Winter Kill

Dear Louie,

11-19-04

Patients get sick and sicker in January and February than in May and June. I initially became aware of this while on the island of Attu in 1945. While on the island, as a member of the US Navy, I became aware of the moist cold of the Arctic Sea.

I arrived in Attu in December of 1945 and on getting off the DC-3 I was cold.  I shivered and almost shook, under my breath, I mumbled that the war was global in nature, “and why in the hell did I draw the short straw for the North Pacific” when the South Pacific beckoned.  I was cold on arrival and remained cold until May when I departed for the States.  My legs ached most of the time; I developed right-handed coldness, which still bothers me to this day.  Feet were cold and remained cold, legs were cold and remained cold, and all body parts were cold and remained cold. There were no warm days, there was some sunshine, but never warm.  For six months I was cold. It was damp, it snowed, it rained, and it was miserable.

But at 19 years of age, hope springs eternal and we made the best of it. Because everyone else felt the same, we enjoyed misery together and developed the ability to bitch, but bitching became boring and we developed the ability to cope, and coping became boring so we developed the ability to subsist and really find enjoyment in daily chores, that is all except a guy by the name of Brown.  He was by nature cold, he was depressed, and he was boring. 

Initially, we all tried to cheer him up, but when the pattern of depression became too great we ignored him.  Somehow he was able to cope with his melancholia and even he, by May smiled occasionally.  Many months later I saw him at Marquette.  In conversation, he recognized his depression and in conversation, it was obvious he was not chronically depressed.  He stated that he found he could not smile on Attu, his face was cold and immobile and he desired sunshine.  If only he could bask in the sun if only his facial muscles could relax in the warmth of the sun.  He stated that one night when alone in the lab he had, out of desperation, turned on all the lights in the lab, and quietly soaked up the rays.  In the morning he felt better and from that moment on he had faith he would get off the rock and back to sunshine and peace. He continued to quietly read each night for four hours with all the lights illuminating the lab, he felt better and when we spoke he was optimistic that his life would be normal, but he was going to move to the south, to sunshine.  I believe he represented the first case of depression due to lack of sunlight, a condition now recognized in the northern locations.

Over the years I recognized that all disease was more difficult to treat in winter Wisconsin.  Depression was constant and somewhat familial deaths were higher in January and February, and each year a harvest of death occurred.  A harvest of souls, of patients who struggled until some illness, some injury seemed to trip the balance and they would die.  The aged seemed to be especially prone to winter dying, but who would die was left to the “Grim Reaper”.  There was no predictability; some years the sickest would rally the winter away, only to die rather unexpectedly the next winter.  Death and illness sometimes bear little relationship.

I recall one individual.  This man of 65 years of age developed a spontaneous small bowel infarction, was operated and lost most of his small bowel. He lived for five years after that horrendous operation which left him with chronic malabsorption syndrome.  He was optimistic and learned to self-medicate and treat himself with multiple small feedings during the day and night.  Surprisingly, he gained weight, led a normal life for five years and then during February he seemed to waste away.  His feeding habits no longer were adequate, he lost weight, his skin literally dried on his bones, his mind dried, and he became cadaver-like.  He lost the spark to live, and died one night, a night no different than any other of the past five years. I remember going to his home to pronounce him dead and give solace and comfort to his family, and standing at the bedside, looking down at him and wondering, the thought I had wondered so often, why now, why not yesterday or tomorrow?  I asked that question hundreds of times and never had the answer. I never heard death, felt death or saw death walking the halls or the rooms, but death was more prevalent in February or January of each year.  The selectivity of death has no answers.

At one time pneumonia was said to be the old man’s reprieve and in the days of lesser diagnostic ability many conditions passed for pneumonia. Pulmonary emboli, congestive heart failure, and renal disease all, at various times have been diagnosed as pneumonia when the lungs became congested and the secretions dried in the nasotracheal passages giving a slight fever.  Then it was easy to say pneumonia was the cause.  No one doubted the physician, except the physician himself and as he left the bedside he questioned his pronouncement and his accuracy.  So often he felt powerless in the fight to prolong life, or at least to give comfort.

One night I was called to a home of a bachelor, to aid the police in determining the cause of death of this elderly man who had been found dead.  He had been found dead by his neighbor after a day when he was not seen out of the apartment.  I arrived and the apartment was cold and smelly.  The body was on the bed, clothed, and somewhat livid, stiff from rigor.  He apparently was dead for some hours, but something was not right.

There was a smell of gas in the apartment, faint but present.  The oven door was open; a pancake was in the oven, half-baked.  The thermometer registered 45 degrees and was unresponsive when adjusted to 70 degrees.  In the bedroom was an outside grill, next to the half-opened window, and containing smoldering brickets.  The police volunteered that the window had been opened on arrival.  It was then obvious how and why he had died.  The furnace was nonfunctional, the night was cold, and in an attempt to heat the apartment he had turned on the oven, and later lit the grill in the bedroom.

The poorly ventilated room had been incapable of supplying enough oxygen to keep the two open flames burning and the old man had died of carbon monoxide intoxication.  This accounted for his rosy red cheeks and dependent rigor, without true cyanosis.

And so one could say that winter kills in many ways.

At any rate, Louie, remember that Spring and light will come again.

Until then stay warm and Keep the Faith.

Jim