Jaime Santana’s family has stitched together some of what happened that Saturday afternoon in April 2016, through his injuries, burnt clothing and, most of all, his shredded broad-brimmed straw hat. “It looks like somebody threw a cannonball through it,” says Sydney Vail, a trauma surgeon in Phoenix who helped care for Jaime after he arrived by ambulance, his heart having been shocked several times along the way as paramedics struggled to stabilize its rhythm.

Jaime had been horse-riding with his brother-in-law Alejandro Torres and two others in the mountains behind his brother-in-law’s home outside Phoenix. Dark clouds had formed, heading in their direction, so the group had started back.

The riders had witnessed quite a bit of lightning as they neared Alejandro’s house. But scarcely a drop of rain had fallen when suddenly it happened.

Alejandro doesn’t think he was knocked out for long. When he regained consciousness, he was lying face down on the ground, sore all over. His horse was gone.

The two other riders appeared shaken but unharmed. Alejandro went looking for Jaime, who he found on the other side of his fallen horse, now dead. He reached Jaime: “I see smoke coming up — that’s when I got scared.” Flames were coming off Jaime’s chest. Three times Alejandro beat out the flames with his hands. Three times they reignited.

It wasn’t until later, after a neighbor had come running from a distant property to help and the paramedics had arrived, that they began to realize what had happened — Jaime had been struck by lightning.

Justin Gauger wishes his memory of when he was struck — while fishing for trout at a lake near Flagstaff, Ariz. — wasn’t so vivid.

If it weren’t, he wonders, perhaps the anxiety and lingering effects of post-traumatic stress disorder wouldn’t have trailed him for so long. Even now, some three years later, when a storm moves in, he’s most comfortable sitting in his bathroom closet, monitoring its progress with an app on his phone.

An avid fisherman, Justin had initially been elated when the rain started that August afternoon. Fish are more likely to bite when it’s raining, he told his wife, Rachel.

But as the rain picked up, becoming stronger and then turning into hail, his wife and daughter headed for the truck, followed later by his son. The pellets grew larger, approaching golf-ball size, and really started to hurt as they pounded Justin’s head and body.

Giving up, he grabbed a nearby folding canvas chair — the charring on one corner is still visible today — and turned to head for the truck. Rachel was filming the storm from the front seat, planning to catch her husband streaking back as the hail intensified. She pulls up the video on her phone.

Initially all that’s visible on the screen is white, a blur of hail hitting the windshield. Then a flash flickers across the screen, the only one that Rachel saw that day, the one that she believes felled her husband.

A crashing boom. A jolting, excruciating pain. “My whole body was just stopped — I couldn’t move any more,” Justin recalls. “The pain was . . . I can’t explain the pain except to say if you’ve ever put your finger in a light socket as a kid, multiply that feeling by a gazillion throughout your entire body.

“And I saw a white light surrounding my body — it was like I was in a bubble. Everything was slow motion. I felt like I was in a bubble forever.”

A couple huddling under a nearby tree ran to Justin’s assistance. They later told him that he was still clutching the chair. His body was smoking.

When Justin came to, he was looking up at people staring down, his ears ringing. Then he realized that he was paralyzed from the waist down. “Once I figured out that I couldn’t move my legs, I started freaking out.”

Describing that day, Justin draws one hand across his back, tracing the path of his burns, which at one point covered roughly a third of his body. They began near his right shoulder and extended diagonally across his torso, he says, and then continued along the outside of each leg.

He holds up his hiking boots, tipping them to show several burn marks on the interior. Those dark roundish spots line up with the singed areas on the socks he was wearing and with the coin-sized burns he had on both feet, which were deep enough that he could put the tip of his finger inside. Justin’s best guess is that the lightning hit his upper body and then exited through his feet.

Although survivors frequently talk about entry and exit wounds, it’s difficult to figure out in retrospect precisely what path the lightning took, says Mary Ann Cooper, a retired Chicago emergency physician and lightning researcher. The visible evidence of lightning’s wrath is more reflective, Cooper says, of the type of clothing a survivor had on, the coins they were carrying in their pockets and the jewelry they were wearing as the lightning flashed over them.

Lightning is responsible for more than 4,000 deaths worldwide annually — according to those documented in reports from 26 countries. (The true scope of lightning’s casualties in the more impoverished and lightning-prone areas of the world, such as central Africa, is still being calculated.)

Of every 10 people hit by lightning, nine will survive to tell the tale. But they could suffer a variety of short- and long-term effects. The list is lengthy and daunting: cardiac arrest, confusion, seizures, dizziness, muscle aches, deafness, headaches, memory deficits, distractibility, personality changes and chronic pain, among others.

Of every 10 people hit by lightning, nine will survive to tell the tale. But they could suffer a variety of short- and long-term effects.

The changes in personality and mood that survivors experience, sometimes with severe bouts of depression as well, can strain families and marriages. Cooper likes to use the analogy that lightning rewires the brain in much the same way that an electrical shock can scramble a computer — the exterior appears unharmed, but the software within that controls its functioning is damaged.

Despite a deep vein of sympathy for survivors, some symptoms still strain Cooper’s credulity. Some people maintain that they can detect a storm brewing long before it appears on the horizon. That’s possible, Cooper says, given their heightened sensitivity to stormy signs in the wake of their trauma. She’s less open to other reports — those who say that their computer freezes when they enter a room, or that the batteries in their garage door opener or other devices drain more quickly.

Yet, even after decades of research, Cooper and other lightning experts readily admit that there are many unresolved questions. Some survivors report feeling like medical nomads, as they struggle to find a doctor with even a passing familiarity with lightning-related injuries. Justin, who could move his legs within five hours of being struck, finally sought out help and related testing last year at the Mayo Clinic for his cognitive frustrations.

Along with coping with post-traumatic stress disorder, Justin chafes at living with a brain that doesn’t function as fluidly as it once did. He doesn’t see how he could possibly return to the type of work he used to shoulder, leading a small team that presented legal cases and defended against property value disputes. Sounding quite articulate, he tries to convey the struggles lurking just beneath. “My words in my head are jumbled. When I think about what I’m trying to say, it’s all jumbled up. So when it comes out, it may not sound all right.”

When someone is hit by lightning, it happens so fast that only a very tiny amount of electricity ricochets through the body. The vast majority travels around the outside in a “flashover” effect, Cooper explains.

By way of comparison, coming into contact with high-voltage electricity, such as a downed wire, has the potential to cause more internal injuries, since the exposure can be more prolonged. A “long” exposure might be just a few seconds. But that’s sufficient time for the electricity to penetrate the skin’s surface, risking internal injuries, even to the point of cooking muscle and tissue to the extent that a hand or limb might need to be amputated.

So what causes external burns? Cooper explains that, as lightning flashes over the body, it might come into contact with sweat or raindrops on the skin’s surface. Liquid water increases in volume when it’s turned into steam, so even a small amount can create a “vapor explosion.” “It literally explodes the clothes off,” says Cooper.

As for clothing, steam will interact with it differently depending upon what it’s made of. A leather jacket can trap the steam inside, burning the survivor’s skin. Polyester can melt with just a few pieces left behind, primarily the stitching that once held together the seams of a shirt or a jacket that’s no longer there, says Cooper.

More is understood about lightning’s ability to scramble the electrical impulses of the heart, thanks to experiments with Australian sheep. Lightning’s massive electrical current can temporarily stun the heart, says Chris Andrews, a physician and lightning researcher at the University of Queensland in Australia. Thankfully, though, the heart possesses a natural pacemaker. Frequently, it can reset itself.

The problem is that lightning can also knock out the region of the brain that controls breathing. This doesn’t have a built-in reset, meaning a person’s oxygen supply can become dangerously depleted. The risk then is that the heart will succumb to a second and potentially deadly arrest, Andrews says. “If someone has lived to say, ‘Yes, I was stunned [by lightning],’ it’s probable that their respiration wasn’t completely wiped out and re-established in time to keep the heart going.”

Lightning begins 15,000 to 25,000 feet above the earth’s surface. Once lightning is 150 feet or so from the ground, it searches pendulum-style in a nearby radius for “the most convenient thing to hit the fastest,” says Ron Holle, a US meteorologist and longtime lightning researcher.

Prime candidates include isolated and pointed objects: trees, utility poles, buildings and occasionally people. In the US alone, annual fatalities from lightning strikes have fallen from more than 450 in the early 1990s to fewer than 50 in recent years.

The popular perception is that the chance of being struck by lightning is one in a million. There’s some truth here, based on US data, if one only looks at deaths and injuries in a single year. But according to Holle, if someone lives until 80, their lifetime vulnerability increases to 1 in 13,000. Then consider that every victim knows at least 10 people well, such as the friends and family of Jaime and Justin. Thus, any individual’s lifetime probability of being personally affected by a lightning strike is even higher, a 1 in 1,300 chance.

Any individual’s lifetime probability of being personally affected by a lightning strike is even higher, a 1 in 1,300 chance.

Holle doesn’t even like the word “struck,” saying it implies that lightning strikes hit the body directly. In fact, direct strikes are surprisingly rare. Justin believes that he experienced what’s called a side flash or side splash, in which the lightning “splashes” from something that has been struck — such as a tree or telephone pole — hopscotching to a nearby object or person. Considered the second most common lightning hazard, side splashes inflict 20 to 30 percent of injuries and fatalities.

As a general rule, in high-income regions of the world men are more likely than women to be injured or killed by lightning; at least two-thirds of the time they’re the victims. One reason is the propensity for “men taking chances,” Holle quips, as well as work-related exposure. They are more likely to be on the younger side, in their 20s or 30s, and doing something outside, frequently on the water or nearby.

When Jaime arrived at the Phoenix trauma center, he had an abnormal heart rhythm, bleeding in the brain, bruising to the lungs and damage to other organs, including his liver, according to Vail, his trauma surgeon. Second- and third-degree burns covered nearly one-fifth of his body. Doctors put him into a medically induced coma for nearly two weeks to allow his body to recover, a ventilator helping him breathe.

Jaime finally returned home after five months of treatment and rehabilitation, which continues today. “The hardest part for me is that I can’t walk,” he says. The doctors have described some of Jaime’s nerves as still “dormant,” says his sister, Sara, something that they hope time and rehabilitation will mend.

“We’re living through something that we never thought in a million years would happen,” says Lucia, Jaime’s mother. They’ve stopped asking why lightning caught him in its crosshairs that April afternoon. “We’re never going to be able to answer why,” Sara says.

Excerpted from an article that was first published by the Wellcome Trust in MosaicScience.com.

Republished under a Creative Commons license.

How to avoid a lighting strike

Avoid mountain peaks, tall trees or any body of water. Look for a ravine or a depression. Spread out your group, with at least 20 feet between each person, to reduce the risk of multiple injuries. Don’t lie down, which boosts your exposure to ground current. There’s even a recommended lightning position: crouched down, keeping the feet close together. Still, “there are cases where every one of these [strategies] has led to death,” said meteorologist Ron Holle. For simplicity’s sake, everyone from schoolchildren to their grandparents these days is advised: “When thunder roars, go indoors.”