Almost a Textbook Case:
In 1992 a man named Jim Glennie was fighting for his life. Jim lived in Colorado where he was a hydrogeologist; he specialized in mapping groundwater. But his work was of little interest to him now. All of his waking moments were dominated by a battle to survive a brain tumor which had been diagnosed just ten months previously.
Jim and his remarkable wife, Mary Margaret, had chosen to fight Jim's illness with every possible resource. Jim had tried surgery, radiation treatment, and half-a-dozen forms of alternate medicine. Now he was back at home, hoping that he had beaten his affliction – although the most recent tests were not encouraging. If the tumor was still growing, he had run out of options for treatment, and there would be only one choice left: To cryopreserve himself in the hope that he would be revived in a future when his illness could be cured.
Initially Mary Margaret had been the one who signed up for cryonics. She was in good health but had just turned forty, and was the kind of compulsively active person who felt there were never enough days in her life to do all the things she wanted to do. To her, cryonics offered a chance to be revived at a time when the aging process would be defeated and she could have centuries to see everything and learn everything that interested her.
As time passed, the idea of cryonics began to appeal to Jim. He had always had faith in science, and wanted to see the future and experience the rewards it could bring. When he discovered he had a life-threatening illness, he had no further doubts. He completed the necessary paperwork and became an Alcor member.
Even while Mary Margaret was doing everything she could to encourage him in his struggle to overcome cancer, she was quietly making contingency plans in case the struggle failed. She informed Alcor when the tests suggested a grim prognosis, and Alcor deployed some emergency supplies in Colorado, just in case. Jim might have another month or two to live, but the final stages could be unpredictable. In particular his compromised immune system could make him vulnerable to opportunistic infections.
After Jim's surgery, Mary Margaret gave Jim a pile of note cards and asked him to write down all of the things he really wanted to do, with one idea on each note card. By June 1992 tests had revealed that the tumor had crossed his corpus callosum and therefore no further treatment was possible. Tanya Jones and Mike Darwin made a reconaissance trip to Fort Collins. After this Jim and Mary Margaret spent their last days together in Glenwood Springs where family and friends came to spend time with him and carry him through the hot springs waters (Glenwood Springs is the largest hot springs in the world).
On Sunday, June 21st Jim's symptoms were serious enough to require a hospital visit, where an x-ray revealed that he had developed pneumonia.
He was admitted as a patient. The infection was progressing with astonishing speed. When Jim's doctor informed Mary Margaret that he would probably not make it through the night, she informed him that it was necessary for him to relate that information to Alcor. Alcor said they said they would send someone out immediately.
She stayed with him in his hospital room all through the night. At first the attending physician thought Jim had bacterial pneumonia, which could be treated with antibiotics. But then the diagnosis was revised to viral pneumonia, which entailed only a thirty percent chance of survival – even for people who were in generally good health.
He was on oxygen, now, and there were IV drips in his arm. Mary Margaret still couldn't believe it, but she had to believe it Jim's survival no longer was being predicted in months. It was down to a matter of hours.
Alcor's Director of Suspension Services, Tanya Jones, flew into Denver, rented a car, and drove to Jim's hospital, wondering if her presence would be entirely welcome. She would have to negotiate with doctors and administrators who might object to Alcor deploying its equipment. Probably she would meet relatives or friends who might be skeptical about cryonics, or even hostile to the idea. And when Jim saw her, he would know that his doctor had lost confidence in the possibility of recovery.
Tanya opened the door to his room and found a dozen friends gathered around Jim's bed. When they looked at her and saw her Alcor name badge, they knew why she was there. But Jim smiled, reached out, and took her hand. Evidently he had reached a point where he accepted his prognosis and viewed cryonics realistically as the last option available.
That made her feel better. Clearly, though, she still needed to work fast. Her biggest nightmare was that the pneumonia might claim him before she and the rest of the team were properly prepared. His physician was concerned that Jim might not last through that night. No one had imagined that he would deteriorate so quickly.
Tanya went to a phone, called Alcor, and told three additional team members to buy tickets for the next available flight. Then she went to the hospital administration and explained the purpose and procedures of cryonics. Fortunately Mary Margaret had briefed them beforehand about Jim's beliefs, and they felt a general obligation to respect a patient's wishes. They would allow Tanya to deploy some of Alcor's standby equipment inside Jim's room, and some in a room across the hall.
She went back to her car and drove to a mortuary where the equipment had been placed two weeks previously. She met the mortician and made sure he understood what was going to happen, then started unpacking everything.
Some of the equipment had to be taken to the hospital. She lugged it back there and set it up. There were medications to be administered after legal death, a specially designed collapsible vinyl tank known as a portable ice bath, cylinders of oxygen, and a cardiopulmonary support device known as a "Thumper" which would restore circulation by exerting pressure on a patient's chest.
She looked at her watch. It was dinner time, though she didn't have time for dinner. She had to confer with Jim's doctor, to impress upon him how important it was for Jim to live through the night. Then she had to go out and buy bags of ice.
In the small hours of the morning, Keith Henson, Carlos Mondragon, and Mike Darwin arrived. Keith worked for Alcor as an unpaid volunteer, Carlos was the president of Alcor, and Mike was the leader of the stabilization team.
They familiarized themselves with Jim's medical history. The hospital had supplied Jim with a full-face mask and were feeding him oxygen through a nasal cannula as well, but his blood oxygen saturation was down to 81 percent, compared with 91 to 99 percent as the normal range. The problem was obvious. His lungs were filling with fluid, preventing them from transferring the oxygen into his blood. He was still "intermittently oriented," meaning that he could understand the world around him and could make decisions regarding his treatment.
At this point the transport team confirmed the following three options with Mary Margaret:
Most patients faced with this dilemma choose option 2, because they find it psychologically impossible to ask to be removed from life support. But Jim was not like most patients, and had already chosen option 1. A long period of low oxygen saturation could harm his brain, which would conflict with his desire to be cryopreserved with minimum injury. Jim and Mary Margaret had already made the decision to do whatever facilitated the best cryopreservation -- which meant NOT prolonging the death process (i.e. prolonged period of damage). They had already informed the hospital nurse that pain medication (morphine) was their choice.
The hospital disconnected the oxygen, the IV drips, and the saturation meter that monitored Jim's vital signs. That was their protocol – it had to be all or nothing. If a patient refused treatment, he was on his own.
For eight hours, as the sky brightened outside the window, the hospital filled with the sounds of footsteps and voices of doctors making their rounds. Mary Margaret lay on the bed beside him, with her head on his shoulder.
She was exhausted by everything that had happened. Gradually, she fell asleep – but suddenly she found herself awake. His breathing had changed slightly. She sensed that something was happening and called for a doctor. The doctor on staff was wonderful. He had put off other rounds to be immediately available for pronouncement. He was standing by Jim, stethoscope ready, when Jim took his agonal breath. He pronounced immediately. A doctor, a nurse, all Alcor team members, and some friends were all in the room when Jim took his agonal breath.
To the Alcor team, the pronouncement of legal death was an arbitrary classification that said nothing about the viability of Jim's brain. Their overriding imperative, now, was to protect his brain cells from damage so that life might still resume in the future. Instantly, the team began the transport procedures. The equipment for this had already been set up in Jim's room before he was pronounced.
Quickly they slid Jim's body into the portable ice bath. Tanya injected mannitol to lower the pressure in the capillaries, heparin to prevent blood clots, and glucose to nourish the cells. Mike placed an esophageal gastric tube airway (EGTA) into Jim's throat – a device that would convey oxygen directly to the lungs and block the pathway to the stomach. Keith positioned the Thumper to press rhythmically on Jim's chest, massaging his heart, forcing blood through his vessels, carrying its precious cargo of oxygen, nutrients, and medications.
The team covered Jim with ice to lower his temperature and reduce his metabolic demands, inhibiting the brain damage that would normally begin. The EGTA and the thumper were both supplied with compressed oxygen in small E cylinders slung across the top of the bath, so the entire apparatus was completely mobile. They wheeled it out of the room and quickly down a hallway, escorted by the hospital's head of nursing administration.
They took an elevator to a loading dock where a van owned by the local mortuary was waiting. The PIB, with Jim in it, was very heavy – maybe 350 pounds. The team struggled to lift it into the van.
The small tanks of oxygen running the thumper and the EGTA were becoming exhausted. Keith ran back and grabbed a larger tank of oxygen that had been stashed on the loading dock in advance. It was so heavy, he could barely manage to roll it and drag it up the ramp, into the vehicle. Then he had to connect it. The hose got tangled. He untangled it. He managed to switch from the small tanks to the large one, and the supply continued without an interruption as the van began its short journey.
One day in the future, the Alcor team might be able to perform its next procedures inside the hospital itself; but not yet. By orthodox medical definitions Jim Glennie was no longer alive and could not receive medical treatment. Consequently the Alcor team was compelled to relocate him at a mortuary.
Jim was wheeled into a prep room tiled in cream and brown and poorly lit by fluorescent panels. Everyone lifted the ice bath and placed it on a mortuary table, then prepared for surgery. It was a scene of orderly chaos, like military medics setting up on a battlefield.
Mike made an incision and carefully exposed the femoral vein. Jim's vein was unusually deep, and the retractors weren't long enough. The position of the ice bath on top of the table made the procedure especially awkward, and the dim lighting didn't help. Surgery under these conditions was a major challenge. Mike inadvertantly separated the vein from a small side branch, and dark venous blood started flowing out.
He called for suction equipment, and Keith set up a unit owned by the mortuary. Tanya grabbed a bulldog clamp and managed to get it on the ruptured vein, to reduce the flow. She applied suction. She managed to clean the area.
Mike returned to his primary objective. First the femoral vein had to be tied off with silk thread. Then another loop of thread had to be tied loosely, further up. Then the vein could be punctured and a tube known as a cannula could be slipped in. Finally the upper loop of thread was tightened around the cannula to hold it in place.
After that he would perform the same procedure to place a cannula in the femoral artery, at which point the team would connect the two cannulae with equipment which they had brought with him to flush out his system, remove the blood, and substitute a specially modified organ preservation solution. This solution would help to sustain Jim's cells and protect them from damage while he was cooled to a few degrees above freezing for air transport to Alcor's facility in California.
Mike managed to get the first tie around the femoral vein. He tightened it. He applied the second loop above the first. Things were beginning to work out after all. Now he needed to insert the cannula.
There was some kind of obstruction inside the blood vessel. An anatomical abnormality? He struggled with it, and time kept ticking by. The vein felt as if it was bifurcated inside. He was under extreme pressure. If he did his job right, he believed that he might help Jim Glennie to see a future where his tumor would be cured and his life would be renewed. If he failed, all this effort would be wasted.
After struggling to cannulate the vein, Mike realized that time was running out – and time was always the biggest enemy for a standby team. He decided on a backup strategy. He could leave the vein open, cannulate the artery, pump in the organ preservation solution, and allow it to drain from the vein with no attempt to recirculate it. This was known as an "open circuit perfusion."
He decided to take this option, because prompt intervention with the ice bath had already reduced Jim's core temperature to about 60 degrees Fahrenheit, measured by a thermocouple probe. Jim was more than two-thirds of the way to the 40 degrees which they regarded as a safe temperature for transporting him.
Mike found the artery and exposed it. No problems this time. He cannulated it, and the team began pumping the organ preservation solution through Jim's cardiovascular system, replacing his blood and preparing him for the rest of his journey.
Few people realize that airlines frequently transport caskets in the cargo areas of passenger aircraft. This was the way in which Jim Glennie moved from Colorado to California, although he travelled in a specially constructed, heavily insulated transport box owned by Alcor. He arrived early on Thursday morning, with his wife, Mary Margaret, traveling in the same plane. Having gone through so many months struggling to overcome his illness, she wasn't going to leave him on his own now.
Ralph Whelan, who worked fulltime at Alcor, met her at the airport. He was a young guy with a tall, athletic build, glasses, and a reddish brown beard. He had been studying for a physics degree, but the concept of cryonics seemed so important to him, he couldn't turn his back on it. He was trained, now, to run perfusion equipment in Alcor's laboratory.
Ralph walked into the terminal as passengers were leaving the plane that had just arrived. He saw a woman with long gold hair hurrying toward him, clutching her bag with an air of great anxiety. He barely had time to greet Mary Margaret before she started expressing her concerns. "We tried to get things finished last night in time for the last flight out," she said. "But the last flight had already left. Mike said the rest of the procedure had to be completed within twenty-four hours. It's almost noon. We have very little time!"
Together they went to the cargo area, where the transport box had just been unloaded. It was painted bright orange so that it would be easy to describe and identify if there was ever any doubt. Ralph checked the box carefully to make sure it hadn't been damaged in transit. Then he called for help, since the box weighed about 200 pounds even when it was empty. He hauled it into the van that he had brought to the airport, and slammed the doors.
Keith Henson, Carlos Mondragon, and Tanya Jones had flown back to California the previous night and managed to catch a little sleep. They emerged from the facility as Ralph arrived, and together they dragged the big orange box out of the van and onto a couple of dollies, so that they could wheel it into a loading bay.
Mary Margaret followed them inside, past a row of gleaming stainless-steel tanks properly known as Dewars. Ten feet high and four feet wide, they were like giant Thermos bottles, specially insulated to contain liquid nitrogen at -196 degrees Celsius. Immersed in the nitrogen were Alcor's cryopreserved patients, waiting for the day in an unimaginable future when science might perfect the means to revive them.
The box containing Jim was guided into an operating room which smelled strongly of disinfectant cleanser. There was a lot of medical equipment in hereComputer screens, an x-ray machine, and glass-fronted cabinets packed full of supplies. The people seemed to know exactly what they were doing, and Mary Margaret felt somewhat relieved. The days in which she had worried and planned and struggled to help her husband were finally over. Here she had finally found a haven among people who shared her beliefs and her determination.
Ralph changed into surgical scrubs – green cotton shirt and pants – like the other members of the team. He checked the roller pumps, which were his responsibility. The pumps were standard hospital equipment. They squeezed liquid through silicone rubber tubing in such a way that they never touched the liquid and it remained sterile. Their purpose was to remove the organ preservation solution from Jim's body and replace it with cryoprotectant that would minimize ice damage when Jim entered cryopreservation.
This was a more elaborate procedure than the simple washout that had been done at the mortuary. The concentration of the cryoprotectant had to increase gradually, as it "equilibrated" with the chemistry of the cells. The temperature, also, had to be controlled. The pressure must be great enough to force the cryoprotectant through every tiny capillary, but not so great that the capillaries would rupture. The only way to do this properly was in a fully equipped operating room.
Hugh Hixon, a calm, quiet man with a shy manner but a friendly face, was outside the operating room mixing the glycerol-based cryoprotectant solution. He was moving methodically, verifying every step. The glycerol was in a big nylon drum with a teflon-coated metal stir-bar that lay loose in the bottom. The drum sat on top of a gadget that contained a powerful rotating magnet, and the magnet acted on the stir-bar, dragging it around inside the drum, swirling the liquid, which remained pure and uncontaminated. The stir-bar could be easily sterilized for each new use.
Keith Henson was shovelling ice into zip-lock plastic bags and dumping them into ice chests. The ice would be packed around Jim's body when he was moved onto the table in the operating room.
There was one job that none of the fulltime Alcor employees was qualified to do. That was the surgical procedure of opening the chest and attaching cannulae to the major vessels of the heart. Alcor employed a professional surgeon for this task. He arrived at the facility and scrubbed in, ready to begin.
Hugh Hixon removed the lid of the orange transport box. Its outer shell was of half-inch plywood, bolted to a welded steel frame. Inside was a three-inch layer of styrofoam insulation, and inside that was another box fabricated from half-inch polypropylene. The lid of this white plastic inner box was held in place by swiveling metal clamps and silicone gasket sealant, to be completely watertight.
The plastic lid was gently eased off, revealing a black vinyl bag covered with bags of ice. The box was so well insulated, most of the ice was still frozen.
At this point Mary Margaret started taking pictures of everything. Jim had requested that she photograph everything so that when he is revived he can acquaint himself to that part of his life that he could not witness directly. He wanted to KNOW.
On a count of three, everyone lifted Jim out of the bag and transferred him to a white plastic operating table that was shaped like a long, narrow tray with sides six inches high. They placed him on a rubber cooling blanket and added bags of ice all around him and all over him to make sure that his temperature stayed close to freezing.
Mike Darwin had arrived a little while earlier. The first thing he wanted was to check the condition of Jim's brain. Perhaps that sounded macabre, but the brain, most of all, was everyone's primary concern.
At this point the standard procedure was to make a small opening in the skull using a surgical tool known as a perforator. In Jim's case he had undergone brain surgery ten months ago, and an opening had been drilled then. The skin had been closed over it, but Mike made an incision to reveal the perforation. He was pleased with what he saw. The cerebral surface was one or two millimeters lower than normal, and the tiny blood vessels were completely free of blood. Evidently the blood washout had been excellent. Jim's circulatory system would be free from blood clots and able to convey cryoprotectant to every part of his brain. Mike felt a great sense of relief.
The operating room became very quiet. Everyone had donned surgical masks and caps, including Mary Margaret, who was still present, still determined to see this through to the end.
Blue disposable cloths were opened over Jim's torso to create a sterile field. The surgeon made a long straight incision down Jim's chest and parted the ribs to reveal the amazingly intricate internal structure of the human body. This was a standard operation that doctors performed any time they needed access to the lungs or the heart.
The surgeon delved into the chest cavity, gently searching for Jim's heart. You might think that the heart would be immediately obvious, but real anatomy isn't color-coded like the pictures in medical texts. Even after the heart had been brought into view, the surgeon took a minute to make absolutely certain which of the big tubes going into it was the aorta and which was the vena cava. During the open heart surgery, the surgeon called the other team members over to look at Jim's vasculature. He said it was the "cleanest" he had ever seen.
The surgeon took a tiny curved needle, clamped it into a pair of forceps, and started sewing delicate loops into the wall of the aorta. Purse-strings, the loops were called. The needle dipped into the vessel, just deep enough to secure the thread but not so deep that it actually penetrated the vessel's wall.
After the purse strings were complete, the surgeon snipped the tip off the atrial appendage to make a hole big enough for a two-stage venous cannula, which slid into the superior vena cava. Next, for the arterial cannula, the surgeon put a purse-string in the aortic arch, then took a number eleven blade and pierced the aorta. The aortic cannular had to be primed with fluid to avoid introducing any air which could cause an embolism.
Finally the surgeon was satisfied. It was time to begin the perfusion. Ralph started the pumps. One of them squeezed cryoprotectant into Jim's body. Another forced oxygen into the fluid on its way to the arterial pump. A refrigeration unit cooled the cryoprotectant and the rubber blanket that had been laid under Jim on the operating table.
The glycerol solution had been purified previously with a filter that was so fine, even bacteria were unable to pass through it. It was stored, now, in a sterilized nylon drum, and there was a maze of flexible, sterile, transparent tygon tubing connecting the drum, the pumps, and the patient. It was a closed loopthe fluid was cooled, pumped in through the patient's aorta, then drawn back out of his vena cava. It was returned to the nylon drum where some of it was drawn off and discarded, while new glycerol of a higher concentration was added. Then it went around the circuit again.
Meanwhile, every fifteen minutes, someone drew off a sample in a syringe and passed it to Hugh Hixon, who checked the concentration, the gases (oxygen and carbon dioxide dissolved in the solution), and the pH (acidity).
Ralph had to watch for leaks, he had to make sure that the fluid level in the drum didn't drop, and most importantly he had to make sure that no air got into the system. He also had to keep an eye on a small cathode-ray tube, like a miniature TV screen, where a yellow dot ran from one side to the other, indicating the pressure in the tubes. Any sudden changes would make the dot jump and a sensor beep.
The cryoprotectant continued circulating. Everyone was alert, now, in case of leaks. If one of Jim's blood vessels had been accidentally nicked or severed, fluid would bleed out of it. If the cannulae weren't properly installed in the aorta or the vena cava, a leak could occur there.
Meanwhile the surgeon was getting ready to fly back to his home in northern California. The tension in the operating room gradually diminished. Cryoprotective perfusion had been established uneventfully, and it would take several hours during which only two or three people were needed to monitor the procedure. Keith Henson went out to wash the orange box that Jim had travelled in. The box would be needed sooner than anyone had expected, because another Alcor member was in critical condition, out in Massachusetts.
When perfusion was complete, Jim Glennie no longer looked the same. The cryoprotectant gave his skin a sallow color and his face seemed gaunt, because much of the water had been removed from his tissues. The team members were pleased to see this, since it provided immediate visual confirmation that the perfusion had been a success.
Not all patients were as fortunate as Jim. Some might die in accidents, and could be autopsied as a result. An autopsy would impose a waiting period and almost always involved dissection of the brain. Other people might die alone, and could be discovered days later. Even a delay of a few hours after legal death could be catastrophic, since blood would coagulate in the veins and arteries, blocking them and preventing cryoprotectant from circulating through the brain and body.
Overall, simply because of circumstances, only about one time in three was an Alcor member fortunate enough to experience legal death with a standby team present. Even in Jim's case, the team had been barely able to reach his bedside in time.
Now, at the end of the perfusion process, came the final step known as neuroseparation.
Much of the money that Jim had provided for his cryopreservation would be set aside for the indefinite future, to earn interest that would pay for his maintenance in liquid nitrogen. In fact the cost of this maintenance was greater than the cost of the procedure itself. Liquid nitrogen is relatively cheap, but Dewars are not, and a substantial minimum is required to preserve a patient for the indefinite future.
Since not everyone can afford the real cost of preserving a whole body, Alcor offers a lower-cost option known as neuropreservation.
Clearly the human brain is the site of our memories, our intelligence, and the attributes that define us as individuals. Since medical science eventually should be able to recreate a person's limbs, torso, and even the organs via tissue regeneration, many people feel it makes sense to eliminate three-quarters of the maintenance costs by preserving only the brain.
Actually, since the human skull provides the best possible protection for the brain, neuropreservation entails preserving the entire head. This has been a source of jokes about cryonics, and the idea has offended some people. Yet it is an entirely rational option, and since Jim Glennie's resources were limited, neuropreservation was the only way he could be cryopreserved at Alcor.
Mary Margaret understood and agreed with this choice. In fact she had signed up with Alcor for neuropreservation herself, and was not disturbed by the idea. From her point of view it was just another step in the protocol which she hoped, one day, would enable her husband to resume his life – ideally, with her beside him.
She remained in the operating room while the neuroseparation procedure was completed. The Alcor personnel were surprised by her insistence on being there, but they respected her decision and certainly didn't object. Full disclosure was a matter of principle, here, as a way to reassure people that cryonics was a legitimate procedure. Nothing was concealed.
Mary Margaret had only one final request. At the last moment, she asked for a lock of her husband's hair.
After that, he was wrapped and transferred to a small Dewar for rapid cooling. The cryoprotectant was designed to protect him from freezing damage, but it was also somewhat toxic, and the toxicity would be mitigated at a lower temperature. Therefore heat had to be removed from the tissues as quickly as possible. A computer-controlled system injected bursts of liquid nitrogen vapor into the little Dewar while numbers on a video monitor recorded Jim's gradual descent into biological stasis. Within a couple of days he would be transferred into one of the large Dewars for his indefinite journey into the future.
The team started the mundane task of cleaning up the operating room. After that they would have an opportunity to rest and recuperate – with one exception. News of the patient in Massachusetts indicated that his condition was worsening, and he might need help soon. Mike Darwin grabbed his bag and headed back to the airport.
Today Jim Glennie is still cryopreserved at Alcor, although he was moved with all of Alcor's patients when the organization outgrew its building in Riverside and relocated in its current facility in Scottsdale, Arizona.
Mary Margaret Glennie is still an Alcor member. She provided many of the details in this account, which was written with her consent. Mike Darwin, Keith Henson, Tanya Jones, and Ralph Whelan also provided details regarding the procedures which were performed. The text was written by Charles Platt, who met Jim and Mary Margaret Glennie while Jim was still alive. Platt also was present as an observer from the time when Jim arrived for cryopreservation procedures in California. All inferences regarding the beliefs, desires, and ideas of people in this account were derived entirely from their interviews with the author.
Some of the personnel in this story are no longer working at Alcor, and some of the procedural details have changed slightly. Instead of glycerol, Alcor now uses a superior vitrification solution for cryoprotection. Still the basic protocol remains the same, and despite the problem that occurred in this case, cannulating the femoral vein for blood washout, the case remains a textbook example of standby deployment, stabilization, and transport. Alcor is the only full-service cryonics organization that provides standby/transport service of this kind, and also is the only organization that offers neuropreservation as an option.
Copyright 2005 by Charles Platt. Permission is granted for reproduction of this text, provided that the text is unabridged and is not used for commercial purposes, and this copyright statement is included.