I have no idea at all what, exactly, Luca di Montezemolo means when he says that the news is not good. I’ve read speculation that actually he said something like “there’s no good news”, and that this has been mis-translated into “news that is not good”.

I assume that had Michael died, it would not be a furtive comment by a relatively distant ex-friend that would reveal this to the world.

We are now over two years since the injury. Despite the family’s silence, one can safely assume that were there to have been ANY good news, we’d have gotten it. After all, the family “allows” close friends to make statements (e.g. “he’s still fighting”, etc).

What we know is that two years after a severe head injury, a patient’s clinical status is (with near statistical certainty) not going to change. Given that the family’s own statements define what we call a “minimally conscious state”, this obviously is about as bad as news can be. What else can go wrong?

Because patients in a minimally conscious state have lost many of the body’s built-in “maintenance” functions, their life expectancies are significantly shortened compared to age-matched controls. Highly skilled and motivated nursing and medical care can forestall many or most of these, but they remain constant threats. The kind of things that happen to people in this situation are:

muscle loss. This is both an expression of the effects of lack of activity, as well as a key factor in several other complications

pneumonias. MCS is often associated with difficulties swallowing, and ineffective coughing to clear the normal secretions that our bronchi constantly produce. The loss of coordinated swallowing places the patient at risk of inhalation of oral and gastric contents, leading to repeated bouts of bronchopneumonia. This is a near constant in this group of patients, so much so that it’s virtually certain that Michael is fed through a tube inserted directly into his stomach or small intestine (a gastrostomy or jejunostomy tube).

urinary stones. These are also extremely frequent, and can lead to repeated urinary infections. These infections can lead to septicaemia, and are a frequent cause of hospitalisation.

pressure sores. Because these patients usually do not move much spontaneously, long-duration pressure on various parts of the body (back of the head, sacrum, heels) can compress the capillaries and lead to tissue breakdown and sore formation. No doubt the extraordinary care that Michael is receiving goes a long way to avoiding this problem.

Long story short? It’s possible that Luca di M is talking about one of the above complications. Anything worse? Could be, but I suspect that should this be a REALLY significant turn for the worse, the family might actually consider the millions of people who pray every day for Michael and say something.