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The Effects of Heatstroke: A Cautionary Tale

Superstition Mountain (Click on the thumbnail for a larger picture of Superstition Mountain)

During the 1990s, I worked on the introduction of the Apache helicopter into UK service and therefore spent a fair amount of time at the McDonnell-Douglas (now Boeing) Helicopter site in Mesa, Arizona where the aircraft was designed and constructed.

In early September 1997, I made an apparently routine visit there, with the intention of witnessing Qualification testing of some of the UK specific modifications to the helicopter. On arrival, I and another member of the UK team decided that it would be pleasant to hike in the Superstition mountains to the East of Phoenix, close to the Mesa factory. As it turned out, things didn't go quite as planned...

After arriving in Arizona the previous night, my hiking partner, Major Malcolm, and I left the Embassy Suites Hotel, Tempe, at about 0630 on Sunday September 7th 1997 to hike on Superstition Mountain. Each of us was wearing appropriate gear (boots, hat etc.). We provisioned with 2 x 1.5 litre bottles of water each, and some food. I applied liberal amounts of my Factor 35 sun cream (Yes, really - 'liquid balaclava': Anyone who knows me will tell you that I'm very fair-skinned) and off we went.

We began the hike at about 0700, and the going was initially easy but later became what I would describe as "medium". Anyway, we eventually reached the summit at about 0930, and the view was just as promised: Outstanding. There was a small amount of smog over the city area but the rest of the view was almost crystal clear and beautiful in its desolation. There really is an awful lot of nothing out there.

During our stay we were alone on the rim, although we had passed and been passed by other hikers on the way up. The silence was marvellous, and though we saw little in the way of wildlife - a couple of small lizards, a large one (chuckwalla) the size of a rat and a regal buzzard - the view was fine in itself.

We began the downward trek at about 1000; initially I found the going quite easy, but it again began to range to the medium. I would never describe any of it as difficult. The problem in the latter part of the descent was my stamina, or rather lack of it. I had a fair amount of water , and seemed to be using it at a reasonable rate but was getting more and more fatigued. Towards the end, on the long flat stretches of rock, I was actually sliding on my bottom trusting to the double layers in my trusty Rohan trousers. In the end I did end up with one blister, and that on the side with my wallet in it!. The temperature by now was probably somewhere in the mid-90s Fahrenheit.

Malcolm was urging me down the mountain then, and I was hallucinating about seeing cars off to our left. It was at about this point that I finished the last of my water, About 500 yards prior to the car park I was hanging from Malcolm's shoulder and a little further on I collapsed. At this point, my memory of the situation ends, but I am told that two oncoming hikers, Michael and his pal Bill, came to assist. The three men then carried me the 500 yards or so to the car park, put me in the car and drove me to the Ranger Station at the entrance to the Lost Dutchman State Park.

Once there, I was taken inside, laid down, cooled and filled with water whilst the Emergency Services were called. They soon arrived - initially Fire Department(!), swiftly followed by the Paramedics who took me to the Emergency Room at Valley Lutheran Hospital in Mesa, where I was placed in an ice bath. There I began to fit, and was intubated and transferred to the Intensive Care Unit about an hour and a half later.

The next part of this story is, as far as I am concerned, entirely hearsay. After having left me in the caring hands of the medical staff at the Valley Lutheran, Malcolm got in touch with the Duty Officer at the British Embassy in Washington DC. He in turn spoke to the DERA Boscombe Down Duty Officer and at 0130 UK time (1730 Arizona time) a Ministry of Defence (MoD) Police Officer woke up Jo, my girlfriend (now wife), with the news that I had been admitted with heatstroke and that she should call the hospital.

Her initial reaction was "Silly fool; what's he doing in hospital?  A bit of sunshine never hurt anybody." Apart from being woken at that time in the morning she had no real indication of how serious things might be, and when she called the hospital they asked her to ring back in six hours when they ought to be able to give her some news. She rang my parents in Cheshire to let them know as much as she did, then called the hospital again at 0700. They asked her how long it would take her to get there, and effectively gave her the impression that they'd try and keep me alive until she arrived... At this point, the awful reality began to dawn.

She called my parents again, and then Elaine, the Boscombe External Trials Co-ordinator. By 0900 Elaine had booked her on that day's 1230 London Gatwick departure to Phoenix and had organised Captain Steve from the Boscombe Apache team, who was therefore very familiar with the area, to travel out with her and help. British Airways were extremely good; they took one look at Jo's distress and moved her and Steve forward to Club Class. My mother was also booked on a flight from Manchester via Chicago.

Almost exactly 24 hours after the MoD policeman arrived on her doorstep, Jo, my mother and Captain Steve had been met at the airport by Rom of the GKN-Westland on-site team at Boeing Mesa and taken to the hospital.

I was in an extremely bad way; I had by this time slipped into a coma, my liver and kidneys had packed up and my brain was severely swollen. The results of a CT scan and EEG gave a very poor prognosis, and the doctors told my family that I was not expected to survive. My mother was asked to give permission for an operation to put a chest line directly into my heart for some of the drugs I was being given.

Over the next day or so, my condition didn't appear to change very much, and Jo and my mother spent hours by my bed, talking to me and trying to elicit some sort of response. Jo spent a lot of time reading to me, too, doing all the character voices much to the amusement of Tari, my nurse, and the rest of the ICU staff! By this time, my father had flown out as well, and so the three of them, plus Steve, had someone with me during most of the allowed visiting time.

By Wednesday the swelling in my brain had begun to decrease and I was also showing some physical improvement, although I had picked up some pneumonia in my left lung. The doctors felt that I was going to survive, but this good news was severely tempered by the neurologist's view that there was a high likelihood of me remaining in a Persistent Vegetative State for an indeterminate period, perhaps even permanently. Jo and my parents had begun to consider how to convert my parent's house, and if Jo would move to Cheshire, if this prognosis was accurate.

Also on the Wednesday a friend of mine from work, Mick, turned up. He had been at Edwards Air Force Base in California undertaking trials on the C-130J Hercules for the RAF when he heard about my condition. He had driven the 500 miles in one go (quite something for a Brit), and was intending to drive back the next day to be at Edwards in time for work on Friday morning. I know that my family really appreciated him doing that, as of course do I, now that I'm in a position to know about it!

As it turned out, Mick was there for the best news of all; early on Thursday morning I came out of the coma, thereby confounding the predictions of the neurologist. My liver and kidneys were beginning to improve, too. I was breathing by myself now; the intubation had been removed.

I was still unable to see, and I still had tubes entering and leaving me in all sorts of unpleasant places, but I was apparently responding to questions in an apparently fairly coherent manner. As it happens, I remember none of this! My condition had improved to such an extent by that evening that I was moved out of the ICU and up to a room in a ward on the fourth floor. My liver and kidneys had by this time begun to work again, but I was still being fed blue goo via a nasal tube and I still had the chest line in.

On Thursday night I was strapped to the bed, since I had fought the nasal tubes to such an extent that I'd pulled them out several times.

On Friday, a physiotherapy team came to visit since I was still unable to co-ordinate my movements and in fact could not control my feet usefully at all. My family were told not to worry too much by this team, who felt that after eight weeks or so of extensive physio I should have recovered most of the control of my movements. A major improvement during the day was that I was beginning to regain my sight.

On Friday night, I was again strapped to the bed. I was even fitted with a form of medical "boxing gloves" to ensure that I couldn't get a grip on the nasal tubes!

My memory of events returns on the Saturday morning; as I awoke I was aware that I was somewhere strange, that I felt extremely drained, and that tubes were going into, and coming out of, places where I wouldn't expect tubes. My awareness improved considerably over the next few hours, to the extent that I knew I was in hospital and that my family were around; I had full recall of events up to and including my collapse on Sunday, so I was aware of why I was in hospital. However, I was still somewhat confused as to how long I'd been there, and of course I had no idea that I'd had quite such a close shave. Because I didn't know I was supposed to endure weeks of physiotherapy, I decided to get up and walk around the room, which is what I was doing when Rom walked through the door and said "Bloody Hell!".

From then on, I improved with each passing hour, except for a recurrent infection whose source (blood, urinary or respiratory) could not be pinned down for 48 hours until swab results were returned from the lab. I was on a liquid diet for the next couple of days, which was extremely boring, and I was given injections every four hours (luckily via the chest tube) along with frequent breathing treatments. I read a lot, slept very little (well, I'd had more than my quota over the previous few days) and slowly got information from my family and friends as to what had been happening to me. They were a little circumspect initially, and so it wasn't for some time that I knew how serious it had been. Because I felt fine, and had no serious difficulties when I was aware and could remember, I had minimal psychological trauma to deal with; unlike those around me, who have found it much more difficult to deal with the experience than I. This, of course, is because I was lucky enough to sleep through the bad parts. I also practiced chatting up the nurses using the husky voice I was left with after the intubation had bruised my vocal chords. Did no good, though!

I was released from hospital after the results of the lab tests came through (the infection was respiratory), and I had begun to respond to antibiotics. This was on Wednesday 17 September, which was coincidentally my father's birthday so there was a double celebration by the pool; sadly I was off alcohol, and would be for a further month due to the antibiotics and more importantly the likely effect on my still swollen brain.

We remained in Arizona for a further six days, during which I began to regain my strength and visited doctors as an out-patient. Finally, on Tuesday 22 Sept my parents, Jo and I flew back to Gatwick.

I spent a further month off work, and it took about a month longer for me to regain my normal speaking voice, but thankfully I have experienced no lasting effects other than a healthy respect for the desert and endless gratitude to Jo, my family, friends, colleagues, the Arizona emergency services and the doctors, Tari and the rest of the staff at Valley Lutheran Hospital.

So the question remains; why did it happen? I was wearing the appropriate gear, we had food and water, the hike wasn't that difficult - what was the problem? It appears that it was a combination of factors. Firstly, I had only flown in the previous evening so the effects of jetlag, and dehydration from 11 hours in an airliner, won't have helped. I had some alcohol on the aircraft, but not an excessive amount (honestly!), plus a rack of ribs, fries and a couple of beers in the hotel on arrival. I went to bed early, but woke up early too, so I won't have had a proper night's sleep. We did not have breakfast, although when stopping for water and food on the way to the mountain I had some orange juice. I was certainly not as fit as I should have been, although I was not that overweight!

It seems (although it is by no means certain) that the major problem, and the reason that the incident was as serious as it turned out to be, was that my blood salts and electrolytes were severely depleted. This meant that although I was taking in water I was thereby further diluting what electrolytes I did have which affected me much more than would normally be the case. I had few of the classic symptoms of bad dehydration (no headache or tingling extremities, for example), and I passed through the heat exhaustion phase extremely quickly, and had collapsed within a short time afterwards. I have since been advised that an improvement on plain water for such an exercise would have been a solution of Gatorade or some other "energy giving" drink, which would have helped replenish some of the missing electrolytes.

Certainly, I was very, very lucky. Not solely because I survived, but that I survived with - as it turns out - no lasting ill effects. I fly in helicopters as part of my job, and I also hold a Private Pilot's Licence, and I was very much afraid that the medical clearance to do both of those would be withdrawn. However, that was not so and after some checks by the Civil Aviation Authority, and the Military doctors at work, I was back flying again within a matter of months.

The entire thing was quite a scare, mostly for everyone else - after all, I slept through all the bad parts.

 

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This site was last updated 07-May-2005