Brianna Pickering, M.D. Class of 2022
Some smoke from the Camp Fire in Northern California drifted into OHSU last week. I stared at the haze as I descended in the tram, taking a mental journey back to a town full of people I had known and cared for in my life before medical school.
A few years ago, I worked as a home health physical therapist in Paradise and Chico, California. Three times a week, I drove up the hill among the deer grazing beside the road and houses hidden by pine trees, to see my patients in Paradise. To qualify for home health services, patients must demonstrate that it is a “taxing effort” to leave their home, so all of my patients had mobility problems to some extent. As soon as I heard about the fire I thought of those patients and silently pleaded for their safety.
In six years as a physical therapist, I saw well over a thousand different patients. I figured there was no way I would remember their names. Still, I looked at the list of the Camp Fire dead and missing, and their names leapt out immediately. I wasn’t surprised to see them there. I knew that someone who needed a walker and 10 minutes to reach their front door was unlikely to escape. I was surprised at how quickly their stories flooded back into my mind. As I share them with you, please know that I’ve changed their names and stories significantly so that I can honor my oath to respect the secrets that are confided in me, even when the patient has died. Although the stories are not factual, they are inspired by my very real patients.
Chris was an oak tree of a man. He stood at least 6’4” and nobody would doubt that his spouse fed him well. The first time I worked with him in his home, his biggest fear was that he was going to fall. I reassured him with the same spiel I had given to hundreds of people before him as we stood together. “I’m an elite level rugby player”, I said. “I can lift 155 pounds above my head, and no one I have ever worked with has fallen when I’m with them.” He smirked at me, and leaned into my body to make sure I could really hold him up. Satisfied, he continued on with the task I had asked of him. That day, I felt proud that I had helped a stoic oak tree feel safe. Today, I feel sad that the safety I gave him then couldn’t reach him as the fire raced through his town.
Frank was another one of those rugged mountain men native to the forests of Paradise. He had spent his life as a highly prolific and highly skilled carpenter, but dementia had quieted his body and mind by the time I met him. He was stubborn and gruff, and had little use for me. I was just the annoying person who came to his house twice a week to try to convince him that getting out of his recliner every once in a while to exercise was a great idea. I usually failed in my efforts, but I remember one time when he happily hopped up and walked with me. “Frank,” I said, “I heard that you were a pretty great carpenter back in the day.” Frank looked me directly in the eye with the closest expression I would ever get to a smile from him. He stood up without his cane and toddled unsteadily out of the room. His hands finally found something solid to hold him up – the counters of his kitchen. He walked around, touching the cabinets and telling me about how he had built them by hand 20 years ago. He had sanded them down from trees he had felled on his own property, and had carefully stained them to match the vision he had for his home. Like I said, Frank was a stubborn man, and dementia had taken away much of his ability to have a reasonable discussion. I don’t know if even the force of the worst wildfire in California history would have persuaded him to leave the home that was still reflected in the old calluses on his hands.
Catherine had been honest from the beginning that she was never going to leave her home again unless there was an emergency. Doctor after doctor had told her that she should move in with her nephew in Oregon; that she was too frail to be out on her own. She knew it too but still she stayed, deciding for herself that life was not worth living if it was not in her own home. Her legs had failed to produce steps a long time ago, and she spent all her time in a wheelchair or her bed. We had talked about safety if a wildfire ever struck her city. We made an exit strategy together and made sure that the fire department knew she would need help if there were ever an evacuation. Catherine had an intimate understanding of the risks of living alone. I respected her right to autonomy in her decisions, but that didn’t stop me from looking in the rear view mirror at least a dozen times the last time I left her home.
I just checked the news again, and the number of people missing has somehow increased tenfold since the first time I looked. I recently left physical therapy practice to become a physician. When I wrote my application to medical school last year, I said that the thing I treasured most about working in healthcare was the moments of humanity that we get to share with our patients. Today, it feels like little pieces of my patients chipped off and are now embedded in my flesh. We are part of each other, and I carry them with me.
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