Pablo Pavo, Guajolote, Pisco

What follows is Creative Non Fiction about a  hot air sauna burn in late November, 2016

I  am Pablo. I most enjoy those times when I alone am personally responsible for what I do, whether in on a mountain peak, or in an ultra-lite over the Sierras, or a Cessna flying from California to Punta Arenas, Chile. At times, of course, that sort of self indulgence, lust for adventure –  arrogance perhaps- has put me precariously clinging to a cliff face, or flying alone over SW Argentina when it was prohibited by the threat of war.  Similarly, I enjoy dry heat so much it recently put me alone in a sauna, on Thanksgiving day 2016, for between 20 and 40 minutes.  I cooked myself like a turkey. The recipe, or receta para asarse:

Lie down in a hot air  sauna at the highest, hottest level. If you are diabetic and use  repository insulin, which activates more quickly in heat, drink some water often, and eat an apple or an orange every 20 minutes.

I  followed the recipe, but remember nothing after lying down to begin my second 20 minute session in the sauna, until sitting in a wheelchair, confused,  frightened, and hyperventilating, amid  about ten strangely dressed strangers in a strange world who spoke in unintelligible tongues.  I had no recollection of being found unconscious in the sauna or being extracted. I could not formulate my own thoughts, or movement or speech. I began to shiver and have coarse  muscular spasms. There was no pain, but I was angry at having no control of what was happening; about missing the rest of my life; maybe that anger motivated me to mumble some jumbled thoughts that surfaced: though it took me several long minutes to get the words to form, i finally managed to say:

“Diabetes!”   a voice in English said,

“Your blood sugar is 87. You are going to be fine.” Happy to hear a familiar language, I said

“Adrenalin?” The voice said

“ No. ” and after  I insisted on some water with sugar. The voice said “ Your blood sugar is 87. ” I said

“Wet towels, Ice” …The voice responded

“Your temperature is normal now.”” But  then my wife and daughters appeared and got the towels, and gave me sugar water with a straw.  I suggested

“Ambulance.” The voice said

“ It is on the way” I still could not get up or control my movements, and felt hopeless, as if i were sliding into oblivion. But  gradually I was thinking more clearly assuming I was in Sacramento. I began to fear I would live, and be terribly embarrassed when my E R colleagues saw me and learned of my my stupid sauna behavior.

I was lifted on to a wheelchair and for what seemed a very long time was pushed down a long series of poorly lighted bare cement halls and walls, set among conduits, and dark recesses. Then out into the night to be lifted onto a sheet, and then to a cot and placed into primitive station wagon ambulance. I began to recall I was in some other country, but couldn’t recall which: In the ambulance I asked about a place I had been recently:

“ Brazil?” My wife,  Marili answered,

“ Panama!” It all came back to me. I had been  alone in the hot air  sauna of a hotel.   I felt that surely I would need to be hospitalized for some time and said,

“ You go home as planned. I’ll fly back later, or come by helicopter.”

“No, we will not and you will not!”

By the time we got to the hospital, I was fully alert, coherent, and coordinated. The nurse took vitals, did an EKG, asked my name and birth date, asked the litany of questions about illness, medicines, and allergies, and drew blood with some difficulty due to collapsed veins. The Dr. repeated the same questions, checked my coordination and strength. My Family Angels were allowed to be with one at a time. Lili asked about an MRI, because it might be possible I that I had a stroke or a fall with injury because  found unconscious  with strange lower extremity injuries. And though the Dr. said there was no need, and I agreed, the universal rule prevailed: when a test is possible and suggested it must be done. In short order the  normal labs and MRI results were back, and I was released. The Dr. explained that I had minor first degree burns. Obviously neither of us knew much about Hot Air Sauna Burns* at the time. We paid the $753 bill, of which more than $400 was for the MRI.

As I write it is six days since trying  to cook myself for Thanksgiving; I am now guardedly thankful to be alive, and in relatively human condition. It was at first curious that most of my  injures were below the knees; it became clear they were not abrasions, but: Bullae! Blisters. The skin is cooled by evaporation of sweat and by cooling from blood circulation; because circulation is less in the lower extremities by comparison to the rest of the body, both circulation and sweating are decreased there… more blistering or burning result. Deep partial thickness burns are  very tender to touch . They can look something like the skin of a turkey leg that begins to blister as it cooks. On standing up the pressure increases immediately and for about 10 min causing pain. very pa. Yet after lying down again they become more tolerable.  I lie about a lot. The deeper ones form an eschar… a leathery covering that must be scraped off to allow healing; that eschar removal process is almost beyond tolerable, but smaller wounds like mine are not worth the risk or trouble of anesthesia. When being cleaned up I despair about the purpose or significance of life.  On the other hand, yesterday I was able to do a half hour of upper body workout and a half hour of elliptical trainer. I should be healed within a few weeks, though full recovery will require several months, and resolve to avoid hot air saunas from now on.

Sinceramente,

Pablo

* Virve Koljonen, MD, PhD Summary  from ResearchGate  file:///Hot%20Air%20Sauna%20Burns-Review%20of%20Their%20Etiology%20and%20Treatment.pdf

Hot air sauna burns (HASBs) are rare but potentially fatal injuries with simultaneous rhabdomyolysis. The mechanism of HASBs involves prolonged exposure to hot air because of immobility. The burned areas are on the parts of the body that are directly exposed to hot air. This type of heat exposure results in a complex injury, in which full-thickness skin damage occurs concurrently with deeper tissue destruction. Sauna bathing is becoming more and more a popular recreational activity around the world. The objective of this review article is to familiarize burn care specialists on this unique and clinically challenging type of burn injury and to illustrate our department’s long experience in treating.