As firefighters snuff out the remaining hot spots in Wine Country, as families mourn the dead, and as devastated communities begin to shift their focus to renewal, Kathy Riordan continues her near-daily trips to the burn unit of St. Francis Memorial Hospital in San Francisco.
For her family, moving forward is not yet possible.
A month has passed since her younger brother, 55-year-old Michael Hanson, was found by a neighbor as he lay on a road near his rural home outside Santa Rosa, overcome by the Tubbs Fire as it surged west from Calistoga, consuming his home and thousands of others. When the threat was over, 22 people were dead, including his 27-year-old daughter, Christina.
He was unconscious and near death. Third-degree burns had destroyed the skin on half of his body, requiring lifesaving interventions that continue today, including a ventilator that helps him breathe.
But Riordan, who lives in the East Bay, saw a glint of hope recently in what has otherwise been a month of darkness and distress. Her brother still can't talk, but as he's regained some consciousness, he can smile. Last week, he mouthed to a family member, "I love you."
"The last time I left the hospital after he was able to smile at me, I was just on cloud nine," Riordan said. "It felt really good to connect with him."
The swarm of fires that ignited in Northern California on the windy night of Oct. 8 killed 43 people and at last count ruined 8,889 homes, businesses and other structures -- the worst disaster of its kind in modern state history. The destruction is stark, but a less visible impact of the tragedy is the plight of several burn victims who suffered almost unthinkable injuries in Sonoma, Napa, Mendocino and Yuba counties.
Patients like Hanson, who has a breathing tube through a hole in his trachea, face a long and grueling journey.
"Because of the severity of the burns, they had him medically sedated," said Hanson's niece, Brittney Vinculado of Oakland. "They've taken him off sedation, but because every few days he's having surgeries, it's hard for him to be aware and awake."
Hanson is one of three remaining victims of last month's wildfires being treated in the Bothin Burn Center at St. Francis Memorial in San Francisco, a state-of-the-art facility with 16 beds where the temperature and humidity are tightly controlled and a team of surgeons, nurses and therapists seek to usher patients from critical care to rehabilitation.
Ten people were taken there for treatment in the days after the fires broke out. UC Davis Medical Center in Sacramento, another major regional burn center, had three critical burn victims from the disaster as of last week.
Some of the most serious burn cases involved the four members of the Shepherd family, who were overcome by flames while fleeing in the early hours of Oct. 9 from the Redwood Valley Fire in Mendocino County. They had been trapped at their mountain home.
Kai Shepherd, 14, died while trying to escape on foot, and his sister, 17-year-old Kressa Shepherd, died nearly three weeks later at Shriners Hospital for Children in Sacramento. Their parents, Jon and Sara Shepherd, remain hospitalized with severe burns, and don't yet know that their children didn't make it.
The relatively few severe burn victims, compared with the number of dead, illustrate the fires' ferocity. Most victims either made it to safety or perished in the flames.
At Firefighters Burn Institute Regional Burn Center at UC Davis Medical Center, Dr. Tina Palmieri, the surgeon who directs the unit, has been among those tending to the influx of patients. What happens in the minutes and hours after people sustain severe burn injuries, she said, can determine whether they survive.
Rushed to hospitals, they may be in immediate need of a breathing tube to clear their swollen airways along with intravenous therapy. Fluids seeping from damaged skin can bring on dangerous dehydration.
"Airway, breathing, circulation, those are the top three priorities," Palmieri explained.
Once the crucial life-or-death issues are addressed, doctors can start looking at the wounds. Third-degree burns -- the most severe -- go through all the layers of skin and sometimes into the subcutaneous fat and underlying muscles. If such a burn travels the circumference of a patient's leg or arm, surgeons may need to ease the pressure with an incision known as an escharotomy, preventing the limb from bursting like an overcooked sausage.
"The skin traps the pressure inside, so we have to relieve it," Palmieri said. "It's a controlled relief of pressure, so the muscle will survive."
Later, surgeons mount skin graft surgeries, removing webs of scorched tissue before borrowing skin from other parts of the patient's body. Unlike in other organ transplants, people cannot receive skin from donors, so surgeons use a tool known as a dermatome, which resembles a cheese slicer, to cut strips of a patient's healthy skin to be transferred onto the burned areas.
"You shave the skin to a level where it will grow back from the site you borrow from," Palmieri said. "You get pieces that develop roots that grow back to the tissues underneath, and then you've got your skin."
A person burned to the bone may require an amputation. Before Kressa Shepherd died, doctors had removed both of her legs below the knees in a bid to save her, said her aunt, Mindi Ramos.
Palmieri called burns "the extreme of injuries," noting that they happen very quickly but heal very slowly and painfully. Moreover, her patients are some of the most vulnerable, because their burns affect all of the body's other organs and the immune system.
A weak immune system, coupled with the body's loss of its natural barrier, exposes the patient to a host of potentially deadly problems like staph infection, sepsis, pneumonia and blood and urine infections, to name a few. Burn patients "can get sick at any time," Palmieri said. "My rule of thumb is you're not out of the woods until you are home."
The general rule in the field is that patients will be hospitalized one day for every 1 percent of their bodies that is burned.
After leaving the hospital, burn victims typically face strenuous physical therapy and other rehabilitation. But over time, they recover.
"Our goal is to get everybody a life that is enjoyable," Palmieri said. "Burn patients can most of the time have that."
It's not clear how long Hanson will be at St. Francis. He was somewhat fortunate in that his burns were mostly limited to his legs and hands, and he suffered only minor smoke inhalation, his family said. He continues to undergo skin graft surgeries as doctors keep close watch on his progress.
All the while, a large group of family and friends keep vigil at the hospital. They've decided to postpone funeral services for his daughter until her father is well enough to attend and grasp what's happened.
"Everyone's state of mind is positive," Vinculado said. "We're trying to be positive for him and help him to see the light at the end of the tunnel. But part of me thinks the hardest part is ahead of us."
She said family members were "trying to split grieving for Christina, while being there and being strong for Michael."
Hanson, a retired electrical contractor, several years ago moved from San Ramon to Sonoma County, where he devoted himself to his hobbies and his daughter, whose mother died when she was 9.
Christina, who was born with a spinal birth defect and used a wheelchair, lived in a unit behind the home on Wikiup Bridge Way about a mile east of Highway 101 in Santa Rosa. Her father had converted a horse barn into the apartment, and he used the other half as a studio for glass blowing -- a craft he'd picked up since buying the property several years ago.
Hanson is an artist as well as a "motorhead" who loves big engines, his relatives said, and in his garage he kept a 1932 Ford coupe and a custom motorcycle.
The family doesn't know exactly what happened amid the chaos of the Tubbs Fire, which caught thousands of people by surprise, prompting frantic escapes by car or on foot. A few people near the Hansons' home jumped in backyard swimming pools to wait out the flames. But Christina was unable to escape, and her father didn't get far. He was found collapsed on Mark West Springs near his property.
"From the day Christina was born, she was his priority," Riordan said. "He always thought about her first. He lived his life to protect her."
The neighbor who found Hanson unconscious drove him down the hill to nearby Sutter Santa Rosa Regional Hospital. But the advancing wildfire had forced the evacuation of the facility, so the staff rushed Hanson 10 miles west to a hospital in Sebastopol, said Steve Gandolfo, a friend and fellow glass artist.
Doctors wanted to fly Hanson by helicopter to St. Francis Memorial, but the smoke was so thick in Sonoma County that they had to take him by ambulance.
Hanson shared a room at St. Francis Memorial with Jon Shepherd when the two were first admitted, Gandolfo said. The first days were full of panic and dread for Hanson's family, followed by moments of clarity, and then a sharp realization of the arduous path ahead.
"It's brutal. It's just such a horrible thing," said Gandolfo, who has visited his friend several times in the burn center. "I just wish I could take his pain from him."
Gandolfo describes Hanson as "just amazingly nice" and "one of my closest friends." Whenever he needs help on a project, Hanson is there. The only repayment he'll ever accept is dinner and drinks with Gandolfo and his wife at their home in Sebastopol.
As Hanson's loved ones continue to make trips to the hospital, his friends in the North Bay are banding together to help. During a recent open studio at his art space, Gandolfo gathered a batch of stemless wineglasses he had made at Hanson's studio and placed them for sale with a photo and story about his friend. The money, he said, will go to a fund to assist the family.
The glasses sold in a flash, and Gandolfo has since created a website, buyacupformike.com, where he plans to raise more money for his friend.
"I'm asking glass blowers from around the country to see if they would donate cups for Mike and Christina," he said. "It's not really the money. I want him to see the support from people all over. I think the empathy and compassion has the potential to be healing for him."
Riordan, who visits her brother at least three times a week, recalled a recent conversation in which he told her she was his "rock in life" following their mother's death in March. She appreciated his words, and told him she'd always be there for him.
"He's a strong man," she said. "He's got lots of love around him, and when he's awake, he knows we're there. That's what's important."
Evan Sernoffsky is a San Francisco Chronicle staff writer. Email: firstname.lastname@example.org Twitter: @EvanSernoffsky ___
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