It started with a nagging headache. I'd spent all day out on a firing range in the Nevada desert as part of a story on a firearms-school. Never having been in a desert before, I thought I'd taken all the necessary precautions. A hat and sunglasses, obviously, and enough high-factor sun cream to marinate an army. And water. I'd been warned about the risk of dehydration, so I'd drunk plenty the night before (even abstaining from alcohol, as recommended), and made sure I guzzled a cup or two regularly from the huge water barrel that had been provided. Yes, I knew the heat could be a problem, but I was ready for it. At least. so I thought.
The dangers of the sun are well publicised every summer, but potentially carcinogenic sunburn isn't the only hazard. Heat exhaustion is caused when the body loses too much fluid and salt, either in hot weather (it doesn't have to be sunny) or through exercise. Symptoms include faintness, vomiting and headache, and in severe cases the body's cooling mechanism can break down altogether. That can lead to the potentially life-threatening condition of heat stroke, where victims can quickly slip into a coma and even die due to organ failure or brain damage caused by their own body heat.
In the UK it's rare to find such extreme cases, but it does happen. "In Britain heat stroke is usually associated with exercise. We've had two or three cases in the London marathon, but it's not common," says Dan Tunstall Pedoe, cardiologist at Homerton and St Bartholomew's Hospitals in London, and medical director of the London Marathon. While the British climate means there's generally less of a risk here than in hotter countries, the very fact that we're unused to high temperatures means they're more likely to clobber us when we do encounter them. "Heat exhaustion is usually the effect of being unacclimatised to the heat," says Tunstall Pedoe. "If you have a heat wave like you have in France last year, then you get a lot of cases of people who don't have enough fluids, who become exhausted and faint or collapse."
Those most susceptible are the very young and old, and people with medical conditions such as heart problems, diabetes or obesity. Outdoor workers are also prone, as are fire-fighters who have to work in high temperatures in heavy clothing. And, evidently, unwary writers in the middle of deserts. For me, the first hint of trouble came when another student, a police-officer from Las Vegas, commented that he hadn't seen me using the toilet during breaks. Not entirely sure how to take this, I assured him that I had. Good, he drawled. Because if I wasn't urinating every half-hour I wasn't drinking enough. For good measure he advised me to check the colour - if my pee was yellow I was dehydrated.
From then on I drank even more. Not just water, but what seemed like gallons of Gatorade, a foul-tasting gunk that contains salts and minerals to replace those the body loses when it sweats. But as I drove back to my motel that evening, a headache was already starting to make itself felt. Within an hour or two it had become excruciating. Untouched by aspirin, it relentlessly squeezed the back of my head and neck as I spent a sleepless night face-down on the bed. Next morning, though, it had eased to manageable proportions. I made it back out to the firing range, and this time draped a wet flannel down the back of my neck while I stood under the sun and blasted away at the targets.
For a time all seemed well. I drank more than ever and stayed in the shade as much as I could. Then the headache began to reassert itself. When I found myself trying to load a magazine the wrong way around I realised something was wrong. Suddenly it occurred to me that I didn't feel well. Not well at all, in fact. A medic was sent for, and my embarrassment turned to sheer mortification when I found that I could hardly stand, never mind walk.
In the first aid station I was given oxygen and attached to a heart monitor and told, surprise, surprise, that I'd got heat exhaustion. Although it was only around 100° - positively cool for Nevada in June - I hadn't allowed for adjusting to the high altitude and almost non-existent humidity. Despite all I'd drunk I was badly dehydrated, and now my body was unable to regulate its temperature. And still I felt worse. Shaking, pins and needles, faintness. After I'd vomited for the second time the medic warned me if I did it again I would have to be medi-vacced to hospital in Las Vegas, fifty miles away.
I didn't throw up again, but going back out into the sun had been a big mistake. The treatment for heat exhaustion is to stay in the shade, drinking cool salty drinks until you're fully recovered. Venturing into the sun again too soon only makes things worse and increases the risk of heat stroke, which can require emergency medical attention. If I'd left it ten more minutes I would have had to be flown out to hospital, the medic assured me. As it was, I would be susceptible to the sun for a few days yet.
But just how susceptible came as a shock. I spent the next two days in my hotel room chugging down copious amounts of water and the noxious Gatorade. Even a brief trip outside was enough to make me feel dazed and wobbly. More worrying was that I felt progressively worse instead of better. On the third day I caved in and asked the hotel for a doctor. There wasn't one - this was in the desert, they reminded me - but they took it on themselves to send for paramedics. By the time the team arrived I felt close to passing out. Too miserable to be embarrassed, I was put on a saline drip and carried out on a stretcher to the ambulance, where an oxygen tube was stuck up my nose yet again.
On the journey to the hospital my bladder began to rebel against all the liquid I'd forced into it. In the space of an hour I used up every receptacle in the ambulance, and by the time we reached casualty was having to resort to a plastic bag. "Ain't never seen a guy pee so much in my entire life!" the ambulance driver, a grizzled Vietnam veteran called ET, announced cheerfully to anyone who would listen. At the hospital I was kept on a saline drip while tests were carried out and blood samples taken. When the results came back I was informed that not only had I heat exhaustion, as expected, but in my attempts to combat the dehydration I'd drunk so much liquid I'd managed to flush all the salt out of my system. "We get it all the time. Take salt tablets and stay out of the sun," the doctor yawned as I was discharged.
Back in the UK the only after effects were a lingering fatigue, and the airmailed hospital bills that fell through the letterbox with alarming regularity for weeks afterwards. With the total cost of my 'touch of the sun' eventually coming to around $2200 (about £1400), it was an experience I wouldn't recommend. For anyone wanting to avoid it this summer, here or abroad, the advice is simple. Drink lots of water, stay in the shade, keep off the booze and don't over-exert yourself when it's hot. Most important of all, if you happen to be going to a desert, make sure you're well insured.
Simon Beckett, 2004
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