Keith Augustine interview

As I've pointed out before, it's not at all clear when she was put into burst suppression. Spetzler started with procedure (1), then changed to a completely different procedure (2) after he had already cut open Pam's scull, and had seen the size of the aneurysm.

There is just no clarity that Spetzler had Pam in burst suppression right from the beginning of the initial procedure (1) he started with.

The paper he wrote (which you quoted from above) is about procedure (2), and it seems clear from that paper, that there is no reason to doubt he would have put Pam into burst suppression for procedure (2). But this paper tells us nothing about procedure (1), because the paper is not written about procedure (1), it was written about procedure (2) - and sure enough, we don't get any NDE OBE veridical type recollections from Pam during procedure (2).

And although we have Spetzler saying he did put Pam in burst suppression, I can't obtain any clarity as to when he did this... for the whole of both procedures (1 & 2), or just (2).

It would be good to get some actual evidence to clear this up.

What is procedure 2 ? I don't understand what you're trying to say there. The paper is logical and consistent with what occurred with Reynolds.

Max said > "And although we have Spetzler saying he did put Pam in burst suppression, I can't obtain any clarity as to when he did this..."

Right, that's something then, Max. Thanks. That is why I specifically worded this question to Spetzler so that there could be no misunderstanding.

"...........when Pam Reynolds overheard the conversation about her femoral arteries being too small for canulation and you (sir) said "Try the other side"...were her brainwaves effectively flat at that moment ? (summary)

His answer was a straightforward and unequivocal "Yes"  signed RFS (Robert Frederick Spetzler). Smithy received basically the same reply. 

Why is that not clear, Max ?

Because it doesn't answer my question... and I need some evidence as to when she was put in to burst suppression... i.e. throughout the whole of procedures (1 & 2), or just for procedure (2).

Spetzler's paper indicates she was put into burst suppression after hemodilution (the process of removing (some) blood still containing good clotting ingredients that can be returned to her body later so that she doesn't bleed to death after all the incisions)   This is before the opening of the skull.

Further than that, I can't tell you. because I didn't ask him that question. Why ?

Because it would have been over ambitious and unnecessary to do so. All I wanted to know was the state of her brain when she heard the conversation and saw the bone saw. I knew he wouldn't have the time or the inclination to reply to a long request for precise technical detail of an operation that will inevitably vary slightly, every time it is conducted, to laypersons such as myself. And why should he ?

It was something of a surprise that he replied at all, to be honest. 

I've answered your question, Max. It would be sportsman-like to accept it, now.

His paper is pretty much irrelevant on this issue, because it is written about procedure (2), so it only tells us about his general method for procedure (2). We already know he changed to procedure (2) only after he had seen the large size of the aneurysm. He tells us he changed procedure, and he only found out it's size, after he had already removed a piece of Pam's scull, because he tells us this.

The fact he changed procedures due to this new information, indicates he was using a different procedure prior to the change. That's what I call procedure (1). We don't know what the method for procedure (1) was.

We know that Pam was put into burst suppression, Spetzler says she was, and his paper on procedure (2) is further confirmation that this was his usual method for procedure (2). There is no credible reason to suspect she wasn't put into burst suppression.

What we don't know is when she was put into burst suppression... and we have no solid evidence to indicate when she was put into burst suppression...

That's always been the nub of the problem in Pam's case... and it remains the problem.

Max, this is just silly nonsense. We know exactly when she was under burst suppression. So do you.

We don’t know whether she was in burst suppression for the whole duration of procedures (1 & 2), or just procedure (2). But I’m just repeating myself...

Repeating yourself, Max, maybe... but worse than that, you're pretending that you can't see what is right in front of your eyes, (for reasons which probably have something to do with your attachment to your theory). 

Why else would a person of your ingenuity and capability, suddenly be unable to read plain English ?

Never mind about procedures 1 and 2,  3... or 33, that's just another attempt to muddy the waters. Read Spetzler's paper. On page 870, one can see that Burst suppression is achieved after Hemodilution. Hemodilution ie adding saline to the circulatory system so that an amount of blood can be stored with good clotting agents. This is not likely to be done AFTER burst suppression because that would mean that the stored blood was full of barbiturates (I would guess).

So Burst suppression was achieved sometime after hemodilution. Because after that, and when her/the temperature dropped down to 33 degree's C, the scalp and skull are/were opened and the bone saw utilised. And when the bone saw is utilised on the skull at Barrow (at least) ..they require flat brainwaves. Spetzler's secretary (Barbara, I think her name was) actually told me this and Spetzler himself very kindly explained the state of her brainwaves when that was occurring.

Anyone can follow that, Max. I can't see any reason you wouldn't be able to.

The standstill paper is not relevant to the issue... because he didn't start Pam's operation with the intention of conducting a standstill procedure (procedure 2), we know because he tells us he decided to change the procedure when he saw the size of the Aneurysm. We can confirm that another way too, because according to his standstill paper, he should already have hooked Pam's groin artery & vein up ready for bypass, before opening up her scull. But in Pam's case, hooking up her groin artery & vein actually took place after he had opened her scull.

I did some more reading last night, and the papers I have read suggest he was at least initially intending to do a simpler clip procedure to Pam's aneurysm, in which case he may only have induced burst suppression just before the temporary and/or final clipping. But the Aneurysms larger than expected size meant he decided to change to the standstill procedure part way through the operation. Thus in the absence of any further solid evidence, I think it's now highly likely that Pam wasn't in burst suppression during the periods of her NDE OBE. I'm much more confident about that now.

Max said >"The Standstill paper is not relevant to the issue"

Really ? So the paper is not relevant and what he said is not relevant, either. So prey tell us what is relevant, Max. Is it what you say ? Or Woerlee ?     

Max said >"...because he didn't start Pam's operation with the intention of conducting a standstill procedure"

Well that's just beautiful  Dear oh dear.... Even though he told her beforehand (the day before) that he would probably have to stop her heart and that was the main reason why she went to Barrow in the first place...because they were the only ones (practitioners) who had the capability to perform such a procedure.

So tell me, Max after opening her skull and examining the bulge in the artery, are you suggesting he suddenly rounded up the other dozen or so relevant surgeons and doctors/members of the team to perform the standstill operation ? Along with all the extra equipment required ? There were over twenty medics in the OR to do this (operation), they didn't have mobile phones in everyday use back then. So where were all the medics waiting ?  Come off it, Max.
 
Max said >"he should already have hooked Pam's groin artery & vein up ready for bypass, before opening up her scull. But in Pam's case, hooking up her groin artery & vein actually took place after he had opened her scull.

Pam was hooked up to the catheters in her groin and neck after the evaluation of the bulge. The paper does not contradict that. 

Max said> "I did some more reading last night, and the papers I have read suggest he was at least initially intending to do a simpler clip procedure to Pam's aneurysm, in which case he may only have induced burst suppression just before the temporary and/or final clipping."

I thought you said there was no point in reading the published papers ?

Max said >"Thus in the absence of any further solid evidence, I think it's now highly likely that Pam wasn't in burst suppression during the periods of her NDE OBE. I'm much more confident about that now."

And that is simply pure and utter bullshit. I'm frankly amazed, Max.