AMID a tangle of tubes and monitors, a small Bob the Builder toy clings to a steel rod attached to a man's hospital bed, a reminder of life before the flames.
An army of medical staff buzz around him, preparing to take a chest X-ray one of many painful but necessary daily rituals. He lies with arms and hands bandaged, burns covering more than 40 per cent of his body.
Heavily sedated, a cocktail of morphine and valium numb the dressing changes that each takes four hours, three times a week.
But there is worse pain to come. When he wakes up, someone must tell this man that his family is gone. His wife and two children perished fleeing the Kinglake fire. A third child, a two-year-old daughter, was rescued but her burns were too extensive. She died on Wednesday.
Like seven other survivors of last weekend's fires, this man's new home is the intensive care unit at the Alfred Hospital.
The hospital's role in the tragedy began about 8pm on Saturday when reports of bushfire casualties came from the Victorian State Emergency Control Centre.
But it would be another two hours before the magnitude of the disaster started to emerge, when ambulance officers radioed the emergency department.
Back in emergency already busy with the usual Saturday night casualties and those suffering heatstroke and dehydration from Victoria's hottest day on record Peter Cameron took the call. As the doctor in charge of the department, he was warned to prepare for mass burns victims.
''The initial call was there were hundreds of people on the oval at Kinglake that were burnt. Then we got these reports from the helicopter guys that it was just mayhem ... they couldn't even see what was going on. But they said there's anywhere between 100 and 1000 people burnt up there, it's just pandemonium, there's cars crashing into each other and all sorts of things,'' Dr Cameron says.
Over the course of the next 10 hours, the Alfred would treat the highest number of burns casualties it had received in one incident. Twenty patients with burns to more than 30 per cent of their body were brought in. Up to 600 people with less serious injuries were taken to other hospitals. The fact the head count did not reach the paramedics' more dire prediction is a sign of how intense the blaze was, says Dr Cameron.
''Most of the people with serious burns were dead,'' he says. ''After receiving the news from Kinglake, Dr Cameron became the first link in a chain of command that would swing Victoria's leading trauma centre swiftly into disaster mode.
First he called Heather Cleland, the surgeon heading up the hospital's burns unit. Due to fly to Vietnam for business the next morning, she cancelled the trip and began calling counterparts in other states, placing surgical teams on stand-by to fly to Melbourne should the casualty count overwhelm the Alfred.
Dr Cameron estimated they could have handled up to 50 burns patients before seeking help.
Andrew Stripp, executive director of acute operations, became hospital incident commander, calling the directors of anaesthesia and intensive care at home and asking them to mobilise teams.
By midnight more than 70 additional staff had reached the hospital. Offers of help from medical staff around the country would continue for days.
Burns liaison nurse Hana Menezes, a pint-sized dynamo known to colleagues as ''Gum Nut'', arrived at the emergency department at about 10.30pm. Five patients had already arrived, some with burns to almost half of their bodies.
The extreme heat of the day meant most had been wearing shorts and T-shirts when the fires swept through. Burns were predominantly to the arms, legs and face. Almost all burnt their feet as they ran for their lives.
Some talked frantically of the carnage they'd witnessed, the loved ones lost to the fire's fury. For some who had just survived one of Australia's worst natural disasters there were fears they would not survive the night.
Nurse Menezes contacted the Victorian tissue bank to appeal for donor skin. It was the first of many 14-hour shifts.
''The night's a bit of a blur, we just seemed to run from patient to patient and we managed to clear people through and get them off to the ward or intensive care,'' she says.
''The sheer number of patients we've admitted into our service was something I've never seen before. A lot of people had very serious burn injuries but they were aware there were people much worse off so they were thankful.''
For most, the first step on arrival was to have smoke-ravaged airways cleared. Victims' faces were photographed so they could be identified should swelling make them unrecognisable. Maintaining fluid intake was vital to combat severe dehydration. Without the protection of skin that had been melted by flames, their body temperatures were dropping dangerously. Loss of limbs was a real risk for some. Burnt skin lacks the elasticity of healthy skin and can constrict, causing a tourniquet effect that cuts off blood supply to the arms and legs.
Nurse care coordinator Yvonne Singer arrived at 11pm and began assessing patients.
''We worked out who had deep burns but ones that were not that big and could wait for surgery so we wrapped them in a dressing that could last three days ... other patients had wounds that could have been contaminated so we'd choose a dressing that we would change every day.''
As the tragedy unfolded, relatives began to arrive. ''I asked one woman if there was anything I could do for her and she said, 'You can tell me it's not true,' and I said, 'I wish I could.' We gave her a hug. She was probably one of the most traumatised family members we've seen.''
Surgical teams worked through the night in four operating theatres double the normal volume as charred skin was peeled from bodies. Excising burnt tissue within the first 24 hours would give patients the best chance of survival. Eleven people were taken directly to the burns ward while staff at the intensive care unit braced themselves for the influx of more seriously injured patients.
For Warwick Butt, a softly-spoken doctor in charge of the intensive-care unit when the casualties came in, dark circles under his eyes betray the toll this tragedy has taken.
''During the night we had to start speaking to the families. One patient was very sick and likely to die and I had to inform his wife. She'd lost a son as well as the family house and that was very sad ... but our job is to look after these people and give them the best care so you really have to divorce yourself from that,'' Dr Butt said.
The stoicism displayed by the Alfred's staff is a trait common to those who work at the sharp end of major disasters. Petty rivalries, usually so fierce among hospital specialities, were set aside. They were a team who did what they had to do. But not without a price.
Yvonne Singer admits it would have been easy to fall apart. ''I rang my parents and my brother that night and told them I loved them. Then I rang a lot of my friends and said, 'Go home and hug your family' ... I've had a few teary moments and when I've gone home and turned on the television and seen the news I've started to get upset and I've just had to turn it off. At this point in time I'm just not ready to go there.'' Each night after work, doctors, nurses and surgeons involved in the disaster have gathered in a pub behind the hospital to swap stories. For those who need more support the Alfred's head of psychiatry services Steve Ellen, has arranged extra counsellors. But he says the pyschological scars of burns victims will take a long time to heal.
''Not only have you got the physical problems that affect the way the world sees you and the way you see yourself, particularly with facial burns, then you've got the pain,'' he says.
''If someone breaks their arm, the pain's controlled within an hour or two but with burns the pain's ongoing, they have to have lots of dressings and it really wears people down. On top of that there's the psychological trauma. A lot of the patients have had family members die and have seen people on fire which is just horrific.''
Every burns patient taken to the Alfred has survived and Heather Cleland and her team are confident they will recover well. But the road ahead is long for some, up to a month in intensive care and several months more in the burns unit.
The most serious cases face surgery up to three times a week initially and then weekly.
They will require one-on-one care from a team of medical staff including burns specialists, plastic surgeons, physiotherapists and dietitians. Simple tasks such as buttoning a shirt or picking up a mug of coffee will be painfully relearned.
Their progress has been further hampered by delays in treatment. As paramedics battled their way through thick smoke and fires still raging, stranded burns victims went into shock, their organs failing.
But they are alive. And as a grieving state comes to terms with the enormity of this disaster that is reason enough for hope.