X-Message-Number: 1254 Subject: CRYONICS Quintessence: Part 2/3 From: (Edgar W. Swank) Date: Fri, 02 Oct 92 07:30:12 PDT Quintessence (part 2 of 3) Jim returned to the Bay Area that evening to fetch from Trans Time essential supplies and materials, which we planned to store at the house or the mortuary so they would be readily available. While Jim was in transit, I conferred with Art Quaife by phone about needed supplies for Jim to fetch and the corresponding charges. I helped Beulah reposition Mother, change bedding, and apply a fresh morphine patch to her back. The slightest motion caused Mother great distress, and Beulah said that the bizarre gesticulation Mother displayed was in response to extreme pain. I filmed for a few more moments and then prepared to spend the night tending Mother and awaiting Jim's return. During that afternoon and evening I spent hours at Mother's bedside, dismayed at her suffering, smoothing her hair, massaging her gently, stroking and kissing her, and talking. I told her that her little boy was staying with her, and her little cat, too, was nestled on the bed. I related her the news of the day and the goings-on there at home. I commemorated the love for Italy that we had both often expressed by repeating a sort of motto of hers, "Mio core e sempre in Italia" (My heart is always in Italy). At this, she stirred turned and raised her head and, though her gaze was glassy and unfocused, looked at me. I outlined a simple meditative technique purported to ease pain (without attempting to affect it, simply attend to the breath), and reminded her of it a few times during the evening; she seemed noticeably calmed each time. I told her of my anguish that she seemed to be leaving me and all who loved her and all she loved, but affirmed that I was not asking her to prolong needless agony, should it be in her power. I apologized should anything I say be presumptuous, attributing it to my ignorance of what is important to one in the grip of her ordeal. Our often tempestuous relationship in mind, I spoke my resolve never again to harbor a reproach against her, but always to remember and love her, and I begged her forgiveness for all the turmoil she might justly ascribe to me. I thanked the God in whom I don't really believe for the inestimable boon of Mother, and I thanked Mother for being my mother and for being herself. And I described in broad outline those yet incomplete and uncertain plans, ones which envisioned that compromise to provide each of us something meaningfully consistent with our own values. It seemed to me that she then began to breathe more easily and lie more quietly. A relief attendant, Patricia, arrived about an hour later, at quarter of ten. She and Beulah arranged the night watch, and Beulah was finally able to retire at 10:15, after almost two days of uninterrupted duty. I planned to lie on Mother's bed or watch her until Jim returned. Five minutes later, about 10:20, with Patricia still sorting out her supplies for the night, I stood at Mother's bed, watching her by now quiet, shallow, steady, but infrequent breaths, again smoothing her hair, and holding her hand,as she lay in a semi fetal position on her right side, her left arm stretched down, her right arm curled round her head. Work Begins Soon I noticed that she seemed not to have taken a breath for too many seconds. I felt a precipitous spasm of panic and despair as I watched more closely, felt for her heartbeat, and murmured questioningly, all the while thinking "No, no, it's too soon; I'm not ready!" Patricia saw this, checked too, and then crossed herself. Mother's work was done. I took her hand, bent down and kissed her,and whispered in her ear, " I swear to you, my dearest Momma, I'm not abandoning you; it's not over!" An unrestrained wave of sobbing drenched me before I realized that, ready or not, the time for some urgent work of my own had begun. Patricia roused Beulah, who then, after the two of them hugged me, phoned my sister and the mortuary. During the fifteen or so minutes before the mortuary personnel arrived, I prepared a pillowcase pack of the accumulated ice cubes, arranged it around her head, and administered CPR. With rapt fascination, and although otherwise declining to participate in these preparations, Patricia helped me to level the bed, lower the railings, and grapple with the bag resuscitator, which I greatly regretted not having previously learned to operate. It was hard to get anadequate seal over the face and took too long to switch between chest compressions and respirations, so I tossed the resuscitator aside, tilted Mother's head back into the appropriate posture, and noting that her decades of effort and expense to keep her teeth healthy had precipitously and unceremoniously terminated, with some effort pried her jaws apart using my fingers, and switched to mouth-to-mouth breathing--easier to perform and more effective, too. When the personnel arrived, I phoned and apprised Art Quaife, who with Jim had about finished loading perfusion supplies. I took the sample Ringer's and heparin and my video camera and went to the mortuary. It was about 10:45. Mother was already laid out on an embalming table in the preparation room. The director agreed to have the procedure filmed. An assistant got more crushed ice; I improvised bags from plastic grocery sacks and stacked them around the head. At my request, the assistant got me a pair of scissors and a plastic bag; I clipped and saved a few strands of hair. Paul Segall phoned the mortuary with last minute instructions on how to proceed. The emblamer cannulated the jugular and the carotid, mixed the heparin into the Ringer's, and perfused the resulting solution to the head using the embalming machine; the effluent seemed good and free of clots. On inquiry, the embalmer answered that the circulatory system seemed that of a thirty-year-old. After this brief partial perfusion, Mother was placed in the coldroom (32-35 F) to await Jim's return. Meanwhile, the three of us chatted in the office. Finally, there was a was a knock at the door at about 1:30; Jim had arrived, delayed by fearsome and heavy Tuley fog in both directions. He had brought twelve liters of Ringer's and five two-liter bottles of BioTime perfusate. The Ringer's was used to complete the washout. The final effluent was clear and just faintly pink. Then the cryoprotective perfusate was circulated in order of increasing concentration. Very significant dehydration of the tissues of the head was observed, especially on the cannulated side. We then returned Mother to the cold room. Jim and I scraped ice from our windshields and drove back to Mother's to spend the rest of the night. I lay sleepless for some three hours, arose at 6:45, showered, rousted Jim, ate, and we left for town. On the way, though slightly disposed to call on the physician in charge, I was uncertain whether to do so or to seek the pathologist first. Jim's reasoning that we try the pathologist first went: It was all very well to try to contact the physician yesterday, when we were trying to arrange contingencies, but today the situation is different, and urgent. The main point of seeing the physician at this point would be to try to arrange for a lower-cost autopsy, which might in itself cause delay and complications by involving other medical personnel or the coroner. We know that the mortuary will cooperate, and it seems certain the pathologist will, too, and is in fact available; we still don't know about the physician. We need a pathologist anyway to do the removal--let's go for it! So, our strategy conforming to Jim's perspicacious estimate of the situation, we visited the pathology clinic, met the doctor, and had by 8:40 that morning enlisted his aid. Not having believed things would go this well, Jim and I had to rush back to Mother's to fetch supplies (ice chest, ice, biopsy tubes, etc.), including a sturdy plastic refrigerator dish which I had found in Mother's cupboard and whose dimensions and composition I judged suitable for holdingthe brain. We all converged at the mortuary by 9:00. Mother was brought from the cold room into the preparation room. I signed forms authorizing the pathologist to proceed and holding the mortuary harmless. When I inquired of the pathologist whether he minded my filming the procedure, he agreed, but then paused and asked: "This is your mother, right?" "Yes." "You're up to this?" "Yes." "Fine, then let's proceed," and immediately performed a gross external inspection of the body, then opened the torso for examination, and procured samples of muscle, bone, skin, lung, liver, and tumor from the stomach lining and abdominal wall. Jim placed each of these seven samples in its own biopsy tube. Besides the lung cancer, the pathologist noted extreme emphysema in the pitifully black and shriveled lungs (smokers, beware!), estimated breathing efficiency at 25%, and argued that, because of the severely weakened condition, even had the lung cancer been detected early, because of the additional debility resulting from it, therapy would not have been able to extend life. Numerous other tumors were observed in various parts of the body, but most organs, however, such as the liver, seemed perfectly healthy. Then, across the top of the head, he incised the scalp and separated it into two flaps, one toward the face, the other towardthe back. With the skull exposed, he employed a circular oscillating saw to isolate a segment-shaped portion of the skull. He easily detached the segment of bone, thereby exposing the brain,which he quickly excised. It seemed in good condition, except for the presence of two tumors, which appeared to be the benign meningiomas; one of them adhered to the inside of the skullsegment, and he flicked it away with the scalpel. The perfusion had not been uniformly effective; the hemisphere opposite the cannulation seemed to contain noticeably more blood. Jim had partially filled the plastic dish with highest-concentration cryoprotectant to ease receipt of the brain; the pathologist placed the brain into the dish, which Jim then topped off with cryoprotectant and, the lid secured, placed in crushed ice. I took a farewell glance at Mother's body before leaving it to be prepared for burial by the mortuary personnel. Jim and I departed the mortuary and returned to Mother's home to prepare the package for travel, by adding water to the crushed iceand assuring that all was secure. We spoke further with John Day, who at my request agreed to formulate and implement a plan for intermediate dry-ice maintenance, which he arranged to be at premises supervised by Carmen Brewer at a location convenient to Carmen, John, Jim, and me. Jim and I arrived there in mid-afternoon. John had designed and was completing a cooling and maintenance unit for this smallish package, a cylinder seven inches in diameter and 6 3/8 inches high. John soon completed constructing the unit and started cooling it down. He and I installed a temperature probe and thermocouple by sliding the leads into the liquid along one side of the brain and securing them with the plastic lid. We inserted the dish loosely into a metal pot and transferred the resulting package into the unit, attached the temperature probe to an electronic thermometer, finished filling the unit with 75 pounds of dry ice, and observed the falling temperature readings, which, after I left about 6 p.m., were monitored until they reached -40, the thermometer's lower limit, at 9:25 that night, 23 hours after death. Consequences As I neared home, I felt pressure building, and hardly had time to get in the door, greet my friendly but hungry cat, and hurriedly replenish her food and water, before I erupted in an unrestrained fit of tears and howling which lasted about an hour. I spent the next several hours on the phone, and around midnight watched the entire videotape (which I hope to make available to serious and interested parties for study). Sleep, when once it came, was soothingly sweet--surcease, I hope on this one occasion at least, for the just. John assumed the task of replenishing dry ice. David Crockett helped to estimate the requirements for my package by supplying for a similar configuration data on dry-ice consumption, which was initially about 15 pounds a day. John improved the unit by affixing aluminum foil to reflect heat, and subsequent consumption was about 10 pounds a day. Meanwhile, Peter Christiansen and Hal Sternberg helped to arrange with Trans Time a proposal for long term maintenance. A few days later, I went to the maintenance site with a stainless steel lidded stock pot, which I judged to be somewhat more effective and protective, and precooled it to dry ice temperature. Brief inspection of the inner plastic dish showed the contents fully frozen, the brain visible within through the translucent perfusate as a pale pinkish cloud. I transferred the plastic dish to the new metal pot and secured the lid. John and I conferred about a metal unit to contain the inner dish and for maintenance in liquid nitrogen. Unable to find one ready made that he judged suitable in size and construction, John designed a cylindrical lidded aluminum pot which he engaged a local machine shop to produce. I ordered a second unit, believing an extra to be useful for promotional and other purposes--and numerous cryonics dinners and meetings since have featured Jerry's show-and-tell with sample equipment! John and I picked up the complete units, which functioned according to John's specification. I conferred with him about a modification and subsequently had the units so altered to secure the lid better. I had a commemorative plaque engraved to be affixed to the aluminum unit. The plaque noted Mother's name, the dates of her first life cycle, and that I had commissioned the project. On January 29, John and I met to transfer the patient to the metal unit. John prepared three portions of half-inch-thick foam rubber. Two of these portions were round, one to go at the bottom of the unit, the other at the top. The bottom portion was somewhat smaller in diameter than the interior of the unit. The seven vials containing the tissue biopsies were to be nestled horizontally into the space between the edge of the foam and the metal wall. The third portion of foam rubber was rectangular and, except for the plastic lid, filled the space between the rest of the plastic container and the inside metal wall. John sawed a slot into the edge of the metal lid to accomodate the temperature leads and bolted the plaque to the lid, and I hand-engraved the same inscription onto the bottom and the side. The metal unit was precooled, and the following procedures were performed while all components were inside the temporary maintenance unit: The bottom insulation was inserted and then the biopsy vials; the plastic container was fitted with its sleeve of foam rubber, and then slid into the metal unit; the top foam insulation was added; the temperature leads were threaded through the slot; the lid was secured. The resulting package with its interior plastic dish containing the patient was left in the temporary maintenance unit. John and I met again the next evening to transfer the patient to liquid nitrogen. Without removing the patient from dry ice, John reduced along the vertical the temporary maintenance unit. This we transported to Trans Time facilities. Within an hour and a quarter, John, Art Quaife, and I had transferred the entire maintenance unit to vapor-phase liquid-nitrogen storage. Art and I signed papers for long term maintenance. [Continued] -- (Edgar W. Swank) SPECTROX SYSTEMS +1.408.252.1005 Silicon Valley, Ca Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=1254