From Cryonics September 1990

The Cryonic Suspension of Roy Schiavello

Part I: Alcor Southern California Perspective

At approximately 2115 Pacific Daylight Time (PST) on the evening of June 22, 1990 my beeper went off as I was sitting in a restaurant in Fullerton, California. It was a familiar setting, The Old Spaghetti Factory, a place the Alcor staff regularly frequented when we were quartered in Fullerton a few years ago. Within a few minutes I was in touch with Hugh Hixon, who was manning the phone at Alcor in Riverside. The situation was a not uncommon one these days: someone was calling to request suspension for a relative who had just deanimated. These calls are now fairly frequent and almost never work out. Almost.

This case seemed especially bleak, since the call was coming from Australia. Nevertheless, Alcor has a rigid policy of returning all such calls and gathering all the information before making any decision to proceed or not. I immediately returned the call made a few minutes before by a woman named Mrs. Frances Costa, reportedly on behalf of her brother who had, according to Hugh, "just experienced cardiac arrest as a result of neurosurgery of some kind."

I reached Mrs. Costa almost immediately, and asked her for details of the situation. The story was both straightforward and heartbreaking. Mrs. Costa's brother, Rocco ("Roy") Schiavello, a 30-year-old computer programmer, teacher, and amateur astronomer, had been operated on for a deep-seated oligodendrocytoma on 20 June. He had developed cerebral edema (brain swelling) during surgery, and experienced cardiac arrest approximately 48 hours afterward without ever regaining consciousness. Prior to his operation, Roy had secured a promise from his family that if he did not survive the operation, he should be placed into cryonic suspension. According to Mrs. Costa, Roy had often talked about cryonics and had always said he wanted to be frozen, whenever discussions about death or methods of disposition came up in conversation.

Roy Schiavello a few months before surgery in 1990.

After gathering the relevant details I did my best to inform Mrs. Costa of the problems. This process took a considerable amount of time and consisted of my best efforts to dissuade the family from pursuing cryonic suspension for Roy. I pointed out that first and foremost they were under no moral obligation to do this, and that the responsibility for making suspension arrangements lies only with the individual. More to the point, I described in great detail the adverse legal, financial, and above all biological situation they were confronting. They were days away from being able to move Roy to the United States, where an attempt to introduce cryoprotectants under ideal conditions could be carried out. Furthermore, many hours had elapsed since Roy experienced cardiac arrest and during much of that time he would have been air-cooling only very slowly in a refrigerated morgue.

Additionally, there was the problem of the primary cause of legal death: brain swelling with accompanying likely compromise of blood flow to large areas of the cerebral cortex many hours before heartbeat and breathing ceased. This alone was a major barrier to any hope of recovery. I did my best to paint the grimmest picture possible of Roy's likely biological condition. I also explained the financial and legal caveats, including Alcor's need for control over Roy's suspension and our "Emergency Conversion to Neurosuspension" clause in the "Cryonic Suspension Agreement." Nothing I said or did affected their resolve to pursue suspension. I was told "This is what Roy wanted, what he would have wanted regardless of the odds, and this is what we are going to give him. If you can't help us, please refer us to others who can, or at least tell us how to freeze him down ourselves until we can set up things locally to take of him."

I did refer them to the American Cryonics Society/Trans Time (ACS/TT), the only other cryonics organization that accepts non-members for suspension (and they indicated that they already had a lead on ACS/TT themselves from local media). I also urged them to contact ACS/TT to get information on their program and find out what they had to offer.

After some additional conversation I told Mrs. Costa that I would take their request to the Alcor Board of Directors, and that it was now critical that I leave the restaurant and drive back to Riverside (30 minutes away) to begin putting the wheels in motion to poll the Alcor Board.

As it happened, the Schiavellos couldn't have been in a better place in Australia. They were located in Melbourne, a city almost three million, where there just happens to be not only a large concentration of cryonicists, but also a sympathetic, supportive, and very competent mortuary firm, Mulqueen's Proprietary Limited, and an embalmer who also fits the same the description, by the name of Peter Irvine. Before I rang off to Mrs. Costa, I told her to contact Terry Mulqueen and arrange to have Roy picked up from the hospital refrigerator and packed in water ice for more rapid and deeper cooling.

I arrived back at Alcor about 45 minutes after ending my call to Mrs. Costa. Hugh had already begun locating Board members and Carlos Mondragon, Alcor's president, had been summoned from home for a briefing. Upon arrival at the facility I faced a decidedly skeptical "core crew" of Carlos and Hugh Hixon. A suspension in Australia seemed pretty far-fetched. After all, we'd had no prior contact with these people and it seemed likely that there could be trouble. What were the odds that they really understood what they were getting into?

I told Carlos and Hugh that I was impressed with Mrs. Costa's levelness, emotional balance and above all her fierce commitment to carry out her brother's wishes regardless of how she felt about them personally. I told them that what actually impressed me most about this situation was Roy's strong and repeatedly expressed desire for suspension and, perhaps paradoxically, Mrs. Costa's own statements that she did not think cryonics would work, but rather was doing this to honor her brother's wishes, something which she felt deeply duty-bound to do. Also, the Schiavellos seemed to meet all of the objective criteria Alcor had set in its "Guidelines For Accepting Non-Member Suspensions" (see Cryonics, 11(4), 6-13 (April, 1990).

Carlos and Hugh still appeared very skeptical at this point and I urged them to resolve this skepticism by talking with Mrs. Costa directly. I felt certain that her determination and her professionalism (yes, professionalism) in such a time of crisis would work its magic on them too. I also put in motion a call to Theo Tatton, the principle activist in the Melbourne area, with the object of getting him over to meet with the Schiavello family and provide an on-the-scene assessment as soon as possible -- as well as provide the Schiavellos with printed material on both Alcor and ACS.

Carlos called and spoke with Mrs. Costa, carefully going over the same ground I had with reference to the biology, and then adding in a new set of disclaimers and negatives regarding legal and financial matters (his special area of expertise). Mrs. Costa held firm and answered all of Carlos' questions in ways that were satisfactory. A particular area of concern was the position and authority of other family members (since there were a total of six brothers and sisters and Roy's Mother, Rosa Schiavello, to consider). Once it was established that Roy's family supported his suspension completely (an unprecedented situation in and of itself) and that the costs of the suspension would be ultimately be borne by Roy's estate (but initially by family members), a decision was made to brief the Alcor Board and take a vote.

The Board was polled in the early morning hours of the 23nd and the vote was a unanimous "Go." A call was then placed to Mrs. Costa, informing her of the Board's decision. Mrs. Costa informed us that the mortician, Terry Mulqueen, was already en route to pick up Roy and begin packing him in ice.

Meanwhile, more good news had arrived as a result of my call to Theo Tatton being returned: due to a lucky coincidence, the Cryonics Association of Australia was having an informal meeting that weekend, and Simon Carter, CAA president, was in town as well as CAA members Michael Connaughton and Joseph Allen (the latter a long-time Alcor Suspension Member and recent immigrant to Australia who now lives in Melbourne).

Within a short period of time we were in touch with Terry Mulqueen and a decision was made to try to carry out cryoprotective perfusion prior to cooling to -79°C (-110°F). This decision was a difficult one, and was made for a number of reasons. First of all, there was the legal requirement that some sort of disinfection of the body take place, and after some consultation it was determined that systemic treatment with a broad spectrum antibiotic would suffice. Another factor was that Roy would need additional time to cool to near 0°C (32°F) on water ice, and dry ice would be unavailable until Monday morning, some 36 hours away! There seemed little reason not to try and get some cryoprotectant in place before proceeding to -79°C.

CAA member Geoff Lee in Canberra was contacted through Thomas Donaldson and asked to do an inventory of the limited supplies that the group had stockpiled there. Geoff confirmed that the Australian group had a limited supply of transport medications, including antibiotics, and moderate quantities of an IV electrolyte solution known as Normosol-R, I.V. mannitol solution, and approximately 12 liters of glycerol. Normosol-R has an electrolyte make-up and pH approximating human plasma and the mannitol and glycerol could be used, in conjunction with other locally available supplies, to prepare a reasonably physiological cryoprotective perfusate.

Geoff agreed to make the 8-hour drive with supplies to Melbourne after grabbing a few hours sleep in the morning. The next action item was to call Alan Sinclair of Alcor U.K. in England and arrange to have him ship the U.K. group's insulated dry-ice air shipping container to Melbourne. After rousing Alan out of bed, he affably agreed to ship the box as soon as possible.

Then, frantically, over a period of about six hours from about 2300 till 0530 PDT, a perfusion protocol was drafted and faxed to Terry Mulqueen for embalmer Peter Irvine to use on Roy. Peter had worked with Alcor in the past; he was the mortician who had perfused Australian Alcor member Michael Connaughton's dog (see Cryonics 11(3), 28-33 (March, 1990) in April of 1989.

MEMO

June 24, 1990

From: Mike Darwin
To: Terry Mulqueen
Re: Perfusion and freezing protocol for Roy Schiavello

The following protocol should be used to prepare Mr. Schiavello for transport to the United States.

MATERIALS AND METHODS: Normal embalming solutions should not be used since they contain particulates and undesirable compounds (dyes, emulsified compounds, etc.) which will cause unnecessary injury.

Preparation Of The Equipment

The embalming pump should be thoroughly cleaned by washing with a mild household kitchen or "dish type" soap (the kind used to wash up after meals). After the pump reservoir and system have been thoroughly scrubbed and cleaned up, the machine should be flushed thoroughly with copious amounts of clean tap water until there is no trace of soap in the reservoir or the output from the unit.

The machine should then be flushed twice with a minimum of two gallons of distilled water (obtainable from a food market) by running the machine until the reservoir empties. Attach the Tygon tubing at the start of the cleaning procedure. It is probably also wise to attach the cannula to the machine during cleaning as well. Everything should be brought to as high a level of cleanliness as possible.

Immediately before the machine is loaded with the perfusate to be pumped through the patient it should be rinsed with at least 2 liters of the Normosol-R that will carry the glycerol.

Before a cannula is placed into the patient's vessels, the cannula and connecting lines must be thoroughly and completely purged of air. This is best done by running solution through the cannula and back into the machine's reservoir for a minute or two before inserting it into the patient's carotid. The machine and lines should be vigorously tapped during this time to dislodge any air bubbles.

The line carrying perfusate to the patient should be packed in ice.

Preparation Of Perfusate

Three concentrations or "strengths" of cryoprotective solution should be prepared and flushed through the patient's "head" circulation.

These solutions should ideally be made up of the following ingredients and in the following amounts:

To each of the following batches add:

1 ampoule Isoptin
1,000 IU heparin per liter
40 mg Solu Medrol

Note: glycerol is the same as glycerin.

Initial Flush:

600 ml glycerol (Australian Pharmacopia Grade)
500 ml 0.3 Molar THAM
500 ml 20% Mannitol
6,400 ml Normosol-R made by Abbott Labs*

*Acceptable alternatives are Plasmalyte made by Travenol Labs or any other intravenous electrolyte fluid replacement solution. The least desirable alternative would be Ringer's Solution.

8,000 ml total volume

Glycerol Concentration: 7.5%
mOsm of base perfusate: 323

Second Flush:

1,800 ml glycerol (Australian Pharmacopia Grade)
500 ml 0.3 Molar THAM
500 ml 20% mannitol
5,200 ml Normosol-R made by Abbott Labs

8,000 ml total volume

Glycerol Concentration: 22.5%
mOsm of base perfusate: 279

Final Flush:

2,400 ml glycerol (Australian Pharmacopia Grade)
400 ml 0.3 Molar THAM
500 ml 20% mannitol
4,700 ml Normosol-R made by Abbott Labs
500 mg Erythromycin

8,000 ml total volume

Glycerol Concentration: 30%
mOsm of base perfusate: 260

When you are down to the last liter of the final flush perfusate you should add 100 cc of Hypaque-76 to the reservoir. Hypaque is the brand name for an iodine-containing radiopaque dye. Its function is to allow us to CT scan the patient when he arrives so we can determine how well, if at all, his brain perfused. The chemical name for what we want is: 66% diatrizoate meglumine and 10% diatrizoate sodium, injection. Any product with roughly this concentration of diatrizoate will do. Hypaque is a product of Winthrop Labs.

All of the above should be perfused through the head via the carotids. The body should be perfused with the following:

First Flush:

2,900 ml glycerol (Australian Pharmacopia Grade)
500 ml 20% mannitol
8,900 ml Normosol-R made by Abbott Labs

12,300 ml total volume

Final Flush:

2,400 ml glycerol (Australian Pharmacopia Grade)
5600 ml Normosol-R made by Abbott Labs

8,000 ml total volume

If you run short on solution, by all means preferentially treat the head.

If you don't have a graduated cylinder for measuring volumes, you can use the bottles that the IV fluid came in, as they are usually graduated. You can pour the mixed up solution back into the 1 liter bottles to facilitate fast chilling by packing them in ice.

All of these solutions should mixed up in clean plastic reservoirs (clean 5 gallon pails or jerrycans can used) and chilled on ice or in your refrigerator for at least several hours. A good source of 20 liter mixing reservoirs is a restaurant supply house or a hardware store that sells 5 gallon pails for mixing paint, etc. Perfusate should be no warmer than 10°C. Do not warm the patient up radically by perfusing him with warm solution!

Perfusion (Injection) Technique

Perfusion should be done using open circuit technique: i.e., alternate perfusion via the carotid arteries and open drainage via both internal jugular veins. It will be necessary to clamp off the "opposing" carotid during alternating perfusion.

The scalp incision from the prior neurosurgery should be carefully opened and the bone flap, if present, should be removed. Any clots obscuring the cortical surface should be gently lifted away. The brain should be carefully observed for signs of blood washout. Close the skin flap (leave out the bone flap) following perfusion using interrupted suture technique. Place the patient's head in a small plastic bag and tape the bag snugly to the neck so that brine solution doesn't get in to the brain during subsequent ice/salt cooling. Also, be sure to protect the brain incision from direct contact with dry ice.

Flow rates should be low: no more than 200 cc/min to the head and no more than 600 cc/min to the body. Pressure should not be over 80 mmHg, this is about 1.5 pounds per square inch. You will probably need to set your pump to just about the lowest pressure possible. Don't be in a hurry. Let the solution flow through the patient slowly. Venous drainage will be modest at first, but will pick up with time (the reverse of the normal situation). If it is necessary to "open up" the circulation, the pressure can be increased to 2-3 psi temporarily.

If you see serious edema (swelling) developing with poor venous return, you may switch to a higher concentration of glycerol solution. If the brain begins to bulge out of the incision, perfusion must be stopped.

Cooling With Ice and Salt

Ice and salt can be used to start cooling down. Be sure the patient is protected from contact with the resulting "brine melt" by wrapping him in a plastic tarp. Be sure to keep the patient covered in ice and salt at all times (it will take a lot of ice and salt). Try to seal up the head wound, or place the head in a plastic bag taped snugly around the neck to provide extra protection from brine getting into the brain. The patient should be held in the ice/salt mixture for no more than 4 hours.

Cooling To Dry Ice Temperature

After 4 hours, remove the patient from the ice/salt mixture and, leaving him wrapped in the plastic tarp, wrap him in a single layer of a bed blanket (a polyester bed blanket) place it in the cooling chest atop a bed blanket or two which is in turn overlaid on a bed of crushed dry ice (2" thick). Completely cover the patient in crushed dry ice.

Keep the patient completely covered with dry ice at all times until he can be shipped to the U.S. Every exposed part will be about 30°C WARMER than areas covered with dry ice!

Monitoring and Record Keeping

Collect as much information as you can. Monitor pharyngeal temperature and perfusate temperature at 10 minute intervals during perfusion. Record perfusion pressures and flow rates (i.e., rate of reservoir level drop vs. time) at 10 minute intervals or whenever a change is made. Note amount of venous drainage: it may be collected in empty glass IV bottles by holding them to the margin of the wound after the initial clotted material has been displaced. Collect venous effluent samples, 10 cc quantity x 2 at 10 minute intervals during perfusion. It is very important to get samples of the "first blood" out of both the head and body so we can do analysis later. Be sure to freeze these samples in 20 cc containers on their sides so that the bottles do not burst from ice expansion.

Take notes about everything you see and every significant event that happens. In particular, note the amount of time that the patient is not packed in ice during transfers and so on.

If you've got a camera: GET PICTURES EVERY STEP OF THE WAY. A picture is worth a thousand words and will help us to understand what really happened.

Part II: The Australian Perspective

by Simon Carter, President of the Cryonics Association of Australia, Inc.

Note: All times given in Part II are Melbourne time, 17 hours ahead of Pacific Daylight Time (PDT). The following material is reprinted with permission from CRYONICS AUSTRALIA, the newsletter of the Cryonics Association of Australia.

Just after 6:00 PM on Friday, 22 June I boarded an interstate coach in Sydney for the overnight journey to Melbourne. The two cities are roughly 550 miles apart, and whilst I usually visit Melbourne once or twice a year, this was to be my first time there for two and a half years. Melbourne is a pleasant city with old-style grandeur and all the attractions of a major cosmopolitan center of nearly three million people. A major reason for my visit was to meet with local cryonicists, whom I rarely see in person, and a mortician sympathetic to cryonics.

About the time my coach departed, Roy Schiavello, a 30-year-old computer programmer, was declared legally dead after having developed brain swelling (cerebral edema) following an operation that was intended to remove a large tumor from the fluid-filled cavities (cerebral ventricles) in the center of his brain. Whilst Roy had never made contact with the Cryonics Association of Australia (CAA) or Alcor he was very much aware of the idea of cryonics and wanted to be suspended should the need arise. He had the tremendous advantage of having had the necessary funds and a family determined to carry out his wish.

Roy had been diagnosed in August of 1989, 10 months before progression in symptoms (short-term memory deficits, headaches, and "blackouts") caused him to undergo the operation, but had withheld this information from his family until a short time before deciding on surgery. Both Roy and his family were informed by the neurosurgeon that the operation had an excellent chance of success and that his risk of mortality was no greater than 3% to 5%. When Roy did not recover and in fact deanimated, his family were stunned. Nevertheless, they embarked on a worldwide search to find a cryonics organization willing and able to suspend Roy. They spent over eight hours on the telephone, finally succeeding in tracking down Alcor via a Melbourne television station.

Unaware of all this I was enjoying my first day in Melbourne. As planned, I met Theo Tatton in the early afternoon in the center of town and spent a good hour discussing the forthcoming Annual General Meeting (AGM) of CAA. We were concerned both with improving Australian suspension capabilities before an emergency hit us, and with how to raise the money required. As things stood, our cryonics capability was woeful, having declined over several years of inactivity to a level little better than that of the early "embalming pump" days of cryonics.

Awaiting us when we arrived at Theo's home in the late afternoon were several telephone messages. One was from Alcor and Theo called whilst I, assuming it would be a private affair concerning his nearly finalized suspension paperwork, went into the lounge to talk with one of his sons about submarines. I am employed as a civilian software engineer supporting the Australian submarine fleet and that often provides an interesting starting point for conversations. All of a sudden I heard "Good heavens, when did he die?" coming from a clearly agitated Theo. End of submarine conversation.

I joined Theo by the phone and we were given a quick synopsis of the situation, although details were sketchy. Mike Darwin wanted us to visit the relatives, assess their degree of commitment and understanding, and answer any questions they had, as well as provide the human face of an otherwise remote cryonics organization in California.

About an hour later, after gathering up some material Theo had available on Alcor and cryonics, (the "Bluebook" and back issues of Cryonics) Theo and I set off to visit the family. Upon arrival we walked into the tail end of an extended wake. I simply didn't know what to expect as we were ushered in to meet five of Roy's siblings and a close friend. I was anxious to express that we were not coming as salesmen and that the two of us, having made suspension arrangements with Alcor, were present as friends offering help. My overall impression of the family was that whilst not all of them fully comprehended (or even agreed with) cryonics they were united in a desire to carry out their brother's wish. This impressed me.

I contacted Mike Darwin, who asked me about the family's state of mind. Once he was satisfied that they were determined to go ahead, I was then requested to inform them that the Alcor Board had approved taking Roy as a non-member suspension. They were understandably delighted by this decision.

Mike then wanted to know the precise quantities of perfusion supplies we had on hand. We have stored our supplies at the home of a member, Geoff Lee, near Canberra, which is some 400 miles from Melbourne. There was therefore to be an inevitable delay whilst Geoff inventoried the supplies, loaded his car, and drove down to Melbourne. Other reasons, such as the unavailability of personnel caused more delays. After the conversation with Mike, Theo and I continued to talk with the relatives. We were shown a photograph of the family, including Roy. They were not only shocked at what had suddenly happened to their brother, but were also angry at what they perceived to be unfeeling and perhaps inappropriate treatment by his neurosurgeon.

As we were about leave, Terry Mulqueen, the cooperating mortician, arrived. He urgently needed personal information on Roy in order to get the paperwork for his journey to Alcor started. Since there was little Theo or I could add, I was concerned to leave. There seemed to be no clear demarcation of responsibilities and I wanted us to have the time to contact relevant CAA personnel and decide what had to be done and when. Mindful of the legal hazards inherent in cryonics as practiced in the late Twentieth Century I was also worried because the family had not signed an agreement with Alcor at this advanced stage (in fact, this was not to occur for a further two weeks). The suspension thus started on simple trust. What if we had only met a pro-suspension part of the family?; what if there had been a financial hitch?; what if any number of problems had surfaced?

By mid-evening we were back at Theo's. The telephone had, and would continue to, ring off the hook. News was already leaking out along the international cryonics hotline and we impressed on all callers the need for discretion. The last thing we wanted was a 60 Minutes crew. Amongst the callers was Geoff Lee, alerted by Thomas Donaldson. Theo and I briefed him and asked him to confirm the supplies we had on hand. Geoff then started loading his car.

As Theo, his family, and I ate a much delayed evening meal the phone continued to ring. Geoff reported that it would take him longer to load his vehicle than at first anticipated and, quite reasonably, he would need to rest before undertaking the drive (intercity roads in Australia are nowhere near the standards to be found in the USA, and the journey times are considerably longer and travel much more wearing). There being little more that either of us could do that night, Theo drove me back to my central city accommodation.

Given the problems facing us it was remarkable and fortunate that I managed to get a decent eight hours' sleep. When I awoke I contacted Theo and was told that Geoff Lee was en route and that the suspension would be conducted at a suburban mortuary in Ivanhoe, about ten miles from downtown Melbourne. As a courtesy I contacted Cath Woof, who is now residing just south of Sydney after living for several years in California (together with Thomas Donaldson, she had helped organize Alcor Northern California and been an Alcor Coordinator). Cath offered to come down, but I thought she would most likely arrive too late to be any of help. In the event, this would not have been the case, and I can only attribute my lack of foresight to the stress of the situation and our lack of contingency plans. I was also under the impression that there would be restrictions on the number of people able to work in what turned out to be an adequate, but cramped facility.

Several hours later I made my way to Theo's home and awaited Geoff's arrival. He telephoned in at 16:30 from the Northern outskirts of Melbourne and we directed him to Ivanhoe. Theo and I then set out ourselves, stopping en route for some last minute items requested by Mike: salt, sample bottles for venous effluent (drainage fluid), and added glycerol to supplement our own limited store. I recommend trying to buy several liters of Pharmaceutical Grade glycerol early on a Sunday evening in Melbourne to anyone interested in challenging exercises. Thanks to some calling ahead by Theo we got what we needed without much extra delay.

Geoff was already present when we arrived, as was Peter Irvine, the embalmer who was to perform the surgery, and Michael Connaughton, who had had his dog suspended by Peter at the same site last year. Geoff and Theo went off to pick up 60 kilos of ice and bags to protect Roy during ice/salt cooling, as well as some film and batteries for the camera. Joe Allen, an Alcor member from the early days of the Institute for Advanced Biological Studies in Indianapolis, Indiana, and now a Melbourne resident, arrived to assist as well. At about the same time Terry Mulqueen also arrived bringing Roy with him (Roy had been maintained on water ice at Mulqueen's Burwood mortuary.). Michael and Joe began the unpleasant task of filling dozens of small bags with water ice to provide cooling for Roy, whilst I started to prepare the first "pass" or "flush" of perfusate containing 7.5% of glycerol.

Our equipment was extremely basic, on a level equivalent to early suspensions of the late 1960's. To deliver the perfusate we had a Porta-Boy embalming pump. The "mixing/holding" tank on this unit is not calibrated accurately in terms of volume, so it could not be relied on for measuring out the volume of the various perfusate ingredients required to make up the solution. Fortunately, Joe brought along a graduated cylinder which allowed us to accurately measure out the ingredients. Other tools that were available were basic mortuary surgical equipment (arterial cannula, scalpel, scissors, aneurysm hooks, and clot forceps) and a standard 12" long mercury-type laboratory thermometer.

The Porta-Boy embalming pump.

The first task was to prepare the embalming pump per the protocol that Mike Darwin had sent us, by first washing the pump and then flushing it with distilled water several times, and finally twice with several liters of particulate-free Normosol-R intravenous solution.

Just after 22:00 we loaded crushed ice onto the operating table and unwrapped Roy. At this point we noticed that he had been very well packed in ice, and further that he must have air cooled to quite near 0°C because very little of the ice he was initially packed in had melted.

We then transferred Roy to the operating table and quickly re-packed him with the previously prepared bags of ice. Peter then began the bilateral cutdown to raise the carotid artery and jugular vein on each side of the neck. The purpose of this procedure was to surgically access these major blood vessels so that cryoprotectant-containing solution (perfusate) could be circulated throughout Roy's tissues to provide some protection during subsequent cooling (and freezing) to -79°C. Peter also opened the skin flap covering the craniotomy wound on Roy's head and removed the bone flap which covered Roy's cerebral cortex. Once this was done, the large clots covering the brain surface were gently lifted away to allow visualization of the brain during subsequent perfusion.

As I began to measure out the perfusate components I noticed that, due to the cool weather (it's winter in Australia), our mannitol had partially crystallized out of solution on the bottom of the bottles. Before the mannitol solution could be added to the mixing reservoir it would first have to be re-dissolved. Whilst Joe Allen and Michael Connaughton warmed the mannitol to dissolve it I continued to measure out the rest of the perfusate components.

At approximately 23:30 we were ready to start the first pass of perfusate, beginning with the right common carotid artery. Perfusion was carried out using the lowest pressure possible with the machine to obtain drainage from the jugular vein. Almost immediately large blood clots 4" to 5" in length and about the diameter of the vessel began to emerge from the right jugular. Almost immediately there was also modest edema of the brain. After ten minutes the edema became pronounced and we stopped perfusing. We were using the laboratory thermometer to monitor Roy's temperature (the bulb was placed in the oral pharynx), as we were concerned that even though we had pre-chilled the perfusate, it might significantly re-warm Roy.

Roy, packed in ice on the operating table during perfusion. Left: embalmer, Peter Irving; Right: CAA member Michael Connaughton.

About the only good thing resulting from the perfusion was evidence that a substantial portion of Roy's cerebral cortex had been receiving blood flow right up until the time he experienced cardiac arrest. The evidence for this was that the arteries on the brain surface appeared normal in color and exhibited substantial clearing of blood during the brief perfusion period. Had Roy's brain been in a no-reflow condition for a prolonged period of time prior to deanimation, these vessels would very likely have been dark, clotted, and incapable of demonstrating blood washout with perfusate. A prolonged period of cerebral no-reflow would have resulted in brown-tinted or pink-tinted hemoglobin-stained brain tissue; we observed only normal-appearing brain tissue with appropriate pial brain surface color and no evidence of hemoglobin stain or hemoglobin denaturation (breakdown) as would be evidenced by a "brownish" color to the vessels.

Perfusion was recommenced at 23:50 via the left carotid artery and the pattern of heavy outflow of clots followed by poor venous drainage and further edema caused us to discontinue perfusion a few minutes later at 00:01. After consultation with Mike Darwin, who stood by all night on a more or less open line, it was decided to discontinue trying to introduce any more 7.5% solution to the head/brain and instead deliver the remainder of the volume (six of the eight liters) down the carotid artery to the body. Michael took venous effluent (drainage) samples for later analysis whilst I prepared the next eight liter batch of perfusate, liaised with Mike Darwin, and took photographs for Roy's patient records.

The second flush using a 22.5% concentration of glycerol in the perfusate began at 01:44 via the right carotid. However, due to poor venous return and a noticeable increase in facial and cerebral edema it was discontinued less than 60 seconds later. A decision was made by Mike Darwin to not attempt any further cerebral perfusion and to instead pass the remaining volume of solution down the carotid artery to the body. It took 57 minutes to pass 5.8 liters of 22.5% glycerol-containing perfusate through the body. This was done primarily to displace clotted blood (leaving the circulation more open for future repair efforts) and distribute antibiotics. Roy's temperature, as measured by the oral thermometer, starting out at 1° to 2°C, had risen to 10°C by the end of perfusion. Once the final pass was completed, perfusion was terminated, the skin flap covering the craniotomy was loosely closed and Roy was quickly cleaned up in preparation for transfer to the ice/salt bath as we were anxious to get his temperature down again and begin freezing him.

Ice and salt mixtures yield a temperature in the -15°C to -20°C range and thus are ideal for beginning the freezing process in the absence of more controlled fast cooling, such as with a silicone oil bath.

Both Joe and Theo had left much earlier in order to be fit for work the next day and Geoff Lee had retired to sleep in the back of Mike's van, exhausted from the long drive down. While Peter and Michael cleaned Roy up and wrapped him in a plastic tarpaulin to protect him from the brine that would result, I prepared the bed of crushed ice and table salt that was to receive him. Mike Darwin was very concerned about the possibility of brine leaking into the wrapping, getting into the craniotomy wound and injuring the brain. For this reason we placed an additional plastic bag over Roy's head and secured it to his neck with mortuary twine before wrapping him in the tarpaulin.

Peter Irvine (left) and Michael Connaughton (center) wrap Roy in plastic sheeting in preparation for ice/salt cooling.

At 03:15 Roy was transferred onto the bed of ice and salt and covered over with a thick layer of additional ice/salt mixture. He was then wheeled into an adjoining refrigerated room (2-4°C), where Michael and I monitored the ice/salt mixture level until Geoff Lee relieved us for a couple of hours around dawn. I was most grateful for this as I was beginning to perform like a badly programmed automaton.

At 08:45 Peter Irvine arrived with 90 kilos of dry ice. Rather hazardously (since we had only a few, unpadded pairs of gloves), we smashed up the dry ice with hammers into suitably small chunks. Roy was then removed from the ice/salt, left in the tarpaulin (which provided something of a thermal buffer as it was several layers thick) and repacked in crushed dry ice.

I stayed until Roy had been completely packed in dry ice and then left for my accommodation. It was 10:30, but I could not sleep and spent my last few hours in Melbourne wandering the streets mulling over the drama of the last couple of days. Later that day Michael constructed a crude but effective insulating box out of chipboard and styrofoam to cut the dry ice sublimation rate whilst we waited for the transport box to come from England. Fortunately, a local source of pelleted dry ice was found and this not only provided a much more snug fit of dry ice around Roy, but also cut the labor cost substantially.

A week later Roy left Australia for Alcor's long-term storage facility in Riverside, California. Selected elements of the media were present to witness his transfer from the temporary container to the shipping box. The media coverage was moderately good [excellent by U.S. standards -- Eds.] although the story had leaked to the weekend "tabloid" gutter press a couple of days previously. There were no hassles with any authorities; it was as if the transport of cryonic suspension patients was a routine, everyday business (of course, our battles are yet to come when they realize how serious we are). Indeed, officials from the Australian government and the U.S. Consulate even called Terry Mulqueen to inquire solicitously if "paperwork had been processed quickly enough, and to his satisfaction." (The first time that's ever happened, according to Terry!) Roy left Australia on a late morning flight on 2 July, accompanied by his brother Tony, his sister Rose, and his mother Rosa Schiavello.

I am still thinking about the implications of this, the first Australian cryonic suspension. It has certainly revitalized cryonics in Australia and we achieved a record attendance of ten at CAA's recent Annual General Meeting. Decisions were made to raise money to fund equipment purchases from Alcor with the aim of achieving Alcor Coordinator status by March of 1991. We have received several serious inquiries and are now able to hold regular dinner meetings in both Sydney and Melbourne to attract more people.

We also appointed Cath Woof the suspension officer of CAA. This is really the most important position in our group, as she now has the job (with assistance from the other members, of course) of arranging our upgraded suspension capability and will have overall control of events during future suspensions. As backups we decided upon myself as the Sidney area alternate and Joe Allen as the Melbourne area alternate.

In hindsight of course, there are many things we could have done better. But, given that Roy had been deanimated almost 24 hours and experienced serious blood clotting before we even heard about his case (and a good 48 hours before perfusion was begun), I think we did a good job for him.

It was fortuitous that I happened to be in Melbourne, even though I felt "out of the loop" without a car, a telephone, or my files. I also felt that we were automatically at a disadvantage as no contract existed between Terry Mulqueen and CAA or Alcor and we were unfamiliar with his facility.

On the cheerier side, we have now had a practical demonstration of what to expect in an emergency and know who can be relied upon. I had expected some people to be considerably more squeamish over such a traumatic experience than they actually turned out to be. Michael Connaughton intends to undergo mortuary and Alcor training. There is much to be thought out before we are next faced with a suspension, sudden or otherwise. Based on our experience with Roy, we have started to lay out plans for future suspensions under different contingencies with more attention to having contact lists and defined lines of authority and communication.

Roy's suspension has taught us much, and for that we are grateful. We hope very much that we have contributed to the realization of his hope for future life.

Part III: Arrival In The U.S.

by Mike Darwin

On June 29, we received notification by phone and FAX that Roy would be arriving in the U.S. on Qantas Airlines flight QF11, on July 2 at 10:25 AM PDT. On Sunday, July 1, during the closing minutes of the Alcor Board Meeting in Wrightwood, California I received a phone call (referred up from Alcor) from a journalist in Australia inquiring about the "cryonic suspension of Mr. Rocco Schiavello" and requesting details. This was totally unexpected and very disturbing. We knew from the start that the story of the first cryonic suspension in Australia would be major news there, and perhaps even create some stir here. We were very anxious, as was the Schiavello family, that there be no leaks or coverage until Roy was safely in our hands here in the U.S. All we needed was to have problems occur with customs on this end, or with the Australian officials or even the airline. There was also our desire to spare the family the glare of media attention at such a trying time: before Roy's suspension was even completed.

That was not to be. A few minutes before the flight's scheduled departure I spoke with Mrs. Costa and was informed that a veritable wall of media people with accompanying cameras and tape recorders had surrounded the three Schiavello family members who were going to fly over with Roy as they made their way to the aircraft. There was also reportedly a busy contingent of photographers and reporters at the loading of the shipping container, which was holding Roy, onto the aircraft.

On July 2, Alcor staffers Carlos Mondragon, Hugh Hixon, and Arthur McCombs set off for LAX to meet QF11 and transport both Roy and his relatives, mother Rosa, brother Tony, and sister Rosa ("Rose") Schiavello to Alcor in Riverside. They were met with an avalanche of press. Carlos was surrounded by a human wall of video cameras and reporters as he tried to make his way to the gate to meet the Schiavello's flight. It was only with difficulty that he was able to escort them to his car and head over to the Lufthansa airfreight terminal where the Qantas cargo, including the shipping box holding Roy, would be taken.

At the cargo terminal, Hugh and Arthur waited inconspicuously while the reporters milled around. Meanwhile, back at the lab, I received an unnerving call from Qantas inquiring about our authorization to pick up human remains (shades of the Department of Health Services!), apparently in response to the media circus going on outside their facility as well as numerous inquiries from journalists. After a little stroking and some authoritative reassurance, the freight manager hung up, apparently satisfied although still very edgy. A quick call was made to Alcor attorneys David Epstein and Chris Ashworth, and contingency plans were put in place in case further trouble should arise.

After a bit more bureaucratic shuffling, Lufthansa raised the door to the cargo facility and allowed the Cryovita van inside. They then closed the door to the facility, effectively barring the press from photographing the loading of the shipping box; this was a courtesy that was much appreciated and which is not normally extended to those picking up freight of any kind, including human remains, but the TV crew's intrusiveness had irritated the Qantas airfreight people considerably.

The Schiavello family and Roy arrived at the Alcor facility in the late afternoon. They had been up over 24 hours, had been on a 18-hour flight and had been able to sleep and eat little. They were exhausted, and after a brief once-over of Alcor's facilities, they were taken to a nearby motel to rest and recover a little.

Upon arrival at the facility the van containing the shipping box had been pulled into the vehicle bay where the ambulance is normally kept, and the facility door quickly rolled down. The front gates were also secured at this time and facility staff were put on alert for the possibility of prying journalists.

Once it was determined that the press contingent had not followed Roy and the family to the facility, the van was partially backed out of the vehicle bay and the transfer box containing Roy was unloaded by fork-lift. Later that day, Roy was removed from the metal inner liner in the shipping box, quickly assessed externally, placed in a pre-cooled sleeping bag, returned to the shipping case, and recovered in dry ice.

The Alcor U.K. transfer box containing Roy shortly after his arrival from Australia.

Hugh Hixon then went back to work on two major engineering projects being carried out under tremendous time pressure, namely to quickly build a patient support system allowing the new Alcor Bigfoot Patient Storage Dewar to be pressed into service using our existing tray system, and constructing a controlled-rate cooling lid to carry out the temperature descent from -79°C to -196°C (-320°F) in a controlled manner. A controlled rate cooling lid for the A-9000M dual-patient whole-body dewars was already in existence, but all of the A-9000M units were full of patients in long-term storage and the existing lid was too small. Thus, a cool-down lid for Bigfoot needed to be fabricated on short notice.

Cooldown lids are important because they prevent stratification of chilled gas inside the storage unit during temperature descent. Such stratification could result in as much as a 100°C difference in temperature between the patient's head and feet. The Alcor cooldown lid addresses this problem by vigorously stirring the atmosphere inside the dewar and adding liquid nitrogen in a controlled fashion using a timer-controlled valve.

While this work and other preparations were underway, the Schiavellos took some much-needed time off to explore Southern California and recover. During this interval arrangements were also made to obtain CT scans of Roy's head to attempt to determine the extent of the surgical procedures carried out during the unsuccessful attempt to remove his deep-seated brain tumor. This was necessitated in part because of the treating surgeon's and the hospital's refusal to release Roy's medical records, including his operative reports and any pre- and post-surgical CT scans. (These records were ultimately obtained under the Australian government's Freedom of Information Act, which was used to free-up Roy's records from an un-cooperative hospital/surgeon.)

On July 5, Roy was removed from the shipping box and placed inside another heavy-duty, intermediate weather military-style bag which had been stripped of all metal fittings to prevent interference patterns on the CT scans (the inner bag was metal-free to begin with). Pulverized dry ice was them placed between the two bags and the outer bag was zipped closed.

Jerry Leaf (left) and Mike Perry (right) prepare Roy for CT scanning by packing him in pulverizing dry ice in an intermediate-weather sleeping bag.

Roy was then loaded onto an ambulance cot and taken to the CT scanner which had been summoned to the Alcor parking lot. The scanner is housed in a large van and its 275 KW power supply is carried by another, smaller truck. Axial scans were made at 5 mm intervals of Roy's head, chest, and upper abdomen. These films revealed incomplete removal of the tumor and the expected cerebral edema. It is anticipated that the films, along with pre-surgical scans obtained after Roy's suspension, will be evaluated by a competent radiologist and neurosurgeon for addition to Roy's medical records. Following the CT scan, Roy was removed from the outer bag, replaced in the transfer container, instrumented with external thermocouple probes on his head and abdomen, and re-covered with dry ice.

The mobile CT scanner in the Alcor parking lot.

On July 6, preparations were completed to place Roy into long-term suspension. A film crew from CBS' 48 HOURS was also present to film the transfer from dry ice to liquid nitrogen. The operation proceeded smoothly. Roy was removed from the transfer box already in place in a sleeping bag and moved onto an ambulance cot. Conventional posterior-anterior and lateral skull X-rays were then taken while Roy was on the gurney.

Roy was then transferred to a standard pre-cooled storage stretcher, moved into the patient care bay, and hoisted through the skylight for vertical placement in the Bigfoot dewar. Once in Bigfoot, the cool-down lid was put in place and the descent from dry ice to liquid nitrogen temperature was carried out over the next 24 hours.

On July 11, two other whole body patients were transferred from the A-9000M dual patient dewar they were in previously to the Bigfoot unit with Roy. Within the next few months it is likely that all Alcor whole body patients will be repackaged into radiolucent cassettes which provide more comprehensive thermal and mechanical protection during subsequent transfers.

Tony (left), Rosa (center), and Rose (right) Schiavello on the day of their departure from Alcor to return to Melbourne.