The hospital room where White House press secretary James S. Brady is recuperating from brain injury is filled with teddy bears, sent by well-wishers from all over the country.
Sarah Brady's favorite, according to Brady's surgeon, Dr. Arthur I. Kobrine, "is a little teddy bear that is obviously not new, that belonged to some little kid -- and that has two bandages on his head."
From Kobrine's description, Brady sounds rather like that teddy: less than two weeks after a bullet slammed into the right side of his brain he is a bit battered, a bit subdued, but still very much the Bear.
He has grown quieter in the last few days than he was earlier, Kobrine said in an interview. "I think the impact of what's happened to him is registering," he said. "His cognitive functions have improved to the point where he's aware of his injury and the impact his injury will have on his life.
"He's talking to us whenever we go in the room," he added. "It's just that he was so bubbly for a couple of days -- the tendency is for all of us to want him to go right back to work . . . That's unrealistic."
The reality for Brady is that recovery will take months of physical therapy, and plenty of emotional support from family and friends. But the reality is also that his recovery, according to Kobrine, is "extraordinary." His chances of even surviving were one in 10.
Barring complications, Kobrine now expects him not only to survive, but to walk, perhaps with a cane, and eventually to go back to doing the kind of work he was doing before his injury. He believes the most serious lasting effect of the wound will be weakness of his left arm and hand.
"I've . . . been encouraging him, telling him that he's done very well . . . that he's going to have to work very hard in the future, but that things look good for him," Kobrine said.
He said Brady's eyelids are still purple from the massive bleeding caused when the bullet struck his forehead. He still cannot open his left eye fully. wIts lid was so swollen that an ophthalmologist had to make incisions during his surgery to relieve dangerous pressure on the eyeball.
He said Brady sleeps much of the day, like many patients recovering from brain operations. However, he sits up and eats his meals, using his right hand. He reads aloud from newspapers and the Congressional Record.
Earlier this week he asked his wife to call Pete Teely, Vice President Bush's press secretary, and according to Kobrine engaged in "what was a normal conversation -- both in content and . . . logical function."
He also jokes, as when he told his wife, "It looks like the Bear was in the wrong place at the wrong time." Kobrine said Sarah Brady tells him she hasn't noticed any change in her husband's sense of humor.
Even though an estimated 20 percent of the right half of Brady's brain is gone -- destroyed by the bullet, damaged by bleeding or removed during surgery -- Kobrine said Brady shows none of the emotional sluggishness or apathy typical of "lobotomy" patients.
He said that is not surprising, since the damage was almost entirely limited to the frontal lobe on the right side of his brain, the so-called "non-dominant" side.
Other than controlling voluntary movement on the left side of the body, the right frontal lobe seems relatively unnecessary for normal human functioning, at least as measured by neurologists, he said. People who have most of the area removed because of brain tumors often recover almost fully.
"The kind of testing we do in 1981 suggests it doesn't do as much as other areas of the brain," he said. "One hundred years from now, when we're far more sophisticated, we'll realize there are functions to that part of the brain. Now, maybe other areas take over those functions when the non-dominant frontal lobe isn't working.
"It would have been an entirely different ball of wax if it had been a mirror-image injury," he said. Identical damage to the dominant left frontal lobe might well have left Brady unable to speak and radically altered his personality.
He said the outcome also would have been different if Brady had not reached a hospital and gotten treatment within 10 minutes. The immediate measures taken in George Washington University Hospital emergency room -- intravenous mannitol and steroids and hyperventilation of his lungs with oxygen -- in effect saved his life, he said.
By retarding the swelling of the brain, already under perilous pressure from bleeding deep within the tissue, those measures "gave us an hour" to get a CAT-scan that showed the site of damage and get Brady to the operating room, he said.
Even so, had the surgeons not operated to remove blood and stop the bleeding, Brady "would have died within a couple of hours," he said.
Brady was taken off antibiotics Thursday morning, and has had no fever since. Kobrine is encouraged that there has been no sign of infection, one of the greatest risks from a bullet that propelled germ-laden fragments of skin and bone into his brain.
Although infections can occur even years after such an injury, Kobrine said if no infection develops during the next week the danger will be mostly past.
He said Brady will have to be watched carefully for any buildup of pressure from fluid inside his skull. For at least a year, he will also have to take medicine to prevent seizures, another possible consequence of brain injury.
So far, Brady can move his left side only a little at the shoulder and hip. But Kobrine is hopeful that Brady's strength will increase in the next few weeks.
The hospital's physical therapists believe that even with the control he already has, he will be able to walk with a cane. Kobrine said they are planning a program of strengthening and walking exercises.
Kobrine said Brady's daughter, Melissa, has spent a lot of time at the hospital, and that his wife, Sarah, hardly leaves his side.
"She's impressed me tremendously as a strong, solid, good person," he said.