4-Minute Coffee with Uncle Reggie: Burns and Scalds
与曾叔叔喝咖啡闲聊四分钟:烧伤和烫伤
(Zhou Ting 翻译)

A sudden scald. I was seriously scalded recently, and it gave me an instant awful feeling, as if I was suddenly vulnerable and naked. This scary moment was only fleeting because I quickly recalled many facts from history and medical training and sprang into action. It all turned out reasonably well and gave me some good lessons. Like this story.

突然烫伤。 我最近发生了一次严重的烫伤,当时我瞬间产生了一种很糟糕的感觉,就像突然赤身裸体般脆弱无助。当我迅速地从常识和我所受过的医学训练中想起一些信息时,这种可怕的瞬间才消失。结果最后还不错,而且由此产生了一些宝贵的功课,比如今天的这个故事。

My recent scald, early phase, enough to begin to make someone uncomfortable.
我最近的烫伤伤口的早期阶段照片,就已经足以让人产生不舒服的观感。

Dedicated to the skin professor

I spent decades in Neonatology, looking after sick premature infants. Each of our academic faculty members had his own area of expertise. We had a skin guy, Steve Hoath, and this story is inspired by him and dedicated to him, as the skinny (1) on skin.

献给皮肤科专家

我长达几十年的新生儿科工作是照顾生病的早产儿。每一个我们的学术成员都有各自的专长。我们当中有一位皮肤科专家 Steve Hoath ,他启发了这个鲜为人知的故事,也因此献给他。

We used to joke that every time we talked about any clinical topic, our skin professor expertly turned the topic into something related to skin. Even when we didn’t think it was related at all. But it was great fun and it resulted in our becoming well versed in the complexities of skin, especially in babies.

我们曾经这样开玩笑说,每一次我们讨论任何临床问题时,皮肤科专家总是能巧妙地将主题引到皮肤上。虽然有时候我们压根不觉得当下的主题跟皮肤有任何的相关性,但是他这样做让我们觉得很有乐趣并且导致我们团队都认识到皮肤的复杂性,特别是在小婴儿身上。

What’s the largest organ in the body?! It’s not intuitively obvious, but the skin is really the largest organ in the body. (It also is really an organ.) It’s all over us and protects us continuously, literally all the time, everywhere we go. It is truly an amazing organ with innumerable critical functions that we easily take for granted, and we forget about our skin until it gets into trouble!

婴儿身上最大的器官是什么?!虽然这在直觉上并不明显,但皮肤确实是身体中最大的器官(是的,皮肤是一种器官)。皮肤覆盖我们全身并且是真正意义上无论什么时候无论我们去哪里,它都在持续地保护我们。它确实是一个令人惊叹的器官,具有数不尽的关键功能,却让我们习以为常。除非皮肤出现问题,不然我们容易忘记它的存在。

Any cut in the skin is instant exposure. Normally, we are well protected and sealed, but any cut in the body instantly exposes our body to the cruel germy outside world. Instantly, opportunistic germs and infections have the long -awaited chance to come in. “The gate is finally open, come on in!” Just a minuscule bite from an insect in your lovely garden can cause instant trouble!

皮肤上的任何伤口都是立即的暴露。通常情况下,我们都是被很好地保护和密封着,但身体上的任何伤口都会立即将我们的身体暴露在外界残酷的细菌中。在一瞬间,一直在寻找入侵机会的细菌和感染终于迎来了它们等待已久的机会。“大门终于打开,进来吧.” 在你美丽花园里,只要被一个小虫子咬一口,你马上就会遭遇麻烦!

Village disaster awaits! When we were on medical missions to villages, burns were a huge problem in the area. The open fires and hot scalding woks right in the villagers’ cramped homes, where small children were also running around, were disasters just waiting to happen!

乡村的灾难在等着!在我们的乡村医疗服务中,烧伤是该地区一个大问题,村民狭小的屋子里,明火和滚烫的锅子,小孩子们还跑来跑去,在这样的环境里危险一触即发!

Children’s disaster waiting to happen in many villages.
很多乡村的儿童灾难诱发现场。

I knew of a child who had 20 operations to treat his extensive burns! Just hearing the story made listeners squirm in serious discomfort.

我认识的一个小孩子就经历了20次手术来治疗严重烧伤,光是听见这个故事,都能让人心碎。

Burns are the most miserable. Frankly, in medical training, the most miserable medical problem I encountered could well be severe burns or scalds. Any visit to the Burn Ward was the most hair-raising experience. Just to see the exposure of the burnt body to the outside world, the rawness of the skin, and the often-painful changing of body fluid-soaked gauze, all of these are still very vivid in my mind.

烧伤是最糟糕的。坦率地说,在医学院里,我遇到的最糟糕的医疗问题很可能是严重的烧伤或烫伤。任何一次对烧伤病房的访问都是最令人毛骨悚然的经历。光是看到被烧焦的裸露在外面的身体,被剥离的生肉,换纱布时被津液浸湿的纱布撕扯皮肤时的痛苦,这一切的一切都还历历在目。

And often there was the smell of burnt skin in the air, mixed with the smell of infected skin and the smell of antiseptics in the room. Probably among the most traumatic experiences for any budding medical student.

空气中时常弥漫着皮肤烧焦的味道,房间里混杂着皮肤感染的味道和消毒剂的味道。对于任何初出茅庐的医学生来说,这可能是最痛苦的经历之一。

A full glass of boiling water. I was having lunch at one of our favorite Chinese restaurants. Instead of tea, I usually order hot water, which is a common traditional alternative to tea. However, the water was boiling hot, and filled a large drinking glass before me. I tipped it by accident, and my entire forearm instantly felt on fire.

满满一杯开水。我在我们最喜欢之一的一家中国餐馆吃午饭。我通常点热水而不是茶,这是一种常见的传统茶替代品。然而,我不小心打翻了一大杯满满的滚烫的开水,我顿时感到整个前臂像被火烧一般。

I immediately thought the best thing to do would be to roll up my searingly hot wet sleeve that was clinging to me. But unknowingly, that simple action tore apart an already instantly developing blister.

我立刻想到此刻最好的办法就是卷起紧贴在我身上的灼热的湿袖子。但谁知道,这么一个简单的动作就撕开了一个已经在瞬间形成的水泡。

I intuitively and immediately ran to the washroom and turned on the cold water. I was relieved that the water felt ice-cold, so I didn’t have to get ice. I just kept the cold water running for a long time, and I think that calmed down the whole scald.
我凭直觉立刻跑到洗手间并打开冷水。冰凉的水让我感觉舒服多了,所以也不需要冰块了。我只是让冷水流了很长时间,整个烫伤的感受平静下来了。

Instant damage control. It was only after I stopped the ice-cold water that I realized, however, that half of the two- inch-long scald was already partly denuded because I had pulled my sleeve off of it. The other half, however, to my great relief, was a skin blister still covering the scald, thus not exposing any raw tissue, the layer under skin. I knew instinctively to not tamper with that delicate situation. Definitely not to touch, cut or trim the peeling skin, or some temptation like that.

即刻伤口处理。等到我关了凉水开关,我才发现那两英寸长的烫伤已经有一半因为袖子被扯下而被剥掉了。但让我欣慰的是,另一半伤口皮肤上还保留着一个皮肤水泡,覆盖着烫伤处,也因此没有暴露任何原始组织(或皮肤下的任何一层)。我直觉地知道,我不能随便乱动这些脆弱精细的伤口,绝对不能触摸,切割或者修剪脱皮的皮肤,以及类似的其他人们可能很想做的动作。

I remembered the training guidelines, “At all costs, let the natural skin cover the burn, don’t let it get raw, and don’t puncture the blister if there is one.” I kept my respectful distance! “Don’t do anything silly!” Maybe “next time” I should not even roll up my sleeve but rather immediately run to pour ice-cold water on the sleeve and forearm, thus maybe avoiding any tearing of a potential blister.

我想起培训指南中:“无论如何,让自然皮肤覆盖烧伤,不要撕它或抠它,如果有水泡,不要刺破。”于是我就尽量对伤口敬而远之也警告自己“别做傻事!”也许“下一次”我不应该卷起袖子,而是立即跑去将冰水倒在袖子和前臂上,这样也许可以避免撕裂潜在的水泡。

Our niece also had a germ-killing (bactericidal) spray with lidocaine (a local anesthetic) in her car, so she quickly grabbed that and sprayed it onto the wound. I assume that the quick ice-cold water and the spray did the trick, because everything remained quite calm and, thankfully, even quite pain-free.

我太太的外甥女的车里也有一种含有利多卡因(一种局部麻醉剂)的杀菌喷雾剂,所以她很快拿来喷在我的伤口上。我猜是快速的冰冷水和喷雾起到了作用,因为一切都非常平静,感谢上天,我甚至完全没有了疼痛。

My scald nearing full healing. In-between images resembling charbroiled steak have been censored for esthetic reasons.
我的烫伤伤口临近痊愈的照片,再之前的照片因为酷似炭烤牛排,出于美学方面的原因就不予分享了。

Daily color show. Over the next week, I observed the changes happening step-by-step in my scald. The half that was denuded began to look quite frightening, changing color from pink to red to purple to brown to black.

每日色彩秀。在接下来的一周里,我观察到烫伤处所发生的变化。被剥光的那一半开始看起来相当可怕,颜色从粉红色变为红色,再变为紫色,然后变为棕色,最后变为黑色。

It was actually fascinating to watch it all happening before my eyes. The other half of the scald had been much better protected by skin and calmly turned brown and then blackish.

看着这一切发生在我眼前让我感觉很奇妙。另一半的烫伤处被皮肤保护得更好,从容地变成棕色,然后变成黑色。

“That’s why I didn’t go to medical school.” I took daily pictures to watch the “exciting” progress of the scald. I’m not sure whether you would feel the same way, so I’m a bit nervous about even showing you my beautiful photos.

“这就是我没有去医学院的原因。” 我每天兴奋地拍照记录烫伤的进展。我不确定你是否也会觉得兴奋,所以要给大家展示我当时的美丽照片,我其实也有点紧张。

At first, my family members were not all that excited about seeing them either, I think, and I just assumed they were probably thinking, “That’s why we didn’t go to medical school!” But hey, you’re stuck with a doctor father/uncle.

起初,我猜想我的家人也一点也不想欣赏这些照片,我(才)猜想他们可能会说“(医学院里总有这些可怕的图片),这就是我们不想上医学院的原因!”但是没办法,谁叫你们有个医生爸爸/叔叔呢。

For me, all the “magical healing” reminded me vividly that the healing process is indeed a marvelous one, all the way from creating a new skin covering, step by step, to peeling off the old one, to complete healing.

对我来说,所有的“神奇治愈”都生动地提醒着我,愈合的过程确实是一个奇妙的过程,从一层一层地形成新的皮肤覆盖物,到剥去旧的皮肤,直至完全愈合。

If not for all the millions of cells rushing to the scene to make the repair system work, the scald could easily have become infected, abscessed or necrotic, or maybe could have even become systemic (full-body) blood poisoning. But none of that happened.

如果不是数以百万计的细胞赶到伤口现场使修复系统发挥作用,烫伤处很容易发生感染、脓肿或坏死,甚至可能发展为系统性血液中毒。但这些都没有发生。

A chance to be creative. In this process, I thought of my plastic eye protector which I had recently used for my glaucoma postoperative care. By cupping it over my eye at night during sleep, it had very efficiently protected my eye from outside injury. So this came in handy now to similarly protect my new scald, perfectly cupped over the scald, especially when I was sleeping and might accidentally injure it. I also regularly sprayed antiseptic spray on the scald to be doubly sure it wouldn’t get infected.

一个发挥创意的机会。在这个过程中,我想到了我最近用于青光眼术后护理的拱形塑料护目片。晚上睡觉时我将它罩在我的眼睛上,这样可以有效地保护我的眼睛免受外界伤害。现在,这个护目片派上用场了,我可以将它完美地包裹在烫伤上来保护我的新烫伤,特别是当我睡觉时有可能会不小心弄伤它的时候。我还定期在烫伤处喷洒杀菌喷雾,以确保它不会被感染。

In fact, just by wrapping my forearm with plastic wrap, I could even take a shower with no water splattering on the wound at all. The marvels of modern conveniences! I couldn’t even brag about any real pain at all to get extra sympathy.

实际上,只要用保鲜膜裹住我的前臂,我甚至可以在洗澡的时候完全避免水溅到伤口。现代设施的便利真是了不起!遭遇这样的烫伤,我都没法抱怨自己的痛苦来获得额外同情,因为实在是没有什么痛苦!

Charbroiled steak representation of the full-blown scald effect.
炭烤牛排代表了完全的烫伤效果。

Raw skin looks so vulnerable. Looking at raw skin that has been denuded is pretty unnerving, because you know that it’s highly vulnerable to all kinds of bad things happening to it. It’s the kind of bad feeling you have when somebody talks about skinning you alive, which I guess happened in old days, or maybe even happens in torture chambers today.

被剥光的原始皮肤看上去很脆弱。观看被剥光的原始皮肤会让人非常不安,因为你能知道任何发生在它身上的坏的情况都会导致它受伤。这种感觉就像当有人谈论要活剥你的皮时,你所能感觉到的那种非常不好的感受。但这在过去实际发生过,或者甚至可能发生在今天的刑讯室里。

Touch, pleasure, or pain. When the skin is intact and healthy, we all know that it is a site for touch and pleasurable sensations. Innumerable babies have been studied for the positive effects of skin-to-skin contact on their emotions, growth and development. And we’ve likely all heard of the great psychologic and developmental damage to babies who did not receive normal skin touch sensations from their mothers and family.

触摸,愉悦或痛苦。当皮肤健康完好时,我们都知道它是能产生触摸和让人愉悦的感官。对无数婴儿的研究已经证实了皮肤接触对他们的情绪、成长和发育的积极影响。我们可能都听说过没有从母亲和家人那里获得正常皮肤触觉的婴儿会受到巨大的心理和发育伤害。

However, we also know that the skin can be the location of many of great pain, since there are abundant pain nerve endings in the skin. Pleasure and pain all in one location.

然而,我们也知道皮肤可能是产生许多剧烈疼痛的部位,因为皮肤中有丰富的疼痛神经末梢。快乐和痛苦都集中在一个地方。

Precious baby skin. The skin of premature babies is particularly sensitive to breaks and injury. How do we protect it from tapes that are too sticky that can tear off the skin, from liquids that injure it, and from germs that are hovering? Especially in the sensitive diaper area. Just even imagine the tiny size of the diapers they need. All were good challenges for our creative skin professor.

珍贵的婴儿肌肤。早产儿的皮肤对破损和受伤特别敏感。我们如何保护它免受太粘而会撕裂皮肤的胶带、伤害它的液体以及盘旋的细菌的伤害?特别是在敏感的尿布区域。想象一下他们需要的尿布有多大。对于我们富有创造力的皮肤教授来说,这一切都是很好的挑战。

Never look down on your humble skin. It’s your one and only organ that wraps all around you and hugs you tightly. In turn, take good care of this wrapper! Like every organ in the body, it is exclusively designed just for you, and has literally thousands of complex mechanisms defending only you, minute by minute. It is so easy not to realize its functions or appreciate it! So, especially keep it intact, safe and sound. Stay away from hot boiling water and keep children away from tipping hot woks!

永远不要看不起你卑微的皮肤。它是您唯一的一个可以环绕你并紧紧拥抱你的器官。反过来,请妥善保管此包装纸!就像身体中的每个器官一样,它是专门为你设计的,并且拥有成千上万的复杂机制,每时每刻保护着你。它太容易被轻忽以至于它的功能不被了解也不被感激!所以,请特别地保持皮肤完好,安全,健康。远离滚烫的开水,让孩子远离翻倒的热锅!

Reference.

1.Skinny: the true information about someone or something that is not known by most. Merriam Webster dictionary online.

1.Skinny(俚语)关于某人或某事的而大多数人都不知道的真实信息。Merriam Webster在线词典。