Stopping the sedation!

Let’s be unambiguous about this – the announcement that Michael’s care team is discontinuing his sedation is the news we’ve been waiting for. It’s the first big transition – from acute, life-threatening head injury to subacute recovery. Followed no doubt, let’s not forget, by a chronic rehabilitation phase. But this is wonderful news.

In terms of how this is done, well it’s actually pretty simple. The electronic pumps driving the continuous infusions of the sedative drugs are turned off. That’s it. But doing that means that the people taking care of Michael have a reasonable expectation that he will not exhibit untoward reactions to the “stress” of these medicines being turned off. The most undesirable of these would be elevations in . . . you guessed it . . . intracranial pressure, but to be honest, we’re now more than four weeks post-injury, and I’d rather think that we’re past that.

So what will happen now that this stuff is turned off?

1) It may or may not be true that, in general, French neurointensivists maintain sedation longer than their Anglo-Saxon colleagues. It doesn’t matter. The people taking care of Michael know what they’re doing.

2) while it’s possible that a long-acting drug may well have been used in the early, “suppressive” phase of Michael’s care, it’s quite likely that if so, it’s been replaced with one or more short-acting substances. These usually allow signs of emergence to appear within several hours of stopping the infusions.

3) What actually happens? Well in general, the first attempt to stop sedation usually gets interrupted by something. The patient gets agitated, the blood pressure goes up, the oxygen saturation goes down . . . something. So you turn the sedation back on, let the situation settle down, and then either try again or wait until tomorrow. It often takes a few tries before everything goes the way it should.

How should it go? Well ideally Michael will start to want to breathe, and allow weaning from ventilatory support. And just as important of course he will hopefully start to show meaningful interaction with his environment. Following simple commands, visual tracking, etc.

Now I’ve heard (from unconfirmed sources), unconfirmed reports (double “unconfirmed” should ring alarm bells of course) that Michael has indeed already done this.

I’d love any neurosurgeons to jump in and comment, but if this indeed is true, it is fairly astonishingly good (but indeed totally conceivable) news. So we need to cross our fingers and hope something like this DOES get confirmed in the future.

Tell you what – let’s not talk about any other alternatives right now, ok, so we keep it positive.

One last thing.

I’ve seen some very heartfelt comments here and there about articles, tv pieces, and blog speculation “hurting” Michael’s family. I wanted to just weigh in for a second.

I’ve been pretty harsh with the tabloid press, and deservedly so. But not because the Daily Mail’s moronity hurts Corinna, Gina Maria and Mick. ARE YOU KIDDING? Could they possibly hurt more? And if so, is it likely to be because of the suffering induced by a British rag? Of course not. I think it’s detestable coz it’s shit “journalism”. I kinda don’t think it’s on Corinna’s reading list, I don’t think their “journalism” could possibly add to their pain, and lastly, Michael’s care team have no doubt been TOTALLY up front with the family. Meaning they have a better idea than any of us of just what the . . . hell . . . is up.

If I thought for a second that anything I’ve written might hurt Michael or his family, I’d not have written it. To be honest, I’ve spoken to you as I’d speak to Michael’s family. I assume you know that, because I think it’s to THAT that you’ve reacted (to my infinite astonishment), more than to the information that I’ve transmitted.

44 thoughts on “Stopping the sedation!

    • il faut toujours croire espérer car déjà son infection il y est parvenu il l’a combattu et pourtant là, la clinique aurait dû songer à ce méchant microbe sur les plus faibles donc laissons lui le temps aussi de cette rémission de récupérer une meilleure stabilité hors infection et ensuite continuer de le réveiller petit à petit que dieu les bénisse tous

      • dieu alain,
        You have posted this as a reply to the “comment” that I have reblogged Gary’s article. When really you should have clicked reply/comment at the very end of the comments already posted. However your sentiments are welcome. :)

  1. Gary, you have told it as it is in your medical opinion all the way along, and although it has sometimes been painful reading it is the nearest thing those of us who love and care for Michael and his family have had to actually sitting outside in the corridor waiting for updates form doctors. For that I think you, and I continue to pray for Michaels recovery, however slow that may be. I have faith! Once again, thank you x

  2. Hey Gary keep feeding us with the information as you do. What we hear through the “rags” is normally sensational journalism at best. It is difficult not to get excited when you hear that Michael is “blinking” but reality can bite one in the ass, so we try keep the enthusiasm in check. Thanks once again.

  3. Brilliant news, let.s hope the “unconfirmed” reports have some basis in truth, sitting here with tears running down my face, wow what a rollercoaster ride we;’ve all been on. I know we;’re not out of the woods but at last there seems to be hope. Thanks doc

  4. If only my teachers were as straightforward as you….
    Thank you for doing this. I learn more here than in neurology-class
    Fingers crossed for Schumi

  5. I’ve been waiting all day for your blog. Thank you so very much. And I agree with your suggestion to just keep it positive and be happy about the progress being made.

  6. Doc, thank you for your insight on this grave matter to all motorsport fans and all fans of Michael. Here’s to keeping him and his family in our prayers. The most important thing is that they get their husband and father back.
    God bless

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  8. Dr. H,
    Well said. I (and all of us) should consider ourselves lucky to have your tweets and blog posts as THE informed source of information; and educated, experienced interpretation of said information regarding Michael’s condition and treatment. It makes me proud to see an anesthesiologist be a sentinel in such a high profile situation. Keep it up!

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  11. Thanks once again for this explanation of the process as always Gary. As you say we take nothing for granted but we hope like hell that he is coming through these steps in the best possible way. If it were left to me you’d have your job back with the F1 circus.

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  13. Thanks a lot Dr. As already said, I hoped to read these (rather) positive news. I often inform our collegues within a well known Belgian Leasing Company that all are Schumacher fans. Would love to hear you again interviewed by Gaetan V on Belgian TV!

  14. Thank you so much for keeping us updated for the last weeks, you are one of the very few trustworthy commenters on Michaels situation. keep it up!

  15. Thank you Doctor from a fan of Michael’s in new Zealand. I always keep a look out for your comments and they do make me feel a lot better knowing what is involved. I truly hope Michael comes through this with all my heart.

  16. I think that they mean incidents like the infamous case of the photographer allegedly masquerading as staff to gain access to the room, and potentially getting in the way of the real staff. That was the incident that first triggered the comments from MS manager, don’t forget.

    The problem is that speculation becomes belief for a lot of people, and ill-informed speculation is the most counter-productive. Your blog posts, in comparison, could never be labelled ill-informed, and – like any responsible journalist should – you tell us when you’re speculating. There’s a world of difference in terms of credibility.

    But I also think, and have said publicly, that MS manager was hopelessly incompetent if she didn’t realize that gossip abhors a vacuum. More frequent updates from her could have avoided a lot of the nonsense being written in the first place. Admittedly, she could have felt that Michael would have wanted her to prioritize the welfare of Corinne and the children, so I am not criticizing her for the lack of updates – just for the unrealistic expectation that she seems to have had that the absence of news would not breed speculation and a demand for greater intrusion.

  17. Hey, Gary, thanks for the update. My other half said to me, yesterday, “They are saying in the Daily Mail that Michael is responding to treatment”, so I went to Twitter and there was nothing. I said to him, “Wait until we hear from Gary, then you will know the truth” and I have waited and you have let us know. Thank you Gary. I was prepared to accept what his manager was saying, that the doctors were bringing him slowly out of the induced coma, but for the Daily Mail to leap from that to “he blinked his eyes and responded to a question” was just ridiculous.

  18. Doc, I’m a Michael’s fan and started to follow you to know your opinion about his care. I am praying for him and his family. Please, don’t stop.

  19. Doc, sincere heartfelt thanks for the update. I pretty much ignore everything I read from media sources. My colleagues and I have been glued to your comments, insight and measured response to Michael’s condition. We cannot thank you enough. God Bless you Dr. H.

  20. THANK you very much for keeping us updated in such a responsible, careful, knowledgeable and positive but realistic way!
    Keep it up Doctor while we keep on lighting candles, praying and… Just in case, crossing fingers!

  21. Anyone interested in the complications of brain injuries know a lot more thanks to you. You’ve turned a difficult subject, both emotionally and medically, into something we can all digest. The media intrusion, as you state, has been appalling but your medical analysis of what may or may not be happening has been an education to us all and has been a shining light in the coverage for all those desperately hoping for a good recovery from Michael. Keep it up Gary.

  22. Most of the unconfirmed reports I’ve read have been on German sites such as Bild, which have then been duplicated in British tabloids. So I don’t know why you’ve directed your approbriam solely over the English Channel. Get well soon Michael.

  23. I’m so glad that Michael is making progress at long last :)

    I would like to thank you for giving MS fans qualified and balanced comments on his condition. Large parts of the media have been a joke …. they almost make it up as they go along.

    Don’t get me started on The Daily Mail. I can’t tell you what I think of them, because I would end up in court!

  24. Thank you again for consistently objective commentary on a story that millions of f1 fans all over the world are following.

  25. Dear Dr. Gary – I stand in line echoing all the positive comments that you have received since Michael’s tragic accident. I want to also thank you for your willingness to reach out to those of us not in the know by providing honest and forthright, clear and insightful, information.
    The word impossible, to me so often, is simply used to define the potential degree of difficulty. My prayer, as are so many others, that Michael can, in fact, be an example of the miracle that so many are praying for.
    Equally important is that you know that we are all grateful to have your voice, your writing, to help us be part of his recovery. Sincerely and with deep appreciation I thank you.

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  27. I am beginning to feel that those many people who are genuinely and rightly concerned about Michael’s condition are being treated badly by Sabine Kehm and her team of PR agents..
    Michael is a public figure with an immense following throughout the world. He may not have been the most popular driver in the UK, largely because of what was, erroneously written about him in the popular and somewhat xenophobic press, but in Europe and in other parts of the world his standing is immense.
    The hospital in Grenoble had to issue a statement yesterday that Michael had “not died”. What strange chain of events brought thatl about? We also heard some days ago that attempts were being made to bring him round from the induced coma. Since then, nothing.
    I am afraid the times we live in often dictate that no news is no longer good news, but bad news and many sections of the press has played out that notion in recent days, culminating in the announcement the other day from the hospital.
    I am not advocating that the family congregate on the steps of the hospital and answer questions, or anything even approaching that, but I do feel some sort of statement, even one which only acknowledges the continued concern about Michael and his family’s predicament from his many fans around the world is now overdue.
    The role of a PR person is to liaise with the public. In good as well as in bad times. These are admittedly bad times for the many people worried and sad about what has happened to Michael. I think Sabine Kehm and her team are doing them a great disservice by simply remaining quiet.

    • Peter – Thank you for your insightful and sensitive comments; thank you for sharing genuine feelings that I and many others, I imagine, are also feeling. I, of course, would have used the word ‘insulting’ rather than “disservice,” however, your choice is so much better.

      • My thoughts are exactly the same as you Peter and I would say also the thoughts of thousands of others from around the world. This no new update on Michael’s condition makes it very hard to bear, the silence is profoundly deafening

  28. It appears that the press has retreated from the hospital in Grenoble. No updated pics of Corinna or the relatives. So privacy has been given, and like you said, Gary, now we wait. In waiting there is panic, since the world is on a different schedule with the internet and smart phones. Everyday I check on updates, only to find nothing. But then yesterday- rumors of the worst kind! My guess is someone planted them to stir the waters. And I can’t help but feel it is the family which continues requesting complete privacy. In any other similar high profile situation, there would have been numerous updates by now. My compassion for what Corinna and the family are going through is strong, and Sabine Kehm may have tried her best to provide new information, but she must above all respect the wishes of the family.

  29. As I feel we are here amongst friends, and whilst we await news about Michael, may I be permitted to share with you a rather special video which I came across in the extremities of Youtube.
    It shows Michael at a Reining exhibition in Oklahoma in 2012, supporting his wife’s love of horses and her involvement in the world of Reining. It is bitter sweet to watch, but it shows what a quite extraordinary man Michael is.

    • Thank you so much Peter for sharing this beautiful video of Michael. yes he really is truely an amazing man. I had tears in my eyes when I watched it and I just can’t believe how full of life he was in it compared to where he is now, absolutely breaks my heart.

  30. Peter, thanks for the video and your comments. I totally agree with you that the PR machine is doing the fans a great disservice in maintaining its silence. While I appreciate the family`s need for privacy it is killing me that we hear nothing for days on end. Surely an update every few days, even telling us that nothing had changed, is better than the silence which allows our fears and imagination to run riot!

  31. Many people pray for him to get better, and I know he will. He is a great man and he belongs here with us. Heaven may cry, but his place is here with his familly and friends. A little advice for Corinna: think about what he loves and try to get him as close as you can to this (including video or audio if you can). It will help. Be strong Corinna! We are here for you!

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