I just wanted you all to know . . .

I’ve surprised myself with how affected I’ve been by Robin Williams’ death. After thinking about it since yesterday, I’ve finally realised why.

I cannot bear the thought that people can be so sad, and see the world coloured so darkly, that they feel there is no one who can help. Or that their sadness and darkness is too much of a burden for others, and needs to be ended. That others would be better if they weren’t around any more. 

I cannot bear the thought that someone reading my blog might feel this way. 

So I want you to know – no matter how alone you think you are, no matter how much of a burden you think you are, and no matter how incontrovertibly correct you think you are, it’s not that way.

If you feel alone, or if you can’t lean on people around you, for whatever reason, please let me know. Send a comment – I won’t publish it, but I’ll get in touch. Please.

I’m no shrink, and I’m not even particularly good at running my own life. But I’m (allegedly) a fellow human being, and this is what we humans do. We help each other. We’ve been doing it since the savannah thousands of years ago, and it’s what makes us what we are. Send me one word – just one – or type me half a novel, it’s fine with me – and you won’t be alone. Just one other person who actually cares. And for whom it’s NOT a burden. Please.

Nobody should die thinking there’s no way out.

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What is wrong with this picture?

I’m going to venture out of my usual terrain, and allow myself to talk about the sport of Formula 1 in general. This is brought on by a tweet this morning by the CEA, the (fabulous) crew of fire marshals at Monza (and Imola). The tweet shows the start of restoration on the tarmac at Parabolica. It jarred me to realise that even Monza has raised the spectre of no longer being able to host the Italian Grand Prix.

This summer has been oddly and uncomfortably full of ruminations and reflections as to what’s wrong with F1. Commissions have been formed . . . and disbanded. Those asking the question itself are accused of negativity. And meanwhile, a spine tingling championship is underway, with team orders given and followed, team orders given and disobeyed, and drivers battling as much with their minds as with their cars. And the cars – brand new, beautiful machines with power trains that are stunning in their sophistication. Is there anything REALLY wrong at all?

Let’s imagine something, to help me illustrate my answer to that question.

I’ve just built a bottling factory. Modern, efficient, state-of-the-art. And you, well you have a soft drink you need bottled. A very popular soft drink indeed. People all over the world want to drink it. And you want to use MY factory to bottle it!

When the time comes to do the deal, you tell me “there’s just one thing Gary. Our business model is a bit . . . unconventional. You see, normally I’d pay to use your factory. But since my beverage is SO popular, YOU’RE gonna have to pay ME for the privilege of hosting my drink”.

I guess you see the concerned look on my face. My factory cost money to build. It costs money to maintain. Everybody ELSE rents my factory when they want to use it. I seek reassurances.

“Don’t worry a bit, Gary, you can run guided tours and have people pay to see your factory working. And you can serve them lunch!”

I guess you see what I’m getting at. I’ll have to charge $100 for a tour, and get 100,000 people over the weekend. No way that’s gonna happen. A guaranteed loss. Every time. Damn.

Right now, as we all know, for $15 million or so, a circuit can buy the privilege of hosting an F1 race. And all it has to do to recoup that is to sell tickets and hotdogs. A lot of VERY expensive tickets and hotdogs. Not one cent of the TV revenues generated by that race, and not 1 metre of signage around the circuit can be used to generate revenue for the circuit itself.

It’s not FOM who makes F1 tickets astronomically expensive. It’s the circuits. Do the math. You need to make up several million dollars with three days of tickets, food, and beer. No wonder it’s only races with government support that avoid the year to year threat of bankruptcy.

So here we are with the backbone of the season, with virtually every European F1 circuit, either under severe financial threat . . . or gone. Spa, Monza, Silverstone, Hockenheim, Nurburgring, etc. This is insane.

Why do these circuits not do what any normal owners of crucial and rare resources would do? Form a cartel.

Why do the owner/operators of the “classic” circuits of the season not band together to put an end to the bizarro world of F1 circuit use. You want to use our infrastructure? It will cost you this much, plus a percent of global TV revenues (averaged over a season, to avoid late season races, with their bigger box offices, earning more just by their place in the calendar), plus some portion of the signage at our circuit.

Sure Bernie will bluster. He’ll threaten to go elsewhere. And to some extent he will go elsewhere- he’s been “going elsewhere” for years now. But remember a few things:

  • F1 homologated circuits are not a dime a dozen. They are rare birds indeed, and the lag time from project to race is YEARS.
  • Google earth is littered with abandoned Tilke-domes, each having cost $200-400 million. Think Istanbul, Korea, India. (What will archeologists in 500 years think these things were?) Only governments awash in petro- (or narco!) dollars will keep building these white elephants, and even that will ultimately peter out. Even the most corrupt autocrats have better ways to waste $400 million!
  • Even if FOM moves strategically away from Europe, it’s wrong to think that the circuits will be losing a prestigious money-making event (countries might be, clubs might be, fans might be . . .); in FACT, they’ll be (temporarily, see below) losing their biggest headache of the year. As a taxpayer here in Belgium, the question of who exactly is going to foot the known and expected loss from the upcoming Belgian GP is a perennial favourite, of which I’m growing quite sick.
  • FOM cannot, by the nature of the series, reduce the number of European/North American/South American races well below half (or slightly more) of the season. How many corners on ANY new-ish circuit do you remember? Is there an Eau Rouge? A 130R? A Becketts-Maggotts complex? A Tabac? This is not a diatribe about circuits, but dammit, they really ARE intimately involved in what we love about the sport. People will not get up early, or stay up late, to watch a race if this is not felt viscerally to be a EUROPEAN series. They’ll watch the evening news, and see the best overtakings and the results . . . and there go your TV revenues Mr. E. Sooner or later, European races will have to comprise close to the bulk of the season, with a smattering of exoticism added, because it’s F1.

Enormous advantages would accrue from a system like this. Not least would be a significant lowering of ticket prices, and an opening of the sport to a wider audience AT THE CIRCUIT. And as you all know, once you’ve seen this sport live, you’re hooked forever!

A different system for distributing revenues from the sport would vastly increase the “health” of the infrastructure supporting it. The team principles, until now staggering by how completely they ignore the long term interests of the sport that gave them all yachts and Gulfstreams, and FOM itself, would have to make do with slightly less. But the pillars of our sport would survive and flourish, and government support for what many view as a frivolous pastime would largely become unnecessary.

Rant over.

Sid, my friend, 20 years after Imola

Image

Nürburgring, watching tennis before a session

It’s 1992. Summer, but it’s cool enough in the Ardennes morning to be happy to put on the long underwear and overalls. Now we’re sitting over that first, anticipation-laced coffee:

“Professor?”

“Yes old boy?”

“Do you think it’d be ok if I called you Sid?”

A big grin. “You know, the tramps sleeping under the stairs of my hospital call me Sid. Don’t see why you couldn’t.”

There. That was easy. Only took two years.

Although I was a lifelong fan of Formula 1, I’d never heard of Sid Watkins when the Chief Medical Officer at Spa-Francorchamps decided to make me the “local guy”, riding in the back of Sid’s FIA Medical Car in 1990. I was a 35 year-old anaesthetist, and had been told, by everyone involved, how important, imposing, and difficult the English gent was.

We found some common ground. Not difficult, you’d say, what with motor racing, medicine and cigars as shared starting points. Worked out fine. At least one big accident each weekend too, so we actually WORKED together.

This is the start of my third Grand Prix weekend. As usual, we’ve met at the medical centre, and hitched a ride to the paddock. I’ve screwed up the courage to ask. Cool. From now on it’s “Sid”.

1994. Two years later, twenty years ago, and I’m seeing Sid for the first time since Imola. Don’t know what to say. I know he loved Ayrton. He seems fine. Say nothing? We’d gotten to the medical car a few moments early, and were standing inside “la triangle” of La Source hairpin, which was (and is) our standby position.

“You ok?”

He leans against the door of the car and says, “We ran some fluid in, and got a pulse. Then the clouds moved a bit, and his face was in the sun. That’s when I knew . . .”

And that was it. We didn’t need to talk about medical care, about ambulances and extrications. This brilliant professor, this locomotive of a man, had lost a great friend.

It was remarkable to see, in the coming months and years, how Sid steered the steady, relentless progress of this “second revolution” in safety (the first, I’d say, was from when Sid came on board as FOCA surgeon in 1978 until the mid 80s). And how brilliantly it was all set up.

That’s what Sid was like – extraordinarily multifaceted. Nothing was done half way. Personality? The most charismatic person I’ve ever seen. Sid drew you in and held you there with his stories, his intelligence, and his heart. Intelligence? Just look where he brought our sport! But he also read voraciously – historical biographies were a particular favourite. And of course, a sense of humour that just didn’t stop.

Jerez 1997. In the hotel lobby with a several of Sid’s “kids”, waiting for him so we can leave for dinner. He’s a bit late. That’s unusual. The inevitable round of “You go get him”. “No, YOU go get him.” “Sorry, not gonna happen, YOU go get him.”

I’m the new guy on the block, so I’m elected. I know after this first season with Sid that if he’s been napping he’s likely to be a bit . . . curt. Oh well, here goes. KNOCK KNOCK KNOCK. Gulp.

The door flies open. And there he is, huge grin on his face . . . and nothing else on . . . anywhere.

Gulp.

“Hello old boy! Come right in!!! I’ll be ready in a moment.”

I love you Sid, but I think I’ll wait in the lobby, thanks.

A comment about comments

As you’ve all noticed, I don’t get very involved with the comments on my blogs. I get an email when each comment is posted, and make a point to read every one. I’ll say something when a comment has been particularly vicious, gratuitous, and personal. My theory being that if they stab you, you shoot them, if they shoot you, you burn their house down . . . that kind of idea. Or I’ll say something when there’s a clear misinterpretation of what I’d posted, or a clear need for some medical information.

Remember, this is my first, and only, blog. Having comments at all was a surprise. That people would take the time to think about what they wanted to say, then actually TYPE it and send it was quite amazing to me. And of course, I had to think carefully about how was I going to deal with this unexpected phenomenon – was I going to be interactive, chatty, available, or rather a bit removed.

As you can tell, I chose the latter attitude. Besides not having the time to continually interact, the great majority of comments express opinions, or ask questions, that either just need to be stated, or don’t require answers, or are answered by subsequent commenters.

Stepping back just a tad, in order to grab some perspective, I think it’s useful to point out that what brought the vast majority of my readers here is my slant on what’s been happening with Michael. So it’s pretty inevitable that sooner or later this kind of situation would lead to people, already very involved emotionally with the shock and unexpectedness of this tragedy, to express their thoughts about some VERY deeply personal issues. The nature and limits of privacy, the meaning of respecting a grieving family’s wishes, the nature of fandom and how that exchange works when it’s not all about fireworks and Ferrari tee shirts anymore, right down to advanced directives and end-of-life decisions. At risk of sounding trite, what we have in common is our humanity, our concern for all victims of seemingly random life-changing events, and a desire to learn and understand more. This has sure pushed me into exploring an area of medicine with which I was only indirectly involved (persistent disorders of consciousness; I’m usually only really involved in the acute phase of head injury, not this less “medical” phase).

It’s normal and expected that the powerfully held, deeply felt, and strongly expressed opinions jostle each other, bang against each other, sometimes even crash into each other.

Now don’t get me wrong – I’m as cynical, sarcastic, and “noir” as anyone I know. Actually a damned sight more than most people I know. That said, I’d love it if we could get back to making the comments section an enriching, respectful place, where opinions can be challenged without the holder being attacked. A place where even the most seemingly difficult statements are considered in their context, and if necessary, clarification sought . . . before the Uzis come out. By trying to keep in mind everything we have in common we might just be able to take the edge off the things that make us each unique.

I’m going to start a series of posts reprising something I did when I first started tweeting – the sequence of events starting with an accident and ending with the patient being evac’d from the circuit Medical Centre. This format (a blog) gives me the possibility to do so with a few more than 140 characters! Aiming at a first installment later today, but that depends on how wrathful the Gods of the ER prove to be.

 

An illustrative anecdote

I’m always going on about the inexperience of the current leadership of the medical arm of the FIA. I think it’s important, especially in view of the issue of intentional water/calorie restriction (which may well need regulatory input from the Medical Commission), that people understand that this is not (only) residual anger and bitterness because I was fired. So here’s a small example of what happens when important decisions are left to people without the background, experience or knowledge to carry them out appropriately.

At a 2012 meeting of the Medical Commission (I was still an observer), the president (Gérard Saillant) and vice president (Jean-Charles Piette, also the Formula 1 Medical Delegate) presented a draft regulation to the commission members, for what they expected to be rubber-stamp approval. In essence the regulation said the following:

In closed cockpit series, if the cockpit of the car is too small to allow either expeditious extrication of the driver or prompt removal of the helmet, drivers are REQUIRED to wear open face helmets.

Sounds simple, eh? Maybe even logical, right? They were happy that the cause of driver safety was being advanced. Interestingly, neither of the authors of this regulation have ever, in any way, managed an airway.

The intention of this regulation was laudable – to allow airway access rapidly under conditions of difficult extrication. But beneath the face of it, this proposition illustrated everything that is wrong with the current leadership.

The reading of the reg was met by silence around the table. I need to point out that the members of the medical commission are massively experienced, massively motivated, and massively frustrated. The president, until he was appointed by his friend Jean Todt, never had direct involvement in motorsport medicine. Same with the vice president, until he was named F1 Delegate, for the same reason.

Just as this proposition was about to be put to a vote, I raised four questions.

Question 1: How many drivers have suffered an adverse outcome due to failure to access/control the airway in a closed car? The answer is rather simple – ZERO. Although this is the nightmare situation of every motorsport doc, IT JUST HASN’T HAPPENED.

Question 2: How many drivers have suffered catastrophic head and/or maxilla-facial injuries due to contact with cockpit elements WHILE WEARING FULL-FACE HELMETS? The answer – well, I can name 4 or 5 off the top of my head. And I’m pretty sure had they been wearing open-face helmets, things would NOT have been better.

Question 3: How will the FIA answer the lawyers representing the family of a driver killed as a result of head injury wearing a mandatory open-face helmet?

Question 4: Why just accept that there are FIA-homogolgated cars still racing, with cockpits so small and roofs so low as to preclude satisfactory rescue operations? As the FIA body responsible for medical regulations, when the Medical Commission gets it wrong, lives are at stake. Why, I asked, has the Med Comm not gone on record with the relevant OTHER commissions to demand a say in cockpit design, before closing the technical regs for each series? This is the concept of cockpit-out design that I blogged about some months ago.

The reg was immediately withdrawn. I needn’t point out the eye-rolling among the membership at having been presented such a . . . silly proposition.

This is why I’m a bit fearful of knee-jerk, symptomatic responses to the weight control issue. This is why I’m enraged by the stagnation in medical progress in motorsport – it’s not down to nothing left to do, or to obstacles to advancement being thrown up. Rather, it’s down to a total lack of vision, perspective and knowledge of the ins and outs of this field, resulting from nepotistic, incestuous appointments. Again, Jean, you can give your mates titles, but that doesn’t mean you’ve made them competent.

Something NOT about head injury!

No seriously, are you guys KIDDING?

I guess we shouldn’t be surprised about Jenson and Lewis’ “revelations” about drivers intentionally compromising their health and well-being to minimise their weight. This is a sport that requires total commitment, and pressure to do anything to shave a tenth or so off one’s lap time. Millions are spent on aero tweaks, on salaries for the best designers around, etc. Remember that in the 80s we had a spate of drivers passing out post-race, because they were all taking beta-blockers. These were felt to improve performance under stress. Not.

I’m shocked and very very concerned about this development. I’m almost equally apprehensive of the potential reaction of the FIA in an attempt to mitigate this insanity. Oh and I think we need to be grateful to Louis and Jenson for their forthrightness about this.

So let’s start with a stable of drivers who are collectively some of the fittest athletes around, whose fitness regimens, 120 km bike rides, triathlons, etc, are the stuff of tweets, newspaper articles and tv reports. Everyone understands that the price of success in Formula 1 requires total physical condition. Only that will allow one to handle the physical stress of driving the cars and to maintain concentration despite physical discomfort. Only NOW we get to watch these guys starve and dehydrate themselves in order to minimise their weight. These are the same guys who never went ANYWHERE without their drinks bottles. I’ve been next to drivers who were tooting away on their bottles WHILE THEY WERE PEEING. Presumably McLaren has issued their drivers carbon fibre “peristalsis reversal devices”. They look just like spoons, and reliably induce vomiting. Jeez. Hey guys – nicotine activates the brain somewhat reliably. Maybe you should all take up smoking?

This is insane, and most worrisome. Obviously the implications of an unwell driver at the helm of a terrestrial cruise missile are huge – for themselves, for their fellow drivers, and for others. And the message this sends to the public, and to every young driver from go karts to GP2 is obvious – train for the week after a race, then totally fuck yourselves up for a week before the next one. Yeah, that’s the message you should be sending. Brilliant.

I needn’t go into ANY detail about why this regimen of starvation and dehydration is ridiculous from a medical point of view.

This has got to stop. And it’s got to stop now. And given the competitive pressures of the sport, this will not be easy. And given the implications for the safety of the public, track workers, and other drivers, it won’t be sufficient to issue some lame statement encouraging the drivers not to act like 90s heroin-chic supermodels.

Problem is, I fear that given the lack of experience of the current medical leadership (I’ll give an example of the absurdity this can lead to in a subsequent post), the solution will be more ridiculous than the problem. Let me make it clear – it is folly to try to paternalistically control nutrition or hydration of mentally competent adults by regulation. Any solutions must be legally acceptable, enforceable, and actually serve to discourage the behaviour in question.

So what’s to be done?

I’ve spend a bit of time thinking about this and pending something better, I think:

1) a statement highlighting the FIA’s concerns about this behaviour should be released

2) it should be stated that the nature of the problem of any driver who is unwell enough at the end of the race to require medical assistance will be investigated. The points of any points-finisher requiring medical assistance after the race will be provisional to the results of this investigation. A driver found to be intentionally dehydrating or starving (go ahead, think of a better word – Jenson said some of them eat NO CARBS for a week pre race!!!!!) will have his points cancelled and will receive a grid penalty for the next race. A second violation will lead to suspension of his or her super license. Forever.

These guys want to win, and as we can see, they’re willing to do anything for that to happen. We can question their sanity, intelligence, and wisdom, but not their motivation. But this also has ethical implications for those around the drivers with a duty to care, notably team physicians and the physios. If they are allowing this to happen, and worse, encouraging this, they are violating the cardinal rule of ANY caring profession: PRIMUM NON NOCERE. First, do no harm.

An incredibly important piece to read

An incredibly important piece to read

David Brooks is a rather conservative columnist, but he usually stays away from politics per se. He is one of the most brilliant men around – and this is proof of that. For everyone who is following Michael’s story, whether you’re deeply involved and suffering along with Corinna and Michael’s loved ones, or more removed from the tragedy, this column helps clarify the deeply human side of how we handle the suffering of others. Please find the time to read this. I have no doubt everyone who does will finish it just a slightly better and fuller person. Yes, it’s that important.

In the absence of any news from Grenoble, I’ll blog soon about some of the terminology that people are going to start throwing about at some point in the not distant future, and some of the possible outcomes we can expect.

Meanwhile, I hope you love this piece as much as I did.