By Demian Bulwa
The San Francisco Chronicle
SAN FRANCISCO — Bryan Stow’s eyes track his children as they circle his bed at San Francisco General Hospital, and he seems to watch his two sisters when they rub lotion into his feet and ask him, “How does that feel?”
He turns his head toward a Giants game on TV, and at times blinks on command. When his girlfriend kisses him, he doesn’t kiss her back. But she says, perhaps hopefully, “He kind of pushes his lips out, like he’s attempting to pucker.”
They are signs of life, and seeds of hope. But more than three months after an attack outside Dodger Stadium shocked the public and left Stow with a wounded brain, the cold reality is this: No one knows where these small steps will lead.
Not Stow’s family members, who make a daily trip from Santa Cruz County to his bedside. And not his doctor, who calls traumatic brain injuries -- which kill 50,000 Americans a year and disable 80,000 more -- an unconquered frontier.
“We haven’t gotten to first base with traumatic brain injuries,” said Dr. Geoff Manley, the hospital’s chief neurosurgeon. “We’ve gotten much better at getting people to survive, but we have a lot of work to do to help people recover.”
Stow is anything but alone among Manley’s patients, who have suffered falls and car wrecks, bullet wounds and bludgeonings. As with many of them, Manley doesn’t know where Stow will “plateau,” whether he will walk, speak or go home.
Stow would not have survived his assault a decade ago, Manley said. But looking deeper into the brain and making better predictions about how patients like Stow will fare in the long term, he said, remains “one of the holy grails.”
Waiting game
For now, an excruciating waiting game surrounds Stow, a 42-year-old paramedic from Santa Cruz who, according to Los Angeles police, was taunted and then punched and kicked by two men in Dodgers attire after an Opening Day game against the Giants on March 31.
The case remains unresolved. One suspect was arrested but has not been charged, and is serving time for an unrelated parole violation.
Stow’s loved ones, meanwhile, are locked in a surreal routine, scrutinizing his every move. He isn’t comatose, but Manley won’t attach a word to his condition beyond that.
Some days are rewarding and others dispiriting, because Stow’s progress, while slow, is not steady. In the hospital parlance, he “waxes and wanes.” So do the emotions of his family.
“I’m just so tired,” his mother, church secretary Ann Stow, said on a recent afternoon after emerging from her son’s room. Crying, she said, “When you see a response that’s there one day, and then not there the next day, it’s hard.”
No-cry zone
It’s not clear if Stow sees that his family is with him, but if he does, he doesn’t see the tears.
“If we start to cry, we leave the room,” said his sister Erin Collins. “We just don’t want him to see us upset. Maybe that will scare him.”
Stow’s family talks to him for hours each day, saying, “You can do it,” and, “We’re not leaving.” Or they say, “Bryan, you’ve got to wake up and read all this stuff they’re saying about you. You’re a rock star!”
They get him up to speed on his kids, 12-year-old Tyler and Tabitha, 9, and his beloved Giants. They play the 1980s metal tunes he grew up with, and read him the messages of support that flood in. Collins and Bryan’s other sister, Bonnie Stow, give him manicures and pedicures.
“He’s a major metrosexual,” explained Bonnie Stow, laughing.
Yes, there is also laughter at the hospital, because that has always been Stow’s way, as quick with a joke as he was to fix his gelled-up hair if it fell out of place. He would expect loved ones to make light of his situation, they said, and so the blue helmet that Stow wears when he’s moved to a chair is his “big boy helmet.”
$56 billion
If the family is anguished, Manley is frustrated. At a recent news conference, while updating Stow’s condition, the 50-year-old Kentucky native, who is stocky and intense, looked into the cameras and urged people to call their legislators to demand more funding for research into brain damage.
“This is really a political issue,” he said.
According to government figures, 1.7 million Americans suffer traumatic brain injuries each year, costing $56 billion in treatment and lost productivity. Today, 5 million people need help with daily activities because of such injuries, which impair everything from speech to memory to personality.
The shooting of Arizona Democratic Rep. Gabrielle Giffords, increased focus on football concussions, and combat casualties in U.S. wars in Iraq and Afghanistan have brought attention to brain injuries.
Still, the National Institutes of Health funds just $85 million in research per year. The Defense Department, faced with escalating troop injuries, has filled some of the void, spending nearly $900 million since 2007 to study brain injuries and post-traumatic stress disorder, a spokeswoman said.
Specific treatment needed
In a series of interviews, Manley complained of the “primitive” tools of his trade, like the pressure monitors that are drilled into patients’ heads. Extensive research into cancer and AIDS have prompted quantum leaps in treatment of those diseases, Manley said, but brain injuries await their moment.
In essence, he said, there aren’t specific treatments or drugs for injured brains, nor diagnostic tools to help tailor such therapies. “Right now we kind of use a one-size-fits-all approach,” he said.
One hurdle is the complexity of the brain. In the laboratories of San Francisco General Hospital, researchers study how the brain learns and heals, but translating their findings to patients remains difficult. Another problem is the way humans think about traumatic injuries.
“You and I probably believe we have a chance of getting prostate cancer,” Manley said. “Our wives and mothers worry about breast cancer. But for some reason, people never believe they’re going to be walking down the street and be hit by a car.”
The ravages of brain injuries were apparent during Manley’s rounds in the brain trauma unit one recent morning.
The ‘dark side’
A slender teen with a mop of hair moved his arms and legs back and forth but couldn’t close his eyes when prompted by chief neurosurgery resident Michael Oh. A collage of pinned-up photos showed him smiling, laughing, wearing a tie for a school dance, before the car crash.
“He’s really coming around now,” Manley said of the boy, who had been given heavy opiates. “That doesn’t mean he’s going to be the kid in those pictures. But he could be.”
A toddler who had fallen down stairs slept, his mother curled beside him. A young athlete -- his muscled body a stark contrast to his breathing and feeding tubes -- showed progress, but with a catch.
“He’s been trying to get up,” reported his nurse, Kevin Langley. “He was a five-person hold-down at one point.”
As he moved from one patient’s room to another, Manley said, “We sort of make sure nothing bad happens, and wait and watch, and hope they wake up.”
In the past, he said, doctors were quicker to give up and take patients off life support. Now, aggressive doctors are saving more lives, and some of those people are returning to work.
Such an approach, though, comes with a “dark side,” Manley said.
“If we treat a patient, get him through the live-die phase, and he doesn’t recover, that’s a bad outcome,” he said. “It would probably be easier on some families if a patient dies after three days rather than three months.”
Langley added, “It’s self-destroying to watch people linger in a state they’ll never recover from.”
Near death
Stow has come a long way since he was rushed from the Dodger Stadium parking lot to Los Angeles County-USC Medical Center.
He had a fracture in the middle of his head, back to front, perhaps from falling and striking the parking lot concrete, said his original doctor, assistant clinical professor of neurosurgery Gabriel Zada.
Worse, Stow had severe contusions to both of the frontal lobes of his brain, a known cause of coma. The underlying sinus -- which drains blood from the brain -- was also injured.
Zada drilled a hole in Stow’s skull for the monitor that measures pressure and drains fluid. The procedure worked at first, but Stow’s injured brain continued to swell on the second day, and Zada had to remove half of his skull to give it room.
“The skull cavity is a closed system,” Zada said. “If the pressure goes up in the brain, nothing else can get in there, like oxygen and blood and nutrients.”
Induced coma
Doctors had another challenge: controlling seizures that can do more damage to the brain. Experts were brought in to give Stow more than a half dozen antiseizure drugs, and he was put into a coma for several weeks.
“The idea,” Zada said, “is to put the brain almost into a hibernation mode, to completely shut down its electrical activity and let it heal, and then jump-start it.”
Once the fight to control the seizures had been won, Stow was flown to San Francisco General, where he has been slowly weaned from his antiseizure medications - a delicate process that continues. Although the drugs were pivotal, Manley said, they also depressed Stow’s consciousness.
“The thing that’s really clouding the picture of the future now,” said Manley, “is that we don’t know whether his exam is being altered by the medications, or whether this is just where he is.”
Dreaded questions
Stow’s family believes the public thinks he’s doing better than he is, especially after his condition was upgraded late last month, from critical to serious. Still, they remain optimistic, partly because of how far Stow has come -- and partly because there’s not much of an alternative.
“I can’t picture anything less than him being Bryan,” said Collins, his sister. “On those negative days, I get to thinking about lifelong care, and that gets me down, because I just can’t picture that.”
When Tyler and Tabitha visit, they touch and hug and kiss their dad. But they also ask what their mother, Jacque Kain of Scotts Valley, calls the “dreaded questions,” including: “Is he going to remember us?”
“We’ve talked about what happens when he does wake up,” said Kain, who remained good friends with Stow after the couple’s divorce. “I tell them, ‘Daddy spent all these years teaching you, and now you may need to teach your dad.’ ”
For Ann Stow, the only way to cope is to remain in the moment. Asked what her expectations are for her son’s future, she said, “Ask me tomorrow.”
Copyright 2011 San Francisco Chronicle
All Rights Reserved