June 18, 2017

We have all heard the horror stories about the child left in the hot car who overheats and tragically dies. As a parent who happens to be a physician I never thought my child could be a victim of over-heating!

Before I tell you what happened let me give you a few basic definitions.

Normal body Temperature: about 97.7 -99.5 degrees fahrenheit. It fluctuates depending on your environment and physical activity, with meals and the time of cycle for women. As the temperature of your body rises above normal so does the amount of water the body loses.

Hyperthermia: when the body can no longer maintain a normal internal or core temperature through heat loss. Normally the body tries to cool down by sweating and peripheral vasodilation ( when your blood vessels expand or dilate usually noticeable on the surface of your face as flushing).

From mild to severe

Heat Cramping: painful muscle contractions which may be noticeable as twitching. Person is alert but may feel weak and their skin may be moist. Their temperature is normal or high temperature.

Heat Exhaustion: Commonly experienced after strenuous exercise or activity  without sufficient hydration in a very hot environment. Person’s core body temperature becomes elevated beyond normal.

Heat Syncope: Suddenly collapsing and becoming unconscious due to excessive heat and dehydration or volume depletion, vasodilation and cerebral hypotension (reduced blood pressure or circulation to the brain).

Heat Stroke: Results in brain/cerebral dysfunction.  This is a Life threatening condition that requires hospitalization & ICU care! Person’s core body temperature is extremely high,  above 104 degrees Fahrenheit.  Person’s skin is hot, they may act confused, complain of blurry vision or exhibit irrational behavior followed by convulsions, dangerously low blood pressure, and loss of consciousness.

So this is what happened

It was a late Sunday afternoon.  Our oldest son just graduated high school and was excited to start his first real summer job.  He planned to take the bus the following week so my husband offered to walk with him to show him the bus route and where the bus stop he needed was located. I was also planning to get some  groceries so as a family we decided to walk together.  Everyone had woken up late and had a light breakfast.  My husband and I and our three children walked out of our apartment into the bright, sunny outdoors.  

It seemed like a nice day as we walked quickly along the sidewalk trying to escape the the shining sun.  Because it was a Sunday in June after all the college graduations,  the streets were not as busy. We talked about how hot it was, about our son’s new job, about starting college etc. Our youngest child Mariam, now 15, didn’t talk much but that was not uncommon because she is generally quiet and reserved.  We walked for about 15 minutes under the hot North Carolina sun past a number of homes, restaurants,  and new apartments undergoing construction. We even walked past a fast food restaurant and my husband asked if anyone wanted some sweet tea but everyone said no.  

So we kept walking  until we reached the corner of Franklin & Columbia Street, a busy area of Chapel hill and college town. The two older boys walked ahead with their father & I walked next to Mariam. We stopped briefly under a building before trying to  cross the road and I looked at Mariam and didn’t think she looked well. She was perspiring a lot and had a slight worried look on her face.  I asked her if she was feeling alright and she said “Yes, I am fine.” I said are you sure? She said, “ Yes, I am fine; lets just go.”  

We walked quickly to cross the road at a busy intersection and before we could reach the end of the cross walk she had started to lean against me. Luckily I was right next to her and grabbed her arm. Within seconds she slumped down and was falling! I yelled out for her father to help and he lifted her up and move her away from the sidewalk. Her eyes rolled upwards and her glasses fell off her face. She lost consciousness! Her body felt heavy and lifeless like a rag doll with her legs bent at the knees behind her on the ground. Her father was saying her name loudly – Mariam! Mariam! Mariam! She did not respond but looked very pale with a ting of blue grey color to her face.  It was one of the scariest seconds of my life. We tried to straighten her legs and drag her to some shade. She was still on the ground as I tried to cradle her head.  She came to briefly and said she wanted to sit up. My husband & I  lifted  her from the ground unto a wide concrete stone wall. She tried to sit up but looked like she was going to lose consciousness again- at this point I was no longer just her mother but a physician barking orders to everyone.  I told my husband  to run across to the drug store and get something cold for her to drink, I handed my camera to my son, took off my handbag and flattened it to cushion Mariam’s head as I sternly told her she needed to lay down.  She whispered, “Mummy  why are you yelling?  I can hear you but I can’t see!” I tried not to panic as her eyes were wide open but blank.   I asked her to bend her legs and remain lying down. Shortly afterwards she said, “I can see now!”

As I waited for my husband to return with the cold drink, a young Black woman rushed over and handed me a large bottle of cold water. She said “I saw you from across the street and I was concerned so here.”  I thankfully took the water from the lady and felt like crying because of her generosity. I  poured some of the cold water on Mariam’s head soaking her recently braided hair and also around her neck & chest.  She still looked pale but said she could sit up now. By this time her father had returned with some cold  Gatorade and I had Mariam sit up and drink it while I fanned her with a piece of paper I had found. It was then I noticed there were people across the street watching us from a restaurant that was three stories high. They were leaning over the rails just watching.  I had her remain seated for several minutes after she had finished drinking the bottle of Gatorade before we cautiously walked across the street into a Starbucks where we knew she could sit more comfortably and was air conditioned. Clearly she had suffered heat syncope but I knew that she would be OK . She was now alert, able to see, talking clearly and able to walk.  My husband and older son went back home to get the car while Mariam, my middle son & I waited at Starbucks where we shared a green tea frappuccino.  

Back home I had time to reflect. I felt sad that this happened but also relieved that she was now OK.  I should have noticed that before we left, Mariam poured herself a drink but I never saw her drink it. Her drink was left untouched on the counter top.  She was notorious for not drinking enough. We were always saying, “Mariam have you had something to drink?” But today I had not asked her this before we left. Instead I had been distracted by what she was wearing on a Sunday, telling her to wear something more suitable.  I mulled over in my head what if I had not noticed she didn’t look well? What if she had been with people who did not know her well or worse what if she had lost consciousness somewhere and no one had seen her? Perhaps we should not have gone walking during the middle of the day and  waited till later in the evening. So many what if’s and feelings of guilt.

Later that evening I  decided to talk to Mariam and asked her what  she was feeling before she passed out. She admitted she had not had anything to drink before we left but that she felt fine when we left the apartment. She said while we were walking she suddenly felt like “ something dropped in my stomach, then it was like I was in space and my sense of gravity had changed and then I couldn’t see clearly – like there were stars and like it was all in black & white…. I felt like I suddenly needed to sleep and I couldn’t control my legs.”   I asked her why she didn’t say anything as soon as she felt bad but she didn’t have an answer.  Truth is I know the answer – she didn’t want to bring any attention to herself. She didn’t want to look like the weak one while her parents & older brothers marched ahead.  I told her to promise me that no matter where she was or who she was with- especially her family -to feel free to speak up! It is OK to say “ I don’t feel well” or “I need to stop or sit.”  Learn to listen to your body and respond to it! It is called self preservation. Who cares what anyone else thinks – especially not your brothers who are only a few years older than you.

Of course we also talked about the importance of staying well hydrated especially in this hot weather.  Drink up to eight glasses of water or more a day when going out in the heat and carry a water bottle or flask with you. Avoiding  persistent  exposure to the sun especially when it was hot and humid. During the summer it is safer to take walks early in the morning or later in the evening when it has cooled down. Also wearing a wide brim hat & sun block if you have to be out in the hot sun. We also talked about how as a family we could all do better looking out for each other.

I share this with you because I hope it will help prevent another incident but if in the unfortunate event you find your friend or loved one suffering from the effects of excessive heat exposure please:

  1. Recognize the symptoms early
  2. Move them to a cool or shaded area and focus on quickly bringing down their temperature down.
  3. Give them cool fluids containing electrolytes if they are able to swallow or have them taken to the hospital for IV fluids.

If the person appears to have heat stroke then they will need to be admitted to a hospital ASAP for careful monitoring & treatment to prevent irreversible tissue damage and organ failure! Be safe this summer &  remember babies, young children and the elderly are particularly vulnerable, so check on them often.

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