The fire’s violence came to life as I stared at the stucco walls that had been sucked inward by the heat-generated vacuum, the pool-side furniture that had been thrown several yards, the shattered glass that had changed color, and the melted metal that had hardened into solid silvery puddles. Our washer, our dryer, and a bathtub survived as black carcasses, but nearly everything else was ash. Our car was ash. Our stove was ash. Even our fire safes were ash (Fig. 4). Only our stone-and-metal mailbox survived. I pulled out the last delivery before our vacation hold had commenced. The envelopes were brilliant white, and I smelled not a whiff of smoke. If only our house had been built like our mailbox.
POSTTRAUMATIC STRESS DISORDER
Our office was in the evacuation zone for 2 weeks, but it survived. After an unsteady month of fire-victim cancellations, work returned to normal. From the office, though, I stepped off terra firma into quicksand. Our new quarters, designed for vacationers, had no desk, poor lighting, and no outlet for a laptop. Along with my computer, hard drives, and organized files, my productive days had burned up in the fire.
An identity thief registered with the Federal Emergency Management Agency as Paco Canales, in hopes of collecting money, which meant that the real Paco Canales had to spend hours on the phone with the Justice Department, Homeland Security, and the Federal Bureau of Investigation with multiple fire-related transactions.
Mail delivery has never completely resumed; we still receive just 10 percent of our previous volume. Some mail has been returned to senders, but most of it has simply disappeared.
Six months after the fire, insurance battles forestall plans to rebuild. Every day we field e-mails, texts, and phone calls from the insurance company, the private insurance adjuster, the demolition team, the bank, lawyers, and assorted other people. The small, temporary house we now have gives us a place to tread water. Prolonged uncertainty is our new normal.
In those first weeks I didn’t sleep well, awakening with dreams of flames consuming my paintings. I was anxious and startled easily. I clutched the few things I owned, fearful of losing something. Even with little to keep track of, I lost things constantly: credit card; driver’s license; clothing; purse; replacement car key; replacement credit card; replacement passports. I had difficulty concentrating on what others were saying, making decisions, and storing anything in my short-term memory. My brain was stressed, and my hypothalamus had shrunk. Only at work did I feel normal.
I lost thousands of beloved books, so my first step forward was to rebuild my library, starting with Winnie the Pooh, for comfort; King Lear, for dramatizing loss; and Robert Sapolsky’s Behave, which I had left half-read on my nightstand. Sapolsky explained the biological and environmental influences that impact the brain, and I was a textbook example of the chapter on stress. I realized that my psychological experience must be similar to that of plastic surgery patients who have experienced sudden loss. In my career, I’d spoken to replant, burn, and other reconstruction patients as if they could comprehend and make informed decisions. I was a living example that such expectations were naive.
To help me process my loss, I thought of others with greater losses: Holocaust survivors who lost all; Abraham Lincoln, who navigated our nation through the Civil War while mourning the loss of his son; Deb Johnson, M.D., who led the American Society of Plastic Surgeons as president with brilliance and grace after losing her husband, Mario Gutierrez; and Barbara Kammerer Quayle.
Humans are resilient. But there have been fire-related suicides, including someone I knew. The number of mental health problems has increased as the months have gone by, confirming experts’ reports that psychological problems often worsen 6 to 12 months after an act of terrorism or a natural disaster.7,8 I believe resilience is an active decision, and it hangs on a sense of purpose. Overcoming past challenges helps, too. The hurdles I’ve dealt with, that we all deal with as plastic surgeons, have given me the experience of rebounding.
The aftermath of the Tubbs Fire is more like an epoch than a time-stamped event, but someday I’ll write new journals, paint new paintings, and tell a new story. I’ve been lucky in life, and I am lucky still. In this postfire dystopia, Paco continues to be my anchor. My family, my work, my friends, and my dreams for a bright future give me purpose. And that’s the best medicine of all.
ADDITIONAL WORDS FROM BARBARA KAMMERER QUAYLE, 2017 PATIENT OF COURAGE
Loss is greatly underrated no matter if it is one’s appearance, lifestyle, parents, spouses, children, friends, possessions, job, or pets. After my burn, I felt shock, disbelief, and a bit of denial until I could grasp the full impact. Then reality gradually set in, accompanied by fear of the future.
My life had been easy until the day I was a passenger in a rear-end car collision. I sustained severe burns of my face, head, back, arms, and hands, and my life turned upside down. I knew nothing about burns, I assumed that the burns on my face were like a severe sunburn, and I would eventually look like I did before. I was afraid to see myself, and I avoided reflective surfaces in the burn center. The staff never asked if I’d seen my face, having no idea I’d need their support that first time.
My first look was in my bathroom mirror the day I was discharged. My image looked like a woman from a Hollywood horror film. I ran from the room screaming and crying. That was the beginning of reality and my emotional and psychological healing. No patient should be discharged without seeing his or her face with the support of staff and family.
I was single, and I had to work. I feared I couldn’t handle teaching again, that the kids might reject me, but no one said the “D” word to me: “Disabled.” Going back to the classroom gave me purpose. Still grieving my former life, I slowly adjusted to a “new normal.”
Burn survivors grieve a life they can only partially retrieve. I grieved not being able to play tennis, and I could no longer watch it. I grieved thinking I’d never have another boyfriend, let alone be married. Sometimes on Saturday nights, when I knew others were out on dates and having fun, I felt very sad.
I was also faced with social changes. Now whenever I walked into a public place, startled glances, stares, whispers, intrusive questions, avoidance, even laughter became overwhelming. Then a dear friend told me: “Walk in that restaurant with your head held high and stand up straight!” Though I may have been a burn victim, I didn’t have to act like one. No longer would I allow strangers to ruin my day, and that vow was a life changer.
To help me project an image of confidence and to feel socially comfortable, I developed a tool: Self-talk, Tone of voice, Eye contact, Posture, and a Smile. Those five letters, S-T-E-P-S, gave me confidence, even when I was scared. To be in control of social situations, I developed another tool: Rehearse Your Response. Whenever a stranger asked an intrusive question, I used a response I’d created and memorized: “I was burned in a car crash. I’m doing better with my recovery. Thanks for your concern.” I headed off persistent questions with: “That’s all I care to discuss today.” Then, I would smile and walk on.
A stare, unlike a glance, can make anyone feel like an object. People who stared could make me feel angry for hours. One day I decided I’d no longer be a victim. Using my STEPS tool, I would look directly at the person staring, and I’d say, “How are you doing? Isn’t this a beautiful day?” The opening line allowed them to see me as a person.
I became active in the Phoenix Society for Burn Survivors (https://www.phoenix-society.org/), the largest worldwide organization assisting survivors, families, and professionals with aftercare community reentry programs. I have also assisted plastic surgeons with online programs I developed.
My plastic surgeon, David W. Furnas, M.D., was my partner in the reconstructive process, and he applauded my successes. Before my first surgery, my therapist encouraged me to say, “Dr. Furnas, I don’t want to be just a file sitting in a cabinet; I don’t want to be just a label: ‘teacher who was burned.’ I need to know that you really care about me as a person and that you will do your very best to help me.” In those days, one did not say something like that to a doctor. But David, as I came to call him, put his arms around me and hugged me and told me he did care a great deal, and he would do his very best. Thinking of that still brings tears to my eyes. I have always held a quote of his close to my heart:
A crisis, at the onset, usually augurs nothing but ill. In the long run, however, my crises have more often than not marked a new course in my life, which is more fulfilling, and more exciting than anything in the past. Yes, a bit of good luck is needed, but the special feature of a crisis is that you are suddenly cut off from past patterns, habits, and interdependencies. Along with the distress and pain is freedom! Freedom to build again, with a new foundation and modern structure, using wisdom you didn’t have the last time you built.
—David W. Furnas, M.D.
The trick is to find your way out of the depths.Copyright © 2018 by the American Society of Plastic Surgeons