Fourth of five parts
The children come here by the thousands, scarred on the outside and scared on the inside.
They come from all over the world. They come from places where people turn away from them in horror.
They find hope, free care, dignity, and strength they never knew they had. They find people like Apryl Calabrese, a 27-year-old occupational therapist at the Shriners Hospital for Children in Boston.
UNSPOKEN CAMARADERIE: Twelve-year-old Dorothy, who was burned in a Newfoundland fire, hugging 2-year-old Sarah. (Globe Staff Photo / Stan Grossfeld)
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''When the kids say, `Will people think I am pretty?' I have to say it's about what's on the inside. I tell them: `You are a beautiful person. Everyone around you loves you and everyone here loves you. You have to let the world see your personality. You cannot be worried about what is on the outside.' ''
Calabrese is one of 250 employees at Shriners, all of whom go above and beyond the call of duty. Since 1968, when Shriners opened its burn hospital in Boston, the survival rate for children with burns over 50 percent of their bodies has doubled. In fact, Shriners now routinely saves children who are more than 90 percent burned.
It was here at Boston Shriners in 1984 that doctors used cultured skin - the patient's own skin that is grown in a lab before an operation - to help children with large burns. The hospital even sends a medical and psychological team to talk to students at schools to which burn victims will return.
In the rehabilitation therapy center, there is a special, unspoken camaraderie among the children. A 12-year-old named Dorothy, burned in a Newfoundland fire, walks in and hugs a 2-year-old named Sarah. They linger face to face without speaking.
''These kids are the most courageous human beings on the earth,'' Calabrese says. ''They've been through so much trauma, and they smile and laugh and play and interact and trust. I don't know if I could go through what they go through every day.''
Calabrese has to retrain her patients to do basic functions.
''I have to try to get kids to do things that they don't want to do, because it hurts, or it is challenging in some way because they can't move normally. You have to make activity interesting and fun for the kids.''
That's difficult because there is a lot of pain.
''I don't like hurting children,'' Calabrese says. ''Many of them know that that is part of what comes with their injuries. There is a window of opportunity to try to stretch the skin as much as possible.'' If the skin is not stretched, movement becomes harder as the children grow, she said.
''Any human being that goes through this type of injury kind of acclimates to their situation, because they have to. Kids who used to have very low pain thresholds now have higher thresholds. We push and push until they can't stand it. I know I'm helping them, not hurting, otherwise I couldn't come to work every day.''
About 4,000 children are treated at Boston Shriners each year, mostly on an out-patient basis. The hospital has only 30 beds.
Sarah, who has burns over most of her face but not her soft blue eyes, is one of the patients. Calabrese has her work cut out for her. Sarah's mother is in another hospital, also with burns, and the little girl misses her. But after a week of playing with her on a soft mat in the rehab room, Calabrese gets Sarah to hold her juice bottle and then drink, a major victory. Hugs and kisses and hoopla bring out a smile.
''She is such a beautiful little girl,'' says Calabrese, looking into Sarah's eyes and not at her burns. ''She is so strong-minded and strong-willed.''
Patients at Shriners wait in huge, airy playgrounds that are a welcome relief from rehab. On a recent visit, a maintenance man puts down his broom and pushes an Arabic-speaking child around on a scooter. The laughter is universal.
Calabrese's next patient is Crystal, 7.
Crystal was burned over 70 percent of her body in a day care fire in Jamaica. Calabrese talks to her about how she does her hair, and then plays a numbers game with Crystal's fingers. ''She's a sweet little girl with a heart of gold,'' she says.
But then comes the hard part - extending the range of Crystal's arms and fingers. They play another stretching game and Calabrese, with a sense of how far to push, praises the child. ''Wow, that was great.''
Calabrese carries Crystal to her mother, by piggyback. They run and giggle like sisters.
Later, Calabrese says she feels guilty. `I'm just trying to gain more motion in her carpal metacarpal joints, more movement for her fingers. But you physically move them and it hurts. The more motion I gain, the more she can use them later.
''I can't even fathom not loving these kids,'' she says, as Crystal wanders onto her lap. ''I think anyone who works here will tell you they learn more from the children than anyone else in their lives.''
Crystal's mother, Patrica Anderson, hugs her daughter, then hugs Calabrese.
''She's my hero,'' she says.
