Articles about Dr. Ghaly
Ten years after losing his small son to a brain tumor, Jim Boland calls upon HIS UNDYING FAITH as he finds himself facing his own lethal brain cancer
November 26, 2006
Sunday Beacon News
Story by Angela Fornelli
Family members gather in the neurosurgical office of Dr. Ramsis Ghaly, where he explains the details of their father Jim Boland's relentless brain tumor.
'Borrowed Little Angel'
Messages of support
Health, then new tumors
Renewing their vows
Annunciation Church was packed to capacity at Jim's funeral Mass. The Rev. Mario Pedi told the story of how, at one of the last masses Jim was able to attend, he knelt and touched the statue of Jesus that sat on the altar. "He knew Jesus suffered more for him and you and me than anyone else," he said. "We need more people like Jim, and we can be, because we heard his words."
Brain surgery gives Joliet woman hope
By Denise M. Baran-Unland
Special to the Herald News
Dulcy Hawksworth, 32, of Joliet, has a passion for community service that is reflected in her numerous outreach activities.
She participates in political campaigns, events that raise awareness for domestic violence and, recently, marketing an Ohio self-esteem and leadership day camp for children ages 9-13.
But Hawksworth's tendency to overschedule and micromanage every minute of her day, including her regular job as an account manager for Storandt Pann Margolis in La Grange, a health care marketing and communications firm, left her unable to pay attention to the subtler, more meaningful aspects of life, until she received the unexpected news that a brain tumora meningiomawas causing her severe chronic headaches and that she required immediate surgery.
"I used to think that I'd pay attention to God and schedule him in my life someday when I had the time," Hawksworth said. "The tumor was God's way of saying to me, 'Thou shalt sit.'"
Yet, during Hawksworth's seven-hour surgery June 12, Ghaly not only removed the entire tumor, he also removed about a two-inch area inside Hawksworth's brain that surrounded the meningioma, just in case the meningioma had infiltrated the brain. The biopsy showed that Hawksworth's meningioma was benign and very slow-growing.
|Pushing to the edge
The Sunday Beacon News
By Marie-Anne Hogarth
Last year, as a national debate raged over the fate of Terry Schiavo, the Florida woman who has existed in a vegetative coma for more than 13 years, a Fox Valley family faced a similar dilemma: To save their loved one's life irrespective of condition, or watch him die within a matter of hours or days.
They were lucky to have had the choice.
In the early morning hours of Palm Sunday a year ago, as he slept peacefully next to his wife in the bedroom of the log home he built with his own sweat and determination, Dennis Ryan's brain began to die.
Unbeknownst to him, three days earlier the 55-year-old swim coach from North Central College had torn a major artery in his neck as he strained to start an old piece of machinery.
But as he lay sleeping that Sunday morning, this injury to the carotid artery finally stopped the flow of blood and oxygen to the brain enough to cause a massive stroke. It would destroy almost half of Ryan's brain and leave him heading toward certain death.
But Dennis Ryan caught a break. From his home in Lee County, he was taken to Rush-Copley Medical Center in Aurora, one of a diminishing number of community hospitals in an era of skyrocketing malpractice rates where a neurosurgeon still operates on brains.
And Dr. Ramsis Ghaly believes in aggressive intervention, even when hope is slim.
He suggested a surgery rarely attempted so late in the game for a patient with so massive a stroke. In the tree of arteries and vessels that feeds to the brain, Ryan's stroke amputated a major branch, destroying almost 90 percent of the right hemisphere, compared to 5 percent in an average stroke.
Within 24 hours of the stroke, the brain had started swelling uncontrollably, the natural reaction of billions of cells and nerve fibers dying together. The brain became like an animal unable to escape the cage of Ryan's skull. Inside the cavity, the pressure increased. Cells collided, releasing toxic substances, further angering the swelling brain.
Two days after the stroke, Ghaly wanted to open the skull to give the brain more room.
It was not the most radical solution. A handful of physicians might have removed parts of the dying brain, but that would have hurt chances of eventual healing. Other doctors might have done nothing because the prognosis for intervention was so poor.
After years of under-utilizing this surgery, doctors are turning to it again for patients with massive strokes accompanied by swelling, says Dr. Jeffrey Frank, a stroke specialist with the University of Chicago. And preliminary findings from a study he's directing for the National Institute of Health, indicate the procedure might modestly increase chances of survival.
Still, there is the risk patients can fall into a lifelong coma.
Ghaly believed it was a chance worth taking.
"I have learned over the years that you cannot predict, only do your best," the surgeon told Ryan's family. "And if God has meant for him to go, we can always withdraw support measures later."
During those hours, as Ryan's brain boiled and doctors used drugs to keep him from death, the family debated what course would be best.
His daughter, Amy Ryan, flown in from her home in the Czech Republic, feared the worst. Ryan's sisters, including one who said God cured her cancer, wanted to give their brother every chance. Meanwhile, Ryan's wife, Venna ("Vee") Raye considered something her husband once said: He didn't want to live unless he could walk in the fields with his dogs.
"What do I do if he ends up paralyzed?" she worried. "Is he going to hate me, be mad at me?"
As morning broke on the third day, Vee Ryan made the final decision opting for surgery.
As dozens of relatives, student swimmers and coaches gathered in a waiting room, Ghaly went into battle against his patient's dying brain. Assisting in the operation was Dr. Jaweed Sayeed, a personal friend who Ryan was teaching to swim.
During the five-hour ordeal, they removed almost half of the coach's skull and placed it for preservation into a pouch in the fat of his abdomen. This is the same surgery that would be used six months later to save the life of entertainer Roy Horn after he was mauled by a white tiger in Las Vegas.
Outside, Ryan's supporters talked and prayed.
"It was so weird," recalls Stephanie Fameree, a North Central junior and one of Ryan's athletes. "It felt like we were at a funeral or a memorial service."
In the first hours after the surgery, all seemed in vain as doctors watched the pressure inside Ryan's head climb a sign the operation had failed. When Ryan's pupils no longer reacted to light, the only reason to keep pushing was because the heart and lungs had not stopped.
Alarmed, the doctors performed a CAT scan and talked briefly with the family. Without taking time to alert the O.R. staff or even scrub in the normal fashion, they pushed the patient back into surgery, fully aware that lost time means lost brain power.
They removed more skull to make room for the swelling brain. But each time they suctioned out blood from the hemorrhaging brain and fed Ryan fresh frozen plasma, more blood ran out.
"I remember Dr. Sayeed came out into the waiting room and he was crying," says Vee Ryan. "He sat on the window ledge and said, 'I held the coach's brain in my hands and it was bleeding so much it wouldn't stop. I don't think he is going to make it.' "
When Ghaly could do no more, he induced a deep coma with barbiturates, cooling fluids and blankets to bring down Ryan's temperature to 33 degrees Celsius, the point at which the body loses consciousness.
Then the doctors called off their efforts.
'Like an infant'
Inside the Copley Intensive Care Unit, a team of nurses and therapists pushed past the limits of the health-care system, into the deep recesses of the human brain and to the edges of the human spirit.
Often it would have been easier to call it quits.
For five days they pushed fresh blood plasma into him. Ryan required sometimes as many as two nurses devoted exclusively to his care. He was hooked up to so many heart monitors, IVs and feeding tubes that it took three people at once to move him.
Managing the coma was a constant juggling act. Too much of one drug could help the brain but hurt the heart; too much of another could help the heart but hurt the brain.
"We were watching him on the ventilator, doing the breathing for him. We were drawing labs every hour, titrating different therapies," recalls Robyn Hansen, an intensive care nurse. "He required more care than an infant."
Vee Ryan stayed at her husband's bedside throughout the long days, ignoring her own body's need for food and sleep.
Ghaly knew how vital her role was. Even in this most dedicated of environments there could never be enough eyes watching over this neediest of patients. For a patient this vulnerable, the slightest mistake could mean disastrous consequences.
Over and over, Vee Ryan touched her husband, kissed him, spoke to him. She recounted their dating days, their first camping trip and how they ate potato pancakes and thick-slab bacon on Sundays. Sometimes she played her husband's recorded message on his cellular phone, hoping the sound of his own voice would awaken him.
Often, as the weeks went by, nurse Hansen sat by her side, playing "spirit fingers" over the patient in a giddy attempt at bringing the coach out of his coma and his wife out of the doldrums. Vee Ryan told the nurse how she missed her husband, who used to call her Honey Bunny.
"One of these days, you will hear him say Honey Bunny," Hansen told her.
Hunting for consciousness
Then Vee Ryan got the discouraging news that two EEG tests showed low amounts of activity inside the coach's brain.
She can't remember the doctor's exact words just that he shook his head a lot.
But she refused to believe her husband would not wake up. She had read that EEG tests are not always conclusive since sweat can disturb sensors. She trusted that somewhere inside her husband's swollen bandaged head there existed some consciousness.
That hope, as tenuous as it was, became significant at crossroads in Ryan's care.
When the drugs that had been used to induce the coma wore off and he did not awaken, for instance, the family did not lose hope. They could have removed the breathing tube then, allowing the coach to die peacefully.
It was appropriate then to question the worth of keeping Ryan alive since he probably wouldn't ever have a quality of life that he would have wanted.
But Vee Ryan never considered letting her husband go. Encouraged by Ghaly, she chose the aggressive option for doctors to cut a hole in her husband's trachea so the breathing tube, which would eventually cause permanent damage to the tissue and vocal chords, could be removed.
"As a physician and as a Christian, I strongly believe that life should be preserved ...," Ghaly says. "In the end, God's will will dominate."
"I don't force my opinion," he adds. "I give people options."
Meanwhile, therapists who regularly moved Ryan to prevent pneumonia, skin deterioration and muscle atrophy, were teaching the family to stir Ryan with smell, tastes and sound.
In coma stimulation therapy, the patient's responses are measured on a scale called Rancho Los Amigos. How quickly patients move along this scale, says speech pathologist Elizabeth Miller, is one way of predicting if patients will emerge soon from the coma or remain in a "persistent vegetative condition" like Terry Schiavo.
But it is a gray area at what point a person transitions from one state to the other. Some say it can take several months; others talk in years.
At the therapists' direction, Ryan's sister, Kathleen Dunagan, a pediatric nurse from Florida whose work includes rescuing the life of fetuses after attempted abortions, reminisced with Vee about things that would be most significant to Dennis Ryan like ginger ale or Necco wafers he enjoyed as a child.
They put these objects up to the patient's nose and lips sometimes defying nurses' orders by placing them in his mouth where they risked entangling in his ventilator. They watched for changes in heart rate and oxygen saturation, twitches in his lips or fluttering of the eyes.
These physiological reactions were meaningful, says Miller, but the therapists wished they were more consistent.
"He was a young guy. He had a lot going in his favor," recalls Miller. "We all wished that he was moving more quickly through the stages."
Vee Ryan wept when she saw her husband's eye roll under its lid after smelling her favorite perfume. "I was very excited," she says. "It gave me hope that he responded to the things that were the most basic or closest to him."
Ghaly considered an even deeper meaning.
He believes in a kind of silent communication between loved ones that sometimes allows them to perceive changes in patients before medical professionals. These inconsistent reactions are like a spiritual vision hard to quantify but nonetheless important.
"The coma," says Ghaly, "is a beautiful mystery."
After a month, Ryan was transferred to a facility for patients on ventilators. But his wife was concerned, because no single nurse would be exclusively devoted to her husband's care.
But here, the patient began showing signs of wakefulness.
When Dunagan came to say goodbye to her brother she was returning to Florida to care for her husband who had cancer she saw Ryan open his eyes.
When Dunagan told him he'd suffered a stroke and fallen into a coma, she felt he understood. Tears streamed from his eyes as she explained she was going home. And then her brother closed his eyes again.
Doctors say open eyes during a coma are common and don't necessarily mean a person is awakening. Still, over the following weeks, Ryan showed more signs of awareness. His eyes tracked movement across a room and he demonstrated purposeful movement on the right side.
His wife, noticing now that Ryan puckered up his lips to drink or receive a kiss, grew more hopeful.
Then, two weeks later, on the first evening Vee Ryan returned to work at Home Depot, she got a telephone call.
Her husband had been rushed to the hospital.
To hear Vee and her mother Pat Hoffmann tell it, the coach lay covered in blood on a gurney in the emergency room at Hinsdale Hospital, his eyes open and struck with fear.
As it turned out, the bleeding, likely caused by an irritation to his stomach lining, was not so terrible to require immediate surgery. Still, Ryan was suffering from dehydration, severe anemia, pneumonia and a staph infection called MARSA, common in people with long hospitalizations.
"These are expected complications of longtime coma patients," says Ghaly. "But they are also how people die."
The danger for Ryan had been averted, but the fear had been instilled in his wife, who continued to worry that after coming so far she would lose her spouse again.
As frightening as that trip was, it proved a turning point, for it was during his two-week stay in Hinsdale's ICU that Ryan truly awakened. He spontaneously moved his arms; his eyes remained open for long periods of time; and he tried lifting his head instead of letting it flop over like a rag doll.
Once, while Ryan watched television, his wife saw him mouth the words she thought she would never hear again: "Honey Bunny."
And then, when North Central College Minister Lynn Pries and Ryan's son Steve stopped by, the coach stuck out his hand so they could shake it.
Another time, while a speech therapist was teaching Ryan to speak using a plastic valve placed over the breathing tube in his throat, she pointed to Vee and asked her patient his wife's name.
"Fred," he answered, panicking his beloved.
"I was so worried he had amnesia, or maybe his brain wasn't functioning, or he knew it was me and couldn't verbalize," Vee Ryan recalls. "I freaked out."
Then the coach looked in his wife's eyes and said, "Pizza Hut," an old nickname from their dating days when they used to eat regularly at the restaurant.
"That's when I knew he was back," she says.
By Marie-Anne Hogarth
Dennis Ryan emerged from his coma, a dazed hero returned from battle.
When nurse Robyn Hansen picked up the phone in the Rush-Copley Medical Center ICU, she was surprised to hear the voice of the North Central College swim coach who had spent six weeks in the coma after suffering a massive stroke.
"Hello, Robyn," he said. "This is Dennis."
"We cried," she said of the nurses. "Usually when people are that bad, they pass away or they go to somewhere where they never wake up."
Together with the doctors, nurses and therapists, Dennis' wife Vee Ryan and the rest of their family had helped battle the assault inside Dennis' brain, when his own body turned against him, when his skull held his swelling brain in a siege until it almost suffocated.
They had averted death, but for what kind of life?
Most of Dennis' right brain was decimated. He was like a victor with his homeland destroyed.
Would he be able to coach swimming again? Live in the log home he had built with his own hands? Would he need a wheelchair or a walker, or somebody to look after him?
Would he have the same personality? Be the same man?
With half of Dennis' right brain so damaged, most of his left side was paralyzed.
The stroke impacted the ability to feel fine sensation and sense of spatial orientation. Dennis would forget where he had placed his arms and legs. He couldn't say if he had been poked with one or two fingers.
The coach could see out of his left eye, but his brain no longer told him to look at the left visual field. He ignored the left side of pages, didn't notice people on the left side of the room, forgot to turn his head in that direction.
Other functions memory, reasoning and intelligence were less damaged. They existed in duplicate form in the salvaged half of Dennis' brain, which also enabled him to control the right side of his body.
It was with this left brain hemisphere that the coach could still think, remember, feel emotions.
It was these surviving portions of the brain that could eventually take over the jobs of the parts that died.
It was in here where hope still existed.
Vee Ryan took the helm of her husband's ship. But even as the couple began their journey, pain, fatigue and fear often threw them off course.
Sometimes it seemed a powerful undertow threatened to pull Dennis into lethargy. With one of his major arteries blocked, less oxygen reached the brain. It was as if he were a four-cylinder car operating on three cylinders. He needed to work harder to do the simplest things chewing, speaking without sounding mechanical, holding up his weakened neck.
But Vee couldn't communicate that urgency to him.
The system demanded Dennis show progress before he could have more therapy. Rehab programs reserve their limited space for those who will most likely succeed. But often the coach stagnated wanting to do nothing but lie in his bed and be cared for.
Vee needed to convince the professionals her husband could do more if only they pushed him harder.
After two months of lobbying to have Dennis transferred from the DuPage Convalescent Center in Wheaton to Marianjoy Rehabilitation Hospital, Vee succeeded. There, she knew, her husband would receive more aggressive therapy.
Dr. Richard Krieger, in charge of Dennis' care at both facilities, agreed the change in environment might spur the coach. But two weeks later, Krieger discharged Dennis from Marianjoy because he felt the patient wasn't motivated.
"We tried. The family tried," said Krieger. "They used guilt, fear and love. They tried all of those things. But you can't make somebody do something."
Vee, exhausted from marathon days divided between work and hospital, became enraged upon hearing this news, insisting doctors were giving up on her husband.
"If he doesn't walk, I'd love to know it wasn't because of the insurance or money or because a doctor wrote him off," she said. "I can't think I'm so out of touch that I imagine Dennis improved."
But Krieger argued the decision was not about money. "If the Saudi king came here, ethically we would not take his money if he did not show improvement," the doctor said. "Dennis lost half his brain. Families forget that."
His intention, he added, was not to give up on the patient. "My last words to Dennis were that I hoped he would prove me wrong."
Dennis' apathy remained a mystery.
The area damaged in his brain the frontal lobe prompts a person to initiate action. And many times the chemical imbalance after a brain injury causes depression.
But doctors don't know why some patients work through pain, fatigue and fear while others don't.
Dr. Ramsis Ghaly, the neurosurgeon who had operated on Dennis after his stroke, says the brain does not heal on the same clock as the health-care system. For that reason, patients often slip through the cracks navigating its maze. That's why he believes families become more important than hospital charts in passing on details about patient care doubly true for those with massive brain injuries.
But Krieger lived in the more tedious world of rehabilitation, which sets standards so patients aren't warehoused endlessly. Dennis was an exceptional patient. But then again, he had already received more therapy than most.
Krieger recommended a nursing home or convalescent center. And while Vee insisted that would be short-changing Dennis, she wasn't ready to provide the 24-hour-nursing care he needed at home.
Streams of people visited, but only a few could be relied upon to help out.
It was the way of a death-obsessed society, said Krieger. People were often more willing to attend a funeral than do the hard work of rehabilitating a person.
The Ryans found safe harbor at Rush Copley Medical Center, where Dennis returned for another surgery. Ghaly would replace the skull piece he had removed from Dennis' head during the efforts to save the coach's life after the stroke.
The weary travelers had come a long way, Ghaly told them. Many never made it this far.
Still, the Ryans were terrified.
On the night before the surgery, two dozen people from the First Presbyterian Church in Rochelle packed into Dennis' room. Vee held tightly to her husband's fingers and wept while the visitors prayed for his recovery.
"You are the greatest of physicians, healer of all," one man called to God. "We pray that you will guide the hand of the doctor in surgery, that it be a successful operation."
As emotions in the room surged, Dennis told his supporters how he heard God's voice when he was in the coma.
"I will heal you," the voice had said. "But you and your wife must spread my word to the young people."
Working through pain
Physical therapist Rious Manabat is a young athletic man with a smile that sets his patients at ease from the start.
But to Dennis, therapists were inflictors of pain. And pain had become Dennis' companion. His damaged brain no longer released the chemical necessary to keep his muscles from becoming stiff and spastic, so they hurt whenever moved or touched. Meanwhile Dennis' weakened joints barely supported his paralyzed limbs. His left arm and leg weighed so heavily that the arm eventually dislocated from its socket.
Drugs might have masked the pain and lulled him to sleep. But Dr. Dennis Keanne, the medical director of Copley's rehabilitation program, felt the patient would never get better if he slept through therapy.
The suffering made it hard for Dennis to recognize his therapist for the kind man he was.
"Please give me a break. Let me off easy," Dennis shouted, "I don't want to swear at you ..."
Fatigue was like a whirlpool that swallows the sea and spits it up again.
When it wore on Dennis, even his wife couldn't skirt her husband's dark moods.
"You don't love me anymore," Dennis said one morning when Vee refused to let him take a nap before therapy at Copley. "You've given up on me because . . . you're going to leave me."
It wasn't true, but Vee was sucked in.
"I stood by you through not being able to have a baby, you going on vacation without me because you were with your kids," she reminded him. "So you think I will leave you now? I would never leave you."
Keanne had said Dennis' stroke meant he lacked even the awareness that he needed to improve. That made Vee's journey all the lonelier.
"I love you more than anything in the world, but I can't motivate you," she told her husband.
"You motivate me each time you see me," he replied. "Now I need a nap."
Under greater pressure
Through it all, Vee struggled to manage the couple's finances.
One morning, working to pay off a mountain of medical bills, Vee and her mother, Pat Hoffmann, worked the hospital phone lines, promising creditors minimum payments.
One call brought Vee to tears.
"It's OK," said Pat, watching her daughter collapse in a chair.
"It's not OK," said Vee, sobbing on her mother's shoulder.
The insurance company had approved as much as $1 million a year an amount the Ryans had exhausted by December and up to $5 million lifetime coverage.
But it wasn't enough.
Dennis' Social Security and disability payment totaled only a third of what he earned teaching at North Central College and running swim classes in the summers. Medical costs aside, the Ryans still owed $1,500 each month after they paid back their monthly construction loan and daily living costs.
Watching his wife cry, Dennis said, "Everything is going to be OK, Vee."
Carefully balancing herself so as not to unsettle the mattress where her husband lay, Vee climbed into bed next to him.
Dennis turned away.
Pushing for healing
The staff at Copley propelled the coach with small victories.
In speech therapy with Joan Blasingame, Dennis typed and sent an e-mail to Ghaly, a significant achievement since Dennis often ignored his entire left visual field.
In occupational therapy, Sherrie Giles told Dennis of their shared faith in God to encourage him to relearn activities like brushing his teeth.
And Manabat joked through the painful physical therapy session, so that Dennis called him "the best guy here."
Still, no one could unleash the motivation that would push Dennis forward.
Vee waged her own campaign.
She barbecued Dennis' favorite pork chops, tailgate-style on a grill in the back of her truck in the hospital parking lot. She drove an hour each way to Paw Paw to bring the coach's favorite dog to therapy.
And she prodded her husband to remember details about their past that they liked to eat burgers by the river when they dated, that he nicknamed her Betty Boop, that it rained on their wedding day.
"Why did it rain," Vee asked.
"I don't know," Dennis answered.
"What time of year was it?" she hinted.
"December," he answered. "It was the 19th of December."
Dealing with depression
When Dennis wasn't motivated, Vee spiraled into her own darkness.
Maybe Dennis was apathetic because he knew his 33-year career as a coach was finished, she thought. Or maybe he'd be doing better if he hadn't been shuttled between hospitals and care centers.
Had she failed him?
As depression set in, Vee resurrected old doubts that she wasn't smart enough for Dennis' academic world.
"You do such a great job," Dennis comforted her.
"I don't," she told him.
"Yes, you do," he answered. You do such a great job taking care of me. Now cut my sandwich in quarters."
Helping him with these everyday tasks made her feel better but she knew she shouldn't.
"Dr. Ghaly isn't going to be happy about me feeding you," she said. "That's why he doesn't want me around so much."
She blamed Dennis, too, for using his newfound faith as an escape.
"Dennis, what would make you good?" she asked.
"God would make me good," he answered.
"I'm asking you to try harder," said Vee.
When Dennis pulled himself to a standing position using the parallel bars one morning, it was as if they had touched the shore.
"Oh my God," said Vee. "I can't believe it."
"Rious pulled me up," said Dennis.
"No, it was you," said Vee. "You basically did it."
While the therapists were excited, they also were cautious. Dennis had never tried pulling himself up from between the parallel bars, only from either side. It was easier this way, they pointed out.
Vee knew Dennis wasn't taking steps on his own. One therapist supported Dennis from behind while another moved the coach's legs.
Still, she saw a glimmer of excitement in her husband that day and her imagination ran away.
If Dennis could stand in a pool, he could go to water therapy. And if anything, water therapy would flip the switch inside the swim coach's brain.
Fearing the future
When Dennis' discharge day arrived three weeks after he began the Copley program, Vee was disappointed.
Dr. Keanne didn't believe the coach's rate of progress was sufficient enough to warrant staying in the inpatient program. He said Dennis would benefit as much from receiving 15 hours of therapy a week by coming to the hospital during the day. Now that he could move to and from his wheelchair with the help of one person, he could travel by car. There also was home-based therapy.
Keanne said these options would be a good bridge into a self-sufficient life at home.
But despite meetings to prepare her for this day, Vee wasn't ready.
She would miss the attention Dennis received at the hospital. She hadn't finished making all of the necessary arrangements for his care at home. Her co-workers from Home Depot had built a ramp to their house, but she hadn't figured out who would care for her husband when she was at work.
Nurse case manager Jayne Wallers had written a letter to the Department of Rehabilitation Services, which could provide minimum-wage home-health workers who could visit the Ryans' home when Vee was working. But there were financial parameters. And it would be considered double-dipping to go to therapy at Copley and also have somebody come to the home.
Most of Dennis' relatives lived far away. And Vee's sister nearby was caring for her husband who suffered from kidney failure. Vee didn't call upon a church or community group to step in with volunteers. It wasn't realistic, said Vee's mother, to ask Dennis' swimmers to come out to the country and care for a sick man. And Vee wasn't prepared to move closer to the hospital and her work.
Selling their dream home despite its $3,000-a-month construction loan would destroy about any hope her husband might have left, Vee said.
At least temporarily, the Ryans decided, Dennis would go to Alden of Waterford, a nursing home.
Looking for meaning
Their journey never-ending, Vee kept hope alive with the smallest of signs. The white underbelly of a hawk flying over the pond outside Alden was enough to lift her spirits.
"Dennis, today is going to be a good day," Vee told her husband one morning. "Remember, this day is Oct. 19. You were born May 19. We were married Dec. 19. This is going to be another great 19th."
That day Dennis "walked" again, as he had at Copley before, with the help of physical therapists. Over the days that followed, the Ryans counted each step as many as 85 in one session.
Vee hoped these victories meant Dennis was moving toward self-sufficiency. In the meantime, she enjoyed sitting outside with him at the pond while he practiced bird-calls."
"Hey guys," Dennis called out to the geese and mallards. "Go for a fly. Fly the coop."
Long way to go
Dennis' long-awaited homecoming finally arrived after three weeks at Alden six months after the stroke.
Vee and her parents would take turns caring for Dennis, conserving precious insurance dollars.
As the Jeep pulled onto the farm road leading to his log home, Dennis was welcomed by a small group of relatives who had just finished sweeping up dead flies, the remains of a summer when chores mattered little.
"We'll have to have a barbecue to make you fat again," his nephew, Kenny Rygh, told him.
Pushing his son-in-law up the ramp, Don Hoffmann reminded the coach to look to his left. Precariously attached to the front-porch railing was a "welcome home" banner and a single helium-filled balloon, blowing with each gust of October wind.
"That's nice," said Dennis, his voice catching.
Inside the house, Vee stood close to her husband for a long time. She lifted up their cat and dangled it above his face so that he could touch its warm fur.
"My Pepper," Dennis stroked the cat, his pained words mixing with his tears as he talked. "Meow."
Feeling his wife's fingertips running through his hair, Dennis looked up at her red and weepy face.
"It's good to come home," he said. "But it's hard at the same time."
A matter of perspective
Much would happen in the months that followed.
Dennis was hospitalized again for common but potentially fatal complications: a blood clot in his leg, severe dehydration and other difficulties. He struggled with depression, also frequent in stroke patients.
Vee often grew discouraged, blaming her husband's setback on the diminished therapy hours at Copley. Dennis never gained enough strength to pull himself up on the parallel bars. Disappointed therapists said their work wasn't reinforced with exercises at home.
As the year anniversary of Dennis' stroke passed this week, he has made strides in reading, short-term memory and motivation. He is starting to move his paralyzed left leg consistently. Images of Dennis' brain also show blood flow returning to the damaged areas, a sign the neurosurgeon interprets as the beginning of long-term healing. And Dr. Ghaly talks of other options for the future vocational therapy and hope in new technologies.
Dennis once said he did not want to live if he couldn't walk in the fields with his dogs. He still can't.
But in a therapy program closer to home he has a new goal: taking steps inside his house. He goes out to dinner with his wife, hosts a Bible study for those who prayed at the hospital when he was sick, and he saw friends married in his home a few days ago. Twice he has conquered a new enemy fear of being trapped in his wheelchair and falling into water to watch his swimmers compete.
At an invitational meet in December at Wheaton College, he hid in an office until Vee convinced him to come onto the pool deck.
As he was wheeled out, glimpses of the old Dennis Ryan shone through. He waved to the crowd and tearfully accepted a standing ovation from his team. A stopwatch in one hand, he kept track of split times for the swimmers, a habit so significant to him even the stroke could not steal it.
And when he wasn't looking, a favorite swimmer, Molly Foote, whispered in his ear.
"You are my motivation ...," she said. "Work hard for me."
"I will," he replied. "And you work hard for me."
Truly a miracle
Neurosurgeon uses faith and science to combat brain tumor
The Sunday Beacon News
He's mindful of the possible outcomes. This is the same type of tumor that attacked former broadcaster and newspaper columnist Tim Weigel, who died last year. As soon as he saw the CT scan images, he knew the outlook was grim, and he didn't hide it from her family. If the orange-sized tumor didn't come out, she had one week to live. In similar cases, people who have the majority of the tumor removed can live about three months. And that's not even counting the possible complications, like loss of understanding and struggles with speech.
At 7:30 a.m., Lazo is wheeled to the operating room. While she won't remember anything beyond having her head shaved a task Ghaly performs himself it begins the longest day of her family members' lives.
As they see her off, Lazo's family members hope this neurosurgeon can engineer the same type of miraculous outcome on which his stellar reputation is built. More realistically, however, they are just hoping Lazo survives, if only for a few extra months.
Ghaly takes a small piece of the tumor and puts it into a specimen jar to send to pathology. The results, which will be back in less than an hour, say the tumor is cancerous, but it is a primary, not secondary cancer. It did not start anywhere else in the body, so if Ghaly can vanquish this foe, Lazo may have a better chance at longevity.
Ghaly has been praying silently throughout the procedure, but his calls to God are vocalized at this point. If his instruments stray a few millimeters from their intended target, he could permanently damage his patient.
The words float through the fog into Lazo's brain. Still in the haze of the anesthesia she has been under for more than eight hours, she looks as if it would take her days, if not weeks, to respond to Ghaly's command.
"I cannot ask for more," Ghaly says, as he marches off to tell Lazo's family members about the war he waged in her skull.
"It's truly a miracle," says Lazo's son, an Aurora police officer.
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