THE BLENDER

I told my friend Mark about what was happening with my friend Ron, and he said simply: "When it's your time in the blender, it's your time in the blender." For the last 18 months, Ron's been through every setting - chopped,  grated,  pureed - until now he's finally whipped. It began with a single-car accident on a twisting country road, just before dawn on the 19th of August. Ron's wife, Ellen,  was ejected at 40 mph through the T-top of her Mustang,  landing on the left side of her head and crumpling like a rag doll. She'd've died right there, except for the recently paroled woman living in a broken-down trailer nearby, who was awakened by the crash. She'd've died in the ambulance on the way to the nearest hospital,  if a medi-vac helicopter hadn't been available.  She'd have died that day if they hadn't flown her to the top trauma unit in the area.

It was still touch-and-go for the next 72 hours (over 20 of them spent in surgery). Her shattered cheek, fractured neck, punctured lung,  dislocated hip and broken back (in three places) would all likely heal. But the TBI (traumatic brain injury), and the deep coma resulting from it, were much more worrisome.  The doctors told Ron that there could be significant paralysis on her right side,  and that it appeared her speech center had taken a direct hit, meaning she might not be able to talk. That is, if she regained consciousness.

Coming out of a deep coma is nothing like the movies, where people suddenly "wake up", a little confused, but essentially there. It's much more gradual, much more subtle, as the different layers of consciousness return in ripples, and then waves.

Somewhere in the fourth of fifth day Ellen's eyes finally opened, fixed in an unseeing, unsettling stare.  The first sign that the coma might be lifting was a slight flutter in her left eyelid, two days later.  I don't know how Ron even saw it through all the tubes and needles running in and out of her, and the wires dangling off of her.  He pinned his hopes and prayers on that flutter, taking Ellen's hand and whispering in her ear: "We won't let this beat us, baby."

Though her expression remained a frozen mask,  Ron swore he saw the flutter again. "We won't let this beat us, "  he repeated.  It would become their mantra over the months that followed.

Ellen was back home with Ron in exactly 45 days,  not the consequence of a medical miracle, but because of a much more common occurrence: they had no health insurance at the time of the accident. After three weeks in ICU at Henry Mayo Newall Hospital, the doctors who had saved Ellen's life told Ron they had some good news. They had managed to get Rancho Los Amigos, L.A. County's nationally known brain trauma center, to accept Ellen for admission and rehabilitation.  Rancho literally wrote the book on coma recovery scales and cognitive levels. It sounded like the answer to Ron's prayers.  Instead, it became the entry into a numbing series of bureaucratic and institutional nightmares.

Somewhere along the line (perhaps during the county's fiscal crisis in the early 1990's), Rancho Los Amigos had stopped attracting the top people. By the time of Ellen's admission,  the administrators and staff were dedicated only to coasting on the hospital's reputation. They were not interested in trying to rehabilitate an indigent patient whose prognosis was highly doubtful - a possible lose-lose on their stat sheet.

After barely one week of evaluation, and in spite of her continuing physical recovery, the doctor responsible for admitting Ellen informed Ron that she had "plateau'd" mentally. He stated flatly that she wouldn't get any better,  and would require 24 hour care for the rest of her life. He told Ron that the sooner he accepted that, the better it would be for everyone. He recommended that Ellen be committed to a county nursing home, and offered to facilitate the transfer. Then he notified Ron that, in any event, her release date had been set for 8 days later.

Ron couldn't believe the news. After getting over his initial despair, he realized that the reason he couldn't believe the news was that he didn't believe it. Everything his eyes saw told him differently. The increments of progress were almost imperceptible, but he wasn't imagining them. And hadn't she already fought off death?  If she wasn't ready to let go, then neither was he. He told the doctor: "You want to release her? Fine. Then I'll take her home.  Because you're wrong."  He told Ellen: "We won't let this beat us."

Eight days later at the time of her discharge, this same doctor gave Ron no information, consultation, or referrals regarding proper neurological follow-up for Ellen, and no instructions for her care. He told Ron nothing about anti-seizure medications, somehow failing to mention that seizures were a common after-effect of injuries as severe as Ellen's. He, and the hospital,  just dumped her.

Ron took Ellen home to their rambler in the high plains, 20 miles outside of Lancaster.  She was still at Rancho Level Three on the coma scale, where the patient has virtually no memory and very little concept of time and place. Imagine if at each moment of the day every object of your surroundings was a total mystery to you, with limited familiarity and recognition carrying over from moment to moment -- a foggy combination of the perpetual now and the perpetual unknown.

What happened next was out of a Frank Capra movie.  In spite of their depleted finances, Ron (who makes his living as a touring comedian) canceled all his gigs to be with Ellen.  He cooked for her, carried her to the bathroom and shower, worked with her on the basics of physical therapy that he'd picked up from the nurses at Rancho. And Ellen responded. With Ron's help, she began to stand for brief periods. Slowly, she regained some control of her right foot, then the right leg and arm. Then they began to work on walking.  Two steps, then three, then the length of the hall. Along with the physical therapy, he worked on getting Ellen's speech back.  They went over and over the days of the week, the names of their dogs, how to count from one to twenty. Progress was painstakingly slow, with the weeks turning to months. But as he showed her photographs and repeated stories from their life together before the accident, Ron
began to see flashes of Ellen's memory returning. Inch by inch, the fog was lifting.

When her back had healed sufficiently, Ron began to take Ellen for short drives through the countryside.  Seeing the panorama of mountains, plains and desert through fresh eyes was nothing short of thrilling for her. Encouraged by the results of these outings, Ron pushed the envelope, taking her across the mountains and down to the ocean. She wept, overjoyed, at the beauty of the California coast unfolding in front of her. One afternoon, maybe four months after the accident,  Ron asked
Ellen if she'd like to go out for lunch at their favorite Thai restaurant in Lancaster. To his delight and surprise, her eyes lit up and she answered him, clear as a bell, "Yes, I would." Another bridge crossed and closer to the world. These were great moments and great days,  and they were starting to far outnumber the bad ones, when Ellen was back in the fog. Meanwhile word of their circumstances spread through the comedy community.  A number of Ron's favorite clubs put together soldout benefits,
featuring celebrity auctions with items donated by many of the country's top comedians (including several signed scripts from Jerry Seinfeld). Then the wife of one well-liked comedian heard the story. She circulated a charity chain letter by email, with the help of several internet comedy news groups. She described Ron and Ellen's situation, gave out their address, and asked the recipient to send them a check for $25 and forward the email to ten friends.

The response was astonishing. For the next two months, when Ron went to pick up his mail he found as many or more checks than bills. Nearly two hundred strangers responded, many with letters of prayer and encouragement.  Ron, choking back the tears, told me "Y'know, I've always believed that people were basically good, and now I know that I was right."

Six months after the accident, and only 4 1/2 after the doctor at Rancho confidently told Ron to forget about his wife, she could dress and feed and otherwise take care of all her basic needs. She didn't just walk down the hall, either. She would stride forward, in spite of her right leg's perceptible drag.

More importantly, her memories were finally beginning to coalesce. She was clearly more cognitive and responsive, even taking care of Ron for a week when he went down with the flu. And while complex speech remained a problem, she was recovering more and more words and phrases with each passing week. Ron and Ellen were halfway to a miracle.

To celebrate, they took a drive to the coast, stopping for a quiet lunch near Malibu. Ron took her hand and told her: "Baby,  if they'd told me that I could be sitting with you like this, six months after your accident . . . I'd've given my right arm." Ellen nodded, beaming, and gave a heartfelt "Yeah."  Then she collapsed, convulsing on the floor. Ron had found out the hard way about seizures shortly after getting her home from Rancho. Since then they'd largely been controlled by medication. But this time it was different.  He took her to the emergency room of their local county hospital.  She'd lost all use of her right side, including some facial paralysis. She'd lost all speech. It looked like classic stroke symptoms, but the doctor told Ron it was probably just another seizure. They took some blood from Ellen, but never ran the tests for stroke. After waiting several hours, the doctor decided there was no reason to admit her, and told Ron to take her home.. In the middle of the night, Ellen had more convulsions, almost choking on her own vomit before Ron woke up. This time he drove her the 45 miles to Henry Mayo Newall. The diagnosis: Ellen had indeed suffered one or more strokes, probably the result of a blood clot left over from the accident. The severity of the strokes was compounded greatly by the hours of treatment that had been lost due to the emergency room's failure to diagnose.

The impact was devastating. Ellen did manage to walk out of the hospital almost a month later, only now it step by step, leaning on her walker. She'd completely lost use of her right hand and arm, and needed a brace from her knee to her ankle to keep the lower right leg from collapsing. Speech was gone, and the fog had descended again. They were back in the blender, big time.

Ron still told her :"We're not going to let this beat us", and she still nodded "yes" as she squeezed his hand. But as they struggled together day in and day out, it now seemed that every small step forward was quickly erased by some setback: a fever or a seizure that would more than wipe out the progress.

With financial pressures building again as the first anniversary of Ellen's accident came and went,  Ron knew he had to find a way to get back to work.  He figured that if he could just get her strong enough to travel, even with the wheelchair, then maybe he could do a week or two on the road every month, and take Ellen with him.  He took one last shot at being her physical therapist.

At first, it seemed to be working. With the help of a new medication that had all but eliminated seizures, Ellen became strong enough to go for drives again. Ron took her with him to Las Vegas for a week, performing his first shows since the accident. The trip went so well that he booked another couple gigs for a month later, calculating that by then Ellen would be up to the task.

But it wasn't to be.  In spite of Ron's efforts,  Ellen's strength began slipping, ever so slightly, as the time for their trip approached. With his options now running out, he hoped against hope that getting out into the world might once again revive her. But instead, the constantly changing stimuli proved too much for Ellen. As the miles and days wore on, she grew progressively weaker and less aware.

Returning home held no more magic, either. This time, Ellen really had plateau'd. Ron no longer told her "we won't let this beat us", because now he no longer believed it. He looked at Ellen, he looked in the mirror, and he knew better.  The cumulative effect of two brain injuries and a similarly disabled health care system had finally overwhelmed both her courage and his devotion.

Two days before Christmas, Ron's bankruptcy was approved by the court. By the end of January, Ellen was re-hospitalized.  Since then she's been in and out of a deep coma, not even reaching Rancho Level Three  As I write this, she is being fed through a tube, with a machine breathing for her. She recognizes no one and nothing. Their best-case scenario for the future is that Ron with happen to be with her when her time comes. I hope so.  They've earned that much.  With any luck, it will be soon.

The larger truths here are both ironic and inspiring.  Inspiring that, at the moment of greatest need, doctors and technology advanced enough to bring Ellen back from the brink were made available without qualification. But ironic that once the triumph over death was achieved, the same person deemed worthy enough to warrant such extraordinary efforts was then cast into a bureaucratic labyrinth, put to the tests of
indifference and incompetence, and (in Ellen's case) ultimately sacrificed to the whims of a cost-benefit mentality.

Yet, even as the system was failing them, the caring response of literally a thousand strangers carried them forward in their struggle. The fact that the fight appears lost takes nothing from that affirmation. I remember visiting Ron and Ellen after a truly magical benefit organized by the entertainment director at the Riviera Hotel in Las Vegas.  After reading her a glowing review of the show, I told Ellen  how everyone had the same questions for me: How was Ellen doing, and was she going be the same as before the accident?  The question was as ridiculous as it was innocent, but what caught me off guard was that Ellen clearly thought so, too.  Without even a trace of bitterness, she responded with emphatic, eye-rolling laughter, which Ron and I joined in on.

When we were done, I added that what had struck me most was everyone's wish for her to be "the same" again, because as I'd watched the faces of the people leaving the benefit it was clear to me that many of them weren't going to be "the same". They went home that night knowing something they'd long forgotten:  that one person caring does make a difference.  That, I told Ellen, was her gift to them.

Even the blender has its gifts. If you asked Ron, or could reach beyond the fog to Ellen,  I'm certain both would tell you that their time in the blender encompassed many of the richest and most real moments of their marriage. That may be the deepest irony, because at the time of her accident., after 13 years together, Ron and Ellen were within days of separating.  The reasons are not important now, but both were heartbroken about it.  She enough to have chosen death right then, and he enough to have just walked away.  Instead, in the face of what proved to be insurmountable odds,  they rediscovered the strength of their love for each other.

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