Victims of R.I. Club Fire Struggle Just to Heal

BOSTON, March 6 -- The West Warwick nightclub fire scorched Frank Canillas' forehead and nose, and gave the 23-year-old nightmares and convulsions. In the first days after the blaze, his slowest movements, even sitting up, made him vomit. But his mother is just grateful he is alive.

"He was holding my hand. I could see the tears in his eyes," said Anna Canillas, describing the first time she visited her son in Rhode Island Hospital's intensive care unit. "They're saying he's pretty well. That's good news. I'm lighthearted about that."

The Feb. 20 fire at the Station nightclub initially killed 96 people and injured dozens. Since then, three more have died, but 33 severely burned people have survived. Twenty-nine remained in critical condition today at regional hospitals, and the others, including Canillas, have been upgraded to serious condition or better.

Some people have deep burns covering more than three-quarters of their bodies. Two victims at a Boston hospital were so unrecognizable that they were not identified for 48 hours. Most of those injured suffered burns on their faces, chests and arms. Some were so horrendously disfigured that a number of families were asked to identify loved ones in intensive care units from the waist down.

Doctors say recovery from severe burns is more like a marathon than a sprint, and predicted that some patients may not survive. Milton Servais Jr. suffered second- and third-degree burns on his face. "They gave him a 50-50," chance said his father, Milton Servais Sr.

Not so long ago, the chances of surviving such injuries were much less than today. Advances in emergency techniques and medical technology, along with specialized treatment at 125 burn centers nationwide, now mean that even someone with extensive burns can survive, though often with permanent handicaps.

Overall, burn deaths in the United States declined about 50 percent from 1971 to 1998, and fatalities in burn centers have dropped to 6 percent. The fact that most of the nightclub fire victims who suffered major burns are still fighting for their lives may seem miraculous to some, but it is less surprising to the doctors and nurses who treat them.

"We've made incredible strides in burn care over the years," said Dennis P. Orgill, acting burn director at Brigham and Women's Hospital in Boston. "Everything has gotten better."

At the Rhode Island fire, paramedics, in line with advances in burn treatment techniques, immediately began treating respiratory injuries, now considered the first priority after a serious burn injury, to keep airways singed by fire and smoke open, and to prevent suffocation caused by swelling.

As the dozens of injured arrived at hospitals -- some flown by helicopter to specialists in Boston -- doctors flushed soot from their lungs, and some patients were temporarily immobilized to facilitate the use of ventilators.

Doctors immediately removed burned skin and tissue. Within days, most of the injured underwent skin grafts -- some undergoing multiple surgeries in the first days. Many will receive grafts of artificial skin to stimulate tissue growth.

In those early days, they were heavily sedated and may never recall the tragedy or their traumatic first treatments, hospital staff said.

"Our job is really for them not to have to remember this particular part of their stay," said Mary-Liz Bilodeau, a clinical nurse specialist at Massachusetts General Hospital in Boston.

Some of these men and women will suffer renal damage or failure; others will contract pneumonia, and almost all will require blood transfusions, doctors said. Skin grafts can be intensely painful, with burning and horrific itching. Some of the normal functions of skin are also impaired, making it difficult for burn survivors to stay cool in summer and warm in winter.

Rhode Island Hospital recently held a town meeting to provide burn treatment information to about 200 of the victims' friends and relatives, many of whom have not yet come to terms with long-term care needs. On average, the daily cost in an intensive care burn unit is between $6,000 and $8,000. Insurance often does not cover the costs of plastic surgery beyond reconstruction.

Families also face the challenges of a loved one transformed.

"I tell them, 'They are not going to look like you remember them right now, and you've got to be ready for that,' " said William Cioffi, chief of surgery at Rhode Island Hospital in Providence.

Three decades ago, burn specialists and mental health experts were focused primarily on keeping their patients alive. Now that medical advances are helping to save so many more lives, they say more attention needs to be devoted to recovering from the psychological trauma that accompanies burn injuries.

In a society that places a premium on beauty, disfigurement is one of the most obvious and painful adjustments. Some burn patients have been known to leave a hospital never having looked in the mirror.

"We have a formula for how to deal with acute burn injury," said Lawrence Park, director of Massachusetts General's psychiatry service. "But we don't really understand what the formula is for returning to life."

Haughney reported from New York.

Rhode Island Hospital physicians Joseph Amaral, right, and William Cioffi describe the condition of victims from the nightclub fire in West Warwick, R.I. The death toll stands at 99; an additional 29 victims remain in critical condition.

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