Opinion | When ‘Do No Harm’ Means Evacuating Hospitals in California

From the command center, I face heart-wrenching decisions. In the hospitals that remain open, we must delay elective surgeries because we’re operating on emergency power. And every week we do this creates months of backlogs. A patient with a sick gall bladder who delays an elective surgery could wind up in an emergency room — or worse — if the gall bladder becomes inflamed and bursts.

As wildfire smoke fills the air, respiratory issues flare and underlying chronic conditions become acute. Patients who rely on insulin, which must be refrigerated, wonder how they will keep their medication cold and their sugar levels managed without power. Cellphone towers falter without generator backup, roads close and the ability to communicate with our patients is compromised.

When the lights come back on and the firefighters manage to tame the flames, we face traumatized communities. Children who packed up their toys in the middle of the night and parents who wondered whether they are leaving their homes for the last time relive the experience, like a horror movie on repeat.

The shelters where our physicians and others volunteer are filled with people who already live on the margins — medically, socially, financially. We donate supplies, we give our hearts, yet their mental, medical and social health needs only increase.

We have been told that this is the “new normal.”

The health care system often serves as an early warning for larger challenges: Food and housing insecurity, unsafe physical environments and social isolation often present at the doors of our hospitals. These issues demand a medical response, but a cure can’t be found through the tools that physicians and care providers have at their disposal.

The consequences of climate change will not be effectively addressed by individuals alone; society must take collective responsibility. Improved infrastructure and preparedness, like de-energizing the power grid, are important steps, but we need a concerted effort at the local, state and federal levels.

We must update the infrastructure required to meet basic human needs, including clean water, clean air and a safer environment. These are the bedrock principles of public health. We need to return our focus to restoring the foundational elements necessary to support human life.