Lots of Hope

Yesterday, Scott responded to the question "What is your name?"  This is pretty amazing.  He has now responded appropriately to questions four times over the past few days.  This signifies that those functions in his brain - hearing, processing language, coming up with a response and vocalizing, are intact.  Great news!  It may take some time before he has those skills fully at his disposal but, they are in there.

Jennifer and I had a great meeting today with a friend, Nerissa Ko, who also happens to be a Neurologist at UCSF.  She knows Scott's doctors and was able to contact them prior to our meeting and get some information about his case.  She was extremely helpful in answering questions and setting some expectations for what lies ahead.  Some points I took away from our two hour long meeting with her:

-- Scott is out of a coma.  The fact that he is able to respond signifies that he is no longer in a "comatose" state.  This is great news, as there is some indication from what I've read that the longer one remains in a coma the harder the recovery process.  The fact that he is officially out of a coma is not entirely obvious when visiting him, he sleeps a lot and when awake seems like he is far away.  However, Nerissa described his current state as being caught between two states of consciousness.  She has reported that patients who recall this state later describe it like being in a fish tank - you can see out, but its really blurry and you can't really tell what your looking at, sounds is muffled and not entirely clear, you think you are dreaming and are inclined to just close your eyes and go back to sleep.  She impressed upon us the importance of trying to bring him out of this state by bringing familiar sounds, smells, voices, all of which Jen has been doing.  She said that, with assistance of nursing staff and others, we can take it further but trying to sit him up in a chair during the visits and trying to get him on a sleep/wake schedule.

--It is impossible to tell anyone's prognosis at this early stage.  This is something that other doctors too have told us, but Nerissa explained that any kind of prognosis is only possible about six months after the accident.  Even then, she stated, people end up defying those guesses.

--Scott is progressing well.  It has been very difficult to gauge where Scott's recovery is and where he should be.  It seems that no doctor has really given a straight answer to this question.  It was helpful to hear from Nerissa that she was actually surprised he is already out of the ICU.  She was very encouraged by the progress he has made so far and stated those were all very good signs in terms of potential for recovery.  Beyond that, it seems impossible for anyone to say any more at this stage.

--The hard part is yet to come.  Nerissa talked a lot about getting prepared for when Scott comes home.  She said that he will not be sent home unless he can physically complete certain tasks on his own.  I got the impression the physical part might come more quickly than the cognitive part -- she said that the acute rehabilitation process which they are already discussing will likely only last weeks (not months).  Thus, there will be a lot to think about in terms of safety when he returns home.  Doctors and social workers have already talked to Jen about the fact that he will require 24 hour a day care and supervision.  For example, if Scott has memory impairments and/or temporary forgetfulness (which can be common in TBI patients) Jen will not be able to leave him alone to go walk the dogs around the block or run to the corner store.  It is way to early to anticipate exactly what this will mean in Scott's case but hearing Nerissa describe the inevitability of it in more detail made me realize that the transition back home, which we are all so anxious and excited for, will also be very challenging.