Jennifer Bell sat in her honors chemistry class on a recent school day, a periodic table of elements and a binder arrayed in front of her. In her running pants and T-shirt, she looked almost like the student athlete she had been just nine months ago.
This school term, though, Jennifer is sitting in a wheelchair. Not so long ago, she was in a coma brought on by the hemorrhage that struck her brain in January.
All around her were signs of the battle she has fought to recuperate. Her school binder was filled with homework assignments, each with a Post-It note attached to remind her when it needs to be done. Such reminders order much of Jennifer's life since the brain injury disrupted her short-term memory. Nearly everything has changed for the Charles County 17-year-old who last year played for the school's volleyball team and kept statistics for the girls' basketball team.
"Initially they thought she wasn't going to survive," said Sallie Bell, Jennifer's mother. "It devastated us." No one expected Jennifer to be sitting in a Westlake High School classroom again. No one even expected her to make it out of the coma she lay in for six weeks. Her chances appeared so slim that the day Jennifer slipped into a coma, her doctors and nurses counseled her family to say goodbye to her.
Jennifer is one of only about 1,000 people in the United States this year who will show signs of having arteriovenous malformation, a tangle of abnormally connecting arteries and veins in her brain, said Vance E. Watson, assistant professor of radiology and neurosurgery at Georgetown University Hospital.
Jennifer's malformation ruptured, cutting some of the blood supply to her brain. About one-third of AVM patients either die or never regain the ability to take care of themselves, Watson said. Jennifer has managed to get herself out of that category, though she has a slight chance of "rebleeding" during her first year of recovery.
Today, she is a high school student once again, taking a full senior year course load, including three honors classes and chorus--no small feat for "the girl with the brain injury," as she calls herself. "My mom said challenge is good for me. I don't want slacker schedules," she said.
The Bell sisters are well known at Westlake High School. Meredith and Leigh Bell, the 16-year-old twins, are star players on the basketball team, and all three sisters played on the volleyball team. (Another sister, Samantha, is a college student.)
When Jennifer got sick, Meredith, the more outgoing of the twins, kept playing basketball in honor of her sister. "I felt my way of paying her back was to play basketball," she said.
The more reserved Leigh did the opposite. "I quit basketball because I couldn't stand to be anywhere but the hospital," she said.
It was the twins who found Jennifer unconscious on her bed Jan. 25.
That day, Jennifer was planning to buy fabric for a dress she was designing, a hobby that she hopes will turn into a career. She began complaining of a severe headache and slurring her words. Before long she was unconscious.
At the hospital, doctors managed to stop the bleeding in her swollen brain, but she didn't wake up, slipping into a coma. During the next six weeks, doctors said she might not live. Jennifer's religious, tight-knit family thought otherwise.
"I was crying, but something inside of me said she was going to be okay," Leigh said.
Family members kept a vigil at her bedside. They squeezed her hand to see if she would respond. They played her favorite Spice Girls CD. Her father, Mark Bell, told her to pray while she was "inside of there," he said.
It took six weeks, but Jennifer finally awoke. This summer, she returned to her Waldorf home after a 4 1/2-month stay at the Washington Hospital Center and the Inova Mount Vernon rehabilitation hospital.
She remembers little of what happened. As her sisters talked recently about the day she fell into the coma, she looked on in confusion.
"You haven't told me this side of it," she said to her sisters.
"Yes, we did. You just forgot," Meredith said.
Jennifer still has scars on her throat from a tracheotomy, and her voice, once loud enough to belt out a song for the school choir, is not much more than a whisper. She undergoes speech and physical therapy every week to rebuild her weakened muscles and to relearn how to control her 5-foot-11, 105-pound body.
At a recent therapy session, she was learning to walk, crawl and roll again. The teenager took small, deliberate steps with a cane as she tried to control her legs. "Pretty soon, I'll be doing this without the cane," she said.
"It's almost like watching her grow up like a baby again," her mother said. "I was so excited when she moved her right index finger."
Sallie Bell's life has centered on taking care of her daughter and learning as much as she could about arteriovenous malformation. When she needs to vent, she often goes to the Internet, where she has found a support group for AVM patients' parents.
"We've learned a lot more about the human body then we ever wanted to," she said.
There is no imminent end to the hospital visits Jennifer will have to make. Since waking from her coma, she has undergone two procedures to block off the AVM so that blood can no longer flow through it. If the procedures work, Jennifer won't have to go through surgery.
"We're praying for that chance," Sallie said, as she squeezed Jennifer's hand.
Just over a week ago, the Bells sat with Jennifer in an observation room at Georgetown University Hospital, looking at her X-rays and waiting for her four-hour procedure to begin. "The first time I saw an angiogram was so hard," Sallie said. "To see what's inside my child's head is so scary." Jennifer will probably have to go through a few more procedures.
But for now, Jennifer has reached her first goal--going back to school. "To be able to go back was wonderful," she said.
Her first day back at school was like her first day in kindergarten. Just a few months ago, Jennifer couldn't dress herself.
Now, she can put on her own makeup and clip a barrette to her hair. Before heading out to school that day in late August, the family gathered in a circle for a prayer.
Letting her go was not easy for Sallie, who still has the urge to read school assignments to Jennifer or help her take statistics at a game. "I have to put more responsibility on her because if she gets used to people doing things for her, she won't do it," Sallie said.
Getting through an entire day of school hasn't been easy for Jennifer. By third period, she is so tired that she has to take a nap in the nurse's office. Taking exams will probably be difficult because of her short-term memory problems. To maneuver around the building in her wheelchair, she enlists the help of her classmates. These are the same classmates who organized fund-raisers for the Bell family and flooded Jennifer's hospital room with calls. Now they wheel her from class to class, help her carry her book bag and take her to the water fountain when she's thirsty.
Nevertheless, that spunk she was known for in school is on its way back. She talks frequently about her main goal--to receive her diploma at her graduation ceremony in the spring. "That's my main concern: to graduate on time and walk across that stage," she said. "I can't walk, but that's temporary."
Staff writer Angie Watts contributed to this report.