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


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