Beneath the skin - a log of a nightmare

It was one of those moments, that brief instant, the blink of an eye that completely changes a life. Steers it in a different direction. Major events, both positive and negative, are never announced long in advance. They happen. From one moment to the next. It happened just before Christmas, on 17 December 2016. The immediate family had already arrived and were looking forward to finally being together again and spending time with their young offspring. We had a barbecue outside, chatted and played inside - and made tea. Everything was completely normal, as it had been countless times before. The kettle was boiling and the tea was freshly brewed. Suddenly, the tea carafe burst and split in two.

The boiling hot water gushed out of the container like a waterfall and poured onto the floor. Even tiny droplets caused unpleasant pain. I instinctively jump to the side, catching sight of my little son Nelson, just one year old, in the corner of my eye. He is standing there on the floor, motionless. A puddle around him. Before I realise what has just happened, I immediately pick him up in my arms. And only when he rubs his neck and face with his hand do I realise what has just happened. The skin rubs off like soft butter. The raw, light-coloured flesh becomes visible. The soaked clothing is immediately removed and cooled with water. At the same time, the emergency call is dialled.

Is it all just a terrible dream?

Emergency doctors and ambulances arrive within a few minutes, treat the extensive burns and prepare everything for transport to the nearby Unfallklinikum Berlin (UKB), one of the best and most advanced clinics in Europe for serious burn injuries. The journey in the ambulance seems endless. It's dark outside, the landscape, trees and houses pass you by. What has just happened here? And how could it happen? Or is it all just a terrible dream? Your gaze drops back to your own child lying next to you on the stretcher. Eyes closed, tied to tubes, wrapped in blankets and a golden-coloured warming foil. Nelson is oblivious to all of this. The painkillers flow into his veins. The treatment at the accident clinic takes time.

«I immediately take Nelson in my arms. His skin rubs off like soft butter. The raw, light-coloured flesh becomes visible. I dial the emergency number.»

Minutes seem like hours to me. We have to leave Nelson alone with the doctors - no doubt for our own protection. After around two hours, the wait comes to an end and Nelson is placed in my arms asleep, lying there motionless like a mummy. I can hardly remember the first few nights today. They were sleepless, that's the only thing I remember. We were in shock. We thought and lived from one moment to the next. From one dressing change under anaesthetic to the next. Step by step. That's as far as you get to think. At first, nobody could tell us exactly what would happen next. All the agonising questions remained unanswered at first. In such a limbo phase, immediate psychological and counselling support is very important. As affected parents, you now have numerous questions. A personal counselling session helps to talk about worries and fears, find comfort, gain new courage and clarify initial uncertainties.

Most common cause of accidents: scalding

Apart from Nelson, there are five other small children in the ward for severely burned patients, otherwise only adults. The children all have very similar injuries and are between one and four years old. «We treat an average of 120 children with burn injuries every year,» says Bernd Hartmann, Chief Physician at the Centre for Severe Burn Injuries with Plastic Surgery at the Unfallkrankenhaus Berlin. «In one to four-year-olds, the most common cause of accidents is scalding, often caused by pots, kettles or other vessels being pulled down, broken hot water bottles or cherry stone cushions that are too hot,» Hartmann continues.

Hot liquids can damage a person's skin from a temperature of 52 degrees.

The chest, shoulder girdle and face are usually affected. «Scalds occur all year round, but more hot drinks are consumed in the cold season, so the likelihood of scalds increases in the winter months,» says Bernd Hartmann. Contact burns on hot surfaces are also more common in the cold season, as wood-burning stoves, for example, are used more during this time. And of course, traditional candles are also a source of danger during the Advent season - «so you always have to be vigilant and think about child safety first,» emphasises Hartmann.

Hot liquids can damage a person's skin at temperatures as low as 52 degrees Celsius. Depending on the depth of the injury, we speak of first, second or third degree burns - the third degree being the most severe. «In the case of severe, complicated burn injuries, surgical treatment is required and the children have to be hospitalised for around three weeks, in milder cases only a good week,» says Head Physician Bernd Hartmann. Nelson's burns are on his neck, shoulders, chest, stomach and arms, with a severity level of 2b to 3. Skin from his head is to be transplanted to the affected areas. We are planning to stay in hospital for around three weeks, with short breaks at Christmas and New Year.

In addition to scalds, contact burns from irons, hobs or hot lamps are also common throughout the year. Fire, electricity and acid are other major sources of danger. The website of Burncare, a German practice specialising in burn injuries, states: «Almost all childhood burns are caused by carelessness, usually at the weekend.» Of course, mindfulness is the most important thing in everyday life, especially if you have small children at home. Accidents happen, nobody can help it. Bernd Hartmann also warns against apportioning blame. The parents of a child with a burn injury would suffer the most themselves and would prefer to take the blame for everything. Nothing is harder to bear than a fate without a reason.

You mentally go through everything again and again

Even in our case, nothing could have been done differently. It's like being struck by lightning. Of course, we all still ask ourselves how the accident could have been prevented. We go over everything again and again in our minds. But it is what it is. Christmas and the turn of the year pass us by. The most important date for us is 2 January, the day on which Nelson's major transplant is scheduled.

There is no point in apportioning blame. The parents of a child with a burn injury would do anything to undo the accident.

Split skin is to be removed from the patient's head and meshed, i.e. incised like a mesh so that it gains surface area so that it can then be transplanted to the affected areas in the best possible way. «Split-thickness skin grafts usually only contain the epidermis and are thinner than full-thickness skin grafts. The advantage: the wound areas created by the removal heal completely within just two to three weeks and the donor area can even be used several times,» explains Bernd Hartmann.

In the best hands

Back then, I recorded the time around the major transplant operation like a log:

1 January: We are in a positive mood and are now looking forward to tomorrow morning, when Nelson's operation will finally start. The transplant is another big step towards recovery. And we know that we are in the best hands - together with our family, close friends and the doctors, we can manage it all. Tomorrow we have to be back at the clinic at 7.45 am, the operation should take around three hours.

2 January: After more than four hours, we are able to pick Nelson up from the recovery room. He has survived the operation and the anaesthetic well. The operating consultant's initial feedback on how the operation went is positive. The dressing will be changed for the first time on Friday and only then will it be possible to say whether the transplants will grow and what the further course of the operation will be. For now, we are happy that he is back with us.

6 January: Good news: Nelson's transplants have grown so well that we are allowed to go home in the afternoon. We had actually planned to stay in hospital for around ten days. We are so happy to finally be home. We have to go back to the clinic on Tuesday morning for a dressing change and check-up. But everything is developing very well. The last three weeks have been a tough test and we are incredibly grateful that we have made it this far - all together.

11 January: Today Nelson is finally allowed to take off his bandage. After 26 days, what a moment. The full extent of his injuries becomes visible to us for the first time today. The doctor, who also supervised most of the treatments and dressing changes, frees Nelson from his tight bandages and is very satisfied with the healing process.

More than three weeks after the accident, the grafts have grown well and the remaining wounds have healed quite well. During the course of the day, almost all the scabs are coming off by themselves and the young skin is beginning to get used to normal conditions. Bathing for the first time in over three weeks is also going well. Fortunately, the itching is limited.

The «Jedi jacket» becomes a second skin

Today, Nelson is also being measured precisely so that the compression garment can be customised. Yes, Nelson is doing well and we are delighted that everything is developing so positively. But the unfamiliar sight hurts his heart and soul. The deep traces of the accident all over his body, his head shaved, the left side of his head still noticeably reddened and crusted in places where split skin was removed for the transplants. Nelson looks more mature and older, as if he has shed some of his light-heartedness along with his bandage.

20 January: Nelson now has to wear a thin, extremely tight long-sleeved shirt and a large neck brace around the clock for around two years, as required by the compression therapy. His «magic roll» and his «Jedi jacket», both of which are now part of him, have become his second skin. He does everything so well. It certainly helps that he is still so young; and later he will no longer remember it. Nelson is cheerful, inquisitive and generally very advanced in his development. He loves going to nursery again. Yes, the accident has (apparently) left him with no mental or other physical traces. What luck!

The treatment of burn scars

After this initial acute phase, long-term treatment begins: intensive aftercare with compression therapy as early as possible, i.e. during the healing phase. It has a firm place in the guidelines for burn treatment. During the first 18 to 24 months, changes are still taking place in the burn scar. Excess connective tissue often forms. The constant pressure exerted by the compression garment prevents the burn scar from proliferating and hardening during this time. The permanent pressure also reduces the itching from which burn victims suffer greatly.

Nelson looks more mature and older - as if he has shed his light-heartedness along with the bandage.

Most patients are soon able to leave the clinic again, as their sensitive skin is protected by the compression garment. The customised garments are made of a transversely and longitudinally stretchable rubber fabric that is very thin and breathable. As a rule, it must be worn day and night for two years - even when playing and swimming. The only compression-free time is in the morning, when the scars are moisturised and massaged, and when showering or bathing.

The right compression garment for every burn

The constant pressure makes the skin smooth, soft and supple during the scarring period. «Only timely and consistent compression treatment of the scars can sustainably improve their function and appearance and avoid the need for subsequent corrective surgery,» says Gertrud Krenzer-Scheidemantel, compression therapist from Würzburg and owner of the Burncare practice. She is regarded as an expert in this field - especially for children. We had consulted her on the recommendation of friends - what luck.

There is the right compression garment for every burn. For example, there are full body suits, jackets, trousers, gloves, stockings, neck rolls, also known as «Paulinchen» rolls, chin slings and face masks in different variations. Nelson tried out a number of things for his neck scar, but in the end it was the Paulinchen neck roll, developed by Gertrud Krenzer-Scheidemantel, that did the job perfectly. Nelson is given a change of clothing and his compression garments have to be carefully washed every 24 hours. Without a special dressing aid, it would be impossible to get the skin-tight clothing on. I'm sure all parents can understand how difficult it sometimes is to get small children to put on anything at all. And when it's so skin-tight ...

Parents have to be inventive here - and above all persevere. Even if it makes parents' hearts ache from time to time. It's worth it for life. Children's clothes are checked every two to three months to make sure they still fit and exert enough pressure, as the little ones are still growing. Nelson is already wearing his eighth set at the moment. What is particularly hard to bear in the first few weeks and months are the sometimes pitying, sometimes reproachful looks from others.

Strangers who approach you with curiosity. And even after it has been confirmed that yes, the little one has had an accident, but everything is fine now, this doesn't stop the inquisitive people from asking more and more questions. It's a very personal, painful stroke of fate that you don't want to pass on in passing during a playground chat and certainly not share with strangers. Unfortunately, some people seem to lack empathy. On the other hand, talking to families who have had similar experiences is very good. The conversations give confidence and a little more security. They are like a lifeline in a roaring tangle of emotions. Because what unites everyone here is dealing with a difficult shared fate.

Irony of fate

Seven years ago, I wrote a report on how a person with a burn injury is admitted to the Unfallklinikum Berlin - from the moment they are delivered by ambulance or helicopter and transported via lift and corridors to the specially temperature-controlled shock room. What an irony of fate, I think today looking back. At the time, I could never have imagined that I would have to go down this path. Even worse - accompanying my own child.

Only very gradually do the images of horror fade, like the scars on Nelson's body. They will never disappear, they will always be visible, burnt into his body and soul. Even time sometimes does not heal all wounds. But a stroke of fate like this puts many things into perspective and makes you think again about the really important things in life. Situations that were stressful in the past become much less important. When we were in hospital with Nelson for so long, we just longed for the day when everything would be good again.

We are all at home together, Nelson is playing happily somewhere and we are all healthy. And suddenly that day arrived. Probably the hardest time is behind us, we have mastered a lot together. We still have a whole life together ahead of us. Such a stroke of fate teaches us humility. We feel gratitude every day. And we no longer get upset about the little things that don't go quite so smoothly. During this intense time, a good friend once said to us that such phases either break up families or bring them closer together. The latter seems to be the case with us: Nelson will have a little sister in the spring.

First aid for burns - what parents need to know

• Notruf 112 wählen
• Verbrennungswunden zur Schmerztherapie ca. 10 Minuten mit handwarmem Wasser kühlen (ca. 20 ° C), bis der Rettungsdienst eintrifft.
• Wichtig: Wegen Unterkühlungsgefahr nur die verletzten Stellen kühlen! Nicht kühlen bei grossflächigen Verletzungen (mehr als 15 % der Körperoberfläche), bei Neugeborenen und Säuglingen und bei bewusstlosen Personen.
• Flammen durch Wälzen am Boden oder mit Wasser löschen.
• Bei Verbrennungen eingebrannte Kleidung nicht entfernen.
• Bei Verbrühungen dem Kind die durchnässte Kleidung sofort ausziehen.
• Bei Stromverletzungen sofort den Stromkreis abschalten.

(Source: Paulinchen e. V.)

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