The following morning, Charlie is moved across the street, from the ER at Mass General to Shriners, which Valerie has been told repeatedly is one of the leading pediatric burn centers in the country. She knows they are in for a long, uphill struggle when they get there, but she also feels relief that Charlie’s condition is no longer a life-or-death emergency, a feeling that is bolstered by the sight of Dr, Russo waiting for them in their new room.
It has not even been a full day since their first conversation, but she already trusts him as much as she’s ever trusted anyone. As he steps toward her, clipboard in hand, Valerie notices how striking his features are, admiring the curve of his bottom lip, his elegant nose, his liquid brown eyes.
“Hello,” he says, forming each syllable carefully, his manner and posture formal. Yet there is something familiar, even comforting, about him, too, and Valerie fleetingly considers whether their paths have crossed before, somewhere, in a much different context.
“Hi,” she replies, feeling a twinge of embarrassment for crumbling the night before. She wishes she had been stronger, but tells herself he has seen it all, many times, and will likely see more tears from her before they are finished.
“How are you?” he asks with genuine concern. “Did you get any sleep?”
“A little,” she says, even though she spent most of the night standing beside Charlie’s bed. She wonders why she’s lying—and further, how any mother in the world could possibly sleep at a time like this.
“Good. Good,” he says, sustaining eye contact with her for several seconds before dropping his gaze to Charlie, who is awake but still heavily sedated. She watches him examine Charlie’s cheek and ear, with the efficient aid of a nurse, the two exchanging instruments, ointment, gauze, and quiet commentary. Then he turns to Charlie’s hand, using tweezers to peel back a dressing from the charred, swollen skin. Valerie’s instinct is to look away but she does not let herself. Instead, she fights a wave of nausea, memorizing the sight of his mottled skin, red and pink in places, black in others. She tries to compare it to her visual from a few hours before, when his bandages were last changed, and studies Dr. Russo’s face for a reaction.
“How does it look?” she asks nervously, unable to read his expression.
Dr. Russo speaks quickly but kindly. “We’re definitely at a critical juncture here . . . His hand is a bit more swollen from all the fluids he’s taking in ... I’m a little worried about the blood flow, but it’s too soon to tell whether he’ll need an escharotomy.”
Before she can ask the question, he begins explaining the foreboding medical term in simple detail. “An escharotomy is a surgical procedure used on full-thickness, third-degree burns when there is edema—or swelling—that limits circulation.”
Valerie struggles to process this as Dr. Russo continues more slowly. “The burns have made the skin very rigid and hard, and as Charlie becomes rehydrated, the burned tissue swells and becomes even tighter. This causes pressure, and if the pressure continues to build, the circulation can become compromised. If that happens, we’ll have to go in there and make a series of incisions to release the pressure.”
“Is there a downside to the procedure?” she asks, knowing instinctively that there is always a downside to everything.
Dr. Russo nods. “Well, you always want to avoid surgery if you can,” he says, an air of careful patience to his words. “There would be a small risk of bleeding and infection, but we can typically control those things . . . All in all, I’m not too worried.”
Valerie’s mind rests on the word too, analyzing the nuances and gradations of his worry, the precise meaning of his statement. Seeming to sense this, Dr. Russo smiles slightly, squeezes Charlie’s left foot through two layers of blankets, and says, “I’m very pleased with his progress and hopeful that we’re moving in a great direction . . . He’s a fighter; I can tell.”
Valerie swallows and nods, wishing her son didn’t have to be a fighter. Wishing she didn’t have to be a fighter for him. She was tired of fighting even before this happened.
“And his face?” she asks.
“I know it’s difficult . . . But we have to wait and see there, too . . . It will take a few days to determine whether those burns are second or third degree . . . When we declare those injuries, we can devise a game plan from there.”
Valerie bites her lower lip and nods. Several seconds of silence pass as she notices that his dark beard has come in since the night before, forming a shadow across his jaw and chin. She wonders whether he’s been home yet, and whether he has children of his own.
He finally speaks, saying, “For now, we’ll just keep the skin clean and dressed and keep a close eye on him.”