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Fran Kitt, RN, is one of a small number of nurses in the nation's 139 burn centers. These nurses must endure the often-grueling task of preserving the body's largest single organ-one that is vital for temperature regulation and protection against a plethora of germs.

'I'm going to take your pillows away and we are going to give you a little bath." Fran Kitt, RN, raises her voice to grab the attention of a large, drowsy patient swathed in gauze.

He nods vaguely as Kitt and two other burn unit staffers gingerly begin peeling off layers of gauze to uncover the tender-or sometimes dead-skin below. The man starts flailing from the pain as a burn care technician daubs saline on his charred right knuckles. The sensitive, pink patches on his fingers actually bode well: a sign that parts of the skin are still alive.

But Kitt's gaze halts as she spots a pale, gray section on the man's back. After 20 years in the burn unit at Santa Clara Valley Medical Center in California, Kitt has seen the fate of bloodless areas like this.

This patient had been driving his car as usual during the early evening the day before when motorists started waving at him. He suddenly realized his car was smoking, but he pulled over only to discover his brakes had failed. The man, in his 20s, was trapped in the burning, smoking car as it rolled down an embankment. The flames destroyed 30 percent to 40 percent of his skin, leaving him at risk for infection, swelling and dangerously low blood pressure.

Although burns can be among the most devastating, life-altering injuries, Kitt said she is hooked working on a team that tries feverishly to give patients a chance to overcome the odds. "The people here are dedicated, crazy and fun," Kitt said. "You have to be a little crazy to do this job, but it's like a family here."

Kitt is one of a small number of nurses in the nation's 139 burn centers. These nurses must endure the often-grueling task of preserving the body's largest single organ-one that is vital for temperature regulation and protection against a plethora of germs. To catch a glimpse of how these nurses reverse the work of flames, scalding water, caustic chemicals and electricity, NURSEWEEK followed Kitt for a day.

Critical watch

Kitt leans toward one of the many machines monitoring the man's progress as she checks his urine output. She wrinkles her forehead. The burn team is racing against the body's natural response to leak fluid from damaged capillaries and other vessels. This leakage leaves precious little fluid for blood to flow to vital organs. To prevent organ failure, the burn team is pumping the man with a vast 13 liters of fluid-about 3½ gallons-during his first 24 hours in the hospital.

The test of their success is his urine output, and this man's urine flow is too close to the minimum of 30 cc's.

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