Michael – five months on

First of all, I want to thank you all for your comments and questions since last week. We’ve got lots to talk about – today it’ll be a bit about Michael Schumacher’s situation, but I’m also going to be writing about the fascinating duel between Lewis and Nico . . . AND continue the series about trackside medical intervention.

I’m also looking at starting a video blog, as a way to better interact with you all. This will probably be through a YouTube channel; one of the things I want to do there is answer your questions in a more comfortable format. (If you’ve got questions you want answered, send them here to comments, and I’ll get to them once the v-log is up and running.

Tons of you have asked about Michael’s current status. Obviously I have no direct information. And I’m STILL considering that if there were good news to be had, we’d have been told. I can conceive of no possible reason that Michael’s entourage, understandably extremely protective of his (and their) privacy, would NOT tell his fans if significantly good things have happened. So as always, I’m speaking based essentially on the published and consensus epidemiology concerning outcome in severe head injury. And of course, as always, a reminder. Every caregiver working with a significant number of head injured patients has seen surprising and unexpected emergences. But these are rare, achingly rare.

Let’s take a look at what’s called a “survival curve” for patients in a persistent vegetative state (PVS) after trauma:

Image

On the graph, we’ve got time (in months) along the bottom, and percent of patients along the y-axis. At time 0 (the day of injury), we’ve got 100% of the study population of patients in PVS. Just as a reminder, PVS means apparent wakefulness (eye opening, something resembling a sleep-wake cycle, etc) without signs of consciousness (awareness of self and/or the environment).

As we move left to right, we see three sub-populations opening up – from top to bottom, there are those who regain consciousness, those who die, and those who remain in a vegetative state. Michael is now 5 months post-injury, but for the sake of simplicity, let’s look at the 6 month mark. Look at the line indicated by the arrows. Notice how at 6 months, this line becomes very nearly horizontal.

This horizontal line says, in the most eloquent and desperately sad way, that after 6 months only a tiny tiny fraction of patients in PVS regain consciousness. In essence, persistence of the vegetative state or death are the primary outcomes remaining. The slope of the line separating “dead” from “persistent vegetative state” shows the approximate death rate of these patients – roughly 25-30% per year. And just to repeat what I’d said in an earlier post, essentially no one in a persistent vegetative state at ONE YEAR will ever regain consciousness.

If Michael is in a minimally conscious state (MCS, defined as the presence of objective, but fluctuating and inconsistently reproducible signs of either self-awareness or interaction with the environment), the outcomes are slightly better. There would then be a low, but real, possibility of improvement in the quality of consciousness over the next several months to years. That said, agonisingly few patients in an MCS at six months ever wind up speaking, walking, dressing themselves, etc.

As to the rumours of Michael being at home, they could easily be true, but I have no way of knowing. This would be the kind of information I’d assume would be EXTREMELY closely held, for obvious reasons.

There is no reason why this shouldn’t be possible. If Michael is still ventilator-dependent, taking Michael home would require a certain amount of equipment and the round-the-clock presence of a significant level of care, but thousands of ventilator-dependent patients are cared for at home. If Michael is breathing on his own, home care becomes even more feasible. As you can imagine, patients with prolonged severe disorders of consciousness require a high level of care, but this would be something that Michael’s family could organise with no major problems.

I’m quite afraid (and virtually certain) we will never have any good news about Michael. At this point, I rather dread seeing that the family has put out a press release. . .

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103 thoughts on “Michael – five months on

  1. Pingback: La F1 revient en Autriche et pense à Schumacher | Pole position

  2. Forgive me for my candor, but it seems quite likely that the Schumacher entourage including his family may be suppressing all information about his vegetative state for the purpose of extending his marketing brand value. Rather than letting his legion of fans share in our collective sadness and collectively pray for a triumph of the spirit, they seem more interested in preserving his post-accident marketability. As a devoted fan of Michael, I would be supportive in any case.

  3. Pingback: Michael Schumacher out of coma and has left hospital, manager saysUkraine Turmoil | Ukraine Turmoil

  4. So today it was announced that Michael has “awakened” from his coma and was released to continue his recovery and rehabilitation. This is so vague and I feel it’s unfortunate that his family isn’t more forthcoming with his current state. Having worked in long-term head injury rehabilitation for over 10 years, I understand all to well what Michael’s “future” may look like. His family has an opportunity to educate the public on the truth of head injury. Sadly, odds are he may never be seen in public again. So many people are celebrating this announcement when in truth, it’s nothing to celebrate. That being said, we should all continue to pray for a miracle for Michael.
    On another note, my husband’s grandfather was race car driver for Sunbeam in the early 20s. During the 1924 San Sebastian Grand Prix in Spain, his car skidded off the track and he crashed. He sustained a serious head injury and was in a coma for a few days (his ride-along mechanic was killed). He was never the same after that, and committed suicide 13 years later.

    • Hi thank you for your comment. Your grandfather in law seemed like an amazing person having looked through his wiki page. All I would like to say is that in “those days” psychiatric care (mental health & counselling) was rather in its infancy.

  5. Pingback: Michael Schumacher in coma, 'critical' after France ski accident

  6. Bonjour, c’est une habitante de Grenoble (France) qui souhaite témoigner. Je m’adresse à l’auteur de ce blog, j’estime injuste les accusations portées contre les neurochirugiens qui ont fait tout pour le soigner.
    Mon conjoint a été opéré au cerveau au CHU DE GRENOBLE opération très délicate car il aurait pu mourir, or il s’en est très bien sorti grâce au neurochirugien qui l’a opéré. Cet homme lui a sauvé la vie. Les neurochirugiens du CHU DE GRENOBLE SONT COMPETENTS très professionnels, et réputés. D’ailleurs je suis pas la seule à être satisfaite, je vous signale que des personnes habitant dans d’autres villes françaises viennent se faire opérer au CHU DE GRENOBLE car le service de neurochirugiens est réputé pour leurs compétences se sont des pointures. Je suis indignée de vos accusations, sur quoi vous basez vous pour dire de tels propos? Avez vous eu accès aux dossiers de Michael Schummarer? Je serai étonnée du contraire car c’est le secret professionnel. Vos propos sont déplacés et injustes, et rejeter la faute sur les médecins qui se sont défoncés c’est inconcevable . En conclusion tout le monde sait qu’au ski que le hors piste est interdit, les personnes qui font du hors piste, qu’elles viennent pas se plaindre ensuite d’avoir des accidents, elles n’ont qu’à aller skier sur les pistes autorisées. désolée je n’écris pas l’anglais bien à vous Mary

    • Bonjour Mary. La prochaine fois que vous prenez plume en main (ou l’équivalent 21ième siècle) pour critiquer qqchose que qqun a écrit, donnez-vous la peine de LIRE ce que cette personne a, en fait, écrit. Et pas des citations journalistiques qui me “citent”, à tort et à travers.

      A toutes fins utiles, voici un couper-coller de ce que j’ai écrit le 31 décembre 2013. Je ne vois guère une critique de l’équipe de Grenoble. Et vous n’en trouverez nulle part dans mon blog. Là-voici:

      Michael is in VERY good hands. It doesn’t matter a hoot that this or that famous neurosurgeon and/or neurointensivist would or wouldn’t do this or that element of Michael’s treatment, the point is that these guys are smart, they’re talking to each other and to the family, and they seem technically up to the job. Oh and by the way, the decision to evacuate the second, intracerebral, hematoma seems to me, a non neurointensivist, to make sense. But more on this later.

      Et si vos talents en anglais ne vous permettent pas de lire mon blog, et de comprendre ce que vous lisez, permettez-moi de vous demander comment vous osez critiquer quelque chose que vous n’avez même pas lu?

    • Mary,

      (Excusez-moi pour mon Francais)
      Vous avez raison. La décision de ski hors-piste a été une erreur. Je ne comprends pas vouloir prendre un tel risque surtout avec un enfant!

      Aussi, je ne pense pas que le Dr Hartstein jamais critiqué les chirurgiens Grenoble. Je sais qu’il était préoccupé par le retard à l’hôpital.

      lm

      • bonjour Lulumoretti J’ai compris votre message merci d’écrire en français (car je ne lis pas très bien l’anglais) D’après un magazine Français (c’est pas moi qui affirme cela bien sûr) il a été indiqué que des critiques ont été dites par Gary Hartsein pour ma part j’igore si ces propos sont vrais ou pas voici le lien
        http://www.purepeople.com/article/michael-schumacher-les-medecins-ont-commis-de-graves-erreurs_a138735/1 – donc cela m’a interpellé voilà la raison pour laquelle j’ai écrit mon article sur le blog plus haut, apparament Gary Hartsein a cru que je réagissais à ces messages sur ce bog chose impossible puisque je ne LIS PAS L’ANGLAIS

    • Mary, I think what you had to say is very interesting the only problem being I don’t speak the beautiful French language.

  7. The answer: hyperbaric therapy (look for Dr Paul Harch) and PEMF (pulsed electromagnetic field therapy)! All the solutions exist outside the box!

  8. Hi Gary,

    thanks for answering my very short comment!
    I am from Germany so please excuse me for my english sometimes.

    Of course we all would like to know, whats about Michael know.
    I also agree with you, that no message is a sad message!

    No Question, i am hoping something else… something positive,
    thats the way human beings are… till tuen and or hopefully the
    recovery!

    Your point of view is realisticly! Thats absolutely correct and you as a doctor
    had to know it much much better than me!

    But i also can imagine that Michaels Family is maybe still hopefully and
    is doing everything to get more privacy. Each of us in the same situation
    will agree with that.

    That was my point of view, in case of ending about these “speculations”.

    Many Greatings from Germany Gary!

    Michael Rolf

    • Well Michael, you made me smile. Not so much because you agree with my decision, but rather because you appear to have kept slogging away at reading me, despite your finding the speculation “never ending”. Thanks for the perseverance!

  9. Dear Gary,
    I read your previous post about the research being done by Stephen Laureys in Liege and clicked on links. I found it fascinating to read about the different grades of the minimally conscious state – in one paper I read that the right hemisphere network was necessary to show MCS- signs such as eye tracking but the left hemisphere was necessary to show MCS+ signs such as obeying commands. I know Liege has been involved in joint working with Addenbrookes in Cambridge and I know they are now using decompressive craniectomy to try to save patients who would have previously died but some of these people are left either vegetative or minimally conscious. A BBC documentary ‘Between Life and Death’ followed patients and explored the moral issues involved. One lady was left in a minimally conscious state like Michael but eventually by 8 months after her injury she was conscious, although she couldn’t talk or walk and could only communicate non-verbally. I think this was be the type of outcome for Michael. This lady’s husband was interviewed and was very pleased she had survived – perhaps Michael’s family feel the same.

  10. Dear Dr Hartstein. I am very sad to read about Michaels situation. We were in a similar situation with our daughter following a traffic accident and a brain injury. We were helped a lot by Dr Esteban A Fridman a neurospecialist that specialises in coma and VS (vegetative state) patients. He is very successful with these type of patients. Maybe he can be of assistance to you. He has written a paper on Off-label Use of Stimulants in Vegetative State and Minimally Conscious State.He is from Lyon but is presently a Postdoctoral Associate in Neuroscience, Brain and Mind Research Institute, Weill Cornell Medical College. You can find him on facebook or at Cornell. Unfortunately I don’t have his present email. Best of luck. Anders Olsson, Sweden

  11. Pingback: Ex-médico da F1 vê pouca chance de recuperação de Schumacher | ***** ScudNews *****

  12. Dear Dr Hartstein,

    One positive that would be helpful would be a either a downloadable or links to papers for motorsport related injuries. A friend of mine flipped an open wheeler upside down and was treated for cardiac issues for a few months before a doctor versed in motorsport specific injuries measured his height and subsequently confirmed a couple of crushed vertebrae. Having access to medical aid materials for ER trauma treatment, for those not privy to an F1 medical staff, would be beneficial when one, or one’s partner, is seeing eye blinks from ER doctors.

    Cheers,
    Randal

  13. Hi Dr Hartstein

    Thank you for your insights. But didn’t you also say this in your previous blog about moments of consciousness and awakening?

    “We all need to thank the team taking care of Michael as well as the people around him, for their devotion and patience. Everyone is going to need to be patient – for WEEKS, MONTHS, maybe YEARS.”

    It has been one and a half months. Surely we cannot make any assumptions based on such a short period?

  14. Jason, I want to apologize for using profanity & this apology extends to all those of you I’ve gotten “close” to. I think you all know who you are. My frustration is at an all-time high. It’s no excuse but I feel I was provoked & I do admit; I shouldn’t have taken the bait. I am no shrinking violet who has been my own advocate & protector since I was very young. I just wish Dr. Gary had a little more respect for those of us who have had his back from the onset. I guess I really mean me. I’m well aware he owes me nothing. So again, I sincerely am sorry for my outburst. I wish I could promise it won’t happen again but who knows, maybe he’ll delete & block me, lol.
    Ps. I’ll try to get some personal messages through before that happens. Take care my friends.

    • Hi Belize, there is a limit to what I can say here. I think the issue was what happened to you on that other thread and how it was handled. It might be better to let off steam on your twitter.

      • Hey Jason…. I only opened the Twitter account to post here. No one is attacking me there. I appreciate that he removed the nasty comment by Steven & Amanda and my little freak out. But why remove my message to Jan? & her message to me? Yet he left up the rude comment directed at him by Sharad Nathan. And Kate’s “I’m sure, I’m sure, I’m sure” telling us all how to feel & that Michael was a good catholic. He wasn’t anymore a catholic then I am a talking frog. He was married in a civil ceremony, never wore a crucifix, his luck charm was a wooden shambala bracelet & his wife has filled his hospital room with “lucky charms” like his daughters hair brush & family pictures, etc.; not statues of the Madonna w/ baby Jesus. I asked him once, about the big silver cross he wore around his neck. You know what answered me ? “decoration” and I laughed …..
        I don’t understand the Doc. And at this point I’m not sure what else he deleted. I’m starting to wonder if he dislikes me for some reason. Do you think he thinks I’m a prude & over reacted to the vulgar comment by He Who Must Not Be Named? LOL….. Sorry, just love Harry Potter, couldn’t resist. Hope you get a chance to read this in case he deletes it.
        I have to say Jason, aside ( yes, pun intended ) from the rough start we had, you really are one of my favorite people.
        Hugs & good wishes
        Be-Liza :-)

      • I don’t understand either Belize, I am actually stunned. In fact a comment I put up where I said “Says you” was deleted as well. What was wrong with that?

      • Dear Jan, I just don’t know what the Doc considers offending anymore. I left you a short message above. Maybe this website is wonky & he had to delete everything that was connected. I have to admit, I really don’t understand why the good posts have to be deleted along with the bad ones. I wanted to write a few more messages to Sue, K.C. & Peter but its almost 5am here & I’m exhausted. I guess we will just have to see what is still here tomorrow. Night,night my friend.
        Hugs

      • Hi if anyone wants to ask Gary a specific question I suggest contacting him via twitter. He is much more expressive on his twitter account
        :)

      • Hi Liza, thanks for mentioning me again. I really feel you are a friend and really felt for you when you had you’re little meltdown and sat on the bed and cried and cried. Been there too but I’m here if there is anything you want to share. Best wishes always

        Sue. X

      • Belize, thank you so much for you kind words. I hope you managed to get a good rest and are feeling a little better today. As you are probably aware by now the Good Doc is not going to be speaking out about Michael anymore which is really sad to hear. Please take care and hugs back to you.

  15. During the Monaco weekend we were reminded (many many times) that it’s been 20 years since Senna’s death at Imola. We watched snippets of his life and his death and the mourning in the streets as thousands followed his casket. I’ve long thought that the degree of public lamentation is an expression of the deceased’s method of death. For example, had Senna drowned in a random jet ski incident would there have been such an energetic outpouring of grief? Random off-season accidents seem to have a dampening effect on public outpourings.

    I think that when Schumacher dies his death will be met quietly. Somehow I can’t see the Germans filling the streets, tearing their hair, or beating their breasts in sorrow. Essentially he removed himself from the world on December 29th when he chose to ski off-piste, through a rock strewn field. Over these past months the public has had a very long opportunity to absorb his passing from the light.
    Life goes on.

    lm

    • Lulu, your first hand personal experience with the pain of a loved one in a coma really helped me realize the dilemma Michael’s wife was in & I really appreciate your sharing on this blog. I have agreed with all of your posts, but respectfully I have to disagree with you here & frankly a bit surprised at the somewhat callus tone. Please don’t take offence; you are one of the people I felt an affinity with. There is great controversy on whether Michael was four feet or 16 metres off piste. One thing I think we can all agree on is that we’ve all made some bad judgments in our lives, but is it really fair to say that his misjudgment on the slope that day should be punished with a devastating head injury? And as for the comparison between him & Senna, well that is plainly are apples & oranges. Senna died suddenly & the report from the hospital & his funeral were highly publicized. Whereas Michael’s condition is totally unknown. I don’t have to remind you there has been a total blackout since the get go. Of course I don’t profess to know anything for sure but my belief is the outcry, if the news of Michael’s death ever becomes public, whether its next month or 5 years from now; it won’t JUST be the German people “tearing their hair out”. I suspect grievous pandemonium from Schumacher fans from around the world will outnumber Senna’s tenfold. With that, I wish you all the best. Sending love & good energy your way. Take care.
      Belize

    • Lulu, wow! It’s refreshing to read something from someone who has faced the reality of the MS situation. No one deserves to be in the situation that MS is in. But he was a thrill seeker….a rich thrill seeker that could afford to seek thrills in many avenues. You live by the sword and you die by the sword.
      The Schumacher family has my deepest sympathy….but my heart breaks for Joe Schmoo who may have suffered a severe brain injury while working to support his six children.
      And I believe you are right about no one pulling their hair out if he passes. In time, depending on how long he lives his fans will have moved on or possibly died.
      Sometimes the truth does hurt……

      • What a really callous comment Mimi. What has being rich got to do with anything? I also believe that if and when he passes there will be thousands of people tearing their hair out as you so put it. He has thousands and thousands of fans from all over the globe that will grieve deeply for him and his family.

      • No need for disparaging Michael Schumacher because of his wealth..it sure isn’t helping him out of the situation he is in, and while your heart breaks for the Joe Schmo’s of the world who have suffered such injuries themselves, it makes it no less heartbreaking because a successful man has endured the injuries he has..while your observation about how people may or may not grieve his passing is your opinion, please note that people do grieve differently and often with a lot more emotion that you give them credit for..and they are far less abrasive and impersonal about it

      • Mimi honey, I do have to agree with Jan ……. Its ok that you aren’t a Schumacher fan & you didn’t know him. But have a little respect please. I hate to keep repeating that you are talking about someone who I’ve know & loved for 35 years as well as all the others who are mortified & grieving to one extent or another.
        I understand I’ve only told one story about Michael but I’ve had dozens of other conversations with him over the years which I would be more then happy to share with anyone who might be interested. I assure you there is a HUGE difference in a “thrill seeker” and some one who likes to be challenged. Bear with me, I’ve had a really shit day in the hospital today & it’s 5am here. I’m not very pleased that my first attempt to let people see this great man from a side he didn’t show the world very often was deleted like a piece of garbage. But that’s life, right? And I choose to believe Lulu didn’t mean to be callus or insinuate Michael deserved his fate. Just the wording seemed a bit strong. In retrospect, I probably should have let it go. But like Jason said, some of us all overly emotional & touchy. I will NEVER FORGET HIM , EVER !!! ………. With that I’m going to say goodnight as I’m seeing double from severe sleep depravation.

      • Hi Be-Liza, many of us have been suggesting to Gary that he should write a book.

        I have been thinking that maybe you could consider doing the same – a form of memoire of your personal experiences of formula one (and motorsport if it extends further). You could add in all your experiences and thoughts of MS in there plus the same for the other people you have met. You could add in the memories of the races plus maybe details of the locations and places to stay. You could turn it into a mixture of “travelogue – motorsport – people in motorsport” memoire. If you know of the work of Bill Bryson – it could be something along those lines in structure.

        You would be in control of that work and no disappearing articles. You could even consider publishing it yourself as there are more options nowadays for publishing. Anyway Just a thought – maybe you could consider it.

        Hoping you have a swift recovery from your ordeal at the hospital. Take care.

      • Oh Jason, how I would LOVE to write a book, but I’m not a professional writer. And the stories I could tell, lol …… UNFORTUNATELY I have signed a confidentiality agreement with the company I’ve been working for over 2 decades. It’s really very sweet of you to believe anyone other than the few friends I’ve made here on Gary’s blog would be remotely interested in what I have to say. Stay tuned as I’ve promised some amusing antidotes’ as well as what I do for a living. Its late afternoon & I’m going for a short siesta. I think the meds they gave me are causing me to be drowsy. I found the deleted post that you so kindly admired from a couple of months ago & Doc. Gave me the ok to post it again. I just have to make a few changes to it later today & then post it. “Talk” to you later love.

      • Jan, have fun twisting my words???? Huh, sweetie?

        Read my lips, Jan…..being rich afforded MS the luxury of thrill seeking that many of us can not afford. I never said that because he was rich he deserved his fate. You said I said that….Do you get it now? Huh, toots?

      • Well Mimi, I was wondering how long it would take you to single me out like you have done in previous blogs. As you can see by a couple of other comments in response to you I was not the only one that was not happy with the wording of yours. That is all I am saying on the matter. Have a good day

      • Hi Mimi,
        Reality bites. No doubt about that. I’ve wondered with all the boo-hooing what if Mick had been injured? His father leading him into a perilous rock-strewn zone? And what then?
        Phil Hill used to say about drivers who died on the track: “They killed themselves.” At first I thought: Whoa. Heavy. But he meant they had choices and they chose the bad one. That’s the truth. Look at photos of the ski trail and the off-piste rocky field. Who would choose the latter? And with his 14 year old son? He made a big miscalculation and wasn’t lucky enough to escape the consequences. Sadly, it’s his family who are now suffering . . .though there was a post that Mick is out driving karts. Good for him. Many have said ‘life goes on’ and that is the truest thing one can say.
        lm

  16. I was hopeful after the last update 6 or so weeks ago, but im afraid I was having the exact same conversation last night. I have checked your blog regularly for any updates on his condition over the last 5 months and Gary I can only sincerely thank you for your insights and for basically helping us all through this and being pretty much the one sole reliable voice of sense and reason during this truly shitty time. I for one will not forget it. Cheers.

  17. Two months ago, the family issued a statement suggesting that MS was interacting with his environment.

    Let’s assume that he was in a conscious state two months ago (~month 4) and is now in a PVS.

    Then we need to determine if his prognosis corresponds to the Graph Line “PVS” month 6, or if he can be reset back to month 2 PVS due to his recent conscious state.

  18. Thank you Dr. Hartstein, I appreciate your blog and you honest opinion. I have a background in nursing therefore I also do not believe in a positive outcome after 5 month coma. I’ve to agree with your opinion that we all have to be prepared for the worst. I had a very bad feeling about Prince Friso. We all know his fate. Unfortunately there a some fans out there who are not happy about your blog because you tell them what they do not want to hear. In my opinion those fans live in a complete denial.

    • Moni, comparing the MS condition to Friso’s is very good. Friso’s brain injury was from being buried in an avalanche which caused lack of oxygen to the brain and not from hitting his head. No? Didn’t Friso die in a rehab and not in the hospital? Didn’t he live a year or two after his accident?

  19. Pingback: Michael Schumacher’s manager denies recent reports - MotorBrief

  20. Doctor, now that you are front page news and before the vultures descend thank you not just for your insights into MS condition but for all the stories about your experiences. Great reading and you should write a book.

  21. Just a quick thought, my contact with head injuries is 35 years out of date. Is manitol still used to reduce IC pressure in conduction with Solu Cortef™? What I remember best is the crystals in the large glass ampoule and the fact it needed to be heated prior to use; almost magical stuff then.

    • Hi Phil. Mannitol is still used, but has tended to be replaced, at a lot of places, by boluses of hypertonic saline. Osmotic therapy is only used, however, to either buy time to get to the OR with a patient who’s herniating, or as part of a protocol in the ICU to fight transient severe ICP elevations.

      Steroids are no longer really used. Hope this helps

    • Mannitol was originally extracted from plants and apparently is used by plants to induce osmotic stress for a variety of water movement applications. It seems that this same property of mannitol is used for reducing IC pressure – so another example of magic being explained “away” by science.

      ps I only discovered this when trying to understand your comment and Gary’s response!
      pps: OR = operating room and ICU = Intensive Care Unit.

  22. HOUSTON, WE HAVE A PROBLEM!!!!!!!!!!!!

    Re. Kate & Sharad Nathan
    Please Doc. nip this in the bud. For blogs sakes, enforce a ZERO tolerance for trouble making instigators who post insulting &/or demanding comments, hit that delete & block button.
    Thank You …… Please …… Thank You …… Please ……. Thank You ….. Please ….. Thank You

    • Hi Belize, you are so right, I do hope the good Doc nips those two comments in the bud and yes I thought to myself when I read them “Here we go again” I hope you are taking good care of yourself. Most of us here love Michael very much. For the last few nights I have gone and sat outside late evening (Winter over here now) and the skies have been so clear with hundred of stars all around. All I could do was think of Michael as I looked up to them with tears rolling down my face.

      • Jan, my dear, thanks for having my back. It’s really unfortunate. I know you are feeling the same as I. Your post touched my heart, felt like I was sitting there staring up at the stars with you. You are a sweet person. Take care my friend. Sending you love & good energy.

  23. The graph indicates that someone in a Persistant Vegetative State after 5 months has about a 20% chance of becoming “conscious” in the following 7 months. This seems to be better odds than a “virtual certainty” of not becoming conscious.

    My view on death I think is similar to a “Christian view”. Be thankful of the time together. If someone close to you dies, let there memories bring you happiness not sadness. Happiness for having known them and having shared time together with them. There are over 7 billion people in this world yet we get to personally meet and know a tiny tiny fraction of them.

  24. Hi All …… SO GOOD to see everyone posting & interacting again. In my mind’s eye, I imagine a bunch of us sitting around a quaint little bistro chatting about the one thing that binds us, with Doc at the helm. (Indulge me please; being a Pisces, I really am a dreamer). Of course as much as I wish we had this intimate ambience, I must remember that this blog is being read by half a million people.
    *Question: What is the last count Doc?

    It’s about 7pm here & it’s the second time I’ve gotten out of bed today. The older I get, the harder it is to bounce back from jetlag. My circadian rhythm is getting more & more screwed up. This morning I woke up to a lovely big breakfast & very strong coffee. My usual morning starts with an open laptop looking for M. S. updates & a continuous succession of coffee & energy drinks to keep the ole synapses firing all day. But this particular morning, moments after uttering the command “Michael Schumacher update” into my smartphone, I read the following at the end of an article.

    {A close friend of Schumacher’s family was concerned that his family members may be in “denial” of the outlook of the 45-year-old’s recovery.
    “Is there a sense of denial at play among them, I would say yes,” the family friend told The Sun.
    His wife Corinna “would view breaking faith with the hope of a miracle a betrayal, little better than treachery,” the insider said.
    “She feels that the family communes around his bed side pulsate their hope and love to him, and that of the millions of fans worldwide who share that faith. She can’t express defeat because that would be the end of her.”}

    I read the last sentence several times. Reverberating in my mind as I ran upstairs to my room; I sat down on the bed and for the first time in over five months I burst into tears for someone other than Michael. A wave of nausea settled in the core of my stomach. I looked up at the window and watched the heavy rain drops run down the window, it seemed like the whole sky was weeping uncontrollably. The heavier it rained, the harder I cried …… I am embarrassed to admit my selfishness at that moment my pain blended into what is Corinna Schumacher’s HELL.
    That is all I am capable of writing today.

  25. Thank you Gary for your continued insight into what may be Michaels condition. It is so refreshing to be able to have some information as to what his prognosis may be.
    I must admit I am still completely baffled by the lack of official updates from his communications people and whilst I understand and respect the families need for privacy, I fail to see the harm a statement every few weeks would do. For the millions of fans who pray daily for his recovery and send healing thoughts and energy his way, it does seem like a slap in the face to have no news at all.

  26. Gary, thanks for the very interesting assessment of the MS situation. I have this question. If it is so hard to bring someone out of an induced coma why do it? Is it to save their lives but commit them to a vegetative state for life? Is it a crap shoot?
    Surely, the doctors knew the condition of his brain when they put him into the induced coma and knowing what they did they had to know how iffey the outcome would be. Were they then searching for a miracle?
    Also, did they need the consent of the family to put him into an induced coma?

    • Hi Mimi! Glad you brought this up.

      In fact, this question originates in what you, and we all, have seen written. In various wordings, it’s implied that either Michael is STILL in a “medically induced coma”, or that the physicians taking care of him are having trouble “bringing him out”.

      Even without first hand knowledge of the case, I can assure everyone that long ago, when we were told that the sedation was being stopped, it was indeed . . . STOPPED. There is absolutely no doubt at all, none whatsoever, that it’s been MONTHS since the medically-induced part of Michael’s coma was stopped.

      Varying degrees of sedation (from relatively light levels, to keep the patient comfortable, to extremely deep levels, to control stubborn and dangerous levels of intracranial pressure) is a routine technique in neurointensive care. It’s not a crap shoot – it’s the standard of care.

      • Doc, thanks! Honestly, if the medically induced part of MS’s coma has in fact been stopped then there is no doubt, from what we can surmise because we haven’t been told anything different, MS is indeed in a vegetative state of sorts.
        What I don’t understand is this….once the swelling in the brain is under control and reduced what then is stopping the person from emerging from the coma? Has the brain, in part perhaps, been so severely damaged that it can never recover? But I guess we never really know that and it is the reason why someone in that condition is artificially kept alive.
        If my questions sound stupid I apologize but I find this all so interesting and I feel very badly that we have to be talking about someone who is so beloved.

      • Mimi, my dear …… They say “There are no stupid questions, only stupid people”….. Don’t shoot me anyone! These are not my words, I just can’t recall who coined this phrase at the moment. I’m really glad Doc answered your previous question because I was wondering about that myself. Nice to have you back my dear. I can relate to you. You’ve got a an hair trigger self-protect button & a fire in your belly …… just like me ;-)
        Sending you peace & tranquil energy.
        (A.k.a. Liza)

  27. Pingback: Schumacher had a bad ski accident - Page 146 - FerrariChat.com

  28. Gary, what proportion of the “conscious” segment of the graph at 6 and 12 months would you say is fully conscious, e.g. able to converse, play a game of chess, versus perhaps being in a lower functioning state?

    Clearly consciousness isn’t necessarily the lightbulb that most of us flick on when we wake in the morning.

  29. “I’m quite afraid (and virtually certain) we will never have any good news about Michael. At this point, I rather dread seeing that the family has put out a press release”. . .

    Probably why there haven’t been any press releases.

  30. Hi everyone. I guess we are all here desperate to hear Gary’s analysis – thanks Gary…and really Gary, thank you for being the only one (as far as I can tell) who is providing coherent updates on TBI in the context of Michael…the only factual analysis on poor Michaels’s situation.

    I recently watched the AMAZING documentary ‘Crash Reel’ [1] about Kevin Pearce the US snowboarder who suffered a TBI and is in recovery. Kevin truly is an amazing guy (and his family is *totally* amazing) and you realise when watching the movie that to come back from TBI is not a recovery as such, but a new phase of life. To all, if you have not watched ‘Crash Reel’, then I would highly recommend it.

    [1] http://thecrashreel.com/store/?index.php

    • Hi Steve JR haven’t seen the documentary but the website seems amazing. They seem to have used this as a launching pad for Brain Trauma Injury Awareness campaign. I’ll have a look around that website.

    • I applaud them for what they are doing: I recommend others check out:
      LOVEYOURBRAIN
      Resources
      Helmet Pledge
      SHARE YOUR STORY

      This is the type of thing I would hope would inspire the MS “franchise” at some point in time to do.

  31. Gary,
    I’m glad you brought up the Mercedes boys. Monaco, between Hamilton’s lamentations of sleeping on his father’s sofa and Rosberg’s spot of RascasseGate, was a real display of childishness in two incredibly highly paid and highly cosseted drivers. In comparison Sebastian Vettel has been a paragon of maturity. After 4 brilliantly triumphant years he is now playing backmarker to his rookie team mate and not showing a shred of ill temper. I confess it’s refreshing not having to look at his digit raised in victory after seemingly every race, but who knew he’d be such a gentleman through adversity?

    Again, I have to look to that great philosopher of Formula 1, Kimi Raikonnen. When asked about the Hamilton-Rosberg kurfuffle he responded: ‘I don’t care about any of that’.

    I would have to agree.

    lm

  32. Hi Gary. Your insight into this ongoing situation continues to be appreciated, so thank you again.

    If I may deviate from the topic of conversation for a moment, I’m thrilled to hear that you’re starting a video blog. If it’s even half as interesting as Mario’s interview with you, it’ll be an enormous success. Best of luck with that.

    You did “ask the floor” for questions, so in light of your recent posts about the Medical Car and rapid response, I’d like to ask a question about the first lap of a race. It’s Spa ’98, the lights have gone out, you’re chasing the cars, when the now-famous multiple-car collision takes out a significant portion of the field. With cars strewn all over the track, how does your response differ to the more “routine” (poor term, I know) one or two car incident? Obviously you will have arrived at the very back, so do you start there and work your way forward, assessing each driver until such a time as you receive word that you’re needed elsewhere, or do you have a specific “major incident” procedure to follow?

    Thanks again, take care.

    Paul Burns.

  33. Thank you Dr Gary for this once again excellent blog. I feel like a lot of other people feel now that Michael is not going to come out of this. It breaks my heart and I feel numb.

  34. he is a good Catholic, family man. i pray for him each day. i believe in miracles and hope that he is the recipient of one.
    who are we to tell the family that they must make decisions, make disclosures just to make us happy. i am sure that they are in such pain and suffering from such exhaustion that they can barely think or act. I am sure that they are looking forward to the day when michael can walk out joking and smiling.
    if some other resolution is had they can face that then. never say that if he is in a coma it is better…his family is on the front lines, let’s just support them and not prognosticate from a position of guesses or routine outcomes. michael is not a routine kind of guy.

    • Hi Kate, I think you are indeed right. I just wish people would leave him and his family alone. This is cheap publicity and no one asked for this to be published. He is not the one treating Michael and this selfie interview is just to grab spotlight/ attention. There are millions like us praying for our hero and it takes one spoilsport to ruin our love and feeling towards a guy who means a lot to everyone world over

      • “Cheap publicity”? can you please tell us what it is you are talking about??????? I have a hard time with riddles.

  35. Hi Gary

    When you say “I’m quite afraid (and virtually certain) we will never have any good news about Michael”

    Does that mean what I think it means?

    Should we now be waiting to hear news about whats seems the inevitable?

    • I would also like to sincerely thank you for the insight you have given us through these past few months since that sad day Michael had his accident!

      With his family being un willing to give us his fans much info

      With your help atleast we have an insight to what might be going on and are able to privately come 2 our own conclusions.

      So thank you for Your special effort and thank you for considering us Michaels fans when his family has none.

  36. Michael – five months on

    Taking that graph there are three possibilities 1) Consciousness 2) Death 3) PVS.

    5 months on and the information position we have from the family is that Michal is in state 3) PVS, rather than states 1) or 2).

    Now if we START with someone in a Persistent Vegetative State 5 months into the accident, then USING THE ABOVE GRAPH we get the following prognosis at 12 months into the accident:
    1) Consciousness 19%
    2) Death 41 %
    3) Persistent Vegetative State 40%
    The accuracy of me taking measurements from that graph is about plus or minus 4 %.

    So at THIS POINT in TIME there is about a One in Five chance of becoming “conscious” and a Two in Five chance of dying over the next 7 months.

  37. I for one believe that even if there’s significant improvement, we would not been told as they try (Michaels entourage) to keep the press and the mass at far distance. They just don’t need the attention. You can call it naive, but I remember that also very little information was shared with the public when Michael had his leg injury after Silverstone 1999. Fingers crosed!

  38. Hi Gary, thanks for the excellent blog, really appreciated.

    You wrote about how important time was when one has had a serious head trauma, and even though Michael was in surgery within hours, do you think that has affected on how he is now, considering the damage he had in his brain? As I understand, damaged brain tissue won’t heal, like bones and muscles do?

    The silence doesn’t make the situation any easier, but I do respect the familys privacy and really wish for good news, but I understand how bad it looks. Sadly.

    • It’s impossible to say. These are clearly devastating injuries. The clinical status of patients with head injuries can change in minutes, from seemingly minor to life threatening. This is why most of the world’s organised trauma systems take this into account by providing expeditious transport to centres capable of full neurosurgical management.

  39. Sadly, Gary, I have to agree with you. If there was any good news I’m sure we would have been told.
    But I still have my fingers crossed for good news because, as you know better than most, the human body is an incredible thing.

    @PeterK – I understand what you are saying and sort of agree with you but if it’s the families wishes not to say anything then I respect their decision.
    Not saying you don’t.

    • Yes, I agree. But I do feel that to continue to seemingly ignore the fact that he was one of the most successful sportsmen that ever lived and thus had many fans who maybe do not have access to Gary and the like – maybe those is third world
      Countries where Michael had a huge following partly for F1 but also in part for his humane charity work – and who thus continue to sincerely believe in his recovery is not particularly right.

  40. I remember watching the first hospital press conference. Everyone with their heads up, seemingly eager to answer questions. I remember the second, 24 hours later, more about the injury had surfaced. All the assembled experts had one thing in common. Complete lack of eye contact with the room and not at all keen to communicate. Hate to say it,but Schumacher’s long term prognosis was obvious following that.

    • Anthony, your post here were my thoughts exactly. I’ve watched that segment so may times, I’ve lost count. The doctor’s body language said it all. That’s why I was angry right away, the first week dragged on forever without anything but the ” stable but critical” statement reiterated over & over. I posted my anger at Kehm in a post on AutoSport website only to be lambasted for having the gall to desire an update. So I shut up until I found Doctor Gary’s blog and after several months, finally, he posted some frustration at the news blackout & I spoke out again. In retrospect, I wish we were wrong but its now 5 months & counting, Sad situation.

  41. I have only been following Gary for a relatively short while following my sons suggestion to do so
    I have to say that it is most refreshing to read his regular posts – a voice of reason in a pool of largely floating crap @joedevanny

  42. Sad.
    I do wonder now that the family have had plenty of time to consider their situation via-a-vis Michael’s fans, what single advantage it brings them to keep everyone totally in the dark about what is happening.
    I was staunchly defensive of their ‘privacy’ obsession to start with, but now, with over 6 weeks passing since the last update, I feel anger and frustration at having to rely on hearsay and conjecture about the health of a man so seriously injured who has been a hero of mine any so many others for over 20 years.
    There are those who naively seem to believe that Michael will one day return to what he was before. They should be put out of their misery and allowed to deal with it as they see fit. It is in my view shameful and lacking in any form of respect for their support and devotion over the years that Michael’s family cannot release one (last, if they really want) definitive statement as to exactly what the situation is.

    • If the family does release an accurate assessment of Michael’s present condition, what would have to have happened in advance of that? Wouldn’t they have had to accept an accurate assessment of his condition? Apparently they are not prepared to do that. We know it’s magical thinking to believe that accepting factual information is synonymous with creating the situation itself, but still we protect ourselves from pain and terrifying inevitability by thinking ‘positively’, or lighting candles, or praying. Or hanging banners, or writing notes on racing cars.

      Perhaps the family have surrounded themselves with those who will help provide buffers against reality. Shamen? Witch doctors? Michael’s famous victories on a continuous loop in hopes that he will be made whole by the sound of his Ferrari at full song?

      Unfortunately, medical technicians are able to maintain a brain/body in a vegetative state for several months. What happens when the body finally dies? The family are left with memories of the nightmare months. In fact, and I’m speaking from personal experience, the image of the loved family member lying there, locked in coma for month after month, becomes imprinted on your brain. The hospital room and then, if he’s brought home, the room where he’s kept, are the memories you carry with you.

      With a great but distant celebrity we fans are freed from that. Now and forever when we think of Michael Schumacher our minds will flash his glory days, or perhaps a moment of meeting him, but for his family, they will struggle to get past reliving daily these 5+ months of misery. I am so sorry for them.

    • Peter, sad as it may be….. soon MS will become a memory to many. Life will go on. People will forget. There will be other things more important than the condition of MS and where he might be. It’s human nature. Time heals.

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