Paul Pelosi, husband of House Speaker Nancy Pelosi, remains hospitalized in San Francisco almost a week after an assailant broke into their house and attacked him with a hammer.
On Monday, Nancy Pelosi (D-Calif.) appeared to offer a more cautious assessment, saying her husband is “making steady progress on what will be a long recovery process.”
Head injuries are one of the most common causes of disability and death in adults, affecting about 1.7 million people annually. Treatment and recovery depend on a multitude of factors, including whether the injury was closed or the skull was fractured open, as well as on the victim’s age and general health, and whether they were unconscious and, if so, for how long.
Numerous complicating factors influence the decision about whether — and when — to operate. In less severe cases, supportive care can be offered to give the brain a “safe place to recover and rehab, which should start as early as possible,” said Thomas M. Scalea, the chief surgeon at the University of Maryland’s Shock Trauma Center in Baltimore.
Paul Pelosi’s recovery process and rehabilitation outcomes are “completely unknown at this point,” Scalea said, adding that it would be unwise to hypothesize about his recovery time, because no hard and fast rules apply to brain injuries. While younger people have a better chance of tolerating such injuries, outcomes depend on results of a neurological exam and imaging studies, regardless of age.
Court documents filed Tuesday by the San Francisco district attorney’s office and based in part on the San Francisco Police Department’s incident report and law enforcement interviews offer a few more details about the attack.
They suggest Pelosi had good recall of events leading up to the attack — a good sign, experts say — including being awakened by his alleged assailant, David DePape, and his attempts to defuse the situation in the half-hour before the police arrived.
The documents emphasize the force of the attack — a significant factor in the physical damage caused. DePape lunged at Pelosi, the documents say, “striking Mr. Pelosi in the head at full force with the hammer, which knocked Mr. Pelosi unconscious.” He was unresponsive for about three minutes, the documents say, “waking up in a pool of his own blood.” It is not clear whether that blood was from his head or from the injuries to his arm and hands.
Pelosi was taken to Zuckerberg San Francisco General Hospital, the only Level 1 trauma center in the city, where he underwent surgery.
Huge progress has been made in the treatment of head injuries, much of it gleaned from the care given to soldiers during the wars in Iraq and Afghanistan.
Injuries involving a loss of consciousness that is less than 30 minutes are considered mild but can quickly become more complex if, for example, the brain is bruised. Secondary complications vary greatly and may become apparent quickly or weeks later. These days, patients are closely monitored for a dangerous increase in intracranial pressure, which can be relieved by medication or surgery. Sometimes older people suffer slow bleeds after hitting their heads, known as subdural hematomas, which can cause confusion, paralysis and even death if the pressure is allowed to gradually build up.
For people 65 and older, the recovery process can be much more complicated than for younger adults. Older individuals have slower recovery times and worse cognitive outcomes.
“Everything is harder when you are in your 80s than in your 20s,” said William Stiers, associate professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. “You are starting out from a somewhat weaker position than in your 30s and 40s, with less cognitive reserve to fall back on.”
The healing of wounds is also slower for older people, though general fitness — including a heart, lungs, kidneys and a liver that are functioning well — makes a big difference to a person’s prognosis, Stiers said.
Still, there is not enough information to accurately assess whether Pelosi will require long-term care. “We don’t know the severity of his injuries,” said Ali Salim, division chief of trauma, burn and critical care at Mass General Brigham in Boston.
Added Scalea, “Nothing I have heard makes me think he can’t have a very good outcome, and we certainly hope that he does.”