I was quite a morbid child. I was obsessed with the concept of ‘not being’. I wasn’t ‘wanting to be dead’, I was merely amazed by the idea that my intense sense of consciousness could ever simply ‘not be’. I used to shut my eyes, hide under the bedclothes and try to imagine ‘not existing’. It was thrilling and horrifying and I could only keep it up for a short time. I later became fascinated by Frankenstein films and then the novel, intrigued by the idea of an inanimate body becoming live. I was always thrilled at the moment when life was imbued into the assembled body parts, with a shot of fizzing electricity. Dr Victor Frankenstein was obsessed with pushing the boundaries of life and death: ‘I will pioneer a new way, explore unknown powers, and unfold to the world the deepest mysteries of creation.’

So, when I was looking for a plot for my second novel, I was instantly fascinated when I stumbled upon the unusual medical phenomenon of being clinically ‘dead’ after a heart attack in freezing temperatures, but where there is still a window of opportunity to be brought back to life many hours later. At extremely low temperatures, the organs, including the brain, need drastically less oxygen, so someone who is ‘dead’ can sometimes be slowly warmed up and their heart restarted, even up to 6 hours later, and they can be ‘brought back to life’. A common saying amongst doctors who deal with this condition is ‘you’re not dead till you’re warm and dead.’ This was the starting point for my novel The Saved. I wanted to dramatize the condition and consider whether someone would be changed by this extreme experience and what effect it would have on their loved ones.

It was an engrossing subject to research. There are many famous examples of this apparently fantastical occurrence. In 1999 a Swedish radiologist called Anna Bågenholm was skiing in the mountains outside Narvik in Norway with colleagues. She lost control as she hurtled down a steep slope, at the bottom of which was a frozen stream. She slammed into it at 18.20pm, the freezing water sucking her under, leaving only her skis visible. She was trapped under a layer of thick ice, at first in an air pocket, but then her heart stopped beating after 40 minutes due to the extreme cold. She was finally pulled out after 80 minutes, pupils dilated, no breath, no heartbeat, clinically dead. Her temperature was 13.7 °C (56.7 °F), one of the lowest survived body temperatures ever recorded in a human with accidental hypothermia. She was given CPR and transported by helicopter to Tromsø University Hospital, where a team of 100 medics worked on her to bring her back. She was put on pulmonary bypass, her temperature raised slowly and her heart started beating again at 22.15pm. She woke up ten days after the accident, paralyzed from the neck down and was at first traumatised that she’d been saved to live in this state. But after months of intensive therapy, she eventually recovered completely except for minor nerve damage to her hands and feet and returned to work five months after the accident. She was glad to be alive and as a scientist herself, was amazed by what she had survived.

Then in 2011, a group of thirteen teenagers and their two teachers were twenty minutes into a boat ride on Præstø Fjord, off the island of Zealand in Denmark. Their boat capsized in bad weather. and they were all submerged in the freezing ice-crusted water. As they surfaced, all screaming, their teacher shouted at them to swim towards the shore to save themselves. Several made it back but seven youths had heart attacks in the extreme cold. They were all clinically dead and floated in the water for two hours before being retrieved, ice cold. They were rushed to hospital, warmed up 1 degree per 10 minutes and their hearts started again at 26 degrees, six hours after they had stopped. They were in comas and on respirators. No one knew if they would wake up. But eventually they all regained consciousness and had no abnormalities in their brain scans. They are the largest group of accidental hypothermic patients ever to be resuscitated together. As one of the survivors said: ‘When you have nearly died, it is a little bit different … I have learned what’s important and what’s not important … what is worth fighting for.’

Thirdly, in 2019 the English teacher Audrey Schoeman, 34, was hiking in the Spanish Pyrenees in November with her husband, when they got trapped in a snow storm. She had trouble speaking and moving and soon her husband realised that she had no heartbeat and he believed that she was dead. The emergency services arrived two hours later when her temperature had dropped to 18 degrees Celsius. She was taken to Barcelona’s Vall d’Hebron Hospital, clinically dead. Her blood was gradually warmed, outside of her body, and fed back into her and at 30 degrees her heart was restarted with electricity. Twelve days later she walked out of the hospital, with only minor mobility issues and hand sensitivity. And determined to hike again!

These examples and many more, have driven the developing science of ‘therapeutic hypothermia’, when heart attack patients are wrapped in cooling blankets, while medics attempt to stabilise their bodies without causing irreversible damage to their organs in the process. We used to think of death as moment in time, a clear cut off in the physical processes, when the heart stops beating. But these new scientific advances show that death is far from a clearly defined end point, but rather, a process. And if death is a process, we can step in and change the course.

These examples also show how cautious we have to be before diagnosing death in people who are very cold. All those individuals were clinically dead but extremely, hypothermically, cold, so they could all be warmed up and their hearts restarted. They all eventually returned to normal life – though with a new perspective on life. When people go through extreme life or death events, they sometimes change personality entirely, give up their jobs, or leave their partners. This can be due to an underlying ongoing injury, PTSD, or an abrupt change in perspective from their near catastrophic event. And the family surrounding the event are often themselves traumatised by what has happened and by how their loved ones have changed.

I hope you enjoy my novel, which explores this occurrence and uses the reactions of loved ones for dramatic effect. I made Nancy, the heroine of my novel, into a film editor who is working on a modern film re-telling of Frankenstein. In the original novel, Dr Frankenstein describes his own fascination with the boundary between life and death, but also the cost of exploring this realm: ‘Life and death appeared to me ideal bounds, which I should first break through, and pour a torrent of light into our dark world. Who shall conceive the horrors of my secret toil, as I dabbled among the unhallowed damps of the grave, or tortured the living animal to animate the lifeless clay?’