Times have been very hard for my region of the US as we have had, like Israel has had in recent months, a rash of uncontrolled wildfires raging in just the past few weeks.  The last I read, seven people in the Texas panhandle combined with northwest Oklahoma  were directly killed as a result of the nearly impossible to stop grass fires.  Fueling these have been dry conditions, low humidity, high velocity winds, and plenty of fresh fuel of broken limbs from our few trees which were lying on the ground.   It is good that we are in very low population areas for Texas, Oklahoma, and Kansas, or the human death toll and destruction of human habitations would likely have been much higher – the death toll to cattle has been inestimable so far.

 

But, as a physician, I wonder how many people’s deaths occurred indirectly as a result of exposure to the chemical and particulate components of the smoke.  It is possible that for the cause of death cited on the death certificate of others who passed away in the region, some other diagnosis besides smoke inhalation or fatal burn injuries might have been cited.  The thought struck me when reading about one of the seven who died – she was a Oklahoma rancher’s wife who was helping her husband as the flames approached their property.  He was reputedly moving their cattle to safety when she suffered a heart attack doing heavy work required to secure their ranch.  Then it dawned on me --- we lost my mother-in-law very recently from a heart attack the day there were grass fires in three counties surrounding where she lived.  How many others lost their lives during this fiery trial because their bodies were unable to properly oxygenate their vital organs?

 

My mother-in-law (a.k.a. “Mother” to me, because I am unusually close to my husband’s family) suffered from diastolic dysfunction congestive heart failure for years as a result of uncontrolled hypertension.  The high blood pressure issue also damaged her kidneys where she had chronic renal insufficiency and she was dangerously close to needing dialysis.  Due to decreasing functionality related to her congestive heart failure coupled with crippling arthritis in her lower extremities, as a family, we were forced to make the hard decision to move her into an assisted living facility about the time the grass fires first started. 

 

However, within a few days of admitting Mother to the assisted living facility, she fell backwards in her room and hit the back of her head on a bedroom end-table.  Apparently, she was attempting to choose what clothing to wear that day without assistance from the staff (I guess her lifelong habits of personal care were hard for her to break while she was first there and getting used to receiving help).  My brother-in-law’s wife  took my mother-in-law  to an emergency room, where it was discovered that while Mother’s head was all right, her serum sodium level was dangerously low.  This was coupled with an excessive bodily fluid load, and both problems were  probably related to both her kidney disease combined with congestive heart failure.  She needed to be hospitalized several days to correct these imbalances, and she responded well to the treatment. 

 

The problem of fires in Texas began three weeks ago, at the time Mother was first moved to assisted living.  Of course, these two unfortunate events were not related, but both had bearing on our family’s respiratory health.  Only I didn’t realize when we left northwest Oklahoma to take care of Mother  that there were fires occurring  in the Texas panhandle.  I thought we were having a bad dust storm, and I could see this orange-to-brown-to-black cloud hovering across the Texas state line  (I can see Texas from my front porch).  We already had extensive beige dust clouds near the ground from the high wind gusts stirring up dust and fanning the fires.  So, I thought this large, darker cloud was a wall of dust moving in from the west.  Usually, since I have well-controlled mild-intermittent asthma,  I would stay inside under conditions like this.  But we had this family emergency and my husband and I needed to drive across the state to eastern Oklahoma. 

 

So, we packed up under these adverse conditions and I soon began having a sore throat and cough about an hour after we got on the highway.  But, it seemed like we were making some progress escaping from the dark Texan curtain of airborne particulates which were whipped up into the lower atmosphere.  We stopped to get some over-the-counter relief medications, which helped greatly and we were able to reach our destination and see my mother-in-law.  But the following day, local allergens produced a worsening respiratory condition in me.  Due to an asthma-type cough I couldn’t control (and I couldn’t absolutely rule out it wasn’t  from an infectious cause at the time), I had to stay away from the hospital for a couple of days.  I was able to go back to the hospital on the day Mother was released to help get her moved back to assisted living, and she and I had several reflective conversations that day (which I am glad we were able to have – it has been good that we’ve always been able to talk). 

 

Due to our responsibilities at work and at home, my husband and I had to return to northwest Oklahoma after my mother-in-law was discharged from the hospital, much to Mother’s dismay.  We had an unusually tearful departure from her, and in light of her emotional state, we even stayed to have dinner with her at the assisted living facility.  Across the region, at this point in time, more wildfires had cropped up in patches across Oklahoma, Kansas, Texas, and Colorado.  Driving home, we managed to avoid any conflagrations or excessive smoke on our journey.  The farther west we travelled to drier, more grass-plains-like biomes, the better both of us felt from our allergic symptoms which flared up in the eastern part of the state.

 

Three nights later, when the grass fires started in the three counties surrounding Mother’s assisted living facility, my brother-in-law called and told us that Mother was back in the hospital – this time in the cardiopulmonary ICU in Tulsa.  That night, she couldn’t breathe so she alerted the assisted living staff that she was having difficulties.  The nurses checked her over, everything sounded normal in her lungs, she was oxygenating well, her heartbeat was regular, and she was able to talk to the staff about what she was experiencing.  My brother-in-law was called and told about her reported difficulties, and the recommendation was made to monitor her closely.  About an hour later, the nursing staff went to check on her, and Mother was found down on the floor, unresponsive.  The staff called an ambulance to take her to Tulsa.  Between the two teams of nurses and paramedics, they were able to resuscitate her and place her on life-support, but she still wasn’t responsive.  An old ICU physician colleague determined that Mother had suffered a heart attack and an anoxic brain injury.  Neurologically, she declined in the hospital, and it was clear by the time my husband and I drove back across the state that we had lost her. 

 

Driving across the state, we encountered a large smoke cloud along the way, but we had no idea that the grass fires had gotten out of control in the central and eastern parts of the state.  We were too concerned about Mother to try to put the whole picture together.  When we arrived at the hospital, we could smell smoke and wondered about it, but our family priorities had to come first.  After Mother had passed away, we left the hospital and drove back to her house.  While wandering around looking for someplace to get food in the middle of the night, we encountered a huge, heavy particulate smoke cloud in a small town just west of Tulsa.  The next day, back at Mother’s house, we discovered that there were a couple of grass fires between Tulsa and this little town which had been burning at least a day or two. 

 

But this wasn’t the worst of the fires – they were yet to come two to three days later.  While we making arranging for Mother’s funeral, massive wildfires spread across the Texas and Oklahoma panhandles and into northwest Oklahoma.  Mother’s pastor asked us if we needed to go back to the northwestern part of the state and check on our house.  My husband wouldn’t consider it, and I told the pastor that if our house burned down, it would be an improvement (it was built by amateur carpenters in the 1950’s so enough said about that subject!).  Instead, we called people from our church who reassured us that while there were fires raging in the next county west over in Texas, everything was safe and sound at our house.  It was better from a respiratory standpoint to stay where were were – nearly everybody in the northwestern part of Oklahoma with respiratory illnesses and cardiac issues were doing much worse than they had been after the first set of panhandle fires. 

 

At this point, several readers in tune with our odd American weather patterns may be thinking, “Didn’t your area get a high amount of rainfall last year, almost ameliorating the long-term effects of a multi-year drought?”  This is true; however, our last significant precipitation came in the form of heavy ice storms in January, which brought down innumerable power lines and snapped off large branches from the few trees we have in the area.  Most of the trees in the area are non-native, which were brought in after the “Dust Bowl” of the 1930’s to serve as wind breaks to retain soil.  So, most trees were planted where people lived – around little towns, around small settlements, around roadways for the large cattle ranches, and on boundaries between people’s properties, etc..   Once there were other mature trees established, there would be enough moisture and natural mulch that encouraged the few native species  to germinate in these man-made tree rows, forming the basis for narrow strips of overly thick forestation near inhabited and developed areas.  Despite people’s best efforts, keeping up with the dead wood that fell recently this winter has been a challenge due to the sheer volume of tree damage we sustained. 

 

What’s left of the trees appears very sad and barren, indeed – and I can’t say we had beautifully-shaped trees to begin with.  A lot of trees were sculpted by the impressive prevailing southwesterly winds (which sometimes make me feel like we’re living in a wind tunnel) to the point where they never grew symmetrically, but rather in a “hunched-over” habit leaning to the northeast.  The branches were taller and longer on the leeward side of these trees as well!  Most old trees have had the top ½ to 1/3 of their height from the crowns snapped off from a thick coating of ice, and most of the side branches are broken off and hanging limply by strips of bark.  A lot of trees now resemble not-so-upright toothpick sculptures a small child might make to represent trees in  a battlefield diorama to take for a school term project.  Our landscape has been adversely transformed into what appears to be like battle zones such those documented in heavy fighting areas of Europe in old photographs taken immediately after the two world wars. 

 

The areas across the state lines affected by the worst prairie grass wildfires definitely have a “scorched earth” feeling to them.  The other night, for “relaxation” (yeah, right!), my husband and I drove over into Lipscomb County, Texas (one of the six hardest hit counties that now qualifies for federal relief aid) not realizing what we were going to see over there.  The sheer scale of the damage reminds me of the dark, ancient lava fields seen preserved in New Mexico’s desert (known as the Malpais – or badlands).   Most of the damage appeared to be on the north side of the railroad tracks for one of the busiest lines of the Santa Fe railroad heading from the midwest part of the US to the west coast.  I am wondering if these fires were caused by sparks emanating from the old, worn bearings on the railroad car wheels which often need maintenance.  It is said that the grass fires we encountered on the night my mother-in-law died were started by flying sparks from a welder and it got out of control faster than the welding crew could manage, so it is possible.  The saddest thing were the number of dead, blackened, bloated cattle lying on the ground next to fences which lined the roads – it was apparent these animals were trying to get to safety and they were prevented by these artificial barriers.  These stiffened,  lifeless bodies didn’t even appear to be naturally created – but rather they looked like artificial cattle “statues” lying on their sides with their legs sticking straight outward.  We took pictures, but I decided the images were too disturbing to include with this blog post.  (The subject matter relating to my mother-in-law’s death is bad enough!)

 

What can we learn from this experience that would help anybody in the world who finds themselves in similar circumstances?  I think most importantly, is if someone has cardiopulmonary health problems, even if they are mild, they need to do everything possible to protect themselves from the effects of  smoke.   This can be in the forms of seeking immediate, emergent medical treatment AND/OR in milder cases, of air filtration methods in homes and automobiles, as well as personal protective devices such as a paint respirator or gas mask.  This seems a bit extreme, but the little paper pollen/dust masks sold at hardware stores are inadequate for most respiratory patients.  Also, evacuation from the smoky areas, even if your home is not threatened, is indicated.  Israel in very blessed and fortunate to be sitting on the coast of the Mediterranean Sea, and the Red Sea in the Negev.  If possible, get to these areas where respiratory irritants are low, so that the lung disease sufferers can breathe clean air (without pollen or airborne particulates) coming off of the sea.  From what I have read, I wouldn’t exactly recommend Haifa or even the Tel Aviv metro area due to pollution from industry and transportation, but it should be fairly easy to find another location away from these areas which could accommodate one’s needs.

 

Second, when you live in a semi-arid climate that has been reforested in the past few generations, special care needs to be taken managing the forests even if they start out as narrow wind-breaks, say between lot lines or lining highways.  This is especially true with keeping up with the fallen dead wood on the ground, as well as detritus in the form of old leaves or needles from conifers.  But it can also mean to plan adequate spacing between introduced trees so there isn’t such a high concentration of combustible materials when the planted groves mature.  Also, it is important to minimize non-native species planted, and if they must be used, to ensure they are not invasive species.

 

Third, no crop or herd of animals is worth the loss of human life.  I know and can relate that these are both very valuable commodities but they can be replaced in another growing season, especially in an area that qualifies for relief aid.  Six of the deaths which occurred with the largest Texas/Oklahoma wildfires between March 6-8, 2017 were cowboys or farm hands who were trying to save cattle.  While we have no direct proof that the wildfires had any part in my mother-in-law’s death, I am theorizing that an epidemiologic study of diagnoses provided as causes of death provided by the Texas and Oklahoma state health departments during this tragic time will show a significant uptick in cardiopulmonary –related deaths.  (I promise to let you know what I find out, in due time for the statistics to be made available.)   But you can’t replace people you love – as evidenced by the heart-breaking Facebook posts from the families in memory of those who perished in the fires. 

 

Fourth, if you have high blood pressure, please take the condition seriously and have it properly treated.  So many dire comorbidities can be inexpensively prevented with modern medicine.

 

As our region recovers, and as those recover who have suffered family losses in the wake of disaster, I ask for the prayers of all People of the Book around the world.  Describing the scale of destruction which occurred is nearly impossible with mere words.  Please ask the Lord to have mercy upon and to heal our lands, as well as to prevent recurrence of fires.  I thank-you for your concern and attention to read this  account, and I pray that you are blessed in return.  


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