More Than Skin

Hospitals bring together people from all walks of life. This is the story of two very different patients brought together by an unfortunate event. In the burn unit their paths cross and the link between them is their surgeon.

Disclaimer: This is a true story and the names of characters in this story have been changed to protect the patients’ identity.

Statue outside the Burn Unit, representing a patient rising to recovery after skin reconstruction in burn surgery

The swastika burned my eyes. It covered his chest like a shield of armor. Monotone beeps of the anesthesia machine hung in the air while I stood over his body in my surgical gown. Gauze neatly folded in my hand and a dermatome in the other. A dermatome is a tool used to shave off strips of healthy skin to replace burned skin.

Scanning his legs, I calculated the burn to be about 600 square centimeters. The charred skin would need to be removed. From where would I take the healthy skin to cover his raw legs?

I fixated on his chest, the swastika. About 600 square centimeters, the perfect size to cover the wound. My hand tightened around the dermatome.

“You know we can’t take it from there”, a voice softly echoed.

This I already knew.

Dr. Lyon, the head surgeon, stood in the corner putting on her surgical gloves. Her horrified look mirrored mine as she stared at the Nazi-tribute on the patient’s chest.

Mr. Floda was a 55 year old man who fell into a bonfire after too many drinks. Unconscious and barely breathing he arrived by ambulance in the middle of the night. I didn’t pay much attention to his tattoo at first, but now, in the sanctuary of the operating room, scalpel in hand, I looked closer.

The black, green and red ink was applied with surgical precision. Perfect straight lines, 90 degree angles, deep, bright color. This was not an old faded tattoo from teenage years. It was fresh hate. Hate for millions of people. Each one, a pigment of red-blood ink, stabbed under his skin to show the world his anger.

The operation finished and I applied the dressings methodically as I had a hundred times before. Skin grafts in place, legs saved, and the swastika untouched, proudly in its place.


I left the operating room and headed to the ER. Eyes fixed on the chart as I entered the room. The red hospital card read “Dennis Jones”.

“How may I help you sir?”

A soft feminine voice corrected me, “It’s Miss”. My eyes peered over the chart. Across the stretcher she lay in a blue hospital gown, wincing in pain. Rich blonde curls streamed from her head to meet a day-old stubbly beard on her face.

I quickly apologized for not greeting my patient with her preferred pronoun and we agreed to use, “Denise”.

Denise had just completed her gender reassignment surgery two months prior and had the misfortune of spilling boiling chemicals in her lap while at work.

I slowly peeled back the wet gauze from her parted legs. Changing a burn dressing may be one of the most painful experiences I’ve ever witnessed in medicine. Each square centimeter of burned skin is raw and inflamed. Most patients only find comfort when lying perfectly still.

She would need surgery and skin grafts.

Later in the OR, dermatome in hand, I wondered, how many kilometers of skin that machine had harvested. Patches of skin, from all walks of life that together could make a quilt of all humanity. What would have happened to this poor woman in the 1940’s if she had the misfortune of crossing paths with my previous patient ?

We wheeled her from the operating room to the recovery bay, next to Mr. Floda. Both asleep, side by side, so peaceful.


Burn Unit: Sunlight shadows on morning rounds

The next morning the sun pierced through the windows of the burn unit. Time to start rounds.

To my surprise both patients shared a room . The thin curtains separating each patient glowed with sunrise. The room was quiet with sleep. Each patient lay there, unaware of the other. I stood there in silence in awe of the situation . The chaos of fire at the wrong place at the right time had brought two very different worlds together.