Killer Show: The Station Nightclub Fire (37 page)

But one group never would. They were the most seriously burned victims of the fire. For those fortunate enough to survive, no part of their “sentence” would be suspended; they would all be lifers.

By mid-morning on February 21, 2003, the day after the fire, the emergency room at the Massachusetts General Hospital had settled into its normal routine, which is to say, normally frenetic. Helicopters no longer clattered onto the hospital’s roof, but doctors and nurses scurried about, attending to the fourteen Station fire victims who had passed through the
ER
’s doors over the prior eight hours. About half those patients remained unidentified.

As hospital personnel fielded calls from people looking for missing loved ones,
ER
staff patiently took down information on each: name, age, height, weight, clothing, distinctive jewelry, tattoos, scars — even shoe size, because many victims were terribly burned about their faces and upper bodies. By midday, all but two female patients had been identified. They were the hospital’s “Jane Does.”

Anna and Joe Gruttadauria were awakened three hours after the fire by one of their daughter Pam’s co-workers at the Holiday Inn, calling to see if she was all right. They checked Pam’s room, only to find her bed empty. She had not come home.

Pam’s parents turned on the
TV
, saw news reports about the fire, then drove to the Crowne Plaza Hotel where Red Cross volunteers were setting up a support center. At 6:30 in the morning, the distraught parents were told there was no “Pam Gruttadauria” on a list of known survivors. They began to call area hospitals, describing Pam as five feet tall, with dark hair. When they spoke with Massachusetts General Hospital, their hopes were dashed. The hospital’s two remaining Jane Does were both about five feet, four inches tall.

By mid-Saturday, the second day after the fire, only one of Mass. General’s Jane Does remained nameless. When the Gruttadaurias called the hospital again that day, they were asked for a more detailed description of their daughter. This time, Anna described acne scars on Pam’s upper chest and a chipped front tooth. The “unknown woman in room 14” also had a chipped tooth.

Sometimes when people are seriously burned, the massive swelling of their bodies makes height measurement difficult. Aided by Anna Gruttadauria’s additional description,
MGH
staff remeasured their unidentified female patient. Taking into account her body’s swelling, the terribly burned woman was closer to five feet. Buoyed by this news, the Gruttadaurias sped to Boston, hopeful that their daughter might still be alive.

Upon arrival at Massachusetts General Hospital, Anna and Joe Gruttadauria were introduced to Dr. Lawrence Park, the hospital’s emergency room psychiatrist. He explained to them that the girl in room 14 was very badly burned, and they would not be able to see her face or hands, which were swathed in bandages. But someone would have to try to identify her.

Anna didn’t hesitate. Donning sterile gown, gloves, and a mask, she stepped into the room and looked at the patient’s terribly swollen feet. Her daughter had one toe that overlapped the one next to it. So did this patient. Pam had red acne scars on her upper chest. As did the poor girl in the bed. And the unconscious burn victim, suspended amid a network of tubes, wires, and monitors, had a single chipped tooth visible above the breathing tube that passed from the respirator into her lungs.

“This is Pam,” said Anna.

A mother knows.

Several regional burn centers and general hospitals cared for victims of the Station fire. Rhode Island Hospital’s burn unit alone performed more than forty skin-graft surgeries in the two months following the fire. The University of Massachusetts Medical Center, Massachusetts General Hospital, and Shriners Hospital in Boston also cared for critically burned Station fire victims.
(This was the first time in the history of the Boston Shriners Hospital that it treated adults, rather than children.) The best hospital care, however, was no guarantee of patient survival, as four succumbed in the days and weeks following the fire. One was Kelly Vieira, the wife of Station stage door bouncer Scott Vieira.

Several fortunate coincidences favored Rhode Island Hospital that fateful night. Three surgeons on its staff had trained at the Army Burn Center in San Antonio, Texas. Their experience would prove invaluable. Also, the Station fire occurred at 11 p.m., right at the hospital’s shift change, resulting in twice the normal number of nurses being available to remain and stabilize emergency admissions. Additionally, because of a renovation then under way at Rhode Island Hospital, new, barely finished space was available to immediately house the influx of patients. A twenty-one-bed burn
ICU
was created on the spot, along with a thirty-four-bed step-down unit.

Three weeks after the fire, thirty Station survivors remained confined to four hospitals, with twelve of those patients still listed in critical condition. Among them were bodybuilder Joe Kinan, reptile fancier Gina Gauvin, and hotel breakfast manager Pam Gruttadauria. Their struggles for survival would test each patient, their caregivers, and their families to the limit.

Care of critically burned patients is not for the faint of heart. It is a high calling among surgeons, requiring not only technical proficiency, but also an encyclopedic knowledge of human physiology. They must understand the body’s need for nutrition as it operates in overdrive to overcome horrendous traumatic insult. They must implicitly understand the precarious balance to be struck while treating the body’s massive loss of fluids. They must be constantly vigilant for bacterial or fungal infections that threaten burn victims all too often.

Burn specialists well know that every treatment they administer imposes its own burden on the critically ill patient. Every surgery stresses an already weakened body. Every antibiotic, in large enough doses, can be toxic to kidneys or liver. No treatment is without risk. But treat they must, if the patient is to stand any chance of survival.

And many interventions are painful. There is no escaping the fact that lifesaving treatments for burn victims can themselves be excruciating. Physicians, aides, and therapists must steel themselves to the often painful nature of their treatments, understanding that they are necessary to the paramount objectives of burn care.

As explained by Colleen Ryan,
MD
, codirector of the Sumner Redstone Burn Center at Massachusetts General Hospital, the three objectives of critical
burn care are, in order of priority, “First, survival; then, function; then, cosmetics.” In other words, critically ill patients must be saved. Once survival has been reasonably assured, procedures can be undertaken to enhance bodily functions. Finally, once a patient’s level of functioning has been maximized, further interventions may be considered to enhance a victim’s appearance.

For Pam Gruttadauria, Gina Gauvin, and Joe Kinan, weeks, even months, passed before doctors could worry about anything but their survival. All suffered second-, third-, and fourth-degree burns over more than 50 percent of their bodies. All had leathery eschar encircling torsos or limbs, requiring escharotomies (incising of the burned skin to allow it to split, so that deeper tissues are not compressed by swelling). Still deeper burns required fasciotomies (incising the fascia that divides muscle compartments, to allow swollen muscle tissue to expand). For some, the deepest burns would even necessitate limb amputations.

Critically burned patients are maintained in a chemically induced coma during initial treatment, which may last weeks, or even months. Their respiration supported by a ventilator, burn victims often “lose” months of their lives, later awakening to a very different reality. If they are lucky.

Skin that has suffered third-degree burn cannot be left in place, lest it become a breeding ground for infection. It must be removed within a few days of injury by cutting, called debridement. Charred skin is cut away, revealing fat, muscle, or even bone, depending upon the depth and location of the burn. In order to prevent fluid loss and infection, the debrided site must be covered with some kind of graft. When patients cannot immediately spare sufficient healthy skin of their own, debrided areas are temporarily covered with cadaver skin or a collagen-based product called “artificial skin.”

Such measures are only stopgaps. Eventually, all debrided areas must be grafted with the patient’s own skin. But how can patients with few unburned areas of their body spare sufficient skin to graft everywhere else? The answer lies in the wonders of split-thickness grafting and the skin’s own regenerative powers.

When Gina Gauvin’s doctors at UMass. Medical Center sought to permanently cover debrided areas of third-degree burn, they took an electric reciprocating blade, called a dermatome, to her few areas of healthy skin. It produced strips of skin graft thick enough to survive if nourished by new blood supply, but thin enough that tissue remaining at the donor sites would later heal, forming new, re-harvestable skin. Each strip of graft material was then passed through a mesher, which produced a latticework pattern in the grafts, allowing it to be stretched to three times its original area. The meshed
grafts were then stapled to debrided areas, where it was hoped they would develop their own vascular supply and fill in the interstices among their latticework — without infection causing the grafts to slough off.

The process was repeated, time and again, for each of the critically ill Station fire victims. Temporary graft material was removed, the patient’s own skin harvested, meshed, and stapled in place over previously debrided areas. Once a donor site healed sufficiently, it was used for another split-thickness graft — and so on, until all debrided areas were eventually covered, and the mesh grafts consolidated into solid skin, of sorts. It would lack hair, nerve endings, and sweat glands, but would have to suffice for the body’s protective envelope.

Patients underwent daily dressing changes and spray debridement of dead skin — a process so painful that it caused even deeply sedated patients to grimace. All fought off infections over the weeks and months — some successfully, some not.

On Gina Gauvin’s admission to UMass. Medical Center, doctors gave her less than a 50 percent chance of survival. Four days after the fire, they removed the dead skin on her scalp, back, arms, hands, and fingers, replacing it with artificial skin or temporary cadaver graft. Throughout the rest of February, March, and April, Gina underwent skin grafting and other surgical procedures, about twice a week. Her doctors had no choice but to remove hopelessly burned structures — most of her left ear, her right pinky, and two thirds of the other fingers on her right hand. Fortunately, Gina, whose hobby was painting, was left-handed.

By the last week of March, however, Gina’s luck was running low. A combined fungal and bacterial infection had taken over her left hand, threatening her overall survival. If the infection spread from that hand to the rest of her body, she would die.

It’s said in the King James Bible, “Wherefore, if thy hand or thy foot offend thee, cut them off.” Gauvin’s surgeon, Dr. Janice Lalikos, knew that her patient was in exactly that terrible situation; not through temptation, as contemplated by the scripture, but due to infection. The doctor would have preferred to consult with a conscious Gina (she was still heavily sedated), but after obtaining consent from her sister, Dr. Lalikos reluctantly amputated the artist’s dominant left hand.