Good news?

As my mom always said, “You make your bed, you gotta sleep in it”. So even though I was sure I’d written my last post having anything to do directly with the Michael Schumacher tragedy, I just want to answer the hundreds of questions I’ve already gotten as to the import of todays statement.

1) It is obviously good news that Michael has left the hospital. Because of the length of time since Michael’s injury, and of the specific role of an Intensive Care Unit (ICU) in supporting and monitoring the function of the body’s major systems, it’s almost certain that Michael has not simply been discharged from the ICU to a rehab, without having “transitioned” by a stay on the regular wards. I have never seen a head injury patient with a 5 month ICU admission be transferred directly to a rehab facility . . . but anything’s possible. 

Remember that there are lots of rehab facilities that can handle ventilated patients, so this transfer also says nothing about whether or not Michael is breathing spontaneously.

2) The moment Sabine announced that Michael had moments of eye opening, we knew he was no longer in a coma. BY DEFINITION. Coma = no consciousness, no eye opening. Open your eyes but unconscious, it’s a vegetative state. Add fluctuating signs of interaction with the environment, it’s a minimally conscious state.

So what does that mean? Sabine is a professional. At the beginning of April, she told us Michael had moments of awakening AND of consciousness. Once again, by saying this, she told us in almost clinically perfect language that Michael was no longer in a coma. She used two terms that only specialists actually distinguish; for laymen being awake and being conscious are the same thing. This language, then, clearly was used based on discussions with Michael’s care team, and reflected a highly accurate description of his minimally conscious state.

Now, we’re told, with what appears to be a bit of a triumphal air, that Michael is no longer in a coma. As stated above, THIS IS NOT NEWS. I cannot help but think that this is a highly cynical use of language, using the truth to convey an impression that is almost certainly false. I cannot but think that if Michael had emerged AT ALL from the minimally conscious state that Sabine so accurately described in April, we’d be told that Michael is leaving for rehab, that he is having problems expressing himself and will work hard to get better. Or that he’s having to learn to walk,read, write, etc all over again. But no, we’re told what we already know, and pretty much told to not ever expect further updates. Kinda like what I was thinking.

This all leaves a very bad taste in my mouth. And a huge space of sadness for Michael’s family, and for you, his fans.

605 thoughts on “Good news?

  1. Dr. H:
    How do soccer players survive the repeated head impacts? (I posted a fairly lurid description of this yesterday.) No helmets and yet they seem to have fewer concussions than the well-helmeted US football players. I read yesterday that the National Football League has 5,500 complaints of concussion filed.

    Germany vs USA is about to begin and thanks to you I will watch through the prism of TBI awareness. sigh. I think prior ignorance carried with it a certain amount of bliss.
    lm

      • lulumoretti

        My admiration!

        How did you know the nickname of the Finnish national soccer team AND how did you know that I am a Finn? Yes, sommtallinnast (=a Finn from Tallinn) is my Internet-pseudonym since I used to live in Tallinn, Estonia but usually I write here with my real name, Jussi Hieta. Logging here to comment goes through my WorldPress account.

        Too bad, but Huuhkajat will probably never play in soccer world championships, they have some kind of a chance to get into the European championships though.

      • Peter,
        If I may speak my mind (no clanging, I promise) . . . it is a mystery to me why soccer is so important to so many people. Brazil has quite possibly bankrupted itself creating an infrastructure for a temporary diversion. And the whining! Good grief, are these adult males? This morning the Wall Street Journal did an analysis of the ‘flopping’ as it pertained to timing – when in the period, running out the clock, etc. – and against whom one chose to ‘flop’. Theirs is not spontaneous behavior!

        (I won’t mention s-o-c-c-e-r again.)
        lm

      • Lulu – I quite agree … I have never remotely understood the attraction of the game, the people who play it and also by and large the people who watch it. There .. I’ve gone and alienated everyone now! 🙂

      • I headed the ball at the half way line from a goal kick once, my brother thought girls were chicken, walked around half knocked out for about 3 seconds, so I suppose you’re right.

      • Peter I so agree and why is EVERY game live on tv, England lasted all of two matches, all that fuss for nothing! Thank goodness for Wimbledon, now that IS worth watching

      • Yes, we low football kicking foot oriented people don’t wear the whites and sip, tend more to guzzle the champagne and rather a round or two of golf, for target practice of course.. (just joking – could never work out why the legs were longer than the arms, mind you my first tennis serve, no second, possibly third but no more than fourth was a perfect ace, my forehand the same, strange, does that mean I’m an animal… oh no ;-…)

      • I just came up with a new way to resolve my backhand, practice at a 5 foot level rather than 3, thus extending my external oblique abdominal muscles also allowing a greater dexterity in my defensive left handed forehand. that’ll work… all I need is a practice partner… hmmm

      • Seriously. I had a good idea about my backhand and thought I would share it, nothing wrong with that is there? I hope not, sorry if inappropriate..

      • Actually I think the truth is, I’ve been driven mad by the whole thing or the human race, and need to go work out what the hell is wrong with people.

  2. @Gary; first of all thank you for your (continuing) insights into head trauma and F1 anecdotes. Highly appreciated and I will follow them with interest as I did before.

    Regarding MS, I think you were spot on when you stated that you wouldn’t write anymore on the MS case anymore. It’s a sad story and I feel for the family – but for all of us I guess it’s time to move on.

    Discussing whether or not fans are entitled to get regular (meaningful) updates on the medical condition of MS is obsolete. The Schumacher family has made a clear decision on this, which we have to respect.

    The legacy of Michael Schumacher continues to exist, just as the legacy of many other (ex) top-athletes. Let’s cherish that and leave the Schumacher family to rest with the peace they ask for.

    Regards,

    Henk

    • Henk,

      I think you are basically right by saying it is time to move on, as far as the discussion is concerned, where to draw the line between his right to privacy and also the legitimate interest of the public to private information when it comes to a public figure.
      To sum up, I would like to say, that, where people draw that line for themselves in my opinion mostly depends on the amount of personal knowledge and the extent of the personal interest in Michael Schumacher.

      However I do not entirely agree with you, that Dr Hartstein will be “spot on” if he does not write about Michael Schumacher anymore.
      On the contrary, precisely because so little information about MS has been disclosed, hundreds of people are referring to this blog whenever there is “news” and I am sure the majority is grateful for his evaluations.

      Since the family does not want to give future updates, the topic will eventually resolve itself, but anyway,
      if there is news or not, I am very thankful for this blog, not only from a medical point of view, I am a physician myself, but due to these high-quality analyses and comprehensive insights into any subject.
      This, in general, is not that easy to find.

  3. Hello All, Doc 😉
    There just might be a very good reason why such a low sum of money was asked………. Frankly, I’m somewhat amazed that absolutely NO ONE on this blog has attempted a guess, considering some have made comments in the not too distant past that indicate hints. Hmmmm ??????
    Although, I do concede, wading through ALL the drivel in the media & on this blog could make one’s eyes crossed. Nonetheless, to borrow the technique first written by Sir Arthur Conan Doyle (Sherlock Holms) using the “art of deduction”, one might see answers that weren’t apparent initially.

  4. Like most of the known world I’m watching soccer and heads colliding with balls and, thanks to this site, all I can think is the potential for concussion. I’m quoting this short article in full because it describes the response of the player post-contact and response of the medical team:

    Soccer-FIFPro criticises handling of Pereira concussion incident

    (Reuters) – Players who suffer suspected concussion during a game should be temporarily substituted while their condition is evaluated, the world players’ union FIFPro said on Friday.
    Following Thursday’s incident at the World Cup involving Uruguay fullback Alvaro Pereira, who played on despite being knocked out in their game with England, FIFPro said independent doctors were needed to decide whether a player could continue.
    Pereira was clattered in the face by England forward Raheem Sterling’s knee an hour into the Group D match in Sao Paulo and lay unconscious as medical staff rubbed his chest and tried to revive him.
    When he got up, staggering along the touchline, Pereira furiously pushed away medical staff who wanted him substituted and forced his way back on to the pitch in what he admitted was a “moment of madness.” Uruguay won the match 2-1.
    FIFPro called on soccer’s world governing body FIFA to conduct “a thorough investigation into its own competition concussion protocol which failed to protect Uruguayan footballer Alvaro Pereira” and said it was seeking urgent talks.
    “FIFPro states that any sideline concussion assessment must not be conducted solely by a national team physician,” said FIFPro in a statement, adding that an independent doctor should make the decision.
    “FIFPro also calls for a review of the laws of the game so that a player with a suspected concussion can be temporarily replaced whilst being diagnosed.”
    “Football is awash with incidents in which players suffer potentially concussive blows to the head and stay on the pitch,” added FIFPro.
    “In Pereira’s case, he demanded to play on, overruling advice from Uruguay’s team physician for him to be immediately substituted.”
    FIFPro said that in some cases, players needed to be protected from themselves and said it would monitor Pereira’s condition.
    “FIFPro understands that in certain moments, faced by the pressures of such an important international stage, many players would react in this way.There are times, however, when the players also require greater protection against the prospect of making any rash decisions.(Pereira) must be subjected to further evaluation and follow-up procedures that help determine if and when he can return to training.”

  5. Two online articles, give some clues as to the investigation of how the breach of security MAY have happened;

    Stolen file is ‘summary of Schumacher’s condition’

    http://www.inautonews.com/stolen-file-is-summary-of-schumachers-condition

    I C&P this section from the above article;

    “The French news agency AFP has further details. It claims the ‘medical file’ is in pact a multiple-page doctor’s summary of Schumacher’s case copied from the hospital’s computer system.
    The report said the hospital is not sure whether an employee stole the dossier or if it had been the victim of ‘hackers’.
    “An individual, communicating by email, is asking for 60,000 Swiss francs to provide a document of several dozen pages that summarises everything that happened at Grenoble during Schumacher’s hospitalisation,” local prosecutor Jean-Yves Coquillat said.
    Hospital director Jacqueline Hubert told Bild newspaper that employees of the hospital with potential access to the file have been interviewed by police.
    “This is a limited number of people,” she said. “Michael Schumacher’s information was saved under a false name in the system.”

    French police probe theft of racer Michael Schumacher’s medical records
    By Agence France-Presse

    http://www.rawstory.com/rs/2014/06/24/french-police-probe-theft-of-racer-michael-schumachers-medical-records/

    Typed from the above article (because of some kind of lock on directly C&Ping), the following four paragraphs;

    “…An individual, communicating by email, is asking for 60,000 Swiss Francs (49,000 euros, $67,000) to provide a document of several dozen pages that summarises everything that happened at Grenoble during Schumacher’s hospitalization,” Coquillat said.

    He (Grenable prosecutor Jean-Yves Coquillat) said parts of the document were provided by email to prove it was legitimate. The document did not appear in Schumacher’s final medical report and was likely to have been a draft which had been left in a hospital bin, according to the prosecutor.

    A source close to the investigation said the document and the hospital was checking its computer system to see if it may have been hacked, sources said.

    THE EX-Formula One star’s management said on Monday that the documents had been stolen and were being offered for sale.”

    • If this was a draft summary or copy that had been thrown into a medical bin … then somewhere along the line someone recovered it from the bin … would that still be classed as stealing? In Britain this happens all the time … but not usually with celebrities. With celebrities (etc) the British media have until recently tapped directly phone calls etc.

    • Who ever took the records appears to be an amateur. A real pro would have asked for much more.
      C’mon, they offer millions for Kardashian wedding photos….surely info and a picture of MS would be worth close to that. That is my opinion and only my opinion.

      • Mimi,
        I agree. . .40,000 Euros is kind of chump change on the International Theft of Important Things market. And if there is one copy available then using even rudimentary technology there are an infinite number of copies available.
        lm

    • Today, while police is hunting “Kagemusha” (that’s the e-mail name which is used), the thief of the discharge summary, the management of MS has just reaffirmed to the german press, that,
      (no matter if data will be publicly disclosed), there will not be any! further news in the future, regarding his condition.
      This is what many people accept as their right to privacy.
      I do have a slightly different view, and please excuse me for using a rather personal comparison here…
      Though my interest in watching every race has decreased in recent years I have been fascinated by Formula 1 since I was small.
      I always had great respect for Michael Schumacher and his extraordinary achievements in this sport,
      but I was not emotionally involved as a MS fan myself.
      If I imagine this had happened to my all time favorite driver in Formula 1 (who has unfortunately died on 1 May 1994) and I was told we will never hear anything again, I would have been very sad and disappointed about that.

      With all respect to his family, in my opinion this is not quite fair towards his loyal fans and true admirers all around the world.
      On the one hand they fuel expectations for his fans by indicating that he has always been a strong fighter in life (I guess it is problematic if being a fighter really helps in his situation) while at the same time they say there won’t be any updates anymore.
      Since I am not a business economist, I can only guess if there are marketing reasons involved that would explain this strict behavior.

      • Thanks for your comment Katharina. I think you express what many of us have thought at various times since 29 December.

        We shouldn’t be shocked by being told we’ll not hear about Michael again. First, we’ve been a bit prepared for this by the comms strategy applied since the accident. (One doesn’t need all the fingers of one hand to count the units of factual information that have been officially released since the second doctor’s press conference in December.) More important, however, is the fact that after the acute phase of severe traumatic brain injury, progress, if any, is achingly slow.

        For example, we’ve been told that Michael has some capacity to communicate with his entourage. This, as it’s been described, is via head shakes and/or nods. This reaction almost certainly fluctuates over time (remember the spokesman at Lausanne said Michael fatigues rapidly – that’s another way of saying that his responsiveness varies a lot throughout the day). The kind of aching progress one sees would be, over months, a decrease in non-responsive time, and longer periods during which Michael would be amenable to responding. This would also include acquisition of further behaviours (appropriate use of sounds and words, motor responses, etc), and their increasing use by Michael.

        This kind of progress, while devoutly to be wished, takes months to years (remember, we’re six months post injury) . . . IF it happens at all. Hardly the kind of thing that makes for good press releases. It’s only by stepping back and looking at things with a perspective of months to years that progress can be clearly perceived. Again, not a perspective amenable to our 24h news cycle society. Given that, and given the family’s strong desire for total privacy, it’s easy to understand, but hard to realise, that we’ve virtually heard the last of this immensely talented man.

        As for motives, I think that different aspects of the termination of Michael’s sponsoring, partnership, and other business relations could easily be/have been (very) complicated. But let’s not fool ourselves – whereas the doctor-patient relationship is legally almost inviolate as concerns “third parties”, insurers are almost always given legal rights (usually by the policyholder’s signature approving such) to access relevant aspects of a patient’s medical record. Similarly, it’s not hard to conceive of parties to a contract seeking legal relief from patient-doctor confidentiality when circumstances require. For me, this means that the virtual news embargo since January was NOT an attempt (or if so, a very misguided one!) to hide information about Michael’s status (diagnosis and prognosis) from various stakesholders.

      • Dr Hartstein,
        please excuse me for mentioning it again, but your way of commenting or describing things is outstanding.
        Thank you very much for your detailed answer, regarding this situation and his current physical condition.

        I have to agree with you, it is absolutely right that this statement of his management should not have come as a surprise, for this strategy was used from the very beginning.
        Carefully reading your posts about traumatic brain injuries, out of my own experiences, (during my studies I was confronted with patients in a neurosurgical ICU for a six-month period) and on the basis of the given informations I realized, that, in this case, one could not expect fast progress during rehabilitation. If, as you mentioned, this slow progress happens at all, which I hope for.
        From this perspective, taking all theses informations together, I again agree with you, their behavior should be understandable, though, I have to admit, it is hard to conceive, (certainly even harder for his greatest fans) never to hear from MS again.
        Thank you very much for additionally giving your very interesting point of view, when taking business reasons and corresponding contracts into account.

      • Contracts are active and which includes continual agreement, and are relative to the subject, so if the subject (could be a person or a computer system) remains in limbo so does the contract.

        Maintenance of existing business is the only conduct allowable, any change such as assets sales for example are only allowed out of necessity.

      • I’ve just read todays Bild article.
        I may well be missing something that is printed elsewhere, but it does not say anything about his Management saying no further bulletins on his condition will be issued.
        Where did this come from?

      • Not releasing media info at the moment – anger out of disrespect is fair enough – but I wonder whether not releasing details of his past condition is also crossing an ethical line.

  6. It seems that there is now enough talent and material on this site to turn the book on Michael’s recovery into a film! In 5 years time when Michael is in a wheelchair but can communicate with his family I hope they will invest the proceeds from the film into research to benefit others who are much less likely to have the resources to recover from such a devastating injury.

    I remain convinced that Michael’s very high intelligence and the fact that he could speak directly after the injury is a good sign. I think the long sedation is a clue that the doctors were trying to heal the deep centre part of his brain (thalamus/insula) using propofol, which at certain doses seems to make that part of the brain more active by preventing signals getting through to the cortex. I think their hope is that connections will eventually grow back. If Michael is really already able to communicate in some way this may already be happening..

    • Afraid some of this has very VERY little to do with actual clinical practice, and very much to do with letting the mind run wild based on tv/print articles, themselves (poorly) interpreting actual scientific papers.

      With one or two minor exceptions, propofol is used for sedation/anesthesia, NOT to “heal” anything or anyone. Period.

      • Gary I know you are the expert.
        ‘Revealing the Brain through States of Unconsciousness’
        Emery N Brown from Havard Medical School and MIT Cognitive Neuroscience has put an interesting public lecture on this subject on youtube.
        Why do you think sedation was so long?

      • Books, movies, wheel chairs and propofol. Sounds like a good plot for a book…

        You’re walking down the street and you see Michael Jackson looking for a lost puppy, you’re frozen, the news has just come out that he’s a pedophile, and you can’t move. He bends over and propofol falls out of his pocket, to which he says, “Oh I’m so sorry, could you possibly help me, someone gave me this and I don’t know what it is?”…

        Standing affixed to the same place, now screaming because his words of terror reigned into your mind to find your deepest darkest fears of pedophiles, being a mother of course, MS comes racing down the street in his Ferrari F1 straight off the final lap, having heard the screams of the damsel in distress, but alas, he crashes into the lamp post and ends up in a wheelchair…

        Such a charming romantic story, like one without a happy ending cos they’re boring now anyway, that can take away all the hope and love in the world and make it a really nasty place for little children to live in.

        Ooh dat so nice. (happy face)

      • Propofol is an anaesthetic that has extremely favourable characteristics. As with any anaesthetic, it needs to be used by people with considerable experience of its properties, and the equipment necessary to handle any untoward effects. There is nothing dangerous about a Volkswagen Jetta sitting in its parking space. As soon as an imbecile fires her up, someone’s gonna get hurt. Same with propofol.

    • Hi Jane,
      Natasha Richardson was also talking just before she became Comatose. Boxer Gerald McClellan went on and continued fighting Nigel Benn for two rounds while suffering a Subdural Haematoma before walking back to his Corner and becoming Comatose. I’m not sure if talking during a lucid Interval is any prediction of a better outcome.

      I wont go on and list Gerald’s Disabilities, you can look that if you so wish.

      In saying that, I do wish MS all the best and hope that He progresses.
      Maurie

    • Maybe someone can confirm or deny, but the fact that MS could talk and walk after the impact demonstrated that at that stage MS brain was still functional and not especially damaged. The main damage occurred later as a result of a combination of a build up of intracranial pressure, and localised but spreading chemical related affects.

  7. Eh, I think I’m going to need more than being wrapped in Cotton Wool if you’re going to start throwing cutlery about. 😀

    Maurie

      • True, I don’t mind that. However, I’m still electing to sit as far away from said Dinning Table while cutlery is airborne since I’m on Coumadin at present. I have this fear that I will bleed to death even if bitten by a Mosquito. Just make sure you have Vitamin K to inject on hand. Lol
        Maurie

  8. The online edition of the British newspaper the Express has published the following information;

    Urgent probe as Michael Schumacher’s medical records stolen and put on sale for £40k
    AN urgent investigation is underway to establish how the top-secret medical file of Formula One legend Michael Schumacher was stolen.

    http://www.express.co.uk/news/world/484495/Investigation-underway-after-Michael-Schumacher-s-medical-records-stolen?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+daily-express-world-news+%28Daily+Express+%3A%3A+World+Feed%29

    C&P of the first few paragraphs of that article;

    “Vile thieves have touted the 10-page dossier for sale to media in the UK, Germany and France for a minimum of ?40,000.
    The document is claimed to be the detailed discharge file compiled by medics when Schumacher left Grenoble Hospital, in France, last week to begin rehabilitation in a Swiss hospital.
    The highly confidential 10-page dossier allegedly explains all of Schumacher’s treatments and his evolution during his time in Grenoble, where he was airlifted on December 29 following a skiing accident in the French resort of Meribel.
    The shocking offer to publications was sent in the form of an email.
    It states that a potential buyer can only negotiate by email, not phone.
    It also states that the transfer will be done at a lawyer’s office in Switzerland and demands the buyer “to pay cash upfront to the lawyer”.

    • Mark H:
      This isn’t surprising given that Michael Schumacher is one of the most famous personalities in the world. Could we have expected less? It’s as though all the information, even the smallest glimpses into MS’s wellbeing, have been held behind a massive concrete dam and now that dam has burst. (or will burst once the funds are transferred)
      lm

    • I wonder how the thieves found the lawyer in Switzerland. Or if they have not found him/her yet. Lawyers do not normally do things like that.

      • Gina,
        ” Lawyers do not normally do things like that.”
        I love your innocence. It really is endearing! (truly) Actually lawyers do things like that all the time because that’s where the money is. Think of every nefarious group you can imagine and there are lawyers greasing the wheels. . . Mafiosi, drug cartels, human traffickers. . . the works.
        lm

      • Hi Lulu, Thanks for the comment. I thought it myself; my view was a bit too innocent. But it is criminal to deal with stolen goods and to disclose secret information. Maybe the thieves knew the crook lawyer already before the theft, if the story is correct. Crooks all of them.

        But isn’t the sum they demand a bit low? € 400,000 or 500.000 or whatever it was?

    • Hi Mark H

      MS gets hurt with serious TBI. Is in hospital for 5 1/2 months and only 10 pages of medical info. HELLLLLO?.. What’s wrong with this picture?

    • Things like this make me wonder that if this wonderful miracle we call universe/world is given back to animals, maybe is better and more beautiful. How terrible anyone could think of making money from another human beings suffering, but well, such heartless thing happens all the time.

      There shouldn’t be any media or lawyer for that matter would involve, though. Unless they are morons and looking for finish their business/career in an ugly way.

      The price tag is also strange. MS’s family can buy it and get it off market if have to,though.

      And what’s the point? Schumacher is severely injured and barely conscious after half year. Isn’t that enough information for public? If it’s 5 months ago, more information maybe eagerly appreciated since we were hoping good news for him every day. But now, cold hard fact is almost certain, what had been done during his treatment, does it really matter?

  9. What is so interesting about this blog is it began as a study of the brain, but, because of the various voices contributing, has become almost a study of the mind! All of these people, us, from different life experiences, present a daily mosaic of responses to real – or imagined – situations. It’s a kind of theater with different characters walking onstage, saying their lines, then leaving the stage to the next voice, The most fun are the scolds with their tut-tut-tuts and long fingers pointing out transgressions of style or taste. They play an almost comic role and wear colorful costumes with lots of chains dangling from their waists that go clang clang clang whenever they move.

    • Love it!
      I will fall on my sword (ouch!) and include myself in the list of clangers – though hope I tinkle melodiously rather than clang – but you should have seen the war zone this place was before His Nibbs started moderating things ….. blood was spilled nightly with the less robust carried off on stretchers! 🙂
      Anyway, nice post!

      • Peter,
        I remember those days when there was a tiny taste of Verdun for all of us. . .(am I actually feeling a little nostalgic for the drama . .?) (no)

        Actually, the way I look at it is that out of billions of people on the planet there are maybe 30 or 40 self-selected folks who show up on this site and talk about those things that touch their minds, hearts, or both. It’s the Magnificent Grey Organ, it’s Michael, it’s his family, it’s choices, it’s our own family trials, our sad times, our learning experiences, our connections to those other humans who are suffering as perhaps we have suffered.

        I see us all sitting at a large family dinner laughing, crying, throwing the cutlery at each other, but still hanging in there and making efforts to share our thoughts, our experiences.

        As E.M Forster said: “Only connect”.
        lm

  10. Why are people so angry at lulumoretti? Care for a MCS patient is excruciatingly boring and excruciatingly expensive. My suggestion to the Schumacher family? Find someone who is willing to have their family member photographed and filmed and published in the media. Offer them in exchange the access to a good rehabilitation facility, which I am sorry to say, not everyone can afford.

    Oh, and if lulumoretti is not a neurosurgeon but knows about TBIs, my guess is she learned about it the hard way. Perhaps she too is entitled to a little bit of respect? Do any readers realize how hard it is to deal with severe TBIs when one does not even have millions, VIP status, and even a spokesperson? Normal patients can only dream about a MCS to be kept in an ICU bed for six months.

  11. Given the Schumacher’s desire for “Privacy” I am a little surprised that Michael was transferred to another public hospital, with all the risk of unauthorised access that brings, and not moved back to his own home.
    There was a story some weeks back of a £10 MILLION (“!!!”) facility being built for him which was of course rubbish but to modify one of the many rooms within Chateau Schumacher in Gland in the time he was in Grenoble would have seemed eminently doable together with the recruitment of qualified, reliable and well paid staff to care for him. They would have been asked to sign binding confidentiality agreements and that would have been that.

    • A home environment is difficult to work in, and he’s probably used to strict environmental partitions, so hospital would be the best place by far.

      I work from home, it’s hard to train yourself to work where you’re supposed to relax and vice versa, you learn how to work anywhere but it muddles your mind a bit which wouldn’t be good.

      I’d like to see rehab units in hospitals for all patients before discharge. It drives me a bit nuts that we have so much money but still the belief of health care being the individuals responsibility rather than supportive assistance being a part of the discharge process.

      • There’s still something . . . weird . . . about this story. $40,000? WTF? That’s like Dr. Evil’s ONE MILLON DOLLARS. A lawyer? Who’d no doubt risk disbarment in what must be a VERY small world of lawyers in Switzerland? Somehow it’s hard to imagine.

        How to make a terrible situation terribler.

      • 20 kg’s weight loss means malnourished muscles, so rebuilding means high risks of strain. It’s full time medical, the more detail he learns about cause and affect in the body, the better his recovery will be.

  12. Reblogged this on Pappillon and commented:
    Dr. Hartstein’s voice on this matter has been a welcome addition to the unfortunate speculation that will continue even in the absence of stolen medical files…

  13. Katharina makes such an interesting point about how perhaps the Schumacher family’s secrecy “…opens the door for criminals who try to exploit the curiosity and the lack of knowledge of people in order to make money.” Of course, she’s right. This is the law of supply and demand in action. Suppose the family started a blog – a good job for Ms. Kehm – writing a daily journal of Michael’s medical condition. She could make it so detailed as to quickly become excruciatingly boring. Soon there would be articles about how the public doesn’t really care about Michael’s blood pressure or the content of the nutritional substances fed to him or the results of his latest CT scan. Enough already!
    Responding to an increasingly saturated constituency, Ms. Kehm could switch to describing what Mrs. S. wears, what are her shoes, her bag? Who caters the meals for visitors? Is there a wine bar? Coffee kiosk? Are lattes available 24/7? What is Ralf driving to the hospital? Who is he dating? Every visitor would be interviewed and posted on YouTube or Entertainment Tonight. Soon it would be impossible to find a quiet corner that is not dominated by the Schumachers. At which point someone would offer on eBay a device that removes all references to MS from their TV, computers, smartphones, tablets, and printed media – and for only 50,000 euros.

    • I’d read that blog MImi! But even more I would love to read an official book by Sabine in 5 years time including selected brain scans and charting Michael’s slow and steady progress. Even better if it featured a very short introduction written or dictated by Michael himself.

      • The best book I have EVER read, was “A different kind of life” by Virginia Williams, about life before, during and after Frank’s accident. Sometime in the future a book by Corrina would be very interesting.

      • I agree with all three of your points.

        I’d just like to point out that whatever it is we DO here (and wherever HERE is!), does not, in any way, shape or form intrude on the Schumachers’ space. Speaking, if I may (don’t worry, these guys will jump in if they don’t agree), for a significant number of those “here”, we impose nothing on anyone. In fact, to get here, you actually have to DO something. Meaning one either wants to, or is misdirected. In any event, there are numerous and speedy ways to quickly remove oneself from the offending material, should one feel intruded upon.

        You might be confusing the broadening of the conversation here to issues that are difficult, that evoke passions, and that by definition have no right or wrong answers, with intrusion. You might, perhaps understandably, take sometimes vociferous criticism of a communications strategy as being directed at either the messenger(s) of that strategy or at the family. This criticism is for US, and expresses our opinions. It is not meant as editorialisation, directed at the general public as from on high.

        I’m pretty sure that the enormous majority of the comments on this blog show nothing but respect and compassion for Michael and his family.

        So thanks Penny for your comment.

      • Gary thank you I understand and accept your points. Believe me I would love to know how exactly Michael is doing, its frustrating but it just saddens me when people have a go at the family (& I am not talking about anyone particular on here but in general) about how they should be doing things. They are the ones who are suffering the most from this whole situation.

    • Lulu, dear that will never happen because there will be a book eventually. All that stuff will be exposed there. Be patient. It will come. ::::::wink::::::

      • I will take you a bet that Sabine Kehm will never write a book. Not a chance. The Schumachers will see to that financially and contractually. And as for Corinna …. come off it!

  14. Doc, please don’t let too much time go by w/o speaking/writing about MS and brain injury in general!! No doubt you’ll have access to his medical file soon – as will all the punters and never-weres – so you’ll be able to finally speak authoritatively on his case, w/o having to defend yourself against hateful buzzards who attack and disparage you as a shameless speculator.

    Seriously, Doc…this is a terrible fate that’s befallen Michael and his family, but in turn you’ve been given a tremendously influential platform from which to speak about brain injury in general, and not just as it relates to MS’s specific case. As someone who’s suffered pro-sports-related head injury + post-concussive syndrome, I am better positioned than most to comment on the stigma connected to TBI.

    Of course it’s totally your right to never comment on or write about these topics again, but I hope you will exploit the opportunity that fate has presented you with, and utilize it to do some more “good”, like you have been doing, and don’t let “fans”, segments of the public in general or Schumacher’s cynical entourage pressure you into unnatural silence!!

  15. According to Bild, someone has managed to obtain Michael’s medical records and is trying to sell them to the press!!!! Unbelievable!!!

    • The online edition of the British newspaper, the Daily Mail has this story;

      BREAKING NEWS: Michael Schumacher’s medical notes stolen, his manager reveals
      Sabine Kehm said documents for the coma-stricken star had disappeared
      The ‘genuine’ dossier is being touted for sale on the internet
      Ms Kehm threatened legal action if any of information was made public

      http://www.dailymail.co.uk/news/article-2666215/BREAKING-NEWS-Michael-Schumachers-medical-notes-stolen-manager-reveals.html

      • UPDATE to that article, can be found here;

        Michael Schumacher’s medical notes stolen after Formula 1 star comes out of his coma
        Seven-time Formula 1 World Champion came out of coma on Monday
        Schumacher had been in coma since December
        Medical notes offered to news outlets for around 50,000 euros
        His management say anyone publishing the notes will be prosecuted

        http://www.dailymail.co.uk/sport/formulaone/article-2666242/Michael-Schumachers-medical-notes-stolen-Formula-1-star-comes-coma.html

      • How horrible. I’m not sure which is worse – that this might have happened, or that I’m almost not surprised that there are people willing to do this.

        Any civil action by the family would of course be in addition to criminal action for theft and presumably other charges related to privacy protection.

      • This is so creepy. . .
        My husband received a letter from his hospital 4 days ago telling him that someone had downloaded patient files to a flash drive and his were included. The flash drive was used by technicians as a temporary means of transferring information to new offices and was stolen by someone unknown. Compensation offered is a year’s subscription to an Identity Theft consulting firm. (I’ll check e-Bay…)

        In MIchael’s case perhaps it is more surprising that secrecy has been maintained this long as it appears that privacy is an illusion.
        lm

        (I am looking at an 18 June comment from Mimi about MS’s hospital transfer: “Some where, some how someone has a picture taken in that ambulance. Betcha a dozen donuts.”
        She’s prescient!)

      • I can’t imagine it’s easy to access the files, most are computerised these days. Would it have to be staff? Or a hacker?

      • Please don`t get me wrong, stealing medical files of MS is a criminal act and absolutely distasteful,
        but somehow this is a price his family pays for their secrecy towards the physical condition of MS.
        That opens the door for criminals who try to exploit the curiosity and the lack of knowledge of people in order to make money.

      • British newspapers and media should hire linguistically apt journalists !!!

        In Sabine Kehm´s statement nor in Bild article there was NOT mentioned that the documents had disappeared (=vanished). Sabine´s statement said: “Die Unterlagen sind gestohlen.” In English it means “The documents have been stolen” – not disappeared as The Daily Mail reported. I do not think that university hospitals in France or in Switzerland use typewriters only for writing documents …

        Price asked for Michael´s medical notes is at least 60.000 Swiss francs, which could hint to Switzerland (or then it is deliberately chosen for the public and police to believe so).

        Here you can find the original Bild.de article with the original Sabine Kehm´s statement: http://www.bild.de/sport/motorsport/michael-schumacher/kranken-akte-gestohlen-36509834.bild.html

        Being a realist and cynical, I believe it is only a matter of time until we see leaked pictures of Michael in the internet. They are not going to be very fotogenetic.

        It seems, that Swiss and French university hospitals have serious issues with document security. I recommend the relevant authorities to contact with Finnish F-Secure for instance to improve on documents secrecy and to study the Estonian way of dealing with electronic documents handling. Estonia has NATO center for cyber-war and is very advanced in computerized society, including voting.

      • I thought it was fairly telling that Sabine spoke of ‘documents and data’. That to me indicates scanned documents and computerised data. It would be fairly easy to get hold of, if you were in the rightlace at the right time; for example, outsource your IT function to a cheaper location, give the outsourcer access to your network whilst they can access their’s and put them in charge of your backups/restores with all the permissions that they need to do this. A disgruntled employee or a chancer realises what they have access to. Given the small sum of money being asked for his medical records -you’d never work in IT again – that sum would have to support you and yours for the rest of your life, comfortably. I know where I’d be looking if I were Interpol…

    • I saw this coming days ago. I’m surprised we haven’t seen a picture of him in ICU. This happens. Someone got a picture of Michael Jackson laying on a table after he died. Elvis Presley was photographed after he died. RFK…JFK….all were photographed after dying. I’ve seen lots of pictures of celebrities on ventilators published in the National Enquirer. Yes, I read it.

      People will sink to all time lows for money….tar and feather them.

    • Motives and reasons fascinate me, hope you don’t mind me giving my opinion.

      1. recklessness – money, fun etc – angry stuff… English law detriment is taken as full if it cannot be measured and is directly related to the heinousness of the action… (I think tar and feather is for treason and this sort of abuse is given the public stock – put in the stock in the square and let to the public.)

      2. fan – love being the motive, someone fed up of life hanging in the balance of hope, the uncaring on a confident although sick platform, the caring lacking the same without information…

      3. person with similarly unwell loved one – level of MS medical care and potential life saving information – a legal pandora’s box of affects and detriments…

      … with 1… is regard for societies conventions expected without social equity? … born poor persecuted by the Police – something about fear of talent – this like 50 adults on one 10 year old child unable to hope to achieve, gives up, loses respect; high birth level chances in life being given allowance; social management of public servant vigilantism or expectation upon layman to recognise/manage corruption…

  16. I guess MS didn’t have a healthcare directive? Or maybe he indicated his wishes to have continued life sustaining measures no matter what the prognosis may be? This is the most critical and personal of issues that we all face and should address. While I wouldn’t want to be kept in a nursing home dependent upon others and I wouldn’t want to burden my family, these are MY wishes. Perhaps things are progessing as he wishes. I can’t believe someone who took so many chances in life wouldn’t have a document or at least a conversation about they would want if the worst of all possible scenarios should occur. And I guess it is hard to believe that someone like MS who was the thrill seeker of all thrill seekers, would want to be facing a future of immobility and reduced faculties. Oh well, we are only on the outside guessing.

    • Deanne,
      There is a short story by Dalton Trumbo (Am.1938) called “Johnny Got His Gun” that has haunted me anew since Michael’s accident.
      (synopsis from wiki) . . .
      “Joe Bonham, a young soldier serving in World War I, awakens in a hospital bed after being caught in the blast of an exploding artillery shell. He gradually realizes that he has lost his arms, legs, and all of his face (including his eyes, ears, teeth, and tongue), but that his mind functions perfectly, leaving him a prisoner in his own body.
      Joe attempts suicide by suffocation, but finds that he had been given a tracheotomy which he can neither remove nor control. At first Joe wishes to die, but later decides that he desires to be placed in a glass box and toured around the country in order to show others the true horrors of war. Joe successfully communicates these desires with military officials by banging his head on his pillow in Morse code. However, he realizes that neither desire will be granted, and it is implied that he will live the rest of his natural life in his condition.
      As Joe drifts between reality and fantasy, he remembers his old life with his family and girlfriend, and reflects upon the myths and realities of war.”
      lm

    • That’s a good point. But healthcare directives I suggest are a little like Prenups. Easy to write and sign …. but much more difficult to enforce when confronted with the reality of life all those years (or in some cases, months) later.
      And here we are talking about the choice of life and death. A whole new ballgame I would have thought.

  17. SO pleased to see a little humour creeping into this blog. It helps, doesn’t it?
    We’re all so sad, some even devastated by what has befallen Michael, but to dissect to the N’th degree the minute of his accident seems a little far fetched, doesn’t it.
    Listen chaps – sorry, I’m English … I believe that equates to ‘Guys’ in American! 🙂 – I’ve found some amusing (inoffensive and really very funny) spoof stories about MS’s racing exploits and derring-do around the web?
    Whilst we wait for Gary’s Video blogs (what’s he going to wear etc et … I can’t wait!) shall I share some of them? I will wait for some reaction before I do it, in case people don’t like the idea.
    But shouldn’t we try and move on now …. just a bit? And I contend a bit of fun is a good way to start.

    • Peter,
      Good idea! I know so little of him other than his F1 exploits. On the track he was so methodical, so focused – he knew what he wanted and how to make it happen – I never thought of him as a fun guy – except when he wore the Ferrari red wig on the podium and was, I understand, given a no-no from Maranello.
      lm

    • Peter, why do you have the need to tell others when it is time to move on because you don’t like the flow of the conversation. And I’m not interested in your spoof stories. Give me a heads up so that I can skip over them.

      • Mimi, maybe you should ask yourself the same question since you have told people to move on several times yourself..surely you can skip over any comments that you do not find titillating or those you don’t wish to read?

  18. Gary,

    Hi. First, I just want to say that I am a relative newcomer to your blog, but as a lifelong F1 fan, have found it incredibly interesting and informative. I’m sure I speak for many contributors here who really appreciate your time and accessibility.

    I have a question for you, but a short preamble first. I’m a software developer who has worked for a number of years on writing software to help run rehabilitation programs for patients (mainly returning military personnel with combat injuries) who have suffered mTBI, so have had an incidental interest in the subject as a result of my work. However, my more recent and intense interest was sparked as a result of Michael Schumacher’s accident.

    The question I have, and which I have not really been able to find a satisfactory solution to, is what exactly happens to the affected brain tissue in TBI to cause such devastating disabilities? You read about people like Phineas Gage who it seems effectively lost the best part of his left frontal lobe yet was apparently, after a relatively short period, able to continue almost normally, yet Michael has had a severe bang to the head and is completely incapacitated. I understand that the brain tissue is “damaged, but does the tissue actually “die” in the same way that other tissue can do, or does this misunderstand the nature of brain tissue? If it does die, but the brain mass is still there, how can dead brain tissue co-exist with healthy brain tissue without decomposing or deteriorating the latter?

    Thanks.

      • The question I have, and which I have not really been able to find a satisfactory solution to, is what exactly happens to the affected brain tissue in TBI to cause such devastating disabilities?

        “Fabulous question. This one deserves a nice written response, and I’ll make this the subject of an upcoming blog post.”

        Just my $0,02 worth of enthusiasm and expression of eagerness for this upcoming post. Cheers.

  19. Hi Jan,
    Thank you. I think Peter nailed it when He said in His comment that MS was traversing across and is something He’s probably done a thousand times before. Just terribly bad luck on that day.

    G’day Mimi,
    As Peter alluded to, MS was apparently traversing across. I did re read the French investigation earlier which said that MS was indeed of piste by a few meters and that allegedly another Skier had footage of MS going to the aid of someone who had fallen.

    The French were unable to obtain this footage and the Helmet Cam did not show footage of another fallen Skier.

    Maurie

  20. G’day Doc, I think I could find or add an element of danger to sitting on the Couch wrapped in cotton wool. 🙂
    Maurie

  21. Doc, when you mention “chronic” head injuries are referring to multiple concussions?
    This has come up with pro football players here in the USA. I’m sure you know that and there is some legal action pending. Players who have had multiple concussions are claiming the result of such has given them dementia, seizures, strokes etc.

    Personally, I think it’s just a money grab. Most of the guys who are a part of the class action did not make big money and it’s there way of getting it now. Of course, this is just my opinion.

    You take the risk for whatever reason and you pay the consequences.

    • Hi Mimi

      If you get a chance, please go to Amazon.com and rent the documentary “The Crash Reel” which, I believe I have mentioned before. Kevin Pearce’s story about his very serious TBI takes the audience from prior to and up to his experience back again riding his snowboard. The only thing the documentary doesn’t show is his actual surgery. The director is Lucy Walker. It answers sooooooooo many questions including questions about ongoing brain injuries. It also gives one an extraordinary exposure to the emotional, physical, and spiritual affects and effects of a serious TBI.

      Today, even mild concussions are looked at as traumatic brain injury. It’s been over 3 weeks since mine and my CT showed only no hematomas. The ER doctor said my symptoms, as a result of my baby TBI, could last up to two months. He was right; even exemplified today by my postings. I really thought, felt, was sure, that Gary had changed the directions of all our posts. I still have small problems, especially in my new job, but things are also getting back to my normal day by day.

      I am sorry to say, and I know you agree, that unless some given-to-Michael miracle occurs, that his prognosis is, at least as of this moment, what all the experts have predicted and shared.

      Best to you from the East coast

      • The Crash Reel is available as a DVD on Amazon UK too. I was given it as a Christmas present and rewatched it this weekend. It is a brilliant and moving documentary and deserves the widest possible audience.

  22. Austria was fun and safe and. . . FINNS FOREVER!!!! If Kimi could manage to get himself on the podium with Rosberg and Bottas it would be (in my personal opinion) perfection. (Also, Finn Mikko Ilonen won the Irish Open today.)

    And Vettel continues to handle his misfortunes with grace. Impressive.

    Of course one can’t watch F1 without thinking about MS and I’ve wondered if he’d gotten the Mercedes team chairman position rather than Lauda (apparently he wanted it very much) would that have given him work away from the ski slopes that December 29th? It’s just all so sad and such a waste. (Shouldn’t his high-tech helmet have absorbed the concussive force of the impact? Why did it split?)

    I’ve…uh..noticed that some fellow commenters disagree with my perception of things and I’ve thought about the true source of their anger. Who knows what goes on in the human mind? On a personal note, I’m a wife and a mother and those are the primary filters through which I see the world. When I heard of MS’s accident my thoughts went to his wife and children and how their lives would never be the same. I believed MS should not have taken the risk of skiing off-piste – and would say that about anyone who has a spouse and children waiting at home.

    This is an excellent website and I really appreciate the time and effort extended to make it exceptional.
    lm

    (Mimi: I’m a fan)

      • This IS an exceptional site.
        I sometimes wonder if you, Gary realise that…..but in my humble opinion it started becoming particularly exceptional since you started moderating the comments …. please don’t stop doing that Gary! All the best.

    • LuLu, the feeling is mutual. We both believe that the truth hurts but it must be told.

      I agree about MS taking unnecessary chances. Putting his life at risk totally ignoring the fact that he had two young children to raise and a wife. I now that’s harsh but it’s also selfish on his part. I’ve read he made a deal with his wife that she could have whatever she wanted as long as he was able to live the dare devil life with her support. Look what that got her….
      This is such a sad situation for all involved….Lulu you mentioned the Mercedes team chairman position that did not go to MS and had it he probably would not have been in the wrong place at the right time. But destiny finds you….you can’t hide.
      Somethings are meant to be…..right?

    • G’day Lulu,

      I think the French team investigating the accident found that His Helmet split due to the camera being mounted on it. Whether this was the cause or not I can’t actually say. Personally IMHO I think these Helmets along with cycling Helmets are inadequate! I didn’t wear them when Skiing or Cycling though to be honest I chose not to out of the fact I thought I looked more like a knob wearing one than not.

      I think life is about taking risks. I know when I used Ski, Ride Motocross,Water Ski,and ride Horses never, not once did I think I would have an Accident and end up with a TBI. I believe His F1 Career to be far more dangerous than skiing.

      We all take risks each and every day in our daily lives as we go about doing things. This can be walking down a flight of stairs to driving to and from work or taking a bath or shower. One can easily slip and do serious if not life threatening damage to ones head.

      Life would be terribly boring if we wrapped ourselves up in cotton wool and sat on the Sofa doing nothing.

      This was freak accident with tragic results.

      Maurie

      • Hi Maurie, yes this was a freak accident with tragic results. It is not as if Michael skied off- piste on purpose, I have heard that he was still actually on the main ski field on the edge of it when his skis went underneath a small rock which catapulted him down the mountain, how true this is I do not know, but as you said this was indeed a very freak accident and you have said it better than what I could.

      • No said MS should have wrapped himself and sat on the couch. I said he should have taken some of his responsibilities a little more seriously. There is an old saying that goes something like this…”don’t go looking for trouble”.
        I guess we will never know why MS was skiing off piste. Was it the dare devil in him? Or was he trying to help someone. Has that ever come out?

      • I too love being wrapped in cotton wool and placed on a couch.
        I always prefer it though if a few cat whips and one to two leather-clad dominatrix’s are to hand as well ….

      • Peter

        I LOVED your post… “I too loved being wrapped in cotton wool…” ABSOLUTELY LOVED IT!

        I am still smiling

        KC

      • Gary – Darn… Am I the slow one or what today. Sorry, the real credit for “cotton wool” goes to you.

      • Maurie
        I guess I am reading or receiving the blog upside down. No matter, I enjoyed what you wrote and I agree with Jan too; it was better than what I could have done as well. Nice read.

    • There’s been a lot of comment about Michael skiing off piste and questioning how ‘responsible’ was.
      Come on! That wasn’t off piste in the real sense. He was just traversing from one marked piste to another across a small bit of terrain, marked as not being a swept piste … We’ve all done it innumerable times (if we ski)
      Oh, and 29th December 2013 was a Sunday … Leading up to the New Year weekend. Even the chairman of Mercedes Motorsport would be unlikely to have been working.
      Let’s not get carried away with unnecessary conjecture! 🙂

      • The whole subject of responsibility and influence is a pain because people expect stereotypical ladylike behaviour, not running, jumping and falling over, but women manage the burdens of those risks, so want to contribute.

      • Philippa,,

        Yes yes yes. In his earlier years my husband rode off-road motorcycles, moto-cross, desert races, and it was all fun. He bought me a bike, had to “try it out first”, skidded across a paved road, bruised his thigh. A couple days later he had a chance to do test runs with factory riders so he did. It was all fun until he fell hard on the same leg. It started swelling and swelling and I took him to the doctor who immediately put him into the hospital for a massive hematoma. He said it was the worst he’d ever seen. I sat at his bedside every day.
        Once out of the hospital the wound continued to drain for weeks. Incredibly nasty stuff. He was left with an ugly puckered scar, but that was it. Once the swelling went away he was back in his leathers and on his bike. All of this was his choice and I understood the joy he found in it, but the consequences were the result of his choices so he had to bear the responsibility. If he’d landed on his head then he might still be in a darkened room somewhere. . . .
        lm

      • Well said Peter and for people to say he put his life at risk is just plain stupid. he never went out intentionally to hit his head on a big damn rock

      • Lulu, they want to get out of bed and go full pelt at anything, not choose something they love but go flying at things, usually anything that goes fast enough, which is dare devil but not the place they all crave.

    • Comments seem to end up in places one doesn’t intend them to. I was replying to Lulu, but my last attempt ended elsewhere, so here goes again –

      There’s been a lot of comment about Michael skiing off piste and questioning how ‘responsible’ was.
      Come on! That wasn’t off piste in the real sense. He was just traversing from one marked piste to another across a small bit of terrain, marked as not being a swept piste … We’ve all done it innumerable times (if we ski)
      Oh, and 29th December 2013 was a Sunday … Leading up to the New Year weekend. Even the chairman of Mercedes Motorsport would be unlikely to have been working.
      Let’s not get carried away with unnecessary conjecture! 🙂

    • Gary isn’t just an excellent medic (plenty of those) he is an excellent science commuincator (rare). Combining both skill sets is what makes the blog readable AND informative.

      As for the comment how come Michael’s helmet didn’t absorb the blow but split instead, the splitting shows precisely how it DID absorb the blow. Sorry if this has been covered.

      There are usually ‘layers’ of protection (literally and figuratively) in protective headgear but the final absorptive effect of a helmet system is normally for it to absorb energy to the point of destruction. After that (i.e. having been exposed to a greater force than it is capable of protecting against) the protective effect of the destroyed remnants is typically minimal and relevant only to light subsequent abrasion, not manor repeat impact.

      It is perfectly possible to design protective headgear that could survive incredible impact forces in one piece (titanium F1 helmets anyone?) but it would be more dangerous that way. Headgear’s failure to self-destruct or massively deform under ultimate impact would give the outward appearance of strength and protection but merely mean that huge forces were trsnsferred to the head instead of being absorbed. Besides which, as I’m sure Gary said very early on, often it is rotation forces rather than blunt compressive impacts that cause serious tearing. That’s why motorcycle helmets typically have a more rounded shape and fewer protruberances since rider heads are far more likely to receive rotational tangential impacts as they strike the road or scenery. With car helmets the user is practically always tightly harnessed and even in open cockpit cars is far less likely to break free and strike stationary surroundings a glancing blow at speed.

      • Peter,
        Thank you for reminding me that the helmet had to absorb the impact – just as an F1 car flies into pieces while the driver emerges with little or no injury.
        lm

    • We have a good chance of seeing Valtteri Bottas wearing dolman and/or pelisse (in Hungary), kimono (in Japan), kosovorotka (in Russia), thawb and agal (in Abu Dhabi) etc., Next year maybe Frank Williams is forced to dress in dirndl 🙂 if the success continues.

  23. Dr. Hartstein, I keep thinking that the lack of skull fractures and the severity of brain bleeding from Schumacher’s injury, do you think it is somehow related?A friend of mine got knocked a hole on forehead, fratured base and temporal skull as well, lost consciousness on impact, was put in comma for few days. The situation looked really bad, but he barely damaged brain. It was just a contusion and he fully recovered.

    It seemed to me that the really bad bone fractures actually absolved most of energy and protected the brain.But I didn’t hear any mentioning that Schumacher had any skull fracture and indeed he was conscious when paramedics arrived. I was just wondering if the helmet designed better or not wearing helmet at all and allow skull to take the impact first, could that be better or be worse?

    • Thanks for your interesting comment!

      While it’s certainly true that some energy of a blow to the head will be expended if the blow is severe enough to fracture the cranial vault (or base), statistically patients with skull fractures have considerably higher incidences of hematomas and other evidence of brain damage when they get scanned. This probably reflects, of course, the impressive energy necessary to fracture the skull.

      I think it’s highly likely Michael had a skull fracture, because we know he had an extradural hematoma. These are very often (almost, but not quite always) the result of a tear of the middle meningeal artery caused by a skull fracture overlying the artery.

      The middle meningeal artery is just inside the skull and can be torn by a fracture overlying it. This often leads to an extradural hematoma.

      Here you see that the branches of this artery (with blood under high pressure) run directly under the skull bones at their thinnest places. The artery can therefore be easily torn by a fracture overlying it; this is a frequent cause of extradural hematomas.

      Hope this helps

      • You’re a pretty smart dude! Anyone who dares say you don’t know what your talking about is a bona fide nut job with an IQ of 9.
        Keep it coming, Doc.

      • Gary,
        Do you think that Michael’s prior head injury (motorcycle) may have ecerbated, in any way, his skiing injury? If it possibly could have,what might the effect of same be, especially with regard to his recovery level?

        Thank you AND Peter is right, the new blog is even better and I am looking forward to your next installment re: your F1 career.

      • Excellent question KC. As far as I know, from vague talks with Michael’s personal physician at the time, he mainly hurt his neck.

        There’s a simple answer, and that is that it’s almost inconceivable that his earlier accident would have a significant impact either on the severity of his skiing injury, or on his brain’s capacity to bring to bear it’s entire reserve of plasticity and repair.

        As you could’ve guessed, I think there’s a complicated answer lurking in there somewhere. It’s related so something I’m going to blog (vlog?) about soon, and that’s the notion of “chronic” head injury. How’s that for a tantalising trailer?

      • Gary – I’m addicted to your fantastic site. I come to this site first every morning now. It is great to have direct link to such a well informed doctor and the level of comments is really thought provoking and fascinating. I clicked on New York times link below – thanks Katharina. Fantastic article.

        I rewatched ‘the Crash Reel’ this weekend which I was given as a Christmas present just before MS had his injury. So poignant to watch now especially to see the part about Sarah Burke’s death and very interesting to chart Kevin Pearce’s recovery. Some of the early footage of him in hospital is even useful to show the type of state MS might be in now.

        Thanks so much Gary.

      • With contusions, bleeding and damage, does it depend on the place of the fracture relative to the functional area. For example, is a fracture at the back worse than the front. As I understand it, fracture at the back causes more serious problems, severe dizzyness, memory loss, and problematic giddyness / concussion, whereas with the front the symptoms are a tenth?

      • For Gary’s eyes only…

        In response to your question regarding your new blog in relationship to my question re: ongoing TBI’s… My answer to your question is SEXY!!!

        I hope my answer puts a smile on your face with your, already, very heavy workload.

        Affectionally… hmmm… and with a very recent experience with a mild concussion… BTW, when the ER Doc came in the room he said, “Your cat scan is normal for a woman your age.” That remark Gary should make you grin as well.

        All of us need a good smile as today’s news, apparently, signifies a new journey for all and in my opinion, could, possibly been avoided with more openness re: MS.
        KC

      • I spent Tuesday recording the first instalment. Need to do it over – I want it to be good, not mediocre. It’s coming – should be up and running pretty soon.

      • Another thing related, can psychological anxiety be classified TBI such that if someone has suffered mentally in such a severe way that it has become physiological; involuntary shake total or partial, inability to speak, loss of hearing or memory, all of which occur, I wonder whether career stresses also affect coma?

      • Fascinating question. This one’s a keeper – to answer you correctly I’m going to have to do some pretty intense looking for the experts. Sid and I spoke often about this, but that was before the immense power of functional neuroimaging was harnessed. Keep your eyes open – I’ll answer this for you, somewhere, somehow.

      • I’m curious about PVS – can the psychology go to sleep as a result of depression hence the low frequency brain waves, so you can give anti-depressants or stimulants to the person, what about LSD?

      • From what I’ve read, the symptoms are the same, one from the outside in and the other from the inside out.

  24. I think we morons and poor devils miss your technical articles, be them about consciousness disorders or about urgent care medicine, be them about serious head protection vs questionable head protection vs placebo which lulls user into a false “feeling safe” complacency, or be them about a chest-mounted or “jaws” GoPro vs helmet mount.
    BUT I do think we should focus on objectivity, engineering and EBM data, or at least data with some scientific support, else we will turn this blog into yet another place “Your opinion vs mine, and mine is correct” which the internet (and our local pubs) have plenty of.

    • That should’ve been directed at me, mine directed out of frustration.. comments about his body giving in when he’s woken from the coma just seemed like devilry to me.

      And I apologise for my comment about morons to some extent, speculation difficult to deal with, and I’ve had it for years with Family Law, some genuine, but most so arrogant they don’t just speculate, they know and you are just an idiot who’s finger painting.

      I’ve just seen so much BS over the months and lost my patience so stomped on it. Sorry.

      • Not to worry – I’m pretty sure that we all get/got it. No need to apologise – morons and devils are orders of magnitude nicer than some of the mud that’s been slung here in the past.

      • To clear it up a bit, I’m not talking about people who are genuine, those sorts of comments/thinking is normal as long as theoretical points of view don’t take the care out of life, wrong in place of opposite theories based on recovery.

        It’s the comments directed at destroying hope or dragging it down, mud slinging to see what sticks my mother calls it, another kind, false accusations to see what someone will admit to, no care but for whatever agenda they have, time and energy in other people’s lives nothing but for waste.

        My mother does it, like a type of munchhausen’s condition, but more general, doing wrong to be controlled but feeling inferior when controlled so hurts to be superior, the same with mother and child, fears inferiority to the child, so hurts the child to damage it so she can be the mother she can’t be without the child being less able than her.

        As for MS, I’ve known of both brothers since 1991-2, and have loved racing since I was small, also loving medicine so it was a natural combination. I’d forgotten about racing until Schumacher’s accident, and realised I’d forgotten a massive part of my life, so it’s been very personal for me from that point of view, but I also remember comments from my mother when he first started winning, and a protective feeling I’d had then which is probably why I’ve been so and kept it in my life since it happened.

        It’s all a bit strange really, but my life is strange, so it’s not really new.

  25. Massa is on pole today. I followed his story when he too was in a coma. I just think it would be in some way fitting if Massa wins today.

    • PS – I wonder if you were there when Massa had his accident. I read at the time that he was very agitated and had to be sedated in the car, then panicked because he was swallowing his tongue and an emergency tracheostomy had to be carried out. Even if you can’t talk about Massa specifically I would be very interested to know if this is a possible scenario in an agitated patient (this might have been the situation for Schumacher as well.)

      • I was there and none of that happened. He was severely injured, we performed an emergency extrication and promptly transported him to the medical centre and from there to the receiving hospital. The only driver to have required airway control by other means than a regular endotracheal tube is Mika Häkinnen, after his accident in Adelaide.

  26. I don´t understand people who keep criticising the family and Sabine for the lack of information about Michael´s condition. When you look at Sabine´s statements in chronological order, they seem reasonable, they don´t contradict one another and they cover all major and even minor changes in Michael´s condition. She doesn´t provide details because details are fodder for tabloids and she doesn´t want to go in that direction. Is there anything wrong about it? Really I don´t get all that criticism.

    • Otto,
      if you have got have a basic knowledge about traumatic head injuries, its various degrees of severity and the statistic outcome for those patients, then you might be able to draw a picture of MS yourself,
      based on what the doctors at both press conferences in Grenoble told us, the length of his phase of “waking up” and the small amount of information Sabine Kehm gives to the press.

      If you do not have that knowledge, only by the informations of Mrs Kehm, I think it is is very hard to imagine the physical condition of MS.
      So if that is the case,one needs much more information to have a clearer view of the situation, and this is what Dr Hartstein does in a superb way!
      Whether you are a medical layman or a physician yourself does not really matter, reading this blog gives a deep insight to this subject.

      Assuming you are reading here too, (??) you already have much more information than people who only read the news, giving by the management of MS.
      Maybe that is why you feel it is sufficient what his family does.

    • Disrespect, leaving people to come out and ask and risk causing offense, leaving fans floating around to give up on him, and leaving him to answer the questions when he wakes up.

      So he wakes up, and copes with “you’ve been asleep for 6 months, it’s June 2014, you can’t move because you’ve lost 20 kilo’s of muscle, oh and honey none of your fans know anything so you’ll have to fill them in with the details (nice mental state right out of a coma) (why won’t they just leave us alone)…

      Oh and by the way (tears tears) all these people set up RIP sites stating you were dead and began stating all this hatred they’d held against you for years, but I told the world to stop invading my privacy, fans and the press demanding information, it was a difficult time…

      So, how you going?

  27. This is an interesting article from Dr Ganesh Bavikatte, consultant and clinical lead in neuro-rehabilitation medicine at The Walton Centre, Liverpool.

    It outlines the course of recovery from an expert in prolonged disorders of consciousness. Although Michael is undoubtedly at the very severe end of the spectrum it is not impossible that he will make some very slow progress even if he remains permanently disabled. It appears he is not in a vegetative state or a permanent coma, both of which are worse than the minimally conscious state.

    ‘When people come out of a coma after a severe traumatic brain injury there are several stages of awareness. Firstly after a prolonged disorder of consciousness they are still on sedation and still not able to perceive their surroundings.

    Then it is like waking up from sleep. They open and close their eyes, try to understand what they are seeing, hearing, smelling, tasting and touching. And then they try to communicate both with health care workers and their loved ones.

    People do struggle to communicate when they come out of a coma. At this stage some people can talk but some people are unable to speak any sentences, so they will use a hand gesture, or a winking eye or some kind of behavioural response.

    So when we start noticing those signs, we try to improve that further through rehabilitation. We use specialised therapy like occupational therapy and psychological and speech and language therapies.
    The first thing a doctor will do is improve awareness, and the communication and then functionality and movement with our physiotherapy colleagues.

    We need to try and improve independent living while also trying to avoid complications. Even small complications could make things a lot worse. He had pneumonia a few months ago, so monitoring for medical complications is very important.

    Being immobile for such a long period of time means that he risks a clot in his legs or his lungs. Physical therapy to the limbs is very important.

    Although he has been moved to a rehabilitation centre it does not necessarily mean he will be up and about. We accept bed bound patients at our unit. And disability can be due to many factors. It may be a result of the injury itself.’

    http://www.telegraph.co.uk/sport/motorsport/formulaone/michael-schumacher/10903061/Michael-Schumacher-road-to-recovery-will-be-long-and-difficult-for-Formula-One-legend.html

  28. Once someone ‘settles’ into an MCS what are the options for moving them around in the open?
    I ask because I saw today a young man, clearly interacting with his environment in only a very minimal way, being wheeled around Portsmouth in a very large, very complex looking electric wheelchair.
    It seemed (though I may be quite wrong) to be even equipped what a ventilator of sorts.
    I wondered whether this represented the future for such patients if any form of interaction with others and ‘freedom’ of movement is to be considered.
    My last post of this ended up in the wrong place.

  29. Pingback: Good news? | Pappillon

  30. I read that MS is variously reported as ‘opening his eyes’ ‘uttering a word’ ‘blinking’ (inferring a message being sent) ‘communicating’ and all sorts of other signs of improvement and I’m reminded, yet again, of the weeks my brother-in-law spent in hospital, locked in coma. At first visitors – even family – were restricted to one at a time. (This was in Mexico.) Each day, as family and friends filed singly out of his room they each reported a glimmer of hope: ‘he smiled at me’, ‘he winked’, ‘he said my name’ and on and on. Yet several times a day when my husband and I went to his bedside we saw a man frozen, with his left arm raised about a foot from the bed and both hands spread like claws. His eyes were slightly open, but there was no light in them. There was no smile, no wink, and no hope. It became a charade that everyone seemed compelled to participate in, but it wasn’t real. Worse than that, it was a crazy-making weight on his wife because she was in the position of having to protect everyone by nurturing their fantasies. Finally, we interceded with the doctors to remove John from the hospital and bring him home. (Only after paying an enormous sum in the form of a Cashier’s Check – it felt like ransom)

    Someone commented that it would be hard on the family to have MS home. Believe me when I say that it was an experience I would never wish on anyone. For weeks and weeks it was as though the dark shadow in the sick-room spread throughout the house and there was not a moment of respite.

    Michael’s situation is so much worse because he’s only 45 and his family had every reason to look forward to spending many more happy decades with him, but now they won’t. They are doing the best they can.

    • Lulu, everything you said is right on. We will never, ever know the truth about MS. We may know at some point after he passes away when someone writes a book. There will be a book.

      • There is an article about Corinna and her marriage in the Scottish Daily Record. I received a link, knew nothing about the publication, but it was kind and sympathetic to a woman in a miserable situation.

    • I understand this all too well. A loved one was in a car accident with terrible head trauma and was in a coma, but then weeks later his eyes opened but seemingly looking at nothing. A man spoke to me one evening in the hallway to ICU. He asked me what my husband did for a living. I said he was an engineer. “He will never be able to do that again”, he told me. He went on to tell me that his nephew hit his head skateboarding and that he will be forever an invalid and dependent on his caregivers. “I wouldn’t wish this misery on anyone – he is simply existing”. He was in street clothes, but after we spoke I looked at his lanyard and ID around his neck. He was an ICU doctor. I also spoke with a lawyer who specialized in TBI. He warned me that death would not be the worst outcome. That hospitals move the TBI patient quick as possible and offload them to rehab facilities and it is very difficult to get insurance to cover any kind of meaningful rehab. Of course with the wealth of the Schumacher’s this is a slightly different story. Although the outcome may be the same regardless of the best care money can buy. After discussing the outcome of tests on brain activity and the various diagnostics they use with his neurologist, and with the blessing of his mother, we decided to not take any extra life sustaining measures and he passed peacefully 4 weeks after his accident.

      • Deanne, I am so sorry. But what you did is sometimes the right thing to do. It’s an unselfish act. Letting go is not easy. You do what is best for the patient and not for yourself and family.

      • Hello Deanne,
        You make the most important point: when is saying goodbye the best decision? What would the patient want? I wonder if there’s anyone who would choose Michael’s existence now over death? I’ve thought so often these past 5.5 months that if he had died on the slope the shock and sorrow of that day would have given way to acceptance and his family could have moved on. But now they are stuck in misery until his body does finally give up. Perhaps this high-profile case will illuminate an area of post-trauma medical care that needs to be addressed: letting go.
        lm

      • I survived a burst appendix, advanced to second degree peritonitis and septicemia, when I was 3 years old, blue and not breathing before the ambulance arrived, probable prognosis of massive brain damage but I have a 130+ IQ.

        Only online documentation I could find, showed 7 similar cases in 1976 where all other children died. So on arrival at the hospital my chances of survival were 100% fatality.

        My son had a dire prognosis also, born 1.5 kg’s at 31 weeks, medical staff struggling to insert a IV because his veins were too small. He walked 13 months, my sister’s full term son walking at 15-16 months, and at 18 months was able to connect, turn on and play my keyboard.

        If you looked at typical prognosis, remembering there was no developed brain structure to rely on as with MS, there was no hope for me even to survive, let alone be as I am, and my son should be severely delayed if not handicapped.

        In short, where there is life there is potential.

      • lulumoretti ” … I wonder if there’s anyone who would choose Michael’s existence now over death? I’ve thought so often these past 5.5 months that if he had died on the slope the shock and sorrow of that day would have given way to acceptance and his family could have moved on. But now they are stuck in misery until his body does finally give up … ”

        But MS didn’t die on the slopes 5.5 months ago. In fact reports suggest he was still conscious and moving about immediately following the accident and it was only when he was in the helicopter that difficulties became apparent and MS had to be put into a medically induced coma. I really don’t see how speculating on something that definitely didn’t happen is going to help in this situation right now.

        Similarly I don’t see how speculating whether anyone would choose “MS existence now over death” is going to help. It is also not clear exactly what you mean by that statement. If you mean
        a) “Would MS choose his present existence now over death”, then you would need to ask him, Since he is not dead at the moment one must imagine he is not “giving up” at the present time. Similarly, since this type of outcome was a possibility during MS racing career, it would appear that MS didn’t leave any forwarding instruction that for the actual current condition he finds himself in now, that his life support systems should be switched off, because they haven’t. In summary we can at best conclude that for the current situation MS has chosen the present condition “rather than death”.

        If you mean
        b) “would his wife Corinna and family “choose MS existence now over death”, then the present indications are – yes they would chose MS existence now over death … as there is absolutely nothing they have done so far that would indicate otherwise.

      • I’ve been thinking about this myself for the sake of my son. If I could write instructions it would say save my life at all costs using any means or methods possible, available or not invented yet.

        Anyone who would say differently, with all due respect, is a moron, adding to that, anyone who would not do the same for their life partner or children is a devil.

      • Phillippa has stated an opinion that, by the nature of the question, is personal, individual, and not the type of opinion that is changed by argumentation. And she draws an equally personal conclusion as to the nature of those who’d not agree. Even though the (contrary) opinions of those who’d not agree are EQUALLY personal, individual, and not the type of opinions that are changed by argumentation.

        I say this because I know the passions of those who read and write here regularly and I WANT TO URGE ALL OF YOU, MORONS AND DEVILS ALIKE (and in lots of ways we’re all morons and devils, trying to be inclusive here), TO LET THIS ROLL OF (Y)OUR COLLECTIVE BACKS.

        Thanks, and let’s enjoy Austria!!

      • It just drives me nuts, and reminds me of my mother, on the one hand people have sympathy for the family but on the other side talk of burden and death, and as someone else said, the family have given no indication they feel this way at all, a contradiction to family itself, and you’re right I won’t see it any other way, nor do anything more than get more annoyed and more angry by anyone who tries.

        I just feel that some people have a fascination with death but wouldn’t have that view if it was their life, and think it’s disgusting, maybe other people wouldn’t say it, but I’m sick of molly coddling what makes me sick, and I mean to the extent of feeling nauseous.

        My mother is always dragging anything down even my son who is only 6 years old, and she’s not the only one, my poor son having no chance in life because of them, they enjoying the pain they cause me.

        The give up and give in comments, and this other comment about his body giving in, god almighty, how can his body give in when he’s woken up from the coma which is one step forward, (I cry for humanity), it’s like they want to impregnate death into the minds of people.

        I’m sorry if you find this a bit heavy, but it’s the truth.

      • With regard Gary’s Comment: I would just like to add the following. One of the most beautiful & emotional films I have ever seen is the 2004 Spanish film Mar Adentro (“The Sea Inside”). It sheds absolutely no light on MS current situation, but it does cover the issue of Personal Choice and the nature of true love.

      • Gary Wrote: “Thanks, and let’s enjoy Austria!!”

        Well, for Finns and for Finland the results are satisfying since half of the drivers on podium were Finns! Valtteri Bottas was first time drinking shampagne after the race and Nico Rosberg has dual-citizenship (Finland and Germany), i.e. 1,5 out of 3.

        ***

        Another issue, regarding the the medical facility Michael Schumacher presently is residing in and taken care of, I want to quote kanton Vaud´s homepage, which states the following.

        There are a number of public hospitals ensuring high quality medical care throughout the canton of Vaud. The main one is the CHUV (Centre Hospitalier Universitaire Vaudois – Lausanne University Hospital) in Lausanne.

        The biggest hospital in the canton of Vaud enjoys an international reputation for excellence and is one of the most important establishments in the whole of Switzerland. It has a dual role:

        -It acts as a general university hospital for people living in the Lausanne area, covering all areas of medical treatment.

        -It also serves as a hospital offering acute and specialist care for the whole population of the canton de Vaud and parts of French-speaking Switzerland.

        The university hospital complex in Lausanne plays a leading role in numerous fields (burns, organ transplants, oncology, cardiovascular disease, AIDS, ophthalmology, psychiatric neuroscience, etc.). It is involved in research activities and clinical trials of new therapies tested around Switzerland, Europe or the world.

        In terms of education and research, the hospital has close links with the Faculty of Biology and Medicine at the University of Lausanne.

        Regards
        Another moron

    • lulumoretti

      RE: “There is an article about Corinna and her marriage in the Scottish Daily Record”, you posted on June 21, 2014 at 4:46 am

      Here is a link to an online edition of a British newspaper discussing Corinna, Michael Schumachers’ wife;

      Michael Schumacher latest: Wife Corinna ‘should rest or risks getting ill herself’
      A doctor has spoken of the need for Corinna to take some ‘downtime’ to prevent her burning out

      http://www.mirror.co.uk/news/world-news/michael-schumacher-latest-wife-corinna-3731421#ixzz35HKmu95y

      • And this is only the beginning for Corinna and family. Do you have any idea how many times she will hear “how’s Michael”?. Or the kids will hear “how’s your Dad”? It will never leave them. Terrible thing to say but had he died they would have been well into the grieving process and beginning to realize that time does heal.
        Not many would want to trade places with the Schumacher family.

  31. Just wanted to say thanks to Gary and the others who responded so positively and with such kindness to my comment. It was not intended to be a criticism of others’ opinions but rather an observation that head injury is difficult to identify with unless you have experienced it first-hand. With regards to fans needing reassurance, recovery is extremely slow (we’re talking years) and improvements happen in very small increments. I don’t think the family have more than “crumbs’ to offer right now.

  32. Almost all of the people commenting here or at least what I’ve read seem to think there’s a prognosis for his condition. When in reality there is not. Instead of citing known and unknown doctors go read about prognosis – it can be made a YEAR after the trauma. It’s been 6 months and Michael is in CHUV now exactly to evaluate him and get a prognosis. Even the doctors around him now do NOT know what is going to happen. This is the first thing everyone should think about before posting their ugly and twisted thoughts here. Also, the attitude toward Corinna and the rest of the family (Sabine too) is the most shameful thing I have ever come across in my life. All of you should be ashamed of yourselves for commenting on her in this way. I don’t know what she thinks, feels or fears at the moment, how she is coping with the most difficult time of her life, but it’s inhuman to talk about her that way. She has done an incredible job of assuring their kids return to the normal course of living, school and racing and so on. Stop criticizing her because you don’t know what it’s like.

    • I think I speak for a great number of “us” in telling you we ARE ashamed, and will all go to bed without dinner tonight.

      If it happens again, we’ll ground ourselves for a week.

    • This blog has been very informative.

      But I must ask Doctor Hartstein, what are his motivations for speculating on this case?

      AFAIK, he is not directly involved in the patient’s care. But yet he is practically the ONLY Doctor that is constantly being quoted in news articles.

      Would it not be more ethical not to offer your commentary on this
      situation?

      • Once someone ‘settles’ into an MCS what are the options for transporting them around in the open?
        I ask because I saw today a young man, clearly interacting with his environment in a only a minimal way, being wheeled around Portsmouth in a very large, very complex looking electric wheelchair.
        It seemed (though I may be quite wrong) to be even equipped what a ventilator of sorts.
        I wondered whether this represented the future for such patients if any form of interaction with others and ‘freedom’ of movement is considered.

    • I don’t know, I think you have to see things from the fans perspective as well, the media indicating how many lives are affected. The current situation leaves people foolish for caring so much given they don’t actually know him, and having to manage whether they’re being abusive towards her.

      But I do wonder whether she wants people to go away when they don’t want to.

      However, in saying that, I agree a wife would suffer a great deal without medical knowledge, and that this is not easily resolved, strength subjective to imagination when people haven’t been in the situation.

      But however again, surely people have a right to complain when the life of someone they care so much about and who has been in their lives for 20 years, is left hanging on 2 or 3 updates. Surely he would want people to have accurate, clear information, vanity and inconvenience impressions not stated but left to the fans to carry in their goodwill, and things that are resolvable.

      As for her struggle, she’s the wife of a world champion and billionaire.

      She needs to instruct Sabine to spend more time with Doctors and research specialists and provide regular informative and informal updates of what is going on.

    • Dear Angie,

      With due respect, at the end of the day this is a viewable private opinion and discussion on what is being read in the newspapers and public media. The day one is prevented from discussing what is read in the daily news, is a day of victory for authoritarianism and a loss for the people’s right to express their own thoughts and engage in deiscussion. Personally, I would be more ashamed in allowing that to happen.

      If you had read the entire blog you will realise that Dr Hartstein set up the blog because of people requesting his view on medical and motor sport related news and matters, given his knowledge, expertise and experiences in these areas. This hopefully answers those questioning Dr Hartstein’s motivations: basically “we” asked for his views.

      Best wishes

      • I think the same goes for people’s feelings, rights to freedom of speech respective to the affect on others. When we have a balance, people thinking about what they say before they say it, our world will be a better place.

  33. Doctor Gary,

    These are the latest news reports in the online editions of the British newspapers;

    Michael Schumacher ‘likely to remain an invalid for rest of his life’
    Michael Schumacher is likely to remain an invalid for the rest of his life claims leading Swiss neurologist

    http://www.telegraph.co.uk/sport/motorsport/formulaone/michael-schumacher/10912937/Michael-Schumacher-likely-to-remain-an-invalid-for-rest-of-his-life.html

    Michael Schumacher latest: F1 legend ‘will remain an invalid all his life’
    Neurology specialist Erich Riederer said it could be counted as a “success” if he is able to sit up unaided after three months and operate an electric wheelchair within six months

    http://www.mirror.co.uk/news/world-news/michael-schumacher-latest-f1-legend-3723437#ixzz356rAqObJ

  34. Michael Schumacher is married with Corinna and not with Corinne or Corrina or Corine or Corina.
    It would be polite to try to spell at least the first name correctly. Maiden name of hers could be difficult to write for commentators of English-origin, especially for those who possess US citizenship.

  35. Dear Dr Hartstein,
    Throughout this blog you share your brillant evaluations and medical views regarding the condition of MS since his fateful accident last year and I want to thank you very much for doing that.
    It may sound a little exaggerated, but you provide the world with more intelligence!!

    Now MS will be treated in a hospital in Lausanne for an unknown period of time.
    Personally I do hope that one day he will be transferred to a “clinical-like” environment at his home.
    According to experience, being surrounded by loved ones for patients in a MCS has shown to be an important factor regarding further improvement, stability and life expectancy.

    I do know that every case is different, but I have a cousin myself who is considered! to be in a MSC after an accident with a severe traumatic brain injury for 22 years now.
    His parents (with the help of friends and a nurse) take care of him.
    His doctors were quite insecure, they considered PVS as well as MCS.
    However, his parents did not want him to take part in a study of Mr Steven Laureys to get a clearer picture of his brain functions (PVS or MCS?) as I suggested to them 7 years ago.
    Anyway they treat hime like a person with MCS, without “knowing” details of his brain injury.
    He has clearly shown signs of awareness from the beginning and I do understand that this is all that matters for his parents.
    His improvements over the years are small, but at least there is improvement.

    I wonder if there is any medical reason (as you have mentioned before, being ventilator dependent is not an obstacle) why a patient like MS should be in a hospital rather than home?

    • Thanks for your comment, your compliments, and your question.

      I think that rather than think of Michael as being hospitalised like an ACUTE patient, it’s more realistic to think of him as being in a long-term treatment facility. Over the entire population of acute patients, the average hospital stay would presumably be measured in days. In a rehab facility, whether free-standing or part of an acute-care hospital, stay would be measured in weeks (for example, an elderly patient after a hip replacement, or after cardiac surgery) to months-years (often patients with neurological problems, such as spinal injury, stroke, head trauma, and post-cardiac-arrest brain dysfunction).

      These kinds of facilities, in addition to taking care of the most basic, physical, needs (including physical therapy to slow muscle atrophy, prevent flexion contractures, and avoid pressure sores) also provide specialised rehabilitation techniques, adapted to each patient’s needs, in order to facilitate brain plasticity and function. This could conceivably be done at home. And even though this kind of environment could be set up by people of considerable means, the decision whether to do so or not is not one based on OUTCOME, but rather on practicalities, on the emotional reaction to having the loved one cared for at home, etc.

      Hope this helps.

      • Dr Hartstein,
        thank you very much for your precise and detailed answer!
        I appreciate it very much.

        Before, I looked at this situation with a rather one-sided view, assuming that a patient in his situation would most likely prefer to be treated in his familiar environment.
        I rather considered the benefits, not the potential emotional stress for the family members, when a complex rehabilitation takes place at home, and I completely agree with you, this must be equally taken into account as well as the high efforts that come along with his treatment.
        Luckily in the case of MS his family for sure has got the freedom and all the means to chose between these opportunities, so they can easily adapt to his or their needs and wishes to cope with that difficult situation.

      • If I were CoriNNa, I don’t think I would want him cared for at home. The family needs to be able to escape from the stressful situation. They need to be able to leave it behind for short or long periods of time.
        Don’t be surprised if in a month or two we see pictures of CoriNNa vacationing somewhere. Take a break from caring for her husband. She would deserve it.

  36. Dr Gary
    As he has been comatose for so long Do you think Michael will ever regain his mobility and speech either fully or partially ?

    • Doc, just trying to satisfy Jussi who loves to be critical of others regardless of the reasons. He insists we spell CoriNNa correctly. Nothing wrong with the keyboard.

      • Ahh I’m glad. I think we can announce that this comments section will tolerate spelling errors. Jussi, much as we all appreciate it, I’ll be the arbiter here of syntactic and semantic correctness. That’ll avoid things getting . . . tense. Right Belize?

      • Hi Mimmi and Kari,

        what a relief it is to know that there is nothing wrong with Mimi´s keyboard.

        In Mimi´s case, it was not a question of one single spelling error but of continued use of incorrect name for Michael´s spouse. Also, there has been other incorrect versions of Corinna´s name by other commentators. Therefore, I thought that it is about time to remind of correct spelling. I would like to add, that my comment was very neutral, general and was not directed to any individual commentator per se. Only afterwards I noticed that it was Mimi who had used “Corrina” constantly and repetitively.

        You Gary can be the referee in matters of syntax and semantics by all means – this is your blog. You did indeed decide to publish my comment, so it was to some extent relevant in your view.

        PS Mimmi and Kari are true Finnish first/christian names.

        PPS I do admire your sense of humour – similar to mine.

  37. News was leaking out like a sieve yesterday – I feel very sorry for Sabine who was reported to be looking pale and tired outside the hospital. Shows just how discreet the hospital in France was. Swiss hospital need to give an official press conference in my opinion and then we can all move on and leave them in peace.
    ‘Dr Richard Franckowiak, director of the neuroscience unit at the Lausanne clinic said:” “During the 120-mile road journey from Grenoble to Lausanne, he kept his eyes open for long periods.”
    Doctors hope Schumacher will regain some speech before the end of the summer, although this is by no means guaranteed.’
    ‘It is understood he is still being fed intravenously and sleeps with the aid of a ventilator, although during the day he has long periods when he can breathe unaided.’

    http://www.mirror.co.uk/news/world-news/michael-schumacher-can-nod-keep-3714506#ixzz354W0KU7q

    • Just to clarify one small point.

      Providing full nutrition intravenously long term (beyond a few weeks) is so difficult, expensive, and fraught with complications that it’s only really done (again, LONG TERM) for patients who CANNOT be fed using their GI tract.

      This is not the case with Michael. He will have been fed since early in his ICU stay, and still now according to Lausanne) via a thin tube placed directly into his stomach (or initial part of the small intestine) called a gastrostomy (or jejunostomy) tube. These formulas provide full hydration and the entire range of necessary protein, fat, carbohydrates, etc.

    • One can never state the obvious when there is a lack of information, but the information now coming from Lausanne, if true, does suggest MS is physically still in quite a bad way. Overall his condition appears to be on the low end of the spectrum of possibilities one would have been hoping for after getting on for nearly 6 months following the accident.

      As has already been mentioned the release of the English statement by SK and family – with its MS has “left” the hospital and “is out of a coma” line – certainly seemed to have been greeted by some with a sense of euphoria and happiness. This reaction would not have been unexpected for someone with knowledge and experience in the field of public relations.

      This is the second time where there has been a public kerfuffle over statements released by KS and the family (following a long period of silence) in which to those lacking experience on such matters, was greeted with joy and happiness, and a sense that MS may soon be “back with us”.

      The first time was when a statement was released about moments of “consciousness and awakening” and the second time was the current one. I think the effect worked by having a more or less complete silence of information followed by a brief statement, that was fairly vague and lacking in context, that gave the sense of great change and great promise to MS condition. I accept that even I have been carried twice on a wave of optimism over possible good outcomes immediately following those statements.

      So all the more credit to Gary for being a voice of caution and reason in all of this. I cannot express just how important this blog has been for me in gaining a sense of perspective and understanding over what has been happening.

      • You’ve got to expect that but it means nothing about the brain injury, and the lack of muscle could be a good thing, he doesn’t have the muscle come down athletes have, rehab will hurt though.

      • The first time was when a statement was released about moments of “consciousness and awakening” and the second time was the current one. I think the effect worked by having a more or less complete silence of information followed by a brief statement, that was fairly vague and lacking in context, that gave the sense of great change and great promise to MS condition. I accept that even I have been carried twice on a wave of optimism over possible good outcomes immediately following those statements.

        While I agree w/ those expressing general unease with a seemingly very cynical and calculating manipulation of the public via a compliant press as regards Michael’s hopeless condition, the one question I have is…Why?

        What’s to be gained from not admitting just how hopeless his condition is?

        Who/what is served by obfuscating and encouraging false hope where none is justified?

        What could possibly be the justification for not simply saying something like:

        “Michael’s condition is dire, his prognosis for recovery remains grim, and he continues in a minimally conscious state – but when/if anything changes we will update Michael’s legions of fans and admirers. In the meantime, please respect the Schumacher family’s wishes for privacy and to be left unmolested during this understandably difficult time.”

        (???)

  38. This article with quotes from the staff at Swiss hospital put current state of play in perspective:

    “And Darcy Christen, the Lausanne university hospital’s head of media, confirmed that Schumacher’s stay “won’t be days. It could be for the long haul”.

    “The transfer doesn’t mean that his condition improved markedly in the last few weeks.

    “He is still going in and out of consciousness but he is having more moments of consciousness more regularly than in April. He certainly can’t talk but there is some degree of communication.

    “His doctors and family speak to him but he gets tired very quickly and needs a lot of rest. So this is kept to a minimum,” he added.

    “It will be a very long journey, and it is hard to say what will be the outcome,” Christen said. “Whatever happens, it will take a lot of patience.””

    http://www.grandprix.com/ns/ns28258.html

    • Each person is different. For me when I had a family member in long medical care, the best thing was medical knowledge and most importantly, the mental health of the brain.

      The worry is worse than learning to trust in yourself regarding your medical judgment. It’s very difficult when a development path offers so little proof along the way, but as you learn one thing after another, how one thing affects another, etc, you begin to see where you were before blind.

      This takes away a lot of the burden of worry, but when doing it alone without a lot of medical information, the burden of the work is ten times the worry, resolving one over the other extremely difficult.

    • How do we interpret “long haul” “long journey”. Is that days, months, years?

      Let’s just assume the family agreed to an update every two months. All this speculation and so forth could all be eliminated and less stress put on the family.
      I know Corrina is devastated, or I think she is….but she has to realize there are a lot of fans out there who are also devastated. Someone needs to reassure these people, on a regular basis, that MS is indeed on the road to recovery. To me, that is not a lot to ask.

      • I would like to add to Mimi’s comment. I assume that the MS family are still receiving income from the public and his fans in the form of merchandise and associated advertising and sponsorship for use of the MS brand.

  39. Cynical, hostile, arrogant,…. I see all those words used to describe Sabine Kehm’s and the family’s attitude / press releases. I for one would love to know more detail about Michael’s condition but I struggle to see why she/they would put so much effort into being cynical and hostile. It seems to imply intent and deliberate effort. I would think they have more important things to deal with than “us”.

    Headlines running amok may be a result of their communication strategy for sure, but somehow I’d like to think that they are not that calculating in their communications to deliberately offend us or want to ” stick it to us “. Surely they have more important things to do..?

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  41. As we know Michael was transferred by Ambulance and the article I read, all Personnel involved, Nurses, Paramedics and staff had to hand in their Mobile Phones and were sworn to secrecy. One of Ambulance Drivers did comment to a newspaper saying Michael has lost a lot of weight…This of course is to be expected.

    The Driver also commented saying that Michael had his eyes open for the 200 mile trip yet did not speak nor can he walk. Michael is still ventilated but can communicate via blinking his eyes.
    Surely this would be great news and one would think something that Corrina would want to share with Michael’s fans.

    Yet She allows speculation and rumors to run wild and then has Sabine try to correct any of these stories. None of this would happen if Corrina would give updates.

    I do understand her want and need for privacy but at the same time Michael is a very public figure, he become one the minute he stepped into an F1 car.

    Getting back to Michael himself. If as Ambulance driver reported that he can in fact communicate via blinking eyes then I believe him to be at the very most to be in an MCS and This the communication is at best inconsistent itself. I would presume it would be very difficult for any long term recovery.

    • Put yourself in Corrina’s place….would you be jumping for joy if your husband couldn’t speak or walk and was on a ventilator? She doesn’t want the world to know that MS maybe be in MVS or a PVS. I think she wants his fans to remember him how he was and I think she may wish she could do the same. Can you only imagine how hard this has to be on these people? I don’t think the shock has warn off…Corrina is probably still in a state of not believing and this is all a dream that she can’t wake up from. Heart breaking!!!

      • Hi Mimi

        I will probably get jumped on by this statement, however, could this situation not be compared to Ariel Sharon, the Israeli Prime Minister who recently passed? His family was devistated, he, after his stroke was in a PVS, but prior to that the entire country… and world… was devistated, and yet all were updated as to his condition essentially until he left hospital, and whose conditioned never changed until he passed.

        The comparison that I am making is because, frankly, I am pretty fed up with the dumbing down of Michael’s fans who, in fact, sincerely love and really care about him. Whether his wife, or the creature Sabine Kehm, want privacy for Michael, then they must at some time recognize the hurt, disappointment and lock-out that all of us have experienced by their choices.

        Granted Ariel Sharon was an internationally known individual for what he did in his life and Michael’s record as an F1 World Champion (way beyond anyone else in the world) was well known internationally as well. That being said, every one has a right to their choices and actions, but I personally draw the line now when my intelligence is insulted.

        I continue to pray for a liveable recovery for Michael. I pray that he breaks all the records re: TBI’s and somehow surprises every one. Until such time then just keep EVERYTHING private. I am not a crumb person therefore – especially to Sabine – keep your darn useless cookies to yourself.

        KC

      • Perhaps I could have worded my comment a little better. If as was reported that MS can in fact communicate via blinking his eye’s or nodding his head, as has been reported elsewhere. This is slightly better news as He is making some progress.

        This is what I was alluding to. I would also agree with you in that Corrina has not come to terms with this tragic situation, and it will take some time for her to accept the reality of it. I know how heartbreaking a situation like this can be.

        I read Brett’s comment and thank you for sharing. From here on out I too will refrain from further comments on MS and leave the Family in peace.

      • Hi, Peter…

        The people in Israel and the world were kept informed of Sharon’s condition. And right before he died the updates were basically daily. His family, obviously thought the world had a right to know. The Schumacher family does not.
        IMO, I don’t think the family wants the world to know how horrible he may look and what his condition really is. They are probably scared to death of a picture leaking. If not why demand the cell phones of the people moving him. He is a small man. 40lbs is a lot. He probably looks emaciated and unrecognizable.
        I try to understand Corrina’s attitude toward revealing too much or nothing but I also try to understand his fan’s need to know more.
        Peter, can you think of an American sports icon who may have been in a similar situation and how that was handled. Dale Earnhardt was big in NASCAR….I can’t think of any that were in a PVS only those who were killed.

      • Hi back to you Mimi

        In NO way am I suggesting that anyone, that I know of anyway, has even expressed any desire to see photographs of Michael in his accident state or of him in the days or months that have followed even up to today. And I don’t believe that any one of us are wanting or desiring of same. Certainily not I.

        As to your question: At this writing I do not remember anyone at this moment… and maybe there isn’t anyone. I will, however, since I have a day to myself, have a look and see if there is someone and I will let you know. Interesting question.

        KC

      • P.S. to Mimi

        A first thought would be Kevin Pearce, a young man who was preparing for the Vancover Olympics and fell during practice. From the beginning of his injury, a documentary was filmed, “The Crash Reel.” He has also started a foundation called “Love Your Brain” to inform the public about TBI’s. It is a extraordinary film.

        I will continue thinking as I am sure there are others. Truthfully, I find myself swaying back and forth about the choices that are being made re: information released to the public about Michael. And, I found Brett’s commentary so poignant, so sensitive, so insightful, and so revealing – it was a welcomed addition to Gary’s blog and so genuinely appreciated.

        KC

      • For Mimi – I agree with you. Clearly, in my opinion, this whole experience must be an emotionally impossible situation. That is as close as I am able to come and I believe I am still miles away from really understanding what the Schumacher family is going throughas they live this tragedy and try to negotiate a new family reality.

        It is so sad…

        KC

      • I don’t mean to be rude but I had a newborn baby in special care for 6 weeks, god forbid someone had called it sad, I would’ve doubled over in shock that someone would say such a thing.

    • Ward manager of the special care nursery.. She’d come into the ward when I’d asked her to check because I felt something was wrong. She leaned over the humidity crib and just stared at me. I then watched as he turned blue and had to be revived…

      • I think the insult is felt in the fear of suggestion of permanence, both because of people’s games and you’re own worries doctors can’t and you don’t want concluded, so you’re not settled and don’t take comments positively, more on the paranoid, protective side of things.

        There’s more. But mainly being responsible for someone neurologically, you have to become different, you can’t see normal comments as normal anymore, in over-drive for affects and then influences. If you can imagine the affect of my son hearing it, you can see why I protect myself falling into conclusive states of mind.

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  43. Hi Gary,

    I’ve been following your posts on Michael Schumacher, most specifically because my husband sustained a serious head injury in 2003 and Michael’s situation brought up many of the emotional difficulties my daughters and I went through at the time.

    With regards to your frustration with the lack of information provided by the family and spokesperson, maybe my own experience will be useful to provide some insight. My husband was a dynamic person, also German, he owned his own company and was sporty and bright, a man amongst men. Not famous like Michael, but well-liked and respected in his sphere. When he was injured, he became so incredibly vulnerable, my first instinct was to protect him from the outside world. He too was in a coma, though for a shorter period. I had no understanding of coma or the consequences, and although his doctors provided me with information and told me what to expect, I couldn’t comprehend that he might be changed forever and I couldn’t face the thought of losing him or having him permanently disabled. Friends and family constantly wanted updates, but communicating this information to others was incredibly painful because it meant voicing my own worst fears. The coma and length of hospitalisation left him utterly frail and wasted away. The reactions of those who eventually saw him mirrored my own devastation and I couldn’t bear to face the reality that was clearly visible in their expressions.

    Obviously the situation with Michael is different because he has a huge fan base and has been a public figure. However, as you know being a doctor, the Michael so loved by his fans has essentially died. He will be a whole different, disabled person in the future. By telling the fans the truth, the family has to face the truth themselves. I know without a doubt that they will not be ready to face that truth for a very long time. It took me two years to realise that my husband as I knew him was never coming back, and the grief of families in this situation remains unresolved because the person is alive and constantly reminds you of the person you have lost.

    It may seem that the family is being indifferent to the feelings of the fans who have shown so much support. However I suggest that the grief felt by fans can in no way match the grief felt by those who really knew and loved Michael. Denial is an important part of that grief and there is no short-cut, they have to go through it despite being told the truth about what to expect. I say we give them their privacy and respect the reasons behind it, it’s the last thing they have to hold onto. The fans still have Formula 1 and a whole host of other heroes to support.

    Hope this helps! Such a sad situation and so many families destroyed by head injury.

    Best regards, Brett Nydahl

    • Thanks so so much for this Brett. It’s EXTREMELY useful, and your courage and openness in sharing with us is immense.

      I can easily imagine, almost feel (and some comments relayed by people close to the family tend to confirm), the utter desperation and loss of Michael’s family. A young and dynamic couple, a magnificent family, facing a long, lovely, and comfortable life after retirement, and then in a horrible instant it all just goes away.

      I agree that probably more than anything else THIS is what explains the family’s PR strategy. Whatever the reasons, it is their absolute right of course. But given how wrenching it must be to prepare updates with the medical team, to choose each word, to be completely immersed in the medical details of a situation, I can easily understand their reacting like this. I’d only say for completeness that this is precisely why comms strategies are left to professionals, especially in crisis situations. It may even be the case, then, that Sabine has tried to open things up a bit, FOR THE FANS, but has met with stolid and forceful resistance, for the reasons you evoke, by the family.

      Thanks again for all of us!

    • Having read this quite remarkable and brave post I retract unreservedly the comments I have made about Michael’s family and the manner in which they have dealt with his accident.
      Only having read Brett’s story do I begin to understand what Michael’s family are going through.
      I for one shall comment no further on Michael or his family’s manner of dealing with the public.

      • Reading Brett’s comment I could easily conceive of Corinna, or Rolf, or anyone who matters to the family, so distraught, so completely afloat in the sadness and desperation of the situation, that uttering certain words could, in the words of a family friend quoted somewhere, be seen as “treason”. NOW this makes sense to me.

        If this is the case, then I especially owe a huge apology to Sabine, for questioning her strategy. If this is the case, she’s spent the last six months putting her instincts as a professional on the back-burner, in exchange for the loyalty she owes the family. That, rather than being a cynical tactic, represents the essence of integrity and courage. The Schumachers should then be immensely proud that she works with them.

    • Brett, your comments are heartfelt. I felt as if I was physically with you. Please know that I am spiritually! YOU certainly have helped me understand what the friends and family of Michael are going through. God Bless and thank you! Michael

    • Brett, thanks so much for sharing this. While I always thought that Corrina and the family would be devastated by this, only now reading you story do I begin to understand the depth of their pain and despair.

      Thanks again

      Sue

    • Having thought about this a bit more I would just say that whilst I can perfectly understand what Brett says about dealing with the press forcing Corinna and the rest of the family to ‘confront’ the difficult truth about Michael’s condition, I do however think that after 6 months the increasingly wild, hysterical even, speculation that is now a feature of the Michael Schumacher story must be equally taking its toll and be frustrating to deal with, maybe even more so because it must seem so outside their control and possibly (who knows) so inaccurate.
      I do wonder therefore whether a ‘once and once only’ statement of some sort is after all not such a bad idea. The feverish speculation is not going to go away any time soon and as the situation develops, however slowly towards some sort of end game (good, indifferent or bad) at some point someone in the Press will get a ‘scoop’ the Schumacher family will more than likely not be happy about.
      Another point. I wonder why the statements we have seen from Sabine Kehm are not placed directly on the Michael Schumacher website. The address on the site is the MS office in Gland which is where she is based. Just seems odd.

  44. I have just read that it was in a Swiss newspaper called Blick, that Michael was conscious and had his eyes opened for most of the journey by Ambulance, that he did not speak but communicated by nodding his head. I wonder how true this could be and what it actually means.
    Doc any idea please

  45. Apparently the Full MS Family – Sabine Kehm Statement Reads:
    ***********************
    “Michael has left the CHU Grenoble to continue his long phase of rehabilitation. He is not in a coma anymore.

    “His family would like to explicitly thank all his treating doctors, nurses and therapists in Grenoble as well as the first aiders at the place of the accident, who did an excellent job in those first months.

    “The family also wishes to thank all the people who have sent Michael all the many good wishes to Michael. We are sure it helped him.

    “For the future we ask for understanding that his further rehabilitation will take place away from the public eye.”
    ***********************
    Basically it seems to be a statement just to give “meaning” to his transfer from the Grenoble University Hospital to the Lausanne University Hospital. The timing of the transfer, in light of the comments made on this blog & associated commentary section, seems to be PRIMARILY an issue of tax avoidance rather than MS health. Of course one would surmise a SECONDARY reason would be convenience for family and friends to visit him.

    As to MS health there seems to be no significant step change improvement in his condition. MS health seems to be neither a primary nor secondary reason for his transfer from Grenoble to Lausanne.

    From all the comments, opinions, official statements etc it seems that MS has had a “minimum level consciousness” since at least April. Unofficial “leaked ?” comments indicate that MS may have eye tracking functionality which I think could be slightly better than minimum level consciousness (?).

    All official statement INDICATE a lengthy period of rehabilitation (years) no matter what the final outcome.

    These are my own best conclusions based on what I have read mainly here on this blog and the limited information available. These are not original conclusions but what I have taken here and there from others. 🙂

    • Hi Jason

      I have been reading up on minimally conscious state since Sabine’s ‘moments of consciousness & awakening’ statement in early April.
      1. Stage 1 – eye tracking (minimally conscious state minus)
      2. Stage 2 – obeying commands (minimally conscious state plus) – Michael may have reached this stage now.
      3. Stage 3 – functional communication ie emergence from MCS shown by deliberate yes/no answers, appropriate use of objects etc.

      If stage 2 follows within about a month of stage 1 it is a good sign and further progress is likely. Many people get stuck at one stage and don’t emerge. The chance of walking, talking etc is close to zero. What would be good news for the family would be communication as it would show he is still there in some way as Gary said. I’m sure we will never see him in public again. He might be able to use computer assisted technology to communicate – this is currently being developed to help such patients.

      • Hi Jane

        thanks for the information. Yes thinking about it eye tracking function must be the minimum evidence needed to demonstrate awareness of the environment and hence consciousness.

      • The various ways patients with prolonged disorders of consciousness demonstrate awareness of, and/or interaction with, the environment have been the object of clinical guidelines published by numerous national and international bodies.

        For example, if we open the Royal College of Physician’s “Prolonged disorders of consciousness</strong: a national guideline", we see:
        Behaviours compatible with a minimally conscious state (MCS):
        1 Following simple commands.
        2 Gestural or verbal ‘yes/no’ responses (regardless of inaccuracy).
        3 Intelligible verbalisation (accepting inaccuracy due to specific speech or language deficits).
        4 Purposeful or discriminating behaviour, including movements or affective behaviours that:
        • occur in contingent relation to relevant environmental stimuli, and • are not due to reflexive activity.
        Any of the following examples provide sufficient evidence for a behavioural response that is only explicable through some awareness being present:
        (a) episodes of crying, smiling, or laughter in response to linguistic or visual content of emotional
        (but not neutral) topics or stimuli
        (b) vocalisation or gestures in direct response to the linguistic content of comments or
        questions
        (c) reaching for objects in a manner that demonstrates a clear relationship between object location
        and direction of reach
        (d) touching or holding objects in a manner that accommodates the size and shape of the
        object
        (e) sustained pursuit eye movement or sustained fixation that occurs in direct response to moving or salient stimuli
        (f) other localising or discriminating behaviours that constitute: • movement towards a perceived object, or
        • differential responses to different objects or people.

        As we’ve mentioned before, it’s extremely important that those making the diagnosis be experienced and specifically trained in the use of the behavioural scale used. Because consciousness can fluctuate dramatically in these patients, extended periods of observation (sometimes weeks) are necessary.

        The link to this guideline is:
        http://www.rcplondon.ac.uk/resources/prolonged-disorders-consciousness-national-clinical-guidelines

        Hope this helps.

      • Hi Gary,

        It has helped very much. It is clear to me I haven’t understood and have difficulty understanding what is classed as severity in mental health. Aspects that I had imagined to be quite advanced brain functioning and cognition (including forms of minimal intelligible verbalisation and yes/no interactions) are still considered part of the spectrum of the “minimal conscious state”. I suppose there are some things that one has to directly experience to begin to understand the full range and fine shades to mental health “recovery” and “rehabilitation”.

    • The more I read the statement (plus additional comments) the more miffed I seem to get. Was it a deliberate play on words or has SK screwed up by not understanding the nuances of English?

      Should she had said ‘transferred’ instead of ‘left’ for example? Surely that would have eased some of the wild speculation that is going around, giving the impression that MS was in a better state than he actually is? Should she have left the ‘he is not in a coma anymore’ statement out of the release, due to the fact that people seem to think, yet again, he is in a better state than he actually is, plus the fact that this was apparent in April and therefore there seems to be no particular change in circumstances?(I’m saying no particular change due to the fact that there was no additional information with regards to MS’s condition contained within the release)

      If it is for tax purposes (as has been mentioned here) then that’s fine, I have no issues with that but surely an experienced PR person should have realised what a can of worms they would be opening by the issuing of that particular press release? I understand that she is representing the family but I would have thought that the job of a PR person is to word the things that their client (MS family obviously) wishes to say properly in the hope of avoiding any ambiguity? Unless their job is to ‘spin the facts’ of course whilst avoiding the actual reasons…but what has been gained by this? More stress for the family I would argue, which is something I thought they were seeking to avoid.

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