Joel Eisiminger was racing to save homes in Northern California from a fast-spreading wildfire when a crewmate noticed that one side of his face was suddenly drooping so much that his mouth hung open.
In his six years fighting fires, Joel had tumbled down burning hills, endured full-body rashes from poison oak and inhaled plumes of smoke that left him gasping for weeks. But he had never felt as bad as he did on this morning in July 2024. He didn’t want to let down his crew, so he kept working deep in the forest until a medic told him to get to a hospital. He might have had a stroke.
As the doctors ran tests, Joel grew sicker. Within days, he was too exhausted to walk. On the eve of his 25th birthday, he received a diagnosis: acute myeloid leukemia, an aggressive, often fatal blood cancer that usually strikes people more than twice his age. Joel told the doctors he was not a regular smoker and had no family history of blood cancers. But he did have one risk factor: his job.
For decades, wildfire fighters have been sent to work in toxic smoke without masks or warnings about long-term health risks, The New York Times has reported. They inhale poisons that are linked to more than a dozen kinds of cancer, including leukemia. Many are falling gravely ill, and some are dying at young ages.
But when these firefighters get sick, they don’t all receive the same help.
About two-thirds of the country’s 40,000 wildland firefighters work for state and federal agencies. By law, many of their cancers are assumed to be job-related, and their workers’ compensation benefits are automatically approved.
The other firefighters — about 14,000 — are like Joel. They work for private companies that the government hires to shore up its ranks against a growing wildfire threat. Reliance on these contract crews has more than doubled since 2019, as climate change drives more extreme fire seasons. They have fought alongside federal workers in every major fire of the last decade.
On the front line, all crews take orders from the same command structure and breathe the same smoke. But the laws that cover government workers do not extend to contractors. To get benefits when they fall ill, contract firefighters must prove that smoke exposure caused their cancer — an all but impossible task.
Some go without needed chemotherapy and radiation. Others take on so much debt their families become homeless. Some return to fighting wildfires even while sick.
At the hospital, Joel asked if he would be able to go back to work. The doctors tried to help him understand how urgent his situation was. Just in the days since he had arrived, the malignant cells had gone from undetectable levels to overwhelming. Without treatment, he would soon die. Even with medical interventions, only about half of patients survive a year.
Joel needed immediate chemotherapy and blood transfusions. He would have to commute to a specialized hospital five hours away. He would get much sicker before he had a chance of getting better. Because the fire season had just started, the only money he had to fund any of it was from the paycheck he had just earned.
During his first night on the cancer ward, he opened an online message board popular with contract firefighters and posted a photograph of himself at the hospital, his boyish face partly hidden by the beard he had been growing out. “This is my 6th season fighting wildfires,” he wrote. “I start chemotherapy tonight at 9 p.m.” He asked for positive thoughts and urged others to stay vigilant about their health.
Responses came in from strangers around the country: “Your army is behind you!” “We are all standing with you!” “Get back to the line quickly, my man.”
But when the screen went dark, he was by himself again. This first round of treatment alone would cost tens of thousands of dollars, and like most contract firefighters, he had no health insurance. There would be no guarantee of help from his company or the government that had sent him into smoke each year since he was a teenager. He watched his IV drip in the dim room, bracing for what came next.
Joel fell in love with firefighting after just managing to graduate from high school, where he had often struggled to concentrate. He was working at Taco Bell. One night, his father turned on a movie called “Only the Brave.” It dramatized a real-life disaster that had killed 19 members of an elite wildfire crew in Arizona. Joel was struck by the bonds between the men as they faced death together.
A shy teenager whose family had moved around a lot, Joel loved the idea of an instant band of brothers. The next morning, he went to Pacific Oasis, one of the country’s largest private firefighting companies. Its president, Steve Dodds, took one look at the excited, solidly built 18-year-old and sent him straight to training.
Joel was signing up for grueling work. Wildland firefighters hike into the backcountry in 20-person crews, cut down flaming trees and shrubs, then dig an unburnable moat of bare earth around the fire. Afterward, they wade through fine ash they call moon dust, extinguishing embers to stop new flare-ups.
This work was once done almost exclusively by government crews, but in the 1990s, after a series of staffing cutbacks, the U.S. Forest Service turned to logging and forestry companies for help. The contracts were so lucrative they launched a new industry. Hundreds of companies — including Pacific Oasis — refashioned themselves into wildfire operations. A political backlash against the practice of sending inmates to fight wildfires for dollars a day has further accelerated this trend in places like California, where the use of contract crews has tripled in recent years.
In the heavily forested strip of southern Oregon where Joel lived, fighting wildfires had become some of the best-paying work available to a person without a college degree.
After a week of training, Joel began going out as a member of the crew. He was making a base rate of about $12 an hour, but the real money came from overtime during deployments that could last for weeks. A busy fire season could bring in $30,000 for five months of work.
First-time firefighters generally either drop out quickly or become hooked. Joel was hooked. He had grown up pushing his limits hiking and mountain-biking with his father. In high school, he had played lacrosse and earned the nickname Battering Ram. Now he drew on that well of endurance to support his crewmates, many of whom soon became his best friends.
Joel began keeping his fire bag packed and ready by the door. Before firefighting, he had often felt anxious and adrift. When he was deployed, he felt exhilarated, marching deep into the woods with 50 pounds on his back and a chain saw on his shoulder. Sometimes, he worked 24-hour shifts amid flames as high as his head.
“It didn’t feel like a job,” he said. “It’s like being in fairyland.”
Back home, he would meet up with other firefighters to play pool at the Wild Goose Cafe and Bar. Locals would thank them and buy them beers. Joel used some of his earnings to help his parents put a down payment on a house. Then he bought a motorcycle and spent the winter months between fire seasons souping it up.
His employee file at Pacific Oasis was stacked with praise from the Forest Service for his crew’s “great attitude,” their “exceptional” work in 108-degree heat, their “huge role in catching this fire.”
After sending Joel across five states, Pacific Oasis tapped him in 2019 to lead a small squad. He took care to teach new recruits about wearing hard hats and goggles. He didn’t give much guidance about respiratory protection, though, because there was little protocol for that. There had been nothing in his training about the long-term health risks of smoke inhalation.
Like most wildland firefighters, Joel had been taught to wear a bandanna in bad air. This has been standard practice for years, even though bandannas offer no barrier against carcinogens.
He bought one decorated with an American flag, and it appeared in all the photos he sent back to his parents, its white stripes turning gray with ash. He told his squad to get their own. He never saw anyone wear a mask.
Joel noticed right away that inhaling so much smoke came with consequences.
Firefighters talk about “camp crud,” an amalgam of respiratory ailments that set in early during fire season. Pacific Oasis workers said that morning meetings sounded like an emphysema clinic. Joel began to cough, and his mucus turned black. Sometimes the smoke made him so dizzy he could barely stand.
Many countries now routinely offer wildfire crews half-face respirator masks. But in the United States, the Forest Service tells its workers not to wear masks on the fire line. The agency says firefighters could overheat. Current and former officials have told The Times that the agency doesn’t want to risk admitting how dangerous smoke really is.
Firefighters themselves often see masks as a sign of weakness. “I would have gotten laughed at,” Joel said. Instead, crewmates traded recommendations for pills and teas that might help their lung issues.
Joel often worked alongside unionized government employees who had better protection against smoke exposure. California’s wildfire agency provides clean-air rest in hotels or trailers and 24 hours off between shifts. Unlike contract crews, Forest Service workers sometimes let ashes smolder instead of “mopping up” every ember.
At Pacific Oasis, bosses talked about the inevitability of “eating smoke” and the need to “suffer and execute.”
Joel occasionally thought about trying to work directly for the government, but his career as a contractor seemed to be taking off. Early last year, his boss, Steve, invited him to train as a crew leader who would oversee an entire 20-person team. It was one of the proudest moments Joel could remember, and he began to imagine spending his life working for the company.
His mother, a care coordinator for veterans with cancer, struggled to understand how he could be out in all that smoke without a mask. Joel told her not to worry. “I guess I thought I was invincible,” he said.
The World Health Organization now says that firefighting can cause cancer. But many company owners remain dismissive about the long-term dangers of wildfire smoke. “I’m very skeptical,” said Lee Miller, whose Miller Timber Services is among the largest U.S. firefighting companies.
Meranda Warren, vice president of the Northern Rockies Wildfire Contractors Association, said some in the industry were aware that smoke exposure can lead to illness. But, she said, “people are afraid to speak up because of fear of losing our contracts.”
For Joel, the risks started becoming clear in the days after his first chemotherapy session last summer. He kept checking the replies to his post on the message board and was surprised to see that in addition to the notes of support, dozens of firefighters were sharing their own stories.
“I got diagnosed with cancer last October. Take care of yourself first, the fires will always be there,” wrote a 36-year-old in Nevada.
“I’m almost at my four-year Cancerversary,” wrote a firefighter in New York. “You’ve got this!”
Another, in California, shared his diagnosis and wrote: “After you are in remission please consider positions where you won’t be on the line. It will be better for your health.”
Joel had known he was taking some chances by becoming a firefighter, but had always felt like he was safe once he made it back to the Wild Goose with no injuries. Now he wondered if his illness was not random bad luck but an almost inevitable consequence of decisions he had made when he was 18 years old.
As Joel grew sicker, the bills started arriving: $880 for a blood test, $15,030 for an overnight stay. He hoped workers’ compensation might cover some expenses.
The government paid Pacific Oasis about $60 an hour for each firefighter. Some of that funded workers’ compensation insurance, which covers medical bills and lost wages when workers are injured or fall ill because of their jobs.
He went to Pacific Oasis headquarters to ask about filing a claim. He was too weak to drive, so his father, Matt, took him. They both remember Steve’s response the same way: “There’s no way that you can prove this is work-related.”
On the car ride home, Joel broke down. His father struggled to contain his outrage at Steve. “I couldn’t believe he’d spent thousands of hours working with Joel, but at the first sign of trouble, he changed completely,” Matt remembered.
Steve, 67, had his own frustrations. He sympathized with Joel’s plight and later said he was just trying to warn him that his claim was unlikely to succeed. A self-described hippie when he founded Pacific Oasis as a forestry company, he had only recently stopped leading fire crews himself and still believed strongly in universal health care.
But he felt no responsibility for Joel’s illness. He doubted that wildfire smoke exposure caused cancer, especially in someone who had spent so few years in the job. Steve was focused more on immediate dangers, like falling trees or chain saw injuries. “Cancer doesn’t even make my top-10 list of worries,” he said.
He also had the concerns of a business owner. Joel’s case might raise his insurance rates, already his largest expense behind payroll. Those who worked with him knew to expect both sides of his personality: He could be a paternal mentor who trained them and gave them second chances, but also a demanding boss who watched out for the bottom line.
Still, Joel decided to pursue the benefits and, as required by law, began getting a portion of his lost wages while the insurer considered his case. It was enough to pay for his parents to stay at a nearby motel during his weekslong treatments.
Joel was one of the youngest patients on the cancer ward and was determined to stay strong. He walked laps with his IV pole, logging miles each day. The nurses cheered him on, but they knew what was coming. By his second stay, in late August 2024, he could barely leave his bed.
One night he looked up the survival rate for acute myeloid leukemia: 70 percent of patients died within five years of diagnosis. For him, that would mean dying before he was 30.
Wildfire smoke contains benzene, a known cause of acute myeloid leukemia, and studies have shown that firefighters die of blood cancers at higher rates. Joel’s oncologist, Dr. Curtis Lachowiez, said he tried to discourage firefighters in remission from going back to that work. “Inhaling all those chemicals is not good for them,” he said.
Joel reluctantly decided to follow his doctor’s advice. He applied for a scholarship through a leukemia foundation to become an arborist. “Having cancer has quickly taught me how precious life is, and reminded me that every living thing can be lost if not cared for,” he wrote.
He spent September in and out of the emergency room with infections. His bones ached, and he was taking 15 pills a day to manage side effects from chemotherapy. One day, a letter came from the insurer. “Your work is not the major contributing cause of your claimed disease,” it read.
Joel was stunned. No more payments were coming. He had no savings left, and months of treatment ahead.
His family cut back on groceries and maxed out their credit cards. His mother started picking up overtime shifts.
With no money for his parents to stay nearby, Joel passed the time in the hospital playing online video games with friends from his crew. They teased him about losing his mountain-man beard and called him their little bald baby.
The treatment was working, but it left him depleted. At home, he crawled the steps to his attic bedroom on his hands and knees. Hospitals were sending second and third notices of unpaid bills.
As the fall passed, he sometimes thought about how different it could have been if he had worked directly for the Forest Service. A 2022 federal law had given those firefighters automatic workers’ comp benefits for many illnesses, including 14 cancers, that Congress determined were linked to their smoke exposure. Similar legislation in Canada had included contract crews, but that didn’t happen in the United States.
Joel could have appealed his insurance denial. But it is rarely possible to prove the cause of cancer. Other contractors and their families have tried. After two years in court, a firefighter in Ohio with testicular cancer is still appealing. The widow and children of a crew member in California who died of esophageal cancer lost their home while fighting for coverage.
In December, after Joel’s final round of chemotherapy, an envelope arrived from Pacific Oasis. Inside was a year-end bonus check for a few hundred dollars and a note: “I hope this reaches you in good health.”
Joel was relieved to be able to cover a bill or two. As the family sank into debt, he had begun to imagine earning overtime again on the fire line. Hiring for the year usually began when the snow melted, and involved a 45-minute hiking endurance test. He wondered if he could get strong enough to pass.
Joel tried to hike again soon after the new year. At first, he took faltering steps and struggled to walk more than a few yards. But by the spring, he could make it to the ridge above town.
His oncologist had told him he was in remission. But if the cancer came back, he would need a bone-marrow transplant. He felt like he had only a brief window. “I’m dying anyway, so I might as well live,” he told a contract firefighter friend who had just returned from the Los Angeles fires.
In March, his scholarship application to study to become an arborist was rejected. There were too many other qualified candidates, the letter said.
A few weeks later, Joel and Matt went on a long uphill hike. Joel told his father what he now felt he had known all along: He was going back to firefighting. His father hesitated, but finally said, “I know you love it.”
“I guess I never realized how much I did,” Joel said. “At the end of the day, if I live to 25, I’ve lived a good life.”
He thought someone from Pacific Oasis might reach out about coming back, but no one did. He couldn’t bring himself to get in touch.
By July, a year after his diagnosis, he was looking farther afield. There were Forest Service jobs in Alaska, where more wildfires were burning than in the rest of the country combined. Soon, that became the plan. His parents bought a $600 plane ticket, paying $50 extra to make it refundable, just in case.
Four days before the flight, Joel drove to Pacific Oasis one last time. He needed his employment records to take to Alaska. But he also hoped that Steve might see him and decide to take him back.
In the office, Joel breathed in the familiar smell of wood chips and made a final appeal. “I’ve been broke from the cancer,” he said. “I don’t have five dollars.”
Steve said he was sorry but Joel’s health problems meant the job wasn’t a good fit anymore. “It’s just life,” he said.
Joel put his motorcycle in storage, packed his fire bag just as he always had, and spent his last day in Oregon trout fishing with Matt. His fingers were stiff, a lingering effect of his illness, so his father tied the bait.
The next morning, he turned 26. His grandmother called to wish him a happy birthday. She didn’t know he was about to catch a flight, and she asked if he had any fun plans.
Joel’s voice broke as he started to answer. It felt like everything — his broken body, the debt, the uncertainty ahead — was landing on him at once. He stared for a while at the door, then pulled on his sunglasses and walked out to the truck.
His father followed behind. “Let’s go, buddy,” he said softly.
Outside, Joel could see smoke rising from the hills behind town. Dozens of large fires were burning across the country.
Soon, he hoped, he would be out on one of them.
Steven Rich contributed reporting. Kitty Bennett contributed research.
Hannah Dreier is a reporter for The Times who covers laws and policies by telling the stories of the people they affect. She can be reached at [email protected].
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