Ariel Sharon, the Israeli Prime Minister, on Friday underwent emergency surgery for the second time after doctors discovered evidence of new bleeding in his brain.
Doctors said they managed to stop the bleeding and reduce pressure in his brain after five hours of surgery, but he remained in a critical condition with most medical commentators suggesting that his chances of survival remain slim.
Condoleezza Rice, the US Secretary of State, cancelled a planned trip to Indonesia out of concern for Sharon’s health. An official said she does not ”want to be a long way from Israel should he die”.
Dr Shlomo Mor-Yosef, the director of the Hadassah hospital in Jerusalem, said on Friday night there was no bleeding in Sharon’s brain at the moment.
”By comparison with previous brain scans, there has been a significant improvement in the appearance of the brain as interpreted by our neurologists,” he said. ”Despite the improvement, the situation remains critical.”
It was a dramatic day at the hospital after doctors first reported no change in the prime minister’s condition overnight and then rushed him into the operating theatre after new complications were detected.
”The night passed without change,” Mor-Yosef told reporters shortly after 7am. ”All the parameters that we are measuring … are stable.” He said then that pressure in Sharon’s brain was steady, adding: ”This is again a positive sign.”
But the situation was soon reassessed. The deterioration in Sharon’s condition was only noticed when doctors analysed the results of a brain scan taken earlier in the morning. They noticed new bleeding in the prime minister’s brain as well as swelling in one area of the brain and an increase in blood pressure. The medical team decided to take Sharon to the operating theatre again to stop the bleeding and reduce pressure on the brain.
Members of Sharon’s office rushed to the hospital and could be seen standing in the courtyard comforting each other.
The second bout of surgery followed a seven-hour operation on Thursday morning after he suffered a major brain haemorrhage on Wednesday night. Doctors said they had put him in a medically induced coma to give his body time to heal and added that it was impossible to assess the scale of brain damage until sedation was reduced, probably on Sunday.
However, several doctors quoted in the Israeli media said that at the very minimum Sharon would suffer severe brain damage affecting his mobility and speech. They also noted that his chances of survival were slim.
Controversy has simmered in Israel over the prime minister’s treatment since he suffered a minor stroke in December. Sharon was treated with blood-thinning drugs that reduce the risk of blood clots but increase the risk of a haemorrhage. Others questioned the wisdom of allowing the prime minister to spend time at his countryside residence on the eve of surgery and the decision to take him to hospital in Jerusalem rather than the nearer hospital in Beersheva, which added 30 minutes to the journey.
Israelis on Friday continued to come to terms with Sharon’s departure from the political scene that he has dominated since he became prime minister in 2001. Ivor Neushotz, from Jerusalem, said it is difficult to imagine who could bring peace in the absence of Sharon.
”He is the person most capable of making peace with the Palestinians. This will put a stop on everything and I just hope he gets better.”
But in Jerusalem’s Zion Square, Meir Cohen was collecting money for the former settlers of Gush Katif.
”Don’t forget your brothers,” he called. However, he did not count Sharon as a brother after giving up Jewish territory during the withdrawal from Israeli settlements in the Gaza Strip.
”I can’t say that I am happy that he is not well. But I am very happy he will not be involved in government any more,” he said. ”My only concern is that he doesn’t work any more, how it happens is less important.”
What are Mr Sharon’s prospects for survival?
Poor and getting poorer by the moment. His age (77), size, duration of surgery, repeat visits to the operating theatre and the fact he had been taking blood-thinners all count against him. Even before he returned to the operating theatre for a third time on Friday, a British stroke specialist told The Guardian his chances of surviving a few days or weeks were no better than 50-50. Half the patients with this kind of stroke die within a month. Even if he pulls through, he is likely to suffer severe disability such as paralysis, loss of language or cognitive problems.
What kind of stroke did he suffer?
First there was a mini stroke, or transient ischaemic attack (TIA), before Christmas. This is caused by a clot or debris in vessels carrying blood to the brain. The suspicion was that this was linked to an undetected small hole in Sharon’s heart. He was due to have surgery on Thursday to put that right. He was put on anti-coagulants or blood thinners in the meantime.
A more major stroke commonly follows such a TIA. These are usually ischaemic, a blockage that deprives part of the brain of oxygen and other nutrients. But Sharon suffered large-scale bleeding in the brain. Such events are usually caused by the rupture of a small, already diseased artery. There was some surprise Sharon was at his ranch in southern Israel so soon before his planned operation. Even then, he was taken to Hadassah hospital, Jerusalem, rather than nearby Beersheba because his condition did not appear serious.
Did blood thinners complicate Sharon’s condition?
It is sometimes difficult to judge the right amount of anti-coagulant to prevent dangerous clotting but avoid excessive bleeding. Even if dosage has been well controlled, the risks of cerebral bleeding increase. Time is of the essence if damage is to be limited. Doctors would have given Sharon fast-acting intravenous drugs on Wednesday night to counteract the effect of anti-coagulants. They would probably have opened a section of his skull to drain the blood and find the leaking artery. — Guardian Unlimited Â