Dr. Ashraf Elsayegh’s house was one of the first to burn.
He stepped out into his backyard atop the Pacific Palisades in early January to find a raging fire leaping from three houses away to two. He gathered his family, helped older neighbors to their cars and fled without a single keepsake.
In the days that followed, Dr. Elsayegh, a pulmonologist, did not have a chance to grieve. As he did his rounds with patients at Providence Saint John’s Health Center in Santa Monica, Calif., his cellphone was bombarded with neighbors and friends seeking his expert advice.
What kind of air purifier?
Is an N-95 mask enough?
My daughter has asthma — should we rent a place farther away?
“Forty phone calls a day with the same set of questions,” Dr. Elsayegh recalled.
So when the chief administrative officer of the hospital invited him into his office to ask Dr. Elsayegh how he could support him and his family, Dr. Elsayegh replied instead, “Let’s open a clinic.”
Just three weeks after the blaze tore through neighborhoods of Los Angeles, the hospital’s urban fire clinic for pulmonary issues began seeing patients. They came in droves, each with a different set of symptoms and concerns. The clinic has served as an early indicator of the types of health problems developing among those exposed to the fires, ranging from newfound shortness of breath in healthy people to exacerbated symptoms in patients with asthma, C.O.P.D. and other lung diseases.
The health effects of an urban fire differ from a those of a wildfire, and when an entire community burns quickly, releasing unquantifiable toxins in unexpected directions for an unknowable period of time, there are long-term health effects that no expert can yet fully calculate. Dr. Elsayegh is making it his mission to support patients from the Palisades and surrounding communities for months and years into the future, when, he fears, cleanup crew members and others with chronic exposure may begin to show signs of severe lung diseases, like asbestosis and silicosis, and even cancers like mesothelioma.
Another long-term concern is pulmonary fibrosis, a progressive disease in which scarring thickens and hardens lung tissue, making it difficult for oxygen to move into the bloodstream. Dr. Elsayegh describes a lung with pulmonary fibrosis as “a stiff balloon from the party store” — your face flushes as you try to force air inside, but it simply refuses to inflate.
As a former Palisades resident intent on returning to the neighborhood, Dr. Elsayegh is also doubling as a trusted confidant, drawing on his personal experience to help his patients face uncertainties and find solutions — or next steps, at least.
“In an ideal world, I would go in there and say, ‘Everyone that lives in the Palisades and in L.A. County, let’s all move. Let’s all go somewhere else and we don’t have to worry about this,’ ” he said. “That’s not reality. I’m trying to find this unbelievably difficult balance of helping us return to normalcy or return to our life, but doing it as safely as possible.”
In early February, Dr. Elsayegh pulled up a chair next to Dana Michels, a cybersecurity lawyer and healthy mother of three who had gone to check the damage at her house and now could not shake a cough.
“Sweetheart, you’re not moving air at all,” Dr. Elsayegh said, listening to her lungs through a stethoscope and quickly ordering a breathing test and a nebulizer, to start. A pulmonary student asked to take a listen, then glanced up at Dr. Elsayegh, looking confused.
“I’m not hearing anything,” the student said. Dr. Elsayegh gave a single nod.
After years of renting, Ms. Michels and her husband got their first mortgage almost four years ago; it was a family milestone. Now, with their Palisades home smoked through, the family is split between two rental apartments in Marina del Rey — one for boys, one for girls — and they are navigating a new school, new insurance paperwork and new prescriptions to manage the wheezing.
Another patient, Andrew Orci, was dealing with the effects of lung scars, which had resulted from cancer treatments more than a decade ago. Mr. Orci’s family was staying in an Airbnb in West Hollywood, far enough from the debris to avoid dust plumes, but Dr. Elsayegh explained that he would still need to be on the lookout for severe shortness of breath in the coming months. His lungs were fragile, and his exposure to pollutants from the burning homes could significantly worsen the course of his condition.
Waves of new patients in March and April showed toxins had made their way farther and farther from the Palisades, affecting people who had been nowhere near the fire’s epicenter when it was raging. One person in Brentwood, about five miles inland, told Dr. Elsayegh that his bronchiectasis, a condition involving excess mucus in the airways, had worsened once trucks from the Palisades began driving through his neighborhood, hauling loads of debris.
Barbara Effros, 67, already had chronic bronchitis when wind off the fire zone carried dust all the way to her windowsills in Culver City, about nine miles southeast. Now, Ms. Effros, who used to walk three miles per day, could hardly get from the car to the hospital check-in counter.
“It feels like I smoke a pack of cigarettes a day and I’m at 12,000 feet,” she said, “like there’s a clogged straw in my throat.”
Dr. Elsayegh’s mental framework for the pulmonary aftermath of the Palisades fire comes not from the burning of more than 5,000 buildings in Southern California but from that of an iconic two 3,000 miles away.
On Sept. 11, 2001, Dr. Elsayegh was a medical resident in New York City. He remembers his hospital’s mad rush that day to transfer all patients out of the city and make space for those injured from the falling World Trade Center towers, only to see their wards lie vacant through the night.
“Either you died, or you were relatively OK,” he said.
It was only months after the attacks, when residents near ground zero had settled back into their apartments and workers had been inhaling dust and toxins in the pit, that a slew of patients began showing up at his hospital, complaining of shortness of breath.
Jen Croft, who monitored the air quality in the Los Angeles area after the fires with the Interagency Wildland Fire Air Quality Response Program, said the destruction of Sept. 11 was not a perfect comparison, given the different materials, footprint and heat source, but that some elements of the aftermath would be similar.
And indeed, Dr. Elsayegh is now beginning to see an uptick in patients coming through the clinic, including firefighters who are complaining of worsening asthma and other symptoms. He plans to visit firehouses throughout the region in May, measuring lung function in those who might still be putting off care.
For a while, new marks of the disaster were everywhere Dr. Elsayegh looked. His medical assistant at the clinic suffered asthma attacks, calling in sick. Dr. Elsayegh needed to call pharmacies and remind them to contact patients instead of mailing prescription medicines to the home addresses on file, since many had burned down.
After a catastrophe, doctors like Dr. Elsayegh sit at the nexus of physical and mental health care. Suicide rates typically surge after natural disasters, as do cases of anxiety, depression and post-traumatic stress, so Dr. Elsayegh often talks with his pulmonary patients about the trauma.
“I tell them, ‘Don’t forget: I’ll take care of your lungs, but here are some ideas and some strategies, including therapists,’” he said. “You need more than the 15 minutes they have with me.”
Luciana Brafman, an environmental activist and film producer, came to see Dr. Elsayegh because she developed a grueling respiratory infection after driving into the Palisades while wearing only a surgical mask. But in the waiting room, her strongest concern seemed to be the broader effects of the crisis.
Ms. Brafman described her ongoing film project about recent floods in Brazil and how it dovetailed with swirling fears about the effects of the Palisades fire on nearby marine life. She eventually needed medication to sleep but was still plagued by the same nightly dream: grabbing her son and running for cover.
At the end of a long clinic day, Dr. Elsayegh sat with Susan Kanowith-Klein, an 80-year-old who felt physically fine — despite a history of pulmonary issues — but emotionally spent. Ms. Kanowith-Klein’s home in the Palisades had survived the fire, but she wondered aloud about whether air quality test results were legitimate, whether hazardous soot meant she should relocate and, deep down, whether her community would ever be the same.
She missed her water aerobics class and her yoga practice; she was in her fourth temporary living situation while she decided whether to move back.
“How’s your home?” Ms. Kanowith-Klein asked Dr. Elsayegh, wiping away a tear.
He answered simply, “Gone.”
Emily Baumgaertner Nunn is a national health reporter for The Times, focusing on public health issues that primarily affect vulnerable communities.
The post An L.A. Doctor’s House Burned. Now He Treats the Fires’ Effects in Neighbors. appeared first on New York Times.
