Moving Forward After a Devastating Burn
When Manoj Rana was supposed to be getting his college diploma, he was fighting for his life in an intensive care unit with 90 percent of his body burned.
In 2005, Rana, a senior engineering student at Purdue University Calumet, was a victim of arson. He lived three floors above a man who set his Hammond, Indiana apartment on fire after a domestic dispute. The fire raged through the building, killing the man’s wife and three-month-old daughter, as well as Rana’s best friend. Yet, Rana managed to survive being trapped for nearly 10 minutes in temperatures between 300 and 600 degrees.
Recognizing that Rana’s burns were life threatening, local physicians had him transferred by helicopter to the eight-bed intensive care unit at the University of Chicago Medicine Burn and Complex Wound Center. Established in 1997, the Burn Center is one of only two in Chicago accredited by the American Burn Association and the American College of Surgeons. Each year, the center treats approximately 250 to 300 patients, including many who have burns on more than 70 percent of their bodies.
A Challenging Case
“For Manoj to survive this devastating injury, a massive effort was required by a multidisciplinary team that included nurses, nutritionists, pharmacists, occupational and physical therapists, social workers, critical care physicians and burn surgeons,” said Lawrence J. Gottlieb, MD, an internationally known reconstructive plastic surgeon who directs the Burn Center and specializes in complex wound reconstruction. “As a plastic surgeon, and leader of the team, my goal was not only to keep him alive, but to produce a functioning human being.”
A major challenge for physicians was keeping Rana metabolically stable so that his body would keep regenerating healthy skin on the 10 percent of his body that was not burned to use as graft material for covering the other 90 percent. “Manoj had one of the worst burns we have seen,” said Avery Tung, MD, director of burn critical care services. Because Manoj needed multiple cycles of skin growth, harvest, and grafting, the care team was concerned that he would eventually develop an infection that would become resistant to antibiotics or worse, kill him. “It was sort of a race against time,” said Tung, a specialist in anesthesia and intensive care medicine. “We had to regrow the skin fast enough so he wouldn’t develop an infection that would be difficult to treat or fatal.” Rana became infected multiple times, requiring increasingly complex antibiotic regimens.
During his initial resuscitation, Rana also was at risk of hypovolemic shock, a potentially fatal condition that occurs in the first 12 to 24 hours after burn injury. The severe, total body tissue damage caused by such a large burn causes blood vessels to become leaky, allowing a significant amount of blood or fluid to leak out (a process called “third spacing”) into the lungs, abdomen, and other tissues. To limit this process, Tung and Gottlieb used higher proportions of albumin, a protein solution derived from blood, during the initial resuscitation. Although unconventional at the time, this therapy has now become increasingly mainstream in massive burns such as the one Rana suffered.
During his first four months at the Burn Center, Rana required frequent operations and was either anesthetized or in a coma for most of that time. When he regained consciousness, pain became another challenge. Many burn patients experience significant pain and develop a tolerance to narcotics. To help manage Rana’s symptoms, Tung added a non-narcotic sedative/analgesic called dexmedetomidine to his regimen. Although dexmedetomidine use for burn patients was not common at the time, this approach helped Rana manage his pain as he faced the next challenges in his recovery: learning to swallow, talk and move again.
“The first time I tried to stand up after being in bed for six months, I was ready to give up,” Rana said. “It was the worst pain I’ve ever experienced. I couldn’t even stand for two or three seconds.” But Rana found help and support at the Burn Center, where our multidisciplinary team of nurses, physical therapists, occupational therapists, respiratory therapists, nutritionists and other experts helped him get back on his feet. They set small goals, and within a week, Rana took five steps. A month later, he was able to walk down the hallway.
“My therapists told me that if I worked hard, I might be able to live independently,” Rana said. That advice motivated him to keep focused on his recovery, as his independence was very important to him.
During his seven months at the Burn Center, Rana required 35 skin grafts. He sustained a fourth-degree burn on his left foot, which required two toes to be removed. However, the team at the University of Chicago Medicine was able to spare his other toes and fingers.
When physicians were certain that Rana was in the clear, they transferred him to an acute rehabilitation facility back in Indianapolis. There, his rehabilitation continued for three years. As Rana grew stronger, he decided to go back to school. In 2012, he received his MBA in finance from Kelley School of Business, Indiana University, Indianapolis, where he earned the highest grade point average (GPA) in his graduating class. Rana, who grew up in a suburb of Delhi, chose to stay in the United States and now works in the finance office at an Indianapolis-based health system. In 2011, he began studying to earn his chartered financial analyst (CFA) designation. Most importantly, he has been able to live on his own. “My treatment at the University of Chicago helped get me to where I am today,” Rana said. “I am so thankful to all the doctors and nurses.”
Yet he has not reached every goal. In 2008 -- just three years after the fire -- Rana ran a half marathon in three hours. He hopes to shave 30 minutes off a future half-marathon and continues to run two to three miles, three to four times a week.
When he is not running or studying, he also volunteers for the Center for Victim and Human Rights, a nonprofit legal services organization, and visits burn patients at a local hospital. “I tell them there is hope and life after burns,” Rana said. “It takes a long time but you have to be patient. You have to treat it like a full-time job. Everything else can wait but your recovery cannot.”