Discoveries Magazine

Cedars-Sinai

In Good Hands

In Good Hands

Larry Davis, photographed at Big Bear Lake in August 2011. After nearly losing his hands in a blaze, the former fire captain is again able to do what he loves best: fishing.

Fire Captain Larry Davis had spent his life helping people in need. But after a horrific blaze devastated his hands, he faced a lifetime of limitations—until a dedicated surgeon reopened his world.

Past the spiked and sculpted Joshua trees, the lazy stretches of sagebrush, and the front yard with the cow and her inquisitive calf, sits the house that Larry Davis built.

He built it back in 1991, when this high-desert community of Apple Valley was beginning to boom. He did all the plumbing and tile work, built the fences, assisted with the framing. He and a buddy did the electrical work. Over 11 months, he hammered, drilled, painted, and sanded, shaping the structure with his hands until the beige-and white ranch house was ready to be called home.

“A lot of what you see here I built myself,” he says firmly.

Inside the house, Larry, 49, leads the way to the dining room table. Six feet tall, with the strong build of the football linebacker he once was, he brings a glass of water and deftly slaps an errant fly with a bright green fly swatter.

Carrying a glass, swatting a fly—most of us take such simple tasks with our hands for granted. At one time, Larry did, too.

The fire changed everything.

The same year that Larry built his house, another dream came true: He became a full-time firefighter.

Originally, he had followed in his uncle’s footsteps as a plumber. But he had also moonlighted as an on-call fireman for Apple Valley. With the town opening three new fire stations, he jumped at the chance to go full time.

It was a perfect fit. He was young and strong. He had played football in high school and community college, and he liked being part of a team. Most importantly, he liked helping people.

“I didn’t think of it as being a hero,” Larry explains. “But I enjoyed all that came with fighting fire and just helping people in need, people who are facing a true emergency.”

It was a good life. He and his wife, Denise, were raising four beautiful daughters. He loved living in Apple Valley on his own two-and-a-half acres of land, with plenty of room for his dogs and a vegetable garden. An avid outdoorsman, he was only a short drive away from prime hunting and fishing—his favorite activities of all.

By the time October 9, 2006, rolled around, Larry had worked his way up to fire captain. He and his crew had just finished their morning workout when a call came in around 11 a.m. It was a house fire.

When they arrived at the scene, there were concerns that people could be trapped inside. Larry and another firefighter entered the house, crawling on the ground under the thick smoke. As it turned out, no residents were in the house.

The firefighters had been inside only a few minutes when conditions started to deteriorate. They needed to evacuate. Larry’s crewman was able to escape within moments, but still suffered second-degree burns.

Larry, though, was trapped for two to three minutes. Fellow firemen rescued him through a window. He suffered severe burns all over his body—especially his hands.

As paramedics airlifted him to a San Bernardino trauma center, Larry’s mind was on one thing.

“My hands,” he recalls. “They felt like they were still on fire.”

When Denise Davis got the call that Larry had been hurt, she grabbed three things on her way out the door: her purse, her cell phone, and her Bible.

It would be nearly two months before she would come home again.

That’s how long Larry spent at the Grossman Burn Center in the San Fernando Valley. He had second- and third-degree burns over 20 percent to 30 percent of his body, including his head, legs, arms, and hands. His face, fortunately, was unscathed, protected by his fireman’s mask.

His hands were not so lucky. They were so badly burned, doctors warned they might have to be amputated. They eventually amputated both pinky fingers as well as portions of several remaining fingers. In all, Larry had 13 surgeries, including skin grafts.

He was in constant, often agonizing pain. He spent hours going through “debridement”—the tortuous removal of raw, damaged tissue. His hands swelled up like balloons, with doctors having to slice them open to release the pressure. He had so many skin grafts, he felt like one giant open wound. He could not walk. He could barely move.

“I took things minute by minute,” Larry says. “Sometimes, it was second by second.” Through it all, Denise stayed at his side, refusing to go home even for a day. The couple had been married nearly 24 years, having met just a few weeks after her high school graduation.

“Larry was the football player, the body builder; just this rough, tough guy,” she recalls. “But underneath all that I could see a very soft heart. He was always thinking of others and helping people, without expecting anything in return.”

Now, Larry was the one who needed help.

Their oldest daughters—Brooke, Aubrey, and Shannon, who were in college—helped take care of their younger sister, Hannah, who was just 13. They brought Denise her clothes and bills. She slept in a reclining chair next to her husband’s hospital bed.

“She stayed with me day and night,” Larry says, his voice quiet. “She was my hero, that’s for sure.”

Fittingly, he was discharged to a rehabilitation hospital on December 14, Denise’s birthday. He stayed at the new facility another month. Finally, on January 12, 2007, he came home. The family celebrated. But soon, reality set in.

His hands were a mere shell of what they had been. He couldn’t grab or hold anything. At first, he couldn’t even eat, shower, or dress without help. He couldn’t pet his dogs, hug his daughters, or hold Denise.

Reminders of his past life—his tools, his hunting guns, his fishing gear—were everywhere.

“I was grateful that my hands had been saved,” he says. “But they didn’t really work anymore.”

The Cedars-Sinai office of David A. Kulber, MD, is more than 100 miles from Apple Valley, and on this hot August Tuesday, the early evening sun is streaming into the window. Dr. Kulber has just finished up with his final patient of the day, and after handing off a file to an assistant, he quickly tweaks the window blinds and relaxes onto the office sofa. A cream-colored surfboard hangs directly above him.

In Good Hands

As someone who has a passion for surfing and loves to play sports, no one needs to explain to Dr. Kulber the importance of hands. Indeed, he makes his living operating with them—and on them.

“We sometimes forget that a lot of the joy we get from life involves doing something with our hands,” says Dr. Kulber, director of the Center for Plastic and Reconstructive Surgery at Cedars-Sinai and of the Plastic Surgery Center at Cedars-Sinai Medical Group. “We need them every single day, for nearly everything we do.”

The human hand’s importance is matched only by its intricacy. A remarkable network of bones, tendons, nerves, and arteries, the hand follows the famed Fibonacci sequence of mathematical symmetry in nature and allows us to do everything from hold an egg to open a jar to play the guitar. What’s more, our hands are an integral part of how we express ourselves and show affection.

The complexity of the hands—and the challenging nature of repairing them—was part of what attracted Dr. Kulber to the field of reconstructive hand surgery. But just as important, and just like Larry, he wanted to help people.

Growing up, he would sometimes go on rounds with his dad, a head-and-neck surgeon who did facial reconstructions at the Grossman Burn Center. Later on, his beloved grandfather underwent one of the first-ever heart bypass surgeries at Cedars-Sinai in the 1970s. The surgery saved his grandfather’s life.

Dr. Kulber’s decision to go into medicine was sealed. He eventually chose plastic surgery—with a specialty in reconstructive hand surgery.

“If someone can’t use their hands, they’re at a deficit in so many ways,” Dr. Kulber emphasizes. “If you can make them functional again, you can make a tremendous difference in that person’s life.”

When Dr. Kulber first met Larry Davis, nine months had passed since the fire. The burns and skin grafts had healed. Left in their wake, however, was a horrendous amount of scar tissue. His remaining fingers were webbed together, and each hand was contracted into a kind of curved fist.

Although he had developed awkward techniques for basic tasks like eating and showering, Larry couldn’t hold or grip anything. Even picking up a soda can with one hand was impossible, let alone driving a car or going to work.

Hand reconstruction surgery is highly sophisticated and complex—and risky. One small misstep can mean the loss of a finger or the entire hand.

“It’s like one big block of cement, and out of that cement you have to carve something that looks like a hand,” Dr. Kulber explains. “And then you have to release all the structures that make the hand work—all the tendons, nerves, and arteries.”

He started with Larry’s right hand—his dominant hand and the most damaged. For hours, he meticulously chiseled away the scar tissue, releasing the hand from its contracted position.

Typically, surgeons then take flaps of skin from the forearm to create a soft-tissue matrix to cover the hand. But with Larry’s prior skin grafts, this wasn’t an option.

Instead, Dr. Kulber took a novel approach: using cadaver skin. Cadaver skin has no cellular activity and thus poses no risk of rejection. It is used often in breast reconstruction, but Dr. Kulber recently published a paper on its successful use in his patients with burned hands.

In all, he would perform six surgeries over two years to repair Larry’s right hand. Meanwhile, Larry underwent extensive physical therapy.

It was a long, slow process. But then, the little miracles started happening, one after another.

He could pick up a cup with one hand. Tie his shoes. Open his wallet and take out money. Eat and shower more easily. Drive his car.

Even more thrilling, he could go hunting again. He went fishing. He opened up his toolbox and did some work around the house. He planted vegetables again.

“It’s like you’re a person in a wheelchair,” Larry says. “And then, all of a sudden, you’re out of the wheelchair, walking around.”

After taking a break from surgeries, Larry went back to Dr. Kulber in May for the reconstructive surgeries on his left hand. He is currently undergoing physical therapy.

He credits his faith in God and the tremendous support from his family for pulling him through. Today, he has a

part-time job for a private company, as a fire prevention consultant. His oldest daughters have married, and he is eagerly anticipating becoming a grandfather sometime soon.

“It would be easy to dwell on what we lost,” Denise says. “But a lot of good has come out of this, too. It’s the hard things in life that make you grow stronger and closer.”

Although his hands have improved dramatically, they will never be what they once were. His toughest adjustment? Saying goodbye to his career as a fire captain.

He briefly worked for the department in the office, but it wasn’t the same. “It just wasn’t me,” he says, “and it was too hard to see all the things that I loved to do that I couldn’t do.” He still misses it, especially when he drives past the station or sees a fire engine. But he has moved on.

“Most firemen worth their salt don’t think of themselves as heroes,” Larry says. “At the end of the day, you just ask yourself, did I serve the public the best I could? That’s what matters.”

Reaching Out Across Borders

Werkneh

During a recent visit to Los Angeles, Werkneh hugs Dr. Myles Cohen who, with Dr. David A. Kulber (in background), removed more than five pounds of tumors from his hands.

Eleven-year-old Werkneh was more than 9,000 miles from the little hut in Ethiopia that he called home. He had traveled alone, all the way to Los Angeles, without his parents. He spoke no English.

He was used to feeling alone. Back home, he was often treated as an outcast—all because of his hands.

Born with numerous cartilage tumors in his hands, the boy was otherwise healthy. But his hands were severely deformed, resembling two giant, lumpy boxing gloves.

Werkneh is one of many children in the developing world— and here in the U.S.—who don’t have access to sophisticated, modern hand surgery.

That’s why Cedars-Sinai recently created the Center for Reconstructive Hand Surgery.

Video

Access to efficient, effective, and modern hand surgery is extremely hard to come by. A new Reconstructive Hand Surgery Center at Cedars-Sinai seeks to provide families living in poverty with fully funded, world class hand reconstruction and state-of-the-art surgical care. Watch video

Sharp Focus

The Center’s goal is to provide needy patients with fully funded, world-class hand reconstruction, as well as to train the next generation of hand surgeons.

The Center is led by Myles Cohen, MD, director of Hand and Upper Extremity Reconstructive Surgery at the Cedars-Sinai Orthopaedic Center, and David A. Kulber, MD, director of the Center for Plastic and Reconstructive Surgery at Cedars-Sinai and of the Plastic Surgery Center at Cedars-Sinai Medical Group.

“Particularly in developing countries, children with severe hand deformities have no social support system and often end up dying young,” Dr. Kulber explains. “Fixing their hands can literally save their lives.”

In Werkneh’s case, Drs. Cohen and Kulber were able to completely reconstruct his hands, removing more than five pounds of tumors.

To the boy’s amazement, his hands began to look—and work—like hands. He could hold a pen and write his name. He played basketball. Over his five-month stay, he learned fluent English and won everyone over with his broad grin and cheerful nature.

Drs. Cohen and Kulber hope to treat more patients like Werkneh through the new Center. “I don’t think anything could be more gratifying than to be able to play a part in dramatically changing someone’s life,” Dr. Kulber says. “This is why I became a doctor.”

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