Warm Bodies

Summers in Texas are hot. I recall the summer of 2011 when we had 40 days of triple-digit highs here in Central Texas. Last year was even worse. Today, I was thinking about the summer of 1979 – my first hospital rotation as a first-year medical resident.

Like most Austin summers, it was sweltering this particular day. Doug and I were called to the ER to see an incoming patient with a tentative diagnosis of heatstroke. We left our rounding duties and headed to the ER arriving just as EMS wheeled our unconscious patient into a treatment bay. The EMTs said that the patient was found down in his East Austin home by a daughter who had gone to see him when he did not answer her phone calls. Down, in this context, means unconscious. They noted his vital signs including a rapid pulse and a temperature of 105F.

His skin was warm and dry. A gentle pinch of his skin showed tenting – a loss of normal turgor and resilience. I had never seen, evaluated, or treated anyone for heat stroke, but like many other medical crises, I had read about it. In the first year of training, almost everything seemed like a first.

We called for ice and chilled normal saline for IV infusion. We placed an electronic rectal thermometer so that we could get continuous core body temperature readings. We placed his neck on an ice bag and put additional bags of ice on his groin – a girding of the loins, as it were. Over the next 30-minutes or so, his core body temperature became normal. We stopped the chilled IV solution, drew some labs, and launched a search for occult infection. There was none.

I’ll call this individual Fred because I have no memory of his actual name. Fred was a robust, African American man probably in his mid-60s. He lived alone in a small house in an area that was then known as Blackland – east of I-35. His home had no fan or air conditioning. He was taking a diuretic medicine for hypertension. From what we could see, his risk factors for heatstroke were age, poverty, diuretic use, and above all, no access to home climate control.

For many others, additional risk factors for heatstroke are homelessness, certain anti-psychotic medications that can interfere with one’s normal thermal regulation, alcohol use, and outdoor activities/work without appropriate rest intervals, or adequate access to water, and shade. If memory serves, Fred woke up and was ultimately discharged home. I think the hospital social worker got him a fan through a local charity. In exchange, Fred taught me how to manage patients with heatstroke.

As many cases of heatstroke as occur every summer across this country, I suspect that the majority of internal medicine, family medicine, and ER trainees will treat one or more folks who develop this potentially life-threatening condition. It’s an unfortunate reality since this condition and its worst complication, death, are entirely preventable.

As an aside regarding Blackland, it had been an African American neighborhood for many years. Just as the barrio that was my home was “on the other side of the railroad tracks,” Blackland was on the other side of I-35. I’ve read that it was initially populated by Swedish immigrants but over the years became an African American enclave.

I’ve lived in Austin, on and off, since 1965, and in the passing of those decades, I have witnessed a black exodus from Blackland. It was caused, in part, by the encroachment of the University of Texas (UT) across I-35 (the original 40 acres of the UT campus were on the west side of I-35). The properties not engulfed by a sprawling UT campus became the focus of gentrification – a scourge of many older neighborhoods including my own.

I haven’t been to East Austin in several years, maybe 10 or more, but I suspect that there is little left of Blackland and its former residents like Fred.