Sharon's medical deterioration

sharon hospital 298.88 (photo credit: Ariel Jerozolimski)
sharon hospital 298.88
(photo credit: Ariel Jerozolimski)
Ariel Sharon's medical file since January reads like a tragedy, an effort of dozens of well-meaning and dedicated doctors and nurses trying to save his life, restore his mental and physical functioning and finally to prevent his inevitable death after months in a vegetative state. No one knows whether the former prime minister would have wanted it to go on so long, but his sons, who periodically claimed their comatose father was reacting to their voices and stimulation insisted that everything be done to keep him alive. Depending on his long-living mother's "good genes" and ignoring advice to change his lifestyle and lose weight, Sharon took his health for granted. But on December 18, everything began to unravel. The then-prime minister, in the midst of an election campaign, was en route from Jerusalem to Tel Aviv when he felt unwell. His driver made a U-turn on the Jerusalem-Tel Aviv highway to take him to Hadassah University Medical Center in Jerusalem's Ein Kerem. There he was diagnosed with a minor ischemic stroke that left no disability, and he was treated and released soon after. But subsequent medical tests uncovered the existence of a hole in the septum between the two atria of his heart. His Hadassah doctors prescribed the insertion under general anesthesia of a clamp to close the hole, to eliminate the risk that it would cause a blood clot to move into his brain and trigger another ischemic stroke. He was given a cocktail of powerful anti-clotting agents to minimize the risk of another clot and told to rest, but he largely ignored the advice because of the election campaign. A press conference on his health and treatment was called by the Prime Minister's Office to which political and diplomatic correspondents rather than health reporters were invited. Two Hadassah physicians who headed his medical team explained his condition in medical terms that were misunderstood by the reporters, who were laymen. Sharon's basic problem, of which he was probably unaware, was cerebral amyloid angiopathy (CAA) a brain disorder in which amyloid proteins accumulate in the blood vessels and make them fragile. Further progression of his CAA led to the development of large holes in his brain, leaving no hope of recovery from his vegetative state. On January 4, the night before he was to undergo a catheterization procedure at Hadassah's cardiology department to close the tiny hole, Sharon suffered a severe hemorrhagic stroke at his Negev ranch. His dispatch by ambulance to Hadassah took longer than necessary due to delays in the arrival of his personal doctor, and it was decided to take him to Jerusalem, where doctors were familiar with his medical history, rather than to Soroka University Medical Center in Be'ersheba, which was much closer. Hadassah neurosurgeons worked for many hours to staunch the massive intracranial bleeding on the right side of his brain that put pressure on the tissue and caused major brain damage. Several operations within a few days brought an end to the bleeding as Sharon was put into a drug-induced coma in the hope that he could recover and be awakened. His chief neurosurgeon, Dr. Jose Cohen, predicted on January 7 that Sharon would survive his massive stroke. "He is a very strong man, and he is getting the best care. He will not continue to be prime minister, but maybe he will be able to understand and to speak," Cohen suggested hopefully. But Sharon suffered one setback after another and wasn't able even to be weaned from his respirator at Hadassah. Criticism of Hadassah's treatment strategy between the first and second stroke was widely voiced by doctors in hospitals in other parts of the country and abroad and some demanded an impartial investigation, but the Hadassah Medical Organization insisted he was given the best possible care. Sharon underwent seven operations at Hadassah, including the insertion of a semi-permanent peripherally inserted central catheter, removal of a section of his large intestine after a clot caused necrosis and the replacement of a quarter of his skull that had been removed for brain operations. Then, with his life signs finally stabilized but remaining in a deep coma, Sharon was transferred on May 28 to Sheba Medical Center's respiratory rehabilitation center, where doctors said they hoped at least to get him to breathe on his own and maybe even to allow him to undergo therapy and be moved to his ranch. But during the last week of July, Sharon took a turn or the worse, developing edema (swelling due to accumulation of liquids), changes in his brain tissue and kidney failure. He was attached to a hemofiltration system at Sheba's intensive care unit and given broad-spectrum antibiotics and corticosteroids to try to fight his double pneumonia. Multiple organ failure was inevitable.