A Hopeful Departure

Maggie was one of the lucky ones. She was ready to leave the hospital and she got a chance to go to a brain rehabilitation program. So with tracheostomy and stomach tubes in place, Maggie was discharged from the hospital and transferred to Spaulding Rehabilitation Hospital in Boston. Spaulding, a Harvard affiliate, is one of the nation's leading programs for brain rehabilitation, and Nancy was hopeful that Maggie might qualify for transfer. Not everyone gets into such rarefied places. They were reserved for those families who knew of their existence and had injuries that might be amenable to whatever rehab they could offer.

At the end of her acute hospitalization, her clinical staff thought that Maggie might be in a minimally conscious state (MCS). (Nancy later recalled that was when she first heard of that diagnostic phrase.) Spaulding had a special program for patients who were in MCS. It was not certain, Nancy recalled, “… but they tested her because they decided that there was a possibility that she would have some consciousness.” Spaulding accepted her into their eight-week program.

Nancy was genuinely happy because the transfer provided a glimmer of hope. It meant that the doctors were wondering if she was not actually vegetative. It was a small opening to a bigger future, but hopeful nonetheless. That eight-week acceptance brought joy because it conveyed the sense that the doctors thought that some degree of recovery was still possible. As Nancy told us, “… It was a hopeful thing just for them to accept her into the minimally conscious” program because it meant that the doctors either knew or suspected that she was minimally conscious as opposed to vegetative. Nancy had learned by now that was a difference that would make a difference.

Good to Go

Not all patients are ready or stable enough to leave the hospital and fewer get to go to a rehabilitation center, ending up instead in a nursing home. As Burt Brody, whose wife Jean collapsed in his arms with a brain aneurysm, began to understand placement options he put it this way, “To learn the terms acute and subacute are almost contradictory to what they really are.