X-Message-Number: 601
From:
Subject: Re: cryonics: #596 - #598
Date: Thu, 9 Jan 92 18:21:05 PST
Re the story of the latest ACS suspension, Alcor did one too in December,
but ours seems to have gone a lot smoother. This will show up in next
month's Cryonics magazine, those with subscriptions are just getting this
story a little early. Keith Henson
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The Transport of Patient A-1312
by H. Keith Henson
[The following article is cleaned up from a collection of personal notes
from my viewpoint on the suspension. The patient's name and his wife's
are pseudonyms. He happens to be a friend of three of the stabilization
team members. The "warts" mentioned here are in keeping with the long
standing Alcor tradition of telling it like it happened so we can learn
from each suspension.]
The first indication that our patient was in imminent trouble came less
than two weeks before his suspension. "Dennis" had metastasized gastric
cancer which had spread into the liver before it was discovered about 5
months ago. He had been out of the country for most of that time in an
experimental program which seemed to be having positive results.
On December 4, word reached Alcor that Dennis was in the early stages of
liver failure. The patient's wife ("Cynthia") was advised of the near
impossibility of doing an overseas transport in his situation, and he was
advised to get back if possible. They arrived back on Dec. 7 and checked
Dennis into a University of California at San Francisco hospital for
evaluation.
The next day (December 8) we moved the transport kit from my place in San
Jose, where it is usually stored, to the coordinator's house in Palo Alto
(closer to San Francisco). There was a regular monthly meeting scheduled
that day, so the local transport team members (Naomi Renolds, Arel Lucas,
Joe Tennant, Leonard Zubkoff, Keith Henson) came early to check out the
equipment and review operational procedures. During the inspection/
review session, we found that the fittings on our high impulse heart-
lung resuscitator (HLR) were incompatible with the oxygen-supply fittings
(something which had been known for some time, but not fixed). Leonard
and I did some running around to get it fixed. (The manufacturer--
Michigan Instruments-- happens to use "M" type air chucks, male on the
machine.) We got the correct air chuck from a local hardware store, and
that was the one actually used for the stabilization. The next day,
Leonard picked up enough of the green Hanson fittings for us to have used
those as well.
Tuesday, December 10, I was out getting a second "H" cylinder of oxygen
when Arel got the word that our patient was in trouble--serious enough
for the team to assemble at the hospital. (Michigan Instrument HLRs use
up two "H" cylinders during a stabilization. More oxygen may be needed
if some gets used up for pre-stabilization supplemental oxygen, or if no
washout is possible. In this stabilization, we emptied one of them and
used about 1400 psi from the other one in an hour and 45 minutes of HLR
operation.)
When I got home, we transferred some materials into the car including the
Nimodipine which had been missed in the first load, threw in our RONKs
(specialized Alcor "Remain OverNight Kits") dropped our daughter Amber
with (designated childcare people) Laura and Johan, and headed off to San
Francisco.
The hospital was fairly easy to find with the directions we had been
given, but directions were about all the correct information we had. The
initial call from the hospital to Alcor central had hit when both Mike
and Carlos were out of the office (Mike was in a dentist's chair!).
Alcor alerted Naomi (our local coordinator) who got in contact with the
nurse who had originated the call. The nurse asked what they should do
if the patient should die before Alcor arrived, so Naomi read her the
abbreviated protocol. The nurse (perhaps in consult with a resident) told
Naomi that they could not do this, so Alcor should bring their own
medication, which Naomi took to imply we could administer the transport
medications if we brought them.
When we got to the hospital Naomi determined that the hospital would not
let us do *any* of the initial transport protocol within their walls. We
would have to remove Dennis and frantically administer the medications in
the parking lot. There is a lesson here in knowing who can speak for a
hospital; and neither nurses nor doctors can do that. We were allowed to
move our portable ice bath into the room along with ice in chests.
About 7 pm, an Alcor transport team consisting of Mike Darwin, Tanya
Jones, and Carlos Mondragon left Riverside in the Alcor ambulance and a
rented backup van. They had a rough time of it going up the central
valley in dense fog (Stephen King grade). During a discussion with
Cynthia about Dennis's condition (over a cellular phone link) Mike
commented that our patient was more likely to live through the night than
the transport team.
Our patient, while somewhat disoriented and hard to understand, did not
seem to be in much danger that evening. He was up to hosting a popsicle
party (the humor of this hit days later) and near midnight (trailing
oxygen and feeding tube lines) insisted on getting out of bed and into a
chair. The reason we had been called was that his condition was
deteriorating very rapidly (he had been completely lucid the previous
day). His family was worried that the team's presence would distress
him, but since he understood his condition, we seemed to be a comfort
instead. When he saw the lab coats with the Alcor insignia stitched onto
them, he began asking, "Thirty years, true or false" in accordance with
the latest local speculations that cell-repair machines might be
available for rescue in that time period.
Discussions in the hospital and over the cellular phone about what we
could do in the hospital led to the conclusion that having our patient
pronounced there would result in a *lot* of delay and very serious
ischemic injury. The doctors were cooperative, but the administration
was not willing to let us do any of the initial procedures in the
hospital. We could have put the Alcor legal team on the case, but
getting him out of there seemed like a much better idea. There were
attempts to get Dennis out of the hospital that night, but it was
impossible to make the proper connections and make the complex
arrangements needed. The most important part--which couldn't be done
late at night--was finding 24-hour hospice-nursing care for quick
pronouncement of legal death. In the meantime, the team socialized with
Dennis's family and friends, and (using a rough floor plan of the house
chalked up on a conference-room board by a friend) decided how to deploy
equipment at the patient's home.
About 2 am we split the team, leaving Naomi and Joe at the hospital.
Arel, Leonard and I went over to a motel to get a little sleep. We
arranged for a place for Mike, Tanya, and Carlos to stay when they got
in. They rolled into the hospital parking lot shortly after 4 am. After
checking that Dennis's condition seemed stable for the moment, they went
off for a few hours' sleep. After an uneventful night where I slept and
Arel did not, we went back over to the hospital at 8 am to relieve Joe
and Naomi. The team from Riverside came back from the motel about 11 am.
As soon as she arrived back at the hospital Arel began to seek out the
discharge coordinators who had already made plans to move Dennis to his
home. It is hard to say enough about the usefulness of hospital social
workers. One of them, Bill Rosenfeld, found hospice nurses, arranged for
commercial ambulance service to transport Dennis home, and took care of
many critical items that no one else considered. It still took from 8 am
to about 2 pm to get everything ready.
The hospital asked us to move the ambulance from their tiny parking lot
about 11 am. I moved it across the street, and stayed with it parked in
a taxi zone so it would not be towed away. If any of you ever get
drafted to drive that beast, *read the instruction book first.* There
are ways you can immobilize it, and do several hundred dollars of damage
by flipping the battery switch at the wrong time.
At 2 pm, the rest of the team, friends and family cleared out patient's
room and loaded the Pizer tank (portable ice bath or PIB), ice chests,
and a little other equipment into the van. Dennis went in a regular
ambulance with a paramedic crew, his wife, and Mike. Since I have driven
trucks before, I was left to drive the Alcor ambulance.
About half way between the hospital and Dennis's home I ran out of gas.
We later determined this to have been caused by a stuck valve which
should switch between tanks. Even with the switch in the (full)
auxiliary tank, position, it was trying to take fuel from the empty main
tank. On the advice of a mechanic, Carlos banged the valve with a mallet
later, but we did not trust that valve for the remainder of the
transport. Carlos was behind me in the van, and stopped. Naomi was
behind him, and stopped. Naomi went down to the next gas station to pick
up some gas, while Carlos left the van parked behind the ambulance to
partly shield it from fast freeway traffic. Sitting beside a freeway
with cars whizzing by is *not* my idea of a fun time! Arel came by, and
we sent her off in to get gas as well since our car had a gas can in it,
and we figured Naomi might have problems getting one (she did not).
Naomi came back with a can and we got the ambulance started, after I took
off the air cleaner and poured a little gas into the carburetor. Arel
locked her keys in the car when she got to the gas station, but we
located her because it was the same gas station where Naomi had picked up
gas. Naomi and Arel, driving the two station wagons took off ahead.
After filling up, Carlos and I drove the van and ambulance to the
patient's home. When we got there, the transfer ambulance was just about
to leave, having been held up on the lack of bed padding which was in one
of the two cars. It took us nearly two hours to make what should have
been a half-hour trip.
Cynthia had had Bill order several cots for us as well as a hospital bed
for her husband. Once the padding arrived, Dennis was put in bed in the
living room, where (as had been planned at the hospital) the furniture
had been pushed back to the walls or moved out of the room. It was the
best place available, and gave us adequate room to put the MALSS (Mobile
Advance Life Support System) cart next to his bed when the time came.
Some of his friends managed to get a plastic sheet down to protect the
carpet. Plastic sheeting and masking tape are going to be added to our
stabilization kit. We certainly would have ruined the carpet without it.
His friends also acquired pitchers for spreading ice, and 5 gallon
buckets for catching blood washout. These should be standard kit items
as well. One of his friends also made an airport run to pick up items
not brought up with the Alcor South team.
With Dennis in bed, and the MALSS cart unloaded from the ambulance, and
brought into the dining room, the team and the first of the hospice
nurses got together for a briefing from Mike. We were either very lucky
or the quality of hospice nurses in this area is very high. They were
all surprised by the complexity (and evident effectiveness) of the MALSS
cart, and the concern team members showed for our patient. The nurses
were on an eight-hour rotating shift, which brought the first one back
the next afternoon. They were all interested in what we were going to
do.
As our briefing and preparations continued, the first of many visitors
began to arrive. Our patient was a well known and highly respected
figure in Silicon Valley, and had been out of town for some time, so a
*lot* of people came through that night, perhaps as many as 50 people
over several hours. The last prominent Silicon Valley figure came
through, his latest amour on his arm, about midnight.
Dennis had markedly deteriorated since the previous night and was now in
a coma from liver and kidney failure, but there seemed to be no immediate
danger of cardiac arrest. We had no idea how long this state might
continue; estimates ranged up to a week. Arel and I left for a couple of
hours, collecting a small refrigerator from home which could keep some of
the ice frozen. When we got back, we sent Joe home. He only got a few
hours' before being recalled about 1:30 am.
After getting things set up as well as it seemed we could, I went to bed
around 1 am. Carlos and Tanya set up cots behind the MALSS cart in the
dining room. Mike had intended to check into a nearby motel, but
Dennis's vital signs kept dropping so he borrowed a sleeping bag and some
foam, and slept on the floor of the garage. Arel stayed up watching
somewhat longer (not entirely trusting the people who were watching
Dennis to call us if he were to quit breathing). I found it impossible
to sleep, being on edge and expecting to be called out at any moment.
Our patient continued to deteriorate all night, and we were called about
7 am to get ready. There was a frantic effort to get the meds drawn up
and to get the Viaspan (washout solution) injected with heparin, insulin
and dexamethasone (supplied from our kit, since it had not been sent with
the Viaspan). We also primed the MALSS cart and move it next to Dennis's
bed. But we had underestimated the strength of Dennis's heart.
At 11 am we were still waiting. At 11:12 Dennis' blood pressure hit an
undetectable low, seeming 0/0, and then to our amazement, he rallied,
with color coming back into his nail beds. We stood down for a few
hours, and managed to send out for some food. There was another crisis
which he got through in the early afternoon. We were beginning to worry
about the life of the drawn up meds, bacteria growing in the ECMO
(Extracoporeal Membrane Oxygenator) circuit, and about the life of the
oxygenator. Mike injected some antibiotic into the circuit to extend its
life, and was starting to think about what we had available to tear it
down and set it up again. About 4 pm Dennis began to experience very
irregular bradycardia and a falling respiratory rate. Still, he lasted
about an hour longer. He was pronounced at 5:03 pm.
[ End of Part 1 of 2 - KQB ]
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