Three weeks after the explosion, Paul Seckinger opened his eyes for the first time in his hospital bed, looked up and smiled weakly at his mother.
Two days later, his mother says, doctors had to halt surgery as they worked to repair the second- and third-degree burns over 80 percent of Seckinger's body because his lungs had filled with fluid and his blood pressure plummeted. When his mother got back in to see him, she saw terror in the eyes that held so much hope the days before.
"His eyes were open real big and he was just looking at me like, 'Mom, help me.' It was very scary," says Karen Seckinger, still shaken by her son's sudden turn.
Nearly a month after a blast that killed 12 workers from the Imperial Sugar refinery in Port Wentworth, Ga., 11 others remain hospitalized at the nation's largest burn center. Eight of them remain in critical condition. They face a long, painful roller-coaster ride to recovery, with peaks of progress followed by terrifying drops.
As of earlier this week, the refinery workers at the Joseph M. Still Burn Center in Augusta occupied nearly half of the intensive care unit's 25 rooms, each with large windows that let nurses keep an eye on every patient at all times.
In general, the prognosis for victims of severe burns is poor. And most of the Imperial Sugar workers are in grave condition.
Family members must scrub their hands and put on gowns and masks before entering the hospital rooms; with much of their skin burned away, the victims run a high risk of infection.
They have tubes in their throats to help them breathe. Feeding tubes constantly pump nutrients into them, even during surgery, as their bodies ravenously consume energy to heal. As many as 13 bags of intravenous fluids at a time drip vitamins, electrolytes, painkillers and anti-anxiety medicines into each patient's veins. Dialysis machines filter wastes from their blood to keep their kidneys from overworking. The pain would be excruciating if they weren't heavily medicated.
"It's going to be a day-by-day thing to see if they make it through it," says Dr. Jeff Mullins, the burn center's medical director.
To stay for months
Changing a single patient's bandages, something done at least once a day, can take two hours. Each one's vital signs must be checked hourly, so the burn center assigns one nurse per patient, day and night. The 11 will probably be at the burn center for several more months.
Eight of the dead were found in the wreckage of the plant, which was flattened by an explosion that investigators blamed on combustible sugar dust igniting. Four more victims died at the burn center in the weeks that followed; the most recent death was Feb. 26.
According to the American Burn Association, the U.S. mortality rate is 57 percent or higher among patients who suffered severe burns over 70 percent of the body or more.
Still, the deaths of the refinery workers at the Augusta burn center have hit its nursing staff hard. Clinical nurse manager Lynn Dowling sheds tears when asked about them.
"That's when we realize it's out of our control," Dowling says. "You're caring for a patient day after day and you're pouring your whole heart into everything you do to save a life, because you know he's the father of a small child or a newlywed."
Growing new skin
The refinery victims have entered a critical stage of their recovery. This week, doctors began covering their burns with permanent skin grafts from a Boston laboratory that uses small skin samples from patients to grow new skin in test tubes. The procedure, developed in the 1970s, is used mostly for burn victims who do not have enough healthy skin left on their bodies to use for grafts.
Because the laboratory skin is grown from patients' own cells, it is not rejected by their immune systems like the skin from cadavers and pigs that is used to cover their burns temporarily.
On Tuesday, Mullins used a staple gun to attach 56 pieces of the lab-grown skin — each the size of a playing card — to the left leg of 19-year-old refinery worker Lawrence Manker Jr., who had raw burns from his ankle to his hip. Manker will need two or three more operations for his other leg and arms.
The new skin restores a protective barrier against infection and helps restore the body's ability to regulate its temperature, the reason Mullins' operating room is kept at a toasty 85 degrees. Still, it will take a year for the skin grafts to thicken and become more durable.
"It's very, very fragile," Mullins says. "It's only four to six cell layers thick, so it's thinner than onion paper. A good breeze could blow it off until it becomes attached."
Seckinger's lungs were seared in the accident. But his face wasn't disfigured; the 33-year-old machine maintenance worker and single father of an 8-year-old girl apparently shielded himself with his hands and arms, which were badly burned.
30-minute visits for family
In the waiting rooms, the wives, parents, brothers and sisters of the refinery victims spend their days swapping stories and updates on their loved ones in the long stretches between visiting hours — or visiting half-hours, mostly. Most of the visitors are 140 miles from home.
Every morning, noon and afternoon, they gather outside the ICU for 30-minute visits. They get one full hour every evening. They stand at the patient's bedside offering words of encouragement and prayers and looking for any sign of response.
Jenny Purnell got more than she expected from her husband, 23-year-old Justin Purnell, when he looked up at her and moved his mouth this week. With a breathing tube in his throat, he couldn't speak, but she managed to read his lips.
"He opened his eyes and said, 'Good morning,' and then he said, 'I love you,'" Jenny says. "Just the littlest things through all this make you feel so much better."
She last heard her husband's voice the night of Feb. 7, when he called her on his cell phone from inside the refinery. Something had blown up, he told her, and she needed to call 911. He phoned back a few minutes later to tell her he had made it outside OK before the phone went dead.
Families try to cope
The families have received an outpouring of donations. They are getting ready to move from hotels into apartments — another reminder of the long recovery ahead — paid for by Imperial Sugar. Church groups deliver hot meals such as fried chicken and lasagna twice a day. The burn center's foundation gives them $50 gas cards for trips home.
Hattie Frazier's son, refinery floor manager Malcolm Frazier, worked in the packing department that took the brunt of the Feb. 7 explosion. A co-worker, his mother says, found him on the floor of the burning building and dragged him to safety. He suffered second- and third-degree burns on 85 percent of his body.
Malcolm had planned to take a week off this month to take a trip with his parents to celebrate their 57th wedding anniversary March 14. Now they will be spending it at the burn center, where visiting four times a day is too much for Malcolm's mother.
"I go in once a day and pray for him, but it's real hard," she says. "To see him open his eyes, but he can't say anything, it's too much to go through. But I let him know I'll be here as long as he's here."