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At the St. John's affiliate in Springfield, a meth cook actually brought his set-up with him to the hospital.
"We have hospitality rooms to make it convenient for patients' families and patients being treated with chemotherapy," explains burn unit director Dr. Ken Larson. "Somebody thought it would be a good place to set up their meth lab."
That oddity aside, Larson suspects a substantial percentage of the patients he treats are injured in meth explosions, but he can only guess at the exact number. "No one walks in and says, 'Hey my meth lab blew up,'" he notes. "It's always, 'My propane tank exploded.' It's always a convoluted story."
Vanderbilt burn doctor Jeffrey Guy estimates that 20 percent of his patients are meth cooks. He says the problem with their cover stories, however flimsy, is that first responders and local emergency rooms often unknowingly risk exposure to toxic chemicals because a meth cook is worried he'll incriminate himself if he reveals the true cause of his injury.
"As a regional burn unit, we're geared up for chemical exposure," Guy says. "These small hospitals are just not expecting it, and they're not equipped."
At least in the short term, the fear of arrest is unfounded. If police book a person while he or she is receiving medical care, they are required by law to foot the medical bill.
"Unless it's egregious, unless they harmed a police officer, they won't get involved," Guy says. "Even if it's a serial killer, they won't do anything while they're hospitalized."
Johnson didn't hear from the Southeast Missouri Drug Task Force until three and a half months after he was released from the hospital. Earlier this month he was placed on house arrest pending felony charges of conspiracy to manufacture meth, a violation of his parole that carries a prison sentence of five to fifteen years. Fearing that his statements could be used against him in court, he asked that a pseudonym be used in this story.
Johnson says he has applied for Medicaid and Social Security disability benefits. "I don't want the help forever," he says. "Just long enough to get back on my feet so I can work, get my life back. I just want to work and provide for the kid I got comin'."
Johnson's girlfriend is due to give birth to the couple's first child, a girl, in June. It's this element of Johnson's life that worries many of the doctors and police officers who deal with meth-lab explosions on a routine basis.
"The alarming fact recently is the number of children inside the fires," Grellner says. "I don't have a ton of compassion for the guy who burns his dick off — which I've seen — but I feel for those kids who don't have a choice about waking up in a meth lab."
"There's this secondary collateral damage," adds Pam Howard, director of the burn unit at Arkansas Children's Hospital. "Because they're using a bottle that says Mountain Dew to do shake and bake, we've had two children try to drink the acid left in the bottle — the residue after they're done making the meth."
At St. John's, Smock says he has seen at least three patients rehospitalized with "multiple significant burns" from subsequent meth-lab explosions.
Johnson admits the temptation to relapse is strong.
"There is no real treatment for a meth addict," he says. "Even if you've been clean for twenty years, I bet you still think about it once a day. And if somebody breaks it out in front of somebody like me, there's a 99.9 percent chance I'm going to do it."
Still, he believes the car catastrophe has scared him straight.
"This wasn't no freak accident," he says. "It's something I never thought would happen to me. But sometimes, goddamn, in a weird way, I'm glad it did."
James Johnson's parents separated when he was four years old. He lived with his mother and her new boyfriend until one morning in 1988 when they packed up the car, drove to his father's house and left him and his older sister on the doorstep. Twenty-two years later, he still remembers the childhood moment "like it happened yesterday."
"They're pulling out the driving wavin', and I'm like, 'Man, where y'all going?'" he says in a thick Missourah drawl. "I'm thinking I'm going to stay with Dad for the weekend. It ended up that my mom and her old man moved to California and started manufacturing meth for the Hells Angels."
Thus began Johnson's long, tragic relationship with methamphetamine. Seated on the couch in the living room of his father's double-wide with the TV tuned to Judge Judy and the mobile home's shades drawn against the spring sun, he describes how he first smoked the drug when he was fourteen and started using a needle at fifteen.
"I just didn't like it, I loved it," he says. "I lived every day for it. I would steal, burglarize — whatever I had to do to get my high. It felt like Superman. It makes you feel unstoppable, just a bunch of energy running through you."