Desert Medicine
Photo: Courtesy of Michael Hyatt
ILLNESS, INJURY and HEALTH RISKS IN THE DESERT
by Dr. Robert Cairns
REMEMBER-- HEAT STROKE IS A TRUE MEDICAL EMERGENCY!!!!
All illnesses, injuries and health threats that affect border crossers are determined and influenced by three constant factors:
These three factors are responsible for the TWO most common and potentially life-threatening conditions each border crosser may face:
The following THREE factors can significantly intensify the effects of any degree of heat-related illness and dehydration:
by Dr. Robert Cairns
REMEMBER-- HEAT STROKE IS A TRUE MEDICAL EMERGENCY!!!!
All illnesses, injuries and health threats that affect border crossers are determined and influenced by three constant factors:
- The HOT (100-110 degrees potentially) AND DRY summer desert environment.
- The STRENUOUS EXERCISE required to pass through this hostile environment (some people walk for days, some up to 50 miles or more)
- The INADEQUATE AVAILABILITY of WATER and the IMPOSSIBLE TASK of carrying enough water to sustain hydration. (a gallon of water weighs about 8 POUNDS!!)
These three factors are responsible for the TWO most common and potentially life-threatening conditions each border crosser may face:
- HEAT RELATED ILLNESS
- DEHYDRATION
The following THREE factors can significantly intensify the effects of any degree of heat-related illness and dehydration:
- CLOSED INJURIES (sprains, strains, contusions, fractures)
- OPEN INJURIES (blisters, cuts, abrasions, punctures)
- VENOMOUS BITES, STINGS, TOXIC EXPOSURE TO PLANTS or CONTAMINATED WATER
The Devil's Highway: A true Story | Luis Alberto Urrea
There may be no finer sensitive description of heat-related illness than can be found in Luis Urrea's book The Devil's Highway (Litlte Brown & Company 2004). The following excerpts are printed here with permission from the author with deep gratitude. http://www.luisurrea.com
From Chapter 9
Killed by the Light
Experts can't give a definitive schedule of doom. Your own death is largely dictated by factors outside of your control, and beyond accurate prediction. Your own fitness is a factor, your genetics. Gender doesn't seem to affect your chances much. Woman are far from being the "weaker" sex. They survive as long as men, and often survive longer. Hydration before the event might buy you time, same with shade, a hat, rest. How much, however, remains unknown. All sources say you will die in a period of time that can vary from hours to days.
However long it takes you to die, you will pass through six known stages of heat death, or hyperthermia, and they are the same for everyone. It doesn't matter what language you speak, or what color your skin. Whether you speed through these stages, or linger at each, hyperthermia will express itself in six ways.
The stages are: Heat Stress, Heat Fatigue, Heat Syncope, Heat Cramps, Heat Exhaustion, and Heat Stroke.
HEAT STRESS
Everyone has been tired, or even dizzy, from walking in the heat. Everyone has been sunburned, sometimes quite badly. And many people have suffered the swollen fingers, feeling like sausages, and the funny stumbling at the tail end of a hot hike. This is where it begins. General discomfort, nothing heinous. A little heat rash. Headache from the glare. Thirst. The Wellton 26 felt this immediately upon climbing their first hill. They were already tired before they began, perhaps slightly dehydrated from all their journeying and restless sleep. Some of them may have had diarrhea from the bad food and water on their long bus trip. When one of the brothers from Hidalgo said, "This heat is killing me," he was telling the truth. The heat becomes personal.
HEAT FATIGUE
As you walk, the relentless heat makes your warm spots wet--your armpits, your crotch. Your head sweats, your neck, your skin blows a fine mist like steam to regulate your heat. You're a big swamp-cooler, with water passing through your membranes and keeping the meltdown at bay. Most of your heat comes out through your head---your head is a chimney. Most of you didn't think to bring a hat. If you're from Mexico, your hair is probably black. The sun encounters body heat on a dark field. Heat wrestles there, rising and descending and meeting itself.
.... But you still have water, so you're okay. If you brought beer, you're an idiot, because alcohol makes you thirstier. The ground is burning your feet--- it's 120 degrees through the soles of your shoes. If you wore sandals, and many do, you are getting sunburns on the tops of your feet. Higher thither is getting in your sandals and giving you minor burns. You might have blisters -- water goes through your system to fill them. And now your jug is getting hot -- your drinking water is starting to get hot as coffee.
...Desolation drinks you first in small sips, then in deep gulps. Your spit turns to paste. Your mouth tastes nasty, so you take another little drink. You tell yourself you'll only sip a couple more times, but to hell with it-- you take a big pull off the bottle. Your lungs, now, are leaking moisture to the vampire air. Your tears leak into the sky -- eyes dry and scratchy. The fluid in your lungs helps transport oxygen through the tissues in the blood. Less fluid, less oxygen. You breathe harder, you get drier.
HEAT SYNCOPE
You have a fever, though it's a fever imposed from the outside. Your face, even though you're a Mexican mestizo, turns pale.....suddenly your hot water is gone. You can't remember where you dropped the jug. Dizzy. Where's the water?
You turn back.
Water's over here. Where. Is. The Water.
Here?
You circle.
Oh, well. To hell with the water. I'll find water.
...where's my water?
your heart beats as though you've been running. You think you'd better take a break. Where's my water?
HEAT CRAMPS
Now you're officially in trouble. Your body has been dumping salts. Without salts, your muscles can't function. That's why people drink Gatorade. Muscle cramps kick in. Your legs suddenly ache. You get clumsy....when you fall, you hit rocks, cactus, gravel....your abdomen clenches on you....you double over. Eighty percent of lost walkers can still be saved if the Migra spots them. You can recover with water and an IV. Even the Migra's famous air conditioning could save your life. ....But if the Migra doesn't find you, you've stepped onto the lip of the death spiral. Your options for salvation wisp away like steam.
HEAT EXHAUSTION
Your fever is spiking now, and like the flu, you have gotten more and more ill. Headaches. You get nauseous, you want to vomit. If you vomit, you lose more fluids. You are not only clumsy, but enervated. Your body is weak, and your will is slipping. Your tongue is wood. You could give a dam.Your heart pounds, loud in your ears. Your breathing is shallow and fast, and each breath dries you further. Eyelids scrape across eyeballs dry as pebbles.
....This is a good place for the infirm among you to have their heart attacks. Your fluid level has dropped---there's not enough fluid to fill the container of your body. Your heart beats baster, trying to suck up some blood from the internal drought. Cardiac arrest hits when the pump overstrains itself and blows up.
Those in good shape will, sooner or later, faint. This is the brain's way of stopping the machine, like hitting the brakes when you realize you're speeding toward a cliff.
....First, you get tunnel vision. You might hear echoes. Your body falls on burning ground. And you sweat, especially where your body forms a seal with the earth. And you breathe. You get up worse than you fell, then you fall again.
And still, you might be saved. But you are now at the borderline, standing before the abyss. One more step, and you cannot return. Another border crossing.
You don't know much anymore. You are confused; your memories are conflated with your dreams. Walkers see demons, see God, see dead relatives and crystal cities. They vomit blood. The only clear thought in your mind now is: I'm thirsty. I'm thirsty....
Sooner or later, you understand that you have to drink your own urine......The first urine is pretty good, as urine goes. It is still relatively clear....the next time though, that same urine has picked up more filtered impurities, and it is a little darker now. Saltier. By the third round, it is orange. It smells bad. Then dark orange. Then pale brown. Then a darker and more poisonous brown. It looks like foaming Guinness stout. By the time your effluent is black, you're doomed--even if you wanted to, you probably couldn't drink it. It stinks of fish. Your body would retch. There is almost more bio-garbage in it than water.
The last stage of hyperthermia begins.
HEAT STROKE
Your blood is as low as it can get. Dehydration has reduced all your inner streams to sluggish mudholes. Your heart pumps harder and harder to get fluid and oxygen to your organs. Empty vessels within you collapse. Your sweat runs out....Your temperature redlines ---you hit 105,106, 108 degrees. Your body panics and dilated all blood capillaries near the surface, hoping to flood your skin with blood to cool it off. You blush. Your eyes turn red: blood vessels burst, and later, the tissue of the whites literally cooks until it goes pink, then a well-done crimson.
Your skin gets terribly sensitive. It hurts, it burns. Your nerves flame. Your blood heats under your skin. Clothing feels like sandpaper.
Some walkers at this point strip nude. Originally, BORSTAR rescuers thought this stripping was a delirious panic, an attempt to cool off at the last minute. But often, the clothing was eerily neat, carefully folded and left in nice little piles beside the corpses. They realized the walkers couldn't stand their nerve endings being chafed by their clothes.
...Once they're naked, they're surely hallucinating. They dig burrows in the soil, apparently thinking they'll escape the sun. Once underground, of course, they bake like a pig at a luau. Some dive into sand, thinking it's water, and they swim in it until they pass out. They choke to death,their throats filled with rocks and dirt. Cutters can only assume they think they're drinking water.
Your muscles, lacking water, feed on themselves. They break down and start to rot. Once rotting in you, they dump rafts of dying cells into your already sludgy bloodstream.
Proteins are peeling off your dying muscles. Chunks of cooked meat are falling out of your organs, to clog your other organs. They system closes down in a series. Your kidneys, your bladder, your heart. They jam shut. Stop. Your brains sparks. Out. You're gone."
Luis Urrea
The Devil's Highway (with deep appreciation)
REMEMBER-- IT IS NEVER ILLEGAL TO GIVE WATER, FOOD AND MEDICAL ASSISTANCE TO ANOTHER HUMAN BEING IN DISTRESS.
From Chapter 9
Killed by the Light
Experts can't give a definitive schedule of doom. Your own death is largely dictated by factors outside of your control, and beyond accurate prediction. Your own fitness is a factor, your genetics. Gender doesn't seem to affect your chances much. Woman are far from being the "weaker" sex. They survive as long as men, and often survive longer. Hydration before the event might buy you time, same with shade, a hat, rest. How much, however, remains unknown. All sources say you will die in a period of time that can vary from hours to days.
However long it takes you to die, you will pass through six known stages of heat death, or hyperthermia, and they are the same for everyone. It doesn't matter what language you speak, or what color your skin. Whether you speed through these stages, or linger at each, hyperthermia will express itself in six ways.
The stages are: Heat Stress, Heat Fatigue, Heat Syncope, Heat Cramps, Heat Exhaustion, and Heat Stroke.
HEAT STRESS
Everyone has been tired, or even dizzy, from walking in the heat. Everyone has been sunburned, sometimes quite badly. And many people have suffered the swollen fingers, feeling like sausages, and the funny stumbling at the tail end of a hot hike. This is where it begins. General discomfort, nothing heinous. A little heat rash. Headache from the glare. Thirst. The Wellton 26 felt this immediately upon climbing their first hill. They were already tired before they began, perhaps slightly dehydrated from all their journeying and restless sleep. Some of them may have had diarrhea from the bad food and water on their long bus trip. When one of the brothers from Hidalgo said, "This heat is killing me," he was telling the truth. The heat becomes personal.
HEAT FATIGUE
As you walk, the relentless heat makes your warm spots wet--your armpits, your crotch. Your head sweats, your neck, your skin blows a fine mist like steam to regulate your heat. You're a big swamp-cooler, with water passing through your membranes and keeping the meltdown at bay. Most of your heat comes out through your head---your head is a chimney. Most of you didn't think to bring a hat. If you're from Mexico, your hair is probably black. The sun encounters body heat on a dark field. Heat wrestles there, rising and descending and meeting itself.
.... But you still have water, so you're okay. If you brought beer, you're an idiot, because alcohol makes you thirstier. The ground is burning your feet--- it's 120 degrees through the soles of your shoes. If you wore sandals, and many do, you are getting sunburns on the tops of your feet. Higher thither is getting in your sandals and giving you minor burns. You might have blisters -- water goes through your system to fill them. And now your jug is getting hot -- your drinking water is starting to get hot as coffee.
...Desolation drinks you first in small sips, then in deep gulps. Your spit turns to paste. Your mouth tastes nasty, so you take another little drink. You tell yourself you'll only sip a couple more times, but to hell with it-- you take a big pull off the bottle. Your lungs, now, are leaking moisture to the vampire air. Your tears leak into the sky -- eyes dry and scratchy. The fluid in your lungs helps transport oxygen through the tissues in the blood. Less fluid, less oxygen. You breathe harder, you get drier.
HEAT SYNCOPE
You have a fever, though it's a fever imposed from the outside. Your face, even though you're a Mexican mestizo, turns pale.....suddenly your hot water is gone. You can't remember where you dropped the jug. Dizzy. Where's the water?
You turn back.
Water's over here. Where. Is. The Water.
Here?
You circle.
Oh, well. To hell with the water. I'll find water.
...where's my water?
your heart beats as though you've been running. You think you'd better take a break. Where's my water?
HEAT CRAMPS
Now you're officially in trouble. Your body has been dumping salts. Without salts, your muscles can't function. That's why people drink Gatorade. Muscle cramps kick in. Your legs suddenly ache. You get clumsy....when you fall, you hit rocks, cactus, gravel....your abdomen clenches on you....you double over. Eighty percent of lost walkers can still be saved if the Migra spots them. You can recover with water and an IV. Even the Migra's famous air conditioning could save your life. ....But if the Migra doesn't find you, you've stepped onto the lip of the death spiral. Your options for salvation wisp away like steam.
HEAT EXHAUSTION
Your fever is spiking now, and like the flu, you have gotten more and more ill. Headaches. You get nauseous, you want to vomit. If you vomit, you lose more fluids. You are not only clumsy, but enervated. Your body is weak, and your will is slipping. Your tongue is wood. You could give a dam.Your heart pounds, loud in your ears. Your breathing is shallow and fast, and each breath dries you further. Eyelids scrape across eyeballs dry as pebbles.
....This is a good place for the infirm among you to have their heart attacks. Your fluid level has dropped---there's not enough fluid to fill the container of your body. Your heart beats baster, trying to suck up some blood from the internal drought. Cardiac arrest hits when the pump overstrains itself and blows up.
Those in good shape will, sooner or later, faint. This is the brain's way of stopping the machine, like hitting the brakes when you realize you're speeding toward a cliff.
....First, you get tunnel vision. You might hear echoes. Your body falls on burning ground. And you sweat, especially where your body forms a seal with the earth. And you breathe. You get up worse than you fell, then you fall again.
And still, you might be saved. But you are now at the borderline, standing before the abyss. One more step, and you cannot return. Another border crossing.
You don't know much anymore. You are confused; your memories are conflated with your dreams. Walkers see demons, see God, see dead relatives and crystal cities. They vomit blood. The only clear thought in your mind now is: I'm thirsty. I'm thirsty....
Sooner or later, you understand that you have to drink your own urine......The first urine is pretty good, as urine goes. It is still relatively clear....the next time though, that same urine has picked up more filtered impurities, and it is a little darker now. Saltier. By the third round, it is orange. It smells bad. Then dark orange. Then pale brown. Then a darker and more poisonous brown. It looks like foaming Guinness stout. By the time your effluent is black, you're doomed--even if you wanted to, you probably couldn't drink it. It stinks of fish. Your body would retch. There is almost more bio-garbage in it than water.
The last stage of hyperthermia begins.
HEAT STROKE
Your blood is as low as it can get. Dehydration has reduced all your inner streams to sluggish mudholes. Your heart pumps harder and harder to get fluid and oxygen to your organs. Empty vessels within you collapse. Your sweat runs out....Your temperature redlines ---you hit 105,106, 108 degrees. Your body panics and dilated all blood capillaries near the surface, hoping to flood your skin with blood to cool it off. You blush. Your eyes turn red: blood vessels burst, and later, the tissue of the whites literally cooks until it goes pink, then a well-done crimson.
Your skin gets terribly sensitive. It hurts, it burns. Your nerves flame. Your blood heats under your skin. Clothing feels like sandpaper.
Some walkers at this point strip nude. Originally, BORSTAR rescuers thought this stripping was a delirious panic, an attempt to cool off at the last minute. But often, the clothing was eerily neat, carefully folded and left in nice little piles beside the corpses. They realized the walkers couldn't stand their nerve endings being chafed by their clothes.
...Once they're naked, they're surely hallucinating. They dig burrows in the soil, apparently thinking they'll escape the sun. Once underground, of course, they bake like a pig at a luau. Some dive into sand, thinking it's water, and they swim in it until they pass out. They choke to death,their throats filled with rocks and dirt. Cutters can only assume they think they're drinking water.
Your muscles, lacking water, feed on themselves. They break down and start to rot. Once rotting in you, they dump rafts of dying cells into your already sludgy bloodstream.
Proteins are peeling off your dying muscles. Chunks of cooked meat are falling out of your organs, to clog your other organs. They system closes down in a series. Your kidneys, your bladder, your heart. They jam shut. Stop. Your brains sparks. Out. You're gone."
Luis Urrea
The Devil's Highway (with deep appreciation)
REMEMBER-- IT IS NEVER ILLEGAL TO GIVE WATER, FOOD AND MEDICAL ASSISTANCE TO ANOTHER HUMAN BEING IN DISTRESS.