Six months ago, Sheila and Richard Engel didn't give a second thought to health insurance.
A 21-year veteran in the Baltimore County Police Department, Captain Engel, 47, and his wife both assumed that their coverage could take care of any health problems that befell them or their family. Like most of us, they didn't take much time to read the fine print in their insurance policy.
Five and a half months ago, the world as they knew it ended.
Today, Richard Engel lies in a coma. Until two weeks ago his prospects of receiving the rehabilitative therapy necessary to aid his recovery were dim because his insurance policy did not provide rehab coverage.
And even today, as Mr. Engel finishes his first week of rehab therapy at Sinai Hospital, health insurance is a subject that haunts the lives of the Engel family.
In the early afternoon of Thursday, April 26, Richard Engel said good-bye to his wife and youngest daughter, Melissa, and left to go turkey hunting with a friend in north-central Pennsylvania.
Mr. Engel and his friend, Milton Duckworth -- also a Baltimore County police officer -- met at Mr. Duckworth's hunting cabin near Troy, Pa., just below the New York/Pennsylvania line. They hunted all morning Friday, but didn't get anything.
After lunch they repaired the ruts in Mr. Duckworth's driveway, then went for a spin on Mr. Duckworth's three-wheeled all-terrain vehicles.
Riding in front of Mr. Engel, Mr. Duckworth heard his friend say "Oh, no." He turned around just in time to see the vehicle flip over. Lying face-down on the ground, bleeding from both ears and his nose, Mr. Engel didn't appear at first to be breathing. But when Mr. Duckworth gently turned him over he gasped and began breathing shallowly.
Eight miles from the cabin, unwilling to leave his unconscious friend alone, Mr. Duckworth cradled his head for about 10 minutes until a passing trucker went for help.
Richard Engel had six broken ribs, a punctured lung, a broken collarbone, a broken breastbone and severe abrasions. But that was nothing compared to the severe brain and brain stem injury that put him in a coma from which he has still not recovered.
A hospital bed dominates the room in the Engel home in Owings Mills, where until last Wednesday Richard Engel spent most of his time. Behind the bed is a wall of get-well cards.
On the bed, Mr. Engel, his head supported by pillows, mostly seemed to be sleeping.
At times he opened his eyes and sometimes appeared to track movement around the room. When his wife asked him if he was uncomfortable, she interpreted his nod as an affirmative answer and adjusted the bed. Sometimes he moved his lips and seemed to be whispering.
Once, a couple of weeks ago, both his wife and mother heard him say "I don't want that" when an oxygen tube was put in his nose.
Mr. Engel has come a long way since he was released from the hospital on June 14. He can breathe on his own. He sometimes responds to questions with a nod; if he is holding your hand and you tell him to squeeze it, sometimes he will.
But it is possible that Richard Engel could be doing a great deal more.
Specialized, intensive rehabilitative care can bring brain-injured patients to a point of recovery that is often beyond expectations. According to Judith Coho, field service coordinator for Sinai Hospital's brain-injury rehabilitation system, the first year after brain injury is the period in which recovery is most likely to occur and the sooner therapy begins, the more optimistic the outcome is likely to be.
"The day they're ready to leave the trauma center is the day they should begin aggressive rehabilitation," Ms. Coho said.
But for four months Sheila Engel fought to find some way to get her husband rehab therapy. A benefit organized by Mr. Duckworth and the Fraternal Order of Police raised $15,000 -- what seems a substantial amount until you realize that sum might pay for only 15 days in rehab, which can cost up to $1,000 a day.
With months of rehab needed and without health insurance to pay for it, Sheila Engel felt she had hit a dead end. Then, earlier this month, relief came when Baltimore County added 70 days of rehab care coverage -- effective October 1 -- to its Blue Cross/Blue Shield policy.
"You just don't think of what you don't have until something like this happens," Mrs. Engel says now about the subject of health insurance.
"Richard Engel is not unusual," says Delegate Lawrence A. LaMotte, D, District 5B. Mr. LaMotte, an insurance salesman, has tried to introduce legislation in the Maryland General Assembly that would either mandate rehab coverage or at least offer it as an option in health insurance policies.
"The idea was pretty well shot down," Mr. LaMotte says. "The climate for that kind of legislation is not very good. Most employers groups are trying to get rid of any mandated benefits, to cut down costs."