Alfred Real took the step of his life Thursday. He walked into school.
He moved unsteadily on legs scorched by fire. His arms, thin from a four-month stay in the hospital and encased in tight fabric, swung awkwardly. He held tightly to Angela Real’s hand as his mother guided him through the front doors of Arcado Elementary in Gwinnett County.
Alfred smiled uncertainly, teeth flashing behind clear plastic that kept his scarred facial skin intact. His mother laid a hand on top of his head, where his face mask’s straps crossed.
The 8-year-old Stone Mountain boy paused in the lobby as administrators gathered in a happy knot around him. Principal Penny Palmer-Young knelt until she was eye level with the third grader.
“It’s so nice to see you, sweetheart,” she said. “We’re so glad you’re back!”
“Thanks,” the kid mumbled.
Alfred Real’s return to school was a watershed moment. He is resuming a life interrupted by a nearly fatal fire and a series of unusual operations during which physicians attached laboratory-grown skin to his wounds.
Alfred and a friend were playing with gasoline and fire outside his home June 7 when the gas ignited. It engulfed the child in an instant. The flames burned him so severely that he was taken from Grady hospital in Atlanta to the Shriners Hospital for Children in Cincinnati, a facility that specializes in burn injuries.
“It was touch and go for nearly a week” after he arrived in Cincinnati, his mother recalled. “We didn’t know if we would have him back.”
They do. Angela and Zac Real, along with their other sons, Graham 12, and Jasper, 1, brought Alfred home Oct. 4. Soon after, his parents and school officials readied for his return to class.
And so, on Thursday morning, he stood in the doorway of Lynne Donohoe’s third-grade class, where a teddy bear had been sitting in his seat since this school year began.
Nineteen young faces looked up.
Fire, ambulance
June 7 had been a good day. It was coming to an end when Zac Real dragged out an old grill from the garage. The family gathered around it to cook shrimp and beef, then went inside to make brownies. Alfred, back from visiting his grandparents in Walton County, went back outside. A boy from a nearby house joined him in the backyard.
What happened next remains unclear. Alfred and his friend were playing with a fire lighter and a gas can in the woods behind the Reals’ back yard. A fire started.
“I was trying to put out the fire and the gas went sploosh!” he recalled.
In a second, Alfred was on fire. Instead of running to the Reals’ house, the neighborhood boy sprinted down the driveway to his house and told his mother, who called 911. Then he ran back to Alfred, who’d stumbled out of the woods. He grabbed Alfred by a hand, dragged him to a creek in front of the Real home and shoved him in.
A man walking his dog saw it all. He had a cell phone, and he also dialed 911.
This happened while Zac and Angela Real were inside. They didn’t know anything was wrong until they stepped outside to check on their son.
“By the time we got outside, Al was already coming back up from the creek,” Zac said. The boy was badly hurt.
Angela grabbed her son, pushed him in a car and headed toward the hospital. Zac and the dog walker put out the fire in the woods.
Angela passed an ambulance, its red lights flashing. She swung the car around and sped back to her home. Rescue workers placed Alfred on a gurney and rolled him in the ambulance. It took him away.
‘Good age group’
Dr. Walter Ingram, medical director of Grady’s burn unit, knew the burned child needed more long-term care than the Atlanta hospital could provide. The boy had second- and third-degree burns over 78 percent of his body and was in danger. Skin is crucial to keeping out infection, regulating body temperature and protecting other organs. Without quick and proper treatment, the child could die.
Ingram also knew, as physicians prepared Alfred for his flight to Cincinnati, that the boy’s youth would play in his favor.
“Younger skin, it grows faster,” said Ingram, whose unit treats about 450 cases a year, more than a third involving people under 18. “He’s in a good age group.”
He’s also part of a much smaller group. While more than 2 million people report burn injuries every year, only about 20,000 are burned over 25 percent or more of their body, according to the Journal of Burn Care & Research.
In Cincinnati, Alfred underwent a series of “cultured skin” treatments. Alfred didn’t have enough unharmed skin for large grafts, a traditional method of burn treatment. Physicians instead took small pieces of Alfred’s healthy skin, the size of a postage stamp, and grew it in a lab. In about a month, each piece grew to about 3 inches square.
In all, the boy had more than a dozen operations.
The Reals have insurance, but did not need it. Shriners hospitals offer free care to burned children and free lodging for their families.
The treatment Alfred underwent debuted 20 years ago at the hospital as clinical research sponsored by the University of Cincinnati.
But the new skin was not the same as that which it replaced. For several years after its application, cultured skin is more tender than skin around it. Children with laboratory-grown skin need to avoid rough-housing.
Also, the replacement skin lacks sweat glands and blood vessels, which naturally growing skin produces. Blood vessels aid a skin’s ability to adjust to heat and cold; sweat glands help a person keep cool.
“Cold weather is not too bad, but hot weather can be” for someone with cultured skin, said Grady Hospital’s Ingram. “And that could be a problem in Georgia.”
The problems also could be psychological, said Kenia Johnson, an Atlanta child psychologist who spent a year working with youngsters at Grady’s burn unit.
Young burn survivors, she said, grapple with fear — of becoming a spectacle, of being teased, of getting injured while playing. As they mature, they may be more anxious about their looks, too.
“They have to be able to talk about it, and not feel sad or depressed,” she said.
‘No one would like it’
A day before Alfred came back to school, his classmates sat, transfixed, and listened to their visitors. Representatives from the Cincinnati hospital had a face mask like Alfred’s and a body suit comparable to the one he wears. The child must wear each for a year or more.
They answered questions, too.
“Can burned people die?” asked one child, a girl with a golden ponytail.
Yes, they replied gently.
A boy tried on the face mask, then wrinkled his nose. “It’s tight,” he said.
“I keep thinking about what happened to him,” said Alex Williams, 8. “And I keep thinking about me being burned.”
Cailleagh Finlayson, who met Alfred in the first grade, took a long look at the skin-toned suit, as close-fitting as Spider-Man’s.
“I feel kind of sorry for him, that he has to wear that stuff,” said Cailleagh, also 8. “I wouldn’t want to wear it.”
Nor does Alfred.
“I don’t like it,” he said. “No one would like it, do you think?”
Smiles all around
On Thursday morning, with the help of his mother, Alfred struggled into the despised body suit. Then he did an hour of stretching exercises to keep his scars flexible. He was almost two hours late in arriving at school.
A hush fell over the class as Alfred reached the doorway of his classroom. “Class, say hello to Alfred,” said Principal Palmer-Young.
Helloooooo!
The kids showed Alfred his chair. He plopped down while his mom unloaded his book bag and lunch. She’d packed a turkey sandwich and a fruit roll-up. Alfred took a water bottle from the bag and tapped its plastic straw on the desk top.
“Don’t play with the straw,” his mother ordered. Alfred stopped.
Motherly duties done, Angela Real readied to leave.
“You’re in charge of taking care of Alfred now,” she said to the class. “Take care of my boy.”
Everyone smiled and nodded. Alfred managed not to look mortified.
Alfred Real faces many more steps in his life. He has more skin grafts to come, countless stretching exercises in his future. There will be questions from strangers.
But sitting among friends, Alfred knew: He was back. The big step was done.
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