Against the odds

 

10.26.03

 

By FELICE J. FREYER
Journal Medical Writer

 

Heather Gauvin spent the night looking for her mother.

From the moment she heard about the fire till the moment she reached her mother's side, three desperate hours passed -- hours to find out where she was, to get a ride to the hospital, to gain admittance to her room.

But when 18-year-old Heather Gauvin finally peered into the hospital bed, all she could do was scream.

That's not my mother! I want to see my mother!

What's your mother's name?

Gina Gauvin.

Journal photo / Mary Murphy LIFE LESSONS: Heather Gauvin, center, feared that she would lose her mother to injuries suffered in The Station fire. But, with a will to live that overcame the odds, by June Gina Gauvin is getting ready to go home, and Heather is learning how to wrap her bandages. See the slideshow

That's Gina Gauvin.

That's not my mother!

Months later, at the rehab hospital, Gina Gauvin would joke about how awful she had looked. "I heard what I looked like. . . . I'm glad they didn't take pictures!"

Months later, as Heather is learning how to wrap her mother's withered arms, Gina smiles and holds up her unbandaged right arm.

"Oh, you haven't seen my hand yet," she remarks to a visitor, displaying what remains of her remaining hand: four round, stubby fingers that end at the first joint, fused together by scar tissue.

"I have a kitten paw," she says brightly, wiggling it.

THE MUSICIANS had just started to play at The Station nightclub on Feb. 20, setting off a plume of fireworks behind them, when Gina M. Gauvin noticed flames devouring the foam soundproofing behind the musicians. For a few seconds, the band continued to play and the audience to cheer.

But Gauvin knew immediately that something was amiss. She started walking quickly and quietly toward the front door. She had come to the concert alone, and she would leave alone.

Though she reached the entrance in seconds, by then coal-black smoke had filled the club and people were cramming into the foyer, shrieking. They fell on top of each other in the doorway, and Gauvin was forced down, squashed near the bottom of a pile of people.

The smoke poured down like lava; it smelled like poison; it covered the people, gushed into their throats, choked off their air.

Gauvin passed out.

A cold spray of water awakened her and gave her hope: the firefighters had arrived. Reaching out the doorway, she waved her arms at them. They struggled to pull her out, but her legs were stuck under the bodies. She heard a firefighter yelling: "I can't get them off of her!"

Finally they freed her, carried her to a stretcher and wheeled her to an ambulance, which sped to Kent Hospital. There, doctors put a breathing tube down her throat and started an intravenous line to dispense painkillers. They could tell that she would need expert care at a medical center devoted to burns. She was rolled onto a helicopter.

Drifting in and out of consciousness as the helicopter went aloft, Gauvin dreamed she was on her way to Russia, with two Asian girls on each side of her. The next thing she remembers -- even though she was heavily sedated, unresponsive, her eyes swollen shut -- was knowing that her daughter Heather had come to visit. She was aware, too, that her sister Denise and Heather's boyfriend were there.

"What are they doing in Russia?" she wondered. "They must have gotten some federal assistance."

It was not Russia, but Worcester, Mass., where Gauvin and three other victims of The Station fire were taken in the early hours of Feb. 21. The UMass Memorial Medical Center has a two-bed burn unit, but the place would scramble to accommodate the excess patients, as would all the hospitals called upon by this disaster.

In scarcely two minutes, a stray spark in a small wooden building caused devastation that would strain the region's medical resources for months to come. Ninety-six people died in the building -- their bodies, as one rescuer put it, "stacked in there like cordwood." More than 200 others were injured, 115 badly enough to require hospitalization.

The most severely hurt were distributed among the region's burn centers: 43 at Rhode Island Hospital, 16 at Massachusetts General Hospital, 8 at Brigham and Women's Hospital, 4 at UMass and 4 at the Boston Shriners Hospital (which normally treats only children). Four people died in hospitals in the days after the fire.

Gina Gauvin was among the dozen who teetered in intensive care for weeks, their doctors unready to call them survivors, their families unable to plan or mourn.

Life first, limbs second

GAUVIN WAS the last of the four to arrive at UMass Memorial Medical Center, and the most severely injured.

Dr. Janice F. Lalikos, the plastic surgeon on call, arrived to find the emergency room's trauma bay clamorous with medical workers tending to the four fire victims. By the time Gauvin arrived, the ER was already staffed up and organized for this sudden challenge.

When Lalikos looked at Gauvin, she was struck by how badly burned her hands were: "Her left hand had no blood flow in it. It was white, white, white. We're not talking just pale." But for any burn patient, the rule is: life first, limbs second.

And to save a burned person's life, you worry first about air and then about fluids. Gauvin was already on a ventilator. Lalikos checked to make sure that the breathing tube was bringing enough oxygen to her lungs and the rest of her body, and that there was an intravenous line providing fluid.

Lalikos listened to Gauvin's heart and lungs and felt her belly -- checking to see if there were any internal injuries. There weren't. Good thing -- the burns were bad enough.

From the top of her head to her left ankle, Gauvin's skin was seared a leathery black and yellow. Her back, her chest, both arms, her left leg -- about 65 to 70 percent of her skin had been scorched. Most of her left ear was burned. But worst of all, she had a significant number of fourth-degree burns, where the fire had consumed all the skin and reached down to fat, muscle and bone.

When someone is burned, fluid leaks rapidly out of the blood vessels into the surrounding tissue and into the lungs. Gauvin was swelling up, and would eventually balloon to twice her normal size and weight. But a more serious consequence of this leaking is the drop in blood volume, which can lead to kidney failure, shock and, quickly, death. Through an intravenous line, each hour Gauvin received a liter and a half of fluid -- water spiked with such essential minerals as potassium and salt.

It sounds simple, but understanding the importance of this "fluid resuscitation" is a major advance in burn care. It was not understood at the time of the 1942 Cocoanut Grove fire, in Boston, and hundreds perished as a result. There are no technological thrills here, just a minute-by-minute attention to detail: pumping in exactly the right amount of the right kind of liquid, and monitoring carefully. Much of burn care is similarly unglamorous; those who dislike it find it tedious and gruesome, and those who love it find it endlessly intricate and challenging.

Luckily for Gauvin and the other Station burn patients, UMass was well staffed with lovers of burn medicine -- nearly a dozen intensive-care nurses trained in burn care, a physician assistant who specializes in burns, plastic surgery residents and a team of plastic surgeons. While many burn doctors are general surgeons or trauma surgeons, UMass has cast in this role its plastic surgeons -- doctors who have trained as general surgeons, but then learned reconstructive surgery.

Minute-by-minute attention to detail

RIGHT NOW, in the emergency department, Gauvin was being strangled by her own skin. Burned skin gets hard on the outside, even as it swells with fluid underneath. The pressure can restrict blood flow and breathing. Watching the ventilator's pressure monitor, Lalikos could see that the machine was pushing hard to get air into Gauvin's lungs. Her skin was squeezing her chest like a corset.

The solution is escharatomy -- the cutting of eschar, or burned skin. Again, no need for technological marvels. Lalikos used a scalpel to slice into Gauvin's chest, cutting a ticktacktoe shape that freed a square of flesh to rise and fall with each breath. Then she made shoulder-to-hand cuts down both of Gauvin's arms and along each finger. Blood finally flowed into both hands, but not quite to the fingertips.

Meanwhile, it was hard to gauge the extent of the damage to Gauvin's lungs. She was a smoker, so that would work against her. Virtually everyone injured in The Station fire suffered lung damage from the toxic smoke, and the severity of the inhalation injuries would challenge all the hospitals that cared for them. Nationwide, only about 6 percent of patients admitted to burn centers die -- but most of them are people who have suffered a bad inhalation injury.

Doctors know how to take care of burned skin and can save even patients burned over 95 percent of the body. But with an inhalation injury, they can only crank up the ventilator, provide nutrition, fluid and antibiotics -- and stand by, hoping the lungs will heal themselves. Weeks after breathing toxic smoke, a patient can suffocate from the damage to the lining of the lungs.

Lalikos says that once in a while a hospital will receive a patient so badly burned that it's clear there's no hope. The doctors just turn on the morphine drip to ease such patients on their way. Gauvin was in very bad shape, but she was not that bad. There was no question, Lalikos says, that everyone would "push right ahead."

No one knew whether she would make it -- only that it was worth trying.

She loved Great White

BEFORE THEY saw her, each of Gina Gauvin's three children asked the same question: did anything happen to her hair?

Gauvin had flaming red hair, red in a shade that nature rarely bestows and no bottle can reproduce. No orange tinges, no blond or brown -- red as desert rocks, red as rust, only brighter. This hair was vast; it was thick and wavy, fringed her face and hung the full length of her back.

Someone with hair like that could walk into a nightclub alone. Someone like that, with red hair down her back, leather jacket and high-top black shoes, could walk into a crowded nightclub and not feel shy. Feb. 20 was a rare night out for Gauvin, 42, a single stay-at-home mother.

She figured she'd meet people she knew. She knew Michael Gonsalves, the radio disc jockey known as Dr. Metal (later listed among the dead), and someone named Tommy, and the guy with the long hair -- what was his name? She loved men with long hair.

Gauvin had grown up poor in Providence, on Federal Hill and in Mount Pleasant. Her mother, Betty Catallozzi, had raised her children alone: Gina, the oldest, Denise, Vincent and Renee.

After graduating from Mount Pleasant High School, Gauvin took courses at Rhode Island College, but ended up getting married at 20 and having a child -- Heather -- at 24. About a year later, she and her husband separated.

When Heather was about 6, Gauvin moved to the country -- Foster and later Glocester, where she rented a house with rabbits and geese in the yard. When she became pregnant again -- this child's father fled to Maine when he learned about it -- she moved into a Johnston three-decker. She gave birth to Shayna Gauvin in 1996.

Two years later, she bore another child, Joseph Jordan. She'd been engaged to Joseph's father, and although their stormy relationship didn't last, they cooperate in raising Joseph.

With two little ones to care for, Gauvin didn't work outside the home. She didn't want to entrust their care to a stranger, and child-support payments from Heather's and Joseph's fathers were enough to scrape by on, without welfare.

She rarely went out. Maybe once every two months she went to a club or a concert. But when she heard that the heavy-metal band Great White was going to play at The Station in West Warwick, Gauvin couldn't resist. She loved Great White.

On the night of the concert, Joseph, 5, went to see his father's parents. Shayna, 7, was staying with Gina's mother. Heather, 18, was visiting friends.

And so, on Feb. 20, Gina Gauvin was free to go to the Great White concert, where her red hair burned away, burned to the scalp.

It got very quiet in the waiting room

ON SATURDAY morning, Feb. 22, a day and a night after the fire, the doctors held meetings with the burn patients' families. Gauvin's mother, older daughter, two sisters, and uncle, along with her sisters' boyfriends, gathered in Worcester, in the intensive-care unit's waiting area.

Dr. Gary M. Fudem, a plastic surgeon who saw Gauvin for the first time about 24 hours after she arrived, and Dr. Charles Foley, the chief resident in plastic surgery, laid out the facts. Medication would sustain Gauvin in a kind of coma for several weeks. She would probably lose at least the tips of her fingers. She would undergo numerous surgeries. She would be vulnerable to innumerable infections, any of which could kill her. She had less than a 50 percent chance of survival.

Fudem was walking a fine line. He wanted to prepare the family for the worst, and not to raise false hopes. But he didn't want everyone to go home and give up, either. There was, in fact, plenty of hope to cling to. Gauvin was young and healthy, and had a lot to live for.

This is why Fudem loves burn medicine: he gets to save lives. Not all doctors do. Once in a blue moon, he says, someone shows up in the emergency room with a bullet in the heart, and doctors do a dramatic rescue. But much of medicine involves helping patients cope with illnesses that either go away on their own, or linger indefinitely.

The burn team, though, enters into hand-to-hand combat with death every day. If Gina Gauvin stayed alive, her caregivers knew it was because of their constant, vigorous efforts.

Fudem, who had trained at Case Western Reserve University with Dr. Richard B. Fratianne -- a champion of the team approach to burn care -- was the leader of Gauvin's treatment team, which included residents, nurses, physical therapists, nutritionists and the physician assistant, Paul Savoie. Day by day, Savoie would be involved in every aspect of Gauvin's care.

In the weeks ahead, Fudem would meet with this team every two or three days. There would be so many details to attend to. More than any other injury, condition or disease, a severe burn stresses every part of the body. Organ system by organ system, Fudem would check the readings and the treatments given, to make sure nothing had been overlooked, nothing duplicated.

As Fudem explained to Gauvin's family what lay ahead, it got very quiet in the waiting room. Renee Walton, Gauvin's youngest sibling, felt numb, then dizzy. The middle sister, Denise Agin, couldn't accept that her big sister could die. Their 67-year-old mother, Betty Catallozzi, who had been scheduled to undergo a cornea transplant in a week, seemed to take each piece of medical news as a physical blow.

They decided that Walton, then 37, would handle Gauvin's financial affairs and Agin, 41, would make the decisions on medical matters. Gauvin's 7-year-old daughter Shayna would live with Walton; 5-year-old Joseph would live with his father's parents. Heather, an adult at age 18, would stay at home or with neighborhood friends.

Fudem urged Gauvin's relatives to pace themselves, not to wear themselves out traipsing to the Worcester hospital day after day while Gauvin was still unconscious. When she came out of her coma, if she survived, Gauvin would need a lot of support -- for months and years to come. Her loved ones would need to save their strength.

For severely burned patients, the factors that nudge the dial from death to life are complex and hard to quantify, as Fudem knew well from nearly 20 years of treating burn victims. The medical staff's best efforts could never be enough: the patient's inner strength and outside support would matter at least as much.

The doctor surveyed the group at the family meeting, and felt heartened. Most patients had two relatives at such a meeting. Gauvin had -- what? eight people? -- a veritable army of helpers. And Fudem was encouraged by what he heard about Gauvin's life and personality. This was a person who had known hardship, who was vivacious and outgoing, who loved her children.

Fudem was getting a good feeling about Gina Gauvin.

Tomorrow: The delicate, grueling work of saving a burn patient.