Friday, April 2, 2010

Burnt Childs

In my practice, I care for adults.  Occasionally, I will see a 17yo and treat them like adults (much like the State of Texas chooses to do with slightly underage criminals), with adult medicine and therapy.  I never, however, manage the medical care of childly children, as in the ones who drink milk from a bottle, carry around a "lovey" or eat Goldfish crackers.  If children were really sick, it broke my heart to deal with them, otherwise, their parents broke my will and patience.  So, early in medical school, I knew that though I love children, I don't want to be their doctor.  

During stem cell transplantation, many patients develop GVHD (graft vs host disease), which is, essentially, an immunologically mediated burn caused by donor lymphocytes which recognize the host tissues (skin, liver, GI tract) as foreign and attack.  However, my exposure to burns in my earlier training consisted of the more traditional skin charring secondary to fire, and I didn't really enjoy this type of medicine at all.  The patients were disfigured, and the collateral damage of terrible, and sadly, often intentional, accidents.  They required their rooms to be intolerably hot while they healed given loss of skin and inability to regulate body temperature, and had frequent dressing changes with wet sloughed skin stuck ingloriously to each petroleum laden cloth.  More than one of the patients with burns I cared for as a medical student blew themselves up by lighting a cigarette while receiving oxygen.  Oxygen is flammable. And, hey, aren't you needing oxygen to breathe as your lungs were ruined by smoking?  [This calls into question Darwin's meaning of "survival of the fittest," and usually led to horrible facial and airway burns].  But I digress.

The burns I have seen here are awful, and not, in fact Darwinian, but rather, most often involving chidren.  The stories are not pleasant: big sibling pushed 3yo into fire, 17 mo boy walks into stove, or 3 yo girl pulled hot oil onto her face.  Here in Iraq, as in much of the 3rd world, the cooking is done often, not in conventional electric ovens, but rather over a fire in an open pit.  In addition, while the epidemiology is not clear, there is clearly an unacceptably high rate of child abuse, and some of these pediatric burns are via hot oil punishment from troubled parents.  Education is the best means to limit this, and improved means of cooking ( are coming, but both egalitarian rights are still farther up the hierarchy of needs than, "security", "food", and "shelter", all of which are just starting to solidify.

Oy!  Children and burns - this is not what I thought I would be doing; so heartbreaking.

At least I don't have to work in the STD clinic.

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