What Do You DoI freeze people's brains for a living
In the latest installment of Hopes&Fears' anonymous interview series, we spoke to a cryonics specialist.
My own interests in Cryonics are a messy mish-mash of different motives.
I read some magazine article by Max More back when he was starting the Extropians in the mid-1990s. Then a book came out, The Engines of Creation, about nanotechnology. I’m a very hands-on thinker and am drawn to three-dimensional, mechanical-type things, which is why I went into Otolaryngology. For me, cryopreservation was an obvious mechanical problem. You’ve got molecules; why not lock them in place so that somebody can fix them later? All these things happening in our cells are just mechanical processes—they are just little machines, basically—and if you can stop them before they start to disintegrate, that seems like a good thing.
Before that I was an ENT physician, but I haven’t practiced for about five years now. I still have my license. My participation in the cryonics field happened very gradually.
There’s a lot of different things that need to be done. It takes a lot of people. I am the leader and do the surgical procedures as well. I keep the instruments organized and I write out the procedures.
You’ve got molecules; why not lock them in place so that somebody can fix them later?
Alive but dead but alive
It's a lot like any procedure in a hospital: you can kind of give someone a general idea but there’s just an awful lot of technical detail that will be missing.
Each case can be very different. I’ll pick a generic case. We might get notified that a member of ours is sick, maybe a few weeks from dying, and maybe they’re located in a nearby state so we have to mobilize and get our equipment nearby to be ready for when they are pronounced legally dead. Let’s say they’re in a hospice situation in some sort of a care facility—that would be better than a hospital because in a hospital they don’t like other people coming in with their own equipment.
If we see that they’re getting closer to death, like a day or two out, we might try to get the equipment even closer to their bed. When they finally stop breathing, the heart stops, and the doctor pronounces them dead, then we take over.
At that point most of the cells are still alive and that’s well known in medicine because that’s how we do organ transplants. Skin that’s transplanted easily stays alive for about six hours. The brain actually stays alive that long too, but within the first few minutes it starts a cascade that would eventually kill the brain cells within a day or two. So when somebody gets brain damage, if the oxygen is cut off, the brain doesn’t die immediately, it dies over the course of a few days from the initial insult.
If somebody’s been pronounced dead and then you start CPR, you don’t want the embarrassing situation where they start to wake up again.
The coldest nap ever
So we’ve got a living brain and person who’s pronounced dead, so we try to slow down the metabolism in the brain so that those cells won’t die. We are trying to preserve all the intricate branches, about 2000, on each neuron, as well as the specific shapes of each synapse. If we cool them, it lengthens the amount of time before they actually die. So we try to keep them alive as long as we possibly can. We put the person in an ice-bath—it’s kind of like a stretcher with walls on it that contains ice water. That’s the fastest we can cool externally. We start cooling, we start moving them out of the facility, we try to give medications that will stop the blood from clotting and will help slow down the metabolism further. An important one would be an antibiotic: we don’t want bacteria to grow while we’re doing this. Another important one would be Heparin to prevent blood clotting; we could also use Citrate depending on the situation. Another medication we can use would be Vasopressin—we want to constrict the blood vessels on the extremities to concentrate the blood flow to the core. We can use some of vasopressors—they use those in emergency medicine too, and might have them in an ambulance.
We try to compress the heart with chest compressions, either via CPR or with a machine, to try to circulate the blood a little bit. The purpose of circulating the blood is to get the medications where they need to be and to also help with cooling.
If somebody’s been pronounced dead and then you start CPR, you don’t want the embarrassing situation where they start to wake up again. For older people that are really far gone it’s not a concern, but sometimes life can start to come back a bit so general anesthetic takes care of that. It happened early in Cryonics, not so much anymore because we do use medications like Pentobarbitol and Propofol, which is what Michael Jackson died from. These are general anesthetics. They slow down the metabolism and reduce consciousness.
There’s a lot of medical decisions that need to be made based on the individual case. What if they died of a hemorrhage in their brain? Maybe they have lung disease and so the chest compressions can cause more damage to the lungs. I would say the antibiotics are the big ones that we use depending on their situation. We might choose a different antibiotic—broad spectrum, gram-negative, gram-positive—based on what the doctors have done so far and what type of bacteria they found. It just depends on what bacterial infection, if any, they have going on.
We move them out of there to a different facility where we can perform surgical procedures.We would prefer to start surgical procedures immediately. If the setting allows it, that's actually our standard protocol: open the chest and begin cardiac massage, but that is rarely possible. We start as soon as is reasonable. Sometime, we only wait until we get to the vehicle; sometimes, we need to wait even longer. We drain the blood out and replace it gradually with a cryo-protectant, like an antifreeze. That takes hours: to do the cooling and to pump those other chemicals in. Then we start cooling sub-zero, taking them down below the freezing point of water. If we do it right, we won’t get ice crystals in the brain. That’s called vitrification.
It’s never 100% perfect. There’s always going to be ice crystals somewhere so its a matter of degrees; it’s a matter of how much we can prevent that. There are different ways of sub-zero cooling: we can use dry ice, we can use nitrogen gas, circulate cold air over them.
At some point, we remove the head usually because we don’t need the rest of the body. That’s not where the brain is. Sometimes we remove the brain also before we start the sub-zero cooling so it kind of depends on the patient. Then we take them down to -196 Celsius and immerse them in liquid nitrogen, and there they’ll sit.
Skin that’s transplanted easily stays alive for about six hours. The brain actually stays alive that long too, but within the first few minutes it starts a cascade that would eventually kill the brain cells within a day or two.
You are not your head
It’s not really a medical issue as much as a social issue. If the family is against Cryonics, sometimes you have to negotiate with them to just take the brain so they can have the rest of the body. Maybe they object to removing the head, so taking the brain makes it easier for them emotionally. Just keeping the brain in storage costs us a lot less, and we charge a lot less for storage, so sometimes it’s a financial issue. Sometimes it’s a transportation issue: it’s a lot easier to transport a smaller item. You can carry a brain on an airline and nobody would even know the difference. People don’t realize how small brains really are but we’re probably talking maybe five-times smaller than an entire head.
Cryopreservation started out with full-body in the 1960s and it never occurred to anybody to do anything different because, emotionally and historically, everybody thought the whole body needed to be preserved.
It occurred to people in the early 1970s that you don’t need the rest of the body and so they started doing neuros [whole head]. We’re breaking new ground with just doing brains. It takes longer to do the process because the skull is thick and it takes about thirty minutes to grin through that much bone, which is a thirty-minute delay in initiating sub-zero cooldown.
Also, physically handling the brain can cause trauma including scratches, cuts, and tears—so sometimes the quality just cannot be as good, but it solves a lot of problems too. It helps you negotiate with relatives, and it helps you move things along faster when it’s just an organ donation rather than a whole body donation. It’s also so much a negotiation between family members: what if you had siblings that were completely against Cryonics but you could offer the whole body preserved intact? Emotionally, they might be able to handle that a little better—no cutting involved.
Furthermore, if somebody is completely frozen immediately after death, once they’re frozen solid it’s hard to do procedures [such as autopsies or other post-mortem studies] on them. Full-body preservation doesn’t make a lot of scientific sense but still, we make use of it.
We drain the blood out and replace it gradually with a cryo-protectant, like an antifreeze. Then we start cooling sub-zero, taking them down below the freezing point of water. If we do it right, we won’t get ice crystals in the brain.
The ultimate thaw
There’s a huge barrier to understanding in the public. They don't really doesn’t understand medicine. Scientists understand it better, but let me try to explain.
To give you a scale for the problem: if an atom was the size of a grain of sand by comparison, do you know how big a cell would be? Do you have any idea how incredibly immense a cell is compared to the size of an atom? A cell would be the size of a forty-story skyscraper, and people just can’t wrap their brains around that—that’s one cell. You have trillions and trillions of cells in your body, and people can’t wrap their head around that number either. And then you multiply those two numbers together and people just completely lose it. The number of atoms that the repair is going to have to manipulate, one atom at a time, is just astronomical.
So no, we’re nowhere near being able to do that. I think 100 years is a wildly optimistic estimate. What you’ll see long, long, long before you ever see that is a society with a fully mature stem cell industry, where you’re 65 and your heart is starting to get a little bit weak so you just go in for a routine surgery and you get a brand new heart, brand new kidneys, a brand new spleen, and then on you go. It’ll be a short recovery and you’re back to work again and you stay young and feeling healthy. There will be nobody who’s fat, nobody limping, nobody wearing glasses, and nobody wearing hearing aids—that’s the kind of society that you would see when you’re about halfway to nanotechnology.
After that point it won’t matter what you died from, it’s just how well you preserve the structure. The future technology will take whatever is sent forward into the future and will deal... It’s a hugely complex molecular puzzle no matter how one was preserved. So we’ve got a long, long way to go and people just can’t see that.
At some point, we remove the head because we don’t need the rest of the body. That’s not where the brain is.
Where are the cryonicists
I’d say there’s less than ten people in the world actually doing it. There’s so few people doing it that it becomes more like a mentor relationship where you try to learn from the people that are already doing it.
In my case, I have a lot of experience with power tools—drilling on bone, cutting tissue, it's no big deal, I do it all the time—so it’s no big leap to do it a little differently. I’m trained in the anatomy of the head and neck, where all the arteries and nerves are, so it’s not that big of a deal. But there’s gaps in my training I have to fill in, like on sub-zero cooling and things like that they don’t get into in Otolaryngology. So everybody comes at it from a different background; they try to fill in the holes in their knowledge as best they can by learning from other people. There is no school for this, not yet—I would really love to see that in my lifetime. Without a school you’re kind of stuck just learning from the people that are already doing it.
A legal grey area
Everytime we deal with other professionals it’s awkward; they never know what to think. Just today I was trying to get a mortician to remove somebody’s head and mail it to us. You can just imagine how that conversation went.
To work in this industry and fight that type of social stigma, it takes a lot of boldness. We have to be willing to put up with all of that.
This is the hardest business that I’ve had to start. When I started my physician’s office, I opened up a medical catalogue and I just circled all the things I wanted to buy and they showed up at my office and away we went. But here, there is no catalogue. There is no local network of repair technicians. With Otolaryngology, I can call my local repair guy and he comes over and he fixes my equipment. I’ve got my local supply guy and he delivers my supplies once a week and sees how I’m doing. There’s no support, there’s not even a known list of equipment or protocol or anything. You kind of have to start from scratch every single time. You try to explain to your insurance company what your business is and it doesn’t fit into any of their neat little categories. You try to get insurance for the truck and they’re like “What are you going to use it for?” and it’s a little hard to explain. Everything we do we run into this obstacle that nobody’s familiar with it. It’s kind of a legal grey area.
The institutions cryopreserving are molded by organization structure, and little else. Each of these companies is very much dependent on the individuals running them. My company is very much dependent on my history and personality and capabilities. It just happens that the people who run Suspended Animation just aren’t interested in storage. They get excited by the idea of doing research and emergency-type services. I think if slightly different people were involved they’d be a full-service organization. There’s nothing stopping them really, that’s just what they like to do.
Let’s say theres four companies in the United States doing Cryonics. There’s thousands of little differences between each of them. Some of it’s money, some of it’s physical location, a lot of it is the individuals running the organization. Back in the 90s when some individuals at Alcor—well, it’s complicated—broke off and started doing their own thing, a lot of people followed them because they’re following the individuals more than company. There’s only a few individuals who do this well, so when people find someone who does a good job they latch on and follow.
All the founders just died in the last few years: Fred Chamberlain, [Robert] Ettinger. Nearly everyone who started this off is gone... I mean, they’re not gone, we tried to preserve them as best we could but I’m not sure how well that was actually done. The young people have to move in at some point. I see people in their 30s and 40s moving in to fill the void at all the major institutions.
Everybody has their own individual life experiences that they come into this with. I haven’t really seen any common theme about why people get involved. It’s not intelligence, it’s a little bit religion—you’re just not really interested in it if you have religion because you’ve already got a plan to live forever—it’s not really any kind of personality type, and there’s different motivations. I think there’s just a very few people out there who kind of get it and see that it might work. It’s a little bit fear, and it’s a little bit technology.
Although there may not be disease and aging in the future, there are going to be plenty of other obstacles that still need to be overcome. Wars come to mind as an obvious problem. Also, if you don't do something to reduce the risks of dying by traumatic accidents, curing aging only results in a lifespan of about 1000 years, I think, based on statistics. That’s just the tip of the iceberg. You still have to deal with personal relationships and making backup copies of yourself for accidents. Backups is an obvious strategy to combat the risk of having your brain destroyed. It certainly wouldn't violate any laws of physics to have another brain standing by, or at least blueprints for one. There’s still plenty to do even if we solve those problems that seem so big to us.
Every time we deal with other professionals it’s awkward. To work in this industry and fight that type of social stigma, it takes a lot of boldness.