Super Typhoon Sinlaku got the coverage it deserved, the satellite loops, the wind speed updates, the landfall reports over the Northern Marianas. Every wobble in the eye wall drew a headline. No one was talking about what was happening inside people’s bodies. I have sat with patients days after a storm passed, experiencing blood pressure that will not budge and hands that will not stop shaking, and the sky has been clear for two weeks. That space between “all clear” on the forecast and what their bodies are still doing is where we lose a lot of people in medicine.

There are always two disasters in a big storm. The first one has cameras: roofs stripped, power lines down, trees bent sideways. The second one shows up later. Blood pressure that stays high. Panic at 2 a.m. A drink “to take the edge off” that quietly turns into a habit. A parent who cannot stop snapping at their kids because their nervous system is still running hot long after the wind dies down. That second disaster does not show up on radar, and most disaster plans do not really look for it.

The silent toll of a natural disaster

If you have ridden out a serious storm, you know what it does to your body before the first band even hits. The sleep that will not come. The chest that tightens at every gust. The part of your brain running evacuation drills at midnight while you lie still so your kids think you are asleep. Now stretch that out, experiencing three days without power, no reliable cell service, and no clear answer on whether the structure above you will hold, and ask: At what point does the body decide it is safe again?

For a lot of people, it does not. The vigilance just changes shape. The person who wakes at 3 a.m. and checks the radar out of habit, weeks after the storm. The elderly patient whose blood pressure jumped the night of landfall and never really came back down. The survivor who startles at a car backfiring in a parking lot two months later. We often drop all of this into a bucket called “mental health,” as if it lives somewhere separate from the rest of medicine. What I see in clinic looks more basic than that: cortisol and adrenaline running on a loop, the heart and vessels and gut and immune system still acting like the storm is overhead. Their bodies never got the message that the danger passed.

The missing piece in disaster planning

Hospitals check generators. Pharmacies plan for supply chain breaks. Dialysis centers, oxygen suppliers, insulin cold chains, all of it gets attention, and it should. People die if we miss those. But if you flip through most disaster plans, stress physiology is an afterthought. A behavioral health paragraph. A hotline number at the end. Meanwhile, we know that after major hurricanes and floods, anxiety, depression, post-traumatic stress disorder (PTSD), and substance use go up and stay up, especially for people who were already carrying a psychiatric diagnosis or past trauma before the storm.

If a Category 4 storm knocked out a hospital’s oxygen system, none of us would treat it as “soft damage.” When that same storm scrambles thousands of nervous systems at once, we tend to hand it off to “support services” and move on to the next structural repair. We do not need a new agency or a new wing of the hospital to start doing better. We can start in the visits we are already having.

Three ways clinics can prepare patients

• The first is to know who is most likely to be knocked off balance before the season starts. Patients with severe depression, PTSD, active substance use, or heavy reliance on sedatives and pain medications are not going to call you when a storm is heading their way. They need to hear from us, a week before landfall, not a month after. What do you have on hand? What happens if you cannot refill? Who is checking on you? That phone call takes 10 minutes. It is as real as any blood pressure adjustment.
• The second is to send those patients into the storm with something better than vague reassurance. A pre-storm mental health plan is just a discharge plan moved a little earlier. For a patient with depression and past suicidal thoughts, that might be a printed medication list, an extra refill if the pharmacy allows it, and a written safety plan that includes at least one person in their circle who has agreed to ask how they are actually doing, not just whether the roof leaks. For a patient with coronary disease and severe anxiety, it might be a clear blood pressure threshold and two or three breathing patterns they can use on a folding chair in a crowded shelter.
• The third is to pay attention to the data their own devices are already collecting. A patient whose resting heart rate is running 15 beats above their normal after two weeks of broken sleep is telling you something. A short weekly check-in, such as a call, a portal message, or even an automated “How are you doing from one to 10?,” is not fancy technology. But it turns a vague sense of “I’m fine” into a trackable signal, and it gives you a chance to intervene before the second disaster hardens into a new baseline.

Shifting focus in the exam room

Picture a patient you probably have on your own panel. Hypertension. Type 2 diabetes. Long-standing anxiety. Lives with family. Money is tight. A big storm is three days out. On a standard visit, I adjust medications, remind her about food and movement, ask briefly about mood, and move to the next chart. By current standards, that counts as good care.

In a clinic that takes the second disaster seriously, that same visit shifts a bit. I say out loud that the storm is going to stress her heart and her nervous system, and we should plan for both. I print an extra copy of her medication list. We practice a breathing exercise together, right there in the room, so it is in her body before the lights go out. I set a reminder for a quick phone check two days after landfall. I make sure her daughter knows not only when to call 911, but also when to call us, not just for chest pain, but for a mom who has not come out of her room all day.

No new clinic. No grant. Just using the visit we already have and looking one step past the eye wall. Next year, Sinlaku’s trail will show up in blood pressure logs, cardiology notes, emergency department (ED) visits, and substance use records that most people will not connect back to a storm. We cannot keep the wind from coming. But we can stop acting like the damage it does to the nervous system is someone else’s job.

Shiv K. Goel is a board-certified internal medicine and functional medicine physician based in San Antonio, Texas, focused on integrative and root-cause approaches to health and longevity. He is the founder of Prime Vitality, a holistic wellness clinic, and TimeVitality.ai, an AI-driven platform for advanced health analysis. His clinical and educational work is also shared at drshivgoel.com.

Dr. Goel completed his internal medicine residency at Mount Sinai School of Medicine in New York and previously served as an assistant professor at Texas Tech University Health Science Center and as medical director at Methodist Specialty and Transplant Hospital and Metropolitan Methodist Hospital in San Antonio. He has served as a principal investigator at Mount Sinai Queens Hospital Medical Center and at V.M.M.C. and Safdarjung Hospital in New Delhi, with publications in the Canadian Journal of Cardiology and presentations at the American Thoracic Society International Conference.

He regularly publishes thought leadership on LinkedIn, Medium, and Substack, and hosts the Vitality Matrix with Dr. Goel channel on YouTube. He is currently writing Healing the Split Reconnecting Body Mind and Spirit in Modern Medicine.