Spring 08
Vol. 15/ No. 1

Joannie Welsh
Traditional BSN student

It wasn't a matter of whether or not I was going to seek an externship, it was just a matter of where.

After spending three years studying at one of the best nursing programs in the United States, I felt I needed to find an opportunity to improve my clinical skills. I started searching for the right program – making call after call to human resource departments nationwide – since the beginning of my junior year.

Then I thought, what is the most populous, most unique city in the United States? New York City. I thought that New York would provide me with the greatest opportunity to learn. Fortunately, I don't think I was proven wrong.

At first, I considered an externship with the New York University Medical Center; but a visit to the hospital yielded a change of mind. NYU Medical Center is a great hospital, but, for whatever reason, I just felt I had to keep looking.

So, I looked into an other option - the New York Presbyterian – Cornell Hospital. I knew one MU nursing student who had enjoyed tremendous success as a postpartum nurse at the hospital. The interview was so warm and welcoming that I felt right at home in a city so foreign. I also liked the cultural diversity.

Prior to landing an interview, I had to submit two letters of recommendation and a copy of my transcript. I was later selected as one of 30 externs from a pool of 200 applicants. After my acceptance, I was asked to choose the unit in which I would work. The nurse recruiter suggested I speak with the nurse manager in the burn unit. If she had not suggested I give the burn unit a try, the thought would have never entered my mind.

When I met with the burn unit nurse manager at New York Presbyterian-Cornell Hospital, I knew this is where I belonged.

He said I would be frightened and find some situations hard to handle, but I insisted that I could handle it.

I had no idea the things I would see, smell, hear or feel. From day one, I felt overwhelmed — the strange jargon, the frantic pace, the draining 12-hour shifts, the all-to-real sight of human suffering.

For those who were anywhere near a TV that day, it is easy to recall the image of a truck with its windshield blown out, its body checkered with gray and black ash, sunk into a crater twice its size caused by a ruptured steampipe near Grand Central Terminal in New York City.

While many people were left wondering whether the happening was founded in terrorism (it was ultimately attributed to faulty infrastructure), a select group of doctors and nurses at New York Presbyterian – Cornell Hospital looked upon a horror show of third and fourth degree burns: the two occupants in the truck were alive, barely.

My apartment was close enough that I could hear the explosion and see smoke rising above buildings. I remember thinking that there must have been some sort of bomb and that victims were probably being rushed to my burn unit. Should I call, do they need my help, how many are injured? Hundreds?

It was at this point, I felt I could be of help in an emergency situation. I would not be just some fumbling, timid nursing student. While the woman in the passenger seat had serious burns to her lower extremities leaving her unable to walk, the driver of the truck had third degree burns covering 90 percent of his body.

He was about my age, 21, and he was in pretty bad shape. The driver received third degree burns that covered 90 percent of his body. He was unconscious, the result of a medically induced coma, and he remained in this state for several weeks.

His room was air-tight and infection-controlled with heat lamps to ensure a proper body temperature and blood pressure. Heat lamps were a common sight in order to ensure a proper body temperature and blood pressure.

His skin was virtually gone. His main protection was gone. It wouldn't take much for an infection to kick in or for cardiac arrest because his core body temperature dropped.

I was one of three nurses in the room working in unison to meet the doctors' requests. I remember sweat stinging my eyes because it was incredibly hot in that room. The young man was on a ventilator, so I managed his airway during burn care — a request that put butterflies in my stomach.

A few days later I performed an even bolder task, one of packing the newly made slits in his thighs, calves, arms and fingers. A fasciotomy had been performed to prevent the breakdown of circulation to the man's extremities. I learned these slits prevented the breakdown of circulation to his extremities. With burns this serious, internal pressure is an issue. If they didn't do a fasciotomy, he would have potentially lost his arms and legs.

During my time in New York, I assisted in the debridement of more than 30 patients. A tremendous painful task that removes all the wound's dead tissue. A process that is unimaginable to someone who has not experienced "the tank," but the countless screams and grimacing faces are proof that burn victims are some of the strongest individuals I have ever encountered.

Although the debridement process proved to be extremely challenging for me, the next task ranked among the hardest. I was asked to soak gauze in a saline solution and then place it in my patients' open wounds, all while simultaneously holding his heavy limbs and wrapping bandages to keep the gauze in place.

The process was more than I ever thought I could handle, and at the first sight of calf, tricep, and thigh muscles, I thought I was definitely going to pass out. After I gathered myself, I re-approached the task and accomplished something technically, physically and psychologically challenging.

Due to the sensitivity involved, the undertaking of packing the wounds and treating the burns took more than two hours.

For the next several weeks I nursed this one specific man — changing his bandages, checking his airway while softly talking to him, explaining what I was doing and why.

In one of my very first lectures in nursing school, I learned that no matter a patient's condition it is important to explain each procedure. I never forgot that lesson.

Even though he couldn't talk because he was intubated, I knew he could hear me. I remember his eyes welling up with tears whenever I reminded him to be strong and reassure him the procedure was almost done.

A month later my externship was completed and he was still there draped with skin grafts. I don't know whether he lived or died, and, in some ways, I don't want to know. I'd rather like to think he's still hanging in there, getting better little by little. I think the same way for all the patients I treated.

But, unfortunately, I learned the dramatic nature of working in a burn center, where a minor infection can turn deadly in a matter of hours, even minutes.

Perhaps more than anyone else I treated last summer, I fondly remember a homeless man placed in my care who had third-degree burns blanketing virtually his entire body. He had been targeted for a hate crime in which he was doused with kerosene and set ablaze.

The man was transformed from a grimacing mass of charred muscle tissue to someone with hope. I remember seeing him walk through the hallway two weeks before I left. His legs were so emaciated that they looked like pretzel sticks that could snap at any minute, but he could walk. I was hopeful that all his pain and suffering would end with a new life.

Then his finger became infected, then it became gangrenous, then – before I could blink – he was back on a ventilator as if he'd never really walked just a few days prior. It was heartbreaking. Infection control is the one of the most important aspects to any burn unit. One bad infection, and you're right back where you started.

On my last day at the hospital I no longer felt helpless as I had that first morning. I felt helpful. Sure I made my share of mistakes, and I admit to breaking down more than once. I'll ev en admit that I have flashbacks that linger in my consciousness.

Inflicting pain on individuals everyday isn't my strongest trait, even when I know how critical it is to the health of these patients. But I also don't admit to giving up.

It was a tremendous challenge for me. Would I do it again? I might first ask if there are positions available in any other units but, if not, I'd absolutely do it.

Joannie's brother, Hugh, helped her write her story.