I’ll admit to being perplexed.
First, about the silence from Grenoble.
If you’re not in the habit of reading the comments section after each post (I do, of course – it’s wonderful to see what those of you who read me think, and a source of wonder that you’d actually take the time to write), it’s worth a look (in chronological order) at the comments to my last entry.
It’s pretty clear that Michael’s fans are beginning to feel like their devotion, commitment, and passion for someone they’ve elevated to hero status over many years means nothing. I see strains of anger, disappointment, frustration. Others, with considerable self-abnegation, are hewing to “respect for Michael’s privacy” and accepting the lack of information with equanimity . . . but even here there is an undertone of frustration at being asked to do so.
I’m not a journalist, and I’m not a PR/communications professional. But I totally fail to see how the current comms policy helps either Michael or his family. I fail to see how talking to us about the significant ups and downs of this long hard process damages Michael’s privacy or makes Corinna and the kids’ journey more difficult. I cannot possibly understand the reasons for any of this. I’ve said it before, and I’ll repeat it. This is totally unfair to the people who made Michael the celebrity he is. The people who vibrated to his victories, and were saddened by his defeats. They deserve to be told something. I didn’t say it’s their right to know (although jurisprudence places looser limits on celebrities’ “privacy” than on that of “normal” citizens); rather I said they DESERVE to know. Why on earth is their pain not being considered? How is keeping the millions of fans in the dark helping ANYTHING?
I’m also a bit perplexed about this latest thing in FOCUS.DE about re-starting the sedation. First of all, the article is rather remarkably poorly written. That, plus a singular lack of content make it useless, and surely not even worth wasting one’s time reading.
With no knowledge of Michael’s current clinical condition, it’s impossible to say why he would be re-sedated at this stage. Generically, any situation requiring a still, tranquil patient might raise consideration of reinstating sedation. This could be, for example, respiratory deterioration that requires a new period of mechanical ventilation. It could mean that there has been a change in his neurological status, with perhaps some signs of agitation, or a systemic infection originating in one of the several catheters still present. Again, we have absolutely no idea.
Right now I’ve really only one question (that predates the re-sedation issue). Has Michael been weaned from the ventilator?
As I’ve mentioned, once the sedation was stopped, the next big step physiologically speaking was respiratory weaning. This appears to me to be a piece of news that is unequivocally good, and therefore I cannot imagine it being held from the public. Imagine having heard Sabine say “I’m happy to say Michael is now breathing on his own”. Once again, if he HAS been weaned and we’ve not been told, then this is a shameful and arrogant neglect of his fan base and the public.
If on the other hand Michael is still dependent on the ventilator, it’s important to look at why. In this case, that of a young and (remarkably) healthy man with a high probability of brainstem lesions, damage to the respiratory centres would be high on the list of reasons.
Damage to the brainstem can be associated with numerous clinical presentations. It is where breathing is controlled. As important, the brainstem contains structures that play a vital role in waking the brain and maintaining wakefulness and attention. It’s also where the nerves to and from the face (for hearing, sight, taste, feeling and movement) enter the brain.
With sufficiently widespread damage to the brainstem, the patient shows no sign of awakening, and remains ventilator dependent. This is obviously a devastating situation. Brainstem injury is suspected based on the clinical status of the patient, and is then sought using imaging, especially MRI scanning. The actual function of the brainstem can be interrogated using several techniques, including what are called “brainstem auditory evoked potentials”. This involves placing headphones on the patient and playing a series of several thousand clicks through them. Then, sophisticated software is used to detect, embedded within the electroencephalogram, the passage of the sound information through the brainstem (where it enters and undergoes initial processing).
Let’s cut to the chase.
If Michael is not breathing on his own, and is (as we suspect) not showing signs of purposeful interaction with his environment (I am ignoring the mouth movements of which Felipe Massa spoke), AND if there is imaging and functional evidence of extensive and irreversible brainstem damage, Michael’s doctors will discuss withdrawing treatment with the family, as under these circumstances there is essentially no chance of recovery. It is possible that this discussion has already happened.
If Michael is breathing on his own but still not showing purposeful interaction with his environment, then patience is still very much in order. Remember that at one month post-sedation, persistence of this state means roughly a 50% chance of awakening, with the quality of that awakening an open question. This falls to 20% at six weeks (three weeks from now), with a larger portion of these patients having severe functional handicaps. And at one year, essentially no one still comatose wakes up.
Lastly, if Michael is breathing on his own AND showing signs of meaningful interaction with his environment (I very much hope, but very much doubt that this is the situation), then a certain number of people should be ashamed of themselves for denying this good news to his fans. If there is indeed progress and good news ready to be told, then the current comms strategy will go down in the annals as among the most ill-guided, unprofessional, and hurtful in the history of Formula 1 PR.