The Long Road to Recovery

Amy in Hospital

Somehow we find the strength to do what we have to do when we are put in charge. I rationalise that the only reason I could stand there frozen in shock and screaming during the actual accident was that Guy was there and I had full confidence that he would act - as he did.

Thereafter, I had managed to run around doing whatever was needed (including getting another lad under the shower once Amy was in the bath, since he had had a relatively minor flash burn from the explosion), and then to be calm for Amy while she was in the bath, stopping her from hyperventilating and holding her - and she was so very brave despite the terrible pain she was in. I had managed to be calm for Amy in the ambulance when she screamed deep blood curdling screams all the way to the hospital because the movement of the ambulance caused her agonising pain and there was nothing to ease the pain bar one inadequately sized burn shield.

But as soon as I handed her over to the nurses' care and they began infusing her with morphine, I began to faint and had to go and lie down myself. ER filled up with family and friends - and I was the only one fainting and shaking and nauseous! Even Amy was joking now that she had enough morphine in her to sink a battleship.

Part of my reaction was the after effect of shock and part was from knowing that this was only the beginning for Amy. The extent of her burns was that both of her thighs were burned all round and on her right leg the burns extended to half way down her calf. Her left hand was burned and there were two small burns on her upper arm and chest.

Her initial surgery for debridement and dressing took three hours instead of the original estimation of one hour given to us - causing me further nausea from fear. And I continued to shake and feel nauseous for the next two days, until I woke one morning and realised that the flames were over and were actually in the past. After that, I actually coped better emotionally than Guy.

Guy's was the hero part - and mine was the part of mothers since time immemorial - nursing one's child. The hospital was very good about letting me sit all day with Amy - keeping away as many visitors as possible, trying to get food and drink into her, and doing all the many tiny errands that she could not do for oneself, since for several days she had to remain mostly in the same position. Being helpless was especially tough for my highly independent daughter! In particular, she needed to have her feet carefully massaged every few hours - which I enjoyed doing for her. The right foot (the more badly burned leg) was swollen because the lymph drainage in that leg had been compromised and so that foot in particular had to be gently massaged often to encourage deeper tissue drainage.

Amy was remarkably positive overall and was both popular with the nurses and impressed the senior medical staff with her keen interest to know what was going on so that she could prepare and adapt(though the moment the pain meds started waning she was in terrible pain again) and set herself goals no matter how small to move herself towards healing. Amy is a little person and there was a lot going on in her body for her to cope with. And from my part it was not all just sitting patiently waiting for Amy to leave hospital. Every day brought another challenge and we could only live through it all from moment to moment – and I did worry profoundly, though I kept it away from Amy for the most part.

I had not realised beforehand how complex a burn injury is, particularly a flame burn.

Firstly - the burns are of uneven depths and this alone makes dealing with them complex.

Secondly - the tissue damage continues to develop beneath the surface of the burnt area for the next five days or so (which is also why first aid by lengthy water immersion to draw away the heat is so important to limiting the damage). So no skin grafting can be done before the wound stabilises. Every 2 days or so, the surgeon assessed the damage as he cleaned and redressed the burns while Amy was under general anaesthetic. And of course having general anaesthetic every couple of days brings its own set of problems, not least that Amy’s veins in her arms were taking great strain!

Thirdly, because the skin barrier has been destroyed, burn wounds leak like a sieve. The body loses not only fluid, salts, vitamins and so on, but also blood proteins, like albumin which buffers the blood pH and antibodies that fight infection.

All this leakage has effects on blood pressure and kidney function. For several days in hospital, Amy’s blood pressure was about 60/40 and her heart rate was well over 100. There is also a risk that blood vessels in the burned area can become blocked or collapse, promoting infection, stroke or heart attack.

Part of the answer is to drink as much as possible and eat lots – especially protein. The dietician prescribed protein supplements – which have to be balanced and low fat. Then extra vitamins are needed, especially D (to boost immune function) and C and Zinc.

Part of the problem was that Amy, who has had a tiny appetite since birth and now was nauseous and probably a bit out of it from morphine – refused to eat or drink! Part of the solution was mother constantly making sure that something was going in – and at one point actually having an angry argument about it – mere days from being so grateful that Amy had survived! And part of the solution was Amy's uncle, who is a chef, making her a series of delicious appetite tempting soups!

Tissue leakage also raises the risk of infection – both from normal skin surface bugs (mostly Streptococcus, Staphylococcus and Pseudomonas) proliferating on the nice leaking serum (which smelled much like the foetal calf serum which we used in the lab as a tissue culture medium additive!) – and from the risk of pneumonia. Hence the isolation ward. Fortunately, Amy had only two mild surface infections – treated with silver dressing.

She was also lucky that her surgeon did a research PhD and as a result was more ready to try new treatments (while remaining properly cautious of course) – and so she was one of the first people in Cape Town to extensively use Suprathel, a German polymeric artificial skin covering that encourages better healing of burn wounds and reduces infection. Thanks to this, Amy’s hand needed no grafting as had first been estimated and healed beautifully, and the extent of grafting needed on her legs was dramatically reduced.

Amy taking her first few assisted steps from the bed to the chair after one week in hospital

Another factor is that the immobility and tissue damage leads to joint stiffness and so Amy had to have daily physiotherapy to move her joints and to relearn to walk (as she said, like a baby and then like a granny) – big cheers as she stood (and remember that her blood pressure was very low), then as she took a step or two, supported by the physio and me (this took place after her painkillers were given!). After a few days she could shuffle along the corridor and then climb a few stairs with assistance. This exercise all came to a temporary end once the grafting was done.

Amy and friends one day after admission - Amy on heavy morphine!

Note her bandaged hand had been decorated as a dog's face by her boyfriend's father.

This bandage was removed after a few days and replaced with a heavier cast to keep her fingers straight.

There was an additional “problem”. Amy is very pretty and was being very positive (and was on heavy doses of pain killers), so apart from her bandaged arm, no visitor could really see the damage to her heavily bandaged legs and thought that she was stronger than she actually was. Amy enjoyed visitors but the visits really tired her - and I was paranoid about infection. So I had to play gate-keeper and in the end we put up a notice on her door for a week or so saying please no visitors.

No two burn wounds are ever alike and the surgeon has to assess the wounds every time he does a dressing change. There is a window for optimal grafting success and the surgeon has to balance between waiting to see how much healing will happen spontaneously and not waiting too long to graft.

Finally, the surgeon announced that he would have to do some grafting. We all knew that this would be the case, yet when actually faced with the prospect – and seeing his photos of her legs, which was the first time that I had seen what they looked like since she went into hospital – I became nauseous and felt like collapsing again. On hearing that she needed grafts, Amy cried for the first time since being in hospital. Having said that, we were all grateful that she was in a position to be able to have grafts!

Amy was also extremely lucky that although she has had grafts above and below the back of her right knee joint, the skin in the fold of the knee was still intact, and so she has no joint mobility problems from having a single graft over the back of the knee.

Fortunately as well, the upper thigh of one leg still had some original skin on it and this became the graft donor site. Of course this necessarily created two new wounds.

Because of the positions of the grafts and because the first five days are critical to the grafts taking, Amy had to be completely immobilised in bed with her leg in a splint for five days.

Finally, Amy was allowed to go home – but that was by no means the end of it!

After Much Reflection...

Over the past few months I have drafted a couple of attempts to describe our family's experience of our daughter having been burned and its aftermath, but the trauma was still too fresh to share in a public forum.

But since we are a few days away from it being six months since the accident happened, I will give some brief notes and impressions.

First - DO NOT EVER pour any flammable substance onto a fire, no matter how dead the fire may look. A five litre container of paraffin and a very small almost dead fire in a small fireplace in a civilised lounge on a Sunday afternoon in the middle of town where a bunch of highly educated people have gathered is no guarantee that the laws of physics and chemistry will be suspended. (The person who attempted this feat was not Amy by the way and the house was not ours). Five litres of fuel that catches alight is essentially a fire bomb.

Second - No one can move as fast as a parent does on hearing their child scream, no matter what the age of that child. Without even knowing what had happened, Guy and I catapulted from the dining room. Another guest said later that she had never before seen anybody move so fast.

Third - terror and disbelief don't help. When I saw my daughter run past me with her legs on fire and then go up in flames and fall to the ground in the passage way so that all I saw were the flames and I heard her scream that the fire wasn't going out - and I thought with terror and horrified disbelief that on a sociable Sunday afternoon lunch date I could be watching my daughter die in front of my eyes, all I could do was scream as well. I do realise that it was actually only for three seconds at most and that Guy was closer to her than I was - but when someone is burning screaming is a luxury that cannot be afforded.

Fourth - Guy was the unmistakeable hero here and saved our daughter twice that day. With absolutely single-minded focus he flung himself onto her to smother the flames. He saved her actual life and by stopping the flames going higher he saved how she would live her life. His shouting instructions all the while also galvanised everyone. Amy's boyfriend put out the flames on her hand and I ran to collect cushions to smother the flames that were still whooshing around her legs.

Fifth - Clothes are important! Guy was wearing a wool coat and jeans or else he would have gone up in flames too. Amy was wearing a close-knit cotton jersey under her synthetic jacket - which is what went up as I saw her fall. The jersey saved most of her body from being burned. Incidentally, Amy had actually dropped because she remembered to "stop, drop and roll" (which did not put the flames out but it did slow them from travelling vertically up her body).

Sixth - Have plenty of people to hand. The lounge was also on fire of course and the house an old Victorian one - so a bunch of guests were available to contain and douse that fire.

Seventh - Time! In a fire you don't have much of it at all. We estimate that Amy was on fire for all of ten seconds and that alone gave her 15% body area mixed depth burns, needing five skin grafts. Amy thought it was thirty seconds and the surgeon said that thirty seconds would have been fatal.

Eighth - Water! You need as much of it as you can get. As soon as the flames were out, Amy was carried to the shower and kept there until a bath of water was run and then kept there for half an hour to remove some of the heat before Guy would allow the ambulance to arrive. The plastic surgeon said that this was the biggest single factor in altering her medical outcome. The long immersion also resulted in Amy's burnt clothing coming away easily from her body instead of sticking to it.

Ninth - Position position! Our friends' house was less than two minutes away from a hospital.

Tenth - Medical Skill! The plastic surgeon on call that night who became Amy's attending surgeon is one of the most meticulous and forward-thinking plastic surgeons in Cape Town. (We later discovered that he attended the same school in Welkom as Guy!)

Tenth - Medical aid! Never under-estimate the importance of having this. One month in hospital and nine theatre visits comes to over R350 000 (for non-South Africans, look up the current exchange rate).

That's enough for this post. I'll continue in the next.

Why No Entries Since Early June?

Two reasons - and both to do with my daughter: one happy and one devastating. Only now are we normalizing as a family and only now can I bring myself to relate it in this blog.

The happy part was our daughter's matric dance, which she had been long looking forward to. The horrendous part happened merely two days later, when she was badly burned in a fire at her boyfriend's house. It has been a long road to recovery since then.

I am now able to relate these events. I would like to begin with Amy's matric dance.

Hindu Wedding

And I got so caught up with relating my impressions of Manil Suri's book, that I forgot to comment on an aspect of Hindu weddings detailed in his book that particularly struck me in the context of my blog title as being another multiple circling of significance:

In a Hindu wedding, the central ritual of the ceremony is the circling seven times of the consecrated fire by bride and groom to sanctify the marriage - which Hindus see as a sacred relationship between souls that lasts beyond life.

The details of the ritual vary in different parts of India.  The bride and groom may or may not be symbolically tied together by their wedding sashes; the bride may first lead the groom around the sacred fire one to three times before the groom in turn leads the bride around the fire for the remainder of the seven circlings. Even the specific prayers or blessings vary with local traditions.

But in all cases everywhere, it is a constant that they circle the fire seven times. Why seven circles?

Manil Suri's "The Death of Vishnu"

I have just finished reading Manil Suri's "The Death of Vishnu".

It is a beautiful book in a number of ways and it raises many memories.

Malawi was a multicultural place to grow up in. Most of the girls in my class in La Sagesse Convent that I attended in Limbe were Indian - Hindu, Muslim or Sikh. Actually, as a side note, few girls in my class were Christian, let alone Catholic. In the few years that I was there, I knew of only one conversion. An Irish Catholic girl became a Muslim.

My mother was also introduced to a number of Indian friends by our dear family friend, Aunty Joyce Mendonca, who was Goanese (and Catholic, since Goa was once a Portuguese colony). It was Aunty Joyce who showed us how to wear a sari and how to cook many Indian delicacies. On occasion, I would accompany my mother and Aunty Joyce to visit various ladies, and it was always well worth it for the food alone. No visit to an Indian household could be made without one being plied with food, and it is extremely rude to refuse what is offered, no matter how many other friends you may have just visited and eaten with. Indian ladies strive to out-do one another with novel delicacies. Visitors praise the food vociferously and there is much discussion about the ingredients, methods of cooking and what variations one might try. It is also an occasion for those who are not so keen on the hostess or who are jealous of her to insinuate that the food has too much of this ingredient or too little of that.

So I found Manil Suri's description of poor Mrs Pathak's preparations for her kitty party and their reception doubly hilarious, even while I felt keenly for her mortification.

In a way, living in Limbe was just a little like living in India. Limbe was then predominantly full of Indian shops ("dukas"), in which we haggled and chatted.  (I loved most the shops that sold spices in large bins and whose aromatic mix of smells hung over the length of the street. I always looked with longing at the bin of jaggri - raw brown clumps of sugar molasses which I was occasionally given a taste of. The owner said that too much was dangerous to one's health - why did I believe him? Years later, while at university in Natal, I used to munch the molasses as my friend Ingrid and I prepared the feed for the horses on her family's small-holding).

With friends in Malawi, Natal and Cape Town, I have also had the pleasure of attending Hindu and Sikh temple ceremonies, being invited to Hindu and Muslim weddings, and sitting in ancient cinemas watching the original old Indian films in Hindi (with a friend translating), long before Bollywood semi-westernized itself. I have also derived great pleasure in reading the Ramayana (in translation of course - it is a wonderful story).

So "The Death of Vishnu" brought back so much to me as I read it: the book was vibrant and colourful-seeming: there were many references to Bollywood movies - indeed, several characters visualized their actions in terms of movies (as I am sure many of us have done from time to time in our own lives, even if it was only when we were in our teens).

An 18th Century Indian painting of Vishnu resting on the Naga Ananta-Sesha, with Lakshmi massaging His feet. Ananta-Sesha is the endless primal being who holds all the planets of the Universe on his hoods and whose mouths constantly sing Vishnu's glories. When he uncoils, time moves forward and creation takes place. When he coils again, the universe ceases to exist and only Vishnu remains, resting on Sesha's coils, floating asleep on the cosmic ocean until Shesha uncoils once more. Sounds so much like modern physics.

An aspect of the book that I both enjoyed and admired immensely was the subtle humour and pathos with which mankind's great existential questions, spiritual beliefs and ethics were played out and considered in even the smallest everyday actions of the various characters throughout the entire story.

It was also a book about relationships, of how men and women understand and misunderstand one another, often over a lifetime and often in silently tragic ways. Here, Suri looks below the surface of the pettiness, meanness or ineptitude of his characters to their inner core with a compassion that makes wonderful reading.

And of course, since I have always had an abiding interest in and love of mythology and legend, "The Death of Vishnu" was delightful in what it had to say about the Hindu religion and its many legends  - and of course about Vishnu himself. For anyone who wishes to gain a deeper understanding of Hindu beliefs, this book provides insight with ease.
I particularly admired Suri's almost living description of a vision of Vishnu. And (reading critically of course), I was struck by a sense of Vishnu being described in fractal terms in the vision. Of course, this would make sense with Suri being a professor of mathematics, though I have not come across him mentioning this aspect of the story as emanating from his experience as a mathematician. I love discovering how each writer consciously or unconsciously brings his or her own special interests and loves to his or her story.

I believe that Suri intends a trilogy. "The Life of Shiva" is published and I am off to find it. I also look forward to his intended book, "The Birth of Brahma".

Here is the link to Manil Suri's website for those who are interested: Manil Suri

How shall I read thee? .... Let me count the ways!

I love reading and always have done so since before I could actually read. And so I should love reading, it seems, if I am to be a good writer: every great author consistently exhorts novice writers to Read, Read and Read Again! What a fantastically too-good-to-be-true enjoyable way to hone one's skills!! What fun to lie around with a book (or several), and to say earnestly to anyone who might ask what one is doing, that one is working - and working hard!

To say that I enjoyed reading before I could read needs a little explanation. When I was very small (being “but a wee lass” – we lived in Scotland), I recall kneeling on the carpet with my older brother one day, looking at a very large story book (It might not have been that large come to think of it, but it seemed enormous then). My brother was directing the proceedings (turning the pages) and seemed to know something about reading, so perhaps he had already started school, which means I would have been about three years old.

Until that memorable occasion, I had enjoyed books solely in the style of Alice in Wonderland: only pictures and conversation mattered. Now I learnt (in conversation with my brother) that the boring stuff that cluttered up the pages was called writing and that it was this stuff that actually told you what the story was – and if you knew how it worked you could tell yourself the story – without anyone else having to tell it to you (or inventing it ad hoc, as I suspect my brother was doing all along, guideing himself by the pictures).

What a revelation!!! What power! What independence! I wanted then and there to do this reading thing for myself! I eyed the hitherto ignored text with interest (but even with my attention on it, it still looked completely senseless). Then my brother pointed out some pictures in one story, each of which included a wavy stream of coloured words. It appeared that this was also writing.  These wavy coloured words looked much more promising in terms of telling the story.

I proceeded to “tell” the story from the words in the picture. That is, I made the story up from the pictures and decided for myself what the writing was meant to convey. But the process was enchanting. I felt very proud that I could “read”. I continued to “read” even after my brother got bored and went off to do something more interesting.

Reflecting on this now, I see that in that long ago moment I experienced both my first pleasure in story-telling via the written word and the first headiness of scientific discovery (that is, I tested a received hypothesis. The evidence appeared sound - I looked at the words and sure enough a story occurred. Okay, the proof was not rigorous, but I was only three).

So there you have it - my “I was always meant to be a writer” story.

Of course it is by the same token my “I was always meant to be a scientist” story, or - as I have hitherto only ever considered it – my “I was always meant to be a keen reader” story.

The cynic might comment that the story did not reflect altogether to my credit, even if I was only but a wee lass. However, I did later make good on the reading bit. In the fullness of time (a mere two years later in real time, but nearly half a lifetime later for the three year old that I then was), I went to school. Though I have little memory of learning the mechanics of reading, I recall my delight at being allowed to read all the little Janet and John books one after the other.

Actually, I must have been a reading snob as a child. When I was about six, I noticed that “big people” read “big books” (lots of writing, few or no pictures) and so I was determined to read a “big book”. I had also noticed that big people did not read aloud – they just looked at the book. I determined that I would do the same.

And so it came about that the first “big” book that I chose to read was the unabridged version of Pinocchio. I am not sure why I chose it - perhaps I liked the cover picture, but it was most enjoyable, even though many of the words I could neither pronounce nor understand. And, yes, I did make the transition to silent reading during Pinocchio by the simple expedient of whispering the words more and more quietly to myself until only my lips were moving – and then, with a great effort of will, even the lip movement ceased. Hooray!!! Grown-up reading!

I promptly chose as my second “big” book, King Arthur and the Knights of the Round Table. Reading a book where on every page knights smote one another and dealt mighty and dolorous blows (verily cleaving each other from the nave to the chaps, forsooth) until they were sore wounded, whereupon one quoth unto the other, “prithee, get thee gone! Yea, and hie thee hence, an it please thee!” made as much sense as anything else I might have read at that age. How was I to know that the language that I took such pains to learn to read was obsolete? It was a great book!

Harlinn - The Film! The Music!

This post is dedicated to "Team Harlinn".

Harlinn is a psychological sci-fi film, conceived, directed and produced by Greg Bakker and his team of friends, who variously acted in and helped with the production of this, Greg's debut film.

A scene from Harlinn

20 years old and still a student at the University of Cape Town, Greg has all the characteristics of a future top-class film-maker. He is meticulous and pays attention to even the tiniest detail. His work already shows a refined sense of artistic judgement. And throughout the project he has shown a maturity beyond his years in his ability to work in a disciplined but generous manner with a disparate group of people of different ages and levels of experience. 

But of all the Team Harlinn members, I most particularly cheer for my husband, Guy.

Guy composed the original musical soundtrack for the film (sound-scaping, he terms it), and his music for the film has received much praise from a variety of quarters, including from a music theoretician.

Guy has a natural and emotional sense of musical composition. After ascertaining what Greg wanted the music to convey in the film, Guy familiarised himself with the actors, the characters, and the script. Then he put all that to one side and composed the music entirely from the silent film footage. The music theoretician noted afterwards that Guy had instinctively composed the music in the sound range that lies below spoken sound (despite composing it to silent footage). This was not only useful in terms of the film's atmosphere, but also ensured that the music did not clutter up the actors' speech.

So where did I fit in? I had only a very small part in this, but it was fairly crucial.

I was about to throw our (outdated) community newspaper away, but saw that I had not read it. So I quickly skimmed through it (being of frugal mind and not wanting to waste it, even though the paper is free). There I saw a short article by Greg in which he had made a request for an interested person to please come forward to compose music for his film.

Knowing that Guy has alway been interested in film music composition, I showed him the article and encouraged him to contact Greg, even though the article was some days old.

Harlinn was Guy's first original filmscore. (He has put music to film before, but it was music that he had pre-composed for other purposes). He has had a lot of pleasure out of the project and has taught himself a lot too in the process and so has gained more confidence in his abilities (funny how very talented people often doubt their abilities). Guy is now looking forward to composing for other film projects.

Our Harlinn experience illustrates something about taking chances.

We all want chances to be given to us. We often bemoan - "if only I had the chance...".

Yet when we come across a chance, we often reject it for one reason or another. Chances are often poorly recognisable at first glance and almost slip past. We might think that the chance offered doesn't fit what we want. Or it doesn't seem worth the trouble of taking up. Or it might seem to be too much trouble. Or we feel that we are unable to take it up. Or it might seem too late. But a chance is not a chance unless it is acted upon.

The good things that come about from taking up the challenge of an offered chance usually exceed expectations vastly and pleasurably. (I am almost sure that there is a moral here that applies to me and blogging....)

Team Harlinn have shown amply that taking a chance has been highly rewarding in so many ways. And they have demonstrated that a first film project can be fully professional. I look forward to attending the premiere.