Perplexity

I’ll admit to being perplexed.

First, about the silence from Grenoble.

If you’re not in the habit of reading the comments section after each post (I do, of course – it’s wonderful to see what those of you who read me think, and a source of wonder that you’d actually take the time to write), it’s worth a look (in chronological order) at the comments to my last entry.

It’s pretty clear that Michael’s fans are beginning to feel like their devotion, commitment, and passion for someone they’ve elevated to hero status over many years means nothing. I see strains of anger, disappointment, frustration. Others, with considerable self-abnegation, are hewing to “respect for Michael’s privacy” and accepting the lack of information with equanimity . . . but even here there is an undertone of frustration at being asked to do so.

I’m not a journalist, and I’m not a PR/communications professional. But I totally fail to see how the current comms policy helps either Michael or his family. I fail to see how talking to us about the significant ups and downs of this long hard process damages Michael’s privacy or makes Corinna and the kids’ journey more difficult. I cannot possibly understand the reasons for any of this. I’ve said it before, and I’ll repeat it. This is totally unfair to the people who made Michael the celebrity he is. The people who vibrated to his victories, and were saddened by his defeats. They deserve to be told something. I didn’t say it’s their right to know (although jurisprudence places looser limits on celebrities’ “privacy” than on that of “normal” citizens); rather I said they DESERVE to know. Why on earth is their pain not being considered? How is keeping the millions of fans in the dark helping ANYTHING?

I’m also a bit perplexed about this latest thing in FOCUS.DE about re-starting the sedation. First of all, the article is rather remarkably poorly written. That, plus a singular lack of content make it useless, and surely not even worth wasting one’s time reading.

With no knowledge of Michael’s current clinical condition, it’s impossible to say why he would be re-sedated at this stage. Generically, any situation requiring a still, tranquil patient might raise consideration of reinstating sedation. This could be, for example, respiratory deterioration that requires a new period of mechanical ventilation. It could mean that there has been a change in his neurological status, with perhaps some signs of agitation, or a systemic infection originating in one of the several catheters still present. Again, we have absolutely no idea.

Right now I’ve really only one question (that predates the re-sedation issue). Has Michael been weaned from the ventilator?

As I’ve mentioned, once the sedation was stopped, the next big step physiologically speaking was respiratory weaning. This appears to me to be a piece of news that is unequivocally good, and therefore I cannot imagine it being held from the public. Imagine having heard Sabine say “I’m happy to say Michael is now breathing on his own”. Once again, if he HAS been weaned and we’ve not been told, then this is a shameful and arrogant neglect of his fan base and the public.

If on the other hand Michael is still dependent on the ventilator, it’s important to look at why. In this case, that of a young and (remarkably) healthy man with a high probability of brainstem lesions, damage to the respiratory centres would be high on the list of reasons.

Damage to the brainstem can be associated with numerous clinical presentations. It is where breathing is controlled. As important, the brainstem contains structures that play a vital role in waking the brain and maintaining wakefulness and attention. It’s also where the nerves to and from the face (for hearing, sight, taste, feeling and movement) enter the brain.

With sufficiently widespread damage to the brainstem, the patient shows no sign of awakening, and remains ventilator dependent. This is obviously a devastating situation. Brainstem injury is suspected based on the clinical status of the patient, and is then sought using imaging, especially MRI scanning. The actual function of the brainstem can be interrogated using several techniques, including what are called “brainstem auditory evoked potentials”. This involves placing headphones on the patient and playing a series of several thousand clicks through them. Then, sophisticated software is used to detect, embedded within the electroencephalogram, the passage of the sound information through the brainstem (where it enters and undergoes initial processing).

Let’s cut to the chase.

If Michael is not breathing on his own, and is (as we suspect) not showing signs of purposeful interaction with his environment (I am ignoring the mouth movements of which Felipe Massa spoke), AND if there is imaging and functional evidence of extensive and irreversible brainstem damage, Michael’s doctors will discuss withdrawing treatment with the family, as under these circumstances there is essentially no chance of recovery. It is possible that this discussion has already happened.

If Michael is breathing on his own but still not showing purposeful interaction with his environment, then patience is still very much in order. Remember that at one month post-sedation, persistence of this state means roughly a 50% chance of awakening, with the quality of that awakening an open question. This falls to 20% at six weeks (three weeks from now), with a larger portion of these patients having severe functional handicaps. And at one year, essentially no one still comatose wakes up.

Lastly, if Michael is breathing on his own AND showing signs of meaningful interaction with his environment (I very much hope, but very much doubt that this is the situation), then a certain number of people should be ashamed of themselves for denying this good news to his fans. If there is indeed progress and good news ready to be told, then the current comms strategy will go down in the annals as among the most ill-guided, unprofessional, and hurtful in the history of Formula 1 PR.

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104 thoughts on “Perplexity

  1. Thanks again Gary for the insights.
    I have been following along with so many others since Michael’s accident, and like so many others looking for some reassurance if nothing else.
    As frustrated as we become waiting for news, I think it is important to remember that none of us care as much for this man’s well being than his family. If the lack of updates is their wish, so be it.
    I was reminded by my mother of the situation surrounding Princess Diana’s death. This also occurred in France of course, and the French do not readily give information on these things. All information is given on a ‘need to know’ basis and interested observers don’t fulfill that criteria – no matter how interested we may be.
    Like many others I’m sure, my concerns are growing with the passage of time. I’m waiting with the rest of you for some good news.

  2. Reading all the comments I am now of the view that Sabine Kehm, MS personal manager & PR, is following instructions from MS last known wishes & now the family (wife, father etc). I suppose this was ever so as she is employed by MS & the family – she can’t possibly go beyond the instructions and leeway given to her. As others have mentioned she is probably a close friend and hence would also most likely know what MS wishes would have been if he was awake, Hence she is in a difficult position and absolutely must refer to the Family first if there is something she is uncertain of answering.

    Also it is likely that the MS family don’t 100% know what is going on – they are not medics. Hence they are limited to the news they receive and will cling on to any possible hope for his recovery.

    The Hospital in Grenoble have to be exceptionally careful in being professional and being seen to be careful. They absolutely cannot release any news that the Family don’t want to be released and they also have to protect themselves from accusations of breaking patient – doctor – family confidentiality. With the global media focus they have to be extremely careful.

    It seems to me, in that light, the Sabine Kehm comments are understandable. She, as far as I am aware, has been making accurate succinct statements of progress and significant changes in treatment. No news of progress or particular milestones being met suggests that there is nothing new to report apart from “as before”. In this manner it seems these statement would be similar to what MS himself might say – given what others have said about his sense of dignity, his precision, his taciturn nature. I would imagine each statement Sabine Kehm makes has to be cleared and discussed with the family first. I am sure they would not release any statements if they themselves were unsure of the information given to them by the doctors. The doctors themselves might not be 100% certain of MS particular prognosis and condition at any given time.

    The story about MS having pneumonia was a leak and I guess it was an exaggeration of a normal chest infection. The doctors probably told the family it was under control and was not important. The family probably then thought there was no need to release this information as it was irrelevant to MS medium to long term prognosis.

    This is all speculative, but I am coming to the view that though MS is considered a celebrity, a sporting god – this is not the view of MS and his family. It seems to me that what we have here is just a “normal family” and the “retired MS” is running as a close family business with a focus on charity work, consultancy, projects and meeting the various PR demands on his time.

    The differing comments on this blog I think largely reflects the two sides of MS – one the legend (& associated fans) the other the private family man. I think I had the wrong perspective when I first started commenting on this blog. I think I am now seeing more of “MS the person” rather than “MS the myth”. I thank Gary for providing the blogs and I thank those that have contributed to helping us see MS the person.

    On my part I am going to stop “being disappointed” regarding “opportunity missed” regarding educating the public on head trauma. That is not for the MS family nor the so-called “PR team” of MS. It is up to the media to explain head trauma but in a depersonalised and generic sense.

    I am thankful to Gary for taking up the time to help us understand the medical aspects of head trauma as potentially applied to the MS case. I should also add Gary’s PR comments (which I thought was carefully worded but maybe slightly on the “strong” side) has resulted in a set of extremely informative comments that has helped me gain a better understanding of the situation as regards information coming from the family.

  3. I am not a doctor but i am a realist, and i think the best we can hope for now is that Michael emerges to have some sort of normal life, being able to hold conversations, make a cup of tea, brush his teeth without help, walk unaided etc, Michael the incredible athlete that we know is gone forever imho, i hope to be proven wrong but as time goes by i think we have to be realistic with our expectations

    • Hi Chris, I am going to have to say I agree with you, I would not have agreed 3 weeks ago but as time goes on, I don’t think we will have the same Michael back, all I can hope for is that he comes back with at least some form of normality, knowing who his family is and the things you have mentioned. It absolutely breaks my heart to think of Michael like this

  4. Hi Gary. An interesting article and an argument I hadn’t thought of before.

    This is probably all academic. I guess Michael is not in a good condition and that is why everything is so quiet.

    The time will come when his family will speak to us again through the press. Until then, we should respect their wishes. No-one is suffering as much as them. It is wholly their decision how they want to handle this situation regarding the press. And all fans should have the patience to endure not knowing what is happening with Michael until the moment Corinne has the strength to make a statement. I really don’t think it is too much to ask.

  5. I think that if Michael’s family want to keep things quiet and private, is their business and nobody else’s.

    Yes, we fans are worried, curious, etc etc etc, but our feelings are the less important in this situation. First comes the Michael and the family.

    Shame if you, me, whoever doesn’t understand why the family may want complete isolation at a time like this, but that’s completely irrelevant. It’s not their business if you understand or not.

    • I appreciate reading a doctor’s interpretation of the Schumacher case. I know I’ll get flamed for this, but unlike many other people here I DO feel that the news blackout is inappropriate.
      He is a human being: he doesn’t “belong” to any other human being. Since he went out of his way to cultivate his fan base and maintained regular communication, I believe he would want to continue to do so now. His life speaks for itself. Of course, the family’s decision must be respected, but they’ve chosen an odd course.
      I also really dislike the media’s characterization of this as a “battle” that Schumacher must “win or lose”. If he does not survive, that doesn’t mean that he has “lost”. It simply means that the skulls of our species aren’t designed to take that type of impact.

      • I DO feel that the news blackout is inappropriate…I also really dislike the media’s characterization of this as a “battle” that Schumacher must “win or lose”. If he does not survive, that doesn’t mean that he has “lost”. It simply means that the skulls of our species aren’t designed to take that type of impact.

        Agree on both counts, Siara, and was very grateful to read your complaint about the media’s use of “war”/battle lexicon. I also object for just that reason, that a negative outcome can now be (mis)interpreted as his “losing” or not having “fought hard enough”.

  6. Hi Gary,
    I would like to thank you for your comments on Michael’s condition. For a long time F-1 and Ferrari fan like me (I’m 49 and started watching F-1 at 10) it is a pleasure and a privilege to be able to read your knowledge-full insights.

    I do agree with you that it is hard for the fans not to know about the real Schummi condition. After all, the fans have certainly helped him reach the “superstar” status!
    However, I do think we should respect the family wishes, if that is the case. If it is the family option not to have any news leak into the public, so be it, even if I wouldn’t do it that way.

    Again thank you very much for your blog and keep it coming!

    Regards,
    Rui Gigante
    Portugal

  7. How can there be so much to say yet so little at the same time? The reason is because our hearts are broken for Michael, the family, friends and fans. I can’t even speak about what should and shouldn’t be anymore-I JUST WANT SCHUMI TO HAVE A SECOND CHANCE. We just don’t know what to do anymore but what matters firstly is what’s best for him and his loved ones. There are so many sides to so many stories but behind it all is the HOPE and LOVE that we have for him. There isn’t much to say except PLEASE GOD bring a miracle for him. He deserves it. I’m just so scared and don’t have words anymore. To Mr Gary, I know you are coming from a place of love and empathy when you write these pieces. Also you are in such a position where whilst you feel the families pain and anguish, you ALSO feel the direct and devastating fear and sadness of the fans cause we all turn to you for guidance. Regardless of whatever- as I mentioned before in a previous post-you have been a shining light in all this and I don’t know what I would do if I didn’t have the privilege of your medical and calming viewpoint on things. We love you and we thank you for all your help. Let’s pray for Michael cause prayer is powerful and I know GOD is hearing us. Kind regards eliza.

    • eliza, you have said it so well and speak for so many of us, my heart is really breaking at the moment not knowing what is happening to Schumi, all we can hope and pray for is that he has at least some form of normality if and when he starts to recover, I so feel for Corinna, the children, his brother and father as they must be going through hell at the moment

  8. Hi Doc

    If in case of brain stem injury, what is the time that it take to set in? Is it immediate or does it take a few hours to set in? MS was breathing normally after the incident, was awake and may have been talking, but do these change after being induced into a coma? Or was the brain stem injury a result of the internal swelling after the accident?

    • I would like to add something to MSConcerns comment. In Hollywood films you see one person trying to keep an injured person awake / conscious – as if if they fall asleep their chances of survival is lowered. Is there any truth in this – the importance of trying to keep an injured person conscious in the immediate aftermath of an accident. I know this is usually related to internal bleeding issues (in the film) but I am wondering if there is also a “head” effect?

  9. Hi Folks. I’m living in Grenoble, just close to this big hospital hiding mountains just by the window… I’m a big fan of F1, I wasn’t a fan of Michael till 2010 when he decided to come back, I found that he had really big balls to do that… I wasn’t a fan because he (and his mangement) didn’t seem to be respectful towards the fans, and during his carreer his appreciation of sport values sometimes was… criticable, from my point of view. Anyway, it was a shock when I learned about the accident… Not being a fan of Michael didn’t mean that I was not respectful of what he achievied and what he was doing, especially in this 2012 season.

    I’m really happy to read Gary’s thoughts because I agree at 100%. About medical stuff, I’ve no idea but it’s really instructive to read your point of view. About communication, Michael’s management is as always : they close everything. The only accurate informations we had were provided by the surgeons at the very beginning of the story. When Michael’s management took the relay… it was desert, almost nothing. They didn’t even give news when Michael was out of Immediate death danger. Today, Michael’s family is not in the need for the next 10 generations, and thousands of fans continue to buy Schumachers goodies… just because of you, me and millions of other people : the Michael’s fans ! Those fans that came from France, Italy and Swiss just a fews days after the accident next to the hospital doors, the same that had a walk around Spa circuit, and all the people trying to find news of their idol in the newspapers or on the web. What about them? What about us? Do we really deserve to have no news? Without millions of fans, F1 drivers are nothing. They shouldn’t forget that I think.
    On the other hand, we don’t ask (and don’t want) to have a photo of Michael nor the details of his day to day life and treatment, we just would like to have some news. By doing that, the family would avoid false rumors, desinformations… But that leads to one question : If the family did so (by releasing some news every week or 10 days), wouldn’t they create other rumors based on those new statements ? If those statements were releasing very bad (or very good) informations, wouldn’t be lead to a massive wave of journalists to the hospital, waiting for something to happen ? Wouldn’t it lead to something worse, by incitating all kinds of people comment theses hypothetic statements?
    The good balance point would be tough to reach, of course. That’s what I respect family’s decision. However, honestly it’s not fair to say nothing. Be obliged to rely on what says l’Equipe or Bild, what a shame…

    • What do I know, but it seems like control of this information would have no affect on the family (who are in seclusion) but a huge impact on his sponsors.

      • Wow, Siara – I wish I had found your comments sooner.

        What do I know, but it seems like control of this information would have no affect on the family (who are in seclusion) but a huge impact on his sponsors.

        This has been my suspicion too for some time now – that there must be business or some other “official” concerns connected to the Schumacher-brand that are driving the news embargo.

        Otherwise there is no legitimate reason to so callously cut-off millions of loyal fans from basic information…

  10. Slow on adding my comment, but here’s my thoughts, for what they’re worth…

    I can’t help feeling that no news is, in this case, not good news. It doesn’t stop me hoping every day that I’ll see something positive from a reputable source (for which read; you Doc, or a respectable journalist – not a click hungry tabloid recycling gossip & speculation). The longer we wait, the less likely it seems there will be an improvement to report, but I have precisely no medical knowledge to base this suspicion on, like many of your readers, hence our appreciation of your explanations & interpretations of the situation.

    I have to confess I wasn’t Micheal’s greatest fan while he was racing (I was on Mika’s side without a doubt) but I’ve been watching F1 for over 20 years and so he’s been a big part of my life, and the news of his accident came as a real shock (as it did to all F1 fans). I think perhaps if my focus in F1 had been more as a Schumacher fan I might react somewhat differently to the absence of news. As it is, I don’t feel I can blame his family for wanting to hold back information. I can’t begin to imagine what they are going through, but I suspect the intrusive behaviour of some of the media has only reinforced their instinct remain as private as they possibly can. I don’t personally feel I have any right to demand more of them.

    Maybe if he’d wasn’t retired he might have more of a PR team who might be able to take a slightly wider perspective & judge what more information might be released to the public. In the vacuum left by the absence of news it’s not surprising that people will look at less reliable sources & we’re hit by the curse of the RT that catches your eye & raises your hopes before you realise where the ‘information’ comes from.

    So in the meantime I just wanted to say thanks Gary for the updates, sobering as they often are. We continue to hope, even if it is a hope against hope, until we hear something definitive.

  11. I’d be interested to know what Gary’s perspective is on coma patient recovery when one considers the case of Terry Wallis? Wallis emerged from a 19 year coma, though it sounds like he generally had a higher state of consciousness than that attributed to Michael at this time.

    Is there such a thing as a truly miraculous recovery where the unresponsive coma patient inexplicably makes a full recovery after a few years when everyone has essentially given up on them a long time ago? It sounds like Wallis’s brain performed a degree of rewiring by itself that enabled him to re-emerge. Maybe there could be a long term hope that something similar could happen to Michael. As family, hearing of cases like Wallis, how could they ever allow the doctors to remove support for Michael?

    http://en.wikipedia.org/wiki/Terry_Wallis

  12. Doc, I’m glad to see you wrote this and think it absolutely fair to point out that the celebrity/fame that facilitates super-stardom and the accumulation of massive wealth is a TWO-WAY STREET!

    Michael’s family are giving millions of VERY loyal fans the COLD-SHOULDER, when no one’s asking for gruesome details released daily, but rather, to understand the truth about their hero’s condition.

    I’ve seen some of the truly horrible things that have been written about you since you published this post, especially by the troop of keyboard monkeys who’re mind-controlled by F1 blogger (not journalist) Keith Collantine, of the F1 Fanatic website in UK. You’ve been a source of great insight and a calming influence during these sad days, and it’s a disgrace that ignorant Internet trollz have taken to abusing your good name just because you dare to express something that countless Schumacher fans are thinking…

    Thanks for all you do &’ve done!

    • Joe – Wonderful comments. Agree with you one hundred percent. Thanks so much for saying what you did. Gary is taking such good care of us – sounds like you may know him personally; we all owe him a debt of gratitude. Thanks again for your words.

  13. From an individual patients perspective, wouldn’t you say that his chances are either 0% or 100%? Everything in between is speculation, and as disappointing as it seems to be kept in the dark, a definitive answer ( when, if ever that happens ) is all that really matters. I think that as fans of the bigger ‘Public Michael’, we have all been extremely lucky to have witnessed and been part of his fantastic career. He might have had his ups and downs professionally, but he certainly has given a lot and rewarded / paid back the support of his fans many times over. The ‘Private Michael’ who is going through this horrible ordeal owes us nothing.

  14. My thoughts are this:

    Michael most likely had a talk with Corinne in his racing days on his wishes if he was ever in a terrible accident resulting in a coma or severe brain damage. I very much hope he did. I would think that a MS type of guy would probably say if it comes to that, then remove the tube and let me pass. I do not think he’d want to live as a vegetable and cause so much heartache to his family, friends, and fans.

  15. Do we know that it’s THE FAMILY that has imposed the news blackout? It seems to me that the family has simply asked for “absolute privacy” and “respect” while they mourn . Any decent human being respects that.

    Who is Sabine and who does she represent? Why does Schumacher have a personal manager when he’s retired? Most people would have a “personal secretary” at that point.
    Sabine seems to be in charge of communication– is she acting on behalf of the companies that sponsor him?

  16. I guess the fans who have loved admired and spent so much money on tickets, merchandise , sponsored products really don’t matter at all. Whilst Michaels family desrve the respect of privacy and most certainly would not need or desire a huge media contingent following them or blocking access to the hospital, I fail to see how a weekly medicall update would be harmful to the family or Michaels privacy.
    I think it a massive coomunications failure by managemnet to read correctly the mood and concern that Michaels accident has had on people worldwide. From the people travelling from other countries to show their respect on his birthday, to the millions of fans distressed, worried and checking news reports daily, to the hardened truck driver who took a day of work as he was so upset, to those who cried in shock, and to those who have had family members suffering similar injuries and sympathizing, the accident has impacted many lives. Surely, with the worldwide tidal wave of love, light, prayers, and concern directed at Michael, the public desrve a small amount of correct information back and not to be treated as fools.
    Thank you Gary for your insights and knowledge and also for bridging the gap of no news.

  17. Hello Doc thank you very much for your professional, understandable and solid blogs, my questions are related to what could be happening in the brain for this possible lack of response is it dead parts on it or their could be more explanations and what makes usually the difference between patients waking at different times? Do the intracranial clots have a chance to dilute or disappear with time or even recovering they stay there forever?

  18. Gary, as an ex-F1-journalist I’ve been irrate about a lot of things that have been published in the past two months on Michael’s – likely – condition. And I’ve been doing my best to deaccelerate pure speculation, mostly by offering a link to your blog from my private Facebook page, so at least connected had someone serious to look for to me understand what is – or might – be going on a little bit better.

    Yet, knowing how it all works in communication and knowing Sabine for many years, I’m sure she’s doing the best she can to filter what’s appropriate for the outside world. I know she’s very good at responding to input. So here’s a suggestion: Why not get in touch with Sabine personally and ask especifically what you’d like us all to understand a bit better? I cannot imagine she’ll refuse to answer. She’s responding to those journalists she knows she can trust. Not too many there, but she does it selectively.

    I’ll be more than happy to relay, if that’d be needed, but I’m convinced she’ll take some of your thoughts on board and perhaps will even share them with Corinna. Knowing Corinna for many years, even longer than Sabine, I can only emphasize that we’re not dealing with arrogant persons here, but two women who are trying to deal with a psychologically stressful and surely often terrifying situation. Corinna and Sabine are different types of characters, but none of them is arrogant, be assured!

    Try the contact, explain why you’re getting in touch and also do explain your point of view you expressed here on your blog how coms might be perceived. I’d be surprised if at the end we’d not have something we can all understand slightly better.

    Greetings and keep up the straigh tforward blogging that has enlightened all of us so much – not just in those past two months.

    Mario-Alberto Bauér

    • Dear Mr. Bauér
      I want to thank you for your timely and very thoughtful suggestion to Dr. Hartstein. So many are thirsty for information; some seeing the glass half full, others seeing the glass half empty.
      I believe that all are hoping, praying, desiring the miracle comeback. At the very least Dr. Hartstein, as well as yourself, may well be in the position to encourage some communication that might shine a light into or upon the darkness so many feel.
      God speed

  19. I understand the frustrations at the lack of news, but let me sadly assume the worst, that Michael isn’t coming back. If this is true, Michael’s press team need to make sure Michael’s family have come to terms with this, and are at peace that there is nothing more that can be done for Michael, before they release any information relating to Michael’s condition that may allow an assessment of his prognosis. Let’s hope this is not why news is scarce, but regardless, the Schumacher family should be given all the time they need.

  20. Pingback: Schumacher had a bad ski accident - Page 115 - FerrariChat.com

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