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The High Quality of Care At Children's Is No Accident

By John Kelly
Monday, December 29, 2008

If you think about all the times something could have gone horribly wrong but didn't, it stands to reason that there are times when something didn't have to go horribly wrong but did.

We call them accidents.

"It's one of those moments that I will never forget," Michelle Calvo said of that awful evening last summer. It was bedtime for her daughters Madison, 6, Paige, then 4, and Raegan, 2. They begged for 10 more minutes and she said okay, announcing that she was just running to the bathroom.

When Paige looked up, she saw that her sisters had left the kitchen, where they'd been playing. A candle was burning atop a slab of butcher block on the counter.

"She thought everyone had gone out to bed," Michelle said. "She was trying to do the right thing and blew the candle out. It caught her skirt on fire. My husband, when he heard her scream, he was on her within five seconds."

Five seconds, a mere moment. But it was long enough for the fire to spread up Paige's clothing, melting the acetate lining of her skirt, burning her right side, up to her shoulder and right bicep.

The helicopter landed just beyond the Sterling family's back yard, on the playground of Horizon Elementary, next to the monkey bars where Paige often played. As paramedics aboard the chopper started to treat the second- and third-degree burns that covered almost 25 percent of Paige's body, Michelle and her husband, Bill, raced to meet them at Children's National Medical Center.

"We got lost on the way there," Michelle said. "A nice cab driver led us over to Children's and wished us luck."

In the pitiless calculus of burns, temperature and time combine to cause damage. Spill a 120-degree cup of coffee on your leg and, as long as it doesn't sit there for 10 minutes, you'll probably be fine. At 155 degrees, that same coffee can cause a severe burn in five seconds. A flame burn, of the sort Paige suffered, is even worse. It can cause full-thickness burns -- through the skin and down to the fat below -- in a heartbeat.

Healthy skin serves two purposes: It keeps things out (infections) and it keep things in (fluids). A burn compromises both of these functions, leaving the body vulnerable to infection and causing it to steal fluids from elsewhere by cutting off the blood supply to other organs.

"That's why kids like Paige, if they don't get treated for burns right away, they can have disastrous consequences," said Ananth Murthy, associate burn director at Children's Hospital.

Paige was sedated as Dr. Murthy and his team worked to remove her burned skin. They gently sliced away layer after layer until they had reached a level of tissue that would support new growth. Then they applied sheets of an artificial skin product called Integra.

When all layers of the dermis are destroyed, new skin grows in from the sides. But this can cause thick scarring and puckering. The Integra stabilized the area and provided a scaffold for what came three weeks later: a graft of Paige's own skin, thin layers of which were taken from elsewhere on her body.

She'll wear a compression garment for the next year, which should help minimize scarring.

Paige celebrated her birthday a few weeks after she tried to blow out that candle in the kitchen. She had a request: no candles on her cake. In fact, she told her mother, they probably shouldn't have any candles until all three Calvo girls are in high school.

"I don't want any other kids to have an accident like I did," she said.

Children's Hospital

Children's Hospital treats about 60 burns a week, Dr. Murthy said. Most are much less severe than Paige's and are treated on an outpatient basis. Only one or two a week require hospitalization, and only about twice a month are skin grafts necessary.

"I do see some patterns," Dr. Murthy said of the children he treats. These include toddlers pulling on tablecloths or the handles of pots sticking out from the stove. Burns from hot tap water are common. Turning the temperature down on hot-water heaters "would probably keep down half our burns," he said. Lately he has seen kids coming in with "noodle burns": nasty injuries caused by boiling-hot microwaveable noodles.

You can help ensure that the type of care Dr. Murthy provides will be available to any child. Make a tax-deductible donation by writing a check or money order payable to "Children's Hospital" and mailing it to Washington Post Campaign, P.O. Box 17390, Baltimore, Md. 21297-1390.

To donate online using a credit card, go to http://www.washingtonpost.com/childrenshospital.

To contribute by phone using Visa or MasterCard, call 202-334-5100.

My e-mail: kellyj@washpost.com. My blog: http://voices.washingtonpost.com/commons.

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