Surviving the extremes....

Clinging to life

Stuart Diver after he was rescued at Thredbo.
Picture:Richard Briggs

Can a strong will to live help you overcome extreme conditions? Lisa Mitchell looks at surviving against the odds.

"I want to live," he must have thought, as he hacked his arm off with a small pen knife. In Aspen, Colorado, rock climber Aron Ralston remained trapped by a 360 kilogram boulder on a rock face for five days before deciding to free himself.

Australia's most extreme survivor, James Scott, lasted 43 days in the Himalayas without food and in freezing conditions.

A 56-year-old man, called Jalil, survived 13 days in the rubble of the Bam earthquake, only to lapse into a coma and die after being rescued.

Why is it that some survive against such impossible odds? Stories of superhuman feats are rarely told to the end. What about the aching months of rehabilitation? The permanent injuries?

Scott, who now works in Brisbane in mental health care, says he still suffers from double vision. He was also unable to pursue a career in surgery due to his injuries.

After being plucked from disaster, the battle also often begins again when the victim reaches hospital.

Dr Damian McMahon, director of shock trauma services at The Canberra Hospital, speaks of the farm accident amputees, lost skiers and people buried alive (Stuart Diver for one) who appear regularly in his case load.

"We service some pretty rugged country and some very serious injuries . . . People can survive quite outstanding environmental assaults, but when you combine a hostile environment with serious injuries, the outcome is more often fatal . . .

"If you take two people and put them on the snow fields for a night and one of them has a broken leg, or broken ribs so they can't breathe properly, that person is less likely to survive."

Rewarming a hypothermic person who has serious injuries can be a dangerous process, says McMahon. "If they have a very low core temperature of say, 31 or 32 degrees, and they have lost a lot of blood, the heart is in danger of fibrillating. And none of the proteins that help clot work because they only function at 36 degrees and above. Any surgery at that level is more risky."

McMahon recalls the case of a 15-year-old boy who was trapped between the blade and caterpillar track of a bulldozer for 36 hours. He died not long after in hospital.

"The part of the body that is trapped is starved of oxygen or blood flow, so the cells die and begin to produce acid and toxins," he says. "These build up in the tissue and when the trapped part of the body is released, the acids and toxins flow back into the circulation system. Among the toxins is potassium, which is toxic to the heart and there's another toxin, called myoglobin, which is toxic to kidneys."

Aron Ralston, who cut off his arm after being pinned under a boulder.
Picture:Reuters

On the surface, the factors that determine survival seem straightforward. It depends on the severity of injuries sustained, how hostile the environment is, and a person's physiological reserves. Ralston would not have lasted much longer on his rock face with such a significant injury, whereas Scott had no serious injuries, neither did Thredbo survivor, Stuart Diver.

But even the experts confess to a point beyond which science fails to explain the endurance of some survivors.

"We have patients who live and die unexpectedly, and the only thing you can attribute it to is their will to live," says McMahon. "It is impossible to quantify the will to live."

For 38 days, Dougal and Lynn Robertson, their three sons and a friend stayed adrift in the Pacific after their schooner was attacked and immobilised by killer whales.

Without water, a human cannot survive beyond 10 or 12 days and the Robertsons had six thirsts to slake. They overcame the ordeal with common sense and a little medical knowledge.

In his new book, Surviving the Extremes: A Doctor's Journey to the Limits of Human Endurance, Dr Kenneth Kamler discusses the importance of knowing your environment and your ability to adapt to it in survival situations. The Robertsons, he writes, used their boat's canopy to collect rainwater, but the first run-off was undrinkable as it was exposed to salt air. So as not to waste a precious drop, Lynn Robertson, a nurse, used the first salty run-off to administer rehydration enemas to each of her family.

"Rectums have membranes that extract water � that is how food that has passed through the digestive system is dried into faeces," writes Kamler. "Sea life can provide at least some water if you know where to look. The blood of freshly killed turtles and birds can be drunk like gravy in the minute or so before it coagulates. An average turtle will yield about four cups."

A castaway can literally wring the moisture from turtle meat or fish and the spinal cords of fish contain watery fluid that can be sucked out. How thirsty are you � fancy eating fish eyes like grapes?

A Chinese man with incredible determination survived for 130 days at sea on an open raft. It was during World War II, after enemy forces sunk his ship in the South Atlantic. Poon Lim, writes Kamler, made fishing hooks from a spring inside his torch and by pulling nails from his raft with his teeth. He made fishing line from unravelled hemp rope. To collect water, he allowed the inside canvas of his lifejacket to become saturated when it rained.

In the Amazon jungle, Kamler describes how tribes evolve to endure the extraordinary challenges they face in this ancient forest. He writes of a seven-year-old boy who had almost severed his hand with a machete while working.

"An injury of this magnitude should cause intense pain .. . I hadn't heard him utter a word since I met him."

The boy only became hysterical when Kamler injected him with anaesthetic. "The reaction made sense from a survival viewpoint . . . Crying would not have been useful while he was in survival mode, but now the boy was in a protective environment."

Nor did the boy take the prescribed course of antibiotics, yet his wrist healed well in record time.

"The Indians believe in seeking cures from witch doctors or otherwise, but societal pressure prevents them from doting on a wound. The exigencies of the jungle simply do not allow it . . . Individuals adapting to their environment must also, therefore, adapt to the rules of the group that provides their protection ... In practical terms, the Indian boy has to learn to take care of his injuries himself because the tribe can't afford to do it for him for very long."

James Scott, 22, had snaffled two chocolate bars by the time he became well and truly lost. In 43 days, he sustained himself on melted snow balls and one caterpillar.

He suffered freezing conditions with minimal clothing, excruciating hunger and the despair of numerous failed attempts to spot him by helicopter. Scavenging birds kept a watchful eye over his deterioration. He lost one third of his body weight, so that his hands, when plunged between his thighs for warmth, found only thin air.

Scott had many factors working in his favour. He was young, fit, with a mental discipline and a musculature earned through six years of karate training. He was also in his senior year of medical school, which gave him a basic knowledge of how to manage his physiological needs.

To pace his rehydration, for example, he would read two pages of his book between each mouthful of snowball. Anything more would induce vomiting and severe cramping. He knew most body heat was lost through the head and used spare clothing to insulate it.

"Independent, inquisitive and active on their own behalf", these are the most likely qualities of exceptional survivors, according to the physiological case study of Scott's experience, published in the Annals of Internal Medicine in September 1997.

Survivors also develop a variety of coping mechanisms and imaginatively redefine stress in order to endure it. Scott occupied his time with detailed and lengthy recollections of pleasant times and drilled himself on the technical minutiae of karate manoeuvres. He repeatedly envisioned his rescue. He enveloped himself in the majesty of the mountains that cocooned him.

In conclusion, the case study admits that much of Scott's experience defies explanation. If only we could divine a scientific cure-all from Scott's own rationalisation, in his book Lost in the Himalayas.

"My attitude throughout the ordeal was generally one of hope and optimism . . . There is nothing extraordinary about me. Before this terrible event occurred, I would not have believed for a moment that I would be capable of overcoming such seemingly impossible odds . . . The lesson I have learnt � simplistic as it might sound � is that no difficulty is impossible to overcome . . . I am just an ordinary person who fell into an extraordinary situation."