X-Message-Number: 4546 Date: 24 Jun 95 20:14:10 EDT From: Mike Darwin <> Subject: Contract Termination Guy Gibson asks still more questions about the ACS contract termination. Fortunately most are straightforward and easy to answer. I will start out responding to a quote from Mr. Gibson, and then number the rest of my responses: >While I fully appreciate the need for research and attention to it, >everyone needs a refreshing break from time to time, and I would think a >suspension would provide that. Mr. Gibson, I am known by and thought of by many as a tactless and insensitive man. Since so many people hold this opinion of me, I find myself compelled to agree that there must be some truth to it; despite my best efforts to muzzle these traits. Recently, as one disappointment in dealing with others has followed another, I have just decided on giving up on not trying to be an "tractless and insensitive monster" and just be one -- openly and from the start. That way, no one is misled and everyone has informed consent and knows from the start the road they are starting down. Now, with * that* prelude in place, I will respond to your quote above. My first response was hysterical laughter which actually brought tears to my eyes. Quite honestly (and no offense intended) I have not read anything so funny since, as a rather warped child, I came across the quote "Other than that Mrs. Lincoln, how did you enjoy the play?" Or, it's more modern counterpart: "Other than that Mrs. Kennedy, how did you enjoy your stay in Dallas?" You say "everyone needs a refreshing break from time to time" when speaking of "suspensions". I will try to compensate for the fact that you are relatively new to this list (I presume) and to cryonics. But I feel compelled to say that this is one of the single most insensitive and unthinking remarks I've ever had pointed my way, and brother, believe me, when you carry the baggage I do, that's saying something! A fair percentage of the people I have cryopreserved have been my friends or colleagues. I have held the severed head of a man I deeply admired and loved in my hands after watching him die inexhorably, and in unrelieved agony, of AIDS. With one or two exceptions, I have been very close to all the people I've known who I've cryopreserved, and even in those cases where the relationship was fractured or imperfect at the time I gave them care, deep bonds of shared grief, joy, and accomplishment still connected us and always will. In others words, despite our differences I felt and continue to feel love and loyalty for these people. In cases where I have cared for patients "already down", who I did not know before we "met" in the operating room, hospital, mortuary etc. it is rare that I have not been overwhelemed with compassion and developed a strong bond of feeling with them. In several cases I have gone to great personal inconvenience and spent thousands of dollars of my own money to rescue a few such people who I did not "personally" know; but whom I had cared for; because I considered I owed them a debt of gratitude for the knowledge my "caring" for them gave me, and because it would have been a negation of all the work and love I put into trying to rescue them had I failed to do so. It would have reduced their and my struggle to a pointless exercise, redeemed only modestly by autopsy data (if lucky) and what I learned in "doing the case." These are NOT satisfactory reasons for me to go about, willy nilly cryopreserving people. My background and my ethos is largely from medicine, and one does not abandon patients once you have begun their care unless your own welfare (life) is rather directly jeopardized. There are corollaries that flow from this: a) First, do no harm. This simple statement is, in my opinion, the guiding beacon of medicine. However, despite its simplicity it is one of the most complex of all dictums to practice, let alone practice well. b) A corollary of a) is: Don't take patients you cannot help or whom you will actively harm. This includes family in many cases since they are making arrangement for loved one or intimately involved in cryonics with them. A good surgeon who takes cases where there is no money to pay for the full course of treatment and then puts his patient out on the sidewalk following a brilliant and successful surgery (and a paid for one!) instead of in the ICU because the patient can't afford further care, is an asshole and is NOT a good physician. c) A physician who is competent and compassionate but who takes more patients than s/he can handle responsibly or who takes patients in circumstances where a good standard of care is not possible, ceases to be a good physian at that instant. But, I get ahead of myself. Fundamentally, leaving my personal feelings aside, the notion of a grueling and often terrifying rush to a dying patient's bedside (praying you'll make it in time, and that prognosis is not as grim as you were told), the USUAL ensuing days or weeks of waiting while the patient rallies, the long hours of turning the patient, cleaning up urine and feces, helping with linen changes and bed baths, comforting family members, doing household chores for exhausted family so they can sit with the patient, the 4:00 AM awakenings to a crisis which may pass or may not; with it being MY judgment call as to whether "this is really it" or whether it is false alarm (and thus whether to mobilize the team or let them get some much needed additional rest so they ARE ready for the emergency when it comes), and finally, watching someone lay there, often in pain, and gasp for air, sometimes for hours -- watch them, while still LEGALLY alive develop postmortem changes like dependent lividity or even rigor mortis in outlying extremeties.... these are most assuredly NOT "a refreshing break from time to time." Nor is being up 72 hours straight, sleeping on concrete floors in garages with just a blanket under and over me (at 50 F), flying in a plane that dangerously is overloaded with dry ice and people, seeing a close friends gutted like a side of beef after an autopsy with even her throat organs and tongue removed or confronting family members who hate your guts, wish to stop their loved from being cryopreserved, and generally behave as complete monsters towards you a "refreshing break." Only a totally warped asshole or grosslty ignorant person could see this things in this way. I will extend you the courtesy of the latter catergory: an ignorant person who said something he shouldn't have. Ignorance, by the way, is no great sin. It can be fixed by knowledge. In this case the information you need to remedy the ignorance is right here in this post. Stupidity is another matter altogether, however I see no evidence that you are a stupid man and will let matters lie as "case closed" on this remark once this post is completed. Now, as to your other questions: 1)"If BPI is involved in research that is *so* important it is on the verge of some immense breakthrough, or whatever, what is supposed to happen to the poor ACS signup who happens to deanimate in the interim between contracts (assuming a new one happens sometime, which both parties said they would like to see occur)?" No one is a slave. And only a fool allows his reach to exceed his grasp. ACS has other options which it can follow, one of which would be to contract with, or have its members join Alcor (not recommend by me) the other of which would be to get its members to PAY THE REAL COSTS OF SELF SUFFICIENT SERVICE AT A LEVEL THEY FIND ACCEPTABLE. As both Jim and I have stressed, this is something I will gladly help ACS with, and it is quite a different kettle of fish than doing UNSCHEDULED work that may take me away from a contractor who TRUSTED ME to work for him/her for an unspecifed period of time resulting in serious business injury to the customer, potential (and likely) loss of animal life, and loss of money to me and my associates for payment of nonperformance penalties. Training and equipping I can schedule and I can delegate. Doing human cases I cannot. Further, ACS has pursued closer ties with Alcor and, it seems(ed) likely to me that they want assets which Alcor has which I cannot give them: access to a technically competent person who can help them achieve independent capability in doing cryopreservations at low or nor charge because he has been added to the ACS Board (i.e., Keith Henson, who is also an Alcor Director), and perhaps most importantly, access to Alcor rescue people for emergency response the Bay Area. So, they have hardly been abandoned, and I even offered in my termination letter to extend the "deadline" for a modest but reasonable period of time to allow them to put interim coverage in place with the help of myself, Keith Henson and/or others. Finally, our operation, providing we DO NOTHING but pay the marginal costs of mortgage, heating/AC, animal care/feeding, insurance, taxes, etc. costs about $15,000 EACH MONTH. Trust me when I say that there aren't any cryonics organizations out there who either can afford to (or if able to would) pay those kind of expenses. Thus, when I see the opportunity to get some of those expenses addressed and acquire personnel, equipment, and cover basic operating costs so I can pursue brain cryopreservation research, I'm going to take it. It doesn't do me, ACS, the patient, the members or ANYBODY (except people who hate me and my associates) any good if we go belly up. You go on to say: "If BPI is involved in research that is *so* important it is on the verge of some immense breakthrough, or whatever..." Actually I think we are doing work that is of that magnitude of importance. But then what I think doesn't count for much, objectively. I can tell you that I have been sick inside for years believing that there was a reasonable chance that our critics were right and the expensive and difficult procedures I have been delivering to patients merely resulted in a hopeless mess of irreversibly damaged tissue (i.e., "hamburger") has weighed heavily on my mind. Even people like Bob Ettinger, within the cryonics community, have criticised me and others for our (paraphrasing) "elaborate and costly procedures which have not been demonstrated to result in any improvement in patients' chances." I feel very strongly that if I am charging somebody about 40K to prepare them for long-term storage, the least I ought to be able to do is to tell them, within the limits of current knowledge and technology (i.e., our current ability to know what is important) exactly what the hell it is I am doing to them and what they are getting for their money. I have now answered that question in part: it now becomes a question of how much more money I want to spend to tease out the cost-benefit ratio (in terms of ultrastructural preservation and biochemical preservation) of ALL of the more costly aspects of the procedure in isolation (something I certainly cannot afford to do financially). So, the short answer here is that until recently I have had very little and rapidly shrinking confidence in the procedures being used on cryonics patients. And, further, having seen the CI electron micrographs saw NOTHING, absolutely nothing to cause me to change my mind; in fact only additional information to buttress my growing pessimism. Our own recent research has improved my outlook on patients' chances considerably, but there is still a LOT of damage and a hell of a lot more unknowns. I remain unhappy about these, I have dying friends, and I wish to improve things for them and I as rapidly as possible. 2) "Mr. Darwin says he hopes in "a little more time, perhaps things will change" - what things? Important research completed? Again, in the meantime, what are ACS signups supposed to do?" If our staff grows and we get mor trained and competent people, particularly people who can do entire research procedures my absence (incuding surgery, complex monitoring, medication judgment calls, survival cardiopulmonary bypass, and ICU care with acceptable pain management) THEN I will be freed up for some more of those "refreshing interludes" called human cryopreservation cases. Further, ACS feels strongly (my perception) that it needs to make changes in their situation so that THEY are happy with their local capability. That is out of my hands completely. 3) "The only other cryonics organization I know of which (presumably still) has a contract with BPI is CryoCare. Mr. Darwin said he enjoyed working with ACS more than any other organization - I assume this includes CryoCare?" Your statement, so far as it goes, is correct. But then, I haven't DONE any cases yet for CryoCare. Having said this I would go further and say that CryoCare has been much harder to deal with because they have asked more of me, asked to pay less for it than I thought it was worth, consumed more of my time over details, wished to be extra-cautious about critical ethical and technical issues, and generally pushed me around more. Another way of stating this is that CryoCare is operating its business in an agressive and proper manner. This doesn't always make life easy for the contractor. Think of it this way, if you are having someone BUILD your home for you and you know a lot about construction and EXACTLY what you want, chances are the contractor is NOT going to as thrilled or has happy in dealing with you as he is a naive married couple getting their first house after living in a cramped apartment and who don't know the difference between green board and regular drywall, between pressure treated fence posts and plain wood ones.... This is not to insult ACS in any way; but get let's real: CryoCare's CEO is medical physicist who knows me like a glove and has over 10 years experience dealing with me. It's key members and organizers are old colleagues, most long-seasoned in the practice of cryonics and some of whom have had to suffer through my arrogance and occassional colossal bad judgment (like the Dora Kent case). These people are "family." They are a hell of a lot harder to deal with and they don't have the professional seperation and respect other customers do. I mean we know about each others' personal lives, we've socialized together, had petty and significant arguments. It's not exactly like dealing with your printer or doctor in a professional way if you also happen to have been married to them for 10 years! 4)" Is CryoCare's contract with BPI also cancellable without a reasonable period of advance notice?" Ahhhh, but you see there is a flipside to #3 above. Many, maybe even MOST people left Alcor * in part* to join CryoCare precisely because they do know me so well. So, they are dear friends. These relastionships are personal: Chirst, I'vehad love affairs (and just good, simple sex too!) with some of these people! All of the people (with the exception of Jim Yount) in ACS whom I knew well are now "in the can." I don't know many of the ACS members well. They did not leave ACS to get my services, and, to be quite honest with you, most don't even care whether they have me, or someone else do their cryopreservation as best as I have been able to tell (here I speak of members not Directors). Many didn't even know who/what BPI was. I cannot and will not abandon CryoCare people because my relationship with them goes beyond a paper copntract. A paper contract (serious though it is) is all I had with ACS. I honored it to the letter. 5) "If not, why are they any different from ACS. And, assuming BPI still has a contract with CryoCare, why wasn't it cancelled the same time as the one with ACS, if "more time for research" is the real reason?" Well the above should make it pretty clear. Incidentally, this kind of behavior is very common and ethical in the business world. Years ago I bought oak picture frames very cheaply from a guy named Mike who ran a company called Oak and Art in Brea. You see his frames everywhere now (I even saw some in Indianapolis!). He has two 30,000 sq foot plants. He doesn't touch an order unless its at least for 5K. Yet, whenever I show up with a print he always calls one of his best people over and does a beautiful job custom framing it for me: and charges me just what he did in mid-'80s. Why? Because we are friends and because I referred many customers to him and maybe because I urged him to broaden his scope by marketing to gift shops in tourist areas. I feel quite confident the average customer off the street would NOT get the same treatment from Mike. I owe the people in CryoCare far more than I owe anyone in ACS. They stood by me when no one else did, they put a roof over my head (for research and patient care), they believed in my ability to give good patient care, and most of all they believed in my ability to improve the state of human cryopreservation. Of course, it wasn't just me they believed in, nor was I by any means the sole reason for the "split". But I WAS a material factor. I knew that and I made NON-PAPER committments at the time to Stay The Course. I have known and worked with some of these people since I was 13 years old (I'm 40 now)!. The short answer to your question is that I will stick with CryoCare as long as: a) they want and need me. b) they honor our paper contract, and c) they allow me the ability to deliver a standard of patient care I consider acceptable and my conscience will let me live with. This latter point is the most important, and it is why I ended my responsibilites with another cryonics organization (not ACS). I will NOT work where I cannot give good care. In the case of that split, in all fairness I must say the feeling was mutual and there were "reasonable" reasons for such feelings on both sides. 6) "Again, I'm a potential cryonics services customer, and am not yet "signed up" with any national organization. I'm still in the process of evaluating credentials, and it doesn't always seem to be easy to sort out..." Mr. Gibson this is the truest and most accurate observation in your post. And I don't envy your task. Ultimately it will come down to gut feel since the variables and the vagaries of chance cannot be computed with any degree of reliability this early in the game. Somewhere a butterfly may flap its wings and all the existing cryonics organization will be history and the best bet will turn out to be a company or organization none of us were even capable of imagining. THAT is life. My advice: visit everybody and meet with their key people personally. Ask tough questions (as you already are). And finally, you will have to do as the rest of us have: pay your money and take you chances. Mike Darwin President BioPreservation Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=4546