Doctors say the PM's condition continues to be serious but stable.
By JUDY SIEGEL-ITZKOVICHjib.awards.298.vote(photo credit: )
Prime Minister Ariel Sharon was taken to undergo another CT scan Thursday evening so doctors could further deduce the level of damage caused to his brain.
The test showed positive results, indicating that the remnants of the blood in the prime minister's brain have been absorbed, hospital officials said in a statement.
In response, doctors had removed a tube they had inserted into Sharon's skull to relieve pressure on his brain, the statement from Hadassah Hospital said.
Meanwhile, doctors updated the press Thursday morning, saying that the prime minister's condition continued to be serious but stable.
Pinched and probed from time to time by his doctors, fed via a gastric tube, attached to a respirator, his eyes closed - with half of the skull on the right side of his head removed so doctors could perform three lifesaving operations - Sharon has spent a week in the neurosurgery intensive care unit at Hadassah-University Hospital in Jerusalem's Ein Kerem.
The quarter of Sharon's skull, sawed off during the first operation and frozen for preservation, will be put back in place with wires when doctors no longer need to monitor his intracranial pressure and no longer fear swelling of his brain tissue.
The million-dollar question is whether Israel's much-loved prime minister, whose health remains the chief subject of conversation in Israel and whose shadowed profile made the cover of Time magazine - will be the same Arik when he wakes up from his induced coma.
Nobody knows.
Prof. Charles Weissman, the New York-born head of the hospital's department of anesthesiology and critical care medicine since 1997, is one of only three physicians constantly at Sharon's bedside on the seventh-floor ward. Four other patients - victims of strokes, brain tumors and other maladies - lie in the same ward, beyond the partition and the security men.
"He is not in pain. He looks like any other patient in a neurosurgery intensive care unit," Weissman told The Jerusalem Post in an exclusive interview on Wednesday night. "He's been under anesthesia for a whole week, but he's coming out of it."
Weissman revealed that Sharon's cocktail of anesthesia drugs, which put him into an induced coma before the first operation and had continued at varying doses, had been halted completely for several hours from time to time - but now a small dose remained because the lack of the drugs raised his blood pressure somewhat.
Sharon was breathing now almost completely on his own, even though he was attached to a respirator, said Weissman. "It [the respirator] is the type that reacts to the pace and depth of his own breathing. The prime minister is, in fact, telling the machine what to do by how he himself breathes. The respirator is just helping him."
It is too early, he continued, to say when the machine will become superfluous. "It depends on the status of his lungs, his ability to cough, our ability to protect his upper airways, his cardiac function and general status. Being connected or not to the ventilator is not dependent on whether he is unconscious or not."
The hospital, which on Wednesday halted its daily briefings in the courtyard below by Hadassah Medical Organization director-general Prof. Shlomo Mor-Yosef, issued a very laconic bulletin via pagers instead. "Sharon remains in serious condition but stable, with slight neurological improvements and a minimum dose of anesthesia," it said.
The Israeli and world press have been pestering Hadassah and its doctors nonstop[ in the past week, resulting in contact with them being barred. Hospital management did agree to let some reporters have access.
The press has begun to fold up its portable tents and to dismantle the mobile transmission stations in the courtyard, especially as hospital management has tried to shoo them away by halting its televised and recorded briefings.
The 54-year-old Weissman, who has spent nearly all his time in the hospital during the past week, insisted that it was premature to predict whether Sharon has suffered extensive cognitive damage. Every patient was different, he said.
Asked if he and the rest of the team were optimistic, Weissman said, "Having taken care of lots of patients in this situation, I think it's much too early to tell. The most important thing is that he continues to make progress and that his neurological situation improves."
Weissman explained that Sharon's ability to be stimulated by pain was "getting more sophisticated. We don't prick him with needles or tickle him. It's mostly pinching - and looking to see how he reacts. We have not tested his response to sound, because we know he has such brain function and think he could hear if he were conscious." It was hard to tell whether he would open his eyes on Thursday, he added.
"You never know the rate of progress. It varies according to the patient," he said. It was true, as the papers said, that Sharon's favorite Mozart compositions were being sounded in a loop near his bed, but at a low volume. It was not true, Weissman noted, that Sharon's favorite lamb shwarma has been brought in for him - not to eat, but to smell. "You can't believe everything you read in the papers," the intensive care expert said with a laugh.
"No, we didn't think of that," he said, when this reporter suggested recordings of goat and sheep bleating to make Sharon feel as if he were home on his ranch.
"We don't know what he hears, but it is known that when a patient in a coma gets stimulation from familiar people and sounds, they may react better than to strange stimulation. We don't talk to him. His sons Omri and Gilad do.
"We have seen a reaction, a positive spike in blood pressure, as a reaction to their talking to him, and sounds do appear to stimulate him." he added.
The rest of the time, his medical and nursing staff make sure Sharon's lungs and heart and kidneys are working properly. He was getting fed, undergoing physical therapy and a special air mattress had him "floating" a bit to reduce the risk of pressure sores. His body was turned every few hours, but he had not yet been put in a vertical position, as it was too early, Weissman noted. He had not lost weight, despite his liquid diet, "because patients in intensive care tend to retain fluids."
Asked if his movements in response to pain meant only that his reflexes were working or that he would not be paralyzed, Weissman said, "As neurosurgery patients get better after such an 'insult' to their brains, movements get more purposeful. Paralysis means you don't move at all. As the patient improves, his movements will be less random. One would think the left side of his body would be paralyzed, given the fact that the hemorrhaging was on the right side of his brain and the three operations to stop the bleeding were there. But he is moving his left arm in reaction to pain stimuli. That doesn't mean that he will be able to walk or move his hand on that side. We don't know what his eventual motor function will be."
Weissman, who made aliya eight years ago, has been treating Sharon only since his second devastating, hemorrhaging stroke a week ago, and not after the first mild ischemic stroke caused by a blood clot. Thus he cannot say whether Sharon, as some newspapers claim, suffers from cerebral amyloid angiopathy (CAA) - a brain disorder in which amyloid proteins accumulate in the blood vessels and make them fragile.
According to neurologists outside Hadassah, it can be diagnosed for sure only in an autopsy, but if the Hadassah neurologists who studied his first magnetic resonance imaging (MRI) scan after the first stroke saw "old" mini-bleeds in his brain after the ischemic stroke, they should have been very careful about prescribing Clexane, a low-molecular-weight heparin anticoagulant that Sharon had injected twice a week at home during the two weeks before his first and second strokes.
"I don't know if he has CAA. I know that our senior Hadassah neurologists and other doctors treating him after the first stroke consulted with other experts in Hadassah, elsewhere in Israel and abroad. All of us have contacts in the US and Europe," and they were consulted, he stated. The idea of giving him Clexane, and not only aspirin and Plavix, to prevent more blood clots was surely bounced off a lot of people.
"You don't take such a decision lightly; you look at the potential risks and benefits. They undoubtedly weighed them against each other," Weissman suggested. "I don't know if Clexane caused the second stroke, but no doubt it increased the severity of a hemorrhagic stroke, as it makes it difficult to stop the bleeding. But if he hadn't received such anticoagulants, he may have had another ischemic stroke. Clexane is not given only under supervision in the hospitals; it is also given at home."
Weissman also could not predict when Sharon, if all went well, would be moved out of intensive care and into a rehabilitation facility. Security was a concern, of course. Ordinary patients do not have to worry about this, and they move on to regular wards when they are ready and able. Then, when the doctors believe they have done everything they can to treat the acute condition, stroke patients go off to rehabilitation in the hope that physiotherapy, speech and occupational therapy and other services will help them reach their maximum potential.
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