X-Message-Number: 3140
Date: Wed, 14 Sep 94 15:39:31 CDT
From: 
Subject: CRYONICS Risks

David Pizer:

> But this is way too serious to jest.  Charles you apparently did
> not pay enough attention on remote standbys or else you would
> realize that you do not disobey the hospitals while they have
> POSSESSION of a patient.  If while they have possession of the 
> patient, the hospital says not to pack the patient in ice and you
> put some ice on the patient, the hospital may elect to not release 
> the patient to you for another 24 hours.  Or if they get angry at
> you they may ask for an autopsy. 

> One thing that Mike Darwin taught us (in the old days) in the
> transport course I partially attended is not to offend the hospital.
> It's ok to argue strongly for the benefit of the patient but when
> you start packing ice on a patient that they told you not to touch, 
> they are going to call security and you are going to be thrown
> out of the hospital at once.

	In 1991 while acting as team leader during the transport of 
Alcor patient A-1324, I flagrantly disobeyed hospital directives 
concerning this patient.  Specifically, I packed the patient in ice, 
restored breathing and circulation with a noisy HLR, and 
administered half a dozen intravenous medications right on the 
floor of the ICU immediately following cardiac arrest.

	Why did I do this?

1)      Doing so made the difference between 9 minutes and 30 
minutes of warm ischemic time.  This is the difference between a 
brain that is marginally recoverable by current medical criteria, 
and a brain that is so swelled and clotted that cryoprotective 
perfusion would be problematic.

2)      The people who issued the directives I was violating were 
hospital administrators from another building who had long since 
gone home for the evening.  The doctors and nurses present in the 
ICU were all friendly and sympathetic.  I doubted they were even 
aware of any directives concerning post-mortem handling of the 
patient.

3)      Since this hospital was remote from Alcor, with few other 
Alcor members in the area, it was unlikely Alcor would have to 
deal with this hospital again for some time.

	What were the consequences?

1)      The patient was the first patient to ever arrive at Alcor from 
out-of-state and not suffer any cerebral edema during 
cryoprotectve perfusion.

2)      I received nothing but praise for my decision to apply prompt 
stabilization to this patient.  The fact that I violated hospital 
directives by doing so was highlighted in extra large print in 
Cryonics magazine.  Everyone at Alcor knew I did it, and I did not 
receive a single word of criticism.

3)      Dave was right about one thing.  The hospital did call 
security to escort us out.  They did so at my request, using an 
"emergency only" elevator to further expedite the cryonics care of 
the patient.  As I anticipated, there were absolutely no later 
repercusions from my actions, and I don't anticipate there will ever 
be any (unless perhaps David Cosenza faxes the hospital a copy of 
this message).

	The one point I would like to get across concerning this 
whole "risks" debate is that there is no such thing as cryonics 
without risk.  There are always risks to the care of the patient, legal 
and health risks to the team, legal and financial risks to the 
organization, and, yes, risks to patients already in storage.  The art 
of cryonics is to balance these risks on a case-by-case basis using 
one's best possible judgment.  Thinking risks in cryonics can be 
eliminated (or best balanced) by sticking to hard and fast rules like 
"Thou shalt always genuflect to the hospital administrator" is an 
illusion.

	I will go further and say that cryonics is so new that its 
virtually impossible to do cryonics without breaking somebody's 
rules, directives, or laws.  (Warning: Anyone who ever quotes the 
preceeding sentence outside the context of this paragraph will be 
subject to early cryopreservation.)  For years Alcor was storing 
whole body patients in violation of the California DHS's 
interpretation of the law.  In fact, if Bob Ettinger is right about 
only pathologists and licensed morticians being allowed to cut or 
inject a "corpse," just about everyone involved in the care of 
cryonics patients is breaking the law.      

				--- Brian Wowk
				    Patient Care Director of CryoCare 
				    (but speaking only for himself)                        

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