Another long-term concern is pulmonary fibrosis, a progressive disease in which scarring thickens and hardens lung tissue, making it difficult for oxygen to move into the bloodstream. Dr. Elsayegh describes a lung with pulmonary fibrosis as “a stiff balloon from the party store” — your face flushes as you try to force air inside, but it simply refuses to inflate.

As a former Palisades resident intent on returning to the neighborhood, Dr. Elsayegh is also doubling as a trusted confidant, drawing on his personal experience to help his patients face uncertainties and find solutions — or next steps, at least.

“In an ideal world, I would go in there and say, ‘Everyone that lives in the Palisades and in L.A. County, let’s all move. Let’s all go somewhere else and we don’t have to worry about this,’ ” he said. “That’s not reality. I’m trying to find this unbelievably difficult balance of helping us return to normalcy or return to our life, but doing it as safely as possible.”

In early February, Dr. Elsayegh pulled up a chair next to Dana Michels, a cybersecurity lawyer and healthy mother of three who had gone to check the damage at her house and now could not shake a cough.

“Sweetheart, you’re not moving air at all,” Dr. Elsayegh said, listening to her lungs through a stethoscope and quickly ordering a breathing test and a nebulizer, to start. A pulmonary student asked to take a listen, then glanced up at Dr. Elsayegh, looking confused.

“I’m not hearing anything,” the student said. Dr. Elsayegh gave a single nod.

After years of renting, Ms. Michels and her husband got their first mortgage almost four years ago; it was a family milestone. Now, with their Palisades home smoked through, the family is split between two rental apartments in Marina del Rey — one for boys, one for girls — and they are navigating a new school, new insurance paperwork and new prescriptions to manage the wheezing.