After the Fire

by Robin Gaby Fisher

  The Llanoses were loving parents. Mansour could see that. But he had found them hard to reach when he spoke to them earlier that day. He wasn’t sure if their expressions were dazed because they understood so little English, or because they were just so bewildered by what was happening. He was certain they did not comprehend that their son’s situation was perilous, or that if he survived, he would be in a coma for a very long time.

  Deep in prayer, neither parent noticed Mansour watching the scene.

  He walked on.

  The families had a long road ahead of them. In some ways, their journey would be more difficult than their children’s.

  For the parents, there was little to do but wait and worry. Mansour knew how agonizing it was for them. He wished there was a magic pill to help ease their suffering. For now, he had done all he could for their children.

  Christine and Kenny Simons were watching television in the waiting room. They had asked if they could bunk there to be close to Shawn.

  “Good night, folks,” Mansour said, stopping at the door.

  “How is Shawn, Doctor?” Christine asked.

  “Sleeping tight,” Mansour said, trying to offer some comfort. “Now get some rest. Tomorrow will be another long day.”

  Mansour had liked the Simonses right away. Both seemed bright and levelheaded. From what he had been able to glean so far, he guessed they were stronger than Daisy and Alvaro Llanos, who were disadvantaged by the language barrier and the effects of Alvaro senior’s stroke. Christine Simons had already won over the nurses with her easy smile and warm way. They marveled at her composure under such terrible pressure. She had even taken the Llanoses under her wing and seemed to be able to comfort them, although she didn’t speak a word of Spanish. And her devotion to her son was palpable, pure, and beautiful.

  If the boys lived, they would be in the burn unit for a long, long time. Family support would mean as much as a dose of good luck. Hani could already see that Alvaro’s case was one that the nurses would debate late at night during breaks in the cafeteria: Were they doing him a disservice by trying to save him? Mansour wasn’t sure Alvaro’s parents were up to the task they faced. There were times when he himself looked at patients he had treated and thought, My God, what have I done? As he walked out of Saint Barnabas and back to his Jeep for the ride home, he prayed this would not be one of them.

  Chapter 6

  Hani Mansour had heard his first burn scream when he was just a boy, growing up in Beirut, Lebanon, in the 1950s. The sound was unlike anything he had ever known. It seemed to start deep in the gut, then build slowly, deliberately, until it finally spilled out into a long, tortured wail.

  Hani wasn’t yet a teenager. He was visiting his ailing father in Beirut’s military hospital when he heard the person in the next room screaming in pain.

  “What is the matter with that man?” young Hani asked a nurse on duty that day.

  “The man was burned in a house fire,” the nurse replied.

  “Why can’t you help him?” Hani asked.

  “There is nothing to do but wait for him to die,” the nurse said resignedly.

  For days afterward, young Hani could hear the scream in his sleep. And whenever the wail replayed in his mind, the boy would squeeze his eyes shut and shake his head — hoping to rattle the memory right out of his brain.

  It was twenty years later, as a young doctor beginning his career in Lebanon’s largest city, that Mansour heard the unmistakable scream again. He was working as a resident in general surgery at Saint George Greek Orthodox Hospital in Beirut. A senior physician had assigned him to care for a group of soldiers burned by napalm during the 1973 Arab-Israeli War. The plastic surgeon on staff didn’t want to deal with the soldiers, and Mansour was put in charge of their treatment. The memory of the man from his childhood still haunted him and he felt a sense of responsibility to do all he could to ease the soldiers’ suffering.

  Lebanon was just gaining its independence from France when Esber “Hani” Mansour was born in July 1947. Beirut, a Mediterranean seaside metropolis, was crowned the new capital city. Mansour’s father, Nicolas, owned a construction company and built apartment buildings there. His mother, Marie, was the daughter of a physician. The Mansour family was by no means wealthy, but they were educated and members of Beirut’s intellectual class. That was saying something, because Beirut was considered the intellectual capital of the Middle East.

  Marie Mansour had always hoped one of her five sons would follow in the footsteps of her altruistic father and study to become a doctor. But her husband had other ideas, and four of the boys followed him into engineering. That left Hani, the middle son, and his mother pushed him hard toward a career in medicine. Following her wishes, he applied to and was accepted at both American University and Saint Joseph’s University in Beirut. He chose Saint Joseph’s, but his mother’s dreams almost ended on the first day of classes. A microbiology professor was lecturing about “echinococcus that multiply by schizogony,” and he might as well have been speaking a foreign language. Hani suddenly realized he was in way over his head. He went home and told his mother he wasn’t going back. She, however, had other ideas. And Hani returned. In the end, he knew he couldn’t let her down.

  For the longest time after earning his medical degree, Mansour couldn’t decide on a specialty. Perhaps if the dream had been his own and not his mother’s, he would have been more focused. It took the severely burned soldiers to stir his passion. If no one else cared enough to try to get past the grisliness and the hopelessness of their condition, then he was determined to help them in whatever way he could.

  Back then, in Beirut, burn treatment was undeveloped, and practitioners were scarcer than scarce, so Mansour turned to textbooks for guidance. The history was fascinating. In 1500 b.c. the Egyptians had used mud and cow dung to treat burns. Things hadn’t gotten much better by the seventh century, when a salve concocted of “old wild hogs and bears and a chunk of genuine mummy” was recommended, or the seventeenth century, when turpentine and maggots were the preferred option. Only after World War I and the terrible toll that modern warfare had taken on the human race was the medical profession forced to pay closer attention to burns, and only then did physicians even begin to realize how little they knew about treating them. World War II brought advances in anesthesia, skin-grafting techniques, and the use of penicillin to treat infection, a deadly side effect of burns. Back on the home front, the 1942 Cocoanut Grove nightclub fire in Boston, which killed 492 people and injured hundreds more, started a revolution in burn treatment research. Using the surviving patients as guinea pigs, doctors in Massachusetts not only treated the surface burns but also focused for the first time on the internal effects of burn injuries. By treating respiratory injuries and shock as well as burns, doctors saved more patients from the Cocoanut Grove and every fire since than would otherwise have survived.

  By the 1960s, doctors were infusing burn patients with liquid formulas to replace the huge amounts of plasma leaking through their pores. Later advances in topical antibiotics to fight septicemia, a massive infection from burns that poisons the blood, further reduced the death rate.

  Still, the prognosis for the burned soldiers in the 1970s wasn’t much better than it had been for the poor man Mansour had encountered twenty years earlier while visiting his father in the hospital. It still held true, after all those years and all of the experimental treatments, that major burns, like the ones caused by napalm, were almost always fatal, and the rare patient who did survive often succumbed to the relentless infections.

  Doctors were healers, so few of them wanted to take up a specialty where the outlook for patients was so often grim. Mansour started to see it differently. Most doctors looked at a burn patient and saw hopelessness; he saw a field that desperately needed developing and that appealed to the sense of ingenuity he had inherited from his engineer father. Looking at the Syrian soldiers, Hani Mansour saw his future.

  Once Mansour had his spe
cialty, he threw himself into it, researching the latest treatments and spending hours at the bedsides of his patients, trying to soothe the excruciating pain of their burns and ease their fears of dying — or worse, living. Mansour spent a year practicing at the Beirut hospital. At the time, civil unrest was simmering in Lebanon. Tensions between Christians and Muslims were bubbling up, and the Lebanese Civil War would soon tear the capital city apart. Before long, Beirut would be divided by religion, with Muslims living in the west and Christians in the east. Many of the residents would flee to other countries rather than carry on amid the growing turmoil. Mansour, a Catholic, decided to further his medical career by studying in America, where the postgraduate training was a decade ahead of Lebanon’s program.

  In December 1974, Mansour immigrated to the United States and began his residency in general surgery at Union Memorial Medical Center in Baltimore. The only thing Baltimore and Beirut had in common was the B, and Hani longed for his homeland and his family. The only compensation was the residency itself. Mansour was constantly stimulated, learning new treatment methods that encouraged him to reconceive what might be possible with regard to the severely burned.

  Six months after he got to the United States, Mansour was introduced to an erudite American nurse named Claudette Crochetiere. Claudette had just returned from six months in France, where she had worked as an au pair in a pension de famille (boarding house) in Paris to be able to live among the French and learn their language. In Baltimore, she was studying for a master’s degree in public health at Johns Hopkins University and working nights as a nurse in a surgery ward at Union Memorial. When she heard the new resident speaking fluent French on the telephone, she struck up a conversation. Hani invited Claudette out for pizza that night. After a three-year courtship, he proposed, and they married in a small ceremony at Claudette’s parents’ home in Connecticut in 1978.

  They hadn’t been married a year when Mansour applied for a fellowship to study under the preeminent burn surgeon Basil Pruitt at the U.S. Army Institute of Surgical Research at Fort Sam Houston in San Antonio, Texas. From everything Mansour had heard, Texas was a dusty, sticky place where men wore cowboy hats and carried guns in their trucks. He didn’t care. The base was touted as the army’s premier medical training center, and Pruitt’s burn unit was considered the best in the world. Mansour was accepted into Pruitt’s program, but because he was a civilian, not a soldier, he was told he would only be allowed to observe. No, no, Mansour said. He wanted hands-on training. The only way would be to join the army, Pruitt said. The timing was certainly right. Army doctors were in short supply when the draft was abolished near the end of the Vietnam War, and Mansour was a willing recruit. By agreeing to serve two years, he was able to join even though he was not a citizen.

  With his new orders in hand, Hani and Claudette packed up their matching Chevy Vegas and drove seventeen hundred miles from Baltimore to San Antonio during a gas shortage. From the Middle East to the Lone Star State within five years — life certainly took some strange twists and turns, he thought.

  It was the first time in Claudette’s life that she had started over for someone else. Having grown up in a close-knit family from Connecticut, she was used to being around her brothers and sisters. With no job, no friends, and no family close by, she was instantly lonely, but Hani was single minded: he was going to be a burn surgeon. In San Antonio, Hani and Claudette took out a VA loan and put five hundred dollars down on a house near the army base. Within months, Claudette was pregnant with their son, Nicolas.

  In short order, Pruitt promoted his younger protégé to chief of burn study, and Mansour’s career was sealed. At the same time, burn treatment was in the midst of a second minirevolution. Since the discovery of penicillin and what was learned from the Cocoanut Grove fire, there had been few new remedies or treatments. But in the 1970s, topical antibiotics came into wide use. The medical profession also began to understand how to use nutrition to prevent a burn patient’s body, which was in a hypermetabolic state, from consuming itself. The technique of skin grafting using cultured and artificial skin was on the horizon. Survival rates had doubled since Mansour’s college years in Beirut, and the number of burn centers in the United States had tripled in the preceding decade, to more than one hundred.

  Mansour had been in San Antonio only a few months when, on October 19, 1979, Typhoon Tip roared into mainland Japan. The storm packed 115-mile-per-hour winds and torrential rain. More than 1,250 U.S. Marines were housed in Quonset huts at a base known as Camp Fuji. The camp’s fuel farm was up the hill from the huts. The downpour eroded the retaining walls around the fuel storage bladders, and one broke free, spilling five thousand gallons of gasoline into the huts. A space heater sparked the fuel, and the huts ruptured into flames, killing thirteen marines. The seventy-two burn victims were airlifted to Pruitt’s burn center in San Antonio. The worst was burned over 92 percent of his body. Ten years earlier, he would surely have died, but Mansour was able to save his life using the newest treatments.

  Two years later, Saint Barnabas contacted Pruitt, looking for a recommendation for someone to head up its budding burn unit. Pruitt didn’t even need to think about it. Mansour was thirty-four at the time and had learned enough to pursue his dream of returning to Lebanon to open a burn unit there. But the civil war raged on. The opportunity to work in the New York area with some of the brightest minds in medicine was too good to pass up, and he agreed to postpone his dream of going home. He would go to New Jersey — but only for a year.

  In Texas, he and Claudette lived fifteen miles and one traffic light from the hospital, and even that distance he thought was too far. So when they came to New Jersey to look for a place to live, Hani bought a map and drew a five-mile circle around Saint Barnabas. whatever house they bought would have to be somewhere in that ring, he told the real estate agent. The first house he set his sights on was directly across the street from the hospital, so close that at night the lights in the hospital parking lot lit up the living room. Claudette, who had a toddler to care for, put her foot down. They settled on a home two miles away.

  Mansour arrived at Saint Barnabas in the summer of 1981 and found a ten-bed burn center tucked in a corner of the hospital basement. The beds were half empty and the small staff were green. He hired more staff and taught nurses, technicians, even plastic surgeons, how to treat burns. The burn unit grew as doctors and nurses were drawn to this modern hospital in northern New Jersey by the possibility of working with Hani. One year turned to ten, and his dream of returning to Lebanon sat on the shelf, collecting dust.

  Mansour was known as impish and eccentric. Some days he arrived at work wearing one black shoe and one brown. He tended to exasperate his staff with his demands and his absentmindedness, but their admiration was boundless and they would do anything to accommodate him. When he needed someone to work a double shift or an overnight shift, five people would volunteer. He was the kind of doctor they could have fun with, too. When he was dieting, the nurses hid the birthday cakes from him. He could be moody and quick to anger, pouting when he gained a pound and blowing up when someone suggested that a homeless man who had deliberately set himself on fire deserved less consideration than a burn patient who was less culpable. When children were admitted to the unit, he could be glum for days. Yet whenever the stress in the unit grew nearly unbearable, it was Mansour who broke it by telling one of his corny jokes, then laughing the hardest of all. When he laughed, his whole body jiggled and his face turned scarlet.

  Under Mansour, the burn unit had moved up from the windowless corner in the basement to a sunny wing on the second floor to accommodate the ever-growing staff of ninety, including surgeons, nurses, social workers, and respiratory, physical, and occupational therapists. A unit that had had only ten beds when he took over now had thirty. Before Mansour knew it, nineteen years had gone by. The Saint Barnabas Burn Center was recognized as one of the top burn treatment centers on the East Coast. The gruesome nature of the wor
k meant that few ever became old-timers in the occupation of treating burns. Those who did were the best in the business. And those few were found at Saint Barnabas, hiding sweets from their boss.

  Chapter 7

  At three in the morning, there wasn’t much to do in a hospital waiting room, and Kenny Simons had that leg-jittering kind of restlessness. A television was on, but the sound was turned off. Fluorescent bulbs on the ceiling lit up the tiny space like Hollywood spotlights, flooding the room with an intense and antiseptic atmosphere.

  Kenny was sitting in a wooden chair so hard it didn’t move even as his leg jackhammered into the floor. Nearby, Christine lay curled up on a couch with her eyes closed. Watching the minutes tick by on a large, round wall clock, he tried not to think about the time. Or the lights. Or facing the world with a mangled son. He had always been so proud of his handsome boy. He loved the way his skin had been as smooth as a baby’s, even though he was in college now. How will Shawn handle being disfigured? How will he handle people staring? How will I? Kenny wondered, the cacophony of thoughts getting louder in his head.

  “I’m worried about how Shawn is going to handle how he looks,” he announced, hoping his ex-wife wasn’t really asleep.

  Of course, Christine wasn’t sleeping. She hadn’t slept a wink in the two days since Shawn had been burned. How do you sleep when your child is fighting for his life? How do you sleep when your ex-husband is squirming and fidgeting less than an arm’s length away? Sometimes, Christine wondered why Kenny was even there. He had hardly been a doting father since he’d left them, at her insistence, fourteen years earlier. She hadn’t forgotten the times he’d missed Shawn’s birthday or the Christmas when he neglected to give him a single gift. Shawn had never been more hurt than he’d been when Kenny had told him, years earlier, “I have a new family now. You’ll have to accept your place in the background.”