"I will send you a photo of me in a saree once I go home, doctor…" she said with a smile of hope bursting through the unimaginable pain she suffered in her young life.

Late in the night it was another request for an intensive care bed. This time it was for a young lady of 23, in respiratory failure after sustaining kerosene oil burns. There were no unoccupied beds and a stable patient had to be transferred back to the ward to make space for her.

She was labouring to breathe. Her face was distorted with oedema. Her neck was burnt up to mid chest including both arms sparing only the palms and a small area where an intravenous cannula was struggling to infuse her with the life giving saline. Whole of her lower body below the umbilicus was blistered and peeling. The skin on her thighs felt like seasoned leather due to the deep burns sustained. It looked a horrible black with pale whiteness of death shrieking underneath the peeling layers. It was a nightmare for all of us. Fortunately for her, she was hovering on the brink of unconsciousness, ignorant of the past and the present and an uncertain future.

The circumstances of the incident were obscure. It was insinuated as an attempted homicide by a close relative. No one knew for sure. May be her foggy state of mind was the nature’s way of keeping at bay the pain of such horrendous magnitude.

She was immediately hooked to electronic monitors to see how she fared in life. Her heart was racing to compensate for the falling blood pressures. Her lungs, instead of being soft and pliable, were like soaked up sponges unable to expand and transport gases across, turning her blood almost blue. In all this mayhem when so much of waste products and toxins were being produced and needed to be excreted, her kidneys were in the verge of failure with a dwindling urine output. It was pure disaster.

The unforgiving heat of the blazing flames had eaten into her flesh leaving her blood vessels leaky resulting in a constant ooze of serum out of her system. Soon her body had become a nurturing ground for infections. She was so ill she was unable to resist and fight back. She could not even mount a fever and her white cell counts were low and getting lower. It was like a drama, one act after another. Initially it was pneumonia followed by urinary tract infection, then the burn wounds and the intravenous lines and back again to pneumonia. Infection kept on going round and round like a horrible game of musical chairs with a broken record that refused to stop. She was on the strongest antibiotics in combination for weeks on end, but every few days some resistant bug would emerge defeating all our efforts to keep it at bay and frequent specialist microbiological opinion had to be obtained from helpful doctors at Kandy and Colombo South Teaching Hospitals.

To compound her problems she was pregnant. She was almost into the eighth month of her pregnancy. It was a precarious time for the baby irrespective of her mother’s dire condition. His lungs were not yet mature to sustain life outside in the world. Pregnancy with a forty per cent burn was almost a losing game. So much so she was not even accepted by the specialised burns units across the country as her prognosis was so poor and her raging infections would have been detrimental to the rest of the patients.

But the collective team of dedicated doctors, nurses and everybody involved in this game of life and death was adamant on saving her. The doctors made crucial decisions. The nurses executed them faithfully on time. The single physiotherapist tirelessly worked to clear her lungs of copious phlegm and improve the flexibility of her stiff joints. The laboratory staff made avail of their services even in the dead of the night. Pharmacists went out of the way to find the drugs from other hospitals and the Medical Supplies Division in Colombo. Blood bank complied with blood products at a moments request. The diet clerk and the kitchen stepped up their meal plans to comply with altered requirements. And the minor staff was there to help everybody out. It was a concerted effort. Never give up had been the call of the day.

With the basic facilities available in this remote general hospital we strategized the war against impending death. Improving her immunity with nutrition and supporting her while she precariously balanced herself on the scale of life and death were our main targets. A naso-gastric (NG) tube was placed. A high protein diet consisting of more than ten eggs per day and other additional proteins were given as a blended liquid through the NG tube. A range of multivitamins and iron were included to improve healing and to encourage the increased cell growth and turn over. Almost ten oranges per day in addition to potassium tablets were needed to maintain her body potassium levels. Blood and plasma transfusions had to be given to compensate for the blood loss at regular wound dressings that lead to a chronic state of anaemia.

Just about one week into her tragedy there were signs of premature labour. Her amnions broke and the amniotic fluid leaked out. In consultation with the senior obstetric doctors and anaesthetists it was decided to let her go into a vaginal delivery as a Caesarean section across the burnt abdomen would inevitably result in the spreading of infection into the surgical wound and into the peritoneal cavity. In her cloudy state she delivered a tiny baby boy weighing just more than one kilogram. While she was slowly recovering from the delivery the little baby struggled for life for just one day in an incubator in the Paediatric Intensive Care Unit with immature lungs and severe infection contracted while still in the womb.

Weeks passed as the war of survival continued. She had to be put back onto the ventilator several times. As her level of consciousness improved so did the awareness of her pain. She had to be on regular high dose morphine and other pain killers. Not knowing the difference between the day and night restrained in an ICU illuminated by constant glow of fluorescent lights, her orientation was playing up. She started to have hallucinations, to the point of aggression and then tipping over into the lonesome land of depression. She kept on gazing… probably at a fragmented memory and an obscured dream with tear glazed unfocused eyes. But with each passing day the sympathetic words and encouraging remarks mixed with a relentless effort to bring back normalcy by the staff seemed to change her outlook. The prescribed antidepressant medication was also starting to take effect. Finally the balance was tilting towards survival.

During her whole stay once only did she inquire after her unborn baby. May be the memory had not been so kind; may be she recalled how it all began; and she never asked how it happened; who was responsible. Through out her ordeal her family had been by her side, everyday, even if only to witness the pain their loved one was going through. But no one had the courage to explain the reality and what became of her baby.

Her superficial wounds on the neck, chest and the abdomen were starting to heal. Probably her emotional wounds too. Acceptance seemed to take off the deep etched frown lines off her face. The down turned corners of her mouth seemed to disappear and at a rare occasion there was even a hint of a smile. She was a beautiful girl. The gross swelling of her face and body had gone down and the added nutrition had kept her from wasting. Her face had been spared miraculously and the now frequent and unscrupulous smiles lit her face up as that of an innocent child. She actually looked more like a child than a young mother who had undergone so much tragedy.

In her despair she had become everybody’s friend. She was the one constant companion for the ICU staff for over two months. Her infections finally seemed to abate and arrangements were made for her to be transferred to the Kandy Teaching Hospital Burns Unit for skin grafting as she had only limited areas of healthy skin for harvesting for the grafting. There were large areas on the legs with deep burns needing significant skin grafts which needed special instruments to make maximum use of the harvested skin.

With removal of extra catheters and vascular lines she was finally mobilised onto a wheel chair and for a few hours a day was placed by the window to see the miracle of life that the world at large still had to offer. She was subsequently moved to a bed closer to an old television to distract her from the current reality of her life. A tiny hand mirror improved her self perception and to see beyond the scars. The regular counselling veiled in insignificant conversations by the staff had infused her with courage to face life afresh.

As much as she was recovering from her disaster my stay had also come to an end as the in charge doctor of the Intensive Care Unit in this remote general hospital in the hill country. It was sad to leave a patient who had taught me so much about endurance for more than two months of my stay of there. Nevertheless, it was, unlike some, a happy outcome despite the losses she suffered and for me, the torture of having to see a young girl go through so much pain and anguish. But in this short walk of life together we all seemed to learn to accept life; the blessings that are thrown our way despite the hardships. As I waved a final goodbye she gave me the heartiest smile for me to remember for the rest of my life.