The Cryonics Institute’s 102nd Patient
The 102nd patient of the Cryonics Institute (CI) is an 87-year-old woman who has been a CI Member since 1984. She was divorced after a very brief marriage, and had no children. According to her second cousin and his wife, the patient had been a loner much of her life, and was very much an individualist. She had been young when her father died, and was very devoted to her mother, who brought her up. She had degrees in mechanical engineering and library science. She designed airplanes and won awards for her skiing.
She joined the army, which gave her the opportunity to travel the world. She spent much time serving in Japan and Germany, and rose to the rank of Major. She was reportedly very health-conscious, only drinking bottled water, and she watched her weight and diet carefully. After she got out of the military she carried a stun-gun for self-protection.
The patient remained a dutiful daughter after her mother died. Her second cousin's wife remembers the patient's memorial for her mother as the most beautiful she has ever seen. The patient visited the family gravesite on a regular basis to refresh the flowers. The patient purchased new gates for the cemetery when they were needed. The patient sent Christmas cards to her family members every year, which showed different flower arrangements around different graves in the family cemetery.The patient's second cousin's wife remembers the patient as being a person who was very exacting: "always crossing the t's and dotting the i's". The patient's cryonics arrangements were much the same, including not only prepayment for Suspended Animation, Inc. standby, stabilization, and transport, but air ambulance.
The patient lived alone in her house in a recluse/hermit-like existence, according to her neighbor who did shopping for her. The neighbor said that the patient had many locks and deadbolt on the doors of her house, and was very untrusting of other people. Her house was full of boxes stuffed with possessions. According to her neighbor, the patient slept 19 hours per day. Her neighbor described the patient as having a sharp mind, and as being an interesting conversationalist, but very frustrating because of the distrustfulness.
When the patient's neighbor had not seen the patient for the a couple of days, noticed that there were unread newspapers at the doorstep, and saw many that lights in the house were uncharacteristically turned-on, she called the police. When the police broke a window to gain entry, the neighbor persuaded them to allow her to enter first. The patient was lying naked on the floor on a blanket next to her bed. When the police approached her, the patient reached for some mace, which the neighbor discouraged the patient from using. The patient agreed to go to the hospital only when her neighbor agreed that she would go as well. The patient was admitted to the hospital late on the evening of Sunday, January 16th, 2011.
Although the patient had a history of osteoporosis, there were no broken bones from a fall. The patient was found to be hypoxemic, hypothermic, and hypoglycemic. Blood sugar was in the 30-40 mg/dL range. The patient was reported to be communicating poorly and showing poor memory.
In the hospital, the patient was reportedly "extremely ill", suffering from "severe sepsis syndrome with septic shock". Both the patient's niece, who had been appointed health care proxy by the patient, and the patient's neighbor, who was meeting the niece for the first time in the hospital, informed hospital staff that the patient had indicated that she did not want to be intubated or placed on mechanical ventilation. The patient was made DO NOT RESUSCITATE/DO NOT INTUBATE.
Only in the hospital did the patient tell the neighbor about her cryonics arrangements, but the descriptions were limited only in part because of the patient's difficulty in talking. The patient simply said that she was donating her body to science, and that she had made arrangements to be frozen — telling her neighbor where the cryonics contracts could be found. Aware that the patient was probably terminal, the neighbor expressed her love for the patient, and the patient expressed love in return. The neighbor told me that it felt good hearing those words coming from her untrusting friend.
The patient died within about a day from the time when she was admitted to the hospital. At about 9 A.M. on the morning of Tuesday, January 18th the patient's body was discharged from the hospital and transferred to a funeral home where she was placed in a cooler. The hospital asked the neighbor what should be done with the body, and the neighbor said not to cremate. The neighbor had to make two trips to the patient's house, searching through the clutter, before she was able to find the cryonics contracts.
On Wednesday morning, the neighbor FAXed the patient's cryonics contracts to the funeral home, and CI was phoned. The funeral home was told to pack ice around the patient immediately, and arrangements were made to ship the patient to CI the next day. The neighbor told me that the patient had never worn a bracelet, but that she found the patient's necklace in a rocking chair a couple of days after the patient deanimated. The neighbor told me that she wished the patient had been more trusting of her, because she would have called the Cryonics Institute as soon as the patient was hospitalized.
Given the fact that so much ischemic time had passed, I had doubts about whether perfusion should be attempted, but I decided that it was worth trying.
The patient arrived at the Detroit airport on Thursday, January 20, 2011. The patient was taken to the funeral home of CI's funeral director Jim Walsh, where Mr. Walsh and his daughter did the surgery for the perfusion. In setting up the roller pump, a household extension cord from the CI facility was used rather than an industrial extension cord. The extension cord was of the 3-prong type that had a ground, so that may not be relevant to the fact that when the pump began running there was a sharp burning odor that came from the roller pump. An industrial extension cord that belonged to the funeral home was used instead, but a burning odor was still detected coming from the roller pump when it began running again. The roller pump functioned normally, however, during the perfusion.
A few days later, Andy Zawacki unscrewed the bottom of the roller pump, but was unable to determine the cause of the problem. To be safe, I purchased another roller pump for backup. CI also still has an old cumbersome roller pump that is functional that was used for perfusions in 2007 and earlier. CI also has a centrifugal pump that was used to perfuse CI's 95th patient. The vitrification solution apparently has a corrosive effect on the centrifugal pump-heads, which would be expensive to replace every perfusion. Pump-head malfunction results in erratic pressures and flow rates, which we cannot allow. The centrifugal pump also has the shortcomings that it does not display flow-rate and requires greater attentiveness to use properly — which increases the possibility of an accident. With our current supply of roller pumps, CI should not need to use the centrifigal pump, but it is worth keeping.
An indication of how much ischemia this patient had suffered was the fact that most of her abdomen had a greenish tinge from gangrene. A decision was made to ramp the perfusion solutions fairly quickly, but not quickly enough, a s it turned-out. Mr. Walsh was reluctant to open the chest of such an ischemic patient, but he agreed to do so. She was a very slender woman, giving the appearance of emaciation. The aorta has been fragile and easily perforated in previous patients, so it was reasonable to expect this could happen for this patient. That proved not to be the case. In fact, both Mr. Walsh and his daughter were pleased by how well they cannulated the aorta.
Perfusion began at 10:11 P.M. Nasopharyngeal temperature was 0.4ºC. The patient was given 2.5 liters of 10% ethylene glycol with an initial perfusion pressure of 130 mmHg. Advanced Neural Biosciences (ANB) research (the research done for CI by Aschwin and Chana de Wolf) had shown that high perfusion pressures are especially to be avoided in ischemic patients, so pressure was soon dropped to 100 mmHg.
There was initially some flow from the jugular veins, and Mr.'Walsh wanted to cannulate the jugulars immediately after cutting, but I decided cannulation should be delayed until blood (and possibly clots) had cleared. Mr. Walsh believed it might be harder to cannulate after waiting, but we waited. As it happened, drainage did not continue.
The patient was given 3 liters of 10% ethylene glycol, 2.5 liters of 30% ethylene glycol, and 2 liters of 70% CI−VM−1 vitrification solution, after which perfusion could not continue. The patient's head had become very swollen with edema, and there was no longer flow or venous return. Fluid was going into the patient, but nothing was coming out.
It is easy to imagine that clotting was the problem, but if clotting had been the problem, fluid could not have flown into the head and caused so much swelling. The problem was leaky blood vessels due to excessive edema. The same phenomenon has been observed by ANB in experiments involving long ischemic periods. It is common for people who are unfamiliar with the effects of ischemia to attribute perfusion problems due to edema as being caused by clotting.
In retrospect, it would have been better to perfuse the patient with 70% CI−VM−1 from the beginning. If there is no venous return and with cryoprotectant going into the patient and not coming out of the patient, there would not be osmotic shock. Vitrification solution would be being diluted by body water, not displacing body water. The problem with this plan, however, is that it is hard to know how ischemicly damaged a patient is. A policy not to perfuse a patient after 4 or more days of cold ischemia makes sense, but between about 3 and 4 days the amount of actual ischemia could vary considerably from patient to patient. In this case, the pre-mortem ischemia and sepsis was considerable.The patient was taken to the CI facility for cooling to liquid nitrogen temperature. A straight freeze cooling to liquid nitrogen temperature is normally done in 24 hours, whereas a vitrification cooling takes five or six days. In this case, the patient had been partially cryoprotected (not vitified), so I compromised and gave her a 3 day cooling with a vitrification protocol.
|Full Cooling curve for the CI's 102nd patient|
Andy and his brother-in-law, David Fulcher, removed the patient from the cooling box, wheeled her to the front on a cart, raised her up to the top of the cryostats in a forklift, and finally l owered her into a cryostat. The 102nd CI patient become the fifth patient to occupy cryostat HSSV−6−11.