I really need to get out and get stuff done, so I’ll post a more (this sounds SOOOOO ridiculous) ummmm . . . detailed analysis (ahem) of the presser when I’m back. Meanwhile, a synthesis. 4 main conclusions for me, for now:
- 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.
- It sounds retrospectively that MichaeL’s ICP was worrisomely and persistently high yesterday, despite the right sided bone flap not having been closed. This was a standard and totally normal decision Sunday in the OR. The ICP problem was so worrisome that they considered a dip to be a “respite” allowing them to scoot to the scan. Now remember, I’m piecing this together from the words used, so everything I say is therefore subject to interpretation. But we’ve all had patients like this and agonised over going to the scan, coz until just before (the respite they’re talking about) every time we TOUCHED them their ICP shot up. So the decision was made to gain some room, and drain what sounds like superficial left-sided hematoma. These are usually left alone, and it had previously (and reasonably) been decided NOT to touch this one. But given the ICP problem, and that overall the brain was less “angry”, it was decided to evacuate it, especially as this meant leaving the left sided bone flap off.
- This leads me to insist on just how sick Michael was yesterday. These guys were sweating bullets, doing everything known to man to help, and they deserve a lot of credit. But this was SERIOUSLY life threatening minute to minute yesterday.
- Lastly, I think we can A) reset all the countdown clocks we started yesterday (time to reduce sedation, time to wean from vent, etc). And B) insist on just how severely Michael is injured. Be patient. This is gonna take a long time.
A Former F1 Doc Writes 
What a tradgedy. Michael is a fighter who never gives up. I believe he will defeat this challenge as he has defeated many others. All strength to his family.
Scott
I agree. But the word’s use is VERY indirect. I SAW a thing in Bild, which QUOTED someone “in the know”. So really we cant say that any of the professionals actually used the word. That said, it IS something we’d say to each other discussing a patient. And the scan CAN be worse (representing the evolution of the contusions and hematomas) with the type of lesions described, without it necessarily implying that LONG-TERM it has significance.
On Michael’s birthday, Friday 3 Jan 2014, there was a comment that referred to a brain scan taken that day, that it was a “catastrophic scan.” If, in fact, that comment was true, how could his condition be upgraded to suggest “improved” the following week?
Hi – thanks for the comment. At this point in his clinical course, his status depends mainly on PHYSIOLOGY – pressures, oxygenation, etc. It’s not an indicator of his neurological status, just his vital status. The reports of a catastrophic scan are of course worrisome, but as I’ve said before there is only a rough correlation between the scan and the final clinical outcome. So let’s keep doing what we (and Michael’s family) can only do – wait, be patient, and cross fingers.
-Gary
Was the term catastrophic used & if so why would they use this term & at this early stage? Surely if the scan & outcome are not necessarily linked in the manner you mention it’s not very clever to use such a damning sort of term to describe the scan.
I’m still praying & thinking of Schumi because he played such a major part of a sport that has been very dear to me for years.
Gary, I want to thank you for responding to my question. It means alot to have some contact for those of us who are far away and are truly lay persons. Your willingness to share your time and knowledge is deeply appreciated.
KC
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Thanks for the update from the inside.. the news we receive is mostly souped up or sheeped up for many / any reasons..
My grown son has always been a fan of Formula One so I have been aware of MS for at least 2 decades. I was just stunned to hear that a man who was about health and safety with lightning fast reflexes had been in such a bizarre and severe accident. It reminded me of when Steve Irwin, the Crocodile Hunter, was so tragically killed. We all thought it would be a croc, not merely a jump into the ocean to film.
I do know if any man is capable of surviving such an injury to some reasonable recovery, it is Michael. I wish him and his loved ones the absolute best and I keep him in my positive thoughts, checking online every few hours for any updates.
Gary, I’ll add my thanks to all those above, much appreciated.
With regards to your first point, you might be interested in the article in this pdf of CHU Grenoble’s hospital magazine describing the functioning of the ‘Alpes Trauma Centre’. Prof. Gay’s section on page 27 mentions 44 emergency cases of intracranial hematoma between September 2011 and April 2012. (1-2 a week). I’ve no idea how that compares with other centres, but It certainly looks like they are no strangers to the job. (I think they mentioned in the first conference that this isn’t the first similar case of the season and, sadly, won’t be the last)
The whole report was interesting tome as a non-medic and it certainly gave the impression that they are serious about providing the best possible care over a fairly wide geographical area and are doing all the right things to achieve that.
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Can’t really add to all the appreciative posts here already, other than to hope the doctors are able to do their job effectively with so much worldwide pressure on them.
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Thank to the doctors, nurses and to the technology we have developed. They never quite seem to get the credit. I think I speak for many… give me the facts with details and I’m far more comforted in my expectations.
Well said!
Gary, it’s comforting to read your takes on what is happening about the unfortunate accident that Michael has had and to explain in simplified terms what is happening.
Fingers crossed all goes well and I’m sure you’ll continue to keep us all up to date with his progress.
Thank you.
What all those other guys said.
My dad had a bilateral subdural hematoma 9 years ago. He was 20 years older and not as fit as Schumacher. His was not just from a fall, but a mishandling of his blood thinners combined with thrashing around on a hospital bed, but the resulting brain bleed was essentially the same. The neurosurgeon performed 2 surgeries with very little improvement, and finally told my mom that maybe it was time to “let nature take its course”. She consulted their family doc who said he didn’t think it was time to give up yet. We had felt hopeless for SO long, though. I really didn’t think there was any hope, as he had been through so much with no improvement. She decided to have the third surgery to evacuate remaining blood and shortly after, he started improving by leaps and bounds. Recovery was a very long process (he was in hospital and rehab for almost 6 months)and he no longer drives due to seizures(which are now extremely rare), but he came back to almost his old self. Retained his memory, personality, etc. Brain injuries are tricky and take a long while to heal, but the human body is amazing! If I could send a message to his family it would be to not give up hope!
What a great story. Gives us all hope that miracles do happen.
Dr. Hartstein,
Thank you for the excellent blog post. Even those of us who are familiar with the clinical interventions, the implications of symptoms and treatments, and the possible courses a patient can take at this time appreciate your objective reporting that the mainstream media seems to be incapable of.
Thank you very much Gary. Whilst it is always challenging to understand ‘doctor-speak’ especially through the medium of a translator, reading your comments in addition to what we are told through the television is making the situation clarify so much more in my own mind. Greatly appreciated.
Thanks Gary, I can’t add anything that hasn’t already been said in the comments above, but I share their opinions.
Hey Brad, great to hear from you! Have a happy and healthy 2014!
Thanks, you too. Great blog!
Thanks
Thanks for the update, greatly appreciated!
Thanks much Doc. These updates from you and your interpretation of what seems a complex medical condition offers us, the F1 and Schumi fans, much solace. God Bless.
Oh, I am very glad i found this from Mr. Herstein… It makes a lot more sense and view on whole matter… Thank you former doc…
Hope Michael gets a lot better very soon, but as doc said, it will take a lot of time…
Thanks Gary. Your valued opinion and interpretation is a knowledgeable one not necessarily found elsewhere.
Mr. Hartstein, thank you for your efforts, your updates really clear up the subject to us, laymen. The worst fears are of the unknown, now we can see the Schumi’s situation much more clearly.
Cheers!
Ondra
Thank you for being so honest and make we all undestand the real meaning of what Michael is going through. I know is only a little deliverance but is much more than we expected after the yesterday´s press conference. Wishing to read more I keep on trust in Michael´s strengh. Thank you again DOC.
It is extraordinary but not surprising seeing what is being reported in the Press as to what was said at this morning’s Press conference, and what was actually said. I see Piers Morgan has gone so far as to report a ‘surprising’ improvement in MS condition.
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Thank very much for putting it in a way we can all understand. We must just hope for the best.
Excellent information Gary. We’re all so concerned for Michael & this is reassuring information so we can understand where things stand without either worrying or speculating ourselves, or listening to speculation of others.
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Join in thanking you again for your comments.
May I draw people’s attention to a (surprisingly, given who they are!) balanced and informative series of undates on the whole sad MS story from the Daily Mirror website. Here is the link
http://www.mirror.co.uk/sport/formula-1/live-updates-michael-schumacher-still-2974443
It’s just a rehash of what was said in the press conferences plus what people like Piers Morgan are saying. The media reporting on the media in other words. Utterly at odds with the kind of insight that Gary is offering.
Yes, for a short time they were being quite selective in their posts, but as less news filtered out they began making it up. Apologies.
Thank you sir. This site have been offering huge comfort (not only to me I believe) in this difficult time. Praying for Michaels full recovery.
Gary – thanks for the regular updates and for putting this into a context we can all understand. Very much appreciated, thank you.
Thanks Gary! Once again your words, even if they weren’t what i was whishing for, where in fact reassuring.
Cheers,
C
Thank you for taking time out to update us all the Schumi fans. We are praying for his full recovery. May God bless him and you.