Waterman is the vice president of primary care for SCAN Health Plan, where he leads Embrace, an integrated payer/provider serving residents of senior living communities.
Tuesday night was the night we didn't know anything.
From news reports, panicked phone calls with our families, and nervous glances at the bloodied horizon where wildfires raged and smeared the sky with a fiery glow, we understood all too well the severity of the fires burning uncontrolled in the Pacific Palisades and Altadena neighborhoods. But the question on all of our minds was: Where are our patients?
I'm a primary care physician and oversee clinicians in a program that provides home-based primary care services to about 3,400 older adults living in assisted living facilities and nursing homes in Southern California and Arizona. Most of our patients are older than 80. About half have dementia.
As I watched images of fire on TV news late into the night and saw one oft-replayed clip of a nursing home in Pasadena that had burned down, I began to wonder ... were those our patients? Soon, I started to hear from members of my staff. Several lived in the areas of the fires and had evacuated. I was as concerned for them as I was for my patients.
As soon as the sun came up, we started calling each other. One nurse practitioner had left her home with her 7-month-old son in tow. Another had evacuated to Long Beach, and the fate of her house was unknown. In all, I learned that seven members of my staff had evacuated their homes.
Yet everyone was ready to get to work. People who literally didn't know if their homes were still standing said their first concern that morning was finding our patients.
We weren't able to physically go to the facilities in the fire zones. Many had lost power and landline connections. But with cellphones, we started to get an understanding of what had happened.
In these cases, it's the individual stories you remember. A woman with a broken hip had been transferred from one skilled nursing facility to another. When fire threatened that facility, she was transferred to yet a third facility.
At another facility, a man who had been in hospice care had passed away just hours before his wife was evacuated. We called her children. Even as they grieved for their father, they had no idea where their mother was.
In total, about 100 of our patients had been evacuated. Many had gone to family members' homes. Most had left without their medications or other medical supplies. While some of us worked the phones, others contacted pharmacies. We wrote and renewed dozens of scripts and had them filled at pharmacies near the patients' new locations.
Later in the afternoon, we learned that about 50 patients had been transferred to the Pasadena Convention Center. Though most of them were able to walk, many were agitated. One woman spent the night in a chair with her dog on her lap. Others sat on cots holding onto Red Cross blankets, waiting for someone to take them back to their homes. The next day they'd get the all-clear to go back. In the meantime, we found our members, delivered medications, dressed their wounds, and attended to their medical problems. Perhaps most importantly, our care brought a sense of normalcy and routine at a time when everything felt uncertain, helping them to stay calm and trust that their needs would be met.
On Thursday, we rounded. We saw some patients in hotel rooms. Others were in facilities. In one, the memory care unit had never been evacuated, everyone was accounted for and mostly oblivious to what had happened, even though the facility lacked sufficient clean drinking water and lost power.
We located one patient who'd been transferred from a different facility and had lost touch with her family. We called her daughter. Much relieved, she immediately came out to see her mother.
Nineteen patients couldn't return to their facilities. So, we started calling around, looking for rooms for them. Physicians who deal with older patients dread filling out move-in orders -- lengthy forms that authorize resident admissions to (or in this case transfers between) senior living communities. The forms are often cumbersome and repetitive. We filled out 19 of them in under two hours.
Our next priority was to get supplies to affected patients. Durable medical equipment had gone missing. Incontinence supplies weren't available. There was still a good deal of particulate in the air, and our patients with COPD needed N95 respirators. No one had clothes. Everyone needed water. We called suppliers and pharmacies. But we also shopped at Target, Costco, and anywhere else we could find supplies. Then we used courier services or our own team members to hand deliver them.
Disasters have a way of showcasing the extraordinary dedication of those who serve, and in this crisis, my team's commitment to our patients was nothing short of awe-inspiring. Despite the personal uncertainties and the looming threat to their own homes, they continued to work tirelessly, ensuring that our most vulnerable residents received the care and support they needed.
That said, I humbly admit that much of what we did in those three days we simply made up as we went along. In the weeks since, we've established firm protocols that we hope will enable us to respond more effectively and quickly the next time we face a crisis of this sort. That, combined with the compassion and professionalism of my team, gives me hope that no matter the circumstances, we'll be prepared to meet our patients' needs no matter the emergency.