The Journal Gazette
Wednesday, December 02, 2015 11:32 am

Burn care takes a special kind of person

Rosa Salter Rodriguez The Journal Gazette

In her time working at St. Joseph Hospital, Jan Trahin has been vomited on, bled on and yelled at by her patients.

She recalls that, as she was exercising one patient’s arm by moving it up and down at the elbow, she was even cursed at. 

"You’re a cold-hearted b----," she recalls the patient saying.

"I said, ‘Yes, yes, I am,’ " she says. And then the two of them broke into laughter.

Nonetheless, Trahin, a petite 64-year-old mother of six, grandmother of nine and great-grandmother of two, says she loves all her patients, even though some don’t always love her back. 

For the past 40 years, she has worked at a job in which most people wouldn’t last a week – cleaning and dressing the wounds of the seriously burned and tending to their physical and emotional needs for weeks or months at a time.

That means the Fort Wayne licensed practical nurse has been with the unit since day one in February 1974. She’s worked every shift and now devotes nights and weekends to the job.

In the past 10 years, the unit and its accompanying outpatient burn unit have treated more than 55,000 patients, hospital officials say.

"Every field of nursing has its challenges," Trahin says. "But burns – the best way to say it is you go to hell and back with these patients."

Trahin says she’s not regretted her decision to go into burn nursing. Asked why she chose the specialty, she does some mental time-traveling, back to when she was brand new to hospital work and stationed on a regular surgical floor.

"We got all the burn patients straight out of the ICU (intensive care unit)," she says, "and they all died."

When she heard a special unit for burns was opening, she decided to go for a job there.

"I had a goal," she says. "My goal was to see one patient, one with a significant injury, survive, go home."   

Within weeks of the opening, that happened, and Trahin can still remember the patient. "His name was Herman Decker," she says. He was "an older gentleman" with what she believes was a workplace-related burn.

"It was the summer we opened that he went home. It was great to see, and I’ve been here ever since," she says.

In her 40 years, Trahin says, much has changed in the way burns and burn patients are treated.

In the early years, she says, the unit had seven beds – it now has 12 and serves patients from northern Indiana and parts of Michigan, Ohio and Illinois – and it was considered a total-isolation unit.

That meant everyone who went inside to care for a patient was suited up in full protective garb – scrubs or a gown, head covering and a mask. The same was true for visitors.

"We wore yellow suits, and the only thing patients could see was our eyes. That went on sometimes for weeks," she says.

She still remembers one severely burned patient, desperate for human contact, who reached a finger under her headgear to stroke her hair and said a single word: "Soft."

Since then, studies have shown the extra precautions do not improve outcomes for patients, and now the unit functions without them, although it is maintained as a clean environment with rigorous housekeeping. 

With the opening of an outpatient unit in 1988, more patients, especially children, didn’t need to be hospitalized, Trahin says. Others have been able to go home much sooner as a result of improved dressings and earlier skin grafting.

Improvements in antibiotic drugs now control infections, and better medications also control pain. These days, some seriously burned patients can be placed in a drug-induced coma while their burns heal, she says, and certain drugs even can allow patients to forget some pain of their experiences.

In the early days, she adds, many patients died of inhalation injuries to their lungs; that situation has improved because of better ventilators. And, patients no longer have to be lowered into a trough-like Hubbard tank to clean their wounds; they simply lie on a stainless steel table under a shower.

Patients still succumb to complications of burns or surgeries, Trahin says. But the survival rate has greatly improved. Hospital officials say they’ve had patients survive despite being burned over more than 90 percent of their bodies.

However, in her 40 years, the goals of burn treatment haven’t changed, Trahin says.

"You try to make them (patients) as comfortable as possible. You can’t take all the pain away, but you do what you can," she says.

Over the years, she says she’s learned and passed on many tricks of the trade in removing and replacing dressings and cleaning wounds. Sometimes she distracts patients by asking them to visualize being in a favorite spot while such treatment occurs. Sometimes she even sings quietly to patients when they are not conscious or able to respond.

"They can hear you. ... That’s why we always tell families to talk to them," she says. "I’ve had one patient (when recovered) actually say to me, ‘Oh, you were the one that sang to me.’ " 

Healing a burn physically is just the first step, Trahin says.

"A burn injury is for life," she says, noting she tries to help patients and their families adjust not only to the unfamiliar world of the hospital but to the new realities that await them.

"This changes their whole life, what they look like and how and they will function again," she says.

"There will be changes, but our goal, it’s always been to return patients to their same role and functions in life as when they came through the door."

Many patients who recover come back to the unit to visit, Trahin says, adding she grew so close to the family members of one patient who did not recover that she’s considered a family friend. "I’ve been to every one of her children’s weddings," she says.

Working nights, she’s sometimes with patients at their lowest moments, when they can’t sleep or time drags interminably.

Patients can get really lonely, she says, and sometimes what they need most is just having another person there.

Her patients, she adds, have taught her what it really means to have a strong will to live. 

People often ask her where she works, and when she tells them it’s in a burn unit, "They’re like ‘ooohhh,’ like it must be awful," she says.  

But those people don’t know the rewards from getting to know the uniqueness of individuals and being able spend her shifts offering companionship and compassion.

Trahin acknowledges that when she’s at home she thinks about her patients; it’s impossible to leave them completely when she’s off the clock.

"Yes, I do take it (the job) home with me, but not to the extent that it consumes me," she says.  

"I simply love my patients," she adds. Even when they were burned because of their own reckless actions, "It’s not my right to judge them because I receive something (valuable) from all of them," Trahin says.

"There aren’t too many patients you won’t feel some bond with."

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