After the cadaver or pig skin has been grafted, the body will eventually reject it, or it will rot off. So skin grafting isn’t a one-shot deal. As the skin starts to rot, the staff debride it, clean up the area, and put more on. It’s like working with adhesive bandages: Once you have a Band-Aid that’s soiled, you take that Band-Aid off and put on a new one. They don’t graft on cadaver skin and think it will last for the next six weeks while you wait for your own skin to be ready. You have to keep changing it.
For autografts, using a burn survivor’s donor sites, doctors shave the hair on the donor site, then slice off the top two layers of skin. They use a dermotone, an instrument that has a very sharp, flat blade that moves back and forth at about 270 strokes per second. I compare it to taking a cheese slicer to a block of Velveeta. Essentially where they remove that donor skin, they create the equivalent of a second-degree burn, because they leave only the lowest level of skin.
Donor sites can be used more than once because the skin grows back faster. The reason they’ll go to a donor site a second time is because after a few weeks the body is still healing that area, so the skin is rich in nutrients.
The skin grafts were exceedingly torturous. But the area that hurt the most after a grafting surgery was the donor site. While my arms would hurt, it wasn’t nearly as much or intensely as the donor site. Once the doctors shaved off the skin, to protect that donor site, they would cover it with a substance called glucan, which is glued and then stapled on. It would stay in place for several days, then the staples were taken out on the third day. The glucan would gradually peel off after that. As with everything else, this hurt. If the staple went in straight it would come out straight. If it went in crooked, it would hurt coming out. But if the glucan started to peel off before it should, a nurse could accidentally tug on it. More pain.
After they’ve sliced off the skin, they put it in a perforator to allow a one-square inch area of skin to cover two square inches. That way they don’t have to take as much skin to cover you. This causes a checkering look to the healed grafted area.
After they slice off the skin, they place that graft in a bowl of sterile saline to keep it moist until it’s time to place it on the wound. When they place it, they staple it in to ensure it stays put.
Part of the problem with having skin grow around and over the burned skin, though, is that when the skin around it grows back, it grows into what is called skin buds; it’s very granular and grows lumpy. And that’s bad. They don’t want granulation because it causes raised and bumpy scaring underneath. So they go in before they graft and shave that off so it’s smooth and level before they put a graft on.
Mel
I was with Brian every moment I could be. The only times they insisted I leave was during his tank sessions, dressing changes, and physical therapy—which was about six hours each day. The first week and a half Brian was in ICU, they didn’t enforce visiting hours. I could come and go any time day or night. So I stayed with him a majority of the time, sitting by his bed. When he was awake, I would talk or read the Bible to him. And when he was asleep or “out of it,” I would read or watch TV or write in my journal. I would bring mail in with me and read that. Anything to make the time pass.
But some days that ICU and Brian’s small room felt oppressively claustrophobic. I had to get out of there. I would wait for him to fall asleep so I could get a reprieve from the suffocating closeness of sickness and death and pain. I would pray for him to sleep so I could rush out in the hallway just to breathe.
Brian
Because I had an inhalation injury, I had to have chest X-rays every day to check the status of the injury. They would bring in a portable X-ray machine, prop me up until I could hardly breathe, and tell me to take a deep breath and hold it.
There were also the daily physical therapy sessions to keep contractures from forming. Otherwise I would be frozen in whatever position the scars determined. But that therapy was painful, too.
Actually, there wasn’t anything that didn’t cause tremendous amounts of pain. If I don’t recall something, it was because I was so often out of my mind with the pain. Most days there wasn’t much that didn’t hurt, with the exception of Mel rubbing my feet. Even with the amount of medication I was on, I was still either physically hurting or in a drug-induced hallucination, a brain scramble.
Mel
I didn’t sleep except maybe fifteen minutes here and there for the first two weeks. And every time I tried to eat something I became physically ill. This was unusual for me, because normally when I feel stressed, I grab as much chocolate or comfort foods as I can. But not now. How could I sleep? or eat? Everything was too stressful. Even drinking anything was a stretch for me.
While I believed with all my heart Brian would survive, the staff was very clear about the fact that Brian’s burns put him in a pretty significant risk group for dying.
They kept Brian heavily sedated while in ICU. Many times it didn’t matter what they gave him—it didn’t help.
Before every surgery, every bath, every dressing change, Brian and I prayed together and I read to him Joshua 1:9: “Have I not commanded you? Be strong and courageous! Do not tremble or be dismayed, for the Lord your God is with you wherever you go.” We relied completely on God’s presence to get us through those agonizing moments.
I also became Brian’s most loyal advocate. When the day nurse gave the night nurse a report and then the night nurse had to come into Brian’s room, I gave him or her a report at Brian’s direction. I would list off everything that he wanted to have done, and if I forgot something, he would remind me. They indulged us.
Everything became a waiting game. After so many operations, I began to know how long a surgery would take. I would get to the end of that waiting period and if Brian wasn’t out yet, I’d feel big knots in my stomach.
One day while Brian was in surgery, Matt and I sat and worked on his math outside the Burn Unit’s operating room, which had an entrance directly from the hallway. All of a sudden I heard the staple gun going off. I panicked, knowing Dr. Jeng was stapling skin to Brian’s burn areas. I said, “Okay, Son, we have to go do math somewhere else.” Matt didn’t know what had happened. But I did. And I didn’t want to hear what was going on in there. It became too difficult not to imagine some horrible thing they were doing to my husband. I never again sat that close to the OR while Brian was in there.
Ten
Previous Pain
* * *
Journal 9/23/01
God, I know you’ve been preparing me for this for a while; I just didn’t expect my trials would come through Brian. Yet I thank you for the ways you’ve prepared me for this, for the tremendous privilege of being Brian’s wife, and for allowing me to love him and help care for him. Thank you, Lord, for sparing his precious life and restoring us as a family.
* * *
Brian
While we had never experienced anything as devastating as September 11, Mel and I were no strangers to pain and tragedy. But what we faced now seemed insurmountable. If it wasn’t for our belief in God, we would have struggled even more intensely. What helped us work through this current situation was that we had proved our faith before, in other life circumstances.
I’m a product of a broken home. Originally from Fort Worth, Texas, I was nine months old when my parents divorced. My mother was awarded custody of my older brother, Wade, and me. When I was about four years old, Mom met and married Patrick Reves, a very godly man. Soon after, we moved to Austin then to California in 1966, where we remained for seven years until we moved back to Texas. Mom had us for the school year and Dad had us for four weeks in the summer and for a week every other Christmas.
In 1971 we were living in Stockton, California. I was ten when we attended a James Robison crusade in the Stockton Civic Center. They gave an altar call, and both Wade and I felt the Lord’s tug on our hearts. We made our decision to give our lives to Christ. Pat, my stepfather, is the primary reason I grew clos
er to Jesus. He modeled a real genuineness and a love for God.
But even living in a Christian home and starting a personal relationship with Jesus didn’t guarantee a perfect life.
My parents’ divorce had caused a significant personal struggle for me—even though I was so young and had no memory of my father living in our home. I felt as if I had to change identities and allegiances whenever my parents traded custody for the summer and every other Christmas. Texas and California were two separate worlds in which I lived two different lives with almost two different personalities.
I determined early on that I would never discuss one parent with the other. The tension was always there but was especially thick during the “exchange” moments. Dad would drive to California, pick us up, throw our bags in the back, and drive back to Texas, where Wade and I would spend the summer with him and our cousins and relatives. Then when it was time to go back to California, during the two days of nothing but driving, my mind would race with the dreaded thoughts of the upcoming exchange and being in the presence of both parents. When we’d pull up to the house, I would ring the doorbell to let Mom know I was home. Pat, my stepfather, would come out to greet us. I never handled the situation well; Wade was always a better diplomat between Mom and Dad and Pat. While I chose to act as if nothing was happening, the reality was that it really hurt. In fact, it hurt so much that I didn’t want to have anything to do with anybody.
I never discussed what I did with the other parent without feeling as if one parent was checking on the other. When Mom would ask, “What did you do this summer?” I was suspicious of her motives—and the same for my father. I felt as if the questions were asked to imply, Whom would you choose? Whom do you love more?
To this day I still carry those emotional scars. It’s the unfortunate side of divorce. And it brought me tremendous pain.
Mel
I grew up in an unstable home. It was a rigid existence, one with few happy memories.
My one safe haven was my grandma’s house. Every weekend Mom would pack my older sister, Connie, my younger brother, Tony, and me into the car. We would drive to my grandma’s, my memmie’s.
I grew up going to church with Memmie. She used to take me to church camp with her every summer and Sunday school every week. She was a godly woman and a huge positive influence, which I needed desperately.
When I was eight, Tony, who was almost seven, was playing T-ball. We went to his game to cheer him on. He was standing at third base when a player hit the ball toward him. Everyone gasped when the ball struck him hard in the chest.
Tony took a step and threw the ball. Then he collapsed. Immediately a group of people ran onto the field. I was so scared I ran to Mom’s car and hid in the backseat. I rocked back and forth and prayed and pleaded for Tony to be okay. I just kept crying and praying.
Tony was rushed to the hospital. The doctors said the ball had struck him in the chest between heartbeats. He was hospitalized for twenty-one days.
I didn’t see Mom or Dad the entire time Tony was in the hospital. I was shuffled from family to friends to whomever could take care of me while they were at the hospital with him.
One day I was at Memmie’s house, playing her piano in the living room. My aunt arrived, and she and Memmie went into the kitchen and spoke in hushed tones. I knew they were talking about Tony so I went in. They both stopped their conversation and looked at me. When I didn’t move, Memmie said, “Honey, your brother just died.”
Her words felt as if I’d been hit by that ball too. My chest was so tight it hurt. But I didn’t cry. I walked out of the room alone.
I knew what dead meant. I knew I would never see my little brother again. And I didn’t know what to do. Tony and I had been really close. We’d cried together and comforted each other. But mostly I knew I would miss our times together before bed. Tony and I shared a room, and every night we’d dress up our dog in doll clothes. She’d lie indulgently in bed with us, wearing those ridiculous clothes, until we fell asleep. And then she’d escape, and Mom would take the doll clothes off her.
I couldn’t believe my brother was dead. But I never cried until the funeral. Then I crawled up in my uncle Gary’s lap and sobbed. Until that moment I had carried that heavy weight alone.
After Tony died, I continued to attend church with Memmie. And when I was thirteen, I accepted Jesus into my life at Falls Creek Church Camp. Charles Stanley was the guest speaker that week.
While I know I accepted Jesus at that camp, I didn’t understand everything about that commitment. Perhaps part of it was that, growing up, I never truly heard that I could have a personal one-on-one relationship with Christ. It was always more like God was up there watching, ready to zap me every time I did something naughty. No one ever told me about knowing God personally, calling him Abba Father, Daddy.
Because of my rough home life, though, I began to rebel against my parents. I became wild. My older sister, Connie, was the good kid. But I had a watch what I can do attitude and did everything I could possibly think of.
When I was in high school, I would stay out as late and as often as I could. I decided it was okay to party and be wild.
After I graduated from high school, I went to Southeastern Oklahoma State University in Durant, Oklahoma. I was a freshman when my mother was diagnosed with breast cancer. She had a mastectomy and went through chemotherapy. It was too difficult for me to deal with the possibility of losing someone else I loved—especially after losing my brother. So I chose not to deal with it; I just ignored it. And I became committed to destroying my life. I drank all the time, partied all the time, never went to class. I had a stellar 1.69 GPA to show for it.
I was so miserable I kept hoping my wild lifestyle would bring me some peace—or at least help me forget my misery. It never did.
Brian
I attended high school and college in Beaumont, Texas. I graduated from Lamar University in 1984 and was commissioned as a second lieutenant in the U.S. Army. I chose the military because of the character and nature of the profession. My father, stepfather, uncle, and other family and friends had served in some capacity during World War II or Korea. I knew it was an honorable profession—and I wanted to be part of it.
I went to Field Artillery officer basic training at Fort Sill, Oklahoma, where I graduated in September 1984, and was sent on my first duty assignment with the Second Infantry division in the Korean demilitarized zone between North and South Korea.
Rod Fronk was a sergeant in my unit. And one day in late 1985, Rod said to me, “My sister-in-law is a perfect personality match for you.”
“Oh yeah?” I said. But I didn’t really think anything more about it because I figured he was joking. I can be a pretty serious person and Rod isn’t—there’s nothing serious about him. The man could be a stand-up comedian. So I wasn’t sure what kind of gal he was trying to fix me up with.
About two months later I received a letter from his sister-in-law, Mel. I was surprised by the letter but thought that was kind of nice. Yet I wasn’t sure how to respond to it, so I didn’t.
She sent two or three more letters before I finally responded. And I sent back a very formal letter: “Dear Miss Collins . . .” At least it started that way! The rest of the letter I joked with her and kept it light. I figured I would have fun with our correspondence.
We passed several letters back and forth—mostly with me giving Mel a hard time about being from Oklahoma!
In late February 1986 I returned to the States to attend school at Fort Knox in Kentucky.
After school I headed to Fort Riley, Kansas, as my new assignment. By July I received a pass for a few days off, so I headed to Oklahoma to meet Mel.
Mel
In July 1985 my sister, Connie, was involved in a car accident, and my brother-in-law, Rod, came home at Christmas from Korea to see her. He brought home a photo directory of his unit in Korea.
One evening my high school friend and college roommate, Nikki Fitzgerald, and I vi
sited Rod and Connie. We had been drinking heavily. I pulled out Rod’s directory, and we began to look through it to pick out men we thought were cute.
I pointed to one guy. Rod said, “That’s Brian Birdwell. He’s my boss. He’s a great guy.” He started telling me all these great things about Brian, and Nikki and I looked at each other, impressed, and said, “Well, let’s just write him a letter.”
So we did. But we didn’t hear anything back from him. So we wrote him again, and this time we received a response. His letter started “Dear Miss Collins.” But then the rest of it was so funny! He talked about being 185 pounds of twisted steel and sex appeal, and that he lived in the last house on bad street.
We started writing back and forth, bantering, giving each other a hard time, and discovering our common interests—we both are big sports fans. Eventually we made contact by phone. One night he called me at my house, but I was out with friends. So my mother answered, and they ended up talking for forty-five minutes! When I arrived home, Mom told me about the conversation and said, “He seems like a really nice young man.” But I thought, What kind of guy calls my mother and talks to her before I’ve even met him?
Finally, by July, seven months after I wrote the first letter, we arranged for our first meeting. He was on leave to visit his family in Texas, so he offered to pick me up and take me to Six Flags over Texas, an amusement park several hours from my house.
The day finally arrived, and I was so nervous! He pulled up in a pickup truck and got out to meet my family. He was wearing his Texas longhorn shirt, which was okay because I was wearing an official Oklahoma Sooner shirt! I presented him with a big Oklahoma-shaped cookie that had a longhorn emblem on it—which represented Texas—with a red circle and a slash through it. He was always teasing me about Oklahoma being substandard to Texas.
I knew he looked handsome from his photo in my brother-in-law’s directory. But he looked even better in person! That made my heart race and my hands shake. Once I calmed down, I had a great time. It felt natural to be with him.
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