But not like this. Much of the South is enduring a heat wave with triple-digit highs and heat indexes in the 120s. It’s sweltering, and it reminds me of the Summer of 1979.
That summer was an ordinary Texas summer except for two things that hardly anyone noticed. The first of these was that I had moved to Austin from Houston where I had spent the preceding three years. The second was that it was the beginning my first year as a medical resident at Brackenridge Hospital.
My first medical rotation was on the inpatient service. One day, I was called to see an older white male in the Emergency room. It was a miserably hot Central Texas day, and this particular fellow had been brought to the ER by EMS – unresponsive with a temperature of 104+F. His skin was dry, and when pinched even gently, it did not resume its normal contours. His eyeballs were a bit sunken.
He had heat stroke, and we put a thermometer in his rectum so that we could continually monitor his core temperature. When you have heat stroke, the indignity of having a thermometer in your butt is the least of your problems.
We called for bags of ice, and he soon had a bag behind his neck, two bags in his armpits and two more over his groin. Prior to this event, I had only read about the management of heat stroke. My supervisory resident called for a chilled bag of saline, and we started infusing the cold solution into the best vein we could find. The nurses started all the peripheral IV lines in the ER, and they were all past masters at the task – even when faced with the collapsed veins of a severely dehydrated patient.
His lab tests revealed dehydration with a higher-than-normal level of sodium. I’m not sure why our high school PE coach insisted on the students taking salt tablets when exercising in the relentless summer heat; the most life-threatening electrolyte derangement is invariably water rather than salt. I guess some bits of health-related lore die only very slowly. Sigh.
Our patient’s core temperature gradually fell toward normal, and he ultimately awoke. I think he stayed in the hospital a day or two as we tried to figure out how he had arrived at this point. There was no evidence of infection. He wasn’t taking any medication that predisposes to electrolyte derangements (diuretics in particular). He wasn’t taking any antipsychotic medications that interfere with normal thermoregulation (shivering when we are cold and sweating when we are hot).
I think that our patient, like so many who develop heat stroke every summer, was simply poor. Poor people are less likely to have air conditioning or to be able to afford the electric bill that it takes to run it. Older folks, often a proxy for being poor, have a diminished thirst response even in the absence of medications that blunt normal thirst. It is little surprise that the majority of heat-related deaths occur among the elderly poor.
The Texas electric grid is perhaps less fucked this summer than it has been in past winters and summers. I say that only because I haven’t heard that Ted Cruz has left for Banff this week. And we in Central Texas have not yet suffered an electricity outage. Still, the worst of our summer is yet to come.
I am sure that in the 44 years that have elapsed since 1979, every summer has brought heat stroke patients to teaching hospitals across Texas, Arkansas, Oklahoma and other southern states. Most of them survived, I think. Those that succumbed to the insult never made it to the hospital.
Being old doesn’t suck nearly as much as being poor or being both old and poor. Alas.