The Parkland Formula and Burns

Anyone who has studied medicine may recognize the Parkland Formula for fluid resuscitation: Fluid required in first 24 hours = (4 x Persons weight(kg)) x %body surface area burned. Giving a burn victim LOTS of fluids shortly after a burn is the mainstay of treatment. The formula for how much fluid to give was developed at Parkland Memorial Hospital...that's right, same Parkland hospital I am at RIGHT NOW! This may sound a little nerdy, but when I first figured out I was going to Parkland for residency, the fact that it had a formula named after it made me feel like I was going to some place very prestigious. Now with 1 1/4 years under my belt I may or may not feel a little differently...but that deserves a blog post all by itself. :) Anyway, as you can probably guess, Parkland receives a lot of very severe burn patients from all over Texas and bordering states and really specializes in the care of burns. We have some of the very best burn surgeons in the country AND some of the very best burn rehab doctors. It is an honor and a privilege to learn from the best. Unfortunately, I have not really been exposed to many burn patients on my rotations. Until today. I attended my first "burn clinic" today and boy were my eyes opened. The majority of these patients were young and healthy until their accident/event occurred. Here is a sampling of some of the stories I heard today(and no personal information will be divulged to protect privacy of course): a young person who was in chemistry class and somehow boiling hot methanol splashed onto the face and caused severe burns on cheeks and forehead. Next, a young diesel mechanic who was working on a truck engine and suddenly a radiator exploded causing severe burns on arms, legs and back. Next, a maintenance worker who was cleaning a circuit board with compressed air and somehow caused sparks to fly which caught the shirt on fire causing significant burns to one arm and lower back. And finally there was another young person who doused themselves with gasoline and lit themselves on fire(I do not know why officially...but I have my guesses) causing nearly 90% of the body to be burned and later suffered multiple complications...but somehow survived. Surprisingly, the one who was most disfigured seemed to be the most optimistic of the four. How many of us would be optimistic when every morning the face staring back at us in the mirror was so disfigured we could hardly recognize it? Now, I am going to be very candid and open in this next paragraph. I see very sick and disabled people every day with very tragic stories, but seeing the burn victims affected me differently. I admit wholeheartedly it is NOT my job to decide whether someone who suffers an ailment and comes to the hospital "deserved it" or not. But, being human, labeling someone as "they deserved it" is sometimes the hardest trap to avoid as a resident doctor. For example, when I have a patient who smokes 4 packs a day, abuses prescription and non prescription drugs, doesn't take any of his prescription medications(like blood pressure, diabetes medicines) and then comes in after suffering a stroke and the family screams at me "why can't you fix him today!" Well, did he "deserve" to have the stroke? Should that change the way I care for a patient? The answer is unequivocally no, I should not treat him differently. But truthfully, living a healthy lifestyle certainly would have helped to potentially prevent the stroke. I mention this because understanding my own biases is the first step to avoid this trap. Unfortunately, the bulk of patients I see in my residency fit the description in the example above. It is easy to become "jaded" and I constantly have to strive to avoid this trap. (FYI there are a host of other reasons that cause healthcare workers to become jaded...but I don't want to get into that right now) I think this trap of labeling is why I was so affected by these burn patients. The majority of the victims were just in the wrong place at the wrong time and did not "deserve" to get burned. It was refreshing to see such healthy patients who were striving to overcome such disfiguring circumstances. I didn't have to fight my unconscious self giving them a label. I thought of my wife Makenna who happened to get burned while she was young and marveled at her bravery and what she went through. I admit I had to consciously overcome the initial reaction of revulsion of the first severely burned face I saw today. But I didn't label the person as "deserving" and that was liberating. Perhaps that young person who was burned in chemistry class unintentionally reminded me of a great lesson today: Labels of all shapes and sizes are not usually earned or deserved and it is ALL of our jobs to stop these labels from spreading. We haven't walked in others shoes and rarely do we know ALL the circumstances. I am always trying (and sometimes struggling) to apply this lesson everyday. I only hope this young person's classmates will learn and apply the same lesson.