Trauma surgeon studies burns in meth war
By Rosemary Parker
Kalamazoo Gazette
KALAMAZOO, Mich. (AP) — Delicate lung tissues scorched by heat and assaulted by toxic gases. Facial features blistered beyond recognition, and fingers charred beyond function. Extreme pain and anxiety.
Trauma surgeon Paul Blostein has seen — and treated — it all.
He has this to say to anyone with thoughts of cooking up methamphetamine: “Don’t do it.”
The 58-year-old physician, at Bronson Methodist Hospital for the last 20 years, has spent considerable time treating victims of serious burns, people injured in car crashes, house fires, industrial accidents and other mishaps.
For more than 10 years he has been tracking a relatively new category of burn victim — those caught up in the burst of flames that can result when amateur chemists try to make illicit methamphetamine from a mish-mash of over-the-counter pills and household chemicals.
The homemade laboratories, usually contained in a 2-litre pop bottle, can explode, spraying flaming chemicals that splash and burn “sort of like napalm,” Blostein told the Kalamazoo Gazette.
His research has documented what Bronson doctors and nurses have observed about meth-related burns — wounds that are slower to heal, lungs that take longer to regain function, pain that is more difficult to manage, and patients who require much more care.
“It was after 2000 when we started to see the patients that came in and began to have some inkling they had been involved in meth production,” Blostein said.
There was one year when the team saw meth-burn patient numbers plummet, and he and colleagues thought the era of making meth in Michigan had waned.
That was seven years ago.
Those hopes were dashed when meth makers learned a way to evade police and laws meant to squeeze off the meth trade through the new “one-pot” system of “cooking” meth.
The simplified method eliminates the need for the hard-to-come-by farm fertilizer anhydrous ammonia and requires little more than a few two-liter pop bottles, plastic tubing, household chemicals, and cold tablets. The next year, meth burns began to climb again at Bronson, and these days Blostein is resigned to his role in the trenches of Southwest Michigan’s war on the drug.
Bronson’s Level I Trauma Center’s burn unit, the regional receptacle for all seriously burned patients, receives patients from all over Southwest Michigan. Because this corner of the state also ranks at the top of Michigan’s illicit methamphetamine activity, the hospital sees more meth-related burns than others, and is one of the few in the country to undertake a long-term study of methamphetamine-related burns.
Last year, 12 patients were admitted to Bronson Methodist Hospital for treatment of meth-related burns, the second-highest total since 2000.
Every case is different, Blostein said. Although the primary meth “cooks” are most frequently burned, he has treated bystanders who are burned, too, patients as young as age 2 and as old as 60. Not everyone lives through a lab explosion, and some who do survive never fully recover, he said.
Nor do serious burns prove enough to break the addiction in every patient, Blostein said. As the saying goes in his department, “trauma is a recurrent disease,” and he’s treated some repeat victims over the years.
Blostein said he enjoys the pace and variety of trauma work, where every day brings surprises and the challenge of saving lives.
Making order of the chaos of trauma starts for Blostein with a change from street clothes to scrubs at the beginning of every 12-hour shift. He takes some ribbing from colleagues who suggest simply wearing scrubs to work makes more sense, but Blostein likes to be prepared for whatever the day brings — and that means having street clothes on hand if the need arises.
Every shift starts and ends the same, too, with a sign-off from the doctor who’s going off duty to the one coming on board on the status of the 10 to 20 patients in the trauma unit at any given time.
“Here we have a nice arrangement where trauma surgeons do an initial evaluation, resuscitation, insert a breathing tube if necessary, manage fluids — a challenging thing for large burn patients,” Blostein said. “The burn surgeon does burn wound reconstruction and skin grafts.”
He will spend the day monitoring trauma patients’ progress — tweaking ventilators, watching fluid output, scheduling surgeries and procedures, checking for signs of infection, overseeing nutrition and managing pain, as well as performing surgeries. “Many have multiple injuries requiring multiple surgeries,” he said. “The trauma surgeon lays out the plan of action for each injured person.”
Extra physicians are always on standby, since the job of overseeing treatment for those patients may be interrupted at any time by incoming trauma emergencies, he said.
That’s the drill for more than 60 hours each week.
“In between all that excitement, on days off we write papers, do research, teach medical students and residents — that happens on a daily basis, “ he said.
Though meth-explosion burns require much the same treatment as those from house fires or car crashes, Blostein said he’s learned over the years to expect differences.
One is immediately apparent. Patients burned by meth usually don’t tell the truth about the source of their burns, he said. “A tell-tale sign is the story doesn’t make sense. ‘It’s 3 a.m. and I decided to fix my
dryer.’ That sort of thing.”
Another: “We’ve sort of noticed a pattern of burns involving hands and face and maybe legs — though it’s nothing we can really put finger on,” he said.
Doctors must be extra alert to signs of infection, extra vigilant about monitoring ventilators and fluids, and should not be surprised if recovery seems slower than normal with meth-burn patients, he said.
Researchers are not sure why those challenges are present, but their studies have documented that the differences are real.
Finally, it may be difficult to control the patient’s pain and anxiety with medication, Blostein said, probably because of pre-existing issues.
“One of the things that makes it difficult is these patients often have multiple substance abuse problems, “ he said, in addition to methamphetamine addiction. If they are addicted to a narcotic, it may be difficult to get pain under control. If they are addicted to meth, they may become agitated, pulling out IVs and feeding tubes, or trying to get out of bed, he said.
Blostein’s thoughts about the Michigan’s methamphetamine problem, he said, reflect his years of work with its burn victims.
“I think when we sit and reflect, we would all like it not to be happening so we wouldn’t have to spend hours and hours taking care of patients burned in meth activities,” he said. “And we think about the larger picture — a lot of people in jail, a lot of man-hours and dollars spent — and that money could certainly be used somewhere else.
“Then there’s the even bigger picture — why are people using meth in the first place?,” he said.
The economic downturn likely contributed, he said, with people perhaps cooking meth as a diversion from hardships in their lives.
“But no, those things don’t get us down,” he said. “We still go off and do our jobs.”
Blostein said he and his colleagues are grateful for the resources they have available working in a Level I trauma center, something he said people in the community may take for granted. They also are acutely aware of the costs of maintaining that resource, and feel the pressure to work efficiently to keep costs down without trimming services, he said. They worry about legislation that might have an impact on funding.
At the end of every shift, Blostein has another ritual — changing back from street clothes into T-shirts and shorts for a 5-mile run.
It’s partly for his health, he said, and a way to work the kinks out after 12 hours on his feet.
The other part?
Clearing his mind — so that he can get up at 5:30 a.m. the next day and do it all again.
