Shocked

by David Casarett

  As I’m thinking about this, my attention is dragged back to the stage by a point that Baldwin is making very earnestly. Their goal, she says, is fifteen minutes from death to bypass. I’m thinking that this is a very optimistic goal, because what often happens to cryonics patients is nothing close to that.

  Consider the sad case of Alcor patient 113. John Monts is an example of what happens when things don’t go as planned, and when you don’t have someone like Baldwin on your side. Monts died October 31, 2012, at the age of sixty-eight. He died alone in a hotel room, and a pathologist’s report estimates the time of death at approximately eleven p.m. So an entire night passed, and part of the next morning, before his body was found. Then the suspicious nature of his death made it a coroner’s case.

  Delays ensued. In fact, it wasn’t until November 4 or thereabouts that Aaron Drake, Alcor’s medical response director, performed the neuroseparation. That is, he cut off Monts’s head and plunked it into a bucket of dry ice. (Yes, Alcor freezes brains in a process that is just about as gruesome as it sounds. But more about this later.) Finally, on November 7, John Monts’s brain began its final descent to the desired temperature of -196 degrees Celsius in liquid nitrogen.

  I’m betting that if John Monts was expecting a fifteen-minute drop to 0 degrees, he would have been dismayed by this pace of events. That lonely evening spent at hotel-room temperature probably wasn’t part of his plans, for instance. Nor, probably, was he counting on a couple of days spent in a morgue’s cooler, at roughly the temperature you would use to keep a head of lettuce from wilting. So I’m thinking that although Baldwin’s slick efficiency is impressive, and although she might be able to freeze cryonauts in a matter of hours, the reality for many Alcor members is probably much more messy.

  Then Baldwin slips in something that captures the attention of everyone around me. It’s her pièce de résistance: liquid ventilation. She acknowledges that it’s still in the early phases of testing, but it has an undeniable geek factor, and the audience is riveted.

  They’re starting to use perfluorocarbon, she explains, a liquid hydrocarbon that has the potential to carry oxygen and CO2, making it a nifty blood substitute. (We encountered this substance, incidentally, in the RhinoChill in chapter 3.) But it can be chilled far below the point at which blood would solidify, and it doesn’t coagulate the way blood would if it’s not flowing. So not only does it allow rapid cooling, it also maintains gas exchange (at least in theory).

  Listening to Baldwin’s technical description, I’m having three thoughts more or less simultaneously. The first, of course, is that this is really, really neat. The second, though, is that what she’s describing sounds like wild science fiction.

  But it’s the third reaction that surprises me: this sounds familiar. A quick Google search on my iPhone provides the obvious explanation. Liquid ventilation is a common device used in science-fiction films including The Abyss, Mission to Mars, and Event Horizon.

  These echoes of science fiction are perhaps inevitable. The grandfather of cryonics, Robert Ettinger, first proposed the idea in—what else?—a science-fiction short story. When he was recovering from war injuries in 1947, Ettinger learned that a French scientist, Jean Rostand, was experimenting with cryopreservation. Inspired by those rumors, in 1948 he published a short story in which freezing was the main plot device: “The Penultimate Trump.”

  Indeed, it’s difficult to navigate the worlds of fantasy or science fiction without bumping into fanciful examples of cryopreservation. It’s almost as common as its more popular cousin, suspended animation, which is easier to use as a plot device because people in suspended animation remain alive. Examples of cryopreservation include, of course, the Thing, in John Carpenter’s film of the same name, which wakes up very hungry and generally unpleasant after ten thousand years frozen in Antarctic ice. And there is Captain America (arctic plane crash), and Austin Powers (frozen in space) . . . the list of fictional references to freezing is a long one.

  That list of fictional cryopreservation examples is also a burdensome one if you’re trying as hard as Baldwin is to convince people that this is real science, damn it. In fact, I get the sense that Baldwin is very much aware of this history and the semantic connections that cryonics has for many of us. Sprinkled throughout her lecture are attempts to normalize and legitimize SA’s techniques. Again and again, she compares what SA does with medical science procedures with which we’re all familiar.

  I’m beginning to realize that this is the main thrust of her sales pitch. Except for a few neat tricks like liquid ventilation, she’s careful to say that SA is only doing what thousands of surgeons and hospitals have been doing for years. Open heart surgery, cardiac bypass perfusion, and mechanical ventilation are procedures, she reassures us, that millions of patients have undergone. “If these techniques are safe and effective for us when we’re alive,” she asks, “don’t you have to trust that they’ll work as part of an effective cryopreservation strategy?”

  That argument is highlighted by the way that she drops names and credentials. For instance, she names two perfusion companies (PEC Perfusion Resources and Perfusion.com), which she says are among the biggest and best in the field. And she happily rattles off the names of four cardiothoracic surgeons she works with, naming their affiliations with prominent academic medical centers such as Duke University and the Texas Heart Institute. She also mentions a home-care and hospice agency in California that SA partners with when a patient dies at home.

  The message is clear: We may not be part of mainstream medicine yet, she seems to be saying, but we should be. And we will be.

  I tear myself away from this procession of slides and look around me. Up and down my row, to my left and right, there are nine people all gazing intently at the screen. Two are taking notes, one is looking pensive, and the others are staring with slack-jawed admiration at Catherine Baldwin and her routine.

  It’s obvious that they’re hooked. She’s giving them what they need. She’s offering them reassurance, first of all, that her company will be there for them. But she’s also offering results. She can report time to cooling, time to bypass, and time to cryopreservation. All real numbers. Of course, there’s no information about what happens next, or whether there is any prayer of waking up a thousand years from now, but there doesn’t need to be. That’s the point. She can take them this far, she is saying. That’s her claim and her promise.

  Her talk ends on a high note, vowing that she will continue to advance the field. It’s a masterful ending, which neatly wraps up science, inspiration, and the reassurance of professionalism. The crowd goes wild. Even I’m ready to sign up.

  But I’m still thinking about Baldwin’s interactions with what must be a very skeptical health-care system, and I’m curious to learn how she navigates those relationships. Not surprisingly, there’s quite a crowd around her after the lecture and so I wait my turn patiently. Finally, up close, she’s warm and engaging. As I watch her talking with the woman in front of me, I see that Baldwin has the quiet competence of a surgeon. I’m thinking that she’s ideally suited to sell just about anything as she turns to me with a friendly smile.

  I decide not to mention the fact that I’m a doctor, and completely avoid the fact that I’m rather skeptical about the whole process. Instead I play the ingenue. What kind of reception can I expect from hospitals? Are they supportive?

  She sighs. “They’re afraid. You [cryonauts] do not fit into their box.” And, she admits, there’s the stigma of cryonics. It’s still not something that people want to be associated with.

  She admits that it can also be difficult to find health-care providers who are willing to do this work. She doesn’t even publicize the names of the health-care providers she works with. She’s found that any association with cryonics is viewed in many circles—particularly among doctors—as career suicide.

  Everyone in the circle around Baldwin laughs
. Including me. Then I remember that I’m a doctor standing in a roomful of cryonauts.

  But Baldwin didn’t get to be where she is by whining. I’m waiting for a solution, and for her sales pitch. I’m not disappointed.

  She smiles. “It’s up to you,” she suggests. “You can choose the hospitals that will be the most supportive, and which would give you the best chance.”

  Her message is perfectly calibrated to the independent, almost libertarian leanings of this group: Use consumer pressure to shift hospitals’ opinions. Make them more open to cryonics. Use your leverage as a consumer.

  “Talk to your doctors,” she suggests. “They’re more open, and they know you. And,” she adds, “they’re the ones who can make things happen. That’s the only way we’re going to develop the relationships we need to make sure that we can work together to provide the best possible care.”

  By “relationships,” Baldwin clarifies, she means the sorts of arrangements that would allow SA staff to use hospital facilities. Annoyed and perhaps a little embarrassed by the necessity of parking an anonymous-looking van at the hospital’s loading dock, she wants a seat inside the tent. She wants to be able to use hospital ORs the way that transplant surgeons use them to harvest organs.

  “And why not?”

  I’m hoping that’s a rhetorical question, because I can think of a whole range of reasons why not. There is, of course, the rather obvious observation that they’re proposing, in all seriousness, freezing people. And reviving them in a thousand years. That is enough to get you kicked out of most hospital executive suites.

  Then, too, there is the language I’ve been noticing as I’ve talked with many of those around me. This group talks about people who are irreversibly dead as opposed to those who are planning on making a second trip through life. Old cryonauts don’t die, they “deanimate.”

  So as I thank Baldwin and she turns to the next person in line, I’m thinking that cryonics’ road to legitimacy is going to be a long, difficult one. But whether she’s able to develop those relationships she wants so badly will depend not on what Baldwin can promise but on what happens after she’s done. Whether we take her team seriously depends almost entirely on whether there is, in fact, a “science” of cryonics that will take over after Baldwin and her team do their thing. And that’s next.

  TODAY A RABBIT, TOMORROW A CRYONAUT: THE NEW SCIENCE OF VITRIFICATION

  Baldwin’s enthusiasm was inspiring, and the science she described was impressive. But the work that her teams do in cooling and transporting is only effective if someone else can fully freeze a patient safely. And by “safely” I mean in a way that makes it possible that they’ll be brought back to life someday.

  But how?

  We’re about to hear the answer from a pharmacologist named Greg Fahy. He’s tall and intense, with an oversize mustache, and he talks like an aging hippie scientist. But he also has the calculating, logical speech of someone who once thought very, very hard about becoming an accountant, and who decided in the end that he wanted something more intellectually challenging. And he seems to have found it.

  He warns us that cryonics is technically very difficult. And the slides flying by in his presentation suggest that there are multiple pitfalls waiting to claim the unwary cryonaut. These slides sport cheery headings like “Approaches to Preventing Brain Shrinkage” and “Preventing Brain Blowout.”

  But at the heart of the cryonics puzzle, Fahy says, is the physics of freezing and thawing. That’s what it’s all about, and that’s where cryonics must succeed. Fahy reminds us, with an intensity that is perhaps more appropriate for communicating the world’s total financial collapse or the untimely death of your dog, that the problem is—he frowns for emphasis—ice.

  So how do we get ourselves down to very low temperatures without letting the water inside us freeze?

  What Fahy is talking about next might hold the answer to that question. Vitrification, he says, is the process by which each one of us could—and perhaps someday will—be cryopreserved. Literally “to transform into glass,” vitrification refers to the process by which a soft, squishy, pillowlike frog, or a human being, is turned into a solid with the consistency of your kitchen counter. As it’s used in the cryonics world, though, vitrification refers to the process by which that cooling and hardening takes place without ice formation. It’s no mean feat and, apparently, the journey from squishy to solid, without encountering ice along the way, is an exceedingly difficult one.

  The first step along that road is to find a way to inhibit ice from forming. Usually that’s accomplished by replacing water with something else that won’t develop ice’s jagged, knifelike crystals and that won’t create dramatic swings in electrolyte concentrations. You’d also want something that won’t expand as it cools, causing you to burst at the seams like something out of a bad horror film. The answer, it turns out, lies in cryoprotectants—substances that prevent ice formation and allow vitrification to occur without damaging cells.

  Remember the humble wood frog? Cryoprotectants are its elegantly simple secret. As the weather gets colder, the frog stockpiles natural compounds like glucose that act as natural antifreeze.

  What is even more interesting is that this protection seems to be triggered by ice formation. That is, as a frog starts to get cold, tiny ice crystals begin to form. When this happens, frogs respond by depleting glycogen to make glucose, effectively constraining that ice formation. Then, rather than becoming frozen, with all of the attendant problems of ice, the frog vitrifies, turning into an ice-free little piece of statuary. And the best part is that glucose and other cryoprotectants are all natural and frog-made, so when it warms up, the frog simply metabolizes them.

  But what about the rest of us who don’t happen to have the ability to generate our own cryoprotectants? Well, the preservative solutions used for freezing various parts of people, such as corneas, rely heavily on glycerol. Glycerol is a by-product of the breakdown of fats, which usually appears in soaps and pharmaceuticals as a thick, viscous liquid. It acts as a protectant, elbowing water out of the way and taking its place.

  Organ preservation also uses dimethyl sulfoxide (DMSO), a spectacularly efficient solvent that crosses cell membranes easily and drags anything dissolved in it along for the ride. I remember working with it at a part-time job in a chemistry lab in medical school. You always knew if you spilled some on bare skin, because it would migrate amazingly fast from there into the body. Within a minute after a few drops landed on a finger, for instance, you could taste it. (In case you’re curious, the taste is not entirely unpleasant and reminds me of day-old garlic bread. But don’t try this at home.)

  However, glycerol and DMSO just don’t work well enough when you’re trying to freeze a whole organ, or an animal (or a person). You still get ice and all of the problems that go along with it. So the cryonics industry has turned to ethylene glycol, the chief ingredient in antifreeze. You know, the green goo in your car’s radiator.

  The problem, though, is that ethylene glycol is highly toxic. If you drink it, it gets metabolized into glycoaldehyde, and then to glycolic acid. Glycolic acid, in turn, has a tendency to bind to calcium, forming calcium oxalate crystals. In tiny amounts, these crystals don’t cause much harm. But in the amounts that are typically used in cryonics, one can only imagine that a cryonaut would wake up with organs that have turned to stone, not to mention a wicked hangover.

  Even with antifreeze, we’ve learned through trial and error in preserving small human organs like heart valves and corneas that the vitrification protocol is very dicey. The cooling and thawing processes have to be rapid and homogenous. You need to get the entire frog—or person—down to the desired temperature as quickly as possible. If cooling is too slow, there will be time for pockets of cryoprotectant-free fluid to freeze into ice. For the same reason, the cooling has to be even. That is, the core of a frog has to freeze at the same rate tha
t its little webbed fingers do.

  So when cryopreservation works, it works on small things—blood cells and corneas and embryos and heart valves. It’s easier to freeze small things quickly and evenly. And you don’t need to use compounds that are probably best left in your car’s radiator. But scaling up is very difficult. In fact, science has yet to adequately preserve anything much bigger than an acorn, and we haven’t come close to replicating the wood frog’s achievement.

  However, there have been a few successes that provide grounds for cautious optimism. In 2005, for instance, a team of researchers was able to extract rat hearts and vitrify them. As cryoprotectants, they used proteins derived from arctic fish (notably the oddly named ocean pout, Macrozoarces americanus), which are accustomed to subfreezing temperatures. These so-called antifreeze proteins allowed the researchers to preserve the hearts and to transplant them into the peritoneal cavities of another set of rats. In their new homes, the hearts (unconnected to a circulation) began to contract. The same team reported later that in a subsequent experiment they were able to produce normal electrical impulses and conduction in the revived hearts.

  Fahy mentions a study of his own that was even more ambitious. A kidney was removed from a rabbit, vitrified, thawed, and then reimplanted. One can only imagine what the rabbit thought about this procedure, which, from its perspective, probably seemed rather unnecessary. The rabbit, Fahy reports happily, lived. So score one for cryonics.

  Later, I looked up Fahy’s published article and discovered that the experiment he described was carried out on two rabbits, one of which died. The lucky rabbit who lived only did so for nine days. I suppose in rabbit years, that’s probably two human months. To be fair, Fahy wasn’t being disingenuous. Those nine days were days that rabbit really shouldn’t have expected.