Hopes fade for Michael Schumacher

WA Today
John F Burns
February 28, 2014
 

Grenoble, France: The hubbub of jostling reporters and television crews is a memory now, nearly two months after the helicopter carrying Michael Schumacher, the most successful Grand Prix racing driver in history, landed at University Hospital Centre in this old Roman city after travelling from a rocky snow slope at the Meribel ski resort 80 kilometres away.

Outside the nine-storey hospital, with a panoramic view towards the snow-covered Alps, the news media scrum has disappeared. Only a solitary, weather-stained banner remains to indicate that Schumacher is still a patient, deeply comatose and in critical condition, in the fifth-floor neurological intensive care unit.After eight weeks, if there's no sign of waking, what most people would do is unplug. 

“Schumi,” the banner outside the hospital says in bold scarlet letters, using the driver's nickname and the colour associated with the Ferrari team, with which he won most of his laurels: a record seven driver's championships and 91 Grand Prix wins. “All our thoughts for you and your family.”

In part, the reporters' disappearance from the hospital's grounds has been a response to appeals by Schumacher's wife, Corinna, to spare the family further intrusion into their privacy as they maintain their bedside vigil. But the news media's absence tells another, more melancholy story, too.

Attention has moved on, with Schumacher becoming only the latest, if one of the best-known, additions to the sobering roll call of those who have fallen into the oblivion - for weeks, months or even years - of long-term comas after suffering traumatic head injuries while engaging in potentially hazardous recreational sports.

Doctors in Grenoble, the gateway to France's best-known skiing resorts, say that hundreds of injured skiers have arrived at the hospital with concussions and more serious head injuries in recent years. Some of them occupy beds near Schumacher's.

The outlook for Schumacher, 45, has been obscured by the decision of his doctors and his family not to give regular updates on his progress. But what is known seems increasingly dispiriting, at least for his prospects of achieving a complete mental and physical recovery, or even of escaping long-term impairment.

His injuries prompted two operations in his first 36 hours at the hospital to remove blood clots from his brain, and a statement by his doctors after the second operation said scans had revealed multiple clots in deeper areas of the brain that were not accessible to surgery. Those deep clots, medical experts say, pose the most serious threat to Schumacher's recovery, and perhaps to his survival.

Unable to remove them, the Grenoble doctors moved more than three weeks ago to a new and critical phase of treatment - an effort to bring Schumacher out of the medically induced coma in which he has lain since he arrived on December 29.

Since that treatment began, the only medical updates have been unofficial and anonymously sourced reports in German newspapers and magazines.

Those reports prompted a new statement by Sabine Kehm, Schumacher's spokeswoman, who said on Monday that the process of lifting the coma remained “unchanged". That was not in itself a denial of the German reports that the attempt to revive him had failed, as experts have said that temporary suspension of the waking process is common in such cases.

In addition, “repeated partial awakening, reassessment and re-sedation” are common, given the complexity of the process, according to Headway, a British brain injury charity.

While cautious because of the lack of detailed information coming from the doctors in Grenoble, other experts were generally pessimistic.

“If they're not releasing good news because there is none, then that's very bad news indeed,” said Gary Hartstein, a US anaesthesiologist based in Liege, Belgium, who worked for eight years until 2012 as head of Formula One's medical unit.

“After eight weeks, if there's no sign of waking, what most people would do is unplug,” he added.

Others were more sanguine.

“A couple of weeks after you stop sedatives it's too early to say that somebody is in a persistent vegetative state,” said David K. Menon, a Cambridge University specialist who heads the anaesthesia division at Cambridge Neuroscience, a research institute noted for its work on traumatic brain injuries. “But the more time you take to wake up, the less the probability that you'll have the sort of recovery you'd hope for.”

One potentially remedial step taken by the family was to invite Schumacher's long-term teammate at Ferrari, the Brazilian Felipe Massa, to sit with Schumacher, talking of common experiences in F1 and of developments in the cars for the new season, which begins March 16 in Melbourne. Massa, who survived a severe head injury when a heavy spring from another car broke loose in Hungary in 2009 and struck his helmet at more than 320kmh, said that he had spent “a long time” with his friend.

“I told him everything, about my car, my new team,” Massa said, referring to his shift from Ferrari to the British Williams team. “I told him to wake up many times.”

At Meribel, skiers continue to flock to the slope where Schumacher, skiing with his 14-year-old son, Mick, had his accident, about 2100 metres up the Saulire mountain, which overlooks the town. Meribel's slopes were used for the women's skiing events in the 1992 Winter Olympics, and complaints then, particularly in the downhill, were that the high-altitude descents were too steep.

But members of the ski rescue team at the top of the mountain, at a station known as Dent de Burgin - the unit that responded to the Schumacher accident, summoning the helicopter that took him to Grenoble - said there had been barely 400 skiing injuries of all kinds among visitors who bought more than 1.3 million day passes for the Meribel slopes last year.

As for Schumacher, they said, he had avoided the most perilous descent, which has an 85 per cent incline at one point. Instead he took a gentler, wind-around route to a lower slope where, for reasons that remain unexplained, he chose to cross between two heavily travelled pistes, or trails. That took him across an area of ungroomed snowfield strewn with rocks, whose perimeter is marked with red-painted poles.

Under regulations set by the Meribel authorities, off-piste areas like the one Schumacher entered generally carry no warning signs, and there were none where Schumacher fell. One of the rescue team members, Philippe Merlin, said an overnight snowfall had left a deep overlay of fresh, uncompacted snow that covered most of the rocks, but allowed Schumacher's skis to sink as much as 30 centimetres beneath the surface.

A French police investigation that was formally closed last week, drawing in part from videotape retrieved from Schumacher's helmet-mounted camera, found that the initial impact had occurred just over one metre from the piste and that Schumacher had been catapulted over the tips of his skis into a headfirst impact with another rock 10 metres farther on that caused his helmet to split. Police ruled that there had been no negligence or other error, by Meribel or Schumacher, that required further criminal investigation.

That conclusion met with broad support among skiers on the Saulire runs, many of whom said they were satisfied with Meribel's safety arrangements. Merlin, of the rescue team, who has skied the mountain for more than 40 years, said that Schumacher, who owns a chalet nearby, was known on the slopes as a good skier and that what he had done in crossing the rocky area was not unusual.

“It's quite normal,” he said. “But he was unlucky.”

The New York Times