The Cryonics Institute’s 84th Patient: By Ben Best
The 84th patient of the Cryonics Institute is Viola Dufault, the grandmother of CI Member Kevin Boyle. The 88-year-old woman originally had been concerned about the prospect of being cryopreserved and later being reanimated in a world of strangers. However, when Kevin cryopreserved his dog Thor in February 2005 Viola gained a sense of comfort in knowing that at least Thor would accompany her into the future. She appeared on television interviews with Kevin in response to journalist interest in Thor's cryopreservation and became a CI Member herself. She attended the 2006 Annual General Meeting at the Cryonics Institute with her grandson Kevin where she was thrilled to meet and have several friendly conversations with Robert Ettinger throughout the weekend.
Viola Rose Dufault was born in Haverhill, Massachusetts on January 9, 1919. She was the youngest of seven children. Her mother was a loving home-maker and her father was a fireman. She graduated from Haverhill High School, the school the Archie comics would later be based upon. During most of her working career she was an office manager for various Boston area companies. Later in life she managed two drive-ins in Brunswick, Maine. She had one child, a daughter Elizabeth, and eventually had three grandsons and three great-grandchildren. She enjoyed traveling and for a length of time she wintered in Homestead, Florida until Hurricane Andrew blew her home away in 1992. She then relocated in Naples, Florida for a few years until returning to Stoughton, Massachusetts permanently. She and her daughter spent a great deal of time together visiting the local park and watching the Canadian geese, swans, and ducks during the last year of her life. Viola was a very outgoing person, made friends easily, and was a voracious reader. Although she did not understand much of modern technology such as computers, she had a great understanding of how the world had changed during her lifetime and what technology was capable of achieving in the future.
On Saturday, September 15, 2007 Viola had been feeling fine. Viola lived in Stoughton, Massachusetts, but she was visiting a friend on Cape Cod when she suddenly felt weak. She shouted for help and, as her friend tried to help her, she fainted. Her friend called the 911 emergency line and an ambulance soon arrived. Although she had already regained consciousness, EMTs rapidly took her to a local hospital where she began to have irregular heartbeats and once again lost consciousness. She soon lost her pulse and she was pronounced dead in the hospital of a myocardial infarction. After her daughter, son-in-law, and grandson Kevin arrived and were told she had passed away, the physician phoned the Cryonics Institute asking if it would be of any use to inject heparin a half-hour post-mortem. I told the physician that such a late injection of heparin is sometimes helpful, so he agreed to administer it through the IV line that was in place. He also agreed to ensure that chest compressions would be given to circulate the heparin. Her head and other parts of the body were covered in ice and she was taken to the hospital cooler where she stayed for a short time until a Boston area funeral home arrived to pick her up. During perfusion at CI's funeral director's funeral home there was not much evidence of clotting.
The patient had no previous history of heart trouble. She was receiving botox treatments for pain in her back muscles near her shoulder blades which radiated to her arms and down to her fingertips. She received EKG tests to ensure that this pain was not referred pain from heart problems. Instead the pain was attributed possibly to lung surgery she had received 27 years previously to remove cancerous tumors. She had experienced gastrointestinal problems attributed to atherosclerosis of vessels in the GI tract, but the atherosclerosis was not deemed serious enough to justify surgery.
In many states there is a problem with shipment on a weekend, but the Boston-area funeral director used in this case was an agent in the Inman funeral director shipping network who was able to get an emergency weekend shipment. Viola was pronounced dead too late in the afternoon for a Saturday shipment, but CI was able to get shipment on a Sunday.
The patient arrived at the Detroit airport at around suppertime on Sunday. When surgery began at 8:22pm her nasopharyngeal temperature (proxy for core brain temperature) was 7.0ºC (44.6ºF). Jim Walsh, our funeral director, did the surgery with the assistance of his funeral director daughter Sara.
Mr. Walsh commented on the relative lack of atherosclerosis displayed for the arteries of an 88-year-old woman. The right vertebral artery was extraordinarily large and could be cannulated independently (rather than in conjunction with the carotid by going through the right subclavian, as has been typically done). But the left vertebral was quite small and was difficult to cannulate. The carotid arteries were both cannulated. The cannulae were all held in place with fixation forceps. Instead of cannulating the jugular veins at the outset, they were secured and kept open with forcepts, which allowed for better drainage in the initial stages of perfusion.
To assist in cooling the patient's head, not only was her head sitting in a tray of ice, but a fishnet containing ice chips was placed on her face. Nonetheless, core brain temperature was 7.4ºC when perfusion began at 8:43pm. Perfusion began with 10% ethylene glycol rather than with m−RPS−2 washout solution in order to reduce edema. No edema was seen in the initial stages of perfusion.
Perfusion pressure was maintained at 120 mmHg throughout the perfusion, while flow rates declined with the increasingly viscous perfusate. The only exception to this was the first introduction of 70% VM−1 (Vitrification Mixture one) vitrification solution (which is more viscous than the 30% ethylene glycol which precedes it, at least partially because it is at a lower temperature). In introducing VM−1 the first 0.2-0.3 liters were introduced at about 70-90 mmHg with a flow rate of about 0.36 liters/minute. Otherwise, perfusion data for the head (brain) can be presented in tabular form, beginning with the blood washout with m−RPS−2 (modified Renal Perfusion Solution two) carrier solution and ending with 70% VM−1 -- with 120 mmHg perfusion pressure.
The objective is to perfuse the brain until the refractive index of the jugular vein effluent and/or the burr hole samples at least matches the refractive index of 60% VM−1. The refractive index of 65% VM−1 is 1.422 and the refractive index of 60% VM−1 is 1.416. A 60% VM−1 solution is deemed adequate for stable vitrification. (A perfect vacuum has a refractive index of 1.000 and water has a refractive index of 1.333 at 20ºC.)
m−RPS−2 = modified Renal Perfusion Solution two (washout/carrier solution)
EG = Ethylene Glycol
VM−1 = Vitrification Mixture one
RBHRI = Right Burr Hole Refractive Index
LBHRI = Left Burr Hole Refractive Index
RJVRI = Right Jugular Vein Refractive Index
LJVRI = Left Jugular Vein Refractive Index
During perfusion with cold 30% ethylene glycol the core brain temperature dropped to about 2.0ºC. Drainage was initially poor on the left side, but then suddenly improved, possibly indicative of a clot being dislodged. (Cryoprotectant solution can more effectively wash-out blood and remove clots than can washout solution.)
At 9pm perfusion was stopped so that the burr holes could be inserted. The forceps were then removed from the jugular veins and replaced by cannulae so that venous refractive index could be sampled.
Core brain temperature had dropped to nearly 1.0ºC, but was up to 3.4ºC by the time perfusion was resumed at 9:13pm. Two minutes after beginning perfusion with cold 70% VM−1 the core brain temperature had dropped to 0.7ºC and one of the vertebral cannulae had slipped-out. Core brain temperature dropped as low as −2.3ºC at 9:26pm and did not rise above 0ºC at any time. There was concern that the fishnet full of crushed ice on the face was diluting the samplings from the burr holes, so the net with crushed ice was not applied to the face any time after 9:30pm. In the future plastic bags containing ice may be used for face cooling during the vitrification perfusion.
An edematous swelling developed along the left side of the neck, for which no explanation can be given.
Perfusion was finished at 10:05pm at which time core brain temperature was 0.3ºC. Viola had not given CI a preference concerning body perfusion. Her grandson Kevin expressed the preference that we not perfuse the body, so we did not. The patient's head was placed in the dry ice enclosure (with her neck resting on the side) and pure isopropyl alcohol was added to accelerate cooling. The patient's body was wrapped in a sleeping bag and she was driven to the Cryonics Institute facility.
By 11:18pm the patient was in the computer-controlled cooling box at the CI facility, ready for cooling to begin. Her skull skin temperature was −17ºC, her core brain temperature was −1ºC and her core body temperature was −9º.
Again I made a great attempt to automate the cooling protocol as completely as possible so that it can be done without manual intervention. I did not manually intervene until the very end, at which time I slightly increased cooling rate so that the patient could be removed at a more convenient time. Otherwise the cooling period was one of the longest for any patients -- a total of nearly 140 hours.
I cooled the brain surface (thermocouple under the skin by the burr hole) to −120ºC and held at that temperature for twenty hours, which allowed the brain core temperature (nasopharyngeal thermocouple) to reach about −120ºC. Then I warmed the surface to −117ºC for one hour which allowed the surface temperature to rise above the brain core temperature. This should have allowed a certain amount of "annealing" to occur.
The thermocouple in the skin above the burr hole is used as the controlling thermocouple by our LabVIEW computer control system. Cooling of vitrified tissue should be as rapid as possible to glass transition temperature (Tg) (solidification temperature), but should not go much below that temperature in the first phase. Cooling must be done quickly above solidification temperature to prevent ice formation which might occur in areas which are poorly perfused. Below solidification temperature cooling must be done very slowly to minimize cracking due to thermal stress.
The cooling strategy is to cool the surface of the brain as rapidly as possible to Tg and then wait until the temperature in the center of the brain approaches Tg. Once the center of the brain is close to Tg the surface is warmed slightly in the hope that the entire brain could be of uniform temperature in a highly viscous "liquid" state just above Tg. This is not actually "annealing", because annealing involves warming a solid to just below melting temperature as a means to relieve thermal stress in a solid. By remaining just above Tg for the entire brain and cooling very slowly through Tg we believe we achieve the greatest temperature uniformity and the least thermal stress, while relying on the very high viscosity to prevent devitrification.
I cooled to −195ºC. The −195ºC is about the lowest temperature which can be achieved in the cooling box. When the skull surface temperature reached −195ºC it bottomed-out (flattened-out), as can be seen clearly in the cooling curve for the last four hours of cooling. The patient was removed from the cooling box still in the sleeping bag on top of the patient's plywood support board. The sleeping bag was closed and zipped over her head very quickly after having been removed from the cooling box.
When we opened the cooling box Facilities Manager Andy Zawacki lowered a bright light into the box and released liquid nitrogen to clear the vapor and to allow visualization (and photography) of the patient's head. The face is perfused off the carotid artery and the brain is also perfused off the carotid artery. For this reason, the quality of face perfusion should match the quality of the brain perfusion. Although there were a few frozen spots near the lips and chin, most of the side of the face showed no sign of freezing -- indicative of good vitrification. This was a very satisfying result.
While liquid nitrogen was periodically poured on the patient's head, the patient was tied to the board using 50 feet of three-eight-inch twisted nylon and polyester rope (as is done for all patients). The patient is also held to the board with red lashing straps. The rope is tied and knotted through holes on both ends of patient's plywood support board. Knots in the rope hold the patient to the board, hold the patient's name plates to the rope and hold the stands of the rope together. The ropes extend from the foot of the patient's board to allow the patient to be lowered, removed (rare) or moved while in liquid nitrogen in the cryostat.
At 4:30pm, Saturday, September 22nd, 2007 the 84th patient was placed in liquid nitrogen in a cryostat. Viola was the sixth and last patient to be put into the HSSV−6−8 cryostat. Kevin had considered coming to watch the event as well as to attend the Annual General Meeting being held the next day, but was prevented from doing so by very recent surgery. There were quite a number of others who witnessed the event, however, including cryonics pioneer Curtis Henderson as well as LONG LIFE Editor John Bull and his daughter Debbie -- all of whom had come for the Annual General Meetings of the Cryonics Institute and the Immortalist Society.