It had been a rare weekend for 45-year-old Janet Rife. For two days she had immersed herself in the tranquility of a religious retreat in McLean, leaving behind the daily pressures of tending to her husband, their five children and their split-level home in Springfield.
At this point in her life, Janet Rife was not at peace. She was searching for something, an inner calm, for some sense of purpose that went beyond her busy life and her job as a legal secretary. On Saturday night, she went alone to the chapel and surrendered to the comforting silence. She meditated for a long time on the 23rd Psalm and its message that God is constantly present: The Lord is my shepherd . . . . He makes me lie down in green pastures . . . . He leads me beside still waters . . . .
The next day, just after breakfast, she was standing in a hallway of the Dominican Retreat House talking with two friends when a white-robed nun, Sister Amy, told her she had a phone call. Janet stepped into a nearby office and picked up the receiver.
She heard the voice of her daughter, Sheri, who was crying. Between sobs, Sheri, 18, managed to say that Brian, Janet's 20-year-old son, had been in a car wreck. The rest of Sheri's words tumbled out in jarring fragments: On his way to Ocean City. Fell asleep at the wheel. Flying him to shock-trauma in Baltimore. Critical.
It was 9:30 a.m., Sunday, July 14, 1985.
About the same time, Janet's husband Curt, 50, was on I-95 somewhere in North Carolina. He was driving home with the couple's two youngest children from Lake Placid, Fla., where he had been visiting his parents. He was tanned and relaxed after 10 days of golf and sunshine. At 3:15 p.m., he turned onto his driveway and was met by his neighbor Ken Bounds, who put his arm around Curt and told him about Brian's accident. At first, Curt thought Bounds was joking.
Several hours later, husband and wife embraced in the grim confines of the shock-trauma center at University Hospital in Baltimore. Their son had been admitted, becoming patient number 18,874 at the 13-year-old unit. It was the beginning of a turbulent odyssey that has already lasted 329 days, 11 months, four seasons.
Twenty years ago, none of this would have happened. Brian Rife would have died on the highway, the victim of a severe brain injury. He survived only because of dramatic advances in medical expertise -- advances so dramatic and far-reaching that society has not learned how to handle the consequences.
As summer turned to fall, and then fall to winter, Janet and Curt Rife found they had entered a bewildering and forbidding world where insurance companies and governments do not or will not pay for some unavoidable expenses, where there are not enough therapists or rehabilitation hospitals, where the pressure sometimes becomes so great that some families are irreparably damaged.
This series of stories is about Janet and Curt Rife's odyssey -- through a summer when Brian came so close to death that a parish priest said last rites at his hospital bedside, through a fall when Brian remained submerged in a deep and discouraging coma, through a winter when the Rifes realized that Brian's fight to recover was threatening to destroy the family emotionally and financially.
Until July 14, Janet Rife's search for inner peace revolved around the purpose and meaning of life. After the accident, she found herself questioning things she had always believed in. On July 27, she sat down to write in the diary that she began keeping the day of the accident. She wrote:
I awoke this morning grieving . . . . I tried to go to bed to sleep with thoughts of green pastures and still waters. I thought of the God of my understanding and considered again that surely He would not bring Brian this far and fail to bring him far enough for a meaningful life.
The thought of the awesomeness of our technology that snatches life away from death. Would death be more merciful for all concerned? Easier to let go of him, give him over to the next world completely than to consign him and us to a half-life.
But, no, continuation of these thoughts I must reject. Think of the things I have to go on, the neurosurgeon's comments, "nothing short of miraculous," the nurse's thoughts, "he's a miracle child." Then, a comforting image comes to my mind. Brian walking toward me, near perfect in his physique, and smiles, saying, "Hi, Mom."
At 1 a.m. on July 14, after having a few friends over for a small party, Brian Rife and one of his best friends, Tom Kilday, 21, got the urge to go to the ocean.
An hour later, Brian put some towels, a shirt, a pair of pants and a bathing suit into his mother's 1978 Dodge Omni -- with a Virginia license plate that said MS RIFE -- and headed for U.S. Rte. 50, the road to Ocean City, Md.
Brian drove, and Kilday sat in the front passenger seat. Neither wore his seat belt. The roadway was dry, but a light fog hung in the hot, sticky air. Kilday remembers stopping once at a 7-Eleven, where they bought potato chips and burritos. Then, Kilday said, "I went to sleep, woke up once to see if Brian was all right, then went to sleep again."
At 5:30 a.m., still 35 miles from Ocean City, Brian dozed off. The white-colored Omni drifted off the road, right at the point where the highway begins to curve sharply to the left, according to the police report.
Brian woke up just as the car hit the shoulder, still traveling 55 miles per hour.
"Tom!" Brian screamed.
A second later the car sideswiped a light pole, which broke away, and then hurtled down the embankment. It smashed into a utility pole, lifting Brian out of his seat and hurling him across the car. His head cracked into the right side of the windshield, right in front of Kilday. As the car began to flip over, Brian fell against Kilday and their legs became entangled.
The car finally stopped, upside down, about 400 feet from where it left the highway.
Photographs, taken by the state police and the Rife family, tell the rest: Blood splattered on the corner of the windshield. Broken glass on the dashboard and the front seat. A Frisbee just inches from the open passenger window. A beer can, apparently from the wreck, resting nearby on the wet grass.
As they lay there, their legs wrapped together and caught under the steering wheel, Kilday remembers turning to Brian and asking, "Brian, can you hear me?" There was no reply, but Kilday said later he was relieved to see that Brian appeared to be unhurt, except for a trickle of blood from his right ear.
During the next 20 minutes, Kilday drifted in and out of consciousness several times, Kilday said. At some point, he heard the sound of footsteps and voices; he remembers nothing else until awakening in the Hebron Rescue Squad ambulance, whose crew had to use a harness to pull him and Brian from the car.
Within an hour of the crash, the ambulance arrived at Peninsula General Hospital in Salisbury, Md. Doctors quickly determined that Kilday's injuries were slight -- cuts on his back and a bruised knee -- and he sat at the hospital for four hours waiting for a ride back home. Brian, however, was still unconscious; the trickle of blood that Kilday had seen was evidence of a severe brain trauma.
The few months before the accident were important ones for Brian Rife.
He had made some decisions about his future, mostly because of pressure from Janet, who worried that Brian had spent his first two years in college rather aimlessly. After talking it over with his parents, Brian decided to transfer from Longwood College in south-central Virginia, where he had compiled a mediocre grade-point average while in the liberal arts program.
He chose Virginia Polytechnic Institute and State University in Blacksburg and switched his major to mathematics. He told his family and friends he wanted to become a fighter pilot, although he had never shown any particular interest in flying and never had taken lessons. As a first step, Brian applied to Tech's Air Force ROTC program. One week before the accident, he was fitted for a military uniform that he would need when school started in the fall.
For Brian, these were no small steps. Until then, his life chiefly had revolved around leisurely pursuits -- hiking, camping, beer blasts, girls and the music of Led Zeppelin, among his favorites. He had a personality to match: Easygoing and uncomplicated, the kind of person whom other people like to be around.
He also was winningly handsome, a slender young man with bright brown eyes, a mop of wavy hair and dark eyebrows that seemed like two strokes put on by a painter's brush.
"Brian was the kind of guy who was always doing things on the spur of the moment," said David Saunders, a 22-year-old boyhood friend. "We never had anything planned. We'd go to bars, camping, hiking on a whim . . . . "
On the night before the accident, Brian decided to have a few friends over for a get-together. His parents were away and he had the run of the house. It was a hot and muggy night, with temperatures still in the mid-70s after a daytime high of 90 degrees. Saunders and his girlfriend arrived at about 8 p.m. with a 12-pack of beer. A little later Kilday arrived with a six-pack. For the next few hours the group watched rented movies -- "The Kids Are Alright" and "The Terminator" -- on the Rifes' videocassette recorder.
The party lasted until well after midnight.
"There was a little marijuana going around. After a while we were feeling pretty good," Saunders said. "If you had put us on one of those stupid little breathalyzers, it would have said we were drunk probably. But we weren't that drunk."
At about 1 a.m. Kilday suddenly announced, "Let's go on a road trip!" It did not strike anyone as an unusual idea. "We'd all gone on late night cruises to Ocean City before," Saunders said.
The night seemed perfect for it, Kilday said later. "It was so hot, I just wanted to get away. Brian was real up for it, too."
Saunders and his girlfriend decided not to go. Before Brian and Kilday left, Brian knocked on his sister Sheri's bedroom door.
"He peeked inside and said, 'We're gonna go to the beach,' " recalled Sheri, a senior at West Springfield High School. "It sounded sort of unusual, but Brian did things like that sometimes . . . . He wasn't acting or talking like he was real drunk. I just said, 'All right, I'll see you tomorrow.' "
A police report on the accident lists fatigue as a cause and says that Brian fell asleep at the wheel. Alcohol is not mentioned in the report.
"When we started out Brian seemed all right. I really can't say alcohol had much to do with it. We just hadn't had any sleep," said Kilday, now a sophomore at Radford (Va.) College.
'We've Got to Stay Calm'
As the state police in Salisbury waited for the morning fog to clear so that a Medevac helicopter could fly Brian to the state's premier shock-trauma center in Baltimore, Janet Rife and her oldest son Scott, 22, started out for the long drive around the Capital Beltway and then north on I-95.
It was about 10:30 a.m. As they drove, Janet remembers, she felt a cascade of emotions -- numbness because the reality had yet to sink in; anger at Brian for taking off for Ocean City in the middle of the night; anxiety because she had no idea what "critical condition" meant.
"Stay calm. We've got to stay calm," she told Scott.
Janet often tells herself to stay calm. She is a slender woman with thick brown hair and eyes that convey a kind of nervous energy. She exudes intensity, not serenity. In conversation, her words tumble out as she tries to match language and feelings. Sometimes, the effort becomes so difficult, she holds the sides of her head in her hands and gently pulls back on her dark eyebrows.
She brings the same intensity to family problems. She is straightforward, unwilling to accept pat answers. Instead of shying away from difficult issues, she tends to confront them. Again and again in her diary, she raises the ultimate questions -- Would death be more merciful for all concerned? -- and carries on debates within herself about the answers.
In contrast, Curt tends to avoid confrontation. In stressful situations, he often cracks a joke or two. He has a friendly, easy smile and a strong, warm handshake. When he becomes pensive, however, the easy smile disappears and Curt's well-lined face seems to show a dozen hidden worries.
He is a casual man at heart, one who prefers open shirts to suits and ties. He dresses formally for work -- he is a 26-year employe of the Pentagon, where he researches the kinds of computer systems the Army should buy -- but takes off his tie as soon as he comes home. After 23 years of marriage, Curt and Janet have learned how to deal with their differences in style and temperament.
They first met on a blind date in 1962. Curt was 26, Janet was 21. Janet had moved here two years earlier from a small town in central Pennsylvania where her father managed the farm of a Franciscan seminary for 38 years. She got a job as a secretary to an Air Force colonel at the Pentagon. "I had no motivation to go to college," she said. "My main goal was to get out of high school and get out of that little town."
Curt grew up in Falls Church, one of five sons of a government printer. At the age of 16, he decided to quit high school in Falls Church to work in an auto repair shop. His father told him, "Curt, this is really stupid. You'll probably regret this as long as you live. But you're old enough now to decide on your own. It's your life."
For Curt, there was a significant moral to this story. "I was always taught that my problems were my problems," he said.
They were married in 1963 and the children came fast. Janet quit her job. Like other women in those days, she never considered the possibility of juggling a career and motherhood. But she really didn't mind. "I loved having babies," she said. "They were the most creative acts of my life."
The Doctor's Report
At 11:30 a.m., after a 45-minute flight, the helicopter carrying Brian landed atop the six-story University Parking Garage, a block from the shock-trauma center in Baltimore. From there, an ambulance sped him down an alley to the back entrance of the shock-trauma building, a drab, five-story structure on the southwest fringes of downtown.
Janet and Scott arrived about 30 minutes later. Beneath a large sign reading "Maryland Institute for Emergency Medical Services Systems," they entered and slowly followed a bright red line painted on the dull gray linoleum floor to the admissions section. As they walked, Scott said, "The place seemed to get worse and worse . . . . You go downstairs and there's this kitchen on the right. Guys are washing and cleaning up and steam's coming out of machines . . . . Suddenly here we are in shock-trauma."
They sat down in the waiting room, a dismal, poorly lit area furnished with a well-worn sofa and several plastic and aluminum chairs. A few minutes later, a neurosurgeon and several other specialists in green gowns came to talk with them.
Their words were cool and direct: Brian was not likely to live.
Brian fit the center's average patient profile: He was between 17 and 24 years of age, male and the victim of a motor vehicle accident. The same characteristics apply to the average head trauma victim. Of the 75,000 Americans who suffer head injuries each year and are permanently disabled, two-thirds are between the ages of 15 and 25. About 2,000 remain in deep and permanent comas.
As medical technology has become more adept at saving lives, that number has continued to grow. A decade ago, the survival rate for victims of severe brain injuries was only 10 percent; today, it is 50 percent.
Brian's age and physical condition gave him a better chance for survival. But as Dr. Robert Schlegel, one of the shock-trauma doctors, explained to Janet and Scott, much depended on how much damage had been done to his brain tissues.
When Brian's head hit the windshield, Schlegel told them, his brain had crashed against the inside of his skull. The collision severed important links between the brain and its stem, a critical area where motor and sensory information is processed. Damage to the stem often means death or, in many cases, irreversible coma.
For the moment, however, doctors could do little for Brian. His brain was badly bruised and swollen, creating so much pressure inside his skull that doctors would not operate for fear that his head would explode. At the same time, however, doctors had to act quickly because cerebral-spinal fluid -- escaping from tears in a membrane surrounding the brain -- was starting to leak from Brian's ears and nose, increasing the chances of infection.
Brian had suffered other injuries. Broken bones in his face. A shattered jaw. Fractures on the front and left side of his head, one of which extended to the base of his skull. That fracture had damaged a vital nerve tract leading to the pituitary gland and was disrupting his body's ability to control sodium levels in the blood. High sodium levels could further damage the brain.
Repeatedly, Schlegel talked about trying to "stabilize the loose elements," an odd phrase that still echoes in Scott's mind. The words "critical condition" now conveyed a horrible urgency. As Janet and Scott sat together in the dingy waiting room, "The tears really started to come," Janet recalled.
At 5:30 p.m., Curt arrived, and Schlegel reappeared to tell him personally about the seriousness of Brian's condition. Curt remembers asking, "If he lives, if he pulls through this, what are we talking about, a vegetable?"
Schlegel paused. "Yes," he replied, but immediately added that Brian could surprise everybody -- which gave the family a glimmer of hope.
Then, Schlegel asked a question that is posed to all families: If Brian should die, would the family be willing to donate Brian's organs for research?
"All I could say was yes," Janet said.
The First Visit
Finally, at 9 o'clock that night, Curt, Janet and Scott visited Brian in the hospital's fourth-floor Critical Care Recovery Unit.
Clad in green gowns, their faces covered by cloth masks, they walked softly through the unit. The room resounded with the beeps and clicks of life-support equipment. Everywhere the Rifes looked there were tubes and wires and computer terminals in a sea of green, silver and red. At the center of the room, there was a nursing station encircled by 12 beds, all occupied by patients with life-threatening injuries. Unlike Brian, most were victims of crime and violence -- gunshot wounds, knife cuts -- from the streets of Baltimore.
The Rifes gingerly approached Bed 11, a corner cubicle where Brian lay in a white gown. He was in a coma. His pupils were fixed and dilated. His fists were tightly clenched. His jaw was wired shut. His face and neck were swollen. He was breathing with the aid of a respirator.
Half of Brian's head had been shaven clean, and a white instrument that looked like a small ram's horn was sticking up from a hole that had been drilled into his skull. It was called a subarachnoid bolt. It kept track of the pressure inside Brian's cranium.
A chill rushed up Curt's back. For a moment, "I couldn't believe it was Brian," he recalled.
Janet said,"It was like looking at a Frankenstein version of my son. His face wasn't badly damaged. Just a few stitches here and there. But he was lying so terribly stiff and straight."
They stood there, not moving, not certain what to do. Finally, someone -- a nurse -- broke their silence. "It's all right to kiss him," she said.
Janet did. She ran her hand tentatively over his cheek and then his hair. "It was almost as if I were touching a mannekin," she said.
Later that night, long after midnight, Curt and Janet held each other tightly in bed in Curt's brother's house in Columbia, Md., where they decided to stay rather than make the long drive back to Springfield. Exhausted, overwhelmed by grief, they wept.
Images from the day streamed through Janet's mind. Sleep seemed far away. Somewhere, somehow, she drifted back to the 23rd Psalm and found herself repeating two phrases, over and over -- green pastures . . . still waters . . . green pastures . . . still waters. She finally fell asleep.
NEXT: The Edge of Life and Death