Message: #0026 - "Cryonics, the Home Town Way", by Steve Bridge (40K bytes) From: alcor@cup.portal.com Message-Subject: The HomeTown Way Date: Sat, 8 May 93 00:17:02 PDT To Kevin Q. Brown >From Steve Bridge After digging around for "Hometown Cryonics," I discovered it was really titled "Cryonics, the Home Town Way." I also remembered I had revised it following some important suggestions from Jerry Leaf. It needs revised again, since things have changed so much; but it is still very useful. Perhaps you could place this most recent edition in a sub-file for people to access. Steve B. CRYONICS, THE HOME TOWN WAY: PRACTICAL PLANNING FOR A CRYONIC SUSPENSION IN YOUR OWN AREA. By Steve Bridge, Midwestern Coordinator (Revised 6-89) ***NOTE: Much about cryonics has changed since this article was written. This is still useful as an introduction; but check with Alcor first before you try anything technical. We hope to revise this someday. Steve Bridge, currently President of Alcor *** So, you're all signed up with Alcor; you've got your life insurance policy; your will is impeccable; you are wearing your cute little bracelet or necktag. Now all you have to do is live your life and Alcor will take care of everything else, right? If you live in Southern California, especially in Riverside County, you might be able to say "right." But if you live in the other 99% of the country, the answer is: WRONG! WRONG! WRONG! For most of us in this big world, Alcor is too far away to handle all steps of an emergency. Alcor *is* a mutual aid society and its staff and suspension team will do everything humanly possible to suspend its members. But while Alcor may be our friend, it is not our MOTHER. If you want to be suspended in as good a condition as possible, and if you want the same treatment for your nearby friends and family, there is a lot you must do for yourselves. In Indianapolis this fall (1988), we had the first full test of the Alcor Cryonics Coordinators program, which was created in 1986. The basic purpose of this program was to establish various members around the country (and in other countries) as leaders for members in their areas. It was apparent from the very beginnings of cryonics that the need for prompt response to emergencies would eventually require regional suspension facilities. Of course, such sophisticated local organizations are hopelessly impractical at the current stage in Alcor's growth, but Alcor's leaders felt that there were interim steps which could be taken. Two types of coordinators were appointed (some individuals could function as both types). Some would share information, speak to the public, and/or follow up on membership leads. Others could receive enough training to be able to coordinate the first steps of a suspension. These steps might include: 1. Arranging with hospital personnel, the coroner's office, or other officials to effect the transfer of the patient's person to Alcor after the patient's legal death. 2. Arranging for a mortician to pick up the patient and transport him to his facility. 3. Packing the patient's body (especially the head) in ice to stave off damaging effects of ischemia (lack of blood flow). 4. Providing CPR and other cardio-pulmonary support. 5. Providing for air transport to Alcor's Riverside facility. And some individuals with more extensive training might be able to: 6. Put in an I.V. and administer various first level medications to further prevent ischemic damage. Currently, Alcor maintains fully equipped facilities in Riverside and in Southern Florida. Thomas Donaldson in Northern California and myself in Indianapolis also have rescue kits and much of the training necessary to use them. I am sure that Thomas, the Florida team, and our Alcor members in Australia and England have their own stories of what preparations they have made and ideas they have which might be useful for all of us to know. I hope they will each share those someday. My perspective will be a bit different, however. Here in Indianapolis, far from any cryonics facility, three local members and myself managed to prepare pretty well for a cryonics suspension, which we then actually accomplished under the direction of Mike Darwin and Jerry Leaf. In the November, 1988 issue of *CRYONICS* ("The Cryonic Suspension of Alice Black"), you read how the suspension occurred. We also learned much from the remote suspension done in Michigan in March, 1989 (see May, 1989 issue of *CRYONICS*). This was organized by the patient's family, none of whom were suspension members, with advice and assistance from Jerry, Mike, and myself. In this article, I will describe the organizational background required to set up these suspensions, with suggestions on how you might organize your friends and family to do something similar. While you might not be ready for the full responsibilities of Coordinator, there is a lot any Alcor member can accomplish which will increase his or her chances at a successful suspension. *GETTING YOUR THOUGHTS IN ORDER* Preparing for a suspension obviously will be pretty difficult if you are the only suspension member in your area. Any kind of organization you can put together will have to be planned far in advance of a serious illness and must rely on the participation of friends and family who are not dedicated to the idea of cryonics. One of the most important motivators for commitment to the work required for a suspension is the thought of each participating suspension member that they want the same level of dedication from others when their own suspensions begin. If you do not have that advantage, you may have to encourage cooperation through financial means. You could (for example) place a sum of money in a trust account, which would be paid out in fees to your physician, mortician, attorney, friends, or family only if they properly assist in getting you suspended. While this level of organization will require some commitment of time and resources on your part, you may be surprised at how many people are quite willing to cooperate. Many people who do not themselves desire to be suspended nevertheless see cryonics as a rational choice. This is especially true if you have presented it to people as the result of a rational decision on your part. Whether you are by yourself or part of a group, the first essential step is: TELL PEOPLE ABOUT YOUR DESIRE TO BE SUSPENDED. Make this known to your family, friends, co-workers, and neighbors; discuss your wishes and commitment in detail; emphasize the seriousness and long-term nature of your decision; make sure they understand that you have made definite legal and financial arrangements to ensure suspension. This course of action gives you many advantages: 1) If you die or become incapacitated suddenly without anyone knowing of your wishes, your ALCOR bracelet may well be ignored, and the odds on you getting suspended become extremely low. However, if you have been honest and open about your desires, there will be many people available to call Alcor, to refuse permission for autopsy, to pack you in ice, etc. 2) If your friends and family have known of your interest for several years, they are more likely to consider your decision acceptable and less likely to panic when it comes time to call Alcor. (Some of your friends and family might even become interested in cryonics themselves -- an advantage for all of you.) 3) It will be impossible for anyone to claim that some cryonics company suddenly had taken advantage of your illness to defraud you of your money (and to defraud your relatives of their inheritance). This *is* a serious consideration, proven by several real-life Alcor conflicts with relatives. If you are worried that you will lose all of your friends and be thrown out of your family if you tell them of your interest in cryonics, past evidence (including my own personal experience) suggests that your fears are probably unjustified. Your family will be surprised, perhaps even shocked at first; but your involvement in cryonics is unlikely to make them change their opinion of you. If they loved you before, they will still love you. If they already thought of you as a damn fool and a crackpot, cryonics is hardly likely to change that opinion either. You may lose a friend or two, but rarely a close one; and many of your friends will actually see you as *more interesting*. Besides, you will gain many more friends in cryonics than you will lose elsewhere. I have had two romantic relationships badly affected by cryonics; but I can realistically say, in retrospect, that I am much better off now with someone who shares my views than I was with someone who did not. In any case, if you are deciding to stay alive, is not that decision more important to you than the sensibilities of friends and family? Few important decisions have 100% positive results. Part of growing up is to accept all of the results of our decisions and go on. If you have strong convictions, you must stand up for them. Finally, some members state that they don't want to tell anyone about their decision to be frozen because it would "upset" their family or friends too much. Now, if these people are honest with themselves, the real reason is more likely that they are short on confidence and are afraid to test their family's love for them. Still, consider this: It will be a lot easier for your relatives to handle this information coming from *you*, when they can still ask questions and give you a hug, than it will be after your legal death when I or someone else try to explain to them that we are carting your body off to California to be frozen (or to freeze your head!). The latter course may eliminate *your* pain, since you won't be there to deal with it, but it will certainly increase the pain of others. If you really love your family and friends, give them the chance to know your true feelings. Whether you are alone or part of a group of suspension members, most of the following suggestions will be useful to you. *WHAT YOU NEED TO PREPARE FOR* There are two basic scenarios you will need to prepare for. The better circumstance (which we in Indianapolis had for our first experience, thankfully) is that of a member who is hospitalized, in a nursing facility, or at home, with a relatively slowly- developing illness (cancer, heart disease, pneumonia, emphysema, etc.) This is better because it gives you and Alcor more time to prepare and because it lessens the need for an autopsy, since the cause of death will usually be well established in advance. With advance warning, Alcor has the possibility of sending a team out to your location to assist you at the time of legal death. (Don't let this make you lazy, though. They can't hang around for weeks at a time, and you still need to have the same basic preparations accomplished.) In this case, Alcor would send out several boxes of equipment and a transport team (probably two people), so they could do a full blood wash-out (but not a glycerol perfusion) at the mortician's before bringing the patient back to California. The other circumstance will require more advance preparations and be harder to motivate yourself for: a sudden, unpredicted illness or injury of a member (maybe yourself!), with legal death occurring before your organization can be called in, and possibly with the member being clinically dead (no breathing or circulation) for many hours before you can do anything for him or her. In this case, the object is to cool (not freeze) the patient as rapidly as possible, pack him in ice, and ship him to Riverside. This may require negotiations with hospital personnel, attorneys, police, and coroners. An emergency like this means that your advance preparations must be thorough. *CPR (CARDIOPULMONARY RESUSCITATION)* Barring severe physical handicaps, almost anyone can learn to do CPR. CPR is a system of artificial ventilations and manual chest compressions, used to continue limited respiration and circulation in a patient whose heart has stopped. In the initial steps of a cryonic suspension, CPR reduces ischemia, circulates the medications given to counter ischemic injury, and increases the patient cooling rate when ice packs are applied. Manual CPR can only be done for a few minutes before exhaustion sets in. If you have a full coordinator in your area, or if you have about $5,000 to spend, Alcor may be able to arrange to obtain for you a Heart-Lung Resuscitator (HLR), a machine which takes over ventilations and compressions. CPR classes are likely to be offered in your area by the American Red Cross, the American Heart Association, and frequently by local fire departments. The cost is never high, and frequently the class is free. Besides the application to cryonics, knowing CPR could help you save someone's life (in the more conventional meaning). Some Alcor members have gone farther and taken classes to earn an EMT (Emergency Medical Technician) certificate (see *Cryonics*, April, 1988). *PHYSICIAN* "A cooperative physician is a thing of joy forever." If you can manage to get a cooperative physician and mortician, a great number of your problems will be solved. If you manage to get either one, that person might help you find the other. Ideally, the physician's duties would include: 1. Interceding for you with hospital or nursing home staff to ensure reasonable discussion and cooperation. 2. Avoiding medical treatments (such as long periods of mechanical ventilation without cerebral blood flow) which would tend to damage the patient's chances for future recovery. 3. Planning for his own prompt arrival at the nursing home or hospital to pronounce legal death. 4. Authorization and perhaps administration of cooling, CPR, and post-mortem medications to prevent brain damage. 5. Prompt release of the patient to Alcor representatives or to the cooperating mortician. I can't tell you much about how to find a helpful physician. Many physicians are willing to be cooperative when the emergency occurs, yet will not commit to such action in advance. For example, many will not agree to sign the "Physician's Affidavit." Most physicians fear legal action more than death, believe me. You will just have to be persistent and keep asking. Giving your doctor a completed copy of the "Patient's Declaration to Physician" and the "Agreement to Hold Harmless" is a good start. At least it shows him that you intend no harm to him. If your physician seems cooperative but will not sign the "Physician's Affidavit," ask him or her what could be changed in it so they *would* sign. Alcor is willing to be flexible with this document. We were incredibly lucky here in Indianapolis, since the patient's personal physician seemed totally unperturbed by the idea of cryonics. He agreed to come promptly to the nursing home to pronounce legal death, to advise us on the patient's condition, and to advise her son, "Jim," on his decisions concerning her medical care. He would not agree to administer the medications after her legal death; but not many are willing to do so. While it would be handy for this to be done by the physician, it is the least important of his duties. You will be doing well indeed if you can find someone who can promise the rest. *MORTICIAN* Just as important (perhaps more so in many circumstances) is a cooperating mortician. The list of a mortician's duties and abilities includes a number of things which you may find legally impossible to do for yourself. Fortunately, Alcor's experience is that cooperative morticians are somewhat easier to locate than physicians. For one thing, handling and transportation of deceased human beings is their *job*. They do it every day; they know the laws and the customs; and they are used to unusual requests and circumstances. Cryonicists might expect that morticians would tend to be defenders of the status quo since they profit, in a sense, from death; but, in fact, many morticians are independent thinkers who are not interested in following the crowd. They are practical businessmen who do not promote death, but merely see a job which needs doing. And you don't have to hem and haw with morticians. They have few, if any, of the taboos against talking about death or disposition of remains which afflicts so many in today's society. I suggest that you begin by asking your friends if they know any morticians. A friendly referral is usually a good place to start. If you cannot come up with a referral, try sending out a few friendly letters. Seek for an independent mortuary, not a big chain. Like anywhere else, the bigger the bureaucracy, the more conservative it probably is. Also try to find one which specializes in shipping bodies to other states. They will know the procedures and the right people to make the shipping go smoothly. It is probably a good idea to have at least two cooperating morticians. Murphy's law would indicate that the one time you need a mortician, your first choice will be on vacation. When you begin interviewing morticians, tell them your basic requirements. If they do not seem interested, ask if they can recommend anyone else. That is how we got our mortician in Indianapolis (courtesy of member Angalee Shepherd's efforts), and it only took about four phone calls. Before going into details with the mortician, simply say that a) you want to contract with him to use his facility for the initial steps of a cryonic suspension (freezing someone after legal death), b) that this would include his cooperation in picking up the "body" (I would use this word initially, rather than "patient") from the nursing home or hospital and arranging for air shipment to California, and c) that he would be reasonably compensated for this. When a mortician agrees to talk with you further, you will need to explain his duties in detail. Do not expect that he will think of everything on his own. We nearly had a problem with our recent suspension when our mortician booked shipment to California for the patient, but neglected to book flights for the suspension team. We hadn't asked him to do this, so why should he have thought of it? We have also discovered that the mortician appreciates the "hold harmless" and other legal forms Alcor uses. They may also like to see some document that the patient signed agreeing to suspension. It increases the confidence in Alcor and in the procedure itself, if we can show that we are a professional, competent organization instead of the "fly-by-night" outfit some might expect. FEES: "Reasonable compensation" may vary according to the locale and situation. Begin by asking the mortician what he would charge for each of two basic situations: a) the use of his facilities for a simple "pack in ice and ship" (1-2 hours at the mortuary) and b) the use of those facilities for a full blood-washout, cool-down, pack in ice, and ship (3-6 hours at the mortuary). Shipping charges would not be part of these fees. (They are paid directly to the shipper by Alcor or by you. See "Air Shipment" later in this article). In our recent experience, you are likely to found these prices to be under $500 for "a" and under $1000 for "b". If any member of the mortuary staff wishes to assist with the patient preparation, the staff member would be compensated by Alcor at his full hourly rate. MORTICIAN'S DUTIES: A. Pick up patient at the nursing facility, hospital, etc. Sign whatever release forms are required. Complete mortician's part of the death certificate. Obtain burial/transit permit and fill out correctly (with consultation from Alcor). B. Transport patient to mortuary. Allow your local group to use mortician's preparation room to pack patient in ice and seal up shipping container, OR allow Alcor transport team to do blood washout and other procedures (primarily using Alcor's equipment) in preparation for shipment. C. Arrange air shipment to Ontario Airport, California at earliest possible time. Shipment should be *direct* (i.e., no change of planes -- a brief stop in another city is acceptable). Arrangements for transportation for any Alcor personnel returning to California should be made at the same time, either by you or by the mortician. At least one Alcor team member should be on the same flight as the patient if possible. If not, it would be best to have at least one team member return *earlier* than the patient. D. Transport patient to airport and deliver to carrier. If a transport team member is not on the same flight as the patient, a local member must watch and make sure the patient is actually loaded on the plane. E. File death certificate and obtain at least three (3) certified copies: one to be sent Federal Express to Alcor; one to be given to next of kin; and one to be kept by the local group (if such a group exists). In most situations, a FAX copy of the death certificate should also be sent to Alcor as soon as it is available. *AIR SHIPMENT* Normally, transport will be made by "common carrier," i.e., a regularly scheduled passenger airline, via its air cargo service. Payment should be made to the air carrier by a local member, a member of the patient's family, or the patient may be shipped collect to Alcor, depending on arrangements made with Alcor staff. If the patient has normal or above normal funding, the transportation costs will come out of his or her suspension fund. But don't guess at this -- make precise arrangements with Alcor as the case occurs. In the recent case in Indianapolis, our patient was shipped out via US Air. The weight of the loaded container was 437 pounds (a small patient, but a lot of ice). The rate was $120.80 per 100 pounds (the normal shipping charge of $60.40 per 100 is doubled for human remains), for a total charge of $527.90. Note: there may be cases where a carrier will not normally allow shipments or pickups by the receiver on weekends. Special arrangements may have to be made before shipment to allow for this. Pointing out that you are shipping a unembalmed body on ice for purposes of anatomical gift will frequently convince the carrier that they don't want this package sitting around for a long time. Further note: The regulations for shipping unembalmed human remains vary significantly from state to state. Most states will allow such shipment by common carrier as long as the deceased person did not have one of a list of highly communicable illnesses. Know those details before any suspension is even contemplated. Alcor keeps a list of such regulations, and your mortician should also have such information in his *Directory of Morticians' Handbook* (frequently referred to as the "Mortician's Redbook"). You should also be able to obtain the regulations on this from the Division of your State Board of Health which deals with human remains. If you get caught by one of these regulations, it may be necessary for you to hire a private air ambulance to fly the patient to Riverside or even to *drive* the patient there yourself. If the suspension becomes public, you may have to go through a lot of legal flack even to accomplish one of these. Staying on the good side of a hot-shot attorney or two is always a useful endeavor. *AIR SHIPPING CASE* The air shipping case we used was one put together by Mike Darwin and sent to us when it was apparent that our patient's clinical death was imminent. Alcor only has one of these, though, and it won't do any good if you have an emergency situation. But you certainly don't want to be shipping your patient in anything less. Putting your patient only in a "Ziegler case" (the standard metal container for shipping human remains) could cause problems if one of the ice bags should rupture or be poorly sealed. A leaking container would probably result in an investigation, complete with local coroner -- a delay which is definitely something to be avoided. Fortunately, this shipping container is something which nearly anyone should be able to put together for around $200. It consists of a standard Ziegler case placed inside a custom-made 1/2" "marine exterior" plywood crate and insulated with styrofoam and fiber glass insulation. The Ziegler case can probably be purchased from a local casket company for about $125. You could make the box yourself or have it made, possibly even by the casket company. The shipping box should be made enough larger than the Ziegler case to allow for 1" of styrofoam in the bottom and on all four sides, but so the case will fit tightly. Do not overestimate. Passenger planes have a limited cargo area and a box too large simply won't fit, no matter how much you plead. A US AIR cargo employee suggested that the outside dimensions of the crate not exceed 32" high, 42" wide, and 80" long. The object is to make a watertight container. Mike used urethane varnish on the inside of Alcor's box and oil-based paint on the outside (latex would be fine, also). The outside should be painted orange or some other bright color to make it easier to see it being loaded on the plane and to make it easier to trace if it somehow gets mis-directed. As you assemble the parts of the box, caulk all joints with paintable grade silicone caulk. Use screws --not nails-- to hold the pieces together, including the lid. If you want to get the unit back from Alcor, you should include your name or the name of your group on the *inside* of the lid. Do *not* include any outer labeling which might make a carrier nervous, such as "Frozen person. Handle with care!" Note: Here is a great opportunity for someone with good carpentry skills to contribute to the organization by contracting to build these units for various people at a reasonable price. PLACING THE PATIENT INSIDE THE UNIT: The patient should be placed inside a plastic body bag (you might be able to get one of these from your mortician) and laid inside the Ziegler case. The patient's body, beginning with the head, should be rapidly covered (above and below, as much as possible) with ice in Zip-Loc bags (1 gallon size), *tightly sealed*. Have at least 100 bags on hand. Get as many ice bags into the Ziegler as you can fit. Do not place ice bags outside of the Ziegler. Before sealing the top of the Ziegler case, if there is room, lay a piece of fiberglass insulation -- paper side down -- over the body bag. Seal the lids on both the Ziegler case and on the plywood container with silicone caulk and screws. All of this care appears to work very well. When our patient's container was opened in Riverside after 12 hours of transportation, only about 10% of the ice had melted and the patient's core temperature was 1 o C, exactly what we desired. *ICE* The immediate availability of large quantities of ice is crucial to the protection of your patient. Reducing the temperature of the patient's brain and providing prompt CPR are the two most important factors in preventing rapid ischemic damage. You will need to look for ice sources in the hospital or nursing home your patient is in (if you have the luxury of a warning), and you will need to check sources in your area for large quantities (up to 500 pounds) of ice. Obviously, this should be cube ice, not block. You don't have time to chop. Indianapolis has only 3 major ice producers. None offer 24 hour delivery, but one company has 24-hour vending where one can get 15-pound bags by feeding quarters into the machine. (We now keep a supply of quarters on hand.) You will need to have this sort of information in advance. Mike suggests it might be possible to make some kind of personal agreement with employees of an ice company to give you emergency service for a fee. We were fortunate that our patient's nursing home had a large ice machine which we could use to do rapid cool-down at the nursing home. Also, her suspension began during normal business hours, so ice availability was not a problem. *THE PIZER TANK* While plastic bags are fine for containing ice and are essential for shipping the patient, they severely reduce the cooling capability of the ice. Not only does the plastic act as an insulating layer, it prevents the ice-cold water generated from the melting ice from flowing over the patient and carrying away heat. This is especially critical immediately after the patient's clinical death, when we wish to lower the patient's temperature as rapidly as possible in order to protect the brain. For the Michigan suspension, Alcor member David Pizer, of Phoenix, Arizona built us a portable tank which could be used to place the patient in an ice bath. It is portable, lightweight (before the ice and patient are placed in it), and reasonably inexpensive. The Pizer Tank is a 6' 2" long (inside) framework of 1 1/4" PVC pipe to which a flexible Naugahyde tank is attached with snaps. It breaks down into easy-to-transport components, is extremely rugged, and can hold a full load of 75 gallons of water without leaking or disintegrating. The ice bath method worked extremely well during this suspension. The rate of cooling for this patient was about twice that of the previous remote case, in which we had used plastic bags. Dave Pizer has agreed to make tanks for the Alcor Coordinators and possibly for other local groups, as well. (Contact Mike Darwin at Alcor for more information on this.) Two cautions: 1) When loaded with a patient and ice, the tank becomes extremely heavy. In Michigan, we required six people to carry it from the apartment to the waiting mortuary vehicle. 2) You cannot submerge the backboard (which goes under the patient) of the Heart Lung Resuscitator (HLR) in water. That would ruin the controls for the unit, which are contained in the backboard. To get around this problem, we used an empty backboard, stripped of its components, under the patient and kept the good backboard outside of the tank. Mike is working on obtaining more "dummy" backboards to use with the Pizer tanks. *OXYGEN* The Heart-Lung Resuscitators (HLR) we use on suspension patients are powered by the same pressurized oxygen they deliver to the patients. As part of our HLR setup, we have two "E" cylinders with a dual-tank yoke. The E cylinders are small enough to carry easily; but they only carry enough O 2 to run the HLR for 15-20 minutes. With the advance notice we had, we were able to arrange to have one "H" cylinder (about 200 cubic feet and hard to move) delivered to the nursing home and two others delivered to the mortuary. It is also advisable to rent or buy a special hand truck for moving the H cylinders and to ask for tank stands to prevent tipping. You will also need to know which oxygen companies offer prompt, 24- hour delivery. There will be several, since hospitals need this service. We are continuing to keep one H-cylinder at the mortuary for emergencies, to cover the time before a delivery could arrive. NOTE: If a patient has undergone more than one hour of warm ischemia before treatment can start, we do not recommend the use of CPR, which might actually accelerate the damage. In that case, the patient would receive sternal compressions only, while medications are given, if even that is possible. Ignore the oxygen, cool the patient, and transport to California as rapidly as possible. (Details in "Emergency Instructions for Stabilization of Alcor Biostasis Patients".) *STERILE WATER* If you have a situation where a total-body washout will be done, it will be handy for you to have about 20 liters of "sterile water for injection" or "for irrigation." This is a bulky item and will save a great deal of trouble for the transport team. If possible, purchase the water in bottles of 2 liters or more, with screw-type caps. They can be opened and poured more easily than bags and are reusable for many tasks. I recently purchased a case of nine 1500 ml bottles of sterile water for irrigation for $70.00. *PAGER* It would be useful for at least one person in your group to be available by pager at all times. The burden of being "on call" could be shared by several people, if you have that luxury. In any case, you should strongly consider this option if one of your members is likely to need Alcor's services soon. We compared local companies and ended up with a Motorola Bravo Numeric Display Pager. It displays the phone number you need to call, or any other prearranged numeric code. (For us, 9999999 meant "drop everything and head for the nursing home.") This pager was a small size which easily fit into a pocket, but had a clear display. It cost us $25.00 each per month and was very useful. We currently can't afford to keep up this expense, but we are hoping to start it again soon. Cheaper options exist, of course, and may be adequate for your needs, although we should point out that the reliability of answering services are subject to question. *THE CORONER* The tough question: Do you discuss cryonics with your local coroner or medical examiner in the hope that he or she will understand your point of view and be cooperative? You may get the tremendous advantages of cooperation; or you may discover you have sensitized an official who will do everything possible to prevent this suspension. Most coroners are probably honorable people who want to do their job well and avoid publicity (although our problems in Riverside point out that is not true of *all* coroners.) We have seen both obstructive and cooperative coroners in the past. Perhaps someone else has ideas on how to approach this. One thing is for sure: if you have a situation which is not a coroner's case (as adjudged by your physician and mortician), there is no need to drag one in. Stay in close touch with Alcor to avoid this type of complication. *THE PRESS* While it is true that cryonics needs more publicity, you certainly don't need a bunch of hyperactive reporters running around while you are trying to save someone's life. If at all possible, keep the press out of the situation until the patient has left your care. This will not always be easy, since there will be many people, especially healthcare personnel, who will find out about the suspension as it proceeds. You cannot control which of them might decide to call her friend, the reporter (or her friend, the policeman, for that matter). In many cases, it is not even a very good idea for the press to become involved *after* the suspension. If you have an uncooperative or extremely private family, or if the legal climate at the time has made officials especially suspicious of cryonics (such as during the past few months), a low profile might be best. If, in spite of your best efforts, the press does become involved, or if you have a family or group that is *prepared* for (and desirous of) publicity, you should immediately consult with Alcor. First, there is the problem of confidentiality. Every suspension member indicates in his/her suspension agreement whether or not Alcor can release his/her name to the media after suspension. If you are going to talk to the press, you need to get permission from Alcor to release specific information, even the patient's name. From that point, there are two basic ways to handle the situation. Simplest is a brief statement to the effect that "My mother wanted cryonic suspension and made the legal arrangements for it. We are simply carrying out my mother's last wishes." Then you should resist the temptation to answer any questions or provide any further information, except perhaps some official Alcor literature. Nothing will inflame a reporter's investigative instincts more than a story where little bits of strange information keep popping up. If you want to tell all, hold a press conference (have your attorney there, too) and prepare to hold nothing back. Alcor leaders can probably advise you how to handle these, and may even be able to participate if they have had time to recover from the suspension itself. If you opt for full disclosure, PLEASE consult with Alcor first. Your friends in California will not be pleased if the reporters and coroners decide to hold another "surprise party" at the Riverside facility. *START YOUR PLANNING NOW* I know that every cryonics group constantly harangues its members about the evils of procrastination. But many people have died and disappeared from our lives before they could "get around to" signing up. Others went into their terminal illnesses assuming they had done what was necessary to get to the future, but were lost anyway. We react to our pain and frustration by doing everything we can to prevent further losses. I am delighted if you have completed your documents; but please don't stop there. We really do want you to be there with us in the future. Following through on this advice will be a big step in that direction.