This is kind of long, but it touched me on how the human mind and spirit can go on, even after injury.

"Sarah, Can You Hear Me?"
By Allison Glock

A Life Cut Short
In September 1984 Sarah Scantlin was 18. She was blonde, with luminous, pale skin and a broad smile. She had just started junior college in Hutchinson, Kansas, where she made the cut for the school's drill team, a group that performed at halftime at football and basketball games. And she'd recently landed an enviable job in office administration at Pegue's, a local department store. Cheered about these developments, she broke up with her boyfriend, John, one of the many guys she was pals with, and decided to celebrate the future.

She rounded up some girlfriends and cooked some spaghetti. They enjoyed some and then gleefully deposited the rest on her ex-boyfriend's car. Then Sarah and her best friend, Lori McConnell, went to a nightclub called Tapper's. "We were feeling mischievous," Lori recalls. They stayed at the club until closing time, dancing and flirting. At midnight they left the bar, along with other patrons. Sarah and Lori headed across the street to where Lori had parked her Ford Lynx.

They had just begun to cross the road, says Lori, when a white Monte Carlo roared out of the blackness and slammed directly into Sarah's torso. Tossed over the car's hood onto its roof, Sarah hit her head on an oncoming car headed in the opposite direction, then rolled off this car and landed head first on the pavement. This grotesque violence happened in little more than the time it takes to blink. Lori ran to Sarah's side and screamed for help as the driver of the first car sped away. In the confusion someone called for an ambulance. Bystanders familiar with CPR kept Sarah breathing until the emergency vehicle arrived 10 minutes later to take her to Hutchinson Hospital, just a few blocks away.

"Shortly after midnight, Lori called us from the hospital and said Sarah was badly hurt," Sarah's mother, Betsy, then 44, recalls. She and her husband, James, then 46, rushed to be with their daughter. "When I arrived at the hospital, I said, 'I am Sarah Scantlin's mother and I need to see her,' " says Betsy. "They said, 'No, you can't go back there.' And I said, 'Yes ma'am, I can. You watch me.' "

Betsy recalls finding her daughter lying alone in a room on a gurney, pale and quiet as if asleep. "The small Hutchinson ER had done all it could for her," Betsy says. "Doctors were planning to airlift her to the Wesley Medical Center, a major regional facility in nearby Wichita where she could get more sophisticated care."

Betsy remembers that Sarah was not bleeding, "but she was bruised -- all beat to hell." Tests later revealed that Sarah had multiple fractures to her collarbone, jaw, skull, ribs and pelvis. As she gazed at her child's face and heard her soft, shallow breathing, Betsy felt her stomach tighten.

"What's wrong with her?" Betsy remembers asking. She recalls the nurse on duty that night explaining Sarah had a head injury -- a bad one.

"What are her chances?"

Betsy recalls there was a long pause, then the nurse's response: "Fifty-fifty."
Betsy latched on to the good 50.

The wounded brain is like a stereo that has been dropped on the floor. The outside may look fine, but the interior may well be scrambled. Connections are torn apart. Cells are damaged, and once a brain cell is dead, it stays dead. Complicating matters is the fact that impairments may not be visible on diagnostic tests, such as MRIs. And there is no conclusive way to test for thought processes or potential for healing.

"The brain is fragile. If it gets hit hard enough, all the elements get damaged," says John Kessler, M.D., chairman of the neurology department at Northwestern University's Feinberg School of Medicine, in Chicago. "No neurologist can give an accurate prognosis in such a case. You can only say, we'll see."

Sarah's parents headed for the Wesley Medical Center, an hour's drive away. As they arrived, a crowd began assembling; it included Sarah's elder brother, Jim, and about 60 of Sarah's friends, who'd heard about the accident from Lori.

After Sarah arrived via emergency airlift, she had X-rays and CAT scans, then was rushed into surgery to stem the bleeding in her brain, her parents recall. When Betsy and James saw Sarah again, eight hours later, she was in bed, her head completely shaved and encircled by a steel halo that kept her neck still. In multiple places screws from the halo bored into her skull, says James. Elsewhere her scalp was punctuated with dense clusters of stitches resembling zippers, James says. She was dressed in a pale-blue hospital gown that ended mid-calf. All around her monitors blinked and beeped, but Sarah remained perfectly still, impervious to it all. She had fallen into a coma, a state of profound unconsciousness in which the patient does not respond to stimuli.

"At Wesley the surgeons removed damaged brain tissue and a blood clot from the left side of her brain," Betsy explains. "The doctor told us the clot was the biggest he'd ever seen, the size of an orange." The prognosis was grim. "We were told she might never wake up, and that if she did, she might not ever recognize us."

Sarah remained under close observation in the intensive care unit for several weeks, during which time her parents waited for the moment when she would awaken. "I kept thinking that she'd open her eyes, lift her head up and say 'Hi, Mom!' " Sarah's mother recalls. "But it didn't happen."

Instead, every day became a slog of angst and sorrow. To dare to hope seemed foolish. To give up was unthinkable. In November Sarah opened her eyes and resumed normal sleep-waking cycles, a sign, Betsy explains, that she'd progressed from a coma to a more responsive state. The following month she began to be able to use her eyes to track moving objects, such as a ball held by a caregiver.

"The doctors told us she had sustained extensive and permanent brain damage," says James Scantlin. "She could not speak or move on her own but we did suspect she could recognize us."

Sarah's parents remained in an exquisitely cruel emotional limbo. "Thanksgiving, then Christmas, came and went. And Sarah still wasn't Sarah," says Betsy. To be closer to her daughter, Betsy moved into an apartment two blocks from the hospital. She spent nine hours a day, sometimes more, by Sarah's side, talking to her, reading to her, watching soap operas. Sarah remained unresponsive -- even, Betsy says, when she climbed into the hospital bed, wrapped her arms around her daughter's shoulders, pressed her body against hers and begged her to come back to her, just please come back.

James, meanwhile, descended into self-pity, he says. He lost his job as a mobile-home sales representative when his company went out of business, grew quiet and, though he kept going to see Sarah, began to find visiting her very difficult. He recalls: "Can you imagine talking to your child and getting no response? You begin to dread it."



At this stage Sarah was likely "locked in" -- fully awake and aware but unable to respond to stimuli. To try to help Sarah escape her bodily prison, James says, her caregivers at the medical center gave her physical and occupational therapy, manipulating and massaging her arms and legs. "The brain isn't dead, but it isn't functioning fully, either," explains Dr. Kessler. "So, while you're working with these patients, trying to figure out what they can do, these exercises keep them from getting blood clots, shortened tendons and shrunken muscles."

James recalls that Sarah remained on a respirator and feeding tube until January 1985, when she underwent another brain surgery to install a tube that drained excess fluid from her brain in order to enable it to resume higher functioning. But nothing changed. "In cases like Sarah's, it's impossible to make firm predictions," says Dr. Kessler.

That same month James penned a letter to the judge hearing the case against Doug Doman, the drunken driver who had plowed into Sarah, arguing that as part of the sentencing Doman should be required to meet Sarah and see the results of his actions.

"We are so very glad and thankful that Sarah lived her life so well, so fully and with such zest," James remembers writing. "There has not been a blank page in the book of her life. It is so sad that her beautiful epic is no more."

In March 1985, Doman, 22, was sentenced to six months on charges of drunken driving and fleeing the scene of an accident. He was also ordered to visit Sarah. He and his mother visited Sarah several times after his prison term was over, Betsy says. The Scantlins couldn't help taking pity on him. James says he has even forgiven Doman. "Living with hate doesn't get you anywhere," Betsy says. "We went on." Adds James: "He suffered, too."

In April, after six months in the medical center, Sarah was transferred to Golden Plains Healthcare Center, a long-term-care facility back in Hutchinson that could offer physical therapy and swallowing therapy, among other types of help. The swallowing therapy was part of an attempt to wean her off the feeding tube she'd been living on. At this point, Betsy says, Sarah's care was still covered by the Scantlins' health insurance.

At Golden Plains, the Scantlins maintained their grueling vigil, keeping their daughter company all day long and into the night: reading her books, brushing her hair, talking to her -- and getting little response. "Her doctors told us she would live, and she might make progress, but it would probably be so slow we wouldn't realize it," says Betsy.

In 1986, after two years of unceasing hope and painstaking care but no measurable results, the Scantlins broke down. They loved Sarah -- and it never, ever occurred to them that she might have been better off had she died, Betsy says, but they were suffocating. They sold their house and most of their belongings, bought a travel trailer and left town.

"Before the accident we had had an idyllic life," James explains. "Then all of a sudden we were in a morass, and there was no getting out of it. It was a nightmare." The couple wound up in Albuquerque, where they "lived like gypsies," James says, until their cash ran out. Then he took a teaching job. Betsy did nothing. Although it felt good to bask in the sunshine and leave the past behind, she felt guilty, untethered, useless. The following summer she insisted they return to Kansas.

James and Betsy have been together since she was 15 and he was 17, growing up in the oil fields of Healdton, Oklahoma. "The people in our town were a rough, tough bunch," says James. With his wide, white-bearded face, he has more than a passing resemblance to Ernest Hemingway. Betsy is lean and angular, her hair cropped sensibly short. Since fall 2005 she has had acute emphysema owing to her long-term smoking habit, and her breathing is now assisted by oxygen delivered to her nostrils via tubes.

James was a roughneck in his youth, full of dangerous charm. He and Betsy fell instantly in love. They wed in 1960. After two years a son, Jim, arrived, followed four years later by Sarah Leanne. Jim is married and lives in Arkansas, working as an information systems director for Wal-Mart. He visits Sarah a few times a year and has taken his two grown daughters to see her.

"This whole thing was so hard on Jim for so long," Betsy says. "When Sarah was injured we forgot his birthday, we were so overwhelmed. He was scooted aside. But he never said a word. When we got back from Albuquerque, we saw we needed to rethink this, to remind ourselves that we still had a son." The family began talking among themselves about what had happened, about their grief and about coming to grips with Sarah's condition.

James renewed his Kansas teaching certificate and began work on a master's in behavioral disorders. Eventually he got a job in a Wichita psychiatric hospital working with adolescents with behavioral problems. Betsy got a job at a nonprofit, assisting families with hospitalized relatives, a post she felt uniquely qualified for, living as she did in a state of constant grief. Helping others became her therapy.

She also came to an important realization: "For years I thought about Sarah every single day. Finally I accepted that she might not get any better." It was a watershed moment for her. The grief began to lift. She warily gave herself permission to live a full life, even if her daughter could not. The all-day vigils shrank to monthly hour-long visits, and the Scantlins began to pick up the pieces of their lives. The years went by.


On February 4, 2005, a little more than two decades after the accident, the phone in the Scantlins' dining room rang. When Betsy picked up, she heard the words she had fantasized about for so long: "Hi, Mom."

Betsy recognized the lilt and intonation of her now-38-year-old daughter's voice immediately. "Sarah, is that you?"

"Yeah," Sarah answered.

Betsy felt the time slip away. "It was as if I'd just talked to her yesterday."

Betsy handed the phone to James, and when Sarah said "Hi, Dad," he began to sob. "I felt an incredible surge of elation and relief," he says.

For some time leading up to that moment there had been small signs of change. Sarah had managed to learn an eye-blink communication system -- one blink for yes, two blinks for no -- allowing her to respond to simple questions. But her capacity to do this was inconsistent. And for a few years she had occasionally shrieked and moaned. At the end of Jim's visits, her brother recalls, "she'd make screaming noises. It was as though she was trapped and couldn't get out. It would rip my guts out."

Then one day in January 2005, Golden Plains activities director Pat Rincon was reading Sarah a story.

Another patient interrupted with a request for a manicure, and Rincon told her she'd do it later. "Okay?" Rincon said to the other woman. "Okay," Sarah chimed in. Rincon whirled around to look at Sarah. She and the other aides were flabbergasted. "Say it again!" they urged. "Say it again!"

Fearful that it was a fluke, they spent some time working with Sarah before telling her parents. For a few weeks they coached her, helping her pronounce the words "mom" and "hello."

"When she spoke it was shocking," says Robin Kenyon, who then worked as a physical therapist at Golden Plains. "It made me think differently about my work. Just because people can't tell you anything doesn't mean they're unaware."

Since her first words Sarah has steadily progressed. She can answer simple questions and make basic requests, saying "I want a drink" or "I want to go to my room," for example. Though her utterances have increased in complexity, she still doesn't engage in extended conversations. She has also begun to move her severely atrophied limbs, which had become contorted owing to lack of use. In March 2005 tendons in both feet, both arms and her left hand were "snipped" to give her additional range of motion. This surgery, combined with the fact that she has relearned how to swallow, means she may one day be able to feed herself.

"We had doctors tell us this was impossible, but now it may be within reach," says James, who is now 68. "When she is focused, Sarah makes things happen."

"The brain does not regenerate," Kessler explains, "but it does have plasticity. Certain areas can take over from others, though it's not understood how that occurs."

Sarah's sense of time is fuzzy. When she began communicating again she couldn't believe she was no longer 18, Betsy says. When her brother told her she was 38, she stared at him, uncomprehending. She still hasn't noticed that her parents have aged.

But, James says, Sarah is able to answer questions about events such as September 11th, which occurred during the time she was incommunicative. The thinking, says Betsy, who is now 66, is that she absorbed much of what went on around her during those 20 years, including information she heard on the TV in her room.

Sarah's upturn has brought peace of mind to her friend Lori as well. "After the accident I hit rock bottom," Lori recalls. "For years I had nightmares in which I would relive the accident. I got depressed and eventually dropped out of college. I continued to visit Sarah twice a month. Her mother told me I should go back to school, but I just couldn't."

When Lori heard from Betsy that Sarah had begun to speak, she began to shake, terrified that Sarah might be angry when she realized that Lori had lived a normal life, marrying and having four children -- all the things Sarah was robbed of and would never do or have. But when Lori walked into the room at Golden Plains, Sarah greeted her old friend warmly. "Hi, Lori," she said cheerfully.

"I asked if she was mad at me, and she said no," says Lori. "You know what? I haven't had a nightmare since the day I found out Sarah was talking."

It's August 2005, and it's time for the Scantlins' monthly visit to their girl. As the two walk down the hall to the rehabilitation room, they discuss finances. Five years after the accident, Betsy says, Sarah's medical bills had passed the $1.5 million lifetime cap of their private health insurance; coverage was then provided by Medicare, Medicaid and Social Security disability benefits, which currently pay for her room, therapy and specialized equipment. Since Sarah started talking, fund-raisers have provided additional money to pay for food and clothing, which the family also helps cover. The Scantlins are not extravagant and have learned to live simply. Every extra dollar goes to Sarah's care.

The rehab room at Golden Plains is gray and spare, save for pieces of well-worn medical equipment and a picture of Tim McGraw someone has taped atop the paper-towel dispenser. Patients line up in wheelchairs to visit and await their physical therapy. Betsy chats with them, patting their knees and shoulders; she has known many for decades.

A staff member named Jennifer Trammel says with a grin: "One day I asked Sarah how she was doing with her rehab, and she said, 'Work, work, work. All I do is work.' " A patient shares an anecdote: "I will never forget us playing bingo and Sarah turning to me and saying, 'I just won blackout, baby.'

As Jennifer and Betsy share a quick hug, Sarah is pushed into the room in her wheelchair. She is in a tank top, gym shorts and black Chuck Taylor high-top sneakers. On her head is a baseball cap, and she wears two bracelets strung with turquoise beads.

"Good morning, Sarah," Betsy says, in a plain, loud voice.

"Good morning, Mom," Sarah answers clearly. She then mumbles something else, her voice clotted and soft, the result of years of inactivity of her mouth, throat and vocal cords.

"You are going to have to talk so I can understand you," Betsy chides.

"Great," says Sarah with gentle sarcasm.

While a therapist straps her into a custom-made lifting chair that raises her body and enables her to stand, James chats with his daughter about his prized flower garden. As he talks he places his hands, palms up, on a table and asks her to put her hands on his. She does, and he holds them tight.

"Excellent. Very, very good," he tells her.

Sarah, now upright, winces as a full-length mirror is rolled into the rehab room.

"What do you think, Sarah?" James asks, as she looks at herself, shaky but standing.

"Fine," she answers, sounding exasperated. "Just fine." Her mouth involuntarily falls open.

"Close your lips," James says. Sarah does, but not before sticking out her tongue.

James chuckles. "She has her Daddy's disposition."

Sarah's occupational therapist asks her to stack colored cones. Lightweight and only a few inches high, they look like toddler toys. The goal is to place one on top of another to form a tower, then unstuck them. The process is slow and painful. Sarah wails and at times simply quits. "No!" she shouts.

"Come on, just a few more," James coaches.

Sarah reluctantly resumes the task.

"She couldn't do that a few months ago," says James, beaming.

Betsy brings over Sarah's high school scrapbook. They start at the beginning, on a page filled with photographs of Sarah as a child, always smiling, her blond hair parted in the center, falling to her shirt collar.

It's an exercise they do often to help Sarah place herself in time. Betsy points to the photos, asking Sarah to identify them. She answers in one- or two-word phrases. Less frequently she'll try a short sentence. She has a vivid memory for people and places of the distant past, though -- sometimes remembering better than her visitors. She can sing the lyrics of songs that were popular at the time of her accident, such as tunes from the movie Grease.

Sarah is staring at her prom photos. Her baseball cap has fallen off, revealing a scar that runs the length of her hairline. "John," she says, remembering her last boyfriend, the one onto whose car she dumped spaghetti.

"You collected boys, didn't you," James teases, then adds: "That was taken not long before the accident. Before Sarah was frozen in time."

When the story of Sarah's awakening hit the papers, the Scantlins were inundated with letters and e-mails from people anxious to know their secret. "It's hard for people to understand that nobody really knows why this happened," says Betsy.

Some insist her recovery was an act of God. Sarah's parents say she was held up as an example in the battle over Terry Schiavo, who was in a persistent vegetative state, a far more serious condition than Sarah's.

This distressed the Scantlins. "We don't want Sarah to become a part of somebody's agenda," explains James, his face flushing. "Her speaking was not a miracle. It was miraculous."

Betsy is cautiously optimistic. She knows that Sarah may not progress. But she can celebrate the now, as she has taught herself to do. And finally, the now is more than enough.

"We have to accept that whatever is happening on any given day may be how it will be forever," Betsy says. "And we must be grateful for that."

Later, over lunch in a local diner, James and Betsy reflect on their survival. "I remember the first time I went into Sarah's bedroom after the accident," James begins, slowly. "I dreaded going in there. All the life had left the house. I opened the door, and the first thing that hit me was the lingering smell of her perfume."

He walked to Sarah's desk. On it was a to-do list. "Number one was to finish a paper for a class. Then, go buy new coat. Number three: Practice with the drill team. For number four, she had written, Clean My Room! She underlined that several times and added a dash, then the word maybe."

James grins. "I laughed and cried when I read that. It was so Sarah. Finding that note was one of the most beautiful and devastating things."

When people ask how she managed to get through the past 20 years, Betsy sighs. "You are never totally past it," she says. "But you have to go on."

"There are eternal lessons to be learned from an event like this," James adds. "Pain is a severe teacher, but you do learn from it. I found out that self-pity is shameful and self-centered. I wasn't the one in the hospital bed. And I discovered that I couldn't spend my life saying, 'If only she hadn't gone out, if only we'd been stricter.' Truth was, Sarah was out having a good time, being young, living her life."

James and Betsy now live in a mobile home in Hutchinson, about five miles from Golden Plains. They have a lake view and a large perennial garden. They live frugally and happily, visiting their grandchildren or road tripping to casinos to play bingo and the slot machines. They have planned ahead. Sarah's guardianship is shared with their son, Jim, who helps with paperwork as well as decision-making on Sarah's behalf; her care is covered by savings and Medicaid, Medicare and Social Security benefits; even her funeral has been paid for, a chore both heartbreaking and necessary.

"It's scary to be nearly 70 and have parenting responsibilities," says James. "It's as if we're starting over."

Adds Betsy: "It's still difficult, but it's better. Our story is a happy story." James manages a small smile. "Sarah has given so many people such hope," Betsy continues, looking at James. "There are so many bad things going on in the world. You hear about a girl who starts talking after 20 years -- what's not happy about that?"

She continues wistfully: "The last 20 years disappeared the second she said, 'Hi, Mom.' Really and truly. In a second, they were gone."