The U.S. National Weather Service issues extreme heat warnings at 105 degrees F. The desert city of Phoenix, AZ, in the Southwest USA, regularly exceeds temperatures of 105 degrees between May and September. Yet, there is no word beyond '' extreme '' to describe these temperatures. Many residents of Metro Phoenix (including 24 municipalities and 5 + million people) have adapted to extreme heat by managing indoor temperatures using air conditioning, including low-cost and energy-efficient water-based evaporative ('' swamp '') coolers. The City of Phoenix implemented its first Heat Response Plan in 2022. However, record-breaking heat in 2023 disrupted long-standing heat and water management adaptations, and exacerbated existing heat vulnerabilities and water insecurities with disproportionate negative impacts on the growing population of people experiencing houselessness in Metro Phoenix. Beginning in late June, Phoenix experienced a record 31 consecutive days of temperatures over 110 degrees. The average high in July was 114.7 degrees and the average low was 90.8 degrees. We build upon and update the findings of our earlier study of the experiences of unsheltered individuals and communities in Phoenix between 2013 and 2016 (Palta et al., 2016).