In her late twenties, Anna Bagenholm was already an accomplished radiologist and deft skier. Adventurous and hard-working alike, and with a vibrant personality, she quickly befriended some coworkers. Together, they frequented the nearby Kjolen Mountains. On one such ski trip, Anna encountered the unthinkable. Her friends were left to discover her in unimaginable circumstances. What ensued was a months-long medical journey that not only transformed Anna’s life but emergency medical practices around the world.
Anna Elisabeth Johansson Bågenholm spent a lot of her adult life in hospitals. Since she worked as a radiologist at the Swedish University Hospital of North Norway, she was used to helping patients achieve optimal health. However, she was in for a shock when she found herself as a patient at the very same hospital. After a truly unpredictable skiing accident in 1999, she was stranded under a layer of ice. Anna spent over an hour trapped in freezing cold water, and froze in the process.
It was supposed to be just another ski trip. A proficient skier, Anna met up with a few of her coworkers to hit up the Kjolen Mountains for an afternoon on the slopes. She was used to the terrain of the Kjolen Mountains. Anna bonded with her coworkers because of their shared love of skiing; the hospital was just a short drive away, and the slopes provided a place to socialize and de-stress. Unfortunately, Anna was in for a cruel surprise.
Anna even accepted her job at the Swedish University Hospital of North Norway because of its close proximity to the Kjolen Mountains. She and her friends had spent the beginning of their residencies exploring the area surrounding the mountains, and went skiing together to blow off steam. A social, therapeutic and exciting activity, Anna was excited for the winter’s bounty of opportunities to ski. What was a perfect balance of work and pleasure soon took a turn for the worst—the stuff of nightmares.
Anna set out on a familiar but challenging route. On the day of the accident, the conditions were great. The snow was powdery, and the sun was shining. For skiers such as Anna, there was no imaginable threat. After a few invigorating descents down the slopes, she had a terrifying encounter with her mortality. On the way down the slope, she lost control. Anna plummeted so quickly that she couldn’t stop the motion. Shortly thereafter, she crashed head-first onto an 8-inch-thick layer of ice. The blow incapacitated her, and she didn’t stop there. She broke through the ice into uncertain territory. She was just 29-years-old, and was suddenly immersed in a life-or-death scenario.
When Anna hit the ice, it cracked open. She fell straight in. By the time her friends got to where she was, her feet and skis remained above the ice. Her entire body, from her head to her ankles, was submerged. Anna’s friends tried to pull her out, but it was to no avail. Her body was freezing, and increasingly impossible to retrieve. When they called for help, they had no idea when to expect support. Little did Anna’s friends know, she found a small pocket of air to keep alert—no matter how excruciating the circumstances.
By the time the rescue team arrived to pull Anna out from under the ice, eighty minutes had passed. They had to dig deeply into the ice with a pointed shovel. When they pulled Anna out, she didn’t even have a heartbeat. She was pale white, and her pupils were dilated. Even though the rescue team pulled her out from under the water after eighty minutes, the emergency helicopter didn’t arrive for another hour. Nothing was certain, and Anna’s friends were deeply concerned for her livelihood.
Since Anna plummeted directly into the icy water, she didn’t have time to resist or even adjust. Her best bet for any chance of recovery was if her brain flash-froze. In a state of flash-freezing, the brain needs minimal oxygen to operate. So, she’d be frozen in time—ready to be warmed up and essentially brought back to life.
People are capable of surviving above 35℃. 35℃, the temperature for hypothermia, is where things start to get uncertain. With a temperature lower than 30℃, most people lose consciousness. With a temperature lower than 25℃, the victim risks cardiac arrest. After cardiac arrest, life itself isn’t guaranteed. Without medical treatment, death is imminent.
While 35℃ is technically the cut-off point, the human body is at its healthiest at 37℃—or 98.6 degrees Fahrenheit. The human body, however, is excellent at fighting off the cold. Andrew J. Young, the author of “The Physiology of Cold Exposure,” noted that when the body notices its environment growing more and more cold, it starts “defending the body temperature.” The human body can generate its own warmth by making its muscles move. By shivering, blood can actually stay warm. With too much shivering comes great risk, though—the body can become susceptible of suffering a stroke or even a heart attack.
After cardiac arrest, the body enters what is called “downtime.” “Downtime,” what Anna was deep in at the time of rescue, is an in-between state of consciousness. Without treatment, “downtime” quickly turns into death itself. Thankfully, for Anna, she got medical treatment in the nick of time. Still, she didn’t even have a pulse.
After her first forty minutes submerged in freezing cold water, Anna lost the ability to move. Her body grew limp. Within the next forty minutes, she suffered circulatory arrest. What came next was a fast-paced series of medical interventions.
At first, Anna’s friends tried giving her CPR. They never imagined they’d be in a situation so traumatic. Their close friend was cold and lifeless on the ground. They were desperate to give her life again. On the cold ground, Anna’s friends were left to contemplate the worst: what if she wouldn’t make it?
As Anna’s friends faced painful questions, an emergency helicopter arrived to transport her to her place of work: Tromso University Hospital. Her anesthesiologist, Dr. Mads Gilbert, noted that her pupils were totally dilated, and she looked dead.
When Anna was in the helicopter, she was attached to an electrocardiogram machine. When she got to the hospital, she was attached to another. Both times, she showed a flat line. Dr. Gilbert hoped that her body was still doing work to fight off the cold. If she was cold enough, as it seemed she was, her brain would have actually slowed down. By slowing down, Anna would have depended on less oxygen. If Anna’s brain had indeed slowed, she would resist brain damage—and potentially be capable of life once again.
Dr. Gilbert commented on the electrocardiogram. He said, “She’s ice cold when I touch her skin, and she looks absolutely dead. On the electrocardiogram… there is a completely flat line. Like you could have drawn it with a ruler. No signs of life whatsoever.” Still, Dr. Gilbert knew that people are capable of extreme surprises.
Kevin Fong, a physiologist and the author of Extreme Medicine: How Exploration Transformed Medicine in the Twentieth Century, explained Anna’s circumstances. He said, “This was genuine terra incognita. Any attempt to resuscitate Anna further could only proceed in the knowledge that in similar situations past medical teams had always failed.” Dr. Gilbert was aware of the risk, but noted, “The decision was made. We will not declare her dead until she is warm and dead.”
Dr. Gilbert explained the benefits and dangers of hypothermia. He said, “Hypothermia is so fascinating because it's a double-edged sword. On the one side it can protect you but, on the other side, it will kill you. But it's all a question of how controlled the hypothermia is. Anna was probably cooled quite slowly but efficiently so that, when her heart stopped, her brain was already so cold that the oxygen need in the brain cells was down to zero. Good CPR can provide up to 30-40% of the blood circulation to the brain and in these cases that is often sufficient to keep the person alive for sometimes seven hours while we try to restart the heart.”
While Anna was technically dead, doctors attached her to a heart-lung machine to warm up her blood and attempt recirculation. With the help of this machine, her body temperature started rising. At the beginning, her temperature was just 13.7℃. She was so cold that doctors had to warm up her blood outside of her body, and then pump it through again. Over the course of hours, Anna’s EKG oscillated between flatline and something more promising of life. The doctors waited diligently, hoping for the best.
After her blood was warm enough to circulate, Anna’s heart started doing the work of pumping blood. Beginning with her heart and spreading throughout her body, she began to heal. Twelve days later, the unthinkable happened: Anna opened her eyes. Little did Anna know, it would take over a year just to be able to move her body because of extensive nerve damage from the hypothermia she suffered.
Anna was dependent on a life support machine for over a month—totaling 35 days. From there, she was able to move to intensive care and eventually onto a rehabilitation unit. The road for recovery was long and painful, but worth every ounce of effort.
Dr. Gilbert recognized the slim survival rate of patients in situations like Anna’s. He said, “Over the last 28 years, 34 victims of accidental hypothermia with cardiac arrest and who were re-warmed on cardiopulmonary bypass and only 30% survived.” The determining factor for doctors responding to situations like Anna’s, which he dubbed the “Bagenholm situation,” is whether the body cooled down prior to cardiac arrest, or if the cardiac arrest occurred first.
Anna Bagenholm’s story was so exceptional that she made it into record books and medical research journals alike. After Dr. Gilbert and his coworkers helped Anna reach a full recovery, doctors around the world had more resources for dealing with hypothermia deaths. Research documented in the journal The Lancet concluded that nine hours of resuscitation and stabilization ultimately explained Anna’s remarkable recovery. She didn’t just recover physically, but mentally too. After Anna’s success, doctors worldwide have adapted their practices to match the treatment Anna received.
Anna talked to CNN just one year after the accident, saying, “I remember what happened two days before and after waking up, like two weeks after. I don't remember anything about the accident. I think that's really good.” In many ways, her memory loss protected her from some truly terrifying recollections, and facilitated a smooth recovery emotionally. Anna’s unique perspective as a medical professional facilitated a deep sense of gratitude for her recovery. She noted, “When you are a patient, you're not thinking you are going to die. You think, I'm going to make it. But as a medical person, I think it's amazing that I'm alive.” With a balance of optimism and realism, Anna understands how unusual her story is.
All the way in Pittsburgh, at the University of Pittsburgh Medical Centre Hospital, doctors have actually started inducing hypothermia in patients suffering from critical conditions. By slowing down heartrates, and mimicking the very symptoms that served as protection for Anna, more lives can be saved. Doctors around the world have Anna Bagenholm to thank for their unlikely innovations.
Doctors utilize therapeutic hypothermia to help victims of epileptic seizures, liver failure and strokes. Furthermore, they’re able to use therapeutic hypothermia to rescue newborn babies who suffered from a lack of oxygen at birth. Anna’s extreme case not only gave her new life, but saved lives worldwide—from Norway to the United States, and beyond.
Anna, a highly determined athlete, was eventually able to return to the very ski slopes where she risked death. She spent years working with physical therapists to re-learn how to move and walk. Eventually, she was able to ski. She still has a hard time with tasks such as writing and cooking, and has a difficult time using her hands as a result of nerve damage. Unfortunately, her future as a doctor is uncertain. This would be a devastating blow for many people, but Anna focuses on the miracle of her life. Furthermore, her commitment to returning to skiing is astonishing. While many people would be too afraid to return to a situation where they almost died, Anna’s determination also reveals powerful bravery.