X-Message-Number: 696
Subject: Report on another suspension
Date: Sat,  4 Apr 92 16:16:46 PST


by H. Keith Henson and Mike Darwin
Transport Team:

Hugh Hixon, Transport Team Leader, Surgical assistant
Mike Darwin, Oversight, Consultant, Femoral Cutdown
Arel Lucas, Airway Management, Temperature Probe Placement
Tanya Jones, Medications, Scribe
Max More, Scribe, Airway Relief
Paul Wakfer, Logistics Support, Airway Relief, MALSS Monitoring
Carlos Mondragon, Film and Video Recording
Leonard Zubkoff, HLR Operator, Oxygen Supplies Management
Keith Henson, Carpenter Assistant, O.R. Nurse, MALSS Monitoring

Suspension phase:

Hugh Hixon, Surgical Assistant, Blood Gases, Housekeeping
Mike Darwin, Oversight, Bur Hole, Cephalic Isolation, Housekeeping
Ralph Whalen, Perfusionist
Mike Perry, Cryoprotectant Ramp Technician
Tanya Jones, Scribe, Sample Taking
Arel Lucas, Logistics Support, Housekeeping
Keith Henson, CPA Concentration Determinations, Housekeeping
Paul Wakfer, OR Circulator
Carlos Mondragon, Records, Transportation
Leonard Zubkoff, OR assistant, Cooldown Preparations
Mark Connaughton, pH and Blood Gas Calibration

    The responsibility of suspending members can be overwhelming at 
times.  After all, if medical personnel err and kill someone, they have 
cost that patient the remaining years of his or her life, at most a few 
decades, more commonly a few years.  If *we* fail, we could be costing 
one of our patients (who are often our friends) a chance at near 
immortality.  Worse yet, if we don't do it, (given the current state of 
cryonics) they will have no chance at all.  Thus, cryonics is a stressful 
occupation (or whatever you think it should be called) and much of this 
article will be illustrating this point.  The oversights are reported for 
the usual reason, so we can learn and do better next time. 

    A few weeks ago, patient A-1260 was one of that growing number of 
people well acquainted with cryonics, but not signed up.  He had been to 
a number of Alcor functions over the years and was friends with several 
key Alcor members.  Because of his desire to remain anonymous, he will be 
known as "Nick" in this article. 

    Nick had been diagnosed with HIV from the time tests became available 
in 1987.  As is common with HIV infection he remained symptom free and 
clinically well for a number of years following diagnosis of his HIV- 
positive status.  However, as is almost inevitable with this disease his 
T-cell count began to decline and he began treatment with zidovudine 
(AZT) and other chemotherapeutic agents to slow the progression of the 
disease, and ward off opportunistic infections. 

    Like many patients on AZT, he stayed relatively free of symptoms 
until the last five months of his illness.  At that point he began 
developing multiple problems starting with a cytomegalovirus (CMV) 
infection of his gallbladder which was treated by surgical removal and 
medication with the antiviral drug ganciclovir.  And again, as is typical 
of patients on AZT, he responded poorly to treatment.  This infection was 
followed by another, this time cryptosporidium.  (It now appears that 
patients on AZT do not live appreciably longer than those not taking the 
drug.  However, they have a course which is characterized by more "well" 
time followed by a rapid decline, with the opportunistic infections which 
cause death being unresponsive to treatment.  The reason for this 
difference is not yet understood.) 

    While the decision to join Alcor came late as a result of the usual 
mix of denial and funding problems (insurance is not available to 
HIV-positive people), once he and his lover "Jim" decided to make 
suspension arrangements, the sign-up process was completed in about two 

    It is worth pointing out that while Nick and Jim had long considered 
making suspension arrangements it was their perception that it was not 
possible to do so given Nick's terminal status and his uninsurability.  
Due in large measure to the intervention and encouragement of Alcor 
member Steve Harris this misunderstanding was cleared up and financing 
was put in place with a mixture of some up-front cash and a second 
mortgage on their home.  While Alcor does not encourage this kind of 
last-minute preparation for cryonic suspension, it is very important to 
point out that flexible financial arrangements ARE available, and that 
Alcor will work with any reasonable person to facilitate their cryonic 
suspension.  This case also points out how the thoughtful intervention of 
a friend can make the difference between someone's getting suspended and 
not getting suspended.  This is not an easy subject to broach with 
someone you care about who is dying, and Steve is to be commended for his 
courage and his decency in undertaking to do this. 

    One of us (Mike Darwin) has had extensive experience both in-hospital 
and in cryonics-related situations in caring for terminally ill patients.  
Pain and discomfort are the handmaidens of death, and at best dying is 
not a pleasant business.  However, even Mike was unprepared for the 
degree of misery Nick was in.  Nick suffered from pancreatitis (perhaps 
as a result of his treatment with the new anti-retroviral drug 
didanosine, and perhaps as a result of CMV infection of his pancreas) 
which caused him severe abdominal pain, unrelenting (day and night) 
hiccuping, and near-constant nausea and vomiting.  In addition, he had 
frequent diarrhea as a result of cryptosporidium infection.  
(Cryptosporidium is an organism that normally infects sheep and 
occasionally infects humans, causing a one-time illness similar to a case 
of the "touristas" from which the patient recovers uneventfully.  It 
causes severe diarrhea in immunocompromised humans, and there is 
currently no effective treatment.  Experimental treatment with the newly 
available antibiotic azithromycin which had been anecdotally reported to  
be effective against cryptosporidium failed to control Nick's infection.)  
Any one of these would have been a nightmare; together, the infections 
had him in intense misery. 

    The constant nausea and vomiting had prevented Nick from eating or 
drinking for several months and his food and fluid requirements were 
being met by intravenous feedings with total parenteral nutrition (TPN).  
Nick had been on every anti-nausea medication available in the US, 
including Marinol, the FDA-approved version of marijuana.  Unfortunately, 
Marinol is not nearly as effective at suppressing nausea as its natural 
counterpart pot.  It was a source of some frustration that due to the US 
drug laws Jim was unable to secure any marijuana in an attempt to relieve 
Nick's nausea.  Mike has known several patients suffering intractable 
nausea secondary to cancer chemotherapy (including a lady in her late 
60s!) who found that the only thing that relieved their nausea was pot.  
The misery that Nick suffered as a result of this law is unconscionable.  
Since both Jim and Nick are libertarians the irony of this situation was 
not lost on them even in the midst of their suffering.  Compounding this 
stupidity is the recent ruling by the FDA that no further applications 
for releases will be accepted for the legal medical use of marijuana.  
Due to drug enforcement efforts marijuana has become difficult and costly 
to obtain--unlike cocaine, a far more dangerous drug, which continues to 
decline in cost. 

    Nick's suspension arrangements were completed by April 14th, so the 
next day Hugh Hixon and Keith Henson went to Nick and Jim's home in the 
Los Angeles area to set up to do the initial stages of the suspension at 
their home.  Hugh had already scouted out the situation, which was about 
as poorly set up for a MALSS-supported stabilization as could be 
imagined.  Nick's bedroom was up a staircase with three turns in it, and 
the twists and turns at the entrance of the house made it impossible to 
get the MALSS (Mobile Advanced Life Support System) cart inside.  The 
only feasible location to set up was a garage located about 60 feet from 
the front door up a steep street.  Considering that it took us over two 
minutes to move the last patient about six feet, there was concern over 
the ischemic time such a move would cause if he were pronounced in his 

    That day, with Jim's assistance, Hugh and Keith cleaned out the 
garage, moved in a number of oxygen bottles, built a plastic enclosure 
large enough to hold the MALSS cart by stapling plastic sheeting to the 
ceiling beams, and installed 2000 watts of lighting.  While it was kind 
of rough and ready, the nurse who pronounced Nick when the time came 
commented that he had certainly seen worse used for operating rooms in 
Vietnam.  Keith and Hugh also restocked the cart and ambulance, refilled 
the cart oxygen cylinders, and ran through as much of the process as they 
could manage. 

    While the patient's name will not be given here, his name and the 
fact that he had made suspension arrangements circulated among his 
friends, and word of this reached Mike Darwin.  Mike (who knew Nick 
personally) offered his services, and, though the team thought they could 
manage without him, the offer was gladly accepted.  Mike came in and 
found a number of oversights and deficiencies and he worked most of the 
afternoon and evening of March 15th with Hugh Hixon to remedy these 
shortcomings.  One of the most glaring was Keith's failure to clean out 
(or even remember) the vacuum system on the MALSS cart from the last 
suspension.  One of the side effects of doing things while 20 hours short 
of sleep.  Well, that one goes on a checklist. 

    Earlier in the day (on the 15th) Mike had participated in a call from 
Steve Harris and conference with the Alcor Staff regarding Nick's medical 
situation and prognosis.  Nick had decided to end his misery by 
dehydration, and had stopped all food and fluids (with the exception of a 
morphine infusion) the previous Thursday (March 12th).  Both Steve and 
Mike expressed concern over this since with Nick's large fluid losses as 
a result of his diarrhea he was liable to dehydrate very quickly.  Both 
Steve and Mike expressed surprise that Nick was even still alive.  The 
Alcor staff related that they had been told by Nick's treating physician 
that death from dehydration would take a week to ten days.  
Unfortunately, this physician was probably not charting fluid intakes and 
outputs and was thus speaking in general rather than specific terms. 

    (Since Nick was still alert enough on Sunday to sit up and hold a 
conversation, knowing that dehydration cases typically last a week or 
sometimes more, and not being aware of the conversation between Steve and 
Mike, Keith went back to San Jose.  He was home for less than 24 hours 
when the call came through that Nick was near death, having dehydrated 
much faster than expected.  Keith now has a rather different view of 
dehydration times when a patient has large fluid losses from diarrhea or 
other causes.  In spite of the cost involved, he has become a champion of 
being on site and ready based on the *shortest* estimate.) 

[ End of Part 1 of 3 ]

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