Johns Hopkins Magazine -- September 1998
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Months after suffering serious burns, Eric Atkinson is on the mend and ready to return to school. But are his fellow fourth-graders ready for him?

B A C K  -  T O  -  S C H O O L    I S S U E

Classmate Compassion
By Kari Rosenthal '00
Illustration by Greg Spalenka

Tuesday, January 13, was an abnormally warm day in Baltimore. The high reached 53 degrees and the skies were clear. The following day the temperature dropped dramatically to near freezing. That Wednesday afternoon, 10-year-old Eric Atkinson came home from Garrett Heights Elementary School in the northeast part of Baltimore City. Chilly from the cold air after taking off his jacket, he went to the kitchen and turned on the gas stove, intending to warm himself.

But as Eric stood by the stove, his flannel shirt brushed too close to the burner, and almost immediately he was engulfed in flames. Hearing his cries, his mother rushed into the kitchen and quickly began extinguishing the flames. Within minutes he was in an ambulance and on his way to the Regional Burn Center at Johns Hopkins Bayview Medical Center.

IN AMERICA, SOMEONE is burned every 17 seconds, and often that someone is a child. Every year, children start more than 25,000 fires, according to the National Fire Incident Reporting System. Burn-related injuries--including scalding and electrocution--are the leading cause of accidental death in children under the age of 14.

For children who survive their initial injuries, the recovery process is often long and painful, both physically and psychologically. Many face months, sometimes years, of arduous therapy, and bear disfiguring scars that can last a lifetime. At Hopkins's Regional Burn Center, the job of helping young burn survivors like Eric Atkinson to get on with the rest of their lives falls to a phalanx of nurses, therapists, nutritionists, a home health coordinator, pediatric specialists, psychologists, and social workers.

"Kids can be so mean," says Ceal Curry. "They can say thinks like, 'Crispy critter,' or 'They look like a monster,' or 'Eeew, that's really ugly.'"
For school-age kids, one woman at the center is particularly important: child-life coordinator Ceal Curry, affectionately known as "Miss Ceal." Fifteen years ago, Curry and a colleague started a program aimed at helping burn survivors make the often-difficult transition back to the classroom.

"Kids can be so mean," says Curry, a friendly, no-nonsense woman in her early 40s. "They can say things like, 'Crispy critter,' 'They look like a monster,' or 'Eeew, that's really ugly.'"

Curry has found that the best way to diffuse such responses is to go into the schools and explain to children what their burned classmates have gone through--and what they can expect when that classmate returns. She presents her one-hour program about 10 times a year in schools all over Maryland; it can be adapted to suit children from kindergarten through high school. Sometimes she addresses a single class. Other times she stands before an entire school assembly.

"The school needs to feel comfortable with the child coming back because a lot of people haven't been exposed to burns," Curry explains. "With the re-entry program, we give the students a chance to talk about their feelings and ask any questions they want answered. If they have concerns, that is the place to talk about them."

In her presentation, Curry usually starts by explaining what kind of injury the classmate sustained, then describes the child's treatment and therapy regimens. For younger audiences, she brings along large demonstration puppets and passes around a collection of splints, braces, and "Jobst stockings"--worn to keep pressure on the skin to reduce scarring.

She emphasizes that the injured classmate will need a lot of support from teachers and classmates. "We tell them that we were the team in the hospital, and now they're the team at school, so they should give him a hand if he needs any help [putting on a jacket, for example] or carrying books." At the same time, she makes it clear that the patient doesn't need to be treated like a special case. "We don't want the classmates to feel sorry for him," she says. "We just want them to empathize with him.

"What we try to tell them is that it could happen to any one of us, and how would you feel if someone said, 'Eeew, your hair's really ugly'?"

The program, modeled after one Curry observed in Washington, D.C., goes a long way toward easing the minds of survivors, who may fear being teased or ridiculed by classmates. "That can be really scary, especially for kids with facial burns or burns that are more visible," she says. "When we go, it takes the pressure off them because we tell the kids in the school that if they have questions, it's better to ask them than to talk behind the kid's back."

Four years ago, Paul Terrell of Baltimore lost his mother and six siblings in a terrible house fire that also left him with burns on his face, head, arms, neck, legs, and hands. Paul spent his seventh birthday at the Bayview Burn Center recovering from his injuries. Once Paul was released, the reception he received from neighborhood children was very upsetting. "The kids were all over him," recalls his grandfather, William Hopkins. "They were calling him names, calling him a monster."

Because Paul's grandparents lived in a different school district, he had to return to first grade in a new school: Roland Park Elementary. Hopkins says that Ceal Curry's visit to the school was a godsend. "Ceal was very sensitive and told the kids, 'You can be little doctors yourself and help Paul out,'" says Hopkins. For most of the day, Paul had to wear a plastic mask to protect himself from germs and further injury. Curry explained this to his young classmates and allowed them to handle a mask like the one he would wear. Darlene Tucker, Paul's first-grade teacher at the time, says the hands-on program helped dispel the kids' fears. "When he actually came, it wasn't a shock for them. They expected him to look different." Sometimes Paul forgot to put his mask back on when it was time for recess, Tucker recalls. "The kids would help him remember. They'd bring it along and say, 'Paul, you forgot your mask.' The kids became very protective of him. They really watched out for him that year."

Says Hopkins, "After the re-entry program, Paul had friends all over the school. People know him even though he doesn't know them. It made him feel like a star."

ALMOST ONE-THIRD of Eric Atkinson's body received second- and third-degree burns. Though his face was not injured, he was badly burned on his neck, chest, hands, arms, shoulders, and back. In January and February he underwent four surgeries (one for his chest, one for his neck, and one for each shoulder), during which doctors grafted skin taken from his legs to cover his wounds. He spent four weeks at the Burn Center, then two in Bayview's pediatrics unit. During his stay at the hospital, Eric's occupational therapists had to help him learn to walk again, for two reasons: his long period of bedrest had weakened his muscles, and the wounds on his legs were still unhealed and tender.

Now it is early March, and he is living at his grandmother's house. Because she works two jobs, he spends most of the day with his great-uncle, Phillip Campbell. Each day, the two take the half-hour bus ride to Bayview, where Eric undergoes 90 minutes of occupational and physical therapy. He'll have to continue the therapy for six months to a year.

Since leaving the hospital, Eric's burned skin has lost its flexibility and is constricting as his wounds heal, causing contractures. These contractures make it difficult for him to lift his arms above his hips. To help him stretch his arms, his first task during each therapy session is to hang his jacket on a coat hook about 18 inches above his head. Two weeks ago, he had no trouble hanging the coat. Now it takes him five heartbreaking minutes to get the jacket's loop anywhere near the hook. After countless failed attempts, occupational therapy student Lucia DiRado has to help him.

"Our main goal is to get them functional, back to the way they used to be before the injury, or as close as we can," explains Michelle Swatski, a burn rehabilitation specialist. "With Eric, that's everything: playing, going to school, being able to do his homework, getting dressed." His therapy can't end with the hour and a half he spends at the hospital, says Swatski. "He needs to be stretching at home in the morning and in the afternoon, and [doing] scar massage at night. That's a lot for anyone, especially a 10-year-old."

To fight the contractures, Eric has five splints he must wear at different times, for a total of 23 hours a day. "It's difficult, especially with children, because an adult can reason, 'Well this is sore and painful and uncomfortable, but I need to wear it,'" Swatski explains. "With a 10-year-old, it's, 'I don't want to wear it. Take it off.' We have to [offer] a kind of education for him and his caregivers and his teachers, to let them understand what can happen if he doesn't wear it."

Swatski says that Eric hasn't been wearing his splints as often as he should. "That's where the school re-entry program comes into play. Not only do we come in to educate the teachers and the students as to what it's like to be here, but it's also to let his teachers know he's supposed to be in these splints, and this is why. They can act as a reminder, saying, 'Come on, put those on.'"

Eric is due to return to school on a part-time basis at the end of March, only a few weeks away. Asked if he's nervous about going back, he replies, "A little bit." When DiRado asks him why, he rolls his head and looks at her incredulously: "If you had the experience I went through, you would be nervous." At this moment, he is lying on a cot with heating pads on his arms; both arms are strapped down to help stretch his skin.

Because his face was not burned, Eric's injuries would be hard to discern if he were wearing a long-sleeved shirt and pants. But since it is a warm day, Eric is wearing shorts and a T-shirt. His neck is covered with pale, taut scars, and his arms are patchy with wounds--some scabbed, some open. The top of his chest is almost completely black with raised, scaly skin. His thighs are mottled with patches of light and dark skin, remnants of his several skin grafts. As DiRado sits by his head, massaging his neck and arm scars with burn ointment, Eric winces in pain and repeatedly asks her to adjust his straps.

Though anxious about returning, Eric thinks his class will be excited to see him again.
Eric says that before the accident, he was a bit of a cut-up in school. "We used to throw spitballs at other people," he says, adding proudly, "and we never got caught." He claims he is going to be well-behaved once he returns, however. "I'm going to do a lot more work," he says, "so I won't have time to play. Maybe at recess, but not in class."

Though anxious about returning, he thinks his class will be excited to see him again. "One of the reasons why my class misses me was because I was the class clown," he explains. "If you're the class clown and something happens [to you], well, no class clown now."

At the end of the therapy, Eric has to put his splints back on. When the therapists try to strap one splint on to extend his arms like airplane wings, the normally cheerful boy begins to cry. "You have to keep that on, Eric," warns DiRado. "Just for a little while, and then you can take a break." After the 10-year-old leaves, one of the therapists says softly, "At least he doesn't scream anymore."

THE RE-ENTRY PROGRAM for Eric's fourth-grade class is set for March 16, 62 days after his accident. Usually, only Curry and the child's occupational therapist go to give the presentation. This time both Swatski and DiRado accompany Curry. Eric asks to come along, too. Curry grants his request to join his two therapists.

Curry has found that there are pros and cons to having the patient present. "Sometimes the other kids will be afraid to ask questions," says Curry. "But on the other hand, sometimes it's good when you have a talkative kid saying: 'This is what I've been through and it was really hard. I'm really scared about coming back to school because I'm afraid of what people will say. The burns were pretty bad and I may have some scars and I need your support. I need you to remember that you're my friends and not to step away.'"

Around 1:30 on the afternoon of the 16th, Curry, Swatski, and DiRado arrive at Room 203 at Garrett Heights and begin unpacking their totebags. Teacher Sirron Rollins switches off the TV, which has been playing "The Magic Schoolbus," and announces the visitors to the two dozen fourth graders who sit at their desks. They are disappointed to learn that Eric has not yet arrived; he and his great-uncle have been delayed at the hospital. In the front of the classroom sits a chair decorated with four helium balloons. A giant homemade card, signed by all the kids in the class, is propped on the front chalkboard.

In the back of the room sits a slender young woman with a ready smile. She is Cheryl Dixon, a lunch aide at the school, who says she has grown very attached to Eric--despite his propensity for making mischief. "Eric is very special to me," she says. When she heard he would be back for his first visit today, she wanted to be there to see him.

Curry starts the program by talking about the three different types of burns: how a first-degree burn affects only the top layer of skin, like a sunburn; how a second-degree burn hurts the most because of nerve damage; and how third-degree burns, the most severe, are located deep in the skin, below the nerve endings. "Eric had mostly third degree burns," Curry tells the youngsters. She moves on to explain the procedures for treating burns.

Then Swatski describes the exercises that Eric has to do every day and the braces he has to wear to help him stretch the new skin. She explains that Eric sometimes forgets to put on his special braces. "Since you're Eric's class, he really needs your support," emphasizes Curry. "Sometimes you need to bug him by saying, 'Where's your splint?' But it's going to help him remember that these things are important for him to continue to get better."

She warns the students that Eric's appearance may be changed. "His skin's going to look a little bit different. There might be places where it looks bumpy," she says. "It might change the way he looks, but it doesn't change the way he is on the inside. He can still play and have a good time, but he has to be a little more careful."

A heavyset boy asks, "Will Eric be able to play football? He was really good at football. I played on his team last fall." Swatski replies that Eric, due to the sensitivity of his wounds, will probably have to wait until at least next year before resuming contact sports.

Other children also raise their hands with questions. One boy asks whether Eric was given the new synthetic skin cells that are being developed. Curry and her companions exchange smiles, impressed by the boy's knowledge; she tells him that Eric did not receive the artificial skin cells, though research in that area is under way at Bayview. A half dozen other children raise their hands in succession, to share stories of when they--or their siblings--suffered minor burns.

Since Eric can't raise his arms, Swatski helps hold the brown plaid flannel shirt up for the class. Most of the front panels are gone; only some charred edges remain.
Then Eric walks into the room. He is wearing shoulder straps and a neck brace. Without it, the contractures would pull his head down to his chest. "Hi, Eric!" several students call out. Rollins greets him warmly, then invites him to say a few words to his classmates.

Eric speaks quietly. "I was nervous coming in here. I haven't been here in a while. If you've been burned like me and have been in the hospital, things are different around here." He walks to the back of the room, where his great-uncle sits, to retrieve a plastic bag. "When I was burned, my grandmother saved my shirt. It was burned pretty bad," he says. Since Eric can't raise his arms, Swatski helps him by holding the brown plaid flannel shirt up for the class. Most of the front panels and almost all of the sleeves are completely gone; only some charred edges remain. "That's a 100-percent cotton shirt and cotton burns quickly," he tells his classmates. "I was playing near the stove when my shirt caught on fire. It's dangerous to be there."

One student raises his hand, then says, "I don't know why people pick on you. You're lucky. You don't have to do any work or come to school." Eric responds solemnly, telling him how boring it's been to be home all day. His teacher interjects, "When you have to sit at home day after day after day, you can only watch so much TV, and you can play only so many video games."

Once the formal part of the presentation is over, Curry and the therapists start packing up their bags. Rollins passes out celebratory cups of orange punch and pieces of sugary cake. Cheryl Dixon approaches Eric. His eyes light up when he sees her. She asks if she can give him a hug, then puts her arms around him and embraces him gently. The two talk quietly for a minute, and he smiles up at her. Then she walks back to her seat, where she searches her pocketbook for a tissue to wipe away her tears.

IN THE TWO WEEKS before he returns to school part time, Eric continues to visit John Lawrence, one of two psychologists on staff at the Burn Center. Lawrence treats most of the pediatric burn survivors while they are staying in the hospital--about 150 per year. Those who need follow-up after being discharged, like Eric, come to see him once or twice a week.

One of the most important parts of recovery is for the patients to get used to their own burns. "There's a mourning process involved with any burn patient," explains Lawrence. "We try to help them understand what a big change has been made."

Adjusting to facial burns is much more difficult, especially for older children who are already self-conscious about their appearances. "A lot of times many burn survivors look at the floor and hide their faces," says Lawrence. Thus, helping kids learn to make eye contact can be a crucial first step in rebuilding their damaged sense of confidence and self-esteem. Lawrence begins by having patients practice with him and members of their immediate family, the people with whom they feel the most comfortable. From there they move on to making eye contact with friends and neighbors, and, finally, strangers.

Lawrence also helps children learn how to have prepared answers for questions about their burns. That way, they don't become flustered every time someone asks about what happened or how they feel. And he teaches them how to be assertive enough to say "Leave me alone," or, "I don't want to talk about it."

Lawrence and other staff working with Eric have seen him progress in his social skills. "He was real quiet when he came in," says DiRado. "He's warmed up a lot." Though he speaks meekly, Eric is open when answering questions. He makes eye contact as well as he can, despite the contractures in his neck that draw his chin down.

Lawrence says that once Eric is done with therapy and counseling (when he feels better, which is impossible to predict), the boy will probably lead a fairly normal, well-balanced life. "Over 95 percent of the Burn Center's patients survive and go on to lead extremely rewarding lives," the psychologist says.

At Roland Park Elementary, Paul Terrell is now in fifth grade. Teacher Darlene Tucker has kept up with him over the years, and says she's amazed at the extent of his recovery--both physically and socially. "The last time I saw him, a couple of weeks ago, I had to do a doubletake because the improvement was so astonishing to me," she says. Even today, she says, Paul remains a "star" among his classmates. Most of the school's kids know about him and his story--"even the kindergartners," she says.

Psychologist Lawrence says this kind of reception is not unusual. "The kids come back as celebrities. They always get a warm welcome."

Eric is no exception. On March 30, his first day back, he decided to surprise his classmates. Says Rollins, his teacher, "When he came in, all the kids turned around and said, 'Hey Eric!' I told them, 'Don't stare at him, it's the same old Eric.'"

Rollins soon noticed a difference in her formerly rambunctious student. "He was scared and really shy. He used to be real talkative," she says. Nevertheless, "he jumped right in, participating like all the other students."

Some of his classmates were still worried about what to say to him. Says 10-year-old Antoine Wright, "To look at him made me feel tingly and hurt and scared. I didn't want to ask him too many questions, so I said, 'Hey Eric. How are you?'"

A week after returning to school, Eric was still having a difficult transition from the hospital to home and back to school, according to his grandmother, Paulette Marshall. "Eric spends about 95 percent of the time in the house," she says. When he does go outside, Marshall says, "I don't let him play with children because they don't understand the extent of his burns. They get kind of rough. So I have him sit on the porch, and anyone who wants to play with him comes up to see him."

Although Eric's accident was horrible, his burns and recovery have taught his classmates a lesson about fire safety. "Before I do anything with fire," says Antoine Wright, "I'm definitely going to think about it for a few minutes." Classmate Candace Everette agrees. "It made me think how to be careful."

The Burn Center's DiRado says of Eric's accident, "As awful as it was, at least he learned something from the experience Now he's passing it on to other people."

Kari Rosenthal '00, a Writing Seminars major, was the magazine's student intern last semester.