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West Virginia has a way of being cold. I know, it isn't Maine or Minnesota. It isn't Alaska or Sweden. But right now, the roads are thick with ice and snow, the wind cuts, and the temperature is about 9 degrees Fahrenheit.

I left work yesterday evening with fresh snow piled on my car. It continued all through the dark Appalachian night. The following morning, I brushed more thick snow from my windshield. I drove to work slowly on slick roads, crunching over large blocks of recently plowed snow and ice. I stopped at my favorite convenience store, where those who had to work were already up, getting a doughnut and a cup of hot coffee. Highway workers in uniforms had been up all night or were sallying forth to battle the elements in the daylight, in vast trucks, with white, blue, and gold emblems. Paramedics, bleary eyed, were filling their ambulance with gas and their bodies with warmth.

It snowed again today, most of the day. Hospital maintenance workers shoveled, and put down chemicals to melt the ice as staff arrived in thick coats, shaking white powder from their hair, stomping it from thick boots. I looked out of the ambulance bay doors to see the fine snow blowing sideways at times. It's the kind that accumulates, driving, steady, unrelenting. It blows against a beautiful gray backdrop of winter skies, heavy with threat.

I have always been in love with inclement weather, ever since my grandparents and parents taught me to embrace thunder and lightning, to tramp about in rain and mud, walking in the small muddy creek in the rain. In particular, I have always loved snow. I remember as boy that I would take off into the snowy woods on a hillside looking down over our house. All alone, sans phone, I would find a snow-drift, dig a cave, and scoot back into it. Sitting there, cozy, I would listen to the wind blow over my small white snow-house and watch as dry, dead broom-straw shook off the flakes and bent with the gusts. The sound of snow-heavy wind in the high bare trees is as precious to me as any symphony I have ever loved. It is a choral work, sung by trees sleeping the transient death of winter, dreaming of leaves and life.

Today, sick patients also came in, thick like snow. Like a snow drift in our halls, patients lined up awaiting beds. Many arrived in ambulances, too afraid to drive, too old to try, too sick, too poor, some doubtless with no cars at all, nor friends or family to dare bring them. Some were probably worried that the weather would get worse and they could not come at all. Sometimes the homeless will come to us in the ED when the weather is too frigid and there are no warming centers and precious few shelters that will take them. Others live in structures that can barely be called houses, with no electricity, where the wind, rain or snow always find a way inside. They are all but homeless. Sometimes we are the only option.

When I see our patients, wrapped in coats or shawls, sick and chilled, I realized how much of my love of winter is predicated on the fact that I can enjoy it. My parents did not struggle to heat our home, or to provide me with a hat, coat, gloves, or boots. There was always warm food, and hot chocolate with toast.

Even now, I know that my adult children are safe and warm. My wife and I have a warm bed to share. We can pay the bills. We do not shiver or struggle when the weather turns to killing.

Because ultimately, that's what winter does. For all its beauty, it can kill. It does kill. Thousands and thousands of people die in the U.S., Canada, Europe, indeed all over the world, due to cold temperatures. People do die from heat exposure, but die from the cold to this day. I have seen hypothermia, I have managed it in cold patients, warming them with blankets, pouring warm fluid into cold veins, into their bladders, pumping warm air into chilled lungs. It is not romantic. It is just cold.

Of course, they die not only because of exposure to the cold but also from its other effects. Some die because they have grave illnesses or injuries and ambulances can't reach them, or helicopters can't take them from the scene of an accident due to ice or poor visibility. Some die because they can't be transferred from one hospital to another. People die because they fall down and have fatal head injuries. Some fall through ice into deadly waters.

Those who work on the highways, or who cut fallen trees, or who work for fire departments, EMS, or police departments may die responding in icy weather. Men and women who work on power lines may die because their work is inherently dangerous but ever more important when weather turns cold and lines are frozen and snapped, or poles struck by vehicles skating on glassy highways. Physicians, nurses, teachers, tradesmen, truck drivers, and anyone who must go out into the elements may die on the highways.

Our ancestors knew the fear of winter. They had seen people freeze to death. They also knew that food would run out, as they had no Costco or Walmart, no Chick-fil-A or Taco Bell. They had what they grew, bought, traded for, and saved. They had prayer. They had community and clan. And often enough they had hunger. Winter was deprivation and death.

In our modern nostalgia for the cold, for white winters, for cozy fires, its simply too easy to be historically "snow-blind." While I'm no expert on climate or climate change, and make no comment here on the topic, I am something of an expert in humans and their afflictions.

And as I drive the slick roads, and watch the cold and sick struggle to get what they need in the harsh weather, as I watch the slantindicular storm whilst safely ensconced in warmth, I have to remind myself that for all its glory, winter is a bitter blow to many humans around the world. When we wish for more of it, in some ways we are wishing for the thing that kills all too many humans, and especially the weak, the diseased, the injured, and the poor.

I looked out into the snow-covered lawn this morning and saw a neat little set of cat prints across the yard. Up the sidewalk, as I drove away, a cat retraced her steps, paws cold and wet. Maybe she has kittens, maybe she's just trying to survive. I hope that she has a warm, dry place to curl up and sleep. I hope she sees spring in all its glory, and can lie blissful and well-fed in the warm sun.

I may love winter, but I would be remiss if I didn't wish all my patients could weather the cold the same way.

You can read more of Leap's writing on his Substack column, Life and Limb, where a version of originally appeared.

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