Robert Falcon Scott is dying, slowly succumbing to hypothermia in a tent pitched on the wastelands of the Ross Ice Shelf, full of the weary knowledge that he was not the first explorer to reach the South Pole—only the first to have lost an entire expeditionary party doing so. It is 1912. Antarctica is as inaccessible as it is fraught with risk; and that, of course, is its attraction, leading men to pit themselves and their lives against its challenges.
Having been beaten to the pole by Roald Amundsen’s Norwegian expedition, Scott is now embarking on a race of a different kind: the scramble to write his letters to the next of kin of his expedition team, telling of their brilliance and honor and taking responsibility for having led them to their deaths. Time is against him.
Scott’s life is a property distributed across the many trillions of cells that comprise his body. Like all human beings, he exists in a state of tension. By that I mean simply that nature seeks equipoise: It would like, as far as possible, for all things to be as equal as they can be.
The default state for an atom or molecule is electrical neutrality. Here the number of positively charged protons, in their composite nuclei, and negatively charged electrons, in orbit around them, is equal. But with a little effort, atoms and molecules can be made to lose or gain one or more electrons, and in so doing lose their neutrality. This is achieved by imparting a little energy—through chemical reaction, radiation, or electrical discharge. Energy transforms molecules and atoms into ions. It changes their nature. They become more dynamic, capable of being influenced by and generating electrical or magnetic fields. In the body, ions can flow across porous barriers—of the type that comprise the walls of our cells—because a negative charge seeks to neutralize a positive charge.
The machinery of our cells is designed to separate charged ions across cell membranes. That process of separation, of creating inequality, leaves a system out of step with the simple arrangement that physics would prefer. It creates the potential for something far more dynamic: a person.
Imagine a budget airline operating a plane that is only half full. Say that it’s a long-haul flight and that the airline chooses to expend a little energy in getting its cabin crew to cram all of those passengers like sardines into the front half of the plane, leaving the rear of the aircraft entirely empty. (This, I think you’ll agree, is a situation with the potential for the release of a lot of pent-up energy.) Now imagine that the chief executive of the airline decides people can sit where they like, just so long as they pay him another $10 for the privilege. The passengers shout and swear a bit, but eventually most of them decide that being crammed into the front of the plane is worse than paying the money and being able to spread themselves out evenly in all those lovely empty seats. The result is a plane whose passengers are distributed more evenly and an unscrupulous airline executive with some extra cash in his pocket.
What the airline does with the passengers and cash is what the body does with ions and energy. By expending energy in creating artificial inequality—in the case of the body, by pumping ions to where they don’t want to be—and then harvesting and storing energy as the system attempts to return to equilibrium, you can save energy for later use. This energy can be stored in the form of chemical intermediates within cells and used to drive growth, repair, replacement, and reproduction.
We see this all around us in nature. In weather systems, for example, winds blow from areas of high pressure to those of lower pressure. The winds are a manifestation of inequalities in pressure and the system’s natural tendency to smooth those differences out. In the same way that this difference allows turbines to harvest energy from wind, the body can exploit the flow of ions across cell membranes.
The flow of ions, along with the beautifully elegant machinery that exploits it, makes complex life possible. It keeps the whole that is greater than the sum of its parts—the whole that is ultimately Scott—going.
It has taken me most of my medical career to finally appreciate the tiny processes that enable biological systems to store and release energy. These biochemical events individually appear to bear little relation to the wonder of life, when in fact collectively they are life; they are everything we do, everything we are.
The privilege of the human body’s complexity is bought at a price: It must expend energy pumping ions where they don’t want to be in order to keep the body going. When that price is no longer affordable, simplicity reigns once again. And here simplicity is synonymous with death.
—
THE ENVIRONMENT OUTSIDE the tent abhors Scott’s complexity. There is more at work here than temperatures that can freeze exposed flesh in seconds. First, there is Antarctica’s aridity. The continent’s great sheets of ice hold water locked away, and less than a single inch of rain falls there each year. So the Ross Ice Shelf is considered a desert, and it will attempt to dehydrate and desiccate Scott’s body. With much of the continent thrust two miles above sea level, Scott is high enough to make heavy exertion uncomfortable, even for the acclimatized. That’s not to mention the scouring Antarctic winds, which will carry heat away from his body, driving his temperature down. All told, Antarctica is a continent of fierce extremes: the coldest, the highest, the most parched. Its climate has made it uninhabitable for all but the last hundred years of human history.
Bleak though Antarctica may be, it’s important to consider how Scott’s body reacts to his plummeting temperature, because that process is the key to an extraordinary advance in future medical technology.
As Scott’s core temperature drops, the pumps that move ions across his cell membranes are grinding slowly but surely to a halt. The process is inexorable. In the absence of energy, borrowed from the fuel of food and burned in the fire of the oxygen that we breathe, the pumps wind down and eventually stop. The ions begin to assume equal concentrations on either side of the cell membranes. This simple symmetry is how death begins.
Scott isn’t yet ready to die. His physiology, ignorant of his predicament, is designed to battle for him, to buy him every moment that it can, to give him his best chance of survival. As Scott writes, he feels the heat draining out of his hand. The blood vessels that run in his body’s periphery, carrying hot blood to his skin’s surface and losing that heat uselessly to the outside world, are constricting. His body hair stands on end in an effort to trap more air close to his skin. Both of these measures are an effort to reduce conductive heat losses. In the context of the Antarctic environment, however, this physiological strategy is next to useless.
Next, Scott will begin to shiver uncontrollably, generating enough heat to slow the drop in his temperature. This shivering is more than the casual tremor we might experience at a bus stop in midwinter; Scott’s muscles will shake themselves as hard as they can, consuming fat and carbohydrates ravenously. This type of shivering, a last desperate attempt at staving off death, becomes an act of physical endurance in itself. It can account for fully 40 percent of the body’s maximum exercise capacity and it will continue while there is fuel enough to do so. But shivering, no matter how athletically, is merely a holding measure, the body’s method of buying time in the hope that something in its external environment will change for the better, not a solution in its own right.
As it proceeds, the deep hypothermia will go on to alter Scott’s mind, making him irritable and possibly irrational. When his body’s reserves of fuel run out, the shivering will stop—a respite that will only accelerate the rate at which he cools. Like a marathon runner hitting the wall, Scott is at the end of all of his reserves. There is nothing left to draw upon. Mercifully, something that looks like sleep will follow as the electrical activity in his brain begins to fail. He will slip into a coma well before the channels in the cell membranes of his heart muscle, the gatekeepers of electrical stability in that organ, are compromised. Frenzied anarchic rhythms may follow, the heart writhing uselessly like a bag of worms before finally coming to a standstill.
With his heart no longer beating, his body will be starved of its fresh supply of oxygen. But at such low temperatures, the rate at which Scott’s cells fail and die will be dragged out in time. Death results from the failure of the chemical processes that drive our cellular machinery. In the deep cold those processes, too, become sluggish. The normal window of a few hundred seconds when his brain is dying yet his circulation might still be reestablished will instead stretch to many minutes. This window, elongated by cold temperatures, will become crucial to medical practitioners in the years ahead.
But for Scott there is no rescue. The seconds become minutes, the minutes hours. Scott, once a blazing furnace of life on the subzero wasteland of Antarctica, is finally no more energetic than the ice and snow that surround him.
—
LIKE ALL LIVING BEINGS, we fight against the laws that govern inanimate objects in an effort to avoid equilibrium with the physical world. Through the act of living, we maintain a level of complexity otherwise unknown in the universe: the ability to grow, to adapt, to reproduce, and as humans, the capacity for sentience and self-awareness. As fascinating and enigmatic as neutron stars and supernovas might seem, your brain is more complicated and more impenetrable to science than either. What makes us different, what sets us apart from the inanimate matter about us, is our ability to defy entropy, to avoid the thermodynamic reorganization, that would see us reduced to a simpler, lifeless state. As the decades pass, we—the human race—become better at it and expand the envelope in which life is possible.
For all its personal tragedy, Scott’s death also contains some hints about the directions in which the envelope expanded in the century that followed his doomed expedition. Trying to conquer Antarctica forced us to confront the world’s most extreme physical conditions and understand the havoc that they wreak upon the human body. Deepening that understanding of the body allowed us to continue our explorations there. Our frail physiology, left unprotected in these hostile environments, stood little chance.
The challenge of exploration became less about the spirit and determination of our plodding expeditionary teams and more about the challenge of how—through science and technology—we might protect them against challenges that had been fatal throughout all of human history. As the decades passed and our knowledge grew, we were able to overcome hypothermia. The answer lay in understanding our narrow limits and what our body might tolerate. With better clothing, habitats, and systems of transport, we could go further.
But today that understanding allows us to do far more than persist in these environments: Hypothermia has become an asset to medicine, a tool for cheating death.
—
NEARLY A CENTURY after Scott’s expedition, a twenty-nine-year-old woman skiing in the mountains of Norway suffered an accident and went through the same sequence of physiological events. She was as lifeless as Scott, hundreds of miles from help, trapped by ice, her heart at a standstill as seconds became minutes and minutes became hours. But she survived.
In May 1999, three junior doctors, Anna Bågenholm, Torvind Næsheim, and Marie Falkenberg, were out skiing off-trail in the Kjølen Mountains of northern Norway, near the town of Narvik. It was a beautiful evening, one of the first days of eternal sunshine at the start of the Arctic summer, and the skiing had been good. They found themselves descending into a shaded gully called the Morkhala, a place they knew well, which had a good covering of snow even late in the season. All three were expert skiers and Anna began her run confidently.
But during the descent, Anna unexpectedly lost control. Torvind and Marie watched from afar as she tumbled headlong onto a thick layer of ice covering a mountain stream. Anna slid across it on her back and then fell through a hole into the water. Her head and chest became trapped beneath the frozen surface. Her clothes began to soak, their extra weight carrying her deeper, dragging her downstream with the current and farther beneath the ice.
Torvind and Marie arrived at the spot just in time to grab her ski boots, stopping her from vanishing under the lip of the ice. Anna was lying face up with her mouth and nose out of the water in an air pocket. She continued to struggle, freezing, in the Arctic stream.
None of the three could have been in any doubt about the seriousness of the situation. Anna was trapped, her clothes soaked with ice-cold water, the stream carrying heat away from her body. Even in those first minutes, her core temperature was beginning to plunge. Torvind called for help on his mobile phone, explaining the life-and-death predicament to the dispatcher. As doctors, Torvind, Anna, and Marie had many friends and colleagues in the rescue services—the dispatcher among them. Firm in the faith that they would make every effort to expedite an emergency rescue helicopter or a mountain rescue team, Torvind returned to help keep Anna from slipping under the ice.
But after what seemed to Torvind like an interminable age of waiting, he rang the dispatcher again, this time demanding to know why nobody had yet arrived. “Yes, Torvind,” came the reply, “we are trying as hard as we can, but you must understand it takes more than three minutes to make these things happen.” To Torvind, fighting for Anna’s life, three minutes had seemed like eternity enough.
Two rescue teams were sent; one from the top of the mountain, on skis, and another from the town of Narvik at its base. The ski team, led by Ketil Singstad, was the first to arrive, but they were lightly equipped, and their snow shovel wasn’t enough to break through the thick covering of ice. All they could do was lash a rope around Anna’s feet to help Marie and Torvind stop her from slipping farther beneath the ice.
A Sea King helicopter had also been scrambled, but even traveling at over a hundred miles an hour, it would take more than sixty minutes to reach them and would take at least as long again to fly back to the nearest major hospital in Tromsø.
Forty minutes after becoming trapped, Anna’s desperate thrashing stopped and her body went limp. The hypothermia, now profound enough to anesthetize her brain, would soon stop her heart.
Another forty minutes passed before rescuers from the bottom of the mountain arrived, carrying with them a more substantial shovel with a pointed tip that was finally able to break through the covering of ice.
Singstad, leading the mountain rescue team, was already deeply pessimistic, believing that their efforts now could only succeed in retrieving the body of a dead friend. Eighty minutes had passed since Anna had first fallen into the water, and her body was pulled clear of the stream limp and blue. She had stopped breathing and was without a pulse.
We call what follows downtime—the period from the moment of cardiac arrest until the point at which spontaneous circulation and breathing can be restored. In that interval, the process of dying begins.
Before that comes the crash. If your physiology has crashed, the processes that keep you alive have stopped working. When confronted with a patient in cardiac arrest, you, as a doctor, are staring at the wreckage of an individual, hoping desperately that something can be salvaged from the chaos. Frankly, it’s a terrifying feeling.
In any emergency room, anyone suffering cardiac arrest who arrives with more than a few minutes of downtime almost invariably dies or is permanently disabled. My time as a newly qualified doctor is peppered with memories of pounding down hospital corridors in the middle of the night answering the crash call: that terrifying screech from your pager accompanied by a burst of static and a voice telling you where you instantly needed to be. The experience was always grim. Of the many thousands of people who suffer cardiac arrest each year, only a handful survive to leave the hospital. The odds always appeared so stacked against us and the outcomes so poor that over time I became deeply pessimistic about crash calls. I remember a registrar, seeing my distress at the end of yet another failed resuscitation, putting a comforting arm around me. “It’s not really resuscitation, you know,” he said. “It’s just a funny dance we do around the dying.”
So as the resuscitation effort began on Anna’s body in the shadow of those Norwegian mountains, the challenge she faced looked insurmountable. She had already been without a pulse for far longer than any of the patients I’d ever rushed to attend on hospital wards. Her core temperature was now perhaps more than 20°C. (36°F.) lower than it should have been.
Torvind insisted that they continue their resuscitation attempts. Just before eight P.M., more than an hour and a half after first falling into the stream, Anna was winched onto the Sea King. Aboard the helicopter, moving at speed across the Norwegian landscape, the struggle to save Anna’s life became a desperate scramble. The art of resuscitation, if you can call it that, is difficult even under ideal circumstances. Helicopters, with their cramped conditions, deafening noise, and vibration, are among the most difficult places in which to try to work.
Once, when transferring an unstable, critically ill patient by air, I asked the pilot what the aircraft protocols were if the patient needed resuscitating midflight. “Just mind the doors,” he said. “It’s usually bad if you fall out.”
The key to good resuscitation is to keep the blood supplied with oxygen and moving around the body. This is achieved by breathing for the patients, ventilating them artificially—literally pumping oxygen into their lungs—and then compressing the chest rhythmically to provide something approximating a circulation. None of this is anything like as efficient or effective as the body’s native heartbeat and breathing, but it buys time. In principle, it sounds pretty straightforward; in practice, there is perhaps nothing that adequately describes the sickening, repetitive crunch of ribs beneath the heel of your hand or the rising sense of desperation you feel as the minutes tick by.
—
WHEN THEY TOUCHED DOWN at Tromsø University Hospital, Anna’s heart had not beaten for at least two hours. Her core temperature was measured at 13.7°C. (56.7°F.)—23°C. (42°F.) below normal, and lower at that point than any surviving patient in recorded medical history. This was genuine terra incognita. Any further attempt to resuscitate Anna could proceed only in the knowledge that in similar situations past medical teams had always failed.
It is often hard to know how to act in the best interests of your patients, even when they can talk to you and tell you what they want. In the midst of resuscitation, faced with an unconscious, dying patient, you have to try to imagine what the person in front of you would say if she could. It is a horribly difficult call to make. Your instinct as a human being is to carry on for as long as there’s a chance of survival, however slim. But your thoughts as a medical professional are different; there are harsh realities to face. Under ordinary circumstances, the prognosis is horribly bleak. Even patients whose hearts are successfully resuscitated can have permanent and disabling damage to their brains because of oxygen starvation.
But the team at Tromsø decided to continue. Despite the amount of time that had passed since Anna’s heart had stopped, there was still the glimmer of a hope that the terrible cold might also have protected and preserved her brain.
Mads Gilbert, the anesthetist leading the resuscitation effort, moved Anna directly to the operating room. He knew that raising her temperature at this point was going to be a massive challenge. Warm blankets and heated rooms alone wouldn’t be anything like enough. Raising the whole body through all those missing degrees would take an enormous amount of energy—equivalent to the boiling of dozens of kettles of water. To do this quickly and without harming Anna in the process, Mads knew she would have to be established on a heart-lung bypass machine, the sort of device normally reserved for open-heart surgery. By removing her chilled blood, circulating it in the bypass machine, heating and then returning it to Anna’s lifeless body, they could raise her core temperature rapidly. At least that was the theory.
They wasted no time. Thirty minutes after being established on the heart-lung bypass machine, Anna’s core temperature had more than doubled, reaching 31°C. (87.8°F.). The heart itself, its molecular machinery now warm enough to work again, stuttered at first, unable to regain its own essential rhythm. But eventually electricity once again began to flow through the muscle of her heart, and this was followed by waves of contraction.
A little after ten P.M., it started to beat independently for the first time in at least three hours. That first explosive beat was captured on film in an echocardiogram.
During the resuscitation, the team had to place a central line, a thin tube inserted into a major blood vessel, allowing them to give fluid and drugs more easily. To do this, they first had to pass a needle into her chest, aiming for a target vein whose diameter was no more than a fraction of an inch. It is a tricky feat to pull off at the best of times. You rely upon your knowledge of anatomy and a steady hand. But lying next to that vein is a large pulsating artery that, as they tell you in medical school with a wry smile, is always best avoided.
But the fight was far from over. During the scramble to save Anna’s life, the team had damaged that artery and, hidden just behind her collarbone on the right side of her chest, it began to bleed. Here again the cold conspired to kill her. The hemorrhage that followed was made far worse by Anna’s hypothermic state because blood loses much of its ability to clot at low temperatures. Having labored so hard to save her life, the team now faced the possibility that she would bleed to death.
They transfused blood, platelets, and clotting factors in an effort to replace what had been lost and encourage her blood to coagulate once more. Cardiothoracic surgeons then decided to open her chest, finally allowing them to isolate the bleeding artery and stop the hemorrhage. After hours of work by dozens of people, she was finally stable enough to be transferred to the intensive-care unit.
Once there, her lungs failed, and to maintain the levels of oxygen in her bloodstream, the team was forced to take the drastic step of establishing her on a device that could oxygenate her blood outside her body, which functioned like a bypass circuit for her lungs. Her kidneys also failed, and their function too was replaced artificially by yet another machine.
Miraculously, Anna survived even this, opening her eyes for the first time after just twelve days. But she found herself paralyzed from the neck down, waking alive but quadriplegic. Later she grew angry, asking the doctors at Tromsø why they had been so determined to keep her alive. Together the costs of her helicopter rescue, resuscitation, and admission to the intensive-care unit added up to many tens of thousands of dollars. All of this was done for a woman who awoke alive but with a body that no longer appeared to work. This was the best that anyone might have dared hope for, given how cold she’d been and how long she’d gone without a pulse. Had their endeavors truly been worth it? Should they have proceeded with the resuscitation at all?
But Anna’s paralyzed body did not remain that way. It wasn’t an irreversible injury to her spinal cord that left her unable to move, as is so often the case after traumatic injuries. It was instead her peripheral nerves, damaged by the extremes of cold, which had failed. Slowly but surely these nerves and her flaccid muscles began to recover and regain their function.
The nerves recovered most slowly in her extremities. Initially she could not use her arms and legs at all. Though after six weeks she was ready for discharge from the hospital, she could not go home. Anna spent another four months in a rehabilitation unit, slowly growing in strength and learning how to move once more. It was a slow process, but eventually she was able to go home. Medicine had brought her this far, and where it stopped, her determination had to take over.
It would ultimately take six hard years of rehabilitation in all, but eventually Anna was well enough to ski again, well enough to return to complete her training as a doctor. Eventually she specialized in radiology and now works in Tromsø, at the hospital that had dared to save her life.
—
ANNA BÅGENHOLM IS an extraordinary survivor. Doctors exploited her profound hypothermia to successfully resuscitate her against seemingly impossible odds. While her survival occurred in the context of an accident, others have benefited from hypothermia by design.
Esmail Dezhbod’s symptoms had begun to worry him. He felt pressure in his chest; at times great pain. Visiting the doctor did nothing to allay those fears. After asking him some questions, his doctor gave him a physical examination and ordered a body scan to investigate the structures within his chest. The pictures didn’t lie: Esmail was in trouble. He had developed an aneurysm of his thoracic aorta, a swelling of the main arterial tributary leading from his heart. Normally no more than 1.2 inches in diameter, this vessel had more than doubled in size, to the width of a can of Coke. With this swelling came the risk of rupture. The greater the diameter of the vessel, the greater the risk that its wall might suddenly tear. The consequences would be catastrophic. Esmail had a bomb in his chest that might go off at any moment. Aneurysms elsewhere in the body can usually be repaired with relative ease. But in this location, so close to the heart itself, there are no easy options. The thoracic aorta carries blood from the heart into the upper body, supplying, among other things, the brain. To repair it, the flow would have to be interrupted by stopping the heart. At normal body temperatures this and the accompanying oxygen starvation would damage the brain, leading to permanent disability or death within three or four minutes.
Yet for Esmail to survive, the repair had to be done. His surgeon, the leading cardiac specialist John Elefteriades, decided to carry out the procedure under conditions of deep hypothermic arrest. He used a heart-lung bypass machine to cool the body to a mere 18°C. (64.4°F.) before stopping the heart completely. Then, while the heart and circulation were at a standstill, Dr. Elefteriades performed the complicated repair, racing the clock while his patient lay dying on the operating table.
—
ON THE DAY OF THE OPERATION, I was there to watch this remarkable feat of surgery. Though Dr. Elefteriades is an old hand with the technique of deep hypothermic arrest, every time feels like a leap of faith. Once the circulation has come to a standstill, he has no more than about forty-five minutes to complete the repair before irreversible damage to the patient’s brain occurs. Without the induced hypothermia, he’d have just four.
Standing in the operating room and marking the moment at which Esmail’s circulation comes to a stop is a sobering experience. At this point, nothing is supporting him: no drugs, no machines, no bypass circuit. Esmail’s physiology is crashing in slow motion. Up until now, the surgery has proceeded in a relaxed fashion. Knife in hand, paring away the tissues around the heart, John has chatted away as if he’s doing nothing more taxing than driving to the supermarket. That demeanor changes at the moment of circulatory arrest. Now there’s no time for small talk.
The hands of the clock on the wall swing around; the digital timer counts off the minutes and seconds. John lays down the stitches, elegantly and efficiently, making every movement count. He has to cut out the diseased section of aorta, a length of around six inches or so, and then replace it with an artificial graft. To this he must stitch other tributaries supplying the brain and upper body. And all the while Esmail is dying.
The electrical activity in Esmail’s brain is, at this point, undetectable. He is not breathing and has no pulse. Physically and biochemically he is indistinguishable from someone who is dead. It seems impossible to believe that he might be successfully resuscitated from this state and go on to be the man he was before.
Yet after thirty-two minutes, the repair is complete and Dr. Elefteriades is ready to reestablish Esmail’s circulation. The team warms his freezing body, and very quickly his heart explodes back into life, pumping beautifully, delivering a fresh supply of oxygen to Esmail’s brain for the first time in over half an hour.
A day later, I visit Esmail on the intensive-care unit. He is awake and well, even if he’s in a little pain, and his wife stands by his bed, overjoyed to have him back.
To cure this man, his surgeons had to come close to killing him—using profound hypothermia to buy his survival. Esmail is living proof that physical extremes can cure as well as kill.
—
THERE IS ANOTHER EXTREME that we have recently begun to explore, defined not by environmental conditions, like Scott’s Antarctica, but by disease and injury. Modern intensive-care medicine hangs ordinary people out at the very limits of endurance, to endure perilous derangements in physiology, with the expectation that they might survive and go on to lead normal lives. Life at the extremes can be lifesaving.
Evolution did not prepare us for life at the extremes. Only engineering and technology allow us to cheat our environment and our biological fate—and then only temporarily. One of the questions this book will address is whether technology emboldens us before we understand its consequences. Think again of that medical team heating Anna Bågenholm’s chilled blood and pumping it back into her body, with only the slimmest hope that she would survive to lead a normal life. Perhaps we have no business pushing the envelope after all. Perhaps we have finally gone too far.
But Anna did make a complete recovery. She owes her life to science, technology, and medicine and to an understanding of the biology of deep hypothermia that is as young as she is. So goes the story of our exploration of the extreme tolerances of the human body. It is a story of tragic loss and outrageous survival, of questions about life and death and an attempt to understand what lies in between.
Within a century, we have come to understand the process that killed Scott. More than that, we overcame it and learned to use it to our advantage in medicine. The intervening decades—between Scott’s heroic death and Anna Bågenholm’s remarkable survival—saw progress in the field of medicine unparalleled in any other century. Flying ambulances, systems for the advanced management of traumatic injuries, the artificial cocoon of intensive care, techniques to bypass and replace the function of the human heart—all of these were necessary to allow Anna to survive an insult that Scott could not. But each of those innovations arose by accident, the products of other, unrelated challenges. There was no grand scheme through which we arrived at this point in history with such high expectations of life and its survival. In medicine and physical exploration, we moved forward into the unknown always hopeful that good fortune and survival lay in store.
—
IN THE END, SCOTT’S EXPLORATION aboard the Terra Nova wasn’t in vain either. The expedition that he led wasn’t the first to reach the South Pole, but it was one with an important scientific legacy. It laid the foundations for the discipline of glaciology and found fossil specimens that would later point to an incredible truth: The southern continents of the world had once been linked together as a single landmass. The penguin skins collected by Scott’s companions Apsley Cherry-Garrard, Edward Wilson, and Henry Bowers on their infamous “worst journey in the world,” a trek across the Ross Ice Shelf to a penguin rookery, provided a benchmark sample that would later help scientists establish the persistence and bioconcentration of DDT insecticide after its introduction into the global food chain in the twentieth century.
Scott’s exploits aboard the Terra Nova were to have been the crowning glory of a triumvirate of expeditions that included Scott’s first voyage to Antarctica aboard the Discovery in 1902 and Shackleton’s Nimrod expedition in 1907—endeavors that were instrumental in opening up the continent of Antarctica to science. Scott may have died, but what he and his expedition team started at the turn of the twentieth century in time became a wider program of scientific research, one of fundamental importance.
By the middle of the century, the scientific survey teams of several nations had established a plethora of permanently manned bases in Antarctica. In 1985, observations by the British Antarctic Survey detected the thinning of the Earth’s ozone layer around the South Polar region: the so-called ozone hole. Ozone in our atmosphere absorbs ultraviolet radiation, protecting us from its harmful effects. This discovery and the later realization that ozone depletion was being catalyzed by halogen atoms in chlorofluorocarbons (CFCs) led to an international ban on these substances.
By the end of the century, these multinational scientific efforts in Antarctica delivered some of the most convincing evidence that global warming is a real phenomenon. Scott’s race to the South Pole began as an exploratory effort into the unknown for which he paid with his life and the lives of his core team. However, the legacies of Scott’s exploration are discoveries that might one day save our entire planet.
That is the truth of all exploration—in science or the physical world. We do not climb mountains, traipse to polar ice caps, split atoms, or unravel genomes simply because “they are there” but because we know that it is within the unanticipated fruits of exploration that our improved survival lies.
Scott’s expedition marked the beginning of the end of the so-called Heroic Age of exploration. The Victorian concept of risking all for honor and the greater glory of God and country was cast into sharp relief by the catastrophe of the Great War. A new era of exploration was born, one that relied less upon the mettle of men and more upon the systems of protection that we were able to engineer to protect them. It is worth noting that after Scott and Amundsen’s parties first arrived at the South Pole in 1912, no human set foot there again until 1956. And when they did, they arrived not in sleds driven by ponies or dogs but in aircraft.
—
TORVIND, ANNA, AND I are walking along Mortimer Street; they have been lecturing about their experiences to an audience of doctors at the Royal Society of Medicine in London. They feel that this retelling of the story is important to change people’s practice and expectations in the face of such extreme hypothermia.
There is a question I must ask Anna. If she’d had the choice at the time of her resuscitation at Tromsø—given the extraordinarily long period for which her heart had been arrested, knowing that the overwhelmingly likely outcome would have been death or a lifetime of disability—would she have chosen to let the team proceed?
“Yes,” she tells me after a short pause, “because you never know.”
We continue our stroll through London. There is a point where water is rushing from what looks like a burst water main, flowing across the paving stones. Anna quickens her pace, breaking into a jog. For a moment, I wonder if this is one of those unexpected aversions that develop after a traumatic event. She was, after all, trapped under the ice, sinking into running water. Torvind says nothing. Perhaps it’s something he’s seen before. I am intrigued, briefly horrified, that this might be a sign of vulnerability or weakness.
I am still pondering this when a taxi runs through the sizable puddle that has collected in the gutter, drenching my feet and trousers. And I realize that, after she was entombed and frozen in an Arctic stream and endured the lowest recorded temperature of any cardiac arrest survivor in medical history, the only reason Anna’s running is because she’s smarter than me.