Thread by @CassieY4

A really random thread (because I haven't written enough fiction today and still have words in me) about why working on a burn unit rocks and it's the best place in the hospital. Follow if interested.

1x

First off, everyone thinks it's gory and horrible and you can do it and shit smells but fuck all that.

The true magic of the burn unit is this -- demographically, the ppl who get burned are most likely to survive.

2x

It's pretty much all dumb 16-25 yr old boys doing dumb shit, and pedi patients with scalds.

Yes, there are sad outliers, etc, BUT...by in large people admitted into burn units for care survive.

3x

& the ones that don't -- we generally know they're not gonna make it ASAP. There's a nifty formula of age vs % burn injury = survivability that lets us look at someone's injured grandma and say, "Let's have hard talks right now." and cuts out a ton of the wavering.

A Ton.

4x

Your patients are generally there for awhile, a few days to few months, & you really get to know them, their families, and you really get to see them get better, live time, as their skin heals. You get to feel like part of their little hospital family, there's nicknames, etc.

5x

You get the time and the space to really dial care in...and then when you're giving care, doing massive dressing changes with your coworkers...it's like an Amish barn raising or a ballet.

Everyone knows what needs doing simultaneously.

6x

Doing a dressing change on an 80% burn is a thing of beauty, of coordination, expectations, just flat out getting shit done...it's so satisfying. SO SATISFYING.

Other job perks include.

7x

Picking at scabs. (Shut up. This is fun. And you don't pull the ones that won't come mostly.)

Taking out staples.

Everyone on the floor standing and cheering when someone gets out of bed to walk the floor successfully.

8x

it's just so nice to get the chance to know someone. You roll in there with their pain meds, and they know you, and you've got a routine, and they feel safe, and you do a good job, and then because you're both awesome their skin heals and things are good.

9x

I don't get to do that anymore on the ICU, rarely if ever can I talk to my patients, and now for like half of my ICU career, we haven't even had visitors.

10x

Skin's like such a nice easy metric too, to see people getting better with...it's not tricky like lungs or cardiac or neuro. You can have a different assignment for a week then come back & ooh & ahh, because they really have progressed, that you don't get on any other floor.

11x

Sure, every once in awhile you'd see something tragic, or you'd have a patient on the cusp and their families wouldn't let go, but by and large you got to make positive change in the lives of people who were going to survive.

11x

Anyhow, I miss the shit out of that job and that place and those people, and if I my body could hack that commute again (and the work itself, which is backbreaking) I'd be back there in a heartbeat.

12x

You don't mind the gore and the smells and the sweat and the labor and the occasionally very sad stories as long as people survive.

If you can make 'em better, all that other shit's worthwhile.

13/13

Oh and also, your skin counts as an organ -- you should definitely let ppl harvest it after you're dead (they do so in places that won't show if you've got a funeral) -- but it makes a huge difference in the ability of burned people to heal.

14x

A patient's own skin is a precious resource, and sometimes they may not have enough to go around--but if we can cut off the dead tissue and put some donor skin on there...

15x

that can really, really help.

Your skin's regenerative layer is the dermis, and you can really only harvest it twice. So if you're 60% burned, and you only have 40% skin left (but some of that's scalp, elbows, fingers, etc) that's a lot of space to fill w/out much tissue

16x

But if we can put donor skin over injured areas until we're sure that they're ready to accept the patient's skin -- or if we can mesh out the patient's skin and put donor skin on top to kinda help net everything together -- huge difference. Huge.

17x

A lot of times ppl thing, 'oh, i'm too old to donate anything' once you're like 70+, but they can still take your skin from you, and we'll put it to good (albeit temporary -- but very good!) use.

18/18 done...for now, lol.