Only a miracle

So now the Telegraph is reporting that the doctors caring for Michael have told his family that “only a miracle can save him”.

1) doctors, no matter their spiritual bent, do NOT talk to patient’s families about miracles saving anyone. Ever. From a practical viewpoint, this gives a patient’s family absolutely NO useful information on which to act. It provides hope, yes, but not for anything with any medical reality. And this hope will then cloud all subsequent decision-making.

A statement like this is more than ambiguous – it lets each recipient interpret it in his or her own context, the opposite of clear precise information. What would the care team mean with a statement like this? Are they saying “let’s wait a bit more for the miracle”? Or are they saying “miracles don’t happen in reality so we’re pretty much out of hope”?

I can only guess that what this report means by “save” is “recover sufficiently to have meaningful interactions with his loved ones”. So you see why this is kinda a dumb thing to say. And why it is impossible for me to imagine doctors EVER communicating like this with a grievously injured patient’s family.

If something like this WAS said, I can only try to “reverse engineer” it, and from there consider what they were saying and how it’d be said.

1) If there is now clinical, radiologic, physiologic and other data that leads to the conclusion that a resumption of any meaningful consciousness at all is impossible (see? no mention of miracles), they would be VERY unambiguous with this. In a situation like this, there must be no guesswork – NONE on the part of the medical team, who need to put the data together and reach an unquestioned and unquestionable conclusion. In this situation, ANY ambiguity in communication with the family is disastrous. They will often cling to any hope left, and this conversation is going to be, tragically, THE conversation that finally (and gently and compassionately) needs to remove all hope. This is crucial. If the message is misunderstood, it will almost inevitably lead to major problems, conflicts and tension subsequently.

Let me just say here that medical ethics allow, and virtually require, doctors to refuse to provide treatments they reasonably consider to be futile. My neighbour cannot show up at the hospital and demand that a surgeon remove her appendix. And in the above situation, where there is incontrovertible evidence of damage so severe as to make resumption of consciousness impossible,  doctors can certainly undertake the process of “therapeutic de-escalation”. Even if the patient’s family insists that “everything be done”, if there is NOTHING left to be done, there is no requirement to do anything more. At that point the patient’s family can make other care arrangements. It’s obviously critical to avoid this kind of situation, so once again you see the need for perfectly clear, concise information, with no ambiguity. Families need time to accept this, whether it’s in intensive care, or oncology, or genetic anomalies, and so on. But with open honest and clear communication, this will happen.

Please note that this is NOT the situation for a patient in a persistent vegetative state, at least not necessarily. This is the situation for a patient whose condition is even WORSE. The essential point is that the impossibility of recovery has to be as certain as current medical science can be AND that this certainty be transmitted to the family.

2) if the clinical situation is desperate, but not without all hope, the family would be told this, with as close to numerical precision as possible. In a situation where there is hope, it mustn’t EVER be taken away. On the other hand, families need to know, at the most basic level, that most patients like this get better, or that a few get better, or that really VERY few do. That 60%, or 20%, or 1% get better. No talk of miracles.

As I mentioned a few posts ago, if this conversation has happened, if Michael’s family has been told that it is extremely unlikely that he recover “satisfactorily”, then it is quite possible that the “several steps of separation effect” between hospital personnel and the press could have led to this kind of language appearing in these articles.

And again, despite a day during which we’ve been told Michael is breathing on his own AND that it would take a miracle to save him, we know nothing more than we knew yesterday or the day before.

About these ads

150 thoughts on “Only a miracle

  1. Hi Gary et al.

    Firstly, I’d like to add my (somewhat belated) thanks for all your insights into this terrible situation. Much appreciated among all the garbage ‘journalism’ we’re constantly subjected to.

    Anyway, and given the content of this particular post, I find the following quote attributed to you a little, shall we say, ‘questionable;’.

    Schumacher, 45, is currently recuperating at a rehabilitation clinic in Switzerland, but Hartstein said: “Unfortunately, it is extremely unlikely that things with Michael are as good as everyone hopes.

    “It is realistic that Corinna is getting in touch with him in some form. But anything beyond that would be a miracle,” he told the German magazine Bunte.

    I didn’t think ‘miracles’ were a part of your vernacular?

    Regards,
    Ian

    • I tend to talk in terms of “extremely low-likelihodd events”. I know it’s a bit of Ronspeak (for you McLaren fans). I haven’t seen the article but I did speak with them. I think they wanted me to say that Corinna was wasting her time trying to establish/maintain contact with Michael. This is patently absurd, whatever his neurologic status is. It’s HUMAN. But unless a rather . . . low-likelihood path has been followed, consistent and reproducible contact with Michael would be a very good outcome from this accident.

  2. Jason, it was a new TV-interview Kehm has given to german TV station RTL on the 15th. Some more details than on the 12th, but yes, not really groundbreaking news, that´s true.

    She mentioned that the family and herself are in hospital every day, that it´s hard for the family to cope with the situation as it was such a comparatively banale incident compared to his life. Then she made clear that MS was only slightly touching the area next to the slope as the snow was new at the edge answering rumors saying he was in the area with the rocks which (she says) are ot true.
    That´s the details – plus, as mentioned above, the fact that he has not woken up yet but “is still in the process”.

    • Hi Annie, okay. The bit where “she made clear that MS was only slightly touching the area next to the slope as the snow was new at the edge answering rumors saying he was in the area with the rocks which (she says) are not true” … I haven’t seen before – so that bit seems new.

  3. I read this morning that MS has lost 25% of his body weight and is down to around 120 pounds.
    Watching this happen has to be torture for the family.
    One has to wonder what MS would want his family to do.

    • MImi, I read this as well yesterday. Maybe Dr. Gary will comment on this in so far as what consequences MS might face as a result of this ongoing weight loss. I believe that significant weight loss can induce coma as well. I am also having difficulty accepting that the family does not exactly know what is happening. I believe thay do. This is not to judge the lack of forthright medical information from them; I just feel that they have a very clear picture of what the real facts are and we will probably also know shortly… then again?????
      KC

    • The article is dated the 16th March & it is not clear how long before that date the statement from Kehm was released. English articles would have occurred at the date of the release of the statement. The last statement to have been released was on or slightly before 12th March – the BBC report (below) titles their report w/ “encouraging signs”. Hence I deduce, based on this limited information, that the German article is referring to the statement of 12th March.
      http://www.bbc.co.uk/news/world-europe-26541565

      I suspect we will next hear news when a) MS wakes up or b) MS gets moved somewhere else or c) some switch is turned off (probably if it comes to that it won’t be for a year or two).

      • Apologies I see you have already specified the 15th March. This is probably connected to the 12th March statement in which many English articles were produced.

  4. There has been nothing new concerning MS. Will he just sink into oblivion and we will go with our lives. Will he eventually be moved to a long care facility? How long will the hospital keep him in ICU?
    My mother was in ICU, and on a respirator while conscious for part of the time, for three months before she passed away and it was hell. For her and for us. I really feel for this family.
    The family does all they can to keep loved ones alive even though they know in the end they will lose that loved one …..but we still do it.
    Only if you’ve been there can you begin to understand what it is like.

    • Mimi, I’ve been there twice. A best friend with brain cancer and my father slowing dying. Each time the worst were the visitors who would swan into the room with false cheer, and say how much better the patient looks! We who were at the bedsides every day were not interested in keeping up appearances and it would have been so much better for us if everyone had just been honest with the situation and not expected us to pretend everything was going to be fine. We couldn’t even share our misery because no one wanted us to break their little bubbles. In the end, no matter how many people brought flowers, we were alone in knowing our dear ones were never going to “be fine”. Basically, our desire to have friends join us in truth-telling is opposite to the Schumacher family’s desire. Of course, they must do what feels best for them.

  5. Earlier on in this sad affair I was ambivalent to the paucity of information coming out of Grenoble. I felt, fair enough, the family needed some space to deal with the situation they found themselves in. Since the last statement my views have changed. Irrational I know, but I’m starting to develop a dislike of the family. How can I feel this way about people I have never met who are going through an awful time I ask myself? I assume that Sabine Kehm is just giving the view of the family, so I don’t hold her accountable for what news is issued. Hence the family and the latest statement….

    ‘The length of the process is not the important part for us.’ Well it should be of interest to them as it significantly impacts upon the likelihood and quality of any recovery. Will they be okay about him being in the same situation in a month from now? One year? Two years? Five years? This suggests that they don’t care how long it takes, they will wait for a recovery. Disgusting.

    “We try to channel all the energies we have toward Michael and we firmly believe that this will help him. And we believe that he will also win this fight.” Challenging energy is just nonsense. If they really believe this guff will help him then they’re in as much need of help as he is. They also believe he will ‘win the fight’. He is not in a fight. He is seriously ill.

    This whole sad business is really starting to leave a nasty taste in the mouth now and this is nothing to do with the accident. I supported Schumacher from the beginning and lost interest in F1 when he quit. The family think they are preserving his dignity and privacy. But the medical staff are doing that. He is in a coma and presumably knows nothing, thankfully. The family are protecting themselves. They are jeopardising how and what he will be remembered for. I just hope that, if as many suspect that he is unable to recover satisfactorily, that they don’t jeopardise his dignity too. However, I suspect that they are intractable enough to do just that.

      • The wow needs to be repeated!!! Wow! Thank you SarahFi for not being afraid to face the truth like so many are.

    • Thank you, SarahF1, for your keen analysis.

      My husband met Michael Schumacher in Estoril 1991, a quiet young man sitting alone at a lunch table. They attempted pleasantries, but the gulf between English and German was too great for comfortable conversation. We followed Schumacher’s rise to glory and there is no doubt he has dominated our favorite sport for 20 years. The shock that he could be perhaps fatally injured on a ski slope (even if skiing off piste) has still not sunk in.

      Even now, many weeks after his accident, we still feel as though we’re in a state of suspended animation because we haven’t heard anything substantial since the first conference given by the doctors. (pre-Sabine) Is it our business to know how he is? His family would say it’s not. That is how it is now and we have no alternative but to wait. Eventually Michael will either die or he will walk through the paddocks again or be doomed to reside in some hideous state in between. Eventually the truth of these weeks will be made known, and what will we think then?

      Without being too dramatic about it, I suspect many avid fans of Michael and the sport are suffering from some degree of post-traumatic stress disorder. I understand that one of the best ways to deal with PTSD is talk therapy, to trace every detail of the event so everything is known on a fact-based level. The object is to move the event from the amygdala, the emotion center of the brain, to the prefrontal cortex where the trauma can be managed with logic and reason.

      I read every word describing how the accident occurred, watched every video, pieced together every scrap of information, until I felt I understood exactly what happened that sad day. Fact. Fact. Fact. It was comforting somehow. And then “the family” and “the management team” put an end to facts and we were fed “prayers” “hopes” “wishes” “miracles”. Every neurologist who offered his knowledge and expertise to give us facts was dismissed as offering mere “speculation”. And every day, as Michael lies intubated on the hospital bed, there is only silence, silence which we are left to fill with shock, sorrow, and anger.

    • I can’t say my Wow! was an admiring one … rather the opposite, and your statement “How can I feel this way about people I have never met who are going through an awful time I ask myself?” was at the root of my surprise at what you wrote.
      But I suppose people have differing takes on this sad story. No harm done.

    • I think the Michael we either knew, or thought we did from the sometimes convex or otherwise distorted lense of media focus, has gone. I can recall the Ratzenberger/Senna weekend like it was yesterday… perhaps the inevitability and finality of those televiised times is “easier” to accept. albiet it was excruciating to watch (as the blog’s owner details on his video – the FIA knew the world couldn’t watch such deaths live on TV again- to paraphrase). I’ve seen close friends (one in the last weeks) lose loved ones through either freak accidents or – in one case, despite repeatedly seeing it on TV – 9/11 and no those nearest and dearest don’t just accept the finality regardless of what you say and even of funerals.

      Best wishes to those still racing (go Lewis re Melbourne and that p;ole!)

      V

  6. Thanks for all the sound insight Gary. I have a friend who also had a traumatic injury from a skate board crash and was in a coma for 8months. Lost a ton of weight, muscle and all what you would expect but eventually woke up and fully recovered. That gives me hope. These things can happen. We were talking recently and once doctors staring waking him up it took over a month for him to come out. You never know but one can never lose faith. Thanks ago an for shredding some light and professional insight and let’s keep the good energy to the Schumacher family.

  7. I am still at a loss to understand what more information they could release right now. ICP readings? Blood pressure?
    They use some of the strongest language there is to describe his injuries (“terrible” etc) which says it all.
    I’m not saying that how they dealt with it in the past was neccessarily right, but right now we know what Michael’s situation is …. That is all we really need to know.

    • We don’t know what MS’s situation is at all. We are guessing, surmising and putting together bits and pieces of what we read or hear. I don’t see how this is what we need to know.
      We, speaking for myself I guess, don’t need to know anything. It’s more that we want to know. So, “they” know we don’t need to know and “they” don’t want us to know.
      Could it be that right now it is just to damn hard for “them” to talk about it? If that is the case why not just say that.

    • Hi Peter – just another perspective… What was not said by the “Management Team.” AND unless the Team make a report or statement we have said over and over that all other information is to be ignored and is not valid. That being said, it bears repeating that this is what was NOT said:

      At no time did Michael suffer cardiac arrest. 

      Michael’s injury was or was not not a penetrating injury.

      Michael has awakened from the medically induced coma.

      Michael is off the ventilator and is breathing on his own.

      Michael is beginning to respond consistently to verbal commands.

      We are seeing Michael’s GCS numbers improving incrementally on a daily basis.

      We are seeing encouraging brain scans with significantly reduced or the elimination of hematomas and swelling. The lesions are healing or have have healed. We expect no further surgical intervention.

      We are not interviewing other brain specialists – that is false information! We have not changed, or considered changing our medical team.

      Michaels vital signs are all stable. He is free from all life saving equipment. His overall condition in no longer considered critical or life threatening.

      We are very encouraged by his improvement – the small, significant changes that he is making are exciting and increasing, albeit slowly, daily. Yes, it will be a long journey. We rejoice in the knowledge of a reasonable recovery.

      We clearly are not out of the woods yet, but we have good, stable, consistent and supportive information that leads us to believe that Michael will in fact be a functional part of his family in the future.

      The doctors have indicated to us that a _______% recovery is not an unreasonable expectation.

      All swelling in the brain is gone. The flaps have been reattached and all probes have been removed.

      Michael is no longer in ICU. He is in his own private room.

      We are delighted to share this information with all of you, his most prescious fans.

      • Amen. If any of your points were true, I’m certain Sabine would have shouted them to the housetops! Sadly, we are left to believe Michael’s condition can boast of not one avenue toward recovery.. I guess we are left with miracles, urges for Michael to show character and ‘fight’ his coma into submission, and Massa’s musings. Lordy.
        An excellent list. Thank you.

      • I tend to agree with Sharon (but there is no place to “reply” to her). Were the points you make, KC, true! But clearly few, if any of them are relevant to Michael’s current medical state.
        As I said above I am not saying what went before was right – as the situation evolved into where we are now it would have been nice to have had just a little more information – but with the help of the statements from the family (I say again their use of robust words to describe Michael’s condition is I think, telling) and Gary and others input, I think we all know pretty much precisely where Michael is right now, and what his chances of recovery are. We also know what the family’s view is on sharing information.
        I feel we should really stop worrying about what we don’t know, reflect on what we do and turn out attention a little to the new F1 season. I can’t help feeling it is what Michael would wish for his fans.

      • Good morning Peter

        I agree with Sharon (and Gary) as well.
        The point that I was making was what was NOT said was essentially the same with one or two tweaks that were at best nothing more than potentially misleading. In my opinion, and we know how dangerous that can be, the only thing she really said is the MS remains in stable but critical condition. He has not been removed from ventilation – as Gary stated, ‘that would be newsworthy’ – and has not awakened from the induced coma, and what remains really sadly possible is that he never may. Because his medical state has, apparently, not changed in any really significant way, what Sabine Kehm DID NOT SAY was so much louder than what she did say.

        Bottom line, privacy is what they want, privacy, with many positive thoughts toward them, is what they get. We will keep and hold good thoughts for Michael and his loving family. Truly, this is a most extraordinary and difficult journey.

        I also agree with you that worrying is an useless energy expenditure. I never got paid for it; when I finally realized that, I tore up all my worrying bank deposit slips.

        KC

  8. Further to the latest announcement (if you can call it that) Weds 12th I wonder if some or all of the family are in complete denial and/or prolonged shock and therefore can’t release any realistic announcements that simply don’t dovetail with how they feel? Also, MS was known to be very protective of his family re perhaps someone/persons unknown and inexperienced in the field has taken on that mantle hence the two combined might answer why the communication is so poor? Thank you for all your valuable insights

  9. mimi wrote:
    “Sorry, I have to disagree unless Hamilton can give me the reason. MS’s character, IMO has little to do with his recovery.”

    I totally agree. His “character” is on hold now, hopefully as part of the healing process. It bothers me to no end when people gush on about the “fighting character” of this comatose man. To be honest, I kind of doubt he’ll recover at this point and these (in my estimation) silly remarks will imply that his character was at fault if/when he fails to recover.

    I think I’m going to stop commenting now, because I don’t like raining on other people’s parade. I’ll still be following this blog, though, and I wanted to say I think you’re a great group of people and thank you, thank you, thank you Dr. Gary..

  10. Ive been reading Dr Gary Hartstiens blog and Twitter since the accident and I can only thank him for the insight hes given us all. There is unfortunately a huge gulf emerging between official word from Grenoble and what Gary is saying, which combined with the emotionally charged subject matter is going to inevitably cause individuals such as “Le Midi Pile” to lose their cool (assuming they had some in the first place) and shoot the not-even-messenger. People need to remember that everything Gary has said has been clearly and honestly said under the guise of speculation due to lack of information. Its a frustrating situation where the lack of info has meant we can only really think about timeframes and statistics in trying to assess Michaels condition. The family and official word is that hes making small improvements and they believe he will recover and every expert seems to agree that based on the information we have this is unlikley. So then we have to speculate if positive things have happened which we havnt been told about. Its frustrating but in the end we need to remember that although we arnt neccesairly hearing what we want (to put it very mildly) from Gary or Sabine the frustration is caused by the gravity of the situation involving someone we all care about whos been severely injured. To conclude lets all chill and refrain from taking this whole shit sandwich we’ve been served out on each other and keep sending all the positivity we can muster to Michael and his family and the doctors.

  11. Louis Hamilton’s statement ….and I’ll paraphrase,” that all things happen for a reason and that it will show MS’s character”. Hello….what the heck does that mean?

    • It means Louis Hamilton is projecting a positive prognosis, he is not giving up hope, not being a pessimist and is probably the right thing to say for a non sociopath,

      • Sorry, I have to disagree unless Hamilton can give me the reason. MS’s character, IMO has little to do with his recovery.

        It was a stupid thing to say….

        Anyone who really wants to know what it is like to not be able to communicate but be able to be aware of your surroundings should watch The Diving Bell and the Butterfly. That guy’s character couldn’t force his recovery.

    • First Felipe Massa now Lewis Hamilton. What utter fools they make themselves look.
      Hamilton clearly has a screw loose making such idiotic and unhelpful remarks and Massa ..well, he doesn’t actually speak the lingo very well and so drones on until someone gets bored and turns the microphone off.
      But on a more serious note it is almost beyond belief that someone on high in the F1 organisation doesn’t feel the need to suggest to the teams bosses to tell their more garrulous drivers, out of respect for Michael and his predicament to zip it on the (very serious) subject of his medical condition.

  12. Can’t see what’s wrong with this latest statement. They believe the situation is broadly positive (and one assumes this belief is based on what the doctors treating Michael have indicated) whilst acknowledging he has suffered “severe” and “terrible” injuries.
    They can’t say much more as the situation is still in limbo so it seems.
    And as for our friend Midi Pile (which also means Midday battery …. Shades of the Duracell monkeys!!) – shouldn’t we just ignore the little twerp, rather than give him the satisfaction of seeing our anger. He’s nothing but what I believe is called a troll …. !
    Mind you I do enjoy Gary’s treatment if him …. Talk about the pen being mightier than the sword!!

    • Nature abhors a vacuum and we see this truth being played out now. The Schumacher family apparently expect F1 fans to be stupid and docile and wait for pointless press releases from the “management team”. In fact, we are a smart inquisitive group who will persist in looking for some semblance of reality. The hospital staff is in lockdown . . why? We’re going into 13 weeks since Michael’s accident and the only logical explanation for the silence is he is in a grave situation. Every neurologist I’ve read have said the same thing. Can they all be wrong?
      Perhaps the family is in shock that Michael is truly gone and they know that once this news is released to the world it will then be undeniable. As long as silence is maintained the truth can be avoided. Nothing else makes any sense.
      Many thanks to you, doctor, for your illuminating analysis. I must say you reinforced my thoughts on this matter.

      • Sharon Blake Edgar…..that was a wonderful comment. I think you have hit every nail square on the head.
        I have believed for awhile that MS is gone and is being kept alive by machines. I think it was Gary who awhile ago made the statement that the only thing left to do is “pull the plug”. As harsh as that may sound it is the reality and it saddens me.
        If it wasn’t Gary I apologize but I think I did read that in one of his comments.
        If you refuse to admit something then it isn’t.

  13. Hi Gina. From what I understand, and based on standard ICU practice, sedation would appear to have been stopped about two months ago. You’ll still see the phrase “medically induced coma” used just about everywhere, but I believe this is just erroneous.

  14. Dear Gary thank you for all your common sense and information.
    I would like to ask something but please forgive my ignorance and accept my apologies if you think it is a silly question.
    Is Michael still in a medically induced coma or is he in a natural (for want of a better word) coma?

  15. Whilst I agree that the PR handling has been dreadful, as others have commented, the family probably weren’t in the sort of place emotionally to consider anyone other than Michael for a while. I personally wouldn’t want too much information given out to quickly or too often, he’s waking up, he’s sedated again, he’s off the ventilator, he’s back on it. However I do think that the balance lies somewhere in between, perhaps a fortnightly statement, even if it does just say no change would be the right thing to do? It may be prudent with the F1 season starting, when Michael will be in so many people’s thoughts.

  16. I suspect that the Public Relations handling of the MS situation will end up a case study on how NOT to handle a PR crisis. If Schumacher were to recover to the point of being a public figure again (a monumental if), I suspect a not insignificant % of his fan base will have been lost due to the seemingly arrogant treatment of them during this process.

    They have made it perfectly clear that they are not going to provide ANY useful information to the public yet they persist in putting out completely useless press releases.

    • Lars- It never should have been a PR “crisis”. There’s nothing “shameful” about incurring an injury like this. It’s just tragic.

      • If the family does not regard the condition “shameful” then why all the cloak and dagger business.
        Do they feel that this is MS….how could this happen to him? How could it be possible that such a great race car driver could be in a vegetative state if that is what it is? Are they still in shock about his condition and not able to fully grasp it?
        If the truth be told then there would not be all the guessing and perhaps most would be able to move on.

Your turn to speak - write here

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s