X-Message-Number: 2323
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Subject: CRYONICS Reply to Mike Darwin (CRYOMSG #2306)
Date: Fri, 2 Jul 93 12:48:47 PDT
From: Tanya L. Jones, Suspension Services Manager, Alcor
Subj: Response to Mike Darwin's letter to the Editor of *Cryonics*
(CRYOMSG #2306)
I believe that the most appropriate place to post this response is
the politics section of CryoNet, but I also think my response should
appear in the same forum as Mike's letter.
All cryonic suspensions performed by the Alcor Foundation are
reported in *Cryonics* magazine. These reports serve to illustrate the
realities of cryonics *today* for Alcor clients and potential clients, and
have long been an aspect of Alcor's commitment to improvement. From the
first paragraph I ever wrote for *Cryonics*, I have striven to uphold and
perpetuate this commitment by preparing honest and open articles.
Preparing objective suspension reports for publication has been a
challenging aspect of my job. Of the suspension articles I have written,
the most recent one (June, 1993 *Cryonics*) was also the most rigorous.
Objective examination of any suspension is always critical to improving
the quality of cryonic suspensions, and this was my first suspension as
the Suspension Team Leader. I knew that a comprehensive examination would
be a direct reflection of my job performance, and that *any* examination
had the potential to provide me with methods for future improvement.
Everyone who reads that article will have a unique perspective to its
content. Some people who have already read it found details which
appeared inaccurate or incomplete, and some of them quickly responded by
requesting those missing details. I've answered several calls from
members with questions about the content of my article. One similar
inquiry came from Michael Darwin.
When Mike read about bleach (lithium hypochlorite) contaminating the
perfusion circuit, he was justifiably disturbed. My article contained
information about the nature and the origin of this problem, and my
article contained a method for preventing its re-occurrence, but it didn't
address the question Mike felt most important: *How did this affect the
patient's ultimate condition?* My only response to this question (in the
article) was "We are still awaiting test results which will give us the
information necessary to determine the extent of the damage (if any)."
Mike's concerns prompted him to call Hugh Hixon for further information.
Hugh was unable to immediately answer all of Mike's concerns to his
satisfaction. Next, Mike called Steve Bridge to question *him* about this
situation. Steve's answers were also deemed "totally unsatisfactory."
Mike then wrote a letter to the Editor of *Cryonics*, because he believed
that Hugh and Steve were underestimating the seriousness of this problem,
and that this was a mistake. In this letter, he detailed his frustration
at being unable to obtain more information from either one (some of Mike's
frustrations might have been better addressed had he called the Suspension
Team Leader --me-- with his questions), and followed with assertions that
this reflects a fatalistic attitude toward performing quality control for
suspensions.
Unfortunately, this isn't indicative of a fatalistic attitude. It's
indicative of more serious problems.
Historically, Alcor employees have been overworked and underpaid.
Although these are usually motivators which cause a reduction* *in
individual job performance, their negative effects are usually countered
by the intrinsic motivation of self-preservation. Usually, but not
always. The fact is, working at Alcor is stressful and demanding. Every
staff member occasionally feels overwhelmed by the magnitude of his or her
responsibilities. With little or employee, even the occasional critical
task may be found to have slipped through the cracks. critical task
slipping through the cracks.
Hugh Hixon is the only employee with the necessary training to
meaningfully perform such investigations, and he was arranging his post-
suspension work according to *his* priorities. He'd carefully planned an
approach to assessing the cause and effect of bleach in the circuit, but
other tasks intervened.
In some respects, I am glad Mike called Hugh about the article,
because with one phone call, he accomplished something I'd failed to
achieve after repeated requests: Hugh stopped *talking* about how he would
investigate the failure mode of the oxygenator and the subsequent bleach
contamination, and he began *doing* it. His investigation was methodical
and comprehensive.
Long before he physically examined the oxygenator himself, Hugh
discarded the idea of using an external investigator, like Mike suggests.
His reasons included: that independent investigations are usually
initiated to seek out manufacturing or design deficiencies; and that
corrosion by a powerful disinfectant falls outside the standard arena for
external examination. The bludgeoning of an oxygenator with lithium
hypochlorite in the pursuit of cryonics was not so subtle a failure mode
that it demanded outside investigation.
Still, what happened to the oxygenator? The label from the bottle of
bleach recommended that the granules be dissolved before adding them to
the water (in our case, water in the patient ice bath). This wasn't done,
thus, granules were pulled into the ice-water circulation, then into the
stainless steel coils of the heat exchanger. Because the granules remained
undissolved, they lodged inside the tiny coils and began eroding the
metal. This erosion resulted in a few tiny holes, and subsequently,
seepage between the sterile and non-sterile sides of the circuit. By
studying the flow of water through the oxygenator over a 24 hour period,
Hugh discovered the total leakage of contaminated water was less than
20ml.
To address the question of *patient* contamination, lithium analyses
were conducted using samples from the transport and suspension. As both
Hugh and Mike realized, they would be a good indicator of the
contamination levels in this case. Lithium levels of 0.5-1.3 mEq/l are
seen in individuals using lithium to combat clinical depression and a
clinical test was readily available. The results were that no lithium was
detected in our samples, with the lower limit of detection being 0.10
mEq/liter. Hypochlorite damage was also investigated, and Hugh found that
much higher concentrations of hypochlorite than infiltrated the perfusion
circuit were completely neutralized within 10 seconds of exposure to the
washout solution. Given the flow rates used during the perfusion and the
volume of fluid held by the oxygenator, it appears that little or none of
the hypochlorite reached the patient. The damaging agents spent
sufficient time within the oxygenator circuitry to enable complete
neutralization by components in the washout solution.
The preliminary results of Hugh's examination are encouraging, and
have given us the means by which to never repeat this incident. (Once
complete, his examination process may be detailed in a future posting to
CryoNet or in *Cryonics* magazine.) In my article, I stated that bleach
granules will be pre-packaged for suspensions. Now we know that this was
an inadequate solution, and that the disinfectant should be pre- packaged
and *pre-dissolved*.
I believe the above should answer most questions about the perfusion
of bleach into our patient. Now I would like to address another aspect of
Mike's letter.
Mike believes that the encouraging tone of my article was
inappropriate. He submits that the perfusion of bleach was a "biomedical
disaster that in a normal clinical setting would be a cause, not for
rejoicing, but for profound grief and soul-searching." In this, he is
absolutely correct; however, a cryonic suspension does not constitute a
normal medical setting, and I believe that hospitals typically minimize
their staffs' exposure to free-flowing, AIDS-contaminated fluids in
anything except an extraordinary emergency.
It's unfortunate that our patient was involved in a new failure mode,
but I have found profound grief and soul-searching (as advocated by Mike)
to be an unproductive combination, and have therefore preferred to address
damage assessment and solutions rather than the berating myself or poorly-
trained but willing volunteers.
The entire tone of my article is one of encouragement, because in its
entirety (as opposed to dissecting details) it answered an essential
unknown. This suspension demonstrated that Alcor is able to perform
cryonic suspensions without the services of Mike Darwin, and even the
mistakes which surfaced during suspensions with Mike's participation were
largely avoided. It is my opinion that Alcor can and will continue to
successfully perform cryonic suspensions, and that for a long time to
come, each one will teach us more about how better to provide this service
to our clients. If this isn't encouraging news to Alcor's membership, I'm
at a loss for what to say.
My approach to learning how to fulfill the terms of my job
description (Suspension Services Manager: "administer and improve cryonic
suspensions," is the short version) has stemmed from a business
background. Jerry Leaf spent time documenting protocols for cryonic
suspension (over a decade ago), and those protocols were removed from
Alcor by Cryovita and weren't available for me to study when I began
learning about suspensions. Neither was Mike Darwin available to provide
any of the complex protocols (with the notable exception of his transport
manual) he mostly maintained in his head. When both men's services were
lost to Alcor, *no one* had the ability to coordinate a cryonic
suspension. It eventually fell to me to learn.
My education is not yet complete, but an extensive portion of it has
been documented. Should I ever leave this position, much of the
information necessary to train a new person would be quickly retrievable.
This gives me more hope for a better suspension, should my death be the
cause of my departure. Additionally, it gives Alcor more discretion in
evaluating my performance.
On a final note, the most effective portion of Mike's investigation
into the bleach/damage assessment (from my perspective) was his telephone
call to Hugh. Whether or not the timing was coincidental, Hugh began his
investigation almost immediately after learning that others were
interested in the results of an investigation. It's unfortunate that
Mike's letter expressed his accusatory conclusions, rather than his
questions, in a manner which didn't exactly promote cooperation toward
finding answers or solutions, but instead encouraged defensive responses
to his criticisms. Mike raised important issues, however, his presentation
of those issues was unnecessarily abrasive. I have spent a significant
amount of time preparing this response, hoping to avoid inflammatory
comments by concentrating on the *issues*, and my task was made more
difficult by the numerous obfuscating phrases which were colored to evoke
an emotional reaction to Mike's position (and subsequently, Alcor's
inadequacies), as opposed to a rational response to the very real issues
he brought forth.
I do appreciate an opportunity to respond to questions and concerns
about the quality of suspensions Alcor is capable of providing (or has
provided), but I prefer those communications be reasonable exchanges.
They tend to produce more productive results. If anyone else had concerns
about the tone of my article, I hope this has explained my approach to
reporting this suspension. Feel free to contact me with any further
questions, comments, or suggestions.
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