A Jules update, and some wishes

Once again, I find myself moved by Mr. and Ms. Bianchi’s openness. It’s wonderful that they understand how important Jules is for us, and how we just don’t forget. Remarkable people.

I’m pretty sure I speak for a lot of us if I say that Jules is never very far from any of our thoughts. And prayers.

Rehabilitation after severe head injury means a few things. Most importantly, it’s the rehab people who make sure that Jules’ limbs stay flexible, and that his muscles stay as toned as possible. Remember, a good part of our flexibility, and an even bigger part of our muscular health, are due to impulses from the brain that help maintain their growth and metabolic status. When those impulses aren’t incoming, a program of externally applied movement is important. Avoiding pressure sores is also close to a full-time job in anyone with restricted movement.

Respiratory rehab, especially since Jules is breathing on his own (brilliant news, as it’s one less machine to fail dangerously!), can be necessary, to help him cough and clear secretions.

As for brain-specific rehab, I’m at a total loss here. While the other aspects of rehab would presumably feed back body information (“proprioception”) to the brain (gotta help with maintaing plasticity), I don’t know if there are any effective and evidence-based techniques that improve outcome in this phase of severe head injury. It’d be fascinating if any specialists out there commented with info about this.

Lastly, and most importantly, I want to wish you all, EVERY ONE OF YOU, health and joy and warmth. Comfort for those who comfort. Calm after turmoil. You have all been part of this becoming something I had no idea would become as important to me as it has (ok, that sentence sucked. Forgive me, Ms. Dahlberg). Happy New Year to all of you, and let’s really make 2015 amazing!

What’s next

It’s been a fairly crazy weekend. Not the sort of craziness I was expecting, as you can well imagine.

After careful consideration, I’ve decided to go quiet for a bit.

I’m going to be busy this week working through options and what my next steps could/should be. You will be informed of everything, have no fear. In due time. And I’ll let people smarter than I decide when and how that will be.

Meanwhile, I want to tell you that the upwelling of support and good wishes is extraordinarily gratifying. 

To all of you, whether or not we’ve crossed inky swords, have a safe and healthy, happy and loving holiday season.

An open letter to Gérard Saillant (oh yeah Jean Todt too)

Dear Gérard,

Imagine my surprise at learning that you were in my hospital last week. You actually got on the train from Paris to come here to Liège! It’s a pity you didn’t call me ahead of the visit – we could have had a cup of coffee. Or you could have beeped me to say hi once you got here. But I guess that actually being face to face with someone is not your style. Come to think of it, it never really has been, has it? You did fire me via email!

Imagine my surprise to learn that despite having heard nothing from you or your boss since being fired, YOU ACTUALLY CAME TO MY HOSPITAL BECAUSE OF ME. You made an appointment with the Dean of my medical faculty, to speak about me. Then travelled 2 1/2 hours . . . for me. I’d be flattered if I wasn’t so . . . shocked. But let’s not dwell on the fun we could have had together in Liège, and look instead at what exactly you came here for. I think it’s important that people understand just how you and your boss work.

You came here to try to get me fired.

Not from the job you already fired me from. That one was basically a hobby. A very serious, very time-intensive hobby. No, now you’re aiming higher. You and your boss want me fired from the job that pays my rent. The one I’ve held for 25 years. Wow. Were you wearing a black trench coat and fedora? Maybe I’m glad I wasn’t there. Perhaps you also had instructions to break my knees!

You came here with a dossier consisting of printed copies of my blog posts. And a copy of a personal email TO ME (!!!) from Corinna Schumacher. OMG. An email I actually never received. Probably because it was addressed to “garry.hartstein@…”. Seriously? I get scores of emails EVERY DAY from people all over the world who spent all of 30 seconds finding my email address. But the wife of one of the world’s most famous and wealthy sportsmen isn’t capable of carrying out that difficult task? You’ve got to be kidding me. Hell, dude, even YOU (trusted advisor to “the family”) had my email (again, that’s how you fired me!).

You came here to raise the issue of whether THIS blog violated my contract at work and could therefore be a reason to fire me, or at least to muzzle me.

Now you worry me. Maybe you should sit down. That’s better. Let’s talk.

Let’s just look at the facts, ok?

1) This blog makes no claim to represent the opinions of anyone other than myself. And while my bio may mention that I studied and work at the University Hospital of Liège, no other mention is made of this fact. All blog-related activity, then, is part of my personal life. Period.

2) Doctor-patient confidentiality is never violated, for two pretty good reasons. First of all, Michael is not and (other than the stuff that came up over 15 years of F1) never has been my patient. Second, I make perfectly clear that NONE of what I wrote in the days, weeks, and months following Michael’s accident was based on anything other than conjecture and experience.

3) When opinions are expressed, they are clearly identified as such, and are never presented with an intent to harm. This intent is abundantly clear, and is even explained on numerous occasions.

So you see, Gérard, if you’d have put your thinking cap on before flitting off to “le Paris du nord”, you’d have realised the absurdity of your project. My blog has nothing to do with my job. In fact, things like “privacy”, and “free expression” come to mind – not as sterile principles, but as LAWS THAT YOU ARE ON THE CUSP OF VIOLATING. You and your boss.

You have acted like a hoodlum. What you have done was not unexpected, but was thuggish and disgusting. You might wear expensive suits and a Patek Philippe, but your tactics are from the gutter.

Be aware that I’ve referred the “dossier” you handed over to the Dean to my attorney. You are on very very thin legal ice.

Word to the wise?

Shut up, back off, and watch out.

The Bianchi accident investigation panel

We’ve been given a summary of the Bianchi investigation, and the 300-some-odd page report has been condensed to what looks approximately like 1.5 A4 pages.

Over 300 pages to less than 2. Holy crap. Either there are a hell of a lot of wasted words in the full text, or someone has really mastered the art of the resumé.

I can’t say much about the reasons behind not releasing the full text of the report, but it is clear that the credibility of the conclusions, such as they are, is not helped by the absence of corroborating background.

In addition, when we look at the composition of the panel, we realise that fully HALF the members have a clear and unambiguous conflict of interest in any investigation. The current positions, and indeed future careers in motorsport, of those panel members who are not dear personal friends of the FIA president depend intimately on remaining in his good graces. Mind you, I am not impugning the integrity of anyone. That’s what’s so insidious with conflicts of interest. They only have to appear to exist to have their negative effects.

This of course rang alarm bells when the panel was formed, but courtesy, decorum and respect no doubt calmed the chuckling at the idea of a body investigating itself. I fear that chuckling was perfectly appropriate.

Let’s get a bit more specific.

The primary conclusion, that Jules was driving too fast, is, as I’ve said before, true by definition. I’m surprised at the reactions of those who feel that this is somehow unfair, unjust, or unkind. It is none of these. Young men make mistakes of judgement all the time, and some pay a grievous price for it. That is the case here. The technical details of BBW and FailSafe are just that – details.

I smiled when I read:

It is considered fundamentally wrong to try and make an impact between a racing car and a large and heavy vehicle survivable. It is imperative to prevent a car ever hitting the crane and/or the marshals working near it.

Suppose they’d said that 60 years ago about Armco? We’d not have developed the know-how that led to 6-row tire barriers with conveyor belting, and we’d certainly not have Techpro. I wonder what would’ve happened to my friend Perez in Monaco a few years ago? Actually, I KNOW what would have happened to him. Ironic, isn’t it? Somehow both goals stated in that quote seem worthy of pursuit; neither do they appear mutually exclusive.

Now it gets a bit complicated. You see, the entire summary (and therefore presumably the report itself, but we have no way of knowing that) is focused on the events leading up to the accident. There would appear to be no attempt to look at those elements of the response that are there to mitigate the consequences AFTER the event has occurred. And now I start to get rather uncomfortable.

We are told:

All rescue and medical procedures were followed, and their expediency are considered to have contributed significantly to the saving of Bianchi’s life.

The first part of this statement is patently untrue. Egregiously. The self congratulatory second part, while certainly true, is inappropriate.

Bear with me, and struggle through this excerpt from the Appendix H of the FIA’s own International Sporting Code (that concerned with “Supervision of the Road and Rescue Services”).

An evacuation under intensive care by medically equipped ambulance (equipment and presence of a doctor proficient in resuscitation on board) with an escort may, however, be carried out, provided that the receiving hospital has been approved beforehand for the treatment presumed necessary according to the casualty’s condition and that it can be reached in approximately 20 minutes (except for serious burns), regardless of the weather and road traffic conditions (except in a case of force majeure). If these conditions are not satisfied, the timed session must be interrupted.

d) Unforseen circumstances, especially the weather, may prevent the arrival, departure or return of the helicopter. In such a case, and after consultation between:

– the Chief Medical Officer;
– the Race Director; and
– the FIA Medical Delegate;
an ongoing or interrupted timed session may perhaps continue or be resumed depending on the conditions of evacuation of a casualty under intensive care to one of the hospitals mentioned in the medical questionnaire for the event and approved by the FIA Medical Delegate.

We were told at the Sochi press conference that the evacuation took 40 minutes. Twice the 20 minute upper boundary that THE FORMULA ONE MEDICAL DELEGATE HIMSELF HAD WRITTEN INTO THE REGS.

We were also told at Sochi that Jules’ condition at the end of that waterlogged siren-punctuated ambulance ride to the hospital was exactly the same as when he left the circuit. Are you kidding me?

Don’t get me wrong. I have no doubt that my Japanese colleagues were indeed able to make sure that Jules’ blood pressure, heart rate, oxygen saturation, expired carbon dioxide, etc (the EXTERNAL parameters, the ones we measure easily) were unchanged over 40 minutes.

But find the nearest neurosurgeon and ask him if the brain of a patient who’s had a head injury with immediate coma is the same after 40 minutes of transport as after 20 minutes, and he’ll look at you like you were nuts. Because you are.

Why did Dr. Saillant not address the question of EXACTLY when the Medical Delegate (his personal appointee) knew that the helicopter could not land at the receiving hospital? Under difficult circumstances this often requires near real time communication with the helicopter crew. The delegate is up in race control with nothing else to do during the race. That’s why he’s there. Why was racing not stopped? This is far from a trivial issue, and is all the more dramatic that the FIA’s own regulations would appear to have been ignored by their author, the Medical Delegate.

This is a potentially grievous error, and it is all the more shocking that the question is not even addressed. And unfortunately this is precisely the kind of result one would expect with a panel studded with insiders.

 

 

Last week’s Jules update

First of all, as many of you have pointed out, we once again owe a deep and sincere thank you to Jules’ parents.

Obviously this is good news, at a few levels. Being closer to home, to friends and family, is immensely important.

Knowing that Jules is breathing on his own is also very good news. Not so much prognostically; rather because it’s one less open door to potentially life-threatening infections.

The press release also says that the “medically induced coma” has been ended. Remember, ALL patients with severe head injury are anesthetised. This is to allow them to be ventilated by a respirator, and to better control many of the patient’s parameters during the first crucial days.

During the acute phase (roughly speaking from ICU admission until the intracranial pressure/brain swelling was brought under control) if the intracranial pressure rises too high, and the usual means fail to bring it down, this anesthesia (itself a medically induced coma) is deepened significantly, as a last-ditch effort to control the pressure. This was done, as you remember, for Michael Schumacher. It was also almost certainly carried out for Jules. This deep anesthetic is usually only used for a few days up to a week or two (rarely more). Then the background “routine” anesthetic is also slowly weaned. The speed of this process depends on the patient’s circumstances and how withdrawal of sedation is tolerated. This was presumably done prior to Jules being transferred back to Nice.

But he is still unconscious.

The fact that Jules is no longer being sedated, is no longer receiving anesthetic drugs to maintain a state of PHARMACOLOGIC coma, but remains unconscious at almost two months post injury, is obviously of great concern. But his is perfectly compatible with the clinical course of a patient with severe diffuse axonal injury who was unconscious on hospital admission.

While statistically the situation is fairly dire, statistics are just that – numbers. Let’s wait, support the Bianchis in any way we can, and constantly hope things get better.

Sorry for the delay in posting this. Lots of things going on, and just could not find time to write.

Congratulations Lewis

Congratulations, Champ. As happy as YOU are, believe it or not, tons of us are almost as happy. Double world champion. Insane.

I’m not a sports blogger, and I’m not going to start writing about stuff I don’t master. But right now, I feel the need to put into words some of why people are just so happy you won the World Championship.

How about an anecdote first? Sid and I were both following your karting exploits with a lot of interest. We’d both decided that you were well on your way to being a World Champion even then. Anyway, we’re at the Nurburgring, and they’re racing (the race Johnny Herbert won), and it’s bucketing down with rain. Cars are skating off left and right. I can feel Sid is on edge, and I’m as sure as hell we’re gonna have to go out at some point, for something.

Herbie comes on the radio. He says Max is on the phone, and needs to talk to Sid. Could we please park below race control, and could Sid please come upstairs and take the call.

Talk about a WTF moment.

We get to the tower using the internal roads. I tell Sid (I’d only just started working with him) sorry, Dude, but if there’s an accident while you’re talking to Max, I’m going to it without you.

Sid comes back downstairs and gets in the car, shaking his head. You, Lewis, were racing somewhere in France (as I remember, this was 17 years ago I think), and were wearing a wrist brace. Some turd of a French Chief Medical Officer had (for obvious political reasons – this was an important race for the karting championship, and I think a French kid was in with a shot) decided you couldn’t drive. Max, also clearly concerned about French treachery, got in touch with Sid. Who promptly read the riot act to the CMO. This has NOTHING to do with my point, but I love the story.

Long story short, Champ – it’s your humanity that I love, and it’s precisely that humanity that makes me think that you’re unstoppable now.

Let’s forget about your driving. What has fascinated me, and what I think makes you so special to so many of us, has been watching you struggle. With the celebrity. And the wealth. But not just that of course. Watching how powerfully your inner struggles impacted your driving. Questions about who you were, how to live. Who are your friends. All the stuff that NORMAL young adults struggle with.

This is not voyeurism, Lewis. I guess because of the racing, because of WHY you’re in our lives, we’re INTERESTED. You should know that for me, it’s been a privilege.

And now, this season, it’s come to a head. We could SEE it – see you struggle with how to deal with things. Not on track. Off. Of course.

You’ve hashtagged a lot of your tweets this season with “#blessed”. I thought it interesting, and now I realise it was the first clue of what was going on.

Then, before the race Sunday, just a snippet of conversation with Gaëtan, the Belgian TV commentator. You said that it was a joy to be there, that it was “the coolest thing ever”. Right there, I knew that barring mechanical failures you’d already won.

Lewis, to be able to face that kind of challenge, and that kind of pressure, and still FEEL the joy of being there, is a staggering achievement. It’s not “maturity” in the usual sense of the word. For me, it’s an example of where your personal path has taken you. You have learned, despite the temptations and the work, a lesson that many men never learn.

With your talent, Lewis, and the strength of really feeling #blessed, you’ve harnessed something incredibly powerful. Lewis the driver has impressed me for almost 20 years. Now you’ve given me a curiously fatherly joy at watching you become the person you’ve become. Congratulations, Champ.

We have a date, Tuesday 11 November, 5 PM UTC

I’ll be doing a Reddit AMA (Ask Me Anything) this coming Tuesday, 11 November.

Pretty sure all you have to do is navigate to http://www.reddit.com/r/formula1. I guess you’ll have to set up a (free and hassle-less) account, which is simple and should be two-step secure.

Starting at 17h, 5 PM Coordinated Universal. That’s 5 PM in the UK, 6 PM on the Continent, 11 AM Eastern time, and god knows what time elsewhere.

You all know how much I LOVE interaction with fans and readers and followers, and how much I love the diversity and passion of your questions. This will be another way to interact with you, and I am really really excited.

Talk it up, pass on the word, and most important, come on over and ask me anything you want.

See you Tuesday!

Remote control safety?

During the TJ 13 courtroom podcast the other night (link here) I mentioned furtively that I did not think the “pit lane limiter” solution was going to be viable.

This of course led to the inevitable question on Twitter as to why.

I’ll admit that my comment the other night stemmed more from an inchoate sense of non-feasability than from any thinking (at all). So the question this morning, plus the fantastic Belgian coffee, led me to put a bit of flesh on those bones. Let’s have a go.

First of all, I think in the pit lane things are quite controlled, with relatively few dynamic constraints on car or driver. Basically, “all” he has to do is hit the button at the right time, avoid killing anyone stepping in front of him (unless we take that responsibility away from them too!), and stop his car at the correct garage (ahem . . .).

On the other hand, the on-circuit situation is by definition uncontrolled. In the same area of the circuit at the same time cars will be subjected to variable loadings – think back marker lifting and going off line, guys battling for position, etc. Now I’ve seen first-hand how violent the deceleration from “just” the pit lane limiter is, and that’s going in a straight line with none of the above constraints. And remember, we need to add to the above situational factors things like the state of tire wear, the weather, and visibility.

The next issue, and THIS is where it gets complicated, is a bit less obvious.

If we think a bit further about an “external assumption (or assertion?) of responsibility” solution, suppose someone (driver or other) got hurt, either despite of or because of such a system. Who would then be responsible – humanly, morally, and last but surely not least, legally? Race control? The FIA? The CoC?

Under the current situation (and I’m speaking purely theoretically, not in reference to any particular case), in the absence of mitigating circumstances, it is the driver’s responsibility to obey safety rules and injunctions. As a corollary, it is the driver’s “fault” when bad things happen as a result of failure to abide by said rules and injunctions!

To my way of thinking, this eliminates any quick-fix response that’s as simplistic as the current button (no, not Jenson, go back and read the above!). Any “imposed” response required of the car/driver would therefore have to be quite sophisticated. Using “deltas” is unacceptably one-size-fits-all, and equally unadapted to any given situation. We all know that there are tons of extremely smart people in F1; I’m sure they’ll figure this out if they need/want to, but it will not happen fast.

(By the way, this also raises fascinating questions about what’s going to happen when you’ll be able to buy a Google smart car, or switch on “smart” mode in your Merc S-class. Who is responsible when you crash into someone or something? The manufacturer? The guy who wrote the code? Who operates the servers? Damn it’s time to be a liability lawyer!)

Getting back to racing, I’m starting to think that moving forward, a few issues need to be addressed in terms of ensuring the safety of trackside workers (paramount concern, let’s not forget) and drivers (secondary, given the willing and paid assumption of risk).

  • Someone needs to gather statistics as to injuries in trackside personnel (including rallying, hill climb, drag racing, etc). The circumstances need to be elucidated as clearly as possible, in order to discern trends or patterns. Sid, Charlie and Max imposed this approach to safety improvement 20 years ago, and there’s no reason to change now.
  • Strong consideration should be given to quickly developing a policy as to leaving cars on the track side of the Armco under certain conditions. This was standard practice some years ago, and I daresay close scrutiny of the stats will confirm that current “clear-all” policies are responsible for more mayhem than previous, selective “leave ’em and flag ’em” policies.
  • For the future, very strong attention must be paid to reductions in trackside personnel to a strict minimum (it’s getting harder and harder to recruit anyway, never mind what’s going to happen to insurance rates!). There will always be a need for human eyes, ears and brains in the corners; that said, a fresh detailed analysis of roles and how to get them done with minimum risk is long overdue. I’m thinking that some of the FIA’s McLaren money (c’mon guys, it was £100 MILLION, surely there must be some left!) should be used to help to robotise a certain number of retrieval functions. This could almost be economically feasible at some point, with off-the-shelf solutions to piloting current retrieval equipment. Flagging is already somewhat, and can be further, “automated”. Again, competent human backup will of course always be necessary.
  • And as mentioned previously, we need to pretty urgently consider how to improve compatibility between competition machines and retrieval machines.

This wound up longer than I thought it would be. Thanks for the patience!

Merci, Monsieur

No one who has read even parts of Philippe Bianchi’s words could be other than deeply moved, or help feeling almost unbearably close to fellow humans’ suffering. More than a “press release”, Jules’ father spoke with us, shared with us thoughts and information that is usually, and rightfully, intensely private.

And I can only hope Jules, and his parents, have an idea of just how many people feel connected to them now.

It says something about people that here, now, discussing medicine feels wildly inappropriate. What is happening behind the doors of the ICU in Mie Hospital is not for us. Because we are connected with Jules’ family now, because that’s what’s important.

I don’t think we can talk about better or worse media “strategies”. Michael’s early course was about head injury. This isn’t.

This is about people. Jules’ family. And their humanity and dignity are staggering.

#ForzaJules