Three months ago, as Richard Engel lay in a coma in his Owings Mills home, his wife fought to get insurance coverage for the intensive -- and expensive -- rehabilitative care that offered his only chance of improvement.
Sheila Engel won her battle and can see the results every time she looks at her husband.
Today Mr. Engel makes his way around his home in a wheelchair and can walk, an ability that improves daily. He is able to dress, bathe, go to the bathroom and feed himself. He speaks, although much of his communication is nonsensical, and his reasoning and other cognitive functions remain severely impaired.
Mr. Engel was a Baltimore County police officer when he suffered a severe head injury in an accident last April. Rehab care is standard in only a small percentage of health insurance policies, but because of the case of Richard Engel, Baltimore County added 70-day coverage to the Blue Cross/Blue Shield plan it offers its employees.
On Oct. 10 Mr. Engel entered Sinai Hospital's inpatient rehab unit for head injury patients.
He went home Dec. 29 and despite his continuing problems has come a long way since October.
"When he went in he didn't do anything," Mrs. Engel said. "By early November he started progressing. Now there are periods when I feel I have my husband back, where I know it's him. And I have hopes for continued improvement."
"He has the capability of enjoying the people around him, of interacting with his family," said Bob Cameron, the Sinai social worker who has been part of his treatment team. "He has progressed to the point where he can enjoy a much better quality of life than before."
Mr. Engel's most serious deficit is in the area of language, although he talks almost constantly and much of his communication is in the form of seemingly coherent sentences. His demeanor is usually friendly and cheerful. "I feel happy," he responded when a friend told him he looked good. "I like you, I'm glad you got here," he told a visitor.
But his lucidity is interspersed with gibberish and inappropriate usage. "She's an honest guy," he said when Mrs. Engel was explaining how she still has to shave him. He has particular trouble with nouns and gender. He calls most people George. "This is George, I like George to do this," he said referring to his wife. And later, holding her hand: "The only person I really love is George. He does things for you."
At times he seems aware of his deficits. "I'm sorry, but it's probably me," he said in the middle of a stream of gibberish.
Mark Ceglio, the Sinai speech therapist who treated Mr. Engel, calls his condition "fluent aphasia." (Aphasia is the inability to understand and process language and communication.)
"He has the ability of speech and grammatical patterns," Mr. Ceglio said. "But it's difficult to make sense of it. When he's talking it's not true language."
Mr. Engel does have the ability to recognize numbers, evident as he plays cards with his wife. He quickly ascertains the winner in every match in a game of War, taking great glee in his victories.
He is currently not receiving any therapy, and his condition will be assessed in a few months. "He can continue to progress in an enriching environment like his family can provide," Mr. Ceglio said. "I would expect some improvement in his language abilities, but it will be slow. How far he can go from here is the $64,000 question."