2020 Creative Writing Award Recipient: Amy Isabelle

Amy Isabelle is a family nurse practitioner student in her final year. Prior to YSN, she completed her undergraduate degree in Sociology at Wellesley College, with a focus on health disparities. After graduation, she is hoping to practice at a community health center. In her free time, she enjoys making baked goods for her classmates and walking in East Rock Park. 

Med Math for a World on Fire

1. Sarah tells you she is from Paradise, California, a town literally burned off the map. Sarah works for Cal Fire and lives outside most of the year, clearing brush in preparation for fire season. She says she wants to be tested for Lyme disease.
    
   “I have PTSD from the fires. We all do. But I read about Lyme disease last night, and I’ve been having headaches, I can’t sleep, and my knees hurt. I’m anxious all the time, but you can treat Lyme, right?”
    
   How much doxycycline for a home up in flames?
    
2. Judith slipped and fell moving out of her temporary housing. She has to leave by the end of the month, but she does not have anywhere to go after her home burned last year. 
    
   Her back is bruised: ibuprofen, ice. 
   Her finger is dislocated: X-Ray, finger reduction, splint. 
   Her head is sore: CT scan, reassurance, advice to avoid screens for a few days. 
   Her home is gone: a held hand, the phone number of a social worker. 
    
   Once paradise burns, where can you go?
    
3. Tom comes in with a dog bite on his hand. His new puppy got too excited, he left the bite untreated, and now it is hot with infection. Tom came in after his Cal Fire shift; his navy-blue wool uniform is spotless and well ironed. You go to drain the wound with a scalpel, but your preceptor stops you with a sharp look, carefully placing a towel over Tom’s shirt before you can continue. 
    
   “I know you’re not from around here, but we look out for one another,” your preceptor says to you. “We have to keep this man looking good. Those Cal Fire uniforms are pretty dapper,” she smiles at Tom. 
    
   How do you wash ash out of navy-blue wool?
    
4. Your parents live about three hours from where the fires burned in Paradise. You call your mother during fire season. She says the stores ran out of masks and her friends are sharing patterns to make homemade ones using their sewing machines. You offer to send her a few respirators from your own supply, but she says she found some expired ones in her office at the Red Cross.
    
   “They work well enough. I guess it’s that or learn to use a sewing machine,” she laughs.
    
   If you hold your breath, does the smoke over San Francisco feel like fog?
    
5. A refresher from your med-surg days as you flip through an emergency medicine textbook: the Parkland formula for burn victims.
               (4ml of Ringer’s lactate) x (% body surface area) x (weight in kg)
    
   Give half the total volume over the first 8 hours; the next half over the following 16 hours. 
   For reference, the patient’s palm represents approximately 1% of his body surface area. 
    
   The Camp Fire burned 153,336 acres, or approximately 240 square miles. The average fire hose releases 300 to 800 gallons of water per minute. The fire burned for 17 days. 
    
   How fast can we rebuild? Please do not use your calculator. 
    
6. The electric company cuts the power to the city grids when the winds pick up in autumn in an attempt to prevent wildfires. The power cannot be returned until every line is visually inspected. The rolling blackouts affect over three million people. 
    
   Schools close. Traffic jams form where stoplights are no longer functioning. Stores run out of generators and people with medical needs go to shelters for electricity.
    
   News reports claim this is “the new normal” for the state of California. 
    
   How do you measure normal when the meaning changes every year? 
    
   What are the treatment guidelines for climate change?
     
   What do you prescribe for a world on fire?