Dr. Marsha Fowler is a member of the
Nursology.net Advisory Team
Author: Nursing Ethics, 1880s to the Present

Until recently I lived in the 140 year old town of Altadena, California. Altadena is nestled in the foothills of the transverse range of the San Gabriel Mountains, between the San Joaquin and Whittier Narrows fault-lines. I was well prepared for a high magnitude earthquake, with camping gear, tents, shower tent, cookware, stove, pots and pans, sleeping bags, self-inflating mattress, water purifier and more in a large dog house next to my house. I had guessed wrong. I was not prepared for 100 MPH Santa Ana winds whipping a wildfire in my direction. The town of Altadena had never burned – the foothills behind us, yes, but not the town itself. The Santa Anas had looked to be taking the wildfire east. But they switched course across the mountains and overtook my home, my neighbors’ homes, and all that is Altadena, reaching into north Pasadena as well. Unprecedented. My house was in its path and it burned to the ground with everything I possessed. I escaped with the clothes I was wearing and my car.

Rising from the Ashes

Priorities, Crushing detail, and Immobility
When every aspect of life becomes a loose end, attempting to prioritize can be immobilizing. Everything is a priority—but what are the priorities among all the priorities? Well if I will die without my medications, that might be a place to start. And replacing the glasses left behind as it helps to be able to see. Masks for the devastating air quality. A toothbrush. Friends kick in and feed you and you start couch surfing. Presbyterian Disaster Assistance, the Red Cross, Salvation Army, the Firefighter’s Foundation, Grocery Outlet, and others kick in too with supplies, toiletries, cash cards, food, bottled water. Counseling services kick in too.

My needs have their demands – but then FEMA and insurance have another layer of demands and it is overwhelming, like a pachyderm of detail sitting on my chest. I tie up loose ends and frustratingly they do not stay tied. What I needed:

• Tangible help to get me started out of the quagmire of details. Meds, glasses, toothbrush…kind of a pre-cursor to a Maslow list. If I got started, then I could keep rolling.
• Presence. Someone to wait with me in the very long, very crowded, very lonely, lines for FEMA disaster assistance, for FEMA SBA assistance, for Hazmat kits, for bottled water, for World Kitchen meals…I needed someone I knew to be with me, not to say anything, just to be with me.
• Folks to “read the room.” If I say I am okay, trust me. Don’t tell me how badly you feel for me – I can’t take care of you and me too. Don’t tell me I am in denial. I am in shock, not denial, but even if I am in denial, sometimes a sturdy denial is perfectly functional in its season.
• Don’t offer counseling. I don’t want counseling: I need undies, a long hot shower, and a toothbrush. Not counseling before ADLs. ADLs then, when the smoke lifts, and the ash settles, maybe counseling.
• “Every patient is unique” and my trajectory may be different from that of others but to start it is tangible, material, help and presence, presence, presence that got me going.

Our Lives were Redlined
On January 7 the Eaton Canyon (Altadena) fire broke out and started moving swiftly in what were 100 MPH winds. The fire broke out east of Lake Ave, in the affluent, mansionised, half of Altadena. That area had been home to a white “Golden Age of Hollywood” community of actors, writers, artists, and more in the early and mid 1900s. West of Lake Avenue is where the black community could purchase property, where Jackie Robinson, Ivan Dixon, Sidney Poitier, Octavia Butler and others lived. West of Lake is a less affluent, middle-class, historically black, generational community, today still anchored black but widely diverse. The families to the east of Lake Ave were notified within 15—60 minutes of the outbreak of the fire. The families to the west of Lake Ave were notified more than nine hours later, if notified at all. There were no evacuation alerts in this area of Altadena. There was no Sheriff’s deputy cruising the streets with a bullhorn saying “get out.” There were no firefighters in our neighborhood, no firehoses. I was one of those who never received an alert to evacuate. We could not see through the smoke until the fire had crested the hill and was really upon us. We were only alerted by our beloved neighbors who pounded on our doors to get us out. In addition we never had firefighter support, water hoses—nothing—our houses were let to burn to the ground. Nightfall to daybreak, in the catch of a breath, in this historically black community all the generational wealth of the families was consumed by the conflagration.

I need to tell you about my nextdoor neighbor for 16 years, Eshele. Eshele’s family is one of the several extended anchor families of the community. She lived immediately next door to me. Her Mother, Tilly, lived behind me and two doors up on the other side of the block. Eshele’s sister Kim lived around the corner from me in their grandmother’s house and Eshele’s other sisters Krystal and Ellen lived nearby. Four of their family homes burned to the ground displacing 17 family members. Tilly’s daughters’ families – really one large family – lost absolutely everything. Dear Tilly, is renowned for having fostered hundreds of children over the years, and Eshele, whose doctorate is in marriage and family counseling, is a professional therapist with expertise in foster families. They gave and gave to the community over many decades. When the sun rose, we knew that eight homes in that family had burned. The night of our flight, we had no phone service: Eshele, Catherine, Grigorios, Max, Miea all patrolled the block to make sure we were all out of our homes. They looked after us, we looked after each other. And still ALL, ALL, of the deaths in Altadena were in our historically redlined area. Am I angry? Yes. It was not our homes that were redlined, but our lives. There are vehement denials and excuses about glitches in the alert system and more – but the failure to alert west Altadena residents smacks of racism and a current, not simply historical, redlining — a social injustice that is deeply offensive to nursing.

Our richly diverse west Altadena had been a caring community that played together, prayed together, ate together, worked together, partied together, and supported one another across lines that other communities use for separation. When I later returned to the burn area, there were cheerful pink polka-dot ribbons on charcoaled trees at the front of our parcels. I thought that meant that perhaps the EPA had cleared our properties for debris removal. No. It meant that the cadaver dogs had searched our properties. ALL of the deaths in Altadena were in our beloved west Altadena community. Pink polka-dot ribbon will now always symbolize death for me.

Don’t Talk Smack about Nurses
For much of my career I have heard that “nurses eat their young.” I have never actually seen a half-eaten young nurselet, and my experience does not support that slur. I have seen plenty of careful mentoring and guidance. No doubt every profession, nursing included, has it miscreants, but individuals who fall below the standard are not by any means the whole of the profession. The ANA Code of Ethics addresses the nurse-to-nurse relationship in terms of moral duties, but not in terms of its ideals.

My house burned down and I lost everything. But I didn’t. Nurses across the country, and across the oceans, gathered round me and said “you are one of us.” Or, in the words of a dear nursing colleague, “I will not leave a fallen nurse behind.” Nurses I knew, nurses I had met, nurses I had never met, reached out to me in kindness and support, with gifts of texts, emails, substance, a beautiful anthurium, lovely poppies, a much needed quilt, and more. Nurses pulled me from the pit and set me on level ground. The community of nursing is a moral tradition and narrative, but it is also an identity. To be a nurse is to be a part of that moral community, to interiorize its identity and core values of caring and kindness. Never, ever, tell me that nurses eat their young or any such slur. Tell me, instead, that nurses care for one another, that nurses exercise a fierce caring and kindness, that nurses cherish their own, that nurses do not leave their own behind. That is the nursing that I know.

Note from the Nursology.net Advisory Team: For those who are interested in supporting Marsha in this time, see https://gofund.me/d30b5410