A tough school for tough kids! That was how you would have described St John’s Cathedral Boys’ School in the 1970’s. It was a denominational school located on the banks of the Red River 5 miles north of Selkirk, Manitoba. Many of its students were boys whose misdirected energy had led them adrift in the public school system. School programs were based on the principle of “muscular Christianity”; the boys’ self-esteem was rebuilt by pushing them to their physical limits of endurance. They were tested with grueling outdoor events: punishing five-hundred mile canoe trips in the summer, thirty mile snowshoe races and dog-sled runs in mid-winter. It was a school that prided itself on building ‘character’ and its successes were notable, as were its failures. The need to achieve was so compelling that even those whose physical abilities were not equal to these extreme challenges would continue until they collapsed.
On 31 January, 1976, 16 year old Edward Milligan could not complete his 25 mile snowshoe race. He collapsed in the snow about 1.5 miles from the finish: wet with sweat, exhausted and hypothermic. When he was delivered to the Emergency Room of the Selkirk General Hospital about 90 minutes later he was clinically dead. The doctor on duty, Dr. Robert Smith, could detect no signs of life: no responses, no breathing, no heartbeat and the body was cold, below 25º C. The ambulance attendants had made roughly the same observations and had performed CPR en route. With that information any sensible doctor would have turned his efforts to consoling the parents. It was Edward’s good fortune that Dr. Smith and Dr. Gerry Bristow who arrived about the same time, were not sensible doctors. Something about this boy, possibly the cold, puzzled and disturbed them. They continued CPR and began to warm Ted’s body. Within about an hour they were rewarded; his heart began to quiver, and with further CPR and defibrillation it started to beat. He had been in documented cardiac arrest for 85 minutes and restoration of heartbeat carried no certainty that his brain had survived. They worried that they had resuscitated a heart but not a person.
I saw him early next morning, after his transfer to the ICU of the Winnipeg General Hospital. Within a few hours he started to breathe spontaneously and by afternoon he was conscious. From that point his recovery was only marred by some minor frostbite. When interviewed several weeks later he was mentally normal and happy to forget this episode.
At that time it was the longest recorded episode of cardiac arrest with complete recovery. This case attracted much attention and some imitators. Winnipeg soon became known as a world center for hypothermic cardiac arrest. Usually it was as simple as getting drunk, walking home and falling asleep in a snowdrift. One young lady who we came to know well, Sally B., was resuscitated three times in two years. In the course of time she lost bits and pieces to frostbite: some fingers, toes and bits of nose and ears, but not her good natured optimism. Each time she recovered she was bright, cheerful and promised faithfully never to drink again. I must assume she kept her promise because she quit coming to us.
This is the stuff of mythology and science fiction, bodies not alive but not quite dead – suspended between life and death, a state known now as ‘suspended animation’. It is undoubtedly the most puzzling and fascinating of the medical mysteries and has inspired both the mundane and the magical. Suspended Animation was the title of a forgettable album released in 1981 by a UK punk rock group who called themselves The Monks (Polydor, Canada, 1981), but is also the material of myth and legend, drama and science fiction, space travel fantasy and a generation of cryo-preservation wishful thinkers. Time has not diminished its mystique and it is currently being seriously studied by NASA and by respected universities.
The earliest written account may be the myth of the handsome shepherd boy, Endymion, and the moon Goddess, Diana. Jupiter recognized her infatuation for the comely youth and bestowed on him perpetual youth and perpetual sleep so that Diana, being immortal of course, could lie with him forever. Shakespeare used suspended animation as a dramatic effect in several plays. The best known is Romeo and Juliet where Juliet takes a potion to induce a stupor resembling death, so realistic a simulation that Romeo takes her for dead and himself commits suicide. In The Winter’s Tale Hermione, wife of Leontes, is suspended for 16 years as an unfinished statue. In fairy tales it is the stories of Sleeping Beauty and Rip van Winkle, and Hollywood has produced several Sci-Fi epics, including “2001, A Space Odyssey” and in 2016, “Passengers,” starring Jennifer Lawrence.
‘Suspended animation’ is the classical term for this state but it is a bit dated and the connotation of animation has changed. We now see animation every day in the visual arts, creating the illusion of movement and action; and to suspend animation is simply to stop the action. A more accurate medical description would be ‘suspended life’ rather than suspended action. But the older term has the authority of tradition and familiarity and I will continue to use it with the specific reference to life, not just action.
It fascinates both the mystical crowd and serious scientific investigators and their interests range from the spiritual to the practical. What transpires in the mind during this period of suspended life? If the individual has a soul is it in the body, leaving the body or outside the body? Are there medical applications? What is the potential for space travel and time travel?
The ‘near-death ’and ‘out-of-body’ experiences have attracted a cult following, but psychic experiences are not our real interest. Accidental cases, as with Ed Milligan, still occur but the medical potential was quickly recognized as a means to facilitate both open heart surgery and complex neurosurgery. Dr. Wilfred G. Bigelow, who was born and raised in Brandon, Manitoba and graduated in Medicine from the University of Toronto, was one of the pioneers of open-heart cardiac surgery. He understood that cardiac surgeons could only effectively repair intra-cardiac defects if they could see what they were doing, and for that they had to have a bloodless operating field and a still heart to work in. The only possible way to stop the heart for long enough to do a complex surgical repair, and have a patient who would recover to talk to you afterwards, was to induce deep hypothermia for the period of cardiac arrest. He pioneered the experimental work but C. Walton Lillehei of Minneapolis is usually given credit for the first successful open heart operation using hypothermia in 1952. Bigelow’s technique permitted operating ‘in the heart’ to repair damaged valves and congenital defects and for this he was awarded the Order of Canada. The citation describes him as, “an internationally acclaimed pioneer of hypothermia in heart surgery.”
In Winnipeg Dr. Dwight Parkinson pioneered a technique to repair arterio-venous malformations deep in the brain (carotid-cavernous sinus fistulae) under deep hypothermia. Patients’ core temperatures were reduced to about 18ºC, the heart was stopped and he had a perfectly bloodless brain for about 45 minutes. Most patients survived intact. But, medical science moves quickly and these early applications are now of only historical interest. Cardio-pulmonary bypass and interventional radiology (stenting, coiling and embolization techniques) have made it unnecessary to stop the circulation and now the only application of hypothermia in cardiac surgery is local cooling of the heart during cardio-pulmonary bypass.
But as quickly as one use fades others appear: space travel, cryopreservation, transplant medicine and more. Hypothermia is not the only way to protect the brain but it is the most effective. The chemical explanation is known as the Arrhenius equation, proposed by Svante Arrhenius in 1889. Simply stated, chemical reaction rates are temperature dependent. The metabolism of the brain follows the same rule. A decrease in body temperature of 10ºC roughly halves metabolic processes in the body, perhaps a bit more in the brain. This is enough to increase the time the brain will tolerate complete ischemia (cardiac arrest) from 5 minutes to about 40 minutes. The chemistry is wonderfully consistent over a wide range of temperature and it is tempting to speculate – for how long can we extend this state by decreasing temperature to say 0ºC or -273ºC.
Unfortunately, it doesn’t work. Temperatures as low as about 12ºC with survival have been recorded, but not lower. Man is not a natural hibernator and human tissue does not survive freezing. But human embryos have been preserved for 13 years and viable DNA has been recovered from the mastodons. Perhaps this is our clue and we should look to our DNA for the secret of immortality. In 1996 a Finn-Dorset sheep named Dolly was the first animal successfully cloned from the DNA of another animal of the same species. Although my body will decay, my DNA could be preserved for long after I have died. But, of course, my clone wouldn’t be me – though phenotypically identical to me, my much younger identical twin, he would be his own person. On second thought, I will spare him that burden, better to start life with a clean slate rather than such handicaps.
However, science does not advance on hesitation. Successful innovation in science is the exploration of fantasy and this is illustrated by a recent headline in a popular British tabloid, the Mirror. “NASA planning ‘suspended animation’ cryosleep chamber that lets astronauts hibernate whilst travelling to distant worlds.” NASA has been persuaded to invest research money and talent in a project they call “Torpor Inducing Transfer Habitat for Human Stasis to Mars”. The logistics of space travel would be greatly reduced by putting most of the crew in hypothermia induced suspended animation for the journey. This is preliminary research for the Mars mission, about a nine-month return journey. How close are we to seeing this? The Mars mission is targeted for the 2030s and the limiting factor is clearly human endurance, not space technology.
On the medical front the Safar Center for Resuscitation Research at the University of Pittsburgh (named after resuscitation pioneer Peter Safar) continues with ground breaking research. Their projects include hypothermia induced suspended animation for victims of lethal trauma, as well as for neonatal asphyxia and cardiac arrest. The object is to buy time and prevent further injury until definitive treatment is available. Clinical trials have been encouraging. Will this have the same impact as open-heart surgery? Possibly not, but medicine is like the stock market, difficult to predict.
Will suspended animation provide the key to medical and cosmic breakthroughs? Our limitations lie not in our imaginations, but in our physiology. Man’s dreams may extend beyond the heavens and the grave, but evolution has given us a body that is bound to the earth. Our biologic equipment is good for about a century, our brain requires a constant supply of oxygen, and we don’t keep well when deprived of our earthly comforts. Random selection has made us both superior and vulnerable. Perhaps Ted Milligan’s recovery tested the limits of human resilience. But science is optimistic and we refuse to admit limits. Our future on earth may look grim but we still clutch at the hope that suspended animation will enable us to avoid our evolutionary destiny, perhaps even cheat death. It may permit us to escape from this earth to another universe when we have made Earth uninhabitable. Or it may be a way for those left behind to survive the next ice age. On the other hand, these could be just pipe-dreams. The science of suspended animation may have reached its ‘glass wall’. We can see the tantalizing shadows beyond the wall but we are unable to penetrate it. Just as well! If these fantasies were to succeed the survivors would awaken in strange, unfamiliar and probably hostile worlds. Despite my appreciation for science fiction, I prefer to stay firmly planted on earth and enjoy my suspended animation in small doses and familiar surroundings: a glass of single-malt scotch, a wood fire, some Beethoven, and my life’s companion beside me. The evolutionary triumph of the human brain, what makes us truly distinct, is that one’s cosmos can be entirely internal. We don’t have to physically touch the stars in order to experience them.