Patient: Mechanism of injury: self-immolation. Pt conscious upon EMT arrival. Lighter fluid and matches on scene. When asked about the incident, pt reported intent to “turn herself into a phoenix.” Psych eval ordered.

The summer before last, I met a woman who lit herself on fire. I’ll call her R. One evening in June, she poured lighter fluid over and into her body—down her mouth and up her rectum—and struck a match.

Self-immolation isn’t unheard of on the burn unit. But her case included a remarkable detail: “Pt self-reported the incident.” Translation: R herself called 911 while she burned. When the ambulance arrived, she was still smoldering—hair and jean cuffs smoking, iPhone hot to the touch.

In the ICU, her lungs were scanned for smoke damage. Doctors placed a central IV line, racing to pump in fluids faster than her wounds could leak them out. On day three, she had surgery: Allografts (temporary “bandages” made of cadaver skin) were stitched over her deepest burns to keep infection at bay. Meanwhile, social workers tried and failed to contact her family, and psych pronounced her “bipolar schizophrenic” with “no immediate threat to others or self.” Finally, on the sixth day, R’s name appeared on the daily-wound-care board above the nursing station: a sign, in the unspoken code of a burn ICU, that a patient has “made it,” and now the real work can begin.

I was a chaplain intern that summer. My job was to help patients and families deal with the shock of immediate crisis—to explain that 60 percent burn damage across a human body is survivable, that yes, your loved one’s face looks scary right now, but it will get better with time. As weeks stretched to months in the grim rhythm of surgeries (excision, recovery, graft, recovery, repeat), my task was to bear witness to grief and exhaustion, and to hear impossible questions. Will my child recognize me? Will my husband still love me? What did I do to deserve this pain?

The first time I stopped by R’s room, she looked asleep.