Tuesday, September 1, 2009

"Warts and All" - Cryonics Case Reports

This post is dedicated to Saul Kent.

"As to your question of whether Saul Kent wants case reports on cryonics standby cases done, if you have to ask, you don't know the man. For a time, several years ago during the Waynick Alcor administration, Kent actually offered cash bounties out of his own pocket for full Alcor case reports to be done and published. This resulted in some getting done, but others are still hanging fire even now, and quite a lot of this bounty money still remains collectable but uncollected-- a matter of some thousands of dollars. If you want to know the details of why not, you can ask Alcor; that story is not mine to tell. However, suffice to say that SA case reports will certainly be done, warts and all. Everyone at SA understands how critical such things are, for quality control reasons. That includes, perhaps more than anyone else, Saul Kent."

Steve Harris

(A special thanks, to "Phil," for reminding me of this Harris post.)

Today is September 3, 2009, and Suspended Animation, Inc., (a company funded by LEF/Kent), has yet to publish a case report for Curtis Henderson (CI-95), for the procedures an SA team performed on Mr. Henderson, June 25th, more than two months ago. Where are your "warts," Mr. Kent???

Since Phil reminded me of the Harris remarks, others have verified that Kent has often criticized Alcor for not producing timely case reports. One person maintains that some of the reports were produced, but didn't live up to Kent's standards. They seem to think he would prefer something like one of Platt's monstrosities, filled with irrelevant subjective material, to an objective reporting of the facts.

Thus far, most cryonics case reports have been subjective, rambling narratives, of little merit. Subjective reporting is "sometimes completely false, and "destructive in decision making," while objective information is "as close to the truth as we can get," and "helpful in decision making. http://www.asdatoz.com/Documents/Website-%20Objective%20vs%20subjective%20ltr.pdf

We didn't need to know most of the information in SA's CI-81 case report. We didn't need to know one of the people who didn't show up had a job at a local supermarket, or that a former employee wasn't there because she "refused to make herself available to assist in future cases even as an independent contractor," (especially since that last part was untrue...I am the "former employee" being referred to, and as I recall, no one ever asked me to take call as an independent contractor).

We didn't need speculations like: "The batteries in one of the voice recorders may have lost their charge as a result of someone failing to switch off the recorder after a practice session." That wasn't a fact, it was nothing more than a lame excuse for showing up with dead batteries. Cryonics case reports are rife with lame excuses, like this.

Case reports shouldn't include discussions about equipment that isn't even brought to the case, or remarks about the team members being best buddies. You won't read, "Though rewarming from 18-degrees C, took a long time, the heart team all got along well, with the perfusionist and surgeon amusing the other team members with off-color jokes," in a heart surgery case report, though something like that probably happens, a lot, near the end of profound hypothermia cases.

You will see the "warts." You'll read about the time a scrub nurse accidentally threw a vessel intended for a graft off the table and the patient's leg had to be reopened. You'll read about the anesthesia nurse who inappropriately applied pressure to a transfusion bag and filled the patient's heart with air, causing him to "crash and burn" and requiring him to be placed back on the heart-lung machine. (The patient lived to tell about it, because the anesthesia nurse admitted to what he had done, the second he saw the patient's pressure drop and realized what had happened.)

Medical case reports are not intended to be "stories," they are meant to convey a factual representation of the case. They serve several purposes, one of which is to facilitat comparing cases. It should be obvious that the only way to do this is to have uniform reports. It's not as easy to compare the apples in Chef A's Cajun Apple Cobbler, to the apples in Chef B's Apple Walnut Celebration Pie, as it is to compare apples used in identical recipes.

There should be standardized forms, for cryonics case reporting. Aschwin de Wolf and I tried to establish this, at SA, and we caught no small amount of hell, for doing so, from a man who has probably billed cryonics organizations for quite a number of his hours for writing rambling, subjective case reports that contain more "padding" than any professor teaching freshman "Comp and Rhetoric" courses probably sees, in an entire year.

In heart surgery, (something much more complex than a cryonics washout procedure), the reports are in a standard form, and produced immediately after the procedure, by the medical personnel involved in the case, (not three months later, by a science fiction writer who wasn't even present for the case).

I can look at any heart surgery case report and tell a lot about the case, immediately. I can tell you who the personnel were, when the first incision was made, when they went "on pump," when the cross-clamp was applied to the aorta, when they started cooling, how many grafts were done, where each graft came from and where it was placed, when they started warming and how long it took, exactly what medications were administered (including the amounts and time of administration), and a lot of other information about the case, the most important being variations from the norm.

From the perfusion record, I can tell you the perfusion flow rates, a number of temperatures, patient pressures, perfusion circuit pressures, arterial and venous blood gases, how much oxygen was being applied, ACT's, HCT's, (all of these, at approximately ten-minute intervals, throughout the pump (perfusion) run), and more, including how long the patient was "on pump," how much fluid was added, (or removed), etc.

From the anesthesia record, I can tell you everything you want to know about the medications that were administered by the anesthesia team, and a vast amount of information regarding the patient's condition, throughout the case.

A lot of the information will be duplicated on all the records. For instance, the "on pump," "cross-clamp," and "off-pump" times will be called out, and documented by anesthesia, the perfusionist, and the circulating nurse. (The surgeon will ask for those times, (and other information), before he does his dictation.
And, one more thing...there should not be any photos. I believe publishing images of themselves in scrubs, attempting to perform medical procedures they don't really know how to do, probably helps some of the people working in cryonics to maintain the illusion, (or self-delusion), that they really are medical professionals, when most of them are incompetent to the point of inflicting a tremendous amount of harm on their patients.

So, Mr. Kent, if you want timely and productive case reports, you should hire some medical professionals who actually know how to perform the procedures you are selling, at SA. Then, your personnel would be capable of properly documenting the procedures, and producing timely reports that could be used to compare cases. On the other hand, if you want to be entertained by a rambling, inaccurate narrative, with a lot of extraneous information, hire a fiction writer who will make up a story based on information he receives from care providers who don't really know what they are doing. OH...wait...you already made that decision.

I think LEF/Saul Kent are excellent proof that people don't always get what they pay for. LEF could fund competent medical care, for a lot less than what is being spent at SA.

1 comment:

Phil Ossifur said...

Off topic- but convenient to post here-- can you email me with who you think FD is? Thanks. philossifur@yahoo.com