The Burn Ward

You cried at Love Story? Wait 'til you read this

Edwards picked up the stethoscope from his desk. "Look," he said, "You can say what you want about the Army and its problems, but I learned this much from going home: the Army treats you better dead than alive. I know," he added quickly to keep the captain from talking. "I know, it was my fault. I shouldn't have got involved with taking the body back. But I did."

"It's coming," the corpsman said, stepping away from the window.

Edwards stuffed the stethoscope into his back pocket. "OK. Tell the ward master. Better fill the whirlpools. I'll be down at the landing pad." He pushed open the double doors to the burn unit.

The huge overhead lights were off, leaving only the night lights to flicker feebly across the shiny, tiled floor. He walked quietly down the center aisle of the ward, his footsteps echoing lightly ahead of him. The beds lining the wall were barely visible, the patients no more than lumps against the frames. From the far end of the ward came the faint mechanical hissing of a respirator. He stopped a moment near one of the steel-arched Stryker frames to listen. The machines slow regular rhythm was almost soothing. How many times he'd heard it before. Someone had once said he'd signed more death certificates than any other doctor in Japan. Probably right, he thought, continuing on his way. At Kishine, the respirator was the sound of death, not life; in all his time there, he could not think of one patient who had got off the thing.

"Hi, Doc."

"Oh, Crowley," Edwards said, coming to a halt near the little cubicle at the back of the ward. "Sorry, I didn't see you in the dark."

The side curtain had been partially pulled. Stretched out on the bed, barely lit by the dials of the respirator, was a shadowy form.

"How's he doing, Sergeant," Edwards asked the ward master who was standing at attention by the machine that was slowly, insistently hissing air into and out of the charred body.

"Not too good, sir."

"What's his temperature?"

"105. It was 107 before we put him on the cooling blanket."

"Blood cultures growing out anything?"

"Yes, sir, the lab called back tonight-Pseudomonas pseudomallei. Major Johnson put him on IV [intravenous] chloromycetin and tetracycline."

Edwards bent over to look more closely at the restrained body spread-eagled across the frame. The air smelled sweet, like a dying orchard. "When did he come in?" he asked, peering at the grotesquely crusted body. Even the tips of his toes and fingers were charred and oozing, nothing had been spared.

"Four days after you left. Seventy per cent second degree and 15 per cent third. At least Major Johnson thought it was second degree, but it's beginning to look like it's all third."

Edwards examined the crust about the boy's swollen neck and chest. It had a sick metallic green cast to it. "When did he go sour?"

"He was doing fine until this morning. We had to give him Demerol every time he went into the whirlpool, but he's very hard core. Nice kid. Then yesterday, he became confused and agitated. On the night shift his temp spiked and he became unconscious. The surgeons trashed him today, and Dr. Johnson put him on the respirator this evening. The eaves should be in soon, Major."

"Yeah, that's where I'm going. I'll check on him later."

"No need, sir, you'll have your hands full. I'll have you called if anything changes."

As he walked away, Edwards could hear Crowley drawing the curtains closed behind him. The stairwell was empty and he walked slowly down to the first floor and out onto the concrete walkway.

It was summer outside and the night was as warm as indoors. He cut across the empty silent field separating the hospital's squat buildings from the helipad. where the red lights of the landing strip flickered softly in the misty dark. Far away he heard the muffled dull thudding of the chopper whopping its way through the heavy air, and suddenly he felt alone and desperately tired.

"Gentlemen: You have been assembled here at Yokota Air Base to escort these bodies home to the continental United States. Each body in its casket is to have, at all times, a body escort. Those caskets on the plane that do not at the present time have an escort will have them assigned at Oakland. Whatever the case, no casket will be allowed to leave the Oakland area without a proper escort. Escort duty is a privilege as well as an honor. An effort has been made to find an escort whose personal involvement with the deceased or presence with the family of the deceased will be of comfort and aid. Your mission as a body escort is as follows: to make sure that the body is afforded, at all times, the respect due a fallen soldier of the United States Army. Specifically it is as follows: 1) to check the tags on the caskets at every point of departure; 2) to insist if the tags indicate the remains as non-viewable that the relatives not view the body. Remember that non-viewable means exactly that-non-viewable. . . ."

Grimly, with the chopper coming nearer-louder-Edwards walked up a slight rise, past a small, dimly lit sign:

KISHINE BARRACKS

109th UNITED STATES

ARMY HOSPITAL

United States Army, Japan

Burn Unit

"Coastal Airlines loads the bodies on an angle. Be sure that if the body you are escorting is being carried by Coastal Airlines that the caskets are loaded head down-this will keep the embalming fluid in the upper body. If the body is loaded incorrectly, namely feet down, the embalming fluid will accumulate in the feet, and the body may, under appropriate atmospheric conditions, begin to decompose."

By the time he reached the evac area, the floodlights were on and the chopper had landed. Coming in from the dark around the back of the evac guiding Edwards was dazzled by the sudden lights. The Huey, low and glistening, its rotors still whirling, sat like a toy exactly in the middle of the arc lights. Its crew chief and co-pilot were already in the open hatchway unstrapping the litters from their carrying hooks. Edwards watched unseen while the corpsmen hurried out to the chopper to off-load the patients. The choppers usually came in about 10 in the morning, but when a bad burn was evac'd to Japan, they were born in the same night. Burns are a very special kind of wound, and no physician anywhere wants the responsibility of caring for them, not even for a little while. For openers, burns look bad and the patients die.

"Each of the next of kin listed in the deceased 201 file has already been visited by a survivor assistance officer. This was done in person by an officer in uniform from the nearest army unit. Every effort is made to pick an officer from a similar racial and economic background. These families have already been convinced of the death by either the presentation of personal effects or the relating of an eyewitness report from a member of the deceased's unit. You need not convince the deceased's relatives. The point to remember is that the survivor assistance officer has been there before you and the next of kin have already accepted the death."

He was standing in the reflected glare of the landing lights, with the windy noise of the chopper rushing past him.

"Sir. Sir?" one of the corpsmen was shouting above the whining of the motor. "One of 'em's got a head wound, the other is just burned."

"Call the neurosurgeon," Edwards shouted back. He gave the empty chopper one more look and then followed the medic into the air evac area. By the time he reached the building, the medics had placed the two litters on the movable stretcher racks and one of them, working on the patient nearest the door, was already setting up an IV.

"He's OK, Major," the air evac sergeant said. "The head injury's over there."

"One hundred and seventy," the corpsman said as Edwards approached the litter. The wounded soldier, his head wrapped, was lying unconscious on his back, with the blood pressure cuff still wrapped around his arm. "I figured I'd leave the cuff on, sir. He don't look too good."

"I'll give you that," Edwards said. He began to unwrap the gauze from around the patient's head. The boy was breathing; other than that he looked dead. Edwards pinched his neck, but there was no response. As he unwound the gauze it became wet and then blood-soaked. Now he was down to the four-by-four surgical pads, and finally to the wound itself. Carefully he lifted up the last pack. Despite himself, he closed his eyes.

"He's 47 per cent burned." the sergeant said, reading the cover sheet of the soldier's medical record. "Took an AK round a little in front of the right eye. Removed the right eye, traversed the left orbit, removing the left eye and came out near the left temple, apparently blowing out the left side of his head."

"Don't worry. I'll be careful, Bob. Honest, I'll be careful. . . ."

"Send him to neurosurgery," Edwards said. "We'll treat his burns up there."

"An IV?"

"No, just send him up."

He walked across to the other wounded trooper. The corpsman had just got the IV started.

"Sorry it took so long, sir," he said. "Hard to find a vein."

The boy was awake, nervously looking at the needle the corpsman had stuck into the back of his hand.

"Hi," Edwards said. "How do you feel?"

The soldier looked up at him apprehensively. The skin on his face had been seared red and all his hair and eyebrows and lashes had been brunt away.

"I know you're nervous," Edwards said soothingly. "Just try to relax. I'm the chief of the burn unit. I'll be your doctor for a while until you get better.' As he pulled back the blanket the soldier grimaced. "Sorry," he said, lifting the cover more carefully.

The burns, red and raw, ran the whole charred length of the boy's body. Unconsciously Edwards began adding up the percentages of burned area, tallying them in his mind. He suddenly realized what he was doing, and for a moment, as he stood there staring at the burns, he looked stricken. "How did it happen?" he asked gently, carefully dropping back the covers.

"I . . . I was carrying detonators. . ."

"Dear Bob: We are fighting very hard now. I haven't written Mom and Dad about it. I don't want to worry them. But we are getting hit and badly. I'm the only first lieutenant in the company who hasn't been hit yet. And last week I lost two RTO's. They were standing right next to me. It gets a bit spooky. I know what you said about my flack vest, but you haven't been here and you just don't know how hot it can get. On the move, it's just too damn heavy. You can't carry a 60-pound rucksack in 110 degree heat and an 11-pound flack vest. I make the point wear his, but then someone else carries his gear. It's like your complaint about patients demanding penicillin-sometimes you just can't use it. It's the same with a flack vest. Besides, it wouldn't stop a round and that's what we've been getting lately. But I'll wear it when I can. By the way, you're beginning to sound like Mom. About what's been happening lately. I'm not complaining, don't get the wrong idea. There is honestly, something very positive about being over here. I can see it in myself and my men. Not the war itself, God knows that's hopeless enough, but what happens to you because of it. I'll never be the same again. I can feel myself growing. Unfortunately you only see one end of it. That's a bit sad, because there are other endings and even middles. A lot of guys get out of here OK, and despite what they say, they're better for it. I can see it in myself. I'm getting older over here in a way that I could never do at home or maybe anywhere. For the first time in my life everything seems to count. All the fuzziness is gone, all the foolishness. I can't believe the things that used to bother me, or even that I thought were important. You really see yourself over here. It works on you, grinds you down, makes you better. Got to go. Thanks for the R and R. Say Hi to all the guys in the burn unit."

"What?" Edwards said.

"Detonators, I must have taken a round in my rucksack. They just blew up and then I was on fire. Tried to tear my gear off, but my hands. . . ."

"It's all right," Edwards said. The evac sergeant handed him the patient's medical jacket. Quickly turning the pages, he read: "Eighty per cent second degree and third degree. Debrided under general anesthesia at the 60 evac, Chu Ci. Six liters plasmonate . . . catheterized . . . furacin and sterile dressings . . . Demerol . . . 64 mg q three hours." He looked on the cover sheet. David Jensen, MOS B11; 1/30 E-2, Fourth Division, 20 years old.

"Twenty years old," he thought, handing back the chart. Grant's age.

"David," he said warily.

"Yes, sir."

"The first thing we're going to do is put you in a whirlpool bath to soak off your bandages and remove what dead skin we can. It's going to hurt."

"Yes, sir," David said, his voice wavering.

"If it hurts, just let us know. Is that understood?"

"Yes, sir."

"You don't have to call me sir."

"Yes, sir, thank you, sir."

Take him to C-4," Edwards said to the corpsman. "Tell Sergeant Dorsey I'll be right there. And David . . ."

"Yes, sir."

"Burns look and feel a lot worse than they are. You're going to get better."

"Yes, sir."

Edwards watched the corpsman wheel the boy out of the evac area, and then left the area himself to go to the neurosurgey ward. It was a long walk. Like all army hospitals, Kishine is fantastically spread out, its buildings and wards acres apart so that no one shell or bomb can get it all. By the time he got to the ward, the neurosurgeon was already in the treatment room. The patient, partially hidden by the nurse and doctor, was lying naked on the treatment table. There were blood-soaked clothes and bandages all over the floor. Cramer turned his head for a moment, looked at Edwards and went back to work.

"His frontal lobe is torn up," Cramer said. "I'm going to have to take him up to the operating room and have what I can. What do you think about his burns?"

Looking over Cramer's shoulder Edwards saw that the surgeon's fingers were deep inside the half shell of the boy's skull. "Don't worry about the burns," he said, turning to leave.

"Oh, Edwards," Cramer said as he reached the door. "I know how close you two 'd become. I'm sorry."

"Regardless of the branch of service: The emblem of the Infantry, crossed rifles, will be carried on every coffin. The deceased, where the remains are viewable, will be buried in full military uniform. The emblems on his uniform will be that of the service to which he was attached at the time of his death."

He walked down the corridor to the elevator. Leaning wearily against the wall, he pressed the button, and without looking stepped in even as the door was opening, almost colliding with one of the patients. "Sorry," he said, moving over to the other side of the elevator. The patient, his bathrobe slung over his good shoulder-the other was wrapped in a plaster cast-smiled politely, and was about to look away when he saw the doctor's name plate on his uniform.

"Excuse me, sir."

"Yes?"

"Do you have any relatives in Nam?"

"Yes," Edwards said, "I do."

"First Air Cav?"

"Yes."

"Is his name Grant?"

Edwards nodded as the elevator suddenly slowed to a stop.

"Your brother?" The door opened. "I thought so," the trooper said, obviously pleased.

"You sort of look like him."

"Come on," Edwards said pleasantly, holding the door.

"I saw him about three weeks ago. There isn't a better platoon leader in the whole cav. But I can tell you this, they were handing him some shit to do, when I saw him. His unit was on their way to getting their ass whipped."

" Are you sure, Grant? Why don't you go into Tokyo? You only have a few days for your R and R. You might as well have a good time. "

" But, I want to see what you're doing. "

" It's not nice. "

He had been surprised at how well Grant had handled himself in the burn unit. He had seen more than one visitor walking through the ward trying desperately to be natural, moving stiffly from bed to bed, smiling and talking as if the boys weren't burnt at all. When Grant visited, there were two ghastly 90 per cent burns stretched out, blistered and dying on their Stryker frames. Grant had stopped to talk to them and stayed with each much longer than he had to. He was very much at case. He didn't ignore their wounds, or pretend not to see that they were so obviously dying. He simply talked to them, interestedly and honestly with a concern so palpable that no one could doubt his sincerity. He was one of them and, for a moment, watching his brother sitting by their frames, Edwards felt suddenly very much outside it all. He was very proud of his younger brother.

" I've seen worse, Bob. Really . . . a lot worse. "

"Sir?"

"Yes, I know," Edwards said gently. "They did get whipped."

When he got back to the burn unit, he found David in the treatment area, already floating full length in one of the whirlpool baths, his head supported on a padded board to keep it above the waterline, the water gently churning about his burnt body. His IV bottle was still working, hanging down from a ceiling hook. A few of the dressings had already soaked off and the medic was picking them out of the water. Taking an admissions chart off the wall rack, Edwards sat down on a chair next to the huge tub.

"OK?" he asked.

David, clenching his teeth, nodded.

"David," he said, "we're going to deride you a bit-take off the dead skin. We are going to have to do it every day, a little bit at a time. That way it won't be as painful." David was looking anxiously at him. "Once you know what's going on, it won't be so bad. We're going to put you into the whirlpool every day and all the skin that is loose, or loosening, is going to be removed. It has to be done." He hesitated a moment and the went on matter-of-factly. "If we don't take it off, if just stays and decays, forming a place for bacteria to grow and divide, and you'll just get infected. That's what we want to avoid, because if the burns get infected no new skin will form. It's going to hurt, and I'll give you something for the pain when I think you need it."

"Yes, sir."

"I've been doing this a long time, David, and I know when it really hurts and when it doesn't. We're going to have to be doing this for some time and we don't want to make an addict out of you, so we're only going to use the pain medicine when we have to. I know you can do it. There have been a lot of troopers, just like you, and I know you're as fine as they are."

David had been staring up at him the whole time. What was left of his lips were clamped tight against the pain of the water churning against his blistered skin. "Yes, sir," he said, his voice trembling.

"OK, John," Edwards said. David looked nervously from him to the corpsman. Pieces of dead skin were already floating free. The corpsman, kneeling down beside the tub, began picking off those pieces that were still attached but had been loosened. "How long have you been in Nam, David?"

"Five . . . five months," David said, watching the corpsman pick a chunk of skin off his chest. He had to tug to get it off. David grimaced, barely suppressing a groan.

"How do you like the Vietnamese women?" the medic asked.

"Don't know," David said, painfully engrossed in watching the corpsman go after another piece of his skin. "Didn't meet any gooks."

"How come?" the medic asked, scooping a piece of skin out of the water.

"We killed 'em all."

Suddenly David let out a scream and the scream, echoing off the spotless tile walls, pierced Edwards to his heart. His eyes clenched tight, the boy was fighting valiantly for control. Blood began oozing from the new patch of raw skin on his chest and Edwards could see the tears rolling down his burnt cheeks.

" Where you from, Doc?" the cab driver asked.

" Japan. "

" Oh," the cabbie said pulling away from the curb. "though so, saw the Fuji patch on your sleeve. Nice place, huh? "

" No." Edwards said.

" I heard that Japan was paradise. "

" I work in a burn unit. "

" Oh, get many burns over there? "

" There's a war on. Remember? "

" You mean, you get these guys in Japan? "

" Yeah," Edwards said, "We get those guys. "

"Major, Major?"

Edwards opened his eyes. It was the ward master. David was still there, sobbing.

"Excuse me, sir. Those flights back from the States are tough. I'm sure you haven't caught up with the time change. Why don't you take a sleeping pill and get some rest."

"Think I'll take your advice, Edwards said, closing his clipboard. He wrote a Demerol order for David and then went to his room. As tired as he was, though, he couldn't sleep. Every time he drifted off, he'd see Grant's tag: "Remains, non-viewable." And all that time in the States, he thought he could handle it. . . .

He woke up in the morning exhausted, put on his wrinkled uniform and went to the ward.

Johnson was already in the office. "Hi," he said, turning around from his desk. "You know you didn't have to work today-or yesterday, for that matter."

"I know? Edwards hung up his jacket.

"There's really not much else to do."

Both he and Johnson had shared the same office for almost a year now. Johnson had been the plastic surgeon working with the burn unit at Duke University. He had been drafted and assigned to Kishine.

"You want to go on rounds?" Edwards asked.

Johnson pressed the button on the intercom. "Julian, we're gonna start rounds." He pushed himself away from the desk. "Let's go."

"How's the fellow on the respirator?"

"He died this morning." Johnson said, picking up his notes. "I told the corpsman to leave you alone."

After rounds, Edwards went down to the bacteriology lab and then to his office. Johnson had gone to X-ray to check on a few films. He sat down at his desk and looked at the two weeks of correspondence that had been piled nearly at the corner of his desk. He was reaching for the first letter when the intercom buzzed. "Major, Jensen's in the whirlpool."

"OK, be right there, thanks."

David was already in the tub, being debribed Edwards knelt down by the side of the tub and checked the burns. At some places, on the highs and chest, he could see down to the muscle fibers criss-crossing under the burnt fat. "David, I'm going to stop your IV," he said, straightening up. "You're going to have to start eating. The ward master told me you didn't touch your breakfast Hurt?"

Chewing on what remained of his lips, David winced.

"Jessie, why don't you give him 25 of Demerol."

"Yes, sir." the corpsman said.

"Why didn't you eat?"

"No one was there to feed me." David said, watching the corpsman open the medicine cabinet and fill the syringe.

"We don't feed you here," Edwards said. "You feed yourself. You've got to start using your hands sometime." He waited while the medic searched for a place to give the injection.

"In his arm," he said.

The corpsman found a small, unburnt area near the elbow and plunged the needle into the skin. David, watching him, visibly relaxed. He turned his head on the board and looked at Edwards.

"We can help you grow new skin, stop your infections, graft you-if it comes to that. But it will all be for nothing if you leave here with all your joints tied down by scar tissue. If you don't exercise and keep the scar tissue and new skin over your joints loose and flexible it will tie 'em down like iron. All that new skin and scar tissue that will be forming has a tendency to contract with time. If you don't keep it loose, you'll leave here as much a cripple as if someone had shot off your arms and legs. Your hands aren't that bad, David. We'll start today with them."

"But I can't hold a fork."

"We'll put wooden blocks on them, and as you get used to handling one size, we'll make the blocks smaller. Understood?"

"Yes, sir."

"You married, David?" Edwards asked.

"No."

"Engaged?"

"Yes, sir."

"Would you like me to write her for you?"

David closed his eyes. "No, sir. I don't think so."

"All right. I'll check on you later."

That evening, despite the fact that Johnson was on call, he went back to the ward. All the patients had been settled in for the night. The ward master was in the treatment room, cutting adhesive tape into 12-inch strips.

"What's new, White?"

"Nothing, Doc, really. Same old thing."

"How's Jensen doing?"

White put his scissors back into his pocket.

"He's doing all right. We drew two blood cultures on him this evening and sent a titer off for moniliasis. He had some difficulty using the blocks, but he got a few bites down; seems as if the sulfamyelon is bothering him. Stinging him. You never know who it's going to bother."

Edwards walked out into the unit. David was on a Stryker frame halfway down the ward, lying on his stomach. White sulfamyelon cream was smeared all over his burnt back, buttocks, and legs.

"How's it going?"

"Fine, sir."

"The ward master told me that you did all right at supper."

"Yes, sir."

Later that evening, one of David's blood cultures began to grow out Pseudomonas arinosa, a bacillus resistant to most antibiotics. The bacteriology lab called the ward and the ward master called Edwards. He told the ward master to restart David's IV and put him on 200 mg of polymyxin every four hours.

The next morning, after rounds. Johnson got him alone. "About Jensen's polymyxin," he said. "Do you think his kidneys are good enough to handle that big does?"

"What would you suggest?" Edwards said.

"You could destroy his kidneys with that much polymyxin."

"I could save him. too."

"If he's going to die." Johnson said, "he's going to die."

"You sure?"

"Well, he's 80 per cent burned and his blood culture is already growing out Pseudomonas."

When he came back to the ward, he found David lying on his back, and the corpsman was smearing on the last of the sulfamyelon, spreading it over David's charred stomach as if it were butter.

"This stuff stings, honest, Doc," David said, "It just keeps stinging."

"I know," Edwards said. "It does that sometimes, but it will get better with time. You sort or build up a tolerance to it. The point is that you need it now. It keeps your skin from getting infected and gives the new skin a chance to grow. Believe it or not sulfamyelon is one of the major break-throughs in the treatment of burns."

"Can't I have something for the stinging?"

"No, David, I'm sorry."

That evening, down in the hospital bacteriology lab, his second blood culture started growing out another patch of pure Pseudomonas. When Edwards came to work up the new admissions, he stopped by to see David and found him on his stomach again.

"How does the skin grew back?" David asked, speaking to the floor. The day before he had mentioned there were 16 different colors in the floor tiles. "I mean, where's it gonna come from?"

"From you."

"Yeah." David said. "How?"

Edwards pulled up a chair. "You have enough, you don't really need very much," he explained. "The skin grows back from the areas around the hair follicles; the follicles go down pretty deep, down into the area below the skin. Below the burns the new skin grows out from the lining of these follicles, like grass out of a valley. These linings are like nature's reserves. The new skin just keeps growing out from them, creeping over the burned area, until all these little growing areas come together."

"Why am I going to have to be grafted then?" David said sullenly.

Edwards sensed the despair in his question. "Sometimes," he said, trying to sound reasonable, "if the burns are too deep, deep enough to destroy the follicles, then there is no skin togrow back, so we have to graft."

"Where are you going to get the skin for that?"

"From your friends, David," Edwards said gently, "from your friends."

The morning culture again grew out Pseudomonas. That afternoon they took David to the operating room and covered his legs and part of his stomacher with cadaver skin. When Edwards visited him again that evening, he complained that his head hurt and the sulfamyelon was stinging even more.

"What will you do when you get home?" Edwards asked.

David was sullen. "School, I guess."

"You've got to be more positive than that," Edwards said coaxingly.

"I was positive before I got burned."

"I'm telling you, you're going to be OK."

"I didn't see it," David said reproachfully. "I was just walking. I wasn't even point. I swear to God, I didn't even hear it. Can you believe that?" he said loudly. "I couldn't even goddamn hear it."

Within three days, the cadaver grafts failed, refused to take, and Edwards had to order it pulled off, like the rest of the dying skin. David, lying in the water, saw him as soon as he walked into the treatment room.

"I'm handling it, dammit," he said belligerently. "Just leave me alone, will you? Just goddamn leave me alone."

That evening David ignored his presence. "I saw you with some letters this afternoon," Edwards said, noting how the whitish scar tissue under David's chin bad a pale greenish cast to it. "Nice handwriting, Your girl?"

"No, my family."

"What did they say?"

"It's in the drawer."

Edwards opened the drawer of the nightstand next to the frame. It was a rather bright letter, careful, measurably written, filled with support and concern. There was a section about Carol, how much she loved David and how happy she was that he was finally out of the fighting.

"Did you answer?" Edwards asked.

"I don't know how."

"They know you're burned." Edwards refolded the letter. "It seems to me they're holding up quite well. The least you could do is help them out."

David slowly turned his head. His eyes, hollow holes, stared coldly and defiantly at Edwards. "I've been throwing up all day. I can't keep anything down."

"Yes," Edwards said calmly, putting the letter back in the drawer. "I know."

"I'm not going to make it, am I? No, no, don't interrupt. I know I'm not. That stuff you keep putting into my IV bottle-the only other guys who get it are the ones on respirators. I know," he said, almost triumphantly. "I've checked on the way to the whirlpool. I know," It was all there in his eyes-the pain, the suffering, the loss of belief. It caught Edwards off guard.

"I told you about the pain, didn't I?" he said angrily. "Have I bullshitted you yet? Look, if you were going to die, I'd let you know. Right? I'd give you the chance to tie things up, understand?" A certain distance entered David's stare. a vague confusion that was more pathetic than his glaring hopelessness.

Edwards got up. "Now, dammit," he said, "I want you to think of an answer to that letter. I'll be back in the morning and I want an answer. Is that clear?"

Depressed and angry, he left the ward. Outside he passed groups of patients from the other wards, some standing around talking, others doing nothing, or being pushed around in wheelchairs by their buddies. Johnson was right, he thought. David would die. He was probably, all things considered, dead the moment the round hit the rucksack.

The phone woke him a little past three the next morning.

"Majorl"

"Yeah." Edwards fumbled across the night table for the lamp switch.

"This is Sergeant Cramer. Jensen's temperature jus spiked to 105."

"OK," Edwards said, switching on the light and sitting up. He cleared his throat. "I'll be right over." Even as he was hanging up, he was reaching under the bed for his shoes.

The ward master met him at the entrance to the unit and followed him hurriedly down the ward.

"He's becoming disoriented."

"What about the cultures?" Edwards asked quickly. "Still Pseudomonas?"

"No, this morning's grew out Klebsiella."

David was lying on the frame. All the covers were off and he was trembling.

"106," the medic said. reading the stool-smeared thermometer.

"Better add some kanamycin and Keflin to the chloromycetin. How's the blood pressure?"

"Stable."

"How much kanamycin and Keflin?" Cramer asked.

"A lot, a lot. Just get it-"

Cramer looked at him and quickly left to get the antibiotics.

"David, David," Edwards leaned over the frame. "David!"

Slowly he opened his eyes, but there was no light in them, no gleam.

"Listen," Edwards said, lowering his voice. "I'm going to have to put you on a cooling blanket. It's not going to be comfortable, but your temperature. . ."

"I can't think of anything," David said, closing his eyes again.

"He's been confused for the last hour," the medic said.

A moment later, the ward master came back with the antibiotics already drawn into two syringes. While he shot the drugs directly into the IV bottle, Edwards said, "We'd better put in a central venous pressure. How's his urine output?"

"Down 60 cc in the last two hours."

"Does he have any blood cross-matched?"

"Four units."

"Respirator?"

"There's one down in central supply. We can get it any time."

"What about his monoiliasis titers?"

"Still normal."

"White count?"

"The lab technicians are doing it now."

"Let's see his electrolytes."

"Doc."

Surprised, Edwards turned around. David had stopped shivering.

"Doc!"

Edwards hurriedly bent over the frame.

David stared up at him, his eyes strangely clear and deep. "You didn't have to come, not all the time."

"I wanted to," Edwards said.

"They told me about your brother and your taking him home." David was about to go on when, gasping, he suddenly bolted upright and, struggling against the restraints, vomited up a great flood of bright red blood.

Dying in the burn unit is not normally that dramatic. There is usually very little blood; burns die inside out, down at the cellular level, where the billions of struggling cells just simply give up. It is for the most part a kind of gentle going; breathing becomes labored and distant, circulation falls apart, hearts dilate, livers and spleens grow to twice their size, lungs gradually fill with fluid, and there is always a certain period of confusion. But after it, a comfortable time of unconsciousness, where nothing is done and everything-even the last breath-is rather a leisurely giving up.

Suddenly, with the blood still welling out of his lipless mouth, David went rigid and, arching backwards, collapsed against the frame. Edwards grabbed the suction off the wall and, pulling open David's jaw, began sucking out his mouth, trying to clear the blood and vomit out of his airway. The gasping stopped and there was the more comfortable sound of air moving in and out.

"Get the blood," Edwards ordered, reaching for the oxygen mask. He was turning up the oxygen flow, just as Cramer came running back with the blood.

"Call Johnson. Set up a cut-down tray, and get a tracheotomy set."

The ward master unhooked the IV from its bottles. "The blood is still ice cold," he said.

"Just hang it," Edwards ordered, holding open Davids jaw, trying to get out more of the blood. "Just goddam hang it. And call the general surgeon . . . David! David!" He pressed the oxygen mask over the boy's mouth and he could fell the skin slipping away under the pressure of the mask's rubber edges. "David! David! Can you hear me? OK, listen, you have an ulcer. We might have to operate to night. You have a lot of blood and stuff in your lungs. I'm going to have to put you on a respirator. It will help you breathe, so I'll have to make a little hole in your windpipe. It won't hurt." He looked up, checking the blood running down into the IV tubing. "It's just to help you breathe. Honest Just to breathe."

The corpsman had set up the tracheotomy, and Edwards held the oxygen mask in place while the ward master quickly cleaned David's neck as best he could. The noise coming from inside the lungs was getting louder again. Even with the oxygen David was having to fight to breathe.

"I'm going to make the hole now," Edwards said, removing the mask. Little bits of skin came away with it.

"Doc," David gasped. "Take me home, too. . . Please, Doc, I don't want to go alone. . ."