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HEALTH

The miracle of Audrey – The English teacher brought back from the dead in Spain

Just over a month ago, Audrey Mash was, for all intents and purposes, dead. And for six hours she had no heartbeat.

The miracle of Audrey - The English teacher brought back from the dead in Spain
Audrey Mash alongside one of members of her rescue team. Photo: Vall d'Hebron

But on Thursday her case was presented at a hospital in Barcelona as a survival story that could change the way hypothermia is treated.

The 34-year-old Briton had been on a trip to Vall de Núria in the Catalan Pyrenees with her husband Rohan Schoeman to celebrate their sixth anniversary and the pair had set off early from a mountain hut for a day hiking in the snow.

But the couple, who mived to Barcelona in 2017, were caught in a snowstorm and as temperatures plummeted they lost their way and sheltered from the wind and the cold crouching in the lee side of a rock.

For several hours the pair clung to each other for warmth waiting for the weather to clear, but Audrey’s body temperature dropped and she started behaving strangely.

“She started talking nonsense,” her husband recounted to La Vanguardia newspaper. “Then she stopped talking altogether and just made grunts, and then she stopped moving and slipped into unconsciousness.

“Her eyes sort of rolled back and she breathed what seemed to be her last breath,” he said. “I look for a pulse but I found nothing, no sign of life.”

Rohan had already raised the alarm, sending friends’ pictures of their location, and at 3.40pm on the afternoon of November 3rd, a rescue team finally reached them.

But by now, Audrey was turning blue and her body temperature had dropped to 18C and she had entered cardio-respiratory arrest.

Many may have given up hope and given her up for dead but thanks to quick thinking by the rescuers who believed that there might still be a possibility of survival, if they could only get her to the hospital and to the right team, she was airlifted to hospital and arrived at the Vall d’Hebron in Barcelona shortly before 6pm.

Eduard Argudo, an intensive care doctor specializing in hypothermia had just finished a 24 hours shift at the hospital that morning but immediately rushed to meet the helicopter as it arrived.

“I saw a young woman in cardiac arrest and no sign of life. She was pale and blue, with a body temperature of 20.2C. The only good thing is that she was so cold because everything else looked very bad indeed,” the doctor told a press conference at the hospital on Thursday.

She had no vital signs, her heart was showing no electrical activity and her kidneys and lungs were not functioning. In most cases, the story would have ended there.

But not at the Valle d’ Hebron. The patient was immediately placed on an extracorporeal membrane oxygenation (ECMO) machine which oxygenates the blood and gradually warms it to increase body temperature while the heart remains stopped.

“We didn't know if it would work but it was the only option,” says Argudo. “Although we knew there was a risk of neurological damage”.

When she warmed to 30C the doctors tried to defibrillate and get the heart beating on its own. It finally started to beat autonomously at 9.46pm.

On Thursday a smiling Audrey Mash sat beside her husband surrounded by the dozens of people who were involved in her rescue.

 

(In the picture above you can see Audrey on the far left next to her husband and the bearded Dr Eduard Argudo).

Her doctor said part of the reason she survived was due to the hypothermia.

“The hypothermia killed her but also saved her at the same time. With the cold, the body's metabolism slows down, the organs need less blood and less oxygen and that helps protect the brain,” he explained.

“She was able to recover because the brain cooled rapidly and its need for oxygen was reduced before cardiac arrest,” he explained, adding that it helped that she was a fit young woman who regularly runs marathons. 

“When cardiac arrest first occurs and then cooling, as usually occurs in avalanche victims, the prognosis is very bad. But when it is hypothermia that causes cardiac arrest, as in the case of Audrey, we must try to save the victims because survival without serious consequences is possible. ”

Audrey said she has made a full recovery, apart from a numbness in her fingers.

“I didn’t realize that my life was in danger until I woke up in hospital,” Audrey told the press on Thursday.  

“The medical attention has been fantastic.”

“I feel so incredibly grateful to be alive, to all the doctors, medics, rescue teams who went above and beyond their duty to save me. I'm incredibly lucky,” she said. 

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HEALTH

When can doctors in Denmark refuse to continue treating patients?

General Practitioners in Denmark have the right to break off a patient-doctor relationship in specific circumstances.

When can doctors in Denmark refuse to continue treating patients?

Although doctors in Denmark have the right to decide not to continue treating a patient – requiring them to find a new GP – the circumstances in which this can happen are limited, and must be approved by health authorities.

The frequency in which the circumstances arise is also low. A doctor decided to no longer receive a patient on 375 occasions in 2016, according to the medical professionals’ journal Ugeskrift for Læger. The following year, newspaper Jyllands-Posten reported the figure at 458.

There are two main categories of circumstances in which a doctor can choose to take this step. The first is in instances of violent or threatening behaviour from the patient towards the doctor. 

The second (and most common) is when the doctor considers the relationship to have deteriorated to the extent that confidence has broken down, according to Ugeskrift for Læger.

It should be noted that patients are not bound by any restrictions in this regard, and can decide to change their GP without having to give any justification.

A patient also has the right to appeal against a doctor’s decision to ask them to find a new GP. This is done by appealing to the local health authority, called a Region in the Danish health system.

In such cases, a board at the regional health authority will assess the claim and if it finds in favour of the patient may order the doctor to attempt to repair the relationship.

Doctors cannot end a relationship with a patient purely because a patient has made a complaint about them to health authorities. This is because patients should have the option of making complaints without fear of consequences for their future treatment. 

However, if this is accompanied by the conclusion on the doctor’s part that there is no longer confidence in them on the part of the patient, they can remove the patient from their list.

The right to no longer see patients in the circumstances detailed above is provided by doctors’ collective bargaining agreements, the working conditions agreed on between trade unions and employer confederations under the Danish labour market system.

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