X-Message-Number: 2344
From: 
Subject: CRYONICS Response to Darwin CRYOMSG #2332
Date: Tue, 13 Jul 93 17:31:52 PDT

From:  Tanya L. Jones
Subj:  Another response to Mike Darwin

I'll begin this response by rescinding my previous opinion that this 
exchange belonged in the politics section of the CryoNet.  Now that I 
better understand Mike's motivations for placing it into the full forum, I 
must concur that the wider audience is preferable.

I would like to begin with one of the erroneous statements that Mike made 
in his response.  In paragraph five, Mike claims "Tanya and Hugh were 
invited (and were, according to Steve Bridge) going to come over to 
Biopreservation and go over this data with me, however this never 
occurred.  This notwithstanding, this is what I do know went wrong."  To 
these statements, I have two answers:  first, to the best of my knowledge, 
I have never been invited "to come over to Biopreservation" for any case-
history discussions.  Steve and Hugh have also expressed a lack of 
knowledge regarding scheduled discussions of this nature.  This appears to 
be another attempt to discredit one of the few remaining individuals in 
Alcor today who advocates seeking a cooperative relationship with Mike's 
companies!  By assigning blame for an apparent miscommunication to Steve, 
Mike casts aspersion on a man who truly wants to help him.

My second answer to this fifth paragraph is more appropriately expressed 
in the form of an incredulous question:  If no one discussed the *data* of 
the suspension with Mike, and by all accounts, the verbal information he'd 
received from some of the principles of the team involved in that 
suspension was inadequate, and he discounts my written descriptions and 
explanations as well, then how can he say that "this is what I do *know* 
went wrong?" (Emphasis mine.)

Mike's proclaimations that we had "a very poorly organized response to a 
cardiac arrest" couldn't be more exagerrated.  I've already discussed the 
specific deficiencies of this aspect of the suspension.  When Naomi and I 
arrived at the hospital,  everything was in place to move the patient into 
the ice bath (ca. 12 minutes elapsed time between his arrest and our 
arrival) and only transport team members' backs and arms were lacking.  
All notifications to the rest of the team had already been made;  the 
mortician's assistant was signing the papers for discharge;  in remarkably 
short-order, given the bureaucratic constraints, we ran out the door with 
our patient.  What I saw was a fairly capable response to an emergency.  
Mike wasn't there;  perhaps had he been, his perspective would be somewhat 
different.

Mike also asserts that the blood gas machine was inoperative.  That is not 
a true statement.  What we lacked for sample-processing were hands trained 
to operate this device.  Besides Hugh Hixon, two other individuals have 
the proper training to operate the blood gas apparatus.  We'd just left 
one in northern California after the stand-by, and the other (a southern 
California alternative) was unavailable.  Hugh, at the time, had more 
pressing duties than sample-processing.  (*Please,* take this assessment 
at exactly face value, and don't use it to infer any disregard for 
physiologic assessment or data acquisition.)

With respect to the photograph on page 19:  the photo was taken before the 
tubing was secured in the holder (and the large, rectangular object in the 
surgical field near the bottom of the photograph is a tubing holder).  It 
may be improper 'darwinian' procedure for tubing to be connected and 
cross-checked *before* clamping it to the table, but it was the way our 
surgeon chose to verify the viability of the circuit.  The tubing was 
secured once it had been determined that the connections were correct.

Later, Mike once again demonstrated his clairvoyance by asserting "it was 
not the bleach, but the loss of a large fraction of circulating volume to 
the table top, which in turn increased the steepness and terminal 
concentration of the glycerol introduction ramp."  Nope.  Wrong again.  It 
was the significantly *smaller* circulating volume which made this an 
issue.  With only five liters and some change, Ralph had very little 
maneuvering room for determining flow rates.  It is to his credit, and to 
Jay Skeer's who was assisting Ralph, that the cardiotomy suction was 
operable *before* major volume had been lost or an inexcusable 
introduction of air into the patient occurred.  Also, the highest 
perfusate concentration ever used, in conjunction with steeper ramp rates, 
contributed to the steepness of the final curve.  In the future, the 
cardiotomy suction will be set up in advance of the cryoprotective 
perfusion, and this won't again become an issue.

On to the Cryovita manuals.  Some basic arithmetic for starters:  Mike 
left Alcor in December.  These manuals left Alcor "when Paul Wakfer 
finally removed it [sic] last June."  Six months now apparently 
constitutes "a period of nearly a year."  (If six months is almost a year, 
than it may also be referred to as "almost and hour.")  Additionally, in 
such a short time, I am now expected to have understood that *any* 
manuals, even those which were a decade out of date, might be useless(?) 
in an almost exclusively undocumented field.  I did look through the 
manuals at one point, and I found that my time was still better spent 
putting out the brush fires connected with the aspects of a suspension 
with which I was already familiar.  I never had an opportunity to return 
to examination of these manuals before they were removed.

(An aside on Paul Wakfer's assertions that all I had to do was ask:  I 
have asked Paul for Cryovita documentation in the past, and have yet to 
receive a single photocopied page.  I found his promises for information 
from an extensive Cryovita file on pH, among others, to be empty.)

Mike later calls upon Edward Sylvester's portrayal of Dr. Robert Spetzler 
of Barrow's Neurological Institute to advocate "profound grief and soul-
searching," implying that even "consummate neurosurgeons" routinely employ 
this as a method for evaluating, post-operatively, performance.  I found 
it rather typical that Mike significantly truncated the portion he chose 
to quote, and that the text he removed unmistakably demonstrated that this 
was not Dr. Spetzler's position.  From page 14 of THE HEALING BLADE, the 
less reduced text reads:  "And then after a full repose of nightmares, you 
go in and do the procedure, *calm and cool, truly the most confident human 
alive.*  Procedure is the key word to neurosurgery."  I found no mention 
of Dr. Spetzler employing the profound grief that Mike discusses in 
anything except his pre-operation nightmares and his waking response to 
those dreams.  In fact, Dr. Spetzler (through Edward Sylvester) 
specifically denounces the approach of strong negative emotion, which he'd 
seen his exalted predecessor, Harvey Cushing, utilize.  A resident was 
quoted with the following description of Cushing (p.90):  "He was an 
extremely hard man to work with, whether one was over him or under him, as 
his tremendous ambition for success made it impossible for him to allow 
anyone else to get any credit for work done. . . . [W]hen he wanted to be, 
he was one of the most charming people in the world. . . ."  Cushing 
instituted many advances to medicine, yet he was a man referred to as a 
tyrant.

Dr. Spetzler's opinion of Dr. Cushing was summarized on p.129:  "Cushing 
was intolerant of the people who were residents.  He took the attitude of 
treating them as lesser human beings.  He addressed them as underlings, 
and then once in a while to make up for it gave them a pat on the back, or 
invited them for tennis or dinner.

"But it was an abusive system, and that carried over for many years.  
There are currently still a significant number of individuals who are in 
training positions carrying out that philosophy. . . . It's a philosophy I 
personally couldn't be more diametrically opposed to, a philosophy I've 
found exceedingly distasteful whenever I encountered it."  I  felt this 
clarification necessary due to the relevance of the omission in Mike's 
excerpt.

I will not presume to respond to his paragraphs about previous occurrences 
of tying the pulmonary artery;  I intend to thoroughly examine the past 
case histories before making any further comments on this aspect of the 
procedure.

Finally, I will thank Mike for clarifying the level of detail which, 
apparently, should accompany every article discussing a cryonic 
suspension.  In the future, I will also be careful to not misuse the term 
"perfuse" merely because I haven't clearly delineated the distinction 
between "vascular perfusion" and the "equilibration of cryoprotectant 
across the cell membrane".  My apologies to anyone who misinterpreted my 
statements.

I thank those who listened to (read) what I've written with an objective 
ear and those who have called or written with words of support or 
encouragement as the result of this exchange.  Your time and kindness are 
appreciated.

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