A chilling introduction to freezing to death

The moment your Jeep gently slides off the mountain road and hits a snowdrift backwards, the cold is not the first thing on your mind. First, you worry about the dented bumper. Then you remember you haven't packed a shovel. And you are also concerned that you will be late for dinner. Your friends will be waiting at their ski cabin around eight in the evening to set off on a moonlight ski trip, followed by a late supper and a sauna. How could it be otherwise?

As you drove out of the city with the window heaters roaring at full blast, you only noticed out of the corner of your eye that at 18:36 the thermometer in the square by the bank building was showing minus 27 degrees. The weather forecast on the radio reported that large masses of arctic air were flowing into the region. The cashier you paid at the Conoco gas station shook his head and said that if he were you, he wouldn't be going anywhere on such a night. You smiled. As long as you are dressed warmly and have a sturdy off-roader, the freshness of winter frost can't do any harm.

But now you are in trouble. In the lowest gear, you try to claw your way out of the drift. The tires howl on the icy snow, and the wall of snow-covered spruces on the opposite side of the road sways in the glare of the car's headlights. With the gear lever pulled into parking mode, you push the door with your shoulder and scramble out of your heated cocoon. The frost slams into your exposed face, and tears spring to your eyes.

You glance at your watch – it is 19:18. You look at the map – a thin zigzag line winds up the mountain to a pencil-marked cross where the cabin should be.

The clouds of your ragged breath immediately turn to rime. The Jeep, tilted awkwardly, lies in the drift and resembles an empty tortoise shell. Your thoughts linger on the wood-burning stove, the sauna, warm food, and wine. You look at the map again. The marked square could be about another 10 kilometers away. That is the distance you usually run before breakfast every morning. Now you just need to put on your skis. There is no reason to worry.

There is no specific temperature at which a person must die from the cold. In the Dachau death camp, by immersing people in cold water, Nazi doctors determined that death occurs when the body reaches a temperature of approximately 25 degrees. The lowest recorded body temperature from which an adult has managed to survive is 16 degrees Celsius. For children, this threshold can be lower. In 1994, a two-year-old girl in Saskatchewan wandered away from home in minus 40-degree frost. She was found right by her front door the next morning, and her body temperature was 13.9 degrees. She survived.

Others are less fortunate, even in much milder conditions. One of the most severe weather-related accidents in Europe occurred in 1964 during a walking race across the rainy and windy hills of England. Although the air temperature never once dropped below zero and sometimes even exceeded +7 degrees, three race participants died of hypothermia.

No matter how much scientists and statisticians now know about freezing and its psychological aspects, no one has the power to predict how quickly and which of us specifically will be struck by rapid cooling and then, once it has happened – whether the cooling will also cause death. The cold is still shrouded in mystery – preferring men over women, being deadlier to the thin and muscular rather than those with excess weight, and most hostile towards the careless and inattentive.

Its effect begins before you even step out of the car – when you take off your gloves to push the loose ski binding rivet back in. The freezing cold metal bites into your skin. Your body temperature drops.

Within a few seconds, the temperature of your palms has already dropped to a chilling 15.5 degrees. The capillaries in the surface layer of your skin instinctively contract, forcing blood to leave the skin and take shelter deeper in the body. Your body is ready to sacrifice its fingers to preserve warmth for vital organs.

You put on your gloves and notice only that your fingers have become less sensitive. Once your boots are hooked into the ski bindings, you set off.

If you were a Norwegian fisherman or an Inuit hunter who often has to work with bare hands in the frost, your frozen hands would nevertheless occasionally open the surface skin capillaries, periodically supplying warm blood to your fingers and thus allowing you to maintain mobility. This trait, known as the hunting reaction, is capable of raising skin temperature by as much as eight degrees in seven to eight minutes. Other mechanisms for adapting to cold are far more mysterious. Tibetan Buddhist monks are able to raise the temperature of their hands and feet by nearly 10 degrees during meditation. Australian Aboriginals, who once used to sleep on the bare ground without any clothing in temperatures as low as 0 degrees, were able to induce a hypothermic state, suppressing the shivering reflex and thus waiting for the first rays of the sun.

But for you, spending your days at a computer in a climate-controlled office, such defense mechanisms are unavailable. After just ten minutes of skiing uphill, your body temperature rises, blood begins to return to your fingers, and sweat beads on your back and chest.

You leave the road, having decided to cross the forested slope directly and skip one bend in the road. Moving through the soft and deep snow, where the silvery moonlight mingles with the branching shadows of the trees, you reason that your friends were right – it is a wonderful evening for skiing, although, of course, the stings of minus 35 degrees on your face are noticeable because it is, after all, a severe frost.

However, the road cannot be seen even after an hour, and you begin to worry. You stop to look at the map. At this moment, your body temperature reaches its peak – over 38 degrees. By climbing the mountain through the deep snow, you are generating nearly ten times more body heat than when at rest.

As you turn around and try to align what you see on the map with the surrounding forest, you hear a metallic click. A glance downward. The loose rivet has disappeared from the ski binding. When you lift your foot, the ski no longer holds to the boot.

You light your pocket flashlight, but the batteries, exhausted by the frost, can only manage to mark a yellowish circle in the snow. It must be around here somewhere, you reason, and dig through the snow with your gloved fingers. Finding the rivet occupies you so much that you barely notice the cold air wrapping your tired body and sweat-soaked clothes from all sides.

The exertion that kept you warm while climbing the mountain suddenly turns against you – the capillaries dilated by physical activity carry excess body heat to the skin's surface, and your damp clothing helps it to quickly dissipate in the cold night. The lack of a fat layer to insulate muscles allows the cold to get even closer to your warm blood.

Your temperature begins to fall. In 17 minutes, it reaches the normal 37 degrees, but continues to drop.

When 36 degrees are reached, the neck and shoulder muscles involved in the slow searching are tightened by the so-called pre-shivering tone. The receptors have signaled the temperature control center in the hypothalamus of the brain, which in turn has ordered the entire network of surface skin capillaries to contract. Your hands and feet begin to ache from the cold. Ignoring the pain, you continue carefully digging through the snow. Another 10 minutes pass. There is no longer the slightest doubt that you have gotten yourself into serious trouble.

Finally, after about 45 minutes, you find the rivet. You even manage to get it back in place and attach the boot to the ski. But the cold, which at first was only lurking around you, has now penetrated deep inside your body.

Reaching a temperature of 35 degrees, your body has already entered a state of mild hypothermia. You tremble all over because your body is trying to make maximum use of the shivering reflex – an unconscious bodily reaction that attempts to generate additional heat through rapid muscle contraction.

Now you realize that the thought of going anywhere on such a cold night was misguided after all. You must turn back. You fish the map out of your jacket pocket. If it helped you get this far, it should be able to get you back to the warmth of the car. The thought that you could simply ski back along your own tracks does not enter your increasingly panic-stricken and clouding mind.

After such a long pause, even the skiing itself has become significantly more difficult. The moment you start the descent, your muscles are already so cooled and tense that they seize up with difficulty, and once they seize, they do not want to relax. All that remains is for you to clumsily bore through the snow with your arms held straight and your knees wobbling.

And yet, you manage to wind through the spruce thickets, swishing downwards through the silvery light that mingles with shadows. However, you are too cold to appreciate the beauty of the night or think about the friends who wanted you to see it. All you can think about is the warm Jeep waiting for you somewhere down at the foot of the mountain.

In your mind's eye, you already see its shimmering body, but then you reach the crest of a small hill. The moment your speed increases rapidly, you hear the wind whistle in your ears. And then, before you have realized what it means, a sort of bump emerges from the snow in front of you.

Realizing the approaching danger too late, you try to angle your skis to stop. However, in this condition, your sense of balance and reaction no longer function very well, and in the next moment, your ski hits a snow-covered log, and you fly through the air headfirst, tumbling face-first into the snow.

You lie motionless. The forest is as if stilled, and the only sound is the echo of your own blood. Your ankle throbs with pain, and you have also hit your head on something. On top of that, your hat and one glove are gone.

Prickly, sharp snow has gotten under your shirt. Melting snow runs down your neck and back, and blood from a small wound on your head soon joins it.

The situation, as you conclude without yet panicking, is indeed serious. Trying to pull yourself up, you immediately collapse, because your aching ankle cannot hold your weight.

Shocked by the inability to get up, you slump back into the snow, but heat continues to leave you at a terrifying rate – your bare head alone is responsible for 50% of the heat loss. The frost bites into your ears so painfully that you begin to scramble through the snow until you find your hat and pull it back onto your head.

But even the smallest activity requires a huge effort. It is clear that you should also find the glove, but by now you are so dejected that you see no reason to hurry. You decide that it is better to rest a little first. An hour passes, and at one point it flashes through your mind that you should begin to be afraid, but fear seems something too distant and intangible, similar to the bare and already numb hand resting in the snow. You have entered the temperature range where the cold begins to reduce the efficiency of your brain's enzymes. With every degree the body loses after reaching 35 degrees, the brain's metabolic rate decreases by 3–5 percent. Upon reaching 34 degrees, your consciousness begins to be clouded by amnesia. You look at your watch – 00:58. Someone should really find you soon. After a moment, you look again. The numbers no longer stay in your memory. Of what happens next, very little will remain in your memory.

Your head falls back. The snow crunches softly in your ear. At minus 37 degrees, your body temperature drops by one degree every 50–60 minutes; your body heat slowly seeps into the soft snow. Upon reaching 33 degrees, apathy takes over. Losing yet another fraction of a degree, rigidity sets in.

At this point, you have crossed the border beyond which severe hypothermia sets in. When your body temperature drops to 31 degrees, the body loses the drive to warm itself even with shivering. The blood begins to thicken like oil in a cooled engine. Oxygen consumption, which allows one to gauge your metabolic level, has decreased by more than a quarter. At the same time, your kidneys are working to the point of exhaustion to deal with the overproduction of fluid caused by the contraction of blood vessels in your limbs, trying to move as much fluid as possible deeper into the body. The only thing you can still feel at all is a strong urge to urinate.

Reaching a temperature of 30.5 degrees, you would no longer be able to recognize a familiar face if one were to suddenly emerge from the forest.

Losing another half-degree, cardiac arrhythmia begins under the influence of disorders caused by chilled nerve cells. By now, it can pump less than two-thirds of the normal blood volume. At the same time, oxygen deficiency and a slowed metabolism in the brain begin to cause visual and auditory hallucinations.

You hear bells. Lifting your head from the snow pillow, you realize with joy that these are not bells on a sleigh, but welcoming chimes on the front door of your friend's ski cabin. You already knew it had to be close by. The ringing sounds every time someone opens the cabin door, and the cabin is right nearby – just behind the spruces.

You try to get up, but collapse, tangled in your skis and poles. Never mind. You will crawl. It is very close.

After several hours, or perhaps they were only minutes, you realize that the cabin is still behind the trees. You have covered only a few feet. On the illuminated dial of your wristwatch, you can see: 5:20. Exhausted, you decide to lie down for a bit.

When you lift your head again, you are already in the cabin, lying on the floor by the hearth. The glow of the fire turns everything crimson. First, it is warm, then it becomes hot, but after another moment, your whole body is burning. Your clothes are in flames.

When the body reaches 30 degrees, those dying of cold often experience a strange urge at the very last moment to tear off their clothes. This phenomenon, known as paradoxical undressing, is so common that in populated areas, those who have frozen to death are often at first mistaken for victims of sexual assault. Scientists are not in agreement about the causes of this phenomenon, but one of the most logical explanations is that, the moment before loss of consciousness, the constricted blood vessels in the surface layer of tissue expand rapidly, creating a strong burning sensation in the skin.

You realize only that you are surrounded by flames. You tear yourself out of your shell of clothing, rip off your wool sweater, and fling it all away. But then, in one last flash of consciousness, you see that there is no hearth, no cabin, and no friends nearby. You are lying alone in the freezing cold, and you are half-naked. Suddenly, you grasp what a mistake this was, a whole series of mistakes – like a dream that becomes more nightmarish. You have shed your clothes, abandoned your car, your warmly heated home in the city. Without all these sophisticated arrangements, you are simply a vulnerable organism from tropical latitudes, whose suitable living space is only a narrow, sun-drenched strip around the equator.

But now you have wandered far away from it.

There is a saying about hypothermia: "You are not dead until you are dead and warm."

Around six the next morning, friends first found his stuck Jeep, then also him – collapsed not too far from the snow-covered fallen tree, one hand, without a glove, tucked into his armpit. His skin looks like it is covered in wax, limbs are stiff, no pulse is detectable, pupils do not react to light. Dead.

However, those who understand the nature of cold might know that, while it can kill, it also hides a seemingly impossible chance for survival. Heat is a presence, that is – the movement of molecules. Cold is an absence, or the cessation of movement. At absolute zero temperature, molecular movement stops completely. Cooling is a slowing down that can liquefy gases, turn liquids into a solid state, and make solids even harder. It slows down the multiplication of bacteria and chemical reactions. In the human body, cold halts metabolic processes. The lungs take in less oxygen, the heart pumps less blood. At a normal temperature, this would cause brain damage. But a cooled brain, due to the slowed metabolism, requires significantly less oxygen, and under appropriate conditions, it may suffer no damage at all.

One of his rescuers, hunched over, presses her ear to his chest and listens carefully. Seconds tick by. And then she hears a distant and barely audible sound – a single heartbeat, which is so elusive that it could just as well be the echo of her own blood. She presses her ear tighter to the cold body and hears one more beat, then another.

The slowing that accompanies cooling can, in a peculiar way, also be useful and is sometimes even deliberately induced. Doctors often use cooling to a low temperature to slow down a patient's metabolism before heart or brain surgery. In this state, the patient's circulation slows down, the heart rhythm becomes rarer or, in cases where life-support equipment is used, it does not beat at all, and it seems – death is right nearby. However, if carefully monitored, a patient can safely spend several hours in such a cooled state.

The rescuers quickly wrap their half-naked friend in a spare jacket, put mittens on his hands, and finally push him into a sleeping bag. They clear snow from his stiff, frozen face. Then one of them zigs down the forested slope to the nearest cabin. The others remain standing in the bluish dawn twilight around the sleeper, and silence descends upon them. At one point, the woman thinks she hears all those creatures that tend to spend the winter under the thick snow cover stirring, breathing, and snuffling.

After counting "One, two, three," the doctor and nurses slide the man's stiff and arched form onto a table covered with a mattress filled with warm water kept at a specific temperature. They were already warned that a severe hypothermia case would be brought in. Usually, it is possible to straighten such victims from their fetal-like position. This one could not be straightened.

The nurses use stainless steel scissors to cut through the urine-soaked ski pants that have frozen into a kind of corrugated cardboard along with the long underwear. Electrodes for a heart monitor are attached to his chest, and an electronic low-temperature thermometer is inserted into the rectum. Digital readings show 24 beats per minute and a body temperature of 26.2 degrees.

The doctor shakes his head. He does not recall seeing such meager numbers. He is not entirely clear on how to revive this person without killing them at the same time.

Indeed, many hypothermia victims die every year precisely during rescue. In the moment known as "rewarming shock," the constricted blood vessels tend to expand almost all at once, causing a sudden drop in blood pressure. Even the slightest movement can trigger ventricular fibrillation in the victim's heart, completely stopping circulation and causing death. In 1980, 16 Danish fishermen who survived a shipwreck were rescued after spending an hour and a half in the freezing waters of the North Sea. They crossed the deck of the rescue ship on their own, climbed down into the cabin, where they were served a hot drink, and then collapsed lifeless – all 16.

– 26 degrees, – reports the nurse. – Two-tenths lower.

The patient has entered a "post-cooling" period, during which the cold accumulated in the body's external tissues continues to cool deeper tissues even after he has already been brought into the warmth.

The doctor quickly issues orders to his staff: administer physiological saline intravenously, after first heating it in a microwave oven to 43 degrees. To raise the average body temperature of an average-sized man by just one degree, approximately 100 kilocalories of heat must be supplied. One kilocalorie is the amount of heat needed to warm one liter of water by one degree Celsius. Since about a liter of 60-degree hot soup provides about 30 kilocalories, to reach a normal body temperature, the patient lying on the table would have to gulp down 40 liters of chicken broth. Therefore, even warm physiological saline introduced directly into the circulatory system can provide only 30 kilocalories.

Ideally, the doctor would have access to a blood transfusion machine with which it would be possible to draw out the victim's blood, heat it, enrich it with oxygen, and pump it back, thus safely raising the body temperature by one degree in five minutes. However, such equipment is rarely available in hospitals outside large cities, so the doctor must rely on other options.

– Preparing for surgery, – he announces.

A moment later, he inserts a large catheter through a small incision in the man's abdominal cavity. Warm fluid from a bag hung on a stand begins to flow into his abdominal cavity and is drained using another catheter inserted in a second incision. To put it prosaically, this flushing works exactly like a car radiator, only in reverse – the fluid heats the internal organs, and the heart then pumps the warmed blood throughout the body.

The patient's stiff limbs begin to relax. His pulse quickens. And yet, the robotic line of his heartbeat on the electrocardiograph screen makes a strange jump every now and then, which is often observed in cases of hypothermia and is called a "J wave".

– Be ready for defibrillation, – the doctor warns the emergency medical personnel.

For about an hour, the nurses and everyone else continue to hover around the table, in the center of which the patient lies in a circle of warm light like a sacrifice prepared for the sun god. They monitor his heart rhythm. They watch the mattress temperature. They whisper about how reckless it is to go out alone in such weather.

Gradually, the patient begins to respond. A new liter of solution is connected to the system. Blood pressure is still much too low because it is being lowered by the blood flowing away to the capillaries of the limbs that have started to work rapidly. The fluid loss caused by sweating and urination has reduced the total volume of blood. However, every 25–30 minutes, his temperature has risen by another degree. The possibility of fibrillation decreases because both the heart and the thickened blood are gradually warming up. Due to frostbite, he may lose fingers or an earlobe, but it seems he has overcome the worst the frost can do.

In the following half-hour, the nurse quietly calls out the thermometer readings, and it sounds like a mantra accompanying the evolution of his cold-blooded proto-organism into a warmer, conscious being.

– 32,4…

– 33,4…

From a great distance in the endless cold darkness, you hear a muffled, persistent humming. It rapidly turns into a cloud of sound, like a planet rushing toward you, and suddenly transforms into a stream of words.

Someone is calling your name.

You have not the slightest desire to open your eyes. You feel light and warmth playing on your eyelids, but from the depths of the ocean untouched by the sun and the most distant corners of the Universe, a chilling cold continues to rise within you. You lack the strength even to shiver. You only want to sleep.

– Can you hear me?

You force yourself to open your eyes. Above your head is a blinding light. All around the light – people's faces and identical tunics. You try to think: "It must have been a very long time since I was gone, but where was I?"

– You are in the hospital. You were found in the cold.

An attempt to nod. The neck muscles seem completely stiff, unused for years. They can obey your command only with a barely perceptible twitch.

– Most likely, you don't remember anything, – says a voice.

You recall the moon rising over the jagged spruce tops and the fact that you are skiing toward it to some warm place located directly under the cold moon. But after that – absolutely nothing, only the cold that overtook your entire body.

– We are trying to get some warmth back into you, – says the voice.

You would have nodded if you were able. But it is impossible to move. And something is pulsing unpleasantly all over. Looking down, where it hurts the most, at your fingers in the places where they had been bare and in contact with the snow, you notice blisters filled with transparent fluid. In the hours spent in the cold, the tissues had frozen, and ice crystals had formed between the cells, which drew in the water inside the cells and blocked circulation. You look at the blisters with an expressionless gaze.

– I think everything will be fine there, – the voice above your head says.

– The damage seems superficial. It is expected that the blisters will burst in about a week, and the tissues will then recover.

If that does not happen, you know that your fingers will turn black like dead flesh left without blood. And then they will be amputated.

But the worry fades, because a new wave of fatigue overcomes you. Slowly, you slip into a doze and dream of warmth, of tropical ocean waves sliding over your chest, and a shore of warm sand.

Still stiff and numb, you emerge as if from a great depth only after several hours. It feels as if a warm tide is lapping around your waist. With difficulty, looking down, you see tubes inserted into you, the warmth from which flows like a rapid river around the cold that still reigns deep in your abdomen. Your gaze follows the tubes and rests on the solution bag hanging in the air.

If it were in your power, you would have sobbed, because you begin to grasp: in that bag is everything you had almost lost. These people bustling around have brought you sunlight and warmth – everything you recently took as permanent, easily accessible, belonging to you, and obtainable by simply turning a knob or putting on an extra blanket.

But now you have peered into a place where there is no sun. You have experienced that in the endless expanses of the Universe, heat is something as astonishing and fleeting as the light of distant stars. Heat has a place only where matter is, where particles have the chance to dart and move. In the endless winter of the Universe, heat is infinitesimally small; cold reigns there.

Someone speaks. Your eyes turn away from the bright lights and notice vague outlines at the periphery of the room. She is one of those friends you set off to visit, it seems, so long ago. She leans over you and tries to smile.

– It was cold there, wasn't it? – she asks.
Published in the January 1997 issue of Outside Magazine under the title "As Freezing Persons Recollect the Snow—First Chill—Then Stupor—Then the Letting Go".