relatively minor-league earthquake (not the “Great Quake”), I, along with most of the other rescue workers, had gone into varying degrees of shock and functioned accordingly—as had, apparently, the civil disaster plan for the region. Metalogue: Why don’t disaster plans work very well? I think the explanation lies in the domain of what psychiatrists refer to as denial: to deny the existence of something despite overwhelming evidence to the contrary. While denial can be regarded as a protective mechanism, it is also considered abnormal behavior and can be destructive. An alcoholic, for instance, may deny having a drinking problem, despite having lost job and family. In children, on the other hand, denial is often a healthy, normal behavior. For example, a child may have fantasies about being able to fly, which is understandable given the reality of being small and helpless. When it comes to disasters, however, a carryover from childhood is not healthy. The big, bad wolf may blow your house down, and you may end up in Oz from a tornado, but somehow you’ll survive. Even though we may hear about disasters in the news on a daily basis, we feel immune because they so rarely happen to us. It is from that mind-set, I believe, that most disaster plans are generated; accordingly, disaster plans—whether personal or governmental—consistently misapproximate what can actually happen.
What Do You Believe?
I believe the December 2, 1989, U.S. Geological Survey predictions: Another earthquake with magnitude comparable to the October 17 earthquake, but located closer to the population centers in the San Francisco Bay Area, is expected to occur, with a probability of 50 percent over the next 30 years. (Similar predictions are made for Southern California.) The U.S. Geological Survey considers the following cities at significant risk for earthquakes: Boston, Rochester, Buffalo, Charleston, Memphis, St. Louis (the largest quake in U.S. history—8.3 magnitude or greater—was in Missouri in the 1800s), Salt Lake City, Seattle, Anchorage, www.sfms.org
and Honolulu. I’m preparing for the next quake (or a similar disaster) and trying to help others to realize that they need to do the same. But I’m not sure that enough people were awakened by this last quake to achieve even rudimentary preparedness. Will the necessary billions of dollars be spent to reinforce or rebuild at least the critical public structures—particularly the hospitals—to withstand even the largest quake? Will money be spent to develop new technologies to make earthquakeproof buildings? Will all health professionals be trained in disaster medicine, so they will know better what to do? Will our society learn to take earthquakes as seriously as the Japanese, who have whole-city earthquake drills, every citizen included? We seem to be where we were with the AIDS epidemic in the early 1980s: only dimly aware of the magnitude of the crisis. It is obvious that it will take a major and enormously expensive effort to prepare for what is coming—the Great Quake. Metalogue: What is a disaster? In terms of systems theory, a disaster is an event or a series of events that halts or severely reduces the output of a system. A disaster leads to system disintegration and dissolution, a stripping away of structure and of what one has learned or knows. Rebuilding after a disaster is a lengthy and painful process.
Epilogue
The quake has left me feeling as if, for a brief time, I was a part of the Holocaust—yet I survived. (And, like Holocaust survivors, I don’t want to let people forget what happened. I’ve even thought it would have been a good idea to have left a crumpled part of the Cypress as a monument, so we would be less likely to forget.) I’ve developed a deeper mistrust of the capabilities and responsiveness of governmental agencies (a mistrust which, as an inner-city family practitioner who sees homeless and HIV-infected individuals, was already quite high). I’ve come to see more clearly how the editorial policies (and fears) of the media direct their reporting and consequently distort
information. And I’ve come to realize that this little perch of land we’re on up here, San Francisco, is to be appreciated one day at a time. Mark Renneker, MD, is a graduate of the UCSF School of Medicine and the USCF/ SFGH Family Practice Residency Program. He is an associate clinical professor in the Department of Family and Community Medicine at UCSF, and attending phsyician at Laguna Honda Hospital, and he is the founder and president of the Surfer’s Medical Association. This article originally appeared in the Western Journal of Medicine shortly after the earthquake. It has been reprinted in full with permission.
Welcome New SFMS Members! The San Francisco Medical Society would like to welcome the following new members: Arash Babaki, MD
Jennifer Brokaw, MD
John Rampulla, MD California Emergency Physicians
March 2009 San Francisco Medicine
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