Adrian Krasinskas knows what he can tolerate, and when, and keeps to his own schedule.
He can, for example, tolerate quite a bit of pain. His occupational therapist at the Rehabilitation Hospital of Rhode Island, in North Smithfield, uses all her might to push on his upraised arm, to stretch out the scar tissue on his back, shoulder, arms -- toughened skin that otherwise would clamp his limbs at his side. He closes his eyes and takes short breaths. He can take it.
But he can't tolerate looking in the mirror. This surprises his caregivers a little, because Krasinskas, 29, doesn't look bad. Although he was burned over 45 percent of his body, most of his face is unscathed.
Not that it's perfect. The outer rims of his ears are gone. The left side of his mouth droops a little. A patch covers one eye, and a white gauze cap protects the wounds on his head. His hair is gone. He was burned, in one spot, down to the skull.
"You look good, Adrian," Lori Connolly, the occupational therapist, tells him, wondering why he eschews the mirror.
Krasinskas is firm. "I'm not ready for it," he says.
Adrian Krasinskas used to be an insurance claims representative. Now his job is to get better, and it's full-time work. One of the most severely injured survivors in The Station fire on Feb. 20, he left Massachusetts General Hospital a week and a half ago, joining dozens of other survivors who are embarking on the long road to recovery.
Some, like Krasinskas, are in inpatient rehabilitation at a hospital. Others go to outpatient clinics or get in-home care. They all need to regain their strength and dexterity, and work on stretching and smoothing their injured skin. And they all need to adjust to the losses they've suffered.
Krasinskas keeps to his own schedule on that matter, too. He says he's feeling fine emotionally and remembers everything about the fire. He quickly adds, "I don't really think about it too much. I try not to think about it."
His parents, Robert and Aline Krasinskas, of Oxford, Mass., say that the psychiatrist at Mass. General had advised them to wait for Adrian's questions, when he emerged from the medication-induced coma and got off the ventilator.
His questions were slow in coming. It was a week after he regained consciousness before he finally asked his girlfriend, Teri-Ann Wyman, why his best friend, Keith Lapierre, had not come to visit. They were on the phone, so she changed the subject. The next day, Bob and Aline Krasinskas, and Wyman, came to the hospital together to tell him.
"It took us almost two hours," Bob Krasinskas recalls. They kept making comments that they hoped would elicit a direct question about Keith, but Adrian never asked.
Finally, they told him: Keith, Adrian's best friend since second grade, was among the 96 people who didn't make it out when The Station nightclub burned to the ground on Feb. 20.
Krasinskas is one of five victims of the fire who have come to the Rehabilitation Hospital of Rhode Island. Two of the five have already gone home, and more are expected to arrive from Mass. General in the coming weeks.
Before the first patients arrived, the staff covered the wall mirror in the gym with a construction-paper seascape mural.
Before he can leave, Krasinskas must learn to walk without assistance and to take care of himself, and must gain strength and flexibility in his arms, shoulders, neck and back. It's expected to take several weeks.
On Thursday, Krasinskas shaved his face on his own -- with an electric razor, so he didn't need a mirror.
The day before, he took his first stroll without the aid of a walker, walking 100 feet from his room to the gym. His steps were small and halting, his legs thin, showing the rectangular purple patches left by skin grafts.
He had been a robust, athletic guy, 6-foot-2, 214 pounds. But lying in a coma for six weeks takes its toll: the muscles atrophy, the body weakens. Krasinskas lost 45 pounds.
The biggest battle, though, is against the scars, which harden, thicken and constrict in ways that can be crippling. Without months of therapy, scars can become like a cast sealing the arm in a bent pose, or they can curl fingers permanently into the palm. So recovery requires a constant fight against the tightening of this fibrous tissue that now must function as skin. That takes massage, moisturizers, and, most of all, stretching.
In his time at Mass. General, Krasinskas underwent 13 operations and received 46 units of blood. Doctors sheered off thin layers of skin from his legs and abdomen, passed the skin through two metal rollers to cut holes in it, like a screen, and stretched it over his head, back, and arms. The holes fill in, but the screen pattern stays.
Even while he was comatose, Adrian's parents and girlfriend took turns going to the hospital, so that someone was with him every day. His sister, Dr. Alyssa Krasinskas, a pathologist in Pittsburgh, made frequent visits as well.
His parents drove an hour to Boston at midday and would stay until evening. They weren't permitted to sit by his side when he was intensive care, but every hour they had five minutes with him. When their moment came, they quickly donned arm-length gloves and reached through the plastic sheets that enclosed his bed in a box of warm, sterile air, seeking an unbandaged spot -- his nose, his cheek -- to touch.
Now at the rehab hospital, Connolly, the occupational therapist, puts Krasinskas through his paces. She starts by rubbing gobs of thick white cream into Krasinskas's back, to help the skin become more pliable. His entire back is purple and leathery, with grid marks left by skin grafts.
The shoulder, she explains, is a complex joint that needs to move in several directions. As Krasinskas lies back in his bed, she lifts his arm perpendicular to his body, and pulls it up. His own muscles are not yet strong enough to work against the tightening skin. Then she crosses his arm over his chest, and pushes on it. She lifts his arm over his head, grasping his shoulder with one hand and pressing just below his elbow with another. He closes his eyes. "Stop," he finally says. A second or so later, she stops.
"It has to hurt in order to make gains," she explains.
After his therapy, Krasinskas pulls a blanket up to his chin. He's cold: burn victims lose heat easily.
Krasinskas is asked what he most looks forward to. He answers instantly: "Just going home."
ON HER GOOD DAYS, Michelle Spence feels lucky that she survived, that she could come home to take care of her 10-year-old daughter, Hailey. On her bad days, she wonders why this had to happen to her, and gets angry at those responsible. And every night, she sleeps restlessly.
She was one of nine employees of Bickford's Family Restaurant, in North Providence, who went together to the Great White concert at The Station. Four died. Of the five who escaped, Spence, 29, was the most severely injured -- burns over 30 percent of her body, mainly her arms, head and back. She was on a ventilator for a time, and underwent skin grafts on her arms and back.
She's been out of the hospital for more than two weeks now, and last Thursday she went for her first session with occupational therapist Lois Holmes, at Rhode Island Hospital's Coro Building.
With Hailey watching quietly at her side, Spence takes off her jacket and displays her arm, the skin reddened and uneven. The middle of her face has a splash of pink. She says her back is itchy, her arms throbbing.
Spence cannot fully extend her arm. Holmes measures the angle of how far it can go. She asks Spence to go through several motions with her arms, measuring each, and asks whether she can feed herself, tie her shoes, open doors, all of which Spence says she can manage. She has Spence grip a metal device that measures the strength of her hands.
Holmes explains that Spence will soon be measured for her Jobst garments, made of elastic fabric that compresses the skin. Nearly all burn victims wear these garments 23 hours a day. The compression keeps the scars from building up and becoming bumpy.
"It will be like a jacket that zips up in front," Holmes explains. "It's not going to be fun in the summer."
"I'm going to have you come in for an hour, three times a week," Holmes says, "to stretch out your elbow and strengthen your hands."
Spence gets up, looking exhausted and uncomfortable. This might be turning into one of those bad days. Just last Tuesday, she went with another survivor to the cemetery. Spence took it hard when she heard about her friends' deaths, especially that of her boss, Mark Fontaine. She had missed the funerals because she was in the hospital. Tuesday they put flowers on the graves. It was pouring rain. Then they left, saying nothing.
"Sometimes it's not real to me that they're gone," Spence says.
In the waiting room, she finds her mother, Wanda St. Hilaire, who also works at Bickford's. The disaster has been hard on St. Hilaire. Another daughter, Tammy St. Hilaire, was also in the fire, but escaped with minor injuries. When she first saw Michelle in the hospital, right after the fire, Wanda fainted. The next weeks were a chaotic haze for Wanda and Tammy. They didn't eat, they didn't sleep, they didn't go to work. In the hospital, Tammy collapsed from dehydration. At home, laundry piled up and bills went unpaid.
"We went home every night not knowing if she would live or die," Tammy says.
Through it all, meanwhile, St. Hilaire and Spence are virtually homeless. Spence had been living with her mother and daughter in an apartment in Central Falls, but they had to leave when the building was put up for sale. They've been staying with Tammy in Lincoln, and also at a house in Attleboro with Wanda's ex-boyfriend and his mother. The Attleboro house is "not a good situation," Wanda says, but they haven't yet been able to find an apartment they can afford on Wanda's salary as a waitress.
Now, in the therapy reception area, Spence, who is not yet able to drive, tells her mother about the three appointments a week. St. Hilaire gets out her cell phone to find out her work schedule. Talking back and forth with the receptionist, they puzzle over how to get to treatment three times a week.
MISSY MINOR didn't need skin grafts for the burns on her face, hands and arms, but she seems to be in a lot more pain than those who did. "It hurts to heal," says Minor, 28, a hairdresser. "It feels like I'm being burned again." She's still taking painkillers, and expects to need them for many weeks to come.
At her West Warwick home one recent afternoon, Minor rests her elbow on her kitchen table, as Matthew Wright, an occupational therapist with Assisted Daily Living, takes her hand. He rubs in a vitamin E oil, and then bends each finger down as far as it will go, rubbing in small circular motions with his thumb. She says her skin feels like sandpaper, and when he rubs it, it feels like he's scratching an itch.
"I have 90-year-old skin," she comments. "I don't even know if you could call it skin. It's scar tissue, and it's so sensitive."
Wright curls another finger down, and holds it.
"Does that hurt?" he asks.
"A little," Minor says. "I don't know why you ask." She smiles ruefully at a visitor. "He already told me it wouldn't stop him."
In addition to Wright's visits, Minor goes to the outpatient burn clinic at Rhode Island Hospital. She wears Jobst compression garments on her arms. She has a daily regimen of hand exercises: crumpling strips of newspaper, placing an elastic band around her fingers and forcing them open, picking up coins, and hooking paper clips together. Early this month, she happily resumed her workouts at a local gym.
When Minor first returned from the hospital, she couldn't hold her 3-month-old daughter, Mara-Jade, for more than a minute. It hurt her still-bandaged arms. Her fingertips were so sore she couldn't unbuckle the belt on Mara-Jade's child seat. Her husband, John, helped her get dressed and cut her food.
Now she can hold the baby, but has to try hard not to cry out when Mara-Jade grabs her fingers. Her cries upset her three-year-old son, Anakin.
Unlike Adrian Krasinskas, Minor wants to talk about the fire. She thinks it's therapeutic, even though she trembles as she tells the tale.
"The whole place was pitch dark and filled with smoke. There was less and less oxygen." Her voice gets low and quavering. "People were trying to get out. The smoke was so black and thick you could grab it in your hands and carry it. You could taste it, it was thick, it was chemical . . . . I walked toward where I thought the window was. I couldn't lift my leg. I fell onto the floor. I think somebody help me up. I thought, 'I can't believe I'm going to die. I can't believe I'm never going to see my babies again.' "
Outside, in shock, she looked matter-of-factly at the skin hanging off her arms, and tried to put it back on, and put snow on it.
A week later, her injured lungs rallied, and the doctors took her off the ventilator and eased her out of her coma. She thought a few hours had passed. It took her a while to understand "why everyone was looking at me like I had just come back from the dead." Her husband, John, whom she has adored since she was 13, had a different look in his eye.
"I never realized I loved you so much," he told her.
Her face was scabbed and peeling; she didn't even look at it until the day before she left the hospital. But within days after coming home, the burned skin peeled off, and Minor looked fine. Facial skin, infused with many blood vessels, tends to heal fast.
Yet, she says, "I didn't sleep for a long time. I was scared to have nightmares." At night, she kept touching John, assuring herself of his presence.
When she closes her eyes, she sees the faces of people who didn't survive, people she had seen but didn't know well. She's deeply grateful that her two best friends made it out, though one was badly hurt. She's grateful to be back with her family. She's grateful for the medical resident -- if only she knew her name! -- who saved Minor's engagement ring in her pocket, and returned it to her later. The ring had belonged to John's mother.
But with her fingers so tender, it will be a long time before Missy Minor can wear it again.
View a multimedia presentation of The Station fire coverage, post messages to a tribute to its victims, and find related resources at:
http://projo.com/extra/2003/stationfire/
