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I remember standing in my front yard watching the warm, golden Southern California sky as the sun set. The sky was orange, but not the typical soft, welcoming orange of dusk. These were flames, flickering at the night sky with billowing columns of smoke climbing high. Ash drifted down like gray and white snow, settling silently across my front porch like a scene from a post apocalyptic movie. I stood there watching with horror, anxiously tracking updates on the Santa Ana winds, wondering whether our family would need to evacuate.
Fortunately, the winds were in our favor. We were never in the evacuation zone.
But for so many of my patients, colleagues, and friends, that was not the case.
For those in the evacuation zones, there were no leisure decisions. They had minutes to grab a few precious memories, documents maybe, the dog, and then drive away from their homes not knowing whether they would ever come back. Colleagues and patients described to me afterwards the surreal weight of that moment: standing in their house asking themselves what was truly irreplaceable. The lucky ones were able to return. For others, there was nothing left to come back to. Among those who lost everything were physicians and residents, people who had dedicated their lives to caring for others. Some lost their homes, the spaces that had always made them feel grounded and safe. Others lost their practices, the rooms where relationships and trust with their patients had been built over years. Some lost both.
For 25 days, the LA fires burned. The impact was incredibly widespread, extending far beyond the immediate destruction of homes and neighborhoods. Air quality reached dangerous levels across the region, and the threat to respiratory health was immediate and real. In my clinic, I saw a dramatic increase in asthma exacerbations. Patients who had been well-controlled for years were presenting in distress, rescue inhaler use surged, and emergency department visits spiked. The streets told the same story: people wearing N95 masks to buy groceries, an unsettling flashback to the early days of COVID. Prolonged smoke exposure worsened symptoms in patients with COPD, forcing many to stay indoors for weeks, unable to go to work or carry out their daily routines.
The respiratory crisis was only part of what our patients were facing. Evacuation also meant that patients were displaced from the medications and physicians they depended on. Some lost their medications in the evacuation itself, misplaced or left behind. Others, scattered across shelters and temporary housing, found themselves suddenly without access to their pharmacies, medical records, or doctors. For patients managing diabetes, heart disease, or chronic mental health conditions, this was not only an inconvenience, it was a care gap that carried real and sometimes life-threatening consequences. A patient without insulin risks diabetic ketoacidosis, a patient without antihypertensive medication risks hypertensive emergency or stroke. These are outcomes with predictable results of displacing medically complex patients without a plan to keep them connected to the care they need.
The LA fires also took a significant psychological toll on the mental health of those affected. The trauma of evacuation, the uncertainty of not knowing whether a home still stood, and the grief of losing everything left a mark that persisted long after the smoke cleared. Patients and colleagues alike presented with symptoms of acute stress disorder, anxiety, and depression in the weeks and months that followed. Sleep disruption was observed amongst patients, and those with pre-existing mental health conditions including depression and anxiety worsened.
Physicians who lost their homes were expected, in some cases, to show up and continue seeing patients. Those who lost their practices faced not only grief but profound uncertainty about their professional identity and financial stability. Even those of us who were physically unaffected carried the secondary trauma of witnessing the suffering of our patients and colleagues.
What followed the destruction was a true reflection of who we are as a profession and community. Organizations opened temporary clinics to displaced patients without hesitation. Physicians who had lost their own practices were offered space, exam rooms, and supplies by those who had not. Fundraising efforts organized through local, state, and national medical societies, as well as online campaigns, moved quickly, directing money and supplies toward immediate needs: temporary housing, food, clothing, and even toys for children. Families opened their homes. People gave what they had. There was overwhelming outreach to those in need, a collective reminder that in medicine, as in community, we do not let each other fall.
In Southern California, the fires will return. Living in a chaparral climate, that is not a warning; it is simply a fact. California sees thousands of wildfires every year, burning hundreds of thousands of acres of land. What defines us is not the disaster itself, but what we do in its aftermath and how we prepare for the next one.
For our patients, we can be more proactive. That means ensuring that those with asthma, COPD, and other respiratory conditions have written action plans, adequate medication supplies, and clear education about air quality indices and the appropriate use of N95 respirators during smoke events. It means advocating for air filtration access in low-income housing and community centers that can serve as clean-air refuges when the outside world becomes dangerous to breathe. It means thinking ahead about medication continuity for our most vulnerable patients so that the next evacuation does not also become a medical crisis.
For our colleagues, it means pushing our professional organizations to build and maintain rapid-response infrastructure before the next disaster strikes. It means creating and streamlining emergency protocols so that physicians can continue to practice and serve their communities without unnecessary administrative barriers during a crisis, and ensuring accessible mental health support for physicians who have experienced displacement and loss. These are necessities. A physician in crisis cannot fully care for patients in crisis, and if we want our healthcare workforce to remain resilient, we must treat physician well-being as part of the emergency response plan itself.
For ourselves, we can hold onto what I held watching that orange sky from my front yard: the understanding that medicine is not just what we do inside exam rooms, but who we are when everything outside is on fire. In this work, the fires are never only the ones we can see. The work we do is inescapably bound to the communities where we live and serve. When our communities burn, we do not turn away. We show up in the clinic, in the shelter, in the street, and in the wreckage. And when they rebuild, we are right there rebuilding alongside them. Not because we have to, but because that’s who we are as family physicians.
A version of this was published in the CAFP magazine
