From Cryonics, October 1992
by Tanya Jones
Photos by Carlos Mondragon
Suspension Standby has never before been as remote or as time-intensive as the one provided for James Hourihan, A-1410. Jim called Alcor for the first time in February of this year to ask for information about becoming a Suspension Member. He had cancer, and wasn't very optimistic about his long-term chances. But, as he explained to Ralph Whelan, he expected to have at least 12 to 24 months to pursue various therapies intended to slow and maybe even stop the growth of the cancer.
As with many who enter the sign-up process, Jim procrastinated somewhat in completing his Application. In fact, after sending in his Application and receiving the usual (considerably simplified) pile of paperwork in return, Jim did not contact Ralph for a few months. Since Alcor receives calls from people with terminal conditions rather frequently, and only a small fraction of those ever follow-up, Ralph didn't really expect to hear from Jim Hourihan again. More likely, Alcor would receive a brief note from Jim's family some months in the future, explaining that Jim had died, and Cryonics magazine was no longer welcome in their mailbox.
Instead, Ralph received a phone call on June 17. Jim was calling from the Emergency Room of a hospital in the Boston area. He explained that the cancer had invaded the wall of his stomach, and was causing internal bleeding. The cancerous invasion was inoperable, and would cause his death within 48 hours if it did not abate.
Ralph quickly outlined for Jim just how problematical his situation was. First of all, his paperwork was not in place. Remedying that would have to become his highest priority. Second, his funding wasn't approved. He was hoping to use an employment life insurance policy to fund his suspension, which is somewhat more complicated than a personal policy. Third, and worst of all, Alcor's primary Remote Standby and Transport Team was already deployed to Colorado, preparing for the suspension of Jim Glennie! (See "A Well-Loved Man" in the September, 1992 issue of Cryonics.)
Naturally, Jim was scared. He wanted a team standing by right now. Ralph reminded him once again to see to the paperwork immediately, to have someone Federal Express it to Alcor the next morning, and to rest assured, in the meantime, that everything possible would be done to get a team out to him.
With the primary transport team in Colorado, a local group would have to prepare to carry off this transport without assistance from Alcor Central. The New York Stabilization Team, being nearby and well-prepared for such an event, was immediately contacted. Alcor New York team members Stanley Gerber, Gerry Arthus, and Curtis Henderson prepared for the four hour drive to Jim's hospital, on what could be the very first application of their cryonic suspension skills (beyond a multitude of training sessions). Upon arrival, they made the first contact and initial arrangements inside the hospital where Jim was receiving critical care. (With later assistance from Tony Reno, K. E. Nelson, Walter Vaninni, and Dr. David Greenstein of the Boston area.)
Stanley Gerber was designated the hospital/family liaison, and he quickly obtained permission to set up the emergency response equipment (which had been brought from New York by van) in an unoccupied Critical Care Ward directly across the hall from Jim's room. Shortly after their arrival, Arel Lucas was deployed from northern California. About 16 hours after the New York Team arrived, Arel joined them. The four of them maintained a constant watch for another two days before being joined by Michael Darwin and Tanya Jones, both of whom had departed for Boston from Riverside just before the completion of Jim Glennie's suspension.
Greeted at the airport by a somewhat disheveled Stan and Curtis, Mike and Tanya were then briefed on the rather tense situation that faced them at the hospital. Jim's family, although familiar with the concept of cryonics, had been unaware of Jim's strong desire to sign up for suspension. It came as something of a shock. Compounding their distrust of Jim's unexpected request for suspension was the appearance of the New York team. The dedicated New Yorkers, well-spoken and polite, had worked furiously and round-the-clock to prepare the Critical Care Ward for the impending (or so it seemed) transport, in the process neglecting little things, like showering, shaving, and shut-eye. Their efforts were in Jim's best interests, but the family would have preferred to see dapper, professional-looking representatives working 8-hour shifts.
So Stan, Curtis, and Gerry were dispatched to get some well-deserved rest while Arel gave Mike and Tanya a brief tour and introductions to the family and some of the hospital staff. Jim's mother and his fiancee, Devra, became our primary points-of-contact. They were cool and distant and seemed reluctant to talk with us at first. They expressed concerns about cryonics and were worried that this whole thing might be a scam. Once Mike and Tanya explained that the team from New York was comprised of volunteers, more concerned with preparedness than appearance, the atmosphere began to lighten. Over the next several hours, questions and answers flew. Mike spoke with Devra, and I spoke with Jim's mother, Mrs. Winslow. We both spoke to the hospital staff.
With his family feeling a bit more at ease, the hospital began to feel more at ease. Little did we know, that trust was about to be shattered. The first family member to sit down with us for a frank discussion of Jim's prognosis was Ed, Jim's brother. Ed openly told us the concerns that the family had about our presence, and together we were planning how to proceed. We were sitting in a lounge quite some distance from Jim's room when Mr. Winslow, Jim's step-father, arrived in a near panic. He informed us that the press had been called and wanted to interview us. I think that he was expecting that Mike and I would be gleefully rubbing our hands together in anticipation of a media circus. The exact opposite was the case. Mike and I were appalled that the media knew about Jim and the fact that he was a candidate for cryonic suspension. We asked that the media &¬&& be given any information, as it might compromise the quality of care that we'd be able to provide. Mr. Winslow was surprised at our complete lack of enthusiasm about press involvement, but he agreed whole-heartedly that the media should be told nothing. Perhaps this was the moment when we began to gain their trust.
Jim recovered from the internal bleeding. It was the hospital's policy to use extraordinary measures to save the life of every patient in their wards, even if it meant pumping multiple liters of blood products into the patient on a daily basis, which is the course of care that Jim required. Despite his surprising recovery, though, Jim's situation was still delicate enough that the full team stood by for several days, even going so far as to recruit Steve Bridge from Indiana for a weekend when Stan, Gerry and Curtis were sent home. Stan's dedication in assisting with this transport nearly cost him his job as an EMT, due to his extended absence.
Tanya and Arel left Boston a week into the standby. But just hours after they left to return home, the call came through that Jim's condition had taken a drastic turn for the worse. In an attempt to get sufficient trained personnel on-site for the transport, as only Mike Darwin and the local members were remaining, Naomi Reynolds was sent on the first available flight from northern California to Boston. Little did any of us know, Jim was going to rally yet again.
One of the things Stan had done, prior to the arrival of Mike and Tanya, was go through the Boston yellow pages line by line, trying to locate a mortuary which would be willing to work with us. He found one which was a thirty minute drive from the hospital. This mortuary backed out of their verbal contract with us, on the night Tanya and Arel left: just when their services could be needed the most (when Jim gave us a scare!). They did, however, recommend another mortuary which could assist us with the rather special requirements of Massachusetts law. (A body cannot be shipped out of Massachusetts unless it's embalmed!)
This second mortuary caused us a few problems as well, not the least of which was sending us a bill for over $4,000.00 for ten days' storage of equipment! (We didn't even use them for the transport.)
Jim's condition began to improve once again. After two weeks in Boston, Mike returned to Riverside, leaving Naomi to monitor Jim's condition. Jim had been released from the hospital, and he went home with hospice care. His condition continually improved, despite the ever-present danger of bleeding out through his stomach. Jim was even taking in solid food again, something which he'd been unable to do for some time.
It was his relatively good health that prompted the decision to cease the standby. After two weeks in Boston herself, Naomi returned to Riverside. This decision was also based on the understanding that Jim, Devra, and Mrs. Winslow would be re-locating to California at the same time, to assure a rapid transport and successful suspension for Jim.
We set up a fully furnished apartment in the same complex where Ralph and Tanya were living in Riverside, placing them a 15-second walk from their apartment, and ten minutes' drive from the Alcor facility. The apartment complex manager was sympathetic to Jim's plight, and everything was arranged in three days. We even received permission to park the ambulance in the handicapped parking space closest to their apartment. Unfortunately, Jim's flight to California was delayed once, and then canceled altogether. He didn't quite feel able to leave his family and friends, given the circumstances.
With that development, we had to do some hard thinking about re-deployment of a standby team. Financially, it was untenable. Ethically, what else could we do? The arrangement then became that Alcor would only send personnel if the family and physicians agreed that no more heroic efforts would be used to prolong Jim's life. This was as much for our benefit as it was for Jim's. By this time, he was on morphine and frequently was combative and forgetful, even with the people he loved most. Everyone, including Jim, agreed that this was the way things would proceed.
And they did. On July 24, the decision was made to return Mike, Tanya, and Naomi to Massachusetts. Two days later, we landed in the late evening and went to visit Jim immediately. He was looking well. In an attempt to gauge his condition, we used pulse oximetry, a non-invasive procedure which measures the oxygen saturation level in arterial blood. His saturation levels were high, so Mike opined that there'd be no problems that night. We found the nearest local motel and got a few hours of sleep, under the impression that we'd have the entire next day to complete our preparations for the transport.
At 9:00am the next morning, Devra called to tell us that Jim had suffered respiratory arrest. We immediately jumped into our rented van and drove to his house. Devra and Mrs. Winslow had already packed Jim's head in ice. The hospice nurse had been called to pronounce, but she was still twenty minutes away. This gave us a little time to prepare, but certainly much less time than we'd been anticipating.
Although we had a vast majority of the transport equipment in the van and with us, we were missing some critical pieces which were being stored at (Alcor member) Dr. Greenstein's office. Naomi, who best knew the area, drove like a bandit to get the portable ice bath (PIB) and the rest of the equipment while Mike and Tanya drew up the medications and set up the heart-lung resuscitator (HLR). For the second time in as many months, a patient arrested without the transport team in the next room. In Jim's case, we had planned to do all of the equipment set-up that morning (after some rest). The decision to wait was based on his oxygen saturation levels, which are usually an excellent indication of a patient's prognosis. Unfortunately, although we weren't certain of this at first, Jim's respiratory arrest occurred after he had had many hours of undetectable (to any viewer) gastric bleeding.
Pronouncement took place at about 9:25am, after the nurse arrived, and we were finally able to begin the transport protocol. When we began the HLR support, no ventilation was used. Past research has shown that after prolonged ischemia, the administration of oxygen to a patient can do more harm than good. To confirm that Jim had bled out through his stomach, dark, grainy bits of coagulated blood having the appearance of coffee-grounds were expelled through his mouth with each compression of the HLR.
Most of the transport medications, including an extra bolus of heparin to prevent clotting, were administered. It was about this time that Naomi returned. She had stopped to pick up some ice as well. The PIB, however, was missing some important parts — like the bolts necessary to stabilize the bath for transport. The PIB was unusable.
At the last minute, Mr. Winslow had recommended a friend of his who very generously allowed us to use his mortuary facilities for the washout. Luckily, Mr. Winslow's mortician friend had an ambulance cot which he didn't mind getting a little wet. Jim was then loaded onto the cot and taken to the mortuary, which (serendipitously) was a lot closer than either of the two previous had been.
After the surgical equipment was laid out and the pump was set up, Naomi prepared the organ preservation solution, and Mike and Tanya performed the femoral cutdown (the process used to access the femoral artery and vein for blood washout). Just before the cutdown began, Walter Vaninni and Tony Reno were called to assist with the very fast clean-up and re-packing that was needed to make the flight to LAX.
It was almost a textbook cutdown. A local embalmer was observing the procedures with some interest, and he was ready to step in if his help were required, but it wasn't necessary. Jim, as a fairly young man (28) had large femoral vessels and not one ounce of unnecessary weight on his frame. The cutdown and subsequent washout went very well indeed, and both were performed in near-record time.
Once the washout was complete, Jim was loaded into the transport box, sharing the narrow case with a great deal of ice. In addition to providing his facilities, the mortician arranged a police escort for the trip to the airport that afternoon. Although the airport was only about ten miles away, at peak rush hour traffic that trip could be expected to take us two hours. It took twenty minutes. And the police escort is the only reason we were able to make the only direct flight to LAX of the evening. (It was kind of fun, too.)
To make the flight, we had to clean up as quickly as we could, so that when the police arrived we could take our gear and run. Mike drove with Devra and Mrs. Winslow, who had both managed to get reservations for the same flight. Tanya rode with Jim and the mortician, behind blaring sirens and flashing lights. Walter and Naomi drove the van with the transport equipment in the back.
The police escort left us at the cargo bay for the airlines. Jim was offloaded and weighed (510 lbs., including ice and transport box), and the box was labeled for the flight. No problems there.
The problems began again when Mike arrived at the ticket counter to collect our tickets for the flight, and the agent couldn't find our reservations in the computer. And the flight was not only full, it was overbooked! Mrs. Winslow and Devra had already checked in and were ready to go to the gate at this time. Their tickets were fine. Ours were non-existent. As a result, we were placed at the top of the stand-by list, with the glowing assurances of the ticket agent that we'd certainly be on the flight.
Devra graciously offered her seat to Mike, in case we didn't make the flight. In the meantime, I hovered near the gate agents, hoping that hovering made a difference. It didn't. For all that 17 people volunteered to take the next available flight to LAX, we were unable to secure seats for Devra, Naomi, and myself. I went up to yet another gate agent and tried again to get all of us on the plane. Unfortunately, I was only successful in begging one more seat. Devra and Naomi took a flight which left about 15 minutes later, but wasn't directly to Los Angeles. They arrived two hours after we did, after a miserable flight and an excruciating, long day.
Jim was picked up at the airport by Carlos Mondragon and Mike Darwin. Bill Seidel drove Mrs. Winslow to her hotel and then dropped Tanya off at the lab. Jim arrived shortly thereafter, as did the new contract cardiac surgeon, Dr. Nancy McEachern. (Later that evening, when Naomi and Devra arrived at LAX, Alcor member Judy Sharp taxied them to the Riverside facility.)
Surgery began some time later, and proceeded a little slower than we'd become accustomed to with the previous contract surgeon. Dr. McEachern was new to the cryonic suspension business, and Jim had a few anatomical abnormalities in store. Despite the time involved in the surgery, which was comparable to the time Jerry Leaf used to take on every case, the perfusion was completed in about three hours and without major complications. At 05:50am on 28 July, the final samples were taken, showing that a venous concentration of 5.5 molar glycerol had been achieved. Shortly thereafter, cephalic isolation occurred, and Jim was lowered into the Silcool bath for the next cooling phase.
For the first time, some of the volunteers assisting in a suspension were ordered to bed before the completion of the perfusion. The idea was that they could then get a few hours sleep and perform clean-up duties as required. Lack of sleeping space was a problem. Two of the volunteers slept in their cars. Still, they were refreshed sufficiently that the clean-up wasn't much of a hardship. Despite minimal direction, the clean-up was performed much faster than usual. It's amazing what even an hour of sleep can do to restore presence of mind.
Jim Hourihan is now in liquid nitrogen. His family has returned home. Despite the many difficulties, he got his wish: he has been cryonically suspended. Like so many of Alcor's members, Jim is a young, sharp, software engineer with bright eyes and big plans. His passage into the future is probably not what he once hoped it would be, but that it can be at all is a tribute to the many volunteers who worked so hard for someone they knew not at all, to a family committed to the wishes of their son, and to a courageous young man who isn't ready to stop living.
Keith Henson prepares for the Phase II cooling of Jim. To the right, having the appearance of an open refrigerator, is Keith's automated cooling system, seeing its first use in this suspension.
Prior to the beginning of surgery, surgeon Nancy McEachern and Arel Lucas (Instrument Nurse for this case) discuss the procedure.
The eyes have it. Dan Spitzer appears furiously impatient as he observes the surgical proceedings.
Nancy McEachern and Mike Darwin perform the delicate open-heart cannulations.
Dan Spitzer stabilizes the cardiotomy reservoir while Thomas Donaldson (left) looks on.
Ralph Whelan (right) and volunteer assistant "Fred" pass the time at the heart-lung machine during the prolonged surgical procedure.
Mike Darwin secures the probes and the bags at the beginning of Phase II (silicone oil) cooling.