SUSAN DENTZER: Former Navy Lieutenant Kevin Shaeffer was undergoing physical therapy for burns recently at a Washington, D.C., Hospital.
KEVIN SHAEFFER: I've started working down here about four weeks ago on a daily basis, here in the gym, sometimes twice a day, but at least once a day, including the weekends.
SUSAN DENTZER: Shaeffer, who's 29, used to be on the staff of the chief of Naval Operations, helping to chart strategy for the U.S. Navy. He was at his old job at the Pentagon when the attack came on September 11th. As fire roared through the building, he suffered serious burns over 40 percent of his body, especially on his hands and arms.
KEVIN SHAEFFER: It was quite...quite terrifying. It was black. I was knocked down. I knew I was on fire. I had to roll to put myself out, and then find out if anyone else was around, which, unfortunately, no one else was where I was.
SUSAN DENTZER: Shaeffer managed to make his way out of the Pentagon to rescue crews, and was taken here to the burn unit at Washington Hospital Center. He doesn't recall much about those first few hours, except struggling to get his wedding ring and his Naval Academy class ring off of his badly burned fingers.
KEVIN SHAEFFER: I had heard someone say that they were going to have to cut the rings off, and so I basically stopped, made them stop what they were doing, and I was able to rip off both of my rings and give them to them so they wouldn't have to cut them off.
SUSAN DENTZER: James Jeng is one of the burn doctors at Washington hospital center. He says the fact that Shaeffer remembers so little of those first hours and days is typical of victims who suffer painful and debilitating burns.
DR. JAMES JENG, Washington Hospital Center: They go through hell. And my only comfort comes from the fact that, almost to a man and a woman, they don't recall their intensive care unit stay, where the worst of it is. But even now, when they're going through rehabilitation, they're having a lot of pain, they're having a lot of suffering. And it's not just physical, it's emotional, too.
SUSAN DENTZER: Shaeffer agrees.
KEVIN SHAEFFER: Fortunately, I was on some medication, but even all the medication they can give you doesn't even keep the pain from breaking through. So it was very, very painful, both to my body, and trying to deal with it mentally was really difficult, especially early on.
SUSAN DENTZER: Besides the burns, Shaeffer also had devastating damage to his respiratory tract, thought to have been caused when he inhaled jet fuel. Hospitalized until mid December, and in intensive care for weeks, Shaeffer was twice on the verge of death, says his physician, Dr. Marion Jordan.
DR. MARION JORDAN, Director, Burn Center, Washington Hospital Center: I did five operations in five days when the infection was at its worst, because we kept going back to try to get the infected burn tissue off of his arms.
SUSAN DENTZER: Shaeffer and nine other patients from the Pentagon who were brought here to Washington Hospital Center benefited from new burn research and treatments. These advances have improved survival rates for the estimated 50,000 Americans seriously burned each year.
But even with new burn treatment and technology, about 5,000 U.S. burn victims still die annually, and Jordan says that's in large part because serious burns are possibly the worst traumas the human body can suffer.
DR. MARION JORDAN: The burn injury is more than just a surface injury. It's a total body injury, and has the potential for disrupting major bodily functions, including the heart, the lungs, the kidneys, and other body processes.
SUSAN DENTZER: It's clear that the first thing a burn does is damage the skin. In what's called a first-degree burn, for example, a sunburn, only the outermost layer, the epidermis, is harmed. That type of burn usually heals itself without incident. By contrast, a second-degree burn, such as the kind that may take place in a kitchen accident, destroys the epidermis and exposes the second layer of skin, the dermis. Then there are third-degree burns, like those suffered by most of the Pentagon victims.
DR. MARION JORDAN: Both the epidermis and the dermal layers are destroyed, and so you have nothing from which epidermal cells can migrate or can regenerate. Those burns go into the fat. The nerve endings are destroyed, and those are painful.
SUSAN DENTZER: With the body's protective coating of skin gone, these so-called "full thickness" burns pave the way for massive fluid loss and death from bacterial infection. At the same time, for reasons experts don't understand, burns also unleash a flood of chemicals in the body, in what's known as an inflammatory response. That, too, can kill a patient swiftly in the absence of proper care. So nowadays, doctors and nurses move immediately to stabilize burn patients and counteract those harmful body responses. Then, in a procedure known as debridement, the burned, dead skin is thoroughly shaved off.
DR. MARION JORDAN: We put the patient completely to sleep. The patient has no sensation and no feeling as this is taking place. And we take a variety of instruments with very, very sharp blades, and we take off thin layers at a time, about two millimeters thick. And as each layer is peeled off, we look again to see if there is an evident surface that is still injured, or if there is a surface that is now healthy looking.
SUSAN DENTZER: Normally, this surgery is performed two to three days after the burn takes place, when a patient is stable enough to withstand the considerable blood loss of the operation. But in the case of the Pentagon victims, doctors moved up that schedule by about a day. Dr. Jeng says that decision stemmed from new scientific insight about what actually happens when skin burns.
DR. JAMES JENG: Most people at first glance would think that the injury occurs as long as there's that heat source adjacent to the skin, and once the burning of the cloth is done, or the removal of the heat is effected, the injury stops. And that's really not the case. In my own laboratory recently we've published work that shows that the burn wound continues to evolve and indeed worsen over time, even after the burning material has been removed.
SUSAN DENTZER: So by operating on patients earlier, Jeng says, doctors were able to keep already bad burns from becoming far worse, and to speed the recovery process. Once the patients' own burned skin was removed in surgery, the doctors in some cases replaced it temporarily with donated skin from human cadavers. But given the relatively large number of patients they had to treat, they also made use of several innovative biosynthetic skin substitutes. One is called Integra. It's made from the unlikely combination of cow protein and powdered shark cartilage.
DR. MARION JORDAN: You shave the burn wound off, you apply the Integra, and then you have to do a good deal of care and feeding of that material to keep the patient from shearing it off and getting infection under it.
SUSAN DENTZER: After two weeks, new blood vessels grow up through the Integra patch, in effect creating a new live dermal skin layer. Then doctors apply a very thin layer of the patient's own skin over that, to create a new epidermis. Kevin Shaeffer underwent several such procedures, as patches of Integra were covered with thin transplants of skin taken from his legs.
KEVIN SHAEFFER: It's pretty amazing, the amount of coverage that you can get from a relatively small piece of healthy skin. It can be stretched out to cover and protect a large wounded area. And that's what they took to put on my arms and some smaller pieces on my back to cover up my burns.
SUSAN DENTZER: All told, Shaeffer and the other Pentagon burn victims underwent more than 100 operations. All but one patient, who died shortly after the attack in September, have now left the hospital. Pentagon officials visited Shaeffer there recently, on the day he went home.
OFFICIAL: How do you feel?
KEVIN SHAEFFER: I'm feeling great.
OFFICIAL: Thank God.
KEVIN SHAEFFER: So today is the day I've been anxiously awaiting.
SUSAN DENTZER: Shaeffer has received a medical discharge from the Navy, and says he'll spend the coming year figuring out what to do next.
KEVIN SHAEFFER: My main focus right now is on healing and getting better, and being at home.
SUSAN DENTZER: For at least a year, Shaeffer will have to wear these pressure bandages on his hands and arms to minimize formation of scar tissue. He'll also continue to undergo physical therapy to stretch the grafted skin and restore movement.
KEVIN SHAEFFER: You're never the same the day after an injury like this as you were before. But you need to realize that, accept that you can't change it, and try to work as hard as you can to get back to that point and make the best out of the situation.
SUSAN DENTZER: Shaeffer says he's looking forward to the day when his hands and fingers have healed enough so that he can wear his rings again. Until that time comes, his wife, Blanca, will continue to wear them on a chain around her neck.