�He Wears The Scars’

From the small hospital room where his mother had told him to wait, 6-year-old Cody could see the people at the other end of the hall, his mother and grandmother and uncle and aunt, and some of his parents’ friends, and the nurses. All of them talking and smiling and looking happy.

A little earlier, he’d played with a green balloon. He’d blown it up, then let it fly like crazy all around, and everybody had been in such a good mood no one had stopped him. His baby brother, in his rocker seat on the floor, had tried to follow it with his eyes, but he couldn’t. Cody was ready to be happy, too. For a month and a half he’d been staying at friends’ houses, and he missed his room and his toys and Sasha the Rottweiler, too. Today, his mom had said, Dad was getting out of the hospital.

Down the hall, he could see the group of people make an opening. Through the opening came his father.

His father walked very slowly with his arms out to the side, like a monster in a cartoon. He wasn’t wearing his usual hospital clothes, either, but a baseball cap and sweatpants and running shoes. All the other people behind him had to walk slowly, too. They all talked and carried things and smiled.

But his father wasn’t smiling. His father’s eyes were full of tears, and although his mouth was moving, no sound came out. He lifted his walker in his right hand and flicked the fingers of his left back toward himself, signaling to Cody, come to me . . . come to me.

Cody put his toes at the very edge of the room and leaned out into the hall as far as he could.

Come to me, his father’s hand said.

“I’m not supposed to go into the hall,” Cody tried to explain. He was starting to cry, too.

But now he knew, for the first time for sure, his father really wasn’t going to die.

He broke loose and ran to him.

*

*

Todd left the hospital on April 5. Three days earlier, Grossman Burn Center psychiatrist Clinton Tempereau had counseled Todd and Lori about the emotional aftershocks that probably would rattle their domestic life once they were home.

Tempereau: When you go through some kind of life-threatening trauma, you become very smart. Nobody can fool you.

One place where that’s most likely to come into play, Lori, is in the sexual area. What could so easily happen is, OK, Todd’s got these ropy scars on his belly, and you begin to get involved in intimacies, and you think, “I don’t know if I want to touch him.”

And the point is, don’t hide it. He’ll know perfectly well. You might as well just talk about it.

Lori: We’re good at talking.

Todd: Oh, yeah.

Lori: What about Todd’s feelings about himself and the way that he looks? How do I deal with that? Just let him talk and listen?

Tempereau: If you have something brilliant to say, say it. But the point is, don’t try to fake it: “Oh, you look just beautiful and we know that you’re still the same person inside.” The key is, be straight. Be honest.

You have stared over the abyss, Todd. You’ve looked at death. But there’s somebody else over here who’s also been through a major trauma and who’s also been repressing a lot of stuff, staying strong because she’s had to. Somewhere along the line, she’s going to crash.

Todd [to Lori]: Don’t worry. If it happens to you, I’ll be there for you. . . . [To Tempereau:] I needed her. I’d have probably laid in bed every night and cried if I didn’t have her.

*

*

Todd lay splayed in his green easy chair beneath a white flannel blanket. He joked with the houseful of welcomers who shouldered past ubiquitous blue balloons, or sat on the living room couch or floor.

What a feeling, to be back in the house he’d remade with his own hands. Outside the picture window lay the familiar Gardena neighborhood and its little ranches with pickups in the driveways, and small children sitting on curbs while their fathers mowed and trimmed the front lawns.

Somebody handed Todd a half-glass of champagne, and he held it out in front of him.

Lori took it away. “Oh, no, you don’t,” she said. “The doctor said no alcohol while you’re taking pain pills.”

He would not be home long.

Two and a half weeks later, after his second follow-up visit to Dr. Richard Grossman’s office, Todd was rehospitalized and placed in isolation.

A determined strain of pseudomonas bacteria had taken hold in the seams between his skin grafts, and was beginning to moth-eat the grafts themselves. Todd’s troublesome thighs had grown so bloody and painful he could no longer walk.

The next day, April 23, he was operated on for the eighth time. Doctors scraped away infected tissue and applied fresh cadaver skin. The following Tuesday, he had his ninth surgery. Grossman hoped that a 10th, in which more of Todd’s own skin would be transplanted to the recalcitrant areas, a procedure known as autografting, would settle the issue.

During the eighth surgery, Lori lay curled like a fetus on one of the waiting-room couches. She was unshowered, sleep-deprived, miserable. Her energies had been taxed to the limit caring for Todd at home, what with having to wash their bedding and change Todd’s dressings twice a day, plus care for the children and attend to all other domestic matters herself.

She had just imposed order on that life--had just returned to her office job the day before--when Grossman ordered Todd’s surprise readmission. She’d had to make frantic new day care arrangements for her children, and now faced the long drive to Sherman Oaks from Gardena every day, as Todd’s second hospitalization stretched from an anticipated few days to a week.

“Now Dr. Grossman’s talking about a couple of weeks as a worst-case scenario,” she said. “It would have been a lot easier for us if Dr. Grossman had told us at the beginning it could be several weeks. Todd doesn’t want autografts. It’s so painful, and his donor sites are just healed.”

Todd’s 10th surgery took place on May 2. A week later, the combination of antibiotics and new grafts having brought the pseudomonas under control, he was sent home again. He’d been rehospitalized for 17 days.

Through the late spring and early summer, Todd’s wounds gradually closed.

Then, at the end of June, a microbe called by the pretty name “marissa”--or MRSA, for methycillin-resistant staphylococcus aureus--began to undo Todd’s thighs.

On July 22, five months after Todd was scalded on nearly 70% of his body, Grossman ordered him into the hospital again. This time, Todd and Lori went quietly.

It took 15 days for intravenous antibiotics to knock out the MRSA. In two more surgeries, doctors transplanted new autografts onto the unhealed areas.

On Aug. 6, 168 days after his accident, Todd went home for good.

His surgeries had numbered a dozen. His 6-foot frame had received more than 60 square feet of cadaver skin, or about the entire yield from 13 donors. His weight had dropped from 160 pounds to as low as 142.

*

Hospital charges: $646,333

Doctors’ fees: $327,000

(37 physicians, 1 psychiatrist)

Total: $973,333

Insurance remittances accepted

as payment in full: $528,083

A great burn leaves scar tissue in many places, some of them corporal.

On a late morning in September, Todd Robinson is lying on his living room carpet in shorts and a T-shirt that reads “Never Quit.” His hair is trimmed short, and there is no sign his scalp once was meticulously ravaged to provide skin for other parts of his body. The once-livid donor areas on his calves have paled to faint pink.

Physical therapist Leah Garren is pushing against Todd’s upraised right leg, to stretch the tight hamstring.

Todd’s healed body is playing tricks on him. When he sits upright for awhile, his skin stiffens in that posture, and he must stretch slowly and laboriously to stand erect afterward. He has taken to slouching when he sits, to keep himself as straight as possible from shoulders to knees. This, however, contracts his hamstrings.

Once he has been on his feet for a time, bending over presents the reverse problem of standing up.

Todd is no longer an invalid. He can drive a car, take care of his children, go grocery shopping, fly model airplanes with Cody. His debility has dwindled to a stiff parody of its former self.

Regular exercise--he walks half a mile in the evenings, and has begun lifting light weights--ultimately will help control the stiffness, but diligent daily stretching will be a requirement for the rest of his life.

He is still scarring, especially on the thighs. Scar tissue is billowing up from healed areas that once were smooth, and forming itself into low mounds and creases. Collagen, the tough, inelastic protein that makes up scars, keeps throwing itself at the memory of his burn.

Todd no longer wears surgical dressings. His chest and right arm are bound in pressure garments, tight elastic sleeves that deprive scar tissue of oxygen, soften it and impede its growth. In a few months he can begin receiving surface injections of steroids to flatten the scarring further. Later, cosmetic surgery can be considered.

Because his grafted areas cannot sweat, his face and neck and other unburned regions have the entire burden of evaporating the approximately two liters of fluid that he, like every adult, gives off normally each day. His face is often lightly slicked with perspiration.

Sensitivity has returned practically to normal in his groin area and elsewhere. When he touches his bare thighs, however, it feels like he is touching them through a layer of fabric.

Todd receives $490 a week in state disability pay, and is a long way from returning to work. At first, he feared going back to his job as a maintenance engineer at Jersey Maid dairy. The memory of scalding water blasting from the burst pipe was too fresh. But recently, he visited the plant for the first time since.

“When I walked into the shop, it was a weird feeling,” he says. “It looked completely different, even though nothing had changed.”

The change was all his.

*

*

I have this friend Mark who was burned pretty bad on his legs about 15 years ago. If I’m ever in the shape that he’s in I’ll be happy. But he told me that even now when he raises his arms he can feel it all the way to his knees. After 15 years. That really bothered me. I was quite upset that night.

I’ve been out to the lake a number of times, and take my turns driving the boat. I wish I could get out there and do what I used to, but I can’t get in the sun, so I stay under a canopy all the time.

I don’t want to get in the water because I still have a few blisters and I don’t want to take any chance on getting an infection. Sometimes I’ll go in up to my knees, just to tease Lori.

I like going out there, but it’s not as much fun as it used to be. I still kind of hope I can get on skis one of these days, but I may not be satisfied just being towed behind the boat. I might just be more bummed out after that.

I don’t like to look at myself in the mirror after a shower. I probably haven’t accepted the visual end of it. If anything, it’s gotten worse--the not accepting it. I’ve got a whole view of it now. I see the rest of my life. I hope that how I look will change, cosmetically speaking. I’m a lot better than I used to be, but what I really want is to get back to where I was.

Sometimes it seems like Lori doesn’t touch me like she used to. She denies it, but I still think it sometimes. I don’t know if it’s because she’s afraid of hurting me or just doesn’t like it or what.

*

*

It’s wonderful having him back, but it’s not our old life. It’s different. And constantly changing. He’s definitely not his old self. I think he puts up a good front, but there’s times when he breaks down. He’s afraid he’s going to have limitations. He’s got concerns about what he looks like. He knows people notice him.

I tell him he should have a lot of hope, but I’m not in his shoes.

Todd says that me and the kids can get away from it--I can go to work, go out with my girlfriends, and so on. But he wears the skin. He wears the scars. He wears the evidence. He can never get away from it.

When Todd first came home we would have the deepest conversations. But now, all those conversations have gone away. When he’s really depressed and crying and I ask what’s the matter, he won’t say. He’s shutting me out. He’s shutting me out and taking it out on me.

That’s OK. We’ll get through it. He’s got to take it out on someone. I know I’d take it out on him.

We have not had a problem with sex. It’s different, but we have to make the best of what it is, and I think it will get better with time. He doesn’t always like me to touch him. He says, “Hey, don’t. It’s gross.” And I don’t mind it at all. I don’t touch him as much as before the accident because he doesn’t like it.

The other day I gave him a hug and he said, “I don’t want your pity hugs.” It made me cry. I’ve cried a lot more in the last couple of weeks than I have in months.

*

*

Cody and his baby brother and his father have been out visiting friends in the neighborhood. When they come home, his mother is sitting on a couch in the small room that used to be the garage.

His father sets the baby on the floor, and jokes with his mother and makes her laugh. Then he sits down next to her in that funny way, with his body all straight.

Cody is holding a race car. He leans against his father’s right thigh. His mother puts her hand on his father’s other thigh. It’s OK to do that now. They don’t hurt anymore.

The baby is sitting on the floor watching the three of them. He’s gotten big and has a round face. He crawls all over the place, and smiles a lot. He’s smiling right now.

You can read the entire four-part serial, see additional photos and add your comments to an ongoing discussion on The Times’ Web site. Point your browser to http://ukobiw.net/burn/

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

(Ventura Edition, B2)

About This Serial

The Grossman Burn Center at Sherman Oaks Hospital is the region’s preeminent burn ward, serving Ventura County as well as Los Angeles County and other areas. “After the Burn: One Man’s Struggle for Life” is a four-part serial detailing the center’s efforts to help a man injured in an industrial accident.