From Cryonics, November 1991
The Cryopreservation of Diane Wilson
A Personal Account
by Brent Wilson
Diane Wilson and Brent Wilson are pseudonyms.
Brent Wilson is an Alcor suspension member and transport technician.
Winters in Canada are cold. During this season it is possible to experience discomforts on a daily basis that many southerners would find intolerable. It is a season that also brings a generous helping of colds, flus, and general aches and pains. It is not unusual to feel unwell during the winter, especially at the age of 62.
In February of this year my mother wasn't feeling well. She began to experience chronic nausea, and a tenderness on one side of her abdomen. Mom had a history of gall bladder problems (with similar symptoms) and we assumed it was the same problem once again. (I remember complaining that the darn thing hadn't been removed years ago.) Dad convinced her to go see her doctor.
An ultrasound examination in mid-March revealed gallstones, and an ominous "something else." Mom's physician was going on vacation, but said he'd requisition a CT scan. The hospital would call when they could take her. (In Canada, it often takes weeks to obtain CT scans for non-emergency cases.)
In the third week of March, I called up Ralph Whelan to see if Mom and Dad's suspension paperwork was ready for signing. (I had sent in sign-up fees for both of them in December to get in under the old funding minimums.) I explained that I was concerned about my mother's health, and that a gall bladder operation might be coming soon. It seemed prudent to have the paperwork ready to go.
In the meantime, Mom had become very sick. By the end of March she suffered from unrelenting nausea and vomiting. Her days were spent waiting by the telephone to be called in for her CT scan (which we found out later was never requisitioned!). Her doctor was still on vacation. The physician covering for him told her to go to the emergency department of his hospital. She did, and was sent home with indigestion! We returned the next day, and she was referred to a surgeon. He admitted Mom to the hospital, and ordered complete upper and lower GI tract x-rays.
Thursday, April 4, we knew the cause of the nausea. A massive tumor had obstructed her stomach. Surgery was scheduled for the following Monday. I rushed over to the hospital, Alcor paperwork in hand.
Of my two parents, Mom had always been the most receptive to cryonics. Through my years of involvement, her curiosity turned to fascination, which turned to halting agreement. On several occasions during the preceding year she had said to both my father and me that she would "do it."
There was only one big concern my mother had about cryonics. Her life had not been easy. She was sick most of her childhood, and her adulthood was spent working hard caring for a family of four. She always said she didn't want to "suffer all over again." I did my best to reassure her that if cryonics works, it could only work in a world where people lived very long, very healthy lives.
Friday, April 5, Mom was allowed to spend a day at home before being readmitted for surgery. On this day she became Alcor member A-1324. It was also on this day that she met a person who would become very close to her in the months ahead: my girlfriend, Deb.
This particular weekend was the most difficult time of the whole crisis for me. I was simultaneously stricken by grief, shock, and severe doubts that I could make cryonics happen here. There were a thousand things to do, and a thousand obstacles to overcome. Where would I begin? I notified my local funeral director that his assistance might be required imminently. I had several awkward phone conversations with Mom's doctors about cryonics. I loaded 200 pounds of ice into our household freezer, and put 30 pounds in the trunk of my car with some ZipLoc bags.
Sunday morning I went to the hospital to ask one more time if Mom really wanted cryonics, which Dad had doubts about. Such was the depth of my own doubts, that part of me wished she wouldn't. She did (but only after I assured her it wouldn't interfere with my exams!).
Monday morning, April 8, a wonderful thing happened: I went to the Coroner's office. Mom was having her surgery, and I knew if anything went wrong she would be in the clutches of the Provincial Medical Examiner. I would have to explain cryonics to these people. As it turned out, the investigator I met with (who I will call Denise) was the most understanding person imaginable. She was very sympathetic to my predicament, and within minutes was making all sorts of phone calls on my behalf (to check details of air transport, etc.). I stayed in regular contact with Denise in the months ahead, and she was a constant source of support. Most importantly, she secured the cooperation of the Chief Medical Examiner himself in removing obstacles to Mom's suspension.
Mom survived the surgery. I met with the surgeon later that afternoon to discuss the details. He successfully performed a stomach bypass to relieve the nausea, but the tumor was an "inoperable gastric carcinoma" with metastases to the liver, pancreas, and other organs. He gave Mom six months to a year to live. No treatment was possible.
The outlook was poorer than we hoped for, but not entirely unexpected. I went ahead and wrote my exams while Mom recovered from surgery.
The second week after surgery, Mom was still in the hospital, and some oncologists were brought in on the case. They wanted to confirm the surgeon's diagnosis, but the surgeon had neglected to take a tumor sample for biopsy. The next several weeks were wasted in pathetic, futile attempts to obtain biopsies by endoscopy and needle aspiration. All the while suspicion was growing that Mom's cancer might be a treatable lymphoma rather than an untreatable carcinoma.
This was an incredibly frustrating time. Whenever a biopsy attempt failed, the next was scheduled a week later. Yet if the cancer was a lymphoma, then every day of delay was decreasing the chances of successful treatment.
As much as it was frustrating, it was also disillusioning. Canada is full of propaganda about how great socialized medicine is, and how Canadians get the finest medical care "free." Sure, there are long waiting lists, but these are mere inconveniences. Nobody actually DIES on these waiting lists. Yet this was precisely what was happening to my mother.
It was now the beginning of May, and Alcor and I were struggling to get a Coordinator's Kit (including transport medications, a heart-lung resuscitator, and patient ice bath) into Canada. The paperwork required to clear Canada Customs was a nightmare. Each of hundreds of separate items had to be individually recorded and assigned the appropriate tariff codes. A commercial customs broker quoted me $2000.00 for clearing the shipment (which was a fancy way of saying he didn't want the job). I ended up borrowing his coding book over a weekend and doing it all myself. On May 14th, after dozens of pages of paperwork, and outrageous duties and taxes, I finally brought the kit home. . . all 250 lbs of it. Hurray!
Mom was home now, still on a waiting list to see an oncologist, still not properly diagnosed or treated. A CT scan showed the tumor now occupied one half of her abdomen. Over the long weekend of May 20th, she became jaundiced.
8:30am Tuesday morning, May 21, I marched into the provincial cancer center and demanded that she be seen by an oncologist IMMEDIATELY. She was, and was admitted to the city's largest teaching hospital the same day. This hospital declared the biopsy attempts of the previous hospital as totally inadequate, and scheduled Mom for surgery all over again for the sole purpose of obtaining a proper tumor sample.
Meanwhile, the stress of the past few weeks had been taking its toll on me. I became bedridden the day after taking Mom to the hospital, and by the weekend was hospitalized myself with a raging case of strep throat. That was the sickest I've ever been in my adult life, and I will never forget it. I particularly remember the utter helplessness: the dread that if anything happened to Mom, I couldn't lift a finger to help her.
I was released the same day as Mom's surgery (Monday, May 27). Sure enough, her cancer was a lymphoma. It had been treatable all along, and we had lost two months of precious time. A treatment plan was drawn up consisting of two weeks of radiotherapy concurrent with the start of six months of chemotherapy. The oncologist gave a 40% chance of remission, and a 15% chance of cure.
Now that I was getting well again, I continued with cryonics preparations. I moved two big "H" cylinders of welding oxygen (to be used as medical oxygen) into the funeral home. I also told Mom's new doctors about cryonics. This time I did it in writing. I added my own cover letter to Alcor's standard letter to hospitals. I also enclosed signed copies of Mom's Consent for Cryonic Suspension and Authorization for Anatomical Donation, and a copy of Alcor's stabilization protocol.
I slipped this big envelope under the door of Mother's surgeon, and it had amazing effects. Within hours the information was passed to the oncologist, and the next day a meeting was set up with the hospital administration. From this experience, I can definitely say written documentation (especially legal documentation) is worth a thousand spoken words.
Friday, May 31, I met with the hospital president, a consulting physician, and Mother's oncologist. The meeting took place in Mom's room on the oncology ward, with Mom feeling very sick and debilitated. The oncologist explained to Mom that cryonics was not a service this hospital could provide. I said that I understood that, and was most interested in access, not assistance. If she became terminal, could Mom be promptly pronounced when cardiac arrest occurred? I was told a doctor would come as soon as possible, but how soon would depend on the needs of patients elsewhere in the hospital. Could we move her straight out of the hospital (bypassing the morgue)? A nurse in the room mentioned she had seen this done before, so this was approved. What about CPR and other stabilization measures? No way. The hospital president stated that an attorney had advised against allowing CPR because the hospital would be liable for anything done to a patient, living or dead, within its walls. This seemed paradoxical to me. Couldn't someone hold them liable for inflicting ischemic injury on a cryonics patient?
I left the meeting disappointed about the CPR prohibition, but relieved that the hospital was being reasonably accommodating.
Later that afternoon I visited Mom's surgeon. He became quite distraught when I mentioned the CPR situation. He said he didn't see how this thing could possibly work without CPR in the hospital. I found myself consoling him with a mini-lecture on cerebral ischemia, and on how transport medications can prevent "no reflow."
During the first week of June I attended Alcor's transport technician course. This was a very well-organized presentation of the knowledge and skills needed for cryonics transport, with lots of "hands on" training. It was very gratifying to learn the purpose and use of the myriad of drugs and devices in my transport kit. I began to feel confident that I could now do much more than simply "pack the patient in ice" (which is all I could have done a few weeks earlier).
Mom's therapy began at the same time as the course, and I called home daily to keep track of things. Within three days her jaundice resolved. By the end of the week, her tumor was down to 1/4th its original size.
It was the middle of June, and things were looking good. The radiotherapy was finished, and the tumor had all but disappeared. Mom received her second round of chemotherapy, and was sent home.
Things did not go well at home. The oral anti-nausea medication did not work as well as the IV, and she quickly became dehydrated and febrile. She was readmitted to the hospital. The decision was made to delay further chemotherapy until she recovered.
Meanwhile, I had made the difficult decision to attend a scientific conference in San Francisco near the end of July. Mom received her third dose of chemo on July 15, and was doing well. Friday, July 19, the day Deb and I left for San Francisco, she looked great.
Monday, July 22, a serious crisis developed. Mom's gall bladder became infected due to sudden, severe immune suppression. She was moved to the ICU, and scheduled for emergency surgery. Deb and I were still in San Francisco. I spent the afternoon glued to a convention center pay phone talking to doctors, funeral directors, and airlines.
Surgery was attempted that evening. It was aborted because of fulminating pulmonary edema. They couldn't induce anesthesia. If that wasn't enough, Mom also had pneumonia and septic shock. The surgeon gave her 10 hours to live.
Deb and I rushed back home on an overnight flight. Mike Darwin made plans to leave in the morning... if she would last that long. She did. She became stable enough for surgery to be performed the following afternoon. Her gall bladder was successfully removed.
We spent the day at the funeral home (across the street from the hospital) preparing for a suspension. Mike Darwin arrived that evening, bringing with him a cooler full of Viaspan blood substitute and other assorted equipment. (It took me most of the afternoon to obtain Customs clearance for these things.)
Mom was doing surprisingly well. No one had expected her to survive the previous night, let alone the surgery, but she did. The next several days were spent fighting bacterial sepsis, and pneumonia with extremely low white counts. Although she remained comatose, there was gradual improvement.
Thursday, July 25, Alcor's patient transport box arrived by air freight. The arrival of this useful item (far superior to sealer caskets for patient transport) left us well prepared for a suspension.
Mom continued to glide along in critical, but stable condition. Mike decided to leave Sunday morning, July 28. Before he left, he gave me detailed instructions on how to perform a Viaspan flush, "just in case" I had to do it myself.
By Monday the bacterial infection had cleared, but Mom still wasn't waking up. It soon became apparent why. The bacterial sepsis had been replaced by systemic candidiasis (a system-wide yeast infection). Anti-fungal drug therapy was started immediately, and her white blood cell count climbed as her immune system started to recover from chemotherapy. This gave her a fighting chance.
During most of her hospital stay, Mom's blood pressure had been too high. Anti-hypertensives were necessary to keep it down. Early Wednesday morning the problem reversed: she had a hypotensive crisis, and neosynephrine (a pressor drug) was necessary to boost her blood pressure. This suggested the beginning of septic shock (a dangerous and often fatal consequence of systemic infections).
The dose of neosynephrine required to maintain her blood pressure declined during the day on Wednesday, indicating improvement. By evening the maintenance dose had started to rise again, and I called Mike Darwin and a physician-member of Alcor who had been following Mom's case. Mike thought it very likely that cardiac arrest would occur within 24 hours. The physician spoke directly to the ICU nurse, and noted that all organ systems were working fine, and that blood pressure was the only problem. He thought mom might be able to pull out of it.
The maintenance dose of neosynephrine rose all night, and Thursday morning I asked Mike Darwin and Keith Henson (who was in Detroit) to come out for a standby. I also asked Deb back to Winnipeg (she was visiting her parents several hours away). I moved everything I needed for Viaspan perfusion to the funeral home, everything I needed for transport (including the patient ice bath) into my dad's truck, and purchased 300lbs of small cube ice. I stored the ice in Alcor's air transport box at the funeral home.
By mid afternoon Thursday the blood pressure situation improved dramatically. Also, for the first time since her surgery, Mom woke up! She was conscious and responsive, although she couldn't speak because of the endotracheal tube. Her attending physician considered the hypotensive crisis over, and warned that a remote standby at this point could easily last two weeks. I called off Keith Henson, and sent Mike (who was already enroute) back to Riverside.
At 7:00 AM Friday, August 2, the hospital called. Mom was having another hypotensive crisis. This one was MAJOR. She was no longer responding to neosynephrine. To maintain her blood pressure they had to switch to the most powerful pressor known: norepinephrine. I knew then it was "game over."
Deb and I went straight to the hospital and checked out the situation. Mom was stable for now, although definitely terminal within the next 24 hours. We decided to go back to my place (about 10 minutes away) and grab one or two more hours of rest. It would be a long day.
At about 10 AM, we advised Alcor of the situation, and headed back to the hospital. Deb went in her own vehicle, and I stopped on the way to purchase a fresh 50 lb bag of ice.
When I arrived at the ICU, the attending physician explained that all Mom's systems were failing, and normal procedure would be to discontinue medications and respirator support. He was prepared to wait until I gave the word. I asked him if he could hold her till midnight, as this would give enough time for Mike Darwin to come up. He thought that he could. Mike decided to come.
Around noon I requested, and was granted, permission to bring the Pizer tank (patient ice bath) into the ICU. I described it as a "transport container." Deb and I donned our white lab coats and brought the tank up from my dad's truck. Discretely hidden inside the tank was a Brunswick HLR, portable oxygen, and that fresh bag of ice. There was also a bag with various transport supplies, such as gloves, goggles, and end-tidal CO2 detectors.
Thinking that I still had 12 hours to play with, I returned home and spent the better part of the afternoon talking to customs brokers about paperwork for getting Mike's supplies across the border with him. At 3:00 PM, while I was on the phone with a broker, my pager went off. It was the hospital. They said mom was losing it, and could arrest at any time. I immediately began drawing up first-line transport meds (the ones used to prevent warm ischemic injury).
I got back to the hospital at 4:00 PM, and smuggled in all the meds in syringes ready to go. I was told there was no way mom was going to last till midnight. We were going to have to do the transport without Mike. After looking things over, I decided to run back down to the truck and draw up the nimodipine (a temperature-sensitive drug I was holding on ice until cardiac arrest was really imminent). I came back up to the ICU and laid out all the med syringes in firing order on a bed of ice at the bottom of a small cooler.
By this time, my friend Russ had appeared (I was leaving messages on his answering machine all day) and was prepared to lend a hand.
At about 4:30 PM, I called the assisting funeral home and persuaded them to send a couple of staff and their transport vehicle to standby at the hospital. The owner and another staff member appeared at about 5:00 PM. Things looked fairly stable, so we agreed they could go to the hospital cafeteria and grab some dinner. If things went sour, we could summon them via their portable cell phone.
We were essentially ready. I decided to keep going with the medications and respirator support as long as we could. The next plane we could use wouldn't leave Winnipeg until 6:00 AM the next morning, so every hour we could delay the transport would be one less hour of cold ischemic time.
At about 6:00 PM Mike called from a very noisy airplane phone. He couldn't hear me, but I could hear him. He had been in contact with Alcor, and knew the situation. He wished me luck.
By 6:30 PM Mom's systolic pressure dropped below 50, and I became concerned about the adequacy of cerebral perfusion. Her pupils were constricted and slightly responsive, which is good, but I wasn't going to push my luck any farther. I requested that medications be discontinued.
Meanwhile, the funeral directors had not come back from dinner. They were nowhere to be found, their cell phone was not responding, and the nurses were already disconnecting I.V. lines! This was the scariest moment of the transport for me. After a few frantic minutes, Debbie finally located them in the ICU lounge.
Mom arrested at 7:05 PM. The respirator was disconnected and remaining I.V. lines and catheters were disconnected or clamped off. I lifted her in my arms and placed her in the Pizer tank. I cut open her hospital gown, and fastened the HLR thumper in place. Russ and Deb spread 50 lbs of ice over her. Yikes! The thumper was positioned wrong. I had to reposition the thumper and its straps with the tank already full of ice (not an easy task).
The HLR was turned on. (Everything happened so fast, I was surprised to learn later that 9 minutes had elapsed between cardiac arrest and starting the HLR.) I started injecting transport medications, using code numbers to identify them as Deb took notes. Nobody stopped me, so I injected almost all the first line meds right there on the floor of the ICU. I was told later that the entire ICU staff were just standing there in a circle, paralyzed, with their mouths open. Of course, I did not have official permission to do any of this stuff.
We rolled out of the ICU with the Pizer tank covered, and HLR pumping away. The security escort I requested was waiting at the elevator, holding it with a key (something that is only done for "code 99's" -- extreme medical emergencies). The security people even helped lift the tank into the waiting van.
We arrived at the funeral home a few minutes later. We went down to the prep room, and set about the business of piling on more ice, installing temperature probes, and starting IV's. Russ set up his video camera in one corner of the room, and got the next four hours on tape. Deb continued with her expert note taking.
The first IV I started was tromethamine (THAM) to buffer against acidosis, which was probably severe after 30 minutes of HLR support. The solution was in an unvented glass bottle running into a central venous line. To obtain good flow rates, pressure infusion was initiated by injecting air into the IV bottle. IV mannitol was then piggy-backed onto the THAM line, and pressure infused manually.
It was at this point that the most serious errors of the transport were made. In my haste to accomplish various tasks, the pressurized THAM bottle was left running unattended several times. In addition, it appeared on the video that not all IV lines were properly primed. As a result, air embolism almost certainly occurred. How much is unknown. End-tidal CO2 readings did drop from 5% to 2% shortly after I were started, although this could have been caused by pulmonary edema.
Once IV's were up and running, I drew up and injected the methylprednisolone and chlorpromazine (to protect against cold ischemic injury). Periodic injections of epinephrine and nimodipine were also administered to maintain blood pressure and prevent brain injury.
During the second hour of the transport, severe, bluish swelling developed around Mom's eyes and eyelids. This continued for an hour until we discovered the cause of the problem. A strap was wrapped around her face to hold her endotracheal tube in place. Her worsening edema had caused her face to swell within the strap, preventing return of venous blood. The strap was cut, and the swelling stopped. Fortunately, only superficial circulation (i.e., circulation to facial skin and muscle) was affected by this problem.
The funeral directors working with us were just super guys. One made flight arrangements and got us refreshments, while the other (who I will call John) performed all the surgery for femoral vessel access.
When Mom's temperature reached 20°C, preparations were made for the Viaspan flush. The HLR was turned off while John raised the femoral artery and vein. Even with the HLR off, the wound quickly filled with blood. John marveled several times at the effectiveness of our procedures in preventing clotting. Transport antibiotics were mixed with 7 litres of Viaspan in a sterile reservoir.
Following cannulation of the femoral vessels, the Viaspan was perfused through an open circuit at about 100 mmHg pressure (achieved by placing the reservoir on a ladder 4 feet above the patient). After 15 minutes of perfusion with the HLR still off, the HLR was turned back on for the last 5 minutes of the perfusion. With the HLR running, the cold Viaspan caused core temperatures to drop dramatically (several degrees).
When Mike arrived at 11:30 PM it was all over. We prepared Mom for air shipment, cleaned up, and went out for a meal before the plane left at 7:00 AM, August 3.
Thursday, August 8, a Catholic funeral service was held. Mom's unsuspended cremated remains (returned by Alcor after her neurosuspension) were interred at a local cemetery. Only our immediate family knew what really happened.
Looking back, it's hard to believe any of it did happen. For my mother to end up in cryonic suspension when she did (with so much still to look forward to) was a tragedy. Yet I cannot help but marvel at how well everything went from a cryonics perspective. There were so many things that could have gone wrong, but didn't. There were so many things that went right. Of all possible scenarios for a suspension, the one that finally unfolded was as close to ideal as I could have imagined. Mother would have said the Good Lord was looking after her (and us).
The time course of Mother's illness was particularly remarkable. It was long enough to make physical and psychological preparations. (By having time to prepare, and adjust, I was able to do far more than I ever thought myself capable of.) Yet it was not long enough for her to suffer as much as most cancer patients do. Nor did our family have to share in the pain and anxiety for too long.
I also consider myself fortunate to have had the help and support of special people like my dad, Deb, Russ, the assisting funeral directors, and my friend at the Coroner's office. Thanks also to the "physician member" of Alcor who offered so much support and advice. You know who you are.
Most of all, I am grateful that Alcor and its staff (particularly Mike Darwin) were there when Mom and I needed them. The care Mother received (with the exception of my own errors) was first-rate, and a direct reflection of the sophistication and dedication of this organization to its members. Thanks to Alcor, not only was Mother suspended, but suspended so well as to have (in my view) as good a chance as any other patient now in suspension. This is more than I ever dreamed possible during that lonely weekend in April when the crisis began.
Finally, I feel I owe a debt of gratitude to the institution and staff who cared for Mother (and I have sent them a letter to this effect). Although I was constantly frustrated by the snail-like pace of the Canadian health care system, their approach toward cryonics was certainly commendable. Although individual attitudes varied, I never encountered any overt hostility. I mostly sensed indifference, curiosity, and maybe even respect.
I particularly remember one conversation with an ICU nurse. It was late at night, and I asked what criteria would be used to pronounce legal death in this case. She replied that cryonics was so new to them, they were kind of "looking to me for guidance(!)."
The notes of the attending physician at the bottom of the ICU case summary perhaps sum things up best: "She is not felt to have any ongoing risk of infection to other individuals. Case was reviewed and approved by Provincial Medical Examiner for transfer. The family are planning to transfer her body to California for cryopreservation therapy."
|Cry not for the loss of a loved one
Cry only for the fragile memories lost to bad science
Cry only for the life you live apart now, for those events that will pass
in your life that seem so important, that you would have shared, but fifty
or one hundred years from now will not be remembered.
Our lives are short and cruel and plagued by insufficient recall
For this we should cry, but be strong, for in the men of science comes our
brave new world, a heaven of our making
Beseech the gods of science that this time be not long.
-- Crime Meister