Healing from a scalding is a marathon.

It means pain, drugs, itching, peeling skin, hospitals, skin grafts, dressings, lotions and physical therapy.

And a lot of love.

Kirsten and Jay Salmond have lived by that medical maxim every day since March 10, when their toddler daughter, Ariella, pulled a Cup of Noodles filled with boiling water onto her head.

Kirsten, 38, recalls seeing the 22–month–old in the hospital the morning after the accident.

“The first thing that I thought was, ‘Where is my daughter?’ ” she said. “Her right eye was swollen shut and I searched into her left eye to find something that I recognized – nothing. My heart sank and I then thought, ‘God, please heal my sweet baby girl’s face!’ ”

Ariella spent two weeks in the hospital before returning home to Puyallup. Now, more than three months after the accident, she appears and acts like any other 2-year-old.

She smiles. Her dark eyes draw you in. A close look at her face finds only a couple of small red spots.

But then the timer on the stove dings. Off comes her special frictionless shirt, revealing the angry red map that stands out on her skin. It’s time to rub lotion on those continents of pain.

It hurts.

Then comes the physical therapy. Without it, scar tissue could deprive Ariella of the use of her arm or deform her breast as she develops later in life.

So her parents must do what no parent ever wants to do: inflict pain on their child.

Kirsten pulls Ariella’s right arm behind her back and holds it there for 30 seconds.

Ariella begins to cry. She struggles. She cries even harder.

Kirsten holds firm but doesn’t look at her daughter, whose mouth is twisted in agony. She watches the second hand on the clock.

“Three, two, one,” she counts off. Then it’s over. Ariella grasps her mother’s shoulder, her eyes full of tears.

But it’s not over.

“There are a lot of different nerve endings that are messed up,” Kirsten explains to a visitor.

Twice more Kirsten pulls Ariella’s arm – first across her chest and then straight up. The little girl struggles and sobs. Kirsten again watches the clock. She doesn’t want to go one second longer than she must.

Finally it is over. Mother and daughter cling to each other. The sobbing subsides – for now. In another two hours, the timer will ding again. Five times a day. Seven days a week. Every day for a year.

Ariella is among an estimated 2,000 children treated in hospitals each year for scalding burns. Like her, studies show, most are under the age of 4 and most are likely to have been hurt in the bathroom or kitchen.

Compared with how the human body reacts to other common traumas – broken bones, for example, and most infectious diseases – healing from burns can be maddeningly slow.

In serious cases, like Ariella’s, the process can exact a heavy toll, not only in terms of physical pain, but long-term emotional pain as well.

A recent medical trend toward making entire families part of the cure can spread the pain far and wide.

“The problem with burns is that burns are forever,” said Dr. David Heimbach, a burn surgeon at Harborview Medical Center. “A little something that happens in an instant can lead to a lifetime of physical and emotional impairment.”

THE CUP OF NOODLES

The Salmonds remember the afternoon Ariella was burned in excruciating detail.

They can hear her screaming and see her on the kitchen floor, her head folded in pain into her tiny shirt.

Her 11-year-old sister, Melany, was heating the Cup of Noodles and had turned away to put the tea kettle back on the stove. A hungry Ariella reached up on the counter and grabbed the cup.

“I heard a wild scream,” said Jay, who had left the kitchen for the bathroom for a moment. He rushed back to find Melany “in complete shock” and her little sister in agony.

He ripped off Ariella’s shirt and sprinted for the shower.

Over the past 12 years, Jay – a 31-year-old baker and bakery manager at the Top Food & Drug store in Puyallup – had endured his share of burns from hot doors and dishes.

Experience had taught him what worked best on small burns, but his daughter had suffered third-degree burns over 28 percent of her body. Her head, right arm, shoulder, chest and back were scalded. In some places, only two layers of skin were left.

“I put her under cool water,” he said. “If you use cold water, it can make it worse.”

(The burn experts at Harborview Medical Center later told him he was right: cool water always is better than cold.)

“She was screaming horribly,” recalled Kirsten, who’d been in the living room when the accident happened. “Sheets of skin sloughed off of her and were covering the shower floor.”

The minutes moving in slow motion, Jay kept his eyes locked on daughter. He cooed to her that she was brave. He told her everything was going to be better, though he wasn’t sure what that meant.

In the ambulance on the way to the hospital, Jay lay down with Ariella on top of him. She refused to be separated from her father. He told her she was doing great. Morphine coursed through her body, helping to dull the pain. Still she cried.

Because of Ariella’s severe burns, staff members at Mary Bridge Children’s Hospital and Health Center quickly sent her on to Harborview, the Northwest’s leading trauma and burn center.

A second ambulance ride brought father and daughter to Seattle. Mom followed but beat the ambulance by five minutes.

HOSPITAL TIME

Within 15 minutes of Ariella arriving at Harborview, a team of doctors and specialists had gathered to begin her care.

Her tiny body was weeping. Without protective skin, body fluids seeped from the scalded areas. Her lips peeled for days.

She was hooked up to a catheter, a heart monitor and a feeding tube. Her burned arm was placed in a brace that held it away from her body. Her head and half her upper body were swathed in gauze that had to be changed every day.

Either Kirsten or Jay stayed with Ariella all of the time. She cried and whimpered with the pain. Jay used almost all of his vacation and spent most of the nights at the hospital. Kirsten worried at home.

After a week in intensive care, Ariella was moved to a regular room.

Kirsten said the nurses noticed that every time Ariella’s 8-month-old sister, Elizabeth, was in the hospital room Ariella’s blood pressure dropped. When the child left, Ariella’s blood pressure climbed.

“The nurses saw a connection between the family dynamic and how healing that was for her,” Kristen said. At least one study of burn victims and healing has suggested a similar connection, according to a Harborview spokeswoman.

Ariella’s doctor decided she was doing so well that he wanted to treat her case differently than others he had handled, Kirsten said.

He thought Jay and Kirsten could learn how to care for Ariella’s injuries and ease her pain. That way she could go home and stay until she needed to return to the hospital for skin grafts.

The Salmonds learned how to change Ariella’s dressings every day, how to bathe her, administer her medications and perform physical therapy.

Two weeks after entering the hospital, Ariella came home.

BACK HOME AGAIN

Ariella had lost eight pounds while in the hospital.

Building back her strength and managing her care – including her many medications – were the family’s first challenges.

At first the pills had to be taken every four hours. Oxycodone dulled the pain. Then methadone eased her off the narcotic.

Still hurting, Ariella couldn’t sleep. Her parents put a queen-size air mattress in her room so one of them could sleep with her. Unable to lay on her stomach like she was used to, she had to be held.

Only recently has she been able to sleep alone, Kirsten said.

Baths were a battle.

“We would first show her a small new toy or inexpensive new book and explained that we would play after bath time,” Kirsten recalled. “Daddy would hold her and offer words of encouragement while I used a soapy washcloth.

“I would do a hard wipe over every part of her body. She would go into shock almost every time.”

The injuries bled and her body trembled or shook.

“She would try to scream but would lose her voice,” Kristen said. “The pain in her eyes I will never forget.”

Wrapped in a towel, Ariella was carried to a sheet laid in the living room to get new dressings. Her parents wrapped her in large sheets of gauze smeared with a skin-healing cream. Then came sheets of thin, yellow “greasy gauze,” followed by ointment, medical tape, wrapping gauze and mesh netting.

Finally it was time to play. Jay and Kristen read to her constantly to occupy her mind and distract her from the terrible itching as the burns healed.

The marathon became a grueling routine, but Ariella began to heal.

“When we came back for skin graft surgery they found she had healed so much they didn’t have to do so much,” Kirsten said.

The arm brace went away. The dressings came off as new skin began to emerge.

Things have changed around the house, too.

Kirsten said she and Jay realized after the fact they hadn’t talked to Melany about safety in the kitchen with two babies in the house. Now Melany uses only the stove’s back burners when she makes tea and lines up the cups at the rear, away from prying hands.

The family rule now is if someone is cooking, the youngsters are either out of the kitchen or buckled into their chairs.

“We bought a guard for along the front end of the stove so you can’t reach up and pull a handle (of a pot) down,” Kristen said.

While Ariella was in the hospital, Kirsten said she turned down the temperature of their home’s water heater.

“And we haven’t bought a Cup of Noodles since,” she added.

Though Ariella has needed near constant attention, she wasn’t the only child affected by the accident. Melany had an especially hard time, Kristen said.

“She kept going over what she could have done differently,” her mother said.

It took counseling at Harborview for her to understand it wasn’t her fault her sister was burned.

“They helped her realize it would have happened with anyone in the kitchen,” Kirsten said. “They told her we are human and accidents happen.”

Jay and Kirsten also have had to pay more attention to Elizabeth, who was jealous of the attention Ariella received.

“She wanted me to hold her anytime I was taking care of Ariella,” Kristen said.

THE MEDICAL BILLS ADD UP

Medical care for trauma patients is expensive. The ambulance rides cost $4,000. Each day in intensive care at Harborview cost $10,000. Surgery and drugs were extra.

Total cost so far: perhaps $100,000, Kirsten said, adding that bills are still coming in.

The Salmonds’ insurance caps their payments at about $2,400.

“They’ve been good about paying their share,” Jay said of the family’s insurers. “No problems.”

Jay’s co-workers at Top Food have stepped up as well.

They helped raise money with a rummage sale and by putting a photo of Jay with a bandaged Ariella at every check stand. A box for donations brings in $200 a week. Contributions also are made to the Ariella Salmond Benevolent Account at all BECU branches.

The employees’ fundraising, other donations and a contribution from Top Food have raised more than $10,000, Jay said.

“People have helped so much,” Kirsten said.

“A lot of people knew we had to go to Harborview,” Jay said. “They gave us gas cards when we first started and money for parking, little things you don’t think about but you’re paying $10 a day parking and that’s every day until you come home.”

The family is holding onto most of the money for now. Ariella might need plastic surgery, which isn’t covered by insurance. Her frictionless shirts cost $25 each and will be needed for several more years, as will over-the-counter lotions and pain relievers.

Speaking of costs, Kirsten ruefully considers that Cup of Noodles.

“It was fluke I had it in the house,” she said. “I didn’t buy it before.”

But she was looking for something she hoped Ariella would like. A severe asthmatic since birth, the little girl hadn’t been eating well before she was hurt.

The Cup of Noodles was on sale, Kristen remembered.

“About 30 cents.”

A LONG ROAD AHEAD

The marathon of healing will not be over soon for Ariella.

At a checkup June 10, doctors didn’t like the puffed up scars on her body. Kirsten said they ordered a special undergarment to put pressure on the scars. They also said plastic surgery probably will be necessary later on.

“She is doing all right,” Kirsten said of her daughter a couple of days after the appointment, but she is now having shooting pains through the scar tissue as new nerve endings start firing.

One night Ariella dug into her skin and opened up the scar.

“I look into her eyes and see she wants it to be over, but it can’t be yet,” Kirsten said. “It’s a long journey. It’s so hard to explain that to her.

“We just have to keep giving her help. We can’t give her physical comforts, but we try to bring a little joy into her life every day.”

Mike Archbold: 253-597-8692

mike.archbold@thenewstribune.com

Staff writer Rob Carson contributed to this report.