Through the California fires

A hospitalist recalls three devastating fire seasons.

“The hospital is being evacuated.” The voice on my phone in October 2019 was that of our nocturnist. I tightened my grip on the steering wheel of my car as I pulled into the driveway of my home 40 miles away. I had left the hospital 45 minutes ago. The day had been filled with anxiety. Although the Kincade Fire was still far away, several staff members whose homes were in the fire zone had not been able to come to work. PG&E had switched off electricity and the hospital was working on its backup generator, powered by stored solar energy. The hospital command center was in operation, with executives all in on a Saturday. The sun was a red ball. Thick smog enveloped the hills, and when I headed to my car at the end of the day, I found it covered in ash. This wouldn't be a repetition of October 2017, I reassured myself.

Photo courtesy of Dr Attri
Photo courtesy of Dr. Attri

The Tubbs Fire of 2017 had been angry and ruthless as it burned more than 36,000 acres and took 22 precious lives. We had heard horror stories of staff and colleagues waking up at 3 a.m. to see fire in their backyards and jumping into their cars to escape, getting stuck on the jammed freeway southbound towards San Francisco. The stories of entire neighborhoods burned to the ground, the distress, the suffering, the loss, had been so surreal. More surreal were the courage and dedication of the staff members and administrators at Sutter Santa Rosa. They had overseen safe evacuation of their patients that night to other hospitals amid chaos, as the fire reached the parking lot. Remarkably, no one had died or suffered burn injuries.

The fury unleashed by Tubbs had been unprecedented. There were shock and disbelief, grief and despair, tears and hugs. The hopelessness, however, had been short-lived. It had quickly evolved into resilience as people got busy building back their homes. Patient encounters for the next several months had always included the question of whether patients had homes or not.

Coming back to October 2019, I nervously replied to the nocturnist: “I'll drive back to the hospital to help.”

“No need,” he said with palpable tension. “Just triage your patients according to their medical needs.” My pulse rising, I pulled out my patient list and gave him a brief report. The sicker patients were to be prioritized for interhospital transfer. Some stable patients were discharged home. He continued, “We are two hospitalists here, the medical director is on her way, and the administration command center is available to help. We should be OK.”

I promised to remain on high alert and to be available through the night. The evacuation was completed before midnight without the fire reaching our backyards and parking lots this time.

We learned later that approximately 100,000 people were evacuated from the area. There were no fatalities, fortunately. The following several weeks, patients and staff appeared solemn and reflective. The disbelief and shock from two years ago had transformed into acceptance that this could happen yet again.

2020 came with its own unique challenges. By the time COVID cases started to drop off in our area, it was mid-September already. We didn't want to think or talk about fires, but knew they were inevitable.

Sure enough. “Be prepared for the possibility of evacuation,” the group text flashes as I struggle with my N95 and face shield. The Glass Fire seems to be closing in toward Sonoma County. Three hospitalists from my group live in the mandatory evacuation zone. The hospital's command center is in full swing again. Several physicians are living in RVs, some bunk down at friends' and family's homes, and others move into rented homes or hotel rooms. The now-familiar noisy air scrubbers are out in the hospital corridors. Ash is falling from the sky again as I approach the hospital entrance to get my temperature checked and answer the COVID screening questionnaire before collecting masks and scrubs.

Fortunately, the hospital does not have to evacuate this year. Our brave firefighters work nonstop and make progress every day. My colleagues and friends return home. The hospital cautiously resumes operations as usual as we prepare for another season of smog-induced reactive airways.