Meghan slowly regained consciousness 2 days later. She had been intubated and sedated to give her lungs a chance to start recovering from the smoke inhalation. To prevent her from panicking and pulling out her ET tube, her hands had been restrained in soft restraints.

Rick was sitting with her when she woke up, and the smile on his face was huge when he saw her eyelids flutter open. “Meghan! Hi, honey. That’s it. Wake up for me.”

Her eyes darted around the room, getting her bearings, before settling on his face. She pulled ineffectively against the restraints. Rick caught her hand closest to him and held it in his as she calmed down. He also reached around and pressed the call button.

Hello, can I help you?

“Would you let Meghan’s nurse know she’s waking up? Thanks.”

Soon, Meghan’s nurse, Helen, appeared, followed by Dr. Troy. “Meghan! I see that you’re awake! Let me take a listen to your lungs, and then I’ll update you on what’s been going on.” He put his stethoscope in his ears and placed the diaphragm on her chest, and listened intently. After a few moments, he removed the stethoscope and slung it around her neck.

“Sounding a lot better than when I first saw you in the ER!” he declared. He stood close to her side so she could see him easily. “So let’s get you caught up on what’s been going on. We brought you to the Burn Unit from the ER on Friday. We sedated you, did a bronchoscopy that revealed a lot of bronchial edema and swelling. We were able to suction out a lot of gunk while there. We decided that the best course of action for your lungs was to intubate you and put you on the ventilator, which we did.

“We debrided a small area of third-degree burn to your left calf. You now have a cadaver-skin graft over that area that seems to be doing well as of yesterday’s dressing change. We have also been keeping a close eye on the second-degree burns around that third-degree burn, as well as the second-degree burns on the back of your neck.

“We are also keeping a close eye on other bodily systems, and want you to be reassured that your cortisol levels have remained pretty constant. We have you on a cortisol drip as part of your medications, but when you’re able to be extubated and swallow pills again, you’ll easily be able to transition back to your oral dosage.”

Meghan nodded as best she could. That would have been a concern of hers.

“Now, I bet you’re wondering about when you’ll be extubated. The vent settings for you are really low. I’ll need to confer again with the Pulmonology team, but I’m optimistic you’ll be getting off the vent in the next day or two. Today’s Sunday, so hopefully on Monday. I also want to keep you inpatient for another few days to make sure that the skin graft continues to heal as it should. Otherwise, you’re looking to be in pretty good shape.”

Meghan made to gesture something, but was hampered by the wrist restraints.

Dr. Troy chuckled. “You’re not going to try to pull out your ET tube, are you? Helen, we can discontinue the restraints. And let’s get her set up with a whiteboard so she can communicate.”

Meghan gave a thumbs-up as Helen undid one, and then the other, restraint. “I’ll be back in a few minutes with that whiteboard, Meghan.”

Meghan cautiously brought her hands up to her face, feeling for herself the different tubes they had in place. She felt along the ET tube and ventilator tubing before her hands felt the tube that was taped alongside her cheek and placed into her nose.

“You have a nasogastric tube,” Dr. Troy confirmed. “You’re receiving TPN until you’re off the vent. We need to keep your calories up, both to help your body recover and to keep your Addison’s in check.”

Helen reentered the room. “Here you go, Meghan. The marker velcros to the side of the board.”

“Any questions for me?”

Can I sit up some?

Dr. Troy nodded, and Helen helped Meghan get the bed adjusted so she was more comfortable.

“If you don’t have any more questions at the moment, I need to check on a couple more patients. I’ll see you again this afternoon when we do burn care.” He waved goodbye and left.

Helen stayed for a few minutes longer, adjusting pillows and blankets. “I’ll give you a little bit more time to visit, and then Tracy, your tech, and I will be back in to give you a bed bath and change the sheets. If you need anything before then, hit your call button and someone will be in.”

Meghan was extubated Tuesday morning. She gagged as the tube was removed from her trachea, and gratefully accepted the oxygen mask providing oxygen to her lungs as she fought for her body to calm down.

“That’s it. Calm your breathing down. Good girl,” she was coached by Raul, one of the respiratory therapists. “Here, let’s secure this elastic behind your head. Good. Okay, now lean on back. There you go!” He got Meghan calmed down and resting comfortably in bed again.

Raul glanced at the telemetry numbers. “Good. You’re sitting at 98% with the oxygen. If you’re still behaving in a few hours, we’ll switch you to a nasal cannula.” He smiled and cleaned up his trash. “Any questions before I go?”

Meghan shook her head. “Can’t think of… How long will I sound this raspy?” Her voice was very raspy and a little difficult to understand.

He smiled reassuringly. “I’m not sure, but I will say it’s normal. It’s probably due more to the smoke inhalation than being intubated, but your doctor can probably give you a better idea as to when your voice will return to normal.”

Meghan nodded and closed her eyes. Raul took the opportunity to leave.

Wednesday morning, a knock sounded on Meghan’s door, and in walked a man with a walker. “Hi Meghan, I’m Steve. I’m a physical therapist. We are going to start doing some rehab, get you up and walking again.”

“Hi,” Meghan greeted, albeit a bit confused. She hadn’t thought about how her burns would affect her walking, even with the burns to her leg.

Steve noticed the look of confusion. “It’s typical for patients with leg burns to experience some contraction, or even changes to your gait because of pain. Plus you’ve been in bed for several days. So we’re going to get you up, see how walking does for you, and go from there. Besides, it’ll be a change of scenery.”

Meghan nodded. “Sounds good.”

Steve unhooked her from the telemetry, hooked her nasal cannula to a bottle he carried, and adjusted a couple bags of IV fluids so they were all hanging from one IV pole. He came to the side of the bed, lowered the bed rail, and took her hands. “Okay, let’s sit you up first, and then we’ll swing you around so you’re sitting on the edge of the bed.”

Meghan sat up, and carefully swung her legs around the side of the bed. Steve helped her to guide her injured leg so it didn’t bump on anything. Meghan smiled. “I’m sitting!”

Steve chuckled. “Yes, you are. How are you feeling?”

“Okay. Leg aches a little, but so far so good.”

Steve reached around her and secured a gait belt around her waist. He brought the walker close by and grasped the belt. “Okay, let’s stand up. One, two, three.” Meghan stood up, gasped, and reached for the walker.

“Ow! Ow! Ow!” She held onto the walked for dear life as pain radiated through her left calf.

“I’ve got you. Do you need to sit back down?”

“No,” Meghan said through gritted teeth. “Gimme a minute.” She stood there for a few minutes until the sharp pain in her calf calmed down to a slow throbbing. She breathed out slowly. “That hurt.”

Steve nodded. “You’re doing really well. Want to try to walk a bit? We can just go around the bed and let you sit in the chair.”

Meghan slowly nodded. “Yes. I need to try to do as much as I can.”

It was very slow going, as each step was very painful, but 10 minutes later, Meghan was gratefully sitting in the recliner, leg propped up, and proud that she’d made it that far. Steve congratulated her. “You did an awesome job, Meghan. I’ll be back in a few hours, and we’ll get you back into bed. I’ll let your nurse know you’re up.”

Meghan thanked him, and he left the room. Cynthia, Meghan’s nurse for the day, soon popped in. “You’re sitting up, that’s awesome!” She bustled around the room for a minute, making sure IVs, her catheter bag, and such were positioned well. “I’ll be sure to send your tech in. We’ll get you cleaned up and your bedding changed while you’re in the chair. Do you need anything? A snack, perhaps?”

“Please. Sprite and a chocolate pudding if you have it would be great,” Meghan replied.

“Coming right up!” Cynthia smiled. She left the room, and Meghan sighed. She cautiously shifted her leg on the pillow, only to regret the action as it throbbed.

Cynthia returned with the drink, pudding, and some graham crackers. She noted the pained expression on Meghan’s face. “Hurting?” she asked, as she brought over the tray table and set the snacks down within reach.

Meghan nodded. “I tried to shift my leg on the pillow. Kinda regretting that decision.”

“I think you’re due for some pain meds. Let me go get those for you. Be right back.”

Cynthia was soon back with a small cup of medication. “Time for a few others, as well. Need help with the soda, or would you like your water?”

“Water, please.” Meghan accepted her water jug and the cup of meds. She got them down and placed her jug back on the tray table. “Any idea when I’ll get the NG tube removed from my nose?”

Cynthia shook her head. “No clue. I’ll make a note to ask the doctor when I see him again.”

A tech, Trudy, popped her head in. “Hi there! I’m Trudy, your tech for today. How’d you like to get a bed bath and sheet change?”

Meghan swallowed her mouthful of chocolate pudding. “Sounds good to me.”

“Awesome! I’ll go get supplies and be back in a few minutes.”

Half an hour later, Meghan was clean, in a new gown, and had fresh sheets on her bed. She was still sitting in the chair when Mitch walked in.

“Hey! Sitting in a chair is good progress! How are you feeling?” he asked, as he leaned in for a hug.

“Pretty good, as long as I remember not to move the leg. It flares each time. Just wish I didn’t sound like a chain smoker with COPD,” she replied.

He pulled up a chair and sat down. “Have they said anything about when you’ll be going home yet?”

Meghan shook her head. “Considering it took 10 minutes or so just to walk to the chair from the other side of the bed, I think I’m here for a little while longer.”

Mitch nodded. “Well, we want you home, but don’t rush the process. I’ve been keeping Brandi updated for you – she said to pass on her well wishes, and plans to come to visit soon.”

“Thanks for that.”

“You’re very welcome. Kelsey sends her love – she wants to stop by after her shift is over.”

“Well, she’d better,” Meghan deadpanned. Mitch laughed.

Dr. Troy knocked on the door and entered. “Meghan. I’m glad to see you’re in a chair. That’s good.” He turned and shook hands with Mitch. “Good to see you, as well, Branston.” He focused again on Meghan. “How are you feeling?”

“Not too bad, as long as I don’t move my leg. And wishing I didn’t sound like a chain smoker with COPD.”

He laughed. “That’s a pretty good description! I can’t give you an exact date as to when your voice will return to normal, but hopefully within a month. Your leg and neck burns are healing well; while I know that you’re experiencing a lot of pain still, it’s actually a good thing – it means nerves are healing.”

Meghan nodded thoughtfully. “I hadn’t thought of it that way.”

Dr. Troy smiled. “Now, since you’re off the vent and doing well, I’m going to be ordering some changes to your care routine. As you experienced this morning, physical therapy is going to be coming by twice a day to get you up and moving, and will be working with you on leg exercises to keep the muscles from atrophying and keep your skin as supple as possible. You’ll have scarring on both your neck and your leg – the burns are bad enough that it’s inevitable. But we can keep them from being too bad by keeping you mobile.

“We will be stopping the TPA and removing the nasogastric tube today. Dietary should be coming by to help you choose your meals and avoid the mystery meat options. And finally, we’re going to be switching most of your medications back to oral dosing instead of IVs.”

“What about the foley?” she asked.

He chuckled. “Not the most comfortable, I know. But you’re stuck with it until you’re more mobile and can use a bedside commode independently. Probably a couple more days.”

Meghan nodded. “Worth a shot. Any idea as to how much longer I’ll need to be in the hospital?”

“Hard to say, as it really depends now on continued healing of your leg, your mobility level, and being able to adequately control pain levels. Maybe five more days?”

Mitch spoke up. “How long do you anticipate her to still need the supplemental oxygen?”

Dr. Troy looked at him. “Good question. We’ve got her down to 2 liters per minute of oxygen via the nasal cannula, but with the severity of the smoke inhalation she had, she’s going to need oxygen for a while beyond her hospital stay – maybe another month or two. She’ll be followed by a pulmonologist and the outpatient burn clinic until the burns are completely healed and her lungs have recovered.”

“Will there be any need for surgeries or further skin grafting for the burns, especially on my leg?”

He shook his head. “No, you’re very fortunate that the third-degree burn on your leg was small to begin with. The skin graft you have is healing nicely and looks to be sufficient without the need for more surgeries or debridement. Most of our patients here are not that fortunate.”

Meghan nodded somberly. “I know I’m fortunate to have as good of an outcome as I have. Thank you.”

“You’re welcome. Any other questions before I go write some orders? No? Okay. I’ll see you later this afternoon with dressing changes.” Dr. Troy left the room.