Shortly after being accepted into the nursing program at UAB I was offered the opportunity to participate in the Honors in Nursing program, which I gratefully accepted. A large component of this program involves taking part in a service learning project, which is incorporated into two or three semesters of the program. Ideally, the project would provide something of value to mankind (at least in some small way!) while also providing me with valuable learning experiences.
I had a few ideas for what I might do. My first thought was to create a tobacco education program for area middle school kids, complete with lots of creative analogies and shocking props (such as a blackened cadaver lung from a lifelong smoker), in an effort to head off a few possible youth smokers. I also considered using the dedicated course time to reenlist in Frank Hambly’s “Labs for Kids” program, which teaches anatomy, physiology, chemistry-- well, lots of sciences-- to elementary and middle school kids. I think kids are more likely to stay healthy when they understand exactly how a healthy body is put together and how it can be damaged. Do you get a sense that I enjoy educating kids? Well I do, but only in small doses! I have a lot of respect for professional teachers who can keep that up five days a week for many hours at a time!
While deciding which of these options best fit my time constraints and interests, life did what it often does—opportunity knocked! I was riding my bicycle with a group of friends when one buddy, Ed, began asking about enteral feeding (via the intestines) versus parenteral feeding (through an IV directly into the bloodstream) and other healthcare related questions. I knew he was a postdoc at UAB, but didn’t know much else about his work. Turns out, he was beginning to do research involving burn victims, and was brand new to using human subjects. One his queries regarded whether specific training is given to student nurses to enable communication with people during tragic, stressful situations. I let him know that, boy do we ever receive training in “therapeutic communication!” Even as students we need to be able to communicate well with distressed patients and families, beginning with first semester clinical experiences at the hospital. As Ed and I talked, we realized that I could really help him by acting as the face for the research program to the potential candidates and participants. I was kind of excited- here was an actual need for my budding skillset! Ed began to tell me more about the science behind and the purpose for the research.
When people are recovering from being badly burned they frequently experience muscle atrophy, which means a loss of muscle tissue. For instance, a healthy person who receives a burn to the right side of their body will end up losing a large percentage of the muscle mass on the undamaged left side, while recovering over the next many months. This sounds normal right? Lying around in a hospital bed seems like a good way to lose some muscle mass, doesn’t it? It turns out that when we lose muscle from lying around it is called “disuse atrophy,” and that is a very different thing than the atrophy experienced when recovering from a traumatic injury.
Being living things, muscles are constantly being built up and taken apart by the body. Under most conditions these two processes occur at the same rate, and the muscle doesn’t change in size. In disuse atrophy, the muscle is built up more slowly than it is broken down, hence it shrinks. However when the body is recovering from a burn, healthy unaffected muscles begin to be broken down more quickly than they are built up, also causing shrinking. Beyond being a simple inconvenience, this loss of muscle mass can lead to fall hazards and breathing insufficiencies (we don’t think about it, but we need muscles to expand our lungs to breath.) Health care providers give patients steroids, insulin, and five thousand calorie diets partly in effort to fend off this atrophy, but these measures are usually not very effective.
Ed’s goal is to discover the signals within the body which facilitate this process. What signal might travel from the blood serum to begin speeding up the breaking down process? What signal might occur inside of those muscles when the breaking down process is caused to speed up? To begin investigating these signals, Ed needs to collect and examine blood serum and muscle biopsy samples from burn victims, both shortly after their injury and about six months later. If scientists can understand what physical actions are involved at the smallest level, drug companies may be able to create a drug to block those actions.
As I hadn’t learned much about large burn care in my previous courses, I felt my first prudent action should be to become familiar with some very basic information in that area before meeting with patients and families of patients undergoing that experience. Next time I’ll talk about my initial learning experiences, which were simply an introduction to the Trauma Burn ICU.
