people were eager to venture out in the icy weather. I had made my rounds on the pediatric ward and the burn unit and had settled in at the ER nurses' station with a warm cup of coffee and a tattered magazine when the call came in.

The paramedics were on their way with several patients -- all members of a family whose row house had broken out in flames. Space heater? Christmas lights? So many potential dangers in the dark of winter.

As the burn victims were rolled into the ER, I was relieved to see that many of the injuries were relatively minor. First- and second-degree burns, generally over small areas of the body -- deeply painful, but not life-threatening. Then I saw the little boy, barely a year old. His face was untouched, his natural dark brown, but, alarmingly, the flames had charred much of the rest of his exposed body, turning the skin a dull gray-white.

I ran to his side, my voice soothing, trying to calm his cries. His vital signs were stable, he was conscious and alert. It was our job to provide fluids and prevent infection, now that the fire had destroyed the capability of his burned skin to retain moisture and defend against microbes.

Starting an IV was my next step, and I was grateful for the years of experience I'd had as a pediatric resident with uninjured patients. Even so, I wasn't prepared for the little boy's challenge. At every site on the arms and legs I tried, the touch of my fingers would slough off the friable skin and prevent the needle's proper insertion.

Finally, I called for a surgeon to perform an incision and insert the IV needle from a deeper and more stable site under the top layers of skin.

On the other side of the curtain from our exam area, the baby's mother and aunt were being tended by a colleague. Pain medication and antibiotics would help them recover relatively quickly. I could only hope that the baby would have a similar chance.

The surgeon on duty arrived within minutes. I stepped back as he headed for the surgical tray the nurse had prepared for him next to the infant's gurney. Snapping on his gloves, he began looking for a site on which to work.

Seemingly irritated at the difficulty of finding a good site due to the breadth of skin damage, the surgeon finally found a spot on one leg and began the procedure, the nurse and I helping to hold still the fussing infant with gentle pressure on his unburned abdomen.