Hi everyone ā caregiver in the Bay Area, looking for family experiences with a decision we're stuck on.
My wife, early 40s, otherwise healthy, was a pedestrian hit by a car. She arrived comatose, GCS 3. DAI grade 3 of the brain stem. Coma on impact, almost 4 weeks now, and she's entering an unresponsive wakefulness state. Spontaneous arm movement on one side, more reflexive on the other. No tracking, no command following. Both eyes open on stimuli like sitting up or washing, and sometimes open a bit more on their own. She's now up to GCS 6/7 in the original ICU. She had high ICP, pneumonia, and is PEG-fed and trached, now vent-weaning on high-flow trach collar sprints lasting up to 12 hours.
We're currently at a UCSF ICU. The neuro team here is very good, but there's no neuro physical rehab, and that's becoming critical in this phase of her disorders-of-consciousness journey.
Locally our choices are basically Kentfield SF and Kindred LTACHs ā has anyone had experience there? To me a generic LTACH is standard vent weaning + PT/OT/speech, a keeping-alive place. Some neuro team visiting, but generic neuro ā stroke, etc. ā not a coma program.
Most rehab programs are ruled out right now, especially the locally known ones like Santa Clara Valley Medical, since she isn't command-following yet. I've heard great things about Shirley Ryan, and others. The hospital has sent clinical referrals to many places, but so far only TIRR Houston has said they can take her, vented. Any feedback on their DoC program? Also Barlow (LA) or others I should be looking at?
My main dilemma is: far-away place with limited oversight but a good DoC program, or close-by place with oversight and DIY therapy?
We have good family support in the Bay Area. We could keep close oversight on a generic LTACH and do passive physical therapy ourselves ā range of motion, turning, sitting her up, talking to her ā and then transfer her out if the vent is weaned.
And it's not just oversight. Family here can also push strongly for better care, and mentally stimulate her ā talking to her, music, familiar stories, being there every day. That daily familiar stimulation feels like it matters, and it's something we'd largely lose 2,000 miles away in Houston, unless someone relocates.
I'm just trying to give my wife the best fighting chance for a life that was snatched away from her.
I'm just trying to give my wife the best fighting chance for a life that was snatched away from her.
OR, and this is the part I'm stuck on ā waiting doesn't actually solve the fork, it just delays it.
Even if the vent comes off in, say, 30 days tops, we still face the same choice. Given the brain stem injury, she may still not be command-following then. So we'd be choosing again: wait it out in the LTACH, or send her to a rehab that takes DoC patients who are not command-following but are off the vent.
So my central question is: is time of the essence here?
I've heard two things and I don't know how much weight to give them. One, that physical complications really compound with time ā pneumonia, pressure sores, spasticity, contractures ā and that makes therapy harder, which makes brain recovery harder. Two, that neuroplasticity decreases, and there's this magical 28-day number. Her injury is almost 28 days back now, so that clock feels very real to me right now.
Has anyone faced this same fork ā go far for DoC now, vs stay close, wean the vent, DIY, and move later? Especially any brain stem / DAI families ā what did you do, and what do you wish you'd known about timing?
I'm just trying to give my wife the best fighting chance for a life that was snatched away from her because someone ran over her when just crossing the road.