Hot Tamale

         Summer had announced itself in abrupt and rude manner this year. Many were not prepared, oblivious, or simply at the wrong place at the wrong time. Summer solstice had not even officially taken place but it was well over 100 degrees (38 C) outside. For one man it would almost cost him his life. He was in his early 20's and a labourer from Pakistan, surely driven to UAE for its pay and in hopes of a better future while building up his bank account. Fueled by the sweat on his brow and the epitome of working class ethic he did his job day in day out like a well oiled machine. However, on this day he would not be working outside, but in a confined space. A small room with no ventilation, a variable hot box from a wartime torture camp of days gone by. This was his office for the day and he didn't even bat an eyelash as he carried out his duties within it. Like a dog or a child left in a hot car in a searing summers day by its obvlious owner or negligent parent. It was wasn't even noon by the time he collapsed.

I found him confused and disoriented as I took him into our air conditioned ambulance. As I slide the thermometer deep into his ear canal I eagerly awaited the reading. The thermometer let loose the familiar audible tone and I gazed down at the reading in disbelief... 107.6 F(42C). It be must wrong I thought as I rechecked and confirmed it was indeed correct. At this temperature his brain was beginning to cook and if he was not cooled down he was gonna have a bad day, and could even die. 

       The man's heart was racing and I began to remove his clothes and cover him with ice packs. Ultimately  I had now done everything I could to lower his temperature by removing him from the hot environment, taking his clothes off, covering him in ice packs, and turning the air condition on max, so I now needed to move on to his other problems. He was complaining of chest pain and I connected the cardiac monitor to him and watched his heart gallop along at 150 beats per minute. I hoped by cooling him down I could reverse the problem.  I tried apply more ice packs to his face and neck which in addition to cooling him down can also sometimes lower the heart rate by triggering the mammalian diving reflex. However, despite my best efforts this also did not work.

        I pulled out an 18 gauge intravenous catheter and hoped to god I wouldn't stab myself with it; the back of the ambulance rocked back and forth as it raced down the street at 160 Kph (100 miles per hour). At this speed performing any procedure can be extremely difficult, I yelled at the driver to slow down, but to no avail. I grasped the needle as firmly as I could and just went for it. I pierced a large vein on his left arm. As I slid the teflon catheter deep into his vein I simultaneously retracted the steel needle. Blood began to liberally drip out of the IV confirming I was in. I connected some fluids to the IV and watched as they poured into his hungry veins. His tank was on empty and he needed the fluid badly. Our ambulance tires screeched into the Emergency Department entrance as I unloaded him. On arrival thee hospital rechecked his temperature and  our reading was indeed correct. They continued our cooling methods and also monitored his heart rate. He was the first heat casualty of Ramadan on my shift, but certainly not to be the last.