The past 60 hours

Around 10:00am on Friday, April 10 2009, Mark was preparing to do a welding job inside a brewery vat at Calhoun's in Knoxville. While inside the vat he told others he was having a hard time breathing in the confined space. Someone opened a valve to pump oxygen into the cooler for him, and when Mark sparked the torch, it immediately exploded. Mark was able to climb out of the 18 inch opening where others extinguished the flames.
Mark was transported to UT Medical Center in Knoxville, where he was initially assessed and the determination was made to transport him immediately to the burn unit at Vanderbilt Medical Center. Due to severe weather, the medical helicopters were grounded and he had to be transported via ambulance. During transit, there were severe thunderstorms and 6 tornadoes touched down in the path from Knoxville to Nashville. He arrived at Vanderbilt around 2:30pm CST, with family members arriving from various directions shortly after.
Dr Guy assessed Mark upon arrival and began him on hydrotherapy preparing him for surgery. He met with us at that time and gave us the report none of us were prepared to hear. Mark has third degree burns on 98% of his body. The only areas not burned were his feet and hands, due to his shoes and gloves. He only offers a 2 or 3 percent chance of survival. Dr Guy is very direct with us about Mark's prognosis and the obstacles that lie ahead if he survives. The first step, is being aggressive and taking advantage of what he referred to as the "honeymoon" period. This is the first 24-48 hours after the injury prior to the body becoming aware of the extent of it's damage. If he survives, there will be many definite setbacks. Infections will be inevitable. It is not a matter of if they happen, it's a matter of when. Any of these setbacks can happen suddenly, and can be fatal. Preventative antibiotics are not an option, because with each infection comes, it will require a stronger and stronger antibiotic to treat. Also, overuse of antibiotics will challenge the kidneys.
At 5:00pm, we got the first glimpse of Mark as he was taken down the hall past us on the way to the OR. There were 3 surgical teams there working aggressively and simultaneously to remove as much of the damaged skin as quickly possible. After three hours in the OR, they had removed 70% of the burned skin, and replaced it with cadaver skin. (We were told this was the equivalent of 3 days of surgeries done in 3 hours.) This was key in stopping the release of toxins into his system from the damaged skin. At this point, Mark was receiving 115 cc of IV fluid per minute (more than most get in an hour), as well as blood, plasma, and meds for pain and sedation. We are assured he is not in any pain, and they plan to keep him sedated for that purpose. He is in the burn unit ICU, and there is a nurse assigned only to him who stays at his bedside 24/7 to monitor and care for him.
Dr Guy came in to see Mark at 8:00 am on Saturday, and gave us the report on his status. He had made it through the first night as best as could be expected. His swelling had increased significantly, as was expected. His blood pressure had dropped and they were decreasing the sedatives slightly in hopes of bringing it back up. He prepared us for what they were anticipating over the next 24 hours. That is how he says we have to look at things. One day at a time. It is a "marathon." As the 48 hour mark approaches, more setbacks are expected. There are predictable complications that they are proactively preparing a course of action for. He says his lung function is expected to decline around that point, and other issues will arise as his body becomes aware of the state it is in.
We are able to go in to visit with Mark only during limited visiting times due to him being in isolation and highly susceptible to infection. We believe he can hear us, though he is unable to respond.
As Sunday morning comes, Mark has survived another night. Dr Guy makes his visit and again speaks with us about his status. We are now entering into the 48 hour mark, and overnight his status has deteriorated as expected. His heart is now in a state of "shock." His heart rate is down to 50 (should be around 120 for the condition of his body) and is only functioning at around 1/3 of what it should be. Dr Guy says this was predictable, and typically will last for 48-72 hours. They also had to increase the settings on the ventilator. His body is in a state of hypothermia. (temperature has dropped to 95 degrees) and they have heat lamps on him to bring it up. The doctor says that his body is now "trying to give up." They have added some new meds to help regulate his blood pressure. They have significantly decreased his IV fluids to 150 cc per hour now, and will be giving him diuretics to start helping his body to release the retained fluid. At this point, his kidney function is good, and the cadaver skin is working. He has been started on tube feedings today as well. They will be placing a tracheostomy this week. Also, on Monday, Dr Guy will be planning for future skin grafts. A small area of skin will be obtained from Mark's foot and sent to a lab in Boston. At the lab, the skin sample will be cloned to make more of his own skin. When they reach the point that he is ready for the skin grafts, that new skin will then be shipped back here to Vanderbilt to be used.
We are in the midst of the most critical period so far. The doctors and nurses are all doing a wonderful job of anticipating complications and planning for them before they happen. He is in the best possible place for his condition. The doctors here are some of the top in the nation. They are excellent, and have also been wonderful about being very straight with us on his condition.
As each day passes and he becomes more stable, there will be many more surgeries. Possibly 3 this week, and as many as 40 over the next few months. We know that Mark is a fighter and are holding fast to our hope and faith that he will pull through this. 2-3% doesn't sound like much, but if anybody can be that 2-3%, it's Mark!!!