Invisible Heroes

Eight members of the surgical team huddle over a man in Massachusetts General Hospital's Operating Room 36, the heart of the medical center's burn unit. The man's legs are badly burned below the knee. His thighs show long red rectangles where skin has been removed for grafts. The doctors and nurses sweat beneath their gowns in a room heated to its usual 100 degrees, because badly burned patients can't regulate their body temperature.

The staff surgeon, Dr. Colleen Ryan, removes dead skin (eschar) from the patient's legs, looking for a viable layer. She explains her every move to a resident by her side. Everyone works together to save the patient's legs. In this setting, Elizabeth Viano, RN, stands out like a symphony conductor. A petite redhead with a colorful checkered cap, she gracefully weaves around the doctors and equipment, delicately stepping over wires and cables to make sure everyone has everything they need, most of all, the patient.

Viano, the team leader, is one of four nurses who staff the burn unit's operating room. Together, she, Linda Bracey, Terri Leddy-Fitzgerald, and Ann Doig, all registered nurses, run Room 36, where the vast majority of adult burn victims in New England end up.

"There are a lot of wonderful nurses in the burn service, but as OR nurses, these four are often almost invisible to the patients and their families," says Ryan, who nominated them for the Salute to Nurses honor. "The only people who see them are the patients, and for most of that time they're under sedation."

The nurses, on the other hand, are highly alert to the needs of each patient. They calm the patients before they are given anesthesia; they make sure they have an interpreter if needed; they get family members involved when necessary; and throughout every procedure, they make sure the patient is rolled enough, so there are no pressure points that could cause bedsores. And they go the "extra mile," says Ryan, making sure each patient is seen and cared for like a human being.

Ann Doig is particularly dedicated to these tasks. She brushes the patients' teeth, shaves their faces, and even washes their hair, activities that can be very difficult for burn patients.

In addition, the nurses take seriously their role as patient advocates. "We are the voices for people who can't speak for themselves," says Linda Bracey, whose deep brown eyes shine as she describes her work. "When the patient comes down here they may be intubated and sedated, but they can hear. We talk to them and let them know what we are doing."

While attending to the patients, the nurses have also been proactive in instituting the new safety measures introduced over the past decade, as well as in remaining "ahead of the curve in bringing new policies to nursing," says Ryan.

When Leddy-Fitzgerald is asked why she chose the burn unit, she cites both the opportunity to learn and the camaraderie of her team. "I enjoy learning the physiology of what happens to the patient... And the surgeons teach nonstop to the residents, so you get a continuous education."

She adds that working in the unit is "like working with your family."

Her colleagues echo this sentiment.

This ability to pull together came into sharp focus during the aftermath of the legendary 2003 Rhode Island Station nightclub fire. The unit expected to treat four of the victims. Instead, 15 critically ill people arrived. For the first month, three operating rooms were dedicated continuously to the victims, and some had to be operated on in the intensive care unit.

Viano and Leddy-Fitzgerald were in charge during the ordeal. They worked weekdays and weekends throughout, performing triage, making sure the patients got the care they needed, and handling all the scheduling and administration. In addition, they transported patients back and forth from the ICU safely, which is no small feat given the number of lines and tubes and the fragile state of the patients.

The fire was clearly an extraordinary circumstance, notes Ryan. But the nurses' dedication was not unusual for them. "Any time there is a major burn patient," she says, "they have been willing to come in and provide their expertise."