Sagepaper

Slowly but surely, I am paying a price for developing so many of my friendships with people a good bit older than myself. I have to bury them. I just heard that my friend, "Johnny Ray" Ahr, has died of a heart attack at the age of 56. He and I were friends since I was 16. The last loss of this magnitude was eight years ago. Alma Ratliff Sellers (after being widowed, she remarried) died of lung cancer at the age of 62. I first met her when I was 12.

Of course, it is not a forgone conclusion that I will bury all of them. For the second time this year, I am battling a multi-drug-resistant super-infection. This time, the IV antibiotics are more convenient. I go to the hospital once a day. Before, I had home health care and three infusions per day. Both times I have been fortunate in not feeling particularly ill, having only occasional chills or slight nausea. I expect I'll live through this one, too, but it does demonstrate that we are born mortal. We can never take one another for granted. Even a car wreck can upset the expected order of death.

Watch your "last words." Try to talk to your loved ones as if you will never speak again. That keeps you more open and honest throughout your life. Then, one day, your last conversation will, indeed, have been your last. Trust me, it is a comfort to be satisfied with your final words.

In case he finally has Internet access, I'll offer Johnny Ray a few more words that I wish I had spoken: "When you are out of aces, just remember: "Deuces Are Wild."

A little birdy told me he really liked that song. Although we were practically telepathically close friends, I never would have guessed he felt that way. I first learned about thinking that similarly with someone from him. We often partnered in playing "Spades," and were nearly undefeated during a couple of years of daily play. There was no "table talking," but we each knew the other's way of thinking. It only took a faint nod when the other got to the correct thought to ensure the right card was played: every time.

He knew my mind a little better, though. That helped him save my naive a** a few times. He knew exactly what mistake I was about to make in a crisis, and firmly corrected me, or countered the consequences I was about to set in motion. He helped me survive living on the edge in a very dangerous little Appalachian town.

He was a natural philosopher, and helped in the shaping of my world view. He also taught me a lot about diplomacy and negotiations. He was a member of both "The Hatfield's" and "The McCoy's." Loving all of his family, he skillfully kept them away from each other's throats. Renowned for his wisdom, fairness, honesty, and integrity, people far and wide respected him as a peace-maker, and would often come to him with their squabbles.

Hating bloodshed, he quietly and tactfully defused many ugly situations in the local bars. He was not merely intelligent, well-mannered, soft-spoken and kind, though. Only slightly taller than me (I'm short), the stout, little, twice-decorated, Vietnam Vet could single-handedly leave a bar full of people on the floor, with more than one in need of an ambulance. He seldom had to do that, though, since it was well-known that he could.

In leadership, is it better to be loved, or to be feared? Johnny Ray proved that both were possible, and demonstrated that both were desirable and necessary complements in a violent environment. He taught me that you should work hard on developing an unshakeably good reputation, but that it must ultimately be backed by a really bad reputation.

To the dismay of my more cultivated family and friends, I have quite credibly developed and maintained both. Following in his footsteps as a peacemaker, I would not happily forfeit either reputation. It is a sad and bitter occasion when I must refresh my bad one, but I can no more afford to let it slide than I can my good reputation. Oddly, the two can coherently coexist within the same person.

I learned an interesting thing from our geriatrician: there is a powerful correlation between life-expectancy and air conditioning, both across and within nations. This is not simply an artifact of greater wealth (you can afford A/C, so you can afford better medical care). Air conditioning matters! The reasons are not entirely known, but there are other indicators that heat is not good for us.

In a different field, studies indicated that the brain functions optimally for learning at a fairly cool temperature. I am no longer certain of the exact temperature, but I believe it was 68 degrees. (Put your sweater on and learn something.) Notice that it is air temperature, not necessarily body temperature, which matters. Another example of air temperature, rather than body temperature, being significant is found in the care of respiratory patients, like me. We breathe much better at fairly cool temperatures. I do best at 66 degrees, and do well up to 69 degrees. I start getting sick above 75 degrees. I cannot tolerate indoor air above about 82 degrees. My outdoor tolerances depend on other factors, especially humidity. I can't help but think there are similar respiratory benefits correlated with temperature for the healthy, especially those living in areas with poor air quality.

We all know that people die during heat waves, with infants, the chronically ill, and the elderly being at greatest risk. Perhaps part of the increased life-expectancy associated with air conditioning is simply that people survive more annual heat waves, giving them more years to die of something else. The air conditioning correlation, however, is independent of latitude. It is good to have A/C, even if your ambient climate does not include a lot of intense heat days each year, or if the hottest days are cooler than elsewhere.

Besides, life-expectancy is often determined by life-long health practices. Heat injury is not coded as a very common cause of death, even among the elderly. A/C appears to offer some other, less obvious, benefits than keeping us alive during heat waves. Of course, it is possible that there is a lack of insight in coding individual deaths. Individuals may die of heat related injuries, which are coded as cardio-vascular, when others around them are not dropping like flies.

Heat damage can be cumulative over the course of many days. We need time to cool-off, not merely time to rehydrate. Becoming a little overheated while out in the yard can start a deadly downward spiral if there is not a good cooling-off afterward. If you cannot really dissipate the excess heat, even during the night-time hours, you begin the following day at a disadvantage.

Aside from the direct problem of heat, there is the issue of hydration. Although closely linked, overheating and dehydration are separate problems, and either can get you in the absence of the other. We all know that by the time you feel thirsty, you are already behind the curve. Unlike hunger, which should tell you when intake is needed for maintenance, thirst is akin to pain (though it doesn't feel like it). It tells you that something has already gone wrong.

Most people don't appreciate how long it can take to recover from dehydration. If you become short a half-gallon, you cannot chug a gallon, grin, and say, "problem solved." Before long, you will have passed most of the extra, 'catch-up' water. You might have made up for your deficit by only a half-cup. It can take days and days to restore your body, as you drink extra, and pass most of it.

So, with fairly high stakes, and thirst as an unreliable early warning system, how do you make sure you drink enough? There are all kinds of fixed-quantity recommendations and formulae out there, but they are one-size-fits-all. To ensure public safety, they tend to recommend the highest amount likely to be needed by an adult. These don't consider weight, physical condition, kidney function, activity level, etc.

Fortunately, you don't really need lab tests every few hours to monitor your hydration. Your urine should appear pale to clear in a normal toilet. If it is a light to medium yellow, nip it in the bud with some extra fluids. If you see medium to dark, take in fluids, and ease off fluid-loss activities until it looks a little better. If it is dark yellow to orange, you are getting in trouble. This should command as much of your attention as treating a cold. If you have special conditions, you might ask your doctor or pediatrician if there is a different standard you should use.

When you really need to rehydrate, you might need to replace some salts, too. This is dangerous territory, especially for infants, the elderly, and other vulnerable groups. You need the right balance of sodium and potassium, and other salts, in your body for your nervous system, including the brain, to work properly. You could make things better or worse by just using a salt shaker, or by just eating bananas.

Balanced oral rehydration formulas are best. Gatorade is close, but includes additional nutrients for a laboring athlete. There are not, to my knowledge, better researched or formulated sports drinks than the original Gatorade. Pedialyte, for all ages, is preferred by our geriatrician (also board certified in internal medicine). The problem is that no adult who still has taste buds can choke it down.

I made a discovery, though. Pedialyte's Popsicles are quite tolerable. The grape is even kind of good, though I don't usually like grape. Neither drinking unfrozen Popsicles, nor freezing regular Pedialyte, has worked as well for me.

Unrelated to rehydration, which should never include the diuretic alcohol, I will warn you that Vodka in Pedialyte won't make it palatable, either. I can't think of another liquor that might mix well with the stuff. I have no bartending skills, however (as evidenced by the fact that I tried Vodka in Pedialyte). I only know this because I had an excessive amount of it on hand and tried to find some way to drink it. I'll not embarass myself with tales of my other attempts.

So, turn on the A/C, whatever your age. Check on folks who don't get out much, or who live alone. If possible, swing by and visit in person so you can feel their air-temperature yourself. There are a lot of people who cannot afford adequate cooling in the summer, after shelling-out for heating in the winter. If this means you, your priorities are, contrary to ambient practice and wisdom, misplaced. You can always put on enough to keep warm, but you cannot always take off enough to keep cool. Use the A/C in the summer, and bundle-up in the winter.

Fortunately, our utility companies are beginning to be merciful in the summer, not just in the winter. Low income assistance is now available in many places, even in the northern states, for cooling bills as well as heating bills. The thinking has long been that everyone needs heat, but cool is a luxury. Even our ancestors built fires, but not until this century did we have air conditioning. That's true, but our ancestors did not enjoy a modern life-expectancy, either.