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Come Back: The Rehabilitation of Meg Tippett

The idea is to teach the injured brain to work again by bombarding it with stimuli and motion. "Through every pathway that goes into [the] brain we are pounding a message, and that message is: Child, you are not allowed to resign from the human race. Come

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James: There's such a thing as . . . acceptance. And letting go. Sooner or later we all give up, don't we?

Annie: Maybe you all do. It's my idea of the original sin.

James: What is?

Annie: Giving up.

James: You won't open her. Why can't you let her be? Have some--pity on her for being what she is.

Annie: If I ever once thought like that I'd be dead . . .

Keller: Miss Sullivan, I think you ask too much of her and yourself. God may not have meant Helen to have the--eyes you speak of.

Annie: I mean her to!

--from William Gibson's The Miracle Worker

In this defiant moment, The Miracle Worker reaches its climax. Helen Keller's father and brother wish that Annie Sullivan would larn to accept young Helen's fate. God has seen fit to make her deaf and blind, they are saying. Let his will be done.

No! says Annie Sullivan, uneducated and almost blind herself. Her no is the play's miracle. In physical battles with Helen that will be nearer the realm of exorcism than therapy, she means to drive out the demon that has sealed off the girl from the world. And by this deliverance of Helen Keller, she will rebuke all those so certain where God stands.

The routine begins at 4:30 in the morning with the soft playing of some Bach tapes. They help rouse Margaret "Meg" Tippett from her deep sleep. At 5, her father Mike Tippett and the night nurse come in and begin cheerfully discussing the weather and the good things to come on this day: a drive in the country, perhaps, or the arrival of some old friends. They gently lift Meg from the bed into the wheelchair and start the regular round of activities, which include shower and shampoo (in a specially designed mobile unit that rolls into the shower), the brushing of her dark hair, and then breakfast. Meg seems to enjoy all the attention and the stream of chatter of which she is usually the center. She smiles, moves her head around, and makes agreeable sounds.

Meg Tippett is 27 years old, five feet tall, and weighs 104 pounds. Her eyes are bright and intelligent, her complexion clear and youthful looking, everything about her exceptionally well cared for. By the time she is dressed in her "work" clothes--clean sweatshirt and pants and pink running shoes--she could almost pass for the girl athlete next door.

Each step in the routine takes a long time because Meg has been helpless since the catastrophic brain injury she suffered almost three and a half years ago. She cannot walk, talk, or feed herself. She cannot even sit up without assistance. When she's been sitting in her wheelchair for a time her head starts to slip down on her chest and her whole body begins to close up in a kind of reversion to the fetal position. "Come on, Meg," says her father cheerfully, "get that head up."

No one knows for sure what is going on behind those shining eyes because she cannot adequately and consistently express even by nod or gesture what is on her mind. Her father usually feeds her all her meals. Meg can handle soft solids pretty well now, though liquids still give her trouble.

After breakfast and a brief visit by her mother Judith, who is getting ready for work, it's time for a session of masking. Mike Tippett slips a clear plastic bag over her nose and mouth and leaves it there for two minutes. Meg doesn't seem to mind. As her father checks the time on his watch, Meg begins to breathe more deeply, her chest rising and falling with greater effort. When the mask is taken off, she looks a little winded, as if she had just run around the block. Masking, explains Mike, is a technique to make the lungs work harder and thus bring more oxygen into her body, especially the brain. People like Meg tend to breathe shallowly, preventing their system from getting what it needs most. Mike lets her rest for five minutes, then puts the mask on again for another two-minute sprint. The procedure is repeated over and over--ten times in the next hour. When it's done, Meg looks tired but her color is even better than before.

Now comes a more intensive 90-minute workout. Her father wheels Meg down to the exercise room. Five friends have already assembled there and everyone seems extraordinarily upbeat--as if they were about to qualify for the early morning Olympic Games. She is placed on her stomach on a workout table built by her father. He and the five friends take their accustomed positions, one grasping each of her limbs, one her head, and one her lower trunk. Mike checks his watch and five minutes of uninterrrupted "patterning" begins. Rhythmically on the count of three, the team turns her body from one side to the other, again and again. When her head and trunk are turned right, her left leg and right arm are bent and her right leg and left arm are straightened out. When she is shifted to the left, legs and arms are moved in the opposite direction. The movements, called cross-pattern patterning, simulate the motion a normal body experiences effortlessly when it is walking.

For Meg it is a grueling experience. She groans in protest as her body is pulled and manipulated in this rapid, rhythmic sequence. When Mike finally calls "time," she is sweating and panting, and so are her father and the other patterners. There will be 15 minutes of rest, a second five-minute bout of patterning, another 15-minute rest, and patterning a third time. Patterning is less intended to be therapy for her muscles than reeducation of her brain--it's an attempt to send messages to the brain about what it feels like to walk, to reopen pathways that have been blocked off for years.

Next, Meg, whose body seems looser than before--not as determined to curl up into the fetal position--is laid on her side on a wooden slide also built by her father. It is 13 feet long and 28 inches off the floor at the top. The idea here is to encourage leg and body motion. "OK, Meg," says her father, "slide down, show you can do it!" "Go Meg, go!" exclaims one of her patterners. "Let's set a new record!"

Very, very slowly she moves down the slide. Is she pushing with her legs, or is it just her weight assisted by gravity that is moving her along? It's hard to tell. But when she finally gets to the bottom, the team cheers. "That's good time," says her father, "three minutes and 28 seconds." The trip used to take four or five minutes. Meg looks around and grins back at the beaming faces of her cheering squad. Perhaps somewhere in the recesses of her devastated brain, a little connection has been made, a tentative bridge of neurons formed. Only time will tell.

The session continues with flash cards. Mike shows them to her one at a time. On them are simple words like "swim" and "walk" or phrases like "the blue blouse." Mike reads the words on each card slowly and loudly. She looks intently at them and laughs when one strikes her as funny.

How much does she understand? "She knows 80 to 90 percent of what you say or show to her," says Mike. "It's just that she can't respond fully--yet."

It is 10:30 in the morning and the day has just begun. Mike will put her in the wheelchair and take her for a walk through their Uptown neighborhood--but not too long a walk, for there's still so much to do. Before she goes back to bed at about 11 tonight, Meg will have six more hour-long masking sessions, two more 90-minute workouts of patterning, sliding, and flash carding, two more meals, another walk, and some free time visiting with her parents, nurses, and friends who stop in. The patterning aspect of her program is particularly labor-intensive, as it requires five or six able-bodied volunteers for each session--amd there are three a day. The Tippetts can use 60 or 70 volunteers a week, and they are always on the lookout for people with an hour or two to spare for the cause.

"So many people have been good to us right from the beginning," says Mike. "It wouldn't be fair to let Meg just vegetate--fair to them or to Meg."

The intensive program in which Meg is involved was developed by the Philadelphia-based Institutes for the Achievement of Human Potential, where therapist Glenn Doman has had success working with brain damaged children. Its adaptation to adults like Meg is still in the experimental stages. The basic idea is to make the body "teach" the brain how to operate by bombarding it with so many sights, sounds, motions, and pressures that it cannot remain dormant. The program requires a kind of tough love and demands great patience and determination. As Doman put it in his book, What to Do About Your Brain-Injured Child, "We require tremendous intensity over all else, to penetrate the barrier of brain injury. . . . Through every pathway that goes into his brain we are pounding in a message, and that message is: Child, you are not allowed to resign from the human race. Come back! Come back! Come back!"

The Tippetts were just an ordinary upper-middle-class family back in the 1960s. They lived in the Cleveland suburb Shaker Heights and had three daughters: Meg, the oldest, born in 1961; Kathryn "Kit," born two years later; and Brooke, three years after that. Mike was a high school chemistry teacher and assistant principal, Judi a housewife and part-time housing coordinator for Shaker Heights. Solidly built, highly principled people, both were extremely active in their local Methodist church. But they grew increasingly frustrated as they saw how slow-moving and impotent local churches were in the face of larger human needs.

They came into contact with the Ecumenical Institute (EI), a unique organization (founded in the Chicago area) that combines ultraliberal Christian theology with an idealistic dedication to the downtrodden. EI interprets the gospel message almost entirely in terms of this world but asks its adherents to live in an otherworldly, quasi-community style and in a spirit of poverty.

Mike and Judi were especially attracted to the Institute of Cultural Affairs (ICA), the social development arm of EI. This organization works with local churches in promoting grass roots initiative and leadership in areas ranging from New York City's lower east side to the slums of Calcutta and the rural villages of the Philippines. In 1969, when their daughters were still young, the Tippetts began volunteering for the ICA and liked what they saw. Ten years later Meg was on her way to college--Ohio Wesleyan University--and the younger girls were old enough to appreciate the broadening effects of travel. So Mike quit his teaching job of 20 years and Judi resigned her position as housing coordinator. They sold their house and became full-time ICA secular missionaries--with a dramatically reduced income. Neither was yet 40 years old. "You could say we received a call," says Mike. "This was a service we felt we could do and an opportunity for the two of us to work together, to help out in places in the world that needed help."

Adds Judi, "What were we going to do with the rest of our lives? Make a financially secure family more secure? I said So what! to that."

The Tippetts worked in Brazil, Australia, and Nigeria, and traveled extensively besides, persuading communities to work cooperatively with other communities and take responsibility for transforming their parts of the world instead of remaining its victims. In 1982, when they were transferred to Chicago, they moved into an apartment on the top floor of ICA's office building at Sheridan and Lawrence. But they continued to travel extensively as ICA consultants. If people just have enough vision and imagination, said the EI-ICA message they preached, the barriers of history, culture, and prejudice can come down. Reality will bend and anything can happen!

Everyone agrees that Meg Tippett was a remarkable person. "She never met a stranger," says her mother, "always outgoing, vivacious, smiling, interested in people . . . the easiest of our kids to raise." Meg was also self-assured beyond her years. Judi Tippett remembers the time Meg was accused of stealing another girl's tennis shoes in eighth grade. "I assumed she'd want me with her when she faced the girl's parents," she says. "Meg said 'No, I didn't do it. I will handle this myself!' And she did."

In her teenage years Meg hurled herself into drama; she had the lead in her Shaker Heights high school play and worked with a young people's theatre in Cleveland, writing, directing, and acting in a production which turned nursery rhymes into a musical. She was involved in service projects at school and had friends in all the groups and cliques.

"I think of Meg almost every day," says Evy Gordon, of Cleveland, whose daughter Francie was one of Meg's closest high school chums. Less than a year before graduation, Francie committed suicide for reasons no one understands. "Many of her friends were so shocked," says Gordon, "they couldn't handle it. I didn't see them much anymore. But not Meg. She'd stop by and talk all the time, always smiling and encouraging. She helped our family through that time . . . and I think maybe we helped her."

Meg went to Ohio Wesleyan in 1979 just as her folks began their new career with the ICA. "All the guys had a crush on Meg," says Mary Jane Miller Hotaling, a close college friend. "I met my future husband through her. She was something else. She knew all the preppies and was close to the ahtletes, especially the swim team, and the drama group too."

Hotaling recalls the time pranksters blew up dozens of balloons and filled her room with them while Meg was out. "She went wild," she says. "She pushed them all out the window until the whole college courtyard was alive with balloons."

No one pushed Meg around. "Very, very organized," says Hotaling. "When a bunch of us went to Florida during the spring break, she had all our plans worked out months ahead of time. She was so together."

"Meg has a strong will," says Judi Tippett, "like the rest of us." When she graduated in 1983, with a degree in human service, Meg had broken up with her boyfriend and wasn't interested in settling down. She decided to move to the San Francisco area where one of her girlfriends lived, work there awhile, and pay off some tuition debts. "There was no way we could talk her out of it," says her mother. She worked in personnel for a microchip manufacturer and talked about going back to school eventually for a master's degree in social work.

On the Sunday before Thanksgiving in 1984, Meg flew to Cleveland. She was to be a bridesmaid in the marriage of her friends Mary Jane Miller and Clark Hotaling the following Saturday. On Monday, November 19, she and her sister Kit drove a Honda Accord, lent to them by friends in Cleveland, to Ohio Wesleyan University in Delaware where Kit was a junior and their other sister Brooke was a freshman. The three had lunch. Meg then met Mary Jane, tried on her bridesmaid's dress, and visited with old friends at the school. That afternoon, she alone began the 130-mile drive back to Cleveland on Interstate 71, a four-lane superhighway. A light snow mixed with rain was falling.

About halfway back, near Ashland, Ohio, Meg attempted to pass a semitrailer truck and apparently hit an icy patch. Her car slid to the right and sideswiped the trailer, then veered to the left and came to a stop on the snow-covered median strip. The truck driver pulled his rig over to the right, stopped on the shoulder, and got out to inspect the damage. Apparently unhurt, Meg rocked her car back and forth to get out of the snow, then drove across the highway to pull up behind the parked truck.

At that moment a second semi coming down the highway may have hit the same icy spot. The truck jacknifed and the cab slammed into the rear of Meg's car, hurtling it into the tail end of the first truck. It was all over in a second. Neither truck driver was injured, but Meg sat, unconscious and still wearing her seat belt, behind the wheel of the Honda, which was mashed like a bug between the two huge vehicles.

Since there was no way to open the doors of the crumpled car, one of the truckers broke out the rear window and crawled in. Meg had a small cut on the back of her head, there was some bleeding from her nose and ears, and she was not breathing. The truck driver attempted mouth-to-mouth resuscitation inside the car and covered her with a blanket. An ambulance arrived about 20 minutes later. Meg was brought out of the car and rushed to a hospital in Ashland, then quickly moved to a larger hospital in nearby Mansfield that had a head trauma unit.

Mike got the call in Chicago. The doctor on the phone said she had received a severe "closed head" injury and her condition was very serious. She was breathing only with the aid of a respirator and her pulse was faint. A neurosurgeon would have to decide what to do. The doctor noted that she carried a card saying her organs should be donated to science in the event of her death and he wanted to make sure the family understood that. Mike called Judi, who was on ICA business in California. Both caught the earliest flights to Ohio, where they picked up their other two daughters and rushed to the hospital.

The family found Meg lying in bed in a deep coma, her head swathed in bandages, her body rigid, and her hands tightly fisted at her sides. Although no bones were broken, they were told, the prognosis was not good. She had sustained a global head injury. The impact (probably against the car's doorjamb) had violently jarred her brain back and forth inside the skull and twisted it on the brain stem, so that even involutary reflexes like breathing were affected. With the pooling of blood inside the brain and the time that had gone by before she could be put on a respirator, extreme oxygen deprivation had occurred. An EKG showed no brain activity. To relieve swelling inside her skull, a neurosurgeon had made a T-like incision on the left side of her head and sucked out some of the accumulated blood.

When Mary Jane Miller heard about the accident, she thought This is terrible! Meg may have to miss my wedding! But when she saw her the next day "lying there so small, like a little old lady," she knew Meg would miss more than the wedding.

In the days that followed, Meg clung to life. She was fed through a tube in her nose and the respirator kept her breathing. Mike and Judi Tippett settled in for the long haul. "From the moment we got the news we received so much help and support we were overwhelmed," says Mike. Old friends and neighbors from Cleveland and the ICA met them, chauffeured them around, and arranged a place for them to stay in Mansfield. Then one couple, whose daughter had recently died of leukemia, loaned them their car for the duration of their stay. "A lot of people who helped were strangers to us," says Judi. "Everybody extended themselves like we were family."

About a week after her injury, Meg started to take a few breaths each minute on her own--the first hopeful sign. Buoyed by this development, the Tippetts consulted experts on coma arousal. They discovered that long-term memory and recollections from childhood are the most easily stimulated, so they got Winnie-the-Pooh, Alice in Wonderland, and all the Doctor Seuss books they could find in the library and read them at Meg for the 15-minute periods every three hours they were allowed in her room. "Besides maybe helping Meg, it gave us something to do instead of standing around," says Judi.

Meg's breathing attempts continued, and after two and a half weeks she was taken out of intensive care and off the respirator. She began breathing by herself through a tube inserted into her windpipe. Since they could be with her for longer periods now, the Tippetts read more to her and kept the radio in her room going at all other times. Friends who came by were encouraged to talk loudly, sing songs, clap their hands, and make as much noise as possible to penetrate her sleep. That year the Tippetts celebrated Christmas in an apartment rented for them by a Mansfield church group and with a tree and presents provided by the congregation.

Early in 1985 they noticed that Meg's eyes seemed to be moving under her closed lids, another hopeful sign. But at the same time, the rigid position she had been in since the accident began to shift to a more closed-up, fetal position, an ominous sign. A CAT scan disclosed that her brain ventricles were enlarged, so the neurosurgeon operated again, inserting a shunt to drain excess cranial fluid down her spine. Even the most minimal recovery, if indeed there were to be any, the medics told the family, would take two to five years. They advised that she be placed in a quality rehabilitative center for therapy and to determine how much potential she possessed.

So that February Meg was taken by ambulance to the Rehabilitation Institute of Chicago (RIC), where she spent the next seven and a half months. Every day the staff dressed her, put her in a custom-made wheelchair (with a band fitting over her head to prevent her from slumping and side supports to keep her from falling out), and provided her with three hours of physical therapy. Gradually her eyes opened, and the doctors said she was definitely out of the coma. However she simply stared ahead, showing no signs of recognition. Weeks later she managed a little eye movement, then made a few almost imperceptible attempts to move an arm or leg. "In our situation," says Judi, "any insinuation of hope was a big deal. And it still is." Mike and Judi managed their schedules so they could be with her each afternoon from 4:30 to 9 PM.

On a warm spring day in 1985 Judi took Meg for a long outing in her wheelchair. She stopped to watch a group of young people about her daughter's age playing softball on the field behind the Chicago Avenue armory. "I think it hit me then for the first time how total this thing was," she says. "I realized that everything was changed, our lives would never be the same again. In death you do your grieving and get on with life. With this you go day to day, never knowing what's around the corner."

"Here's the way I dealt with it," says Mike. "I kind of thought the Meg I knew had died in the accident, and here's this new person whom I love in a different way."

The long outings continued through the summer and fall. On windy days Judi or Mike would sometimes have to hold a hand over Meg's tracheotomy tube to keep billows of dust from blowing in. Day by day she seemed the same. Measured over months there was minute improvment. She would more often follow motion with her eyes, make slight sounds and swallow food. Her physiatrist (a specialist in physical therapy) disapproved when the Tippetts fed her baby food. He thought she might choke. So they sneaked it into the RIC and gave some to her when staff members weren't around. "We knew she wouldn't make any progress without stimulus," says Judi. "If she was going to die, I wanted her to die trying, not just lying there." Eventually, the feeding tube and the breathing tube were withdrawn, and she survived.

Her doctors and the insurance company concurred that the aggressive therapy program at the RIC had achieved as much as it could. In October Meg was transferred for three months to a nursing home in La Grange. "We were more than pleased with everything they did there, just as we had been at the RIC," says Mike. "Of course, they all told us there are limits to what therapy can do." That remained the big problem, because Mike and Judi found it hard to adjust to limits.

The Tippetts usually brought Meg to their apartment on weekends and holidays. On Christmas morning 1985 an unexpected breakthrough occurred. As the family sat around the tree unwrapping presents, Judi opened a box from friends in Cleveland and held up a pair of frilly, silk underpants--not the sort of garment one would associate with her. Mike, Judi, and their two younger daughters laughed at the joke. And then Meg laughed--a long, loud, joyous laugh--the first sign of sustained emotion since the injury. They started in disbelief for a moment, then hugged her and alternately laughed and cried themselves. Meg's doctor said it was probably just a reflex reaction triggered by others' laughter; it did not mean she grasped the incongruity of the lace panties.

But in the days that followed Meg smiled and laughed in clearly appropriate situations. On one occasion Judi absentmindedly said, "Meg, you farted!" using the word that had always been considered out of bounds in the Tippett home. Meg broke into paroxysms of laughter. On another occasion while watching an old Abbott and Costello film on television, she laughed again. No one else was in the room at the time, and there was no laugh track on the program. When Mike counted from one to ten and deliberately skipped a number or appeared to get confused, Meg soon began to smile or laugh. The Tippetts came to believe that deep in her brain some kind of repair work was going on.

That belief was bolstered when Mike held a card in front of Meg with the word "fart" printed on it. She laughed aloud. Oh my God! he thought, she can read! And she continued to differentiate between written words, although progress remained exceedingly slow.

In February 1986 Meg came to live in the Tippetts' apartment in the ICA building. With the aid of her doctor, a vigorous program of home therapy was worked out. Thanks to her continuing insurance coverage, round-the-clock nursing care was provided. Meanwhile, the Tippetts worked out an arrangement with their employers whereby Judi could continue as a full-time ICA consultant and Mike would remain flexible so he could oversee Meg's reconstruction program.

The conventional wisdom said this was all a waste of time. Why not place the poor woman in a quiet facility where she could be comfortable? Some friends candidly told the Tippetts they were sorry Meg had not died in the accident. And a few suggested that the Tippetts had become unhealthily obsessed with the their daughter.

Others were moved by their single-mindedness. "They're amazing," says Mary Jane Hotaling, who, like many Cleveland friends, comes regularly to Chicago to see Meg and her parents. "They're the kind of people who have no choice but to push hard!"

"No doctor ever told us it was hopeless," declares Judi, " and no one could because nobody knows that much about the human brain."

Throughout 1986 Meg made slight gains. If a pencil were put in her hand, she would try to move it toward a piece of paper to make a mark. When given a brush, she would raise it as high as possible, then move her head down to bring it in contact with the brush. She could indicate by sounds when she needed to go to the bathroom. She obviously recognized people and enjoyed being in the midst of activity.

In 1986 the Tippetts met Dr. Jean Houston, director of the Foundation for Mind Research in Pomona, New York, and an advocate of strong stimulation as a treatment for brain injury. She referred the Tippetts to Glenn Doman and his Institutes for the Achievement of Human Potential. Along with Dr. Carl Delacato, Doman had pioneered methods of teaching reading to learning-disabled children--methods that are now widely used in school districts throughout the country. Less well known was Doman's work with more profound brain problems such as cerebral palsy, epilepsy, autism, and serious trauma. In all these situations, Doman's fundamental conviction was the same: barriers that halt or impede the development of the brain can be covercome by increasing the frequency, intensity, and duration of stimuli through the central nervous system; and since the body is a unit, an improving brain results in an improving overall body.

To be sure, these assumptions are not universally shared by neurologists and rehabilitative specialists. However, a two-year study back in the 60s of 76 children who participated in the Institutes' program indicated "encouraging results," according to the Journal of the American Medical Association. Within a period of about one year the average child in the study had almost doubled his neurological age--which meant, for example, that reactions and mobility had progressed from the level, say, of a two-year-old to that of a four-year-old. Some of these children had shown no advancement for years before entering the program. The basic techniques included patterning, masking, and sight and sound stimulation.

In May 1987 Judi and Mike took Meg to Philadelphia for a two-day evaluation at Doman's institution. While it was clear that she had made unexpected progress over the years, the staff there believed more could be achieved. They recommended an exhaustive--and exhausting--program of patterning and other exercises supplemented by vitamins and changes in nutrition. On their return to Chicago the Tippetts began preparing themselves and Meg for the activities that now consume so much of her and her father's days. It was only last November that Meg was put on the full, rigorous, daily schedule.

At that time a column about Meg by Bob Koehler in the Uptown News (including the Tippetts' phone number, 769-6363) inspired some people from the community to volunteer an hour a week to assist the patterning program. One of these, Lois Klages, a retired property manager, says she responded because she had done some patterning work with a handicapped child 15 years ago. "I know what parents go through," she says, "and I know it requires a lot of work."

Other volunteers include ICA associates and their families and at least one friend from Meg's past. Jeannie Affelder, who went to junior high and high school with Meg in Shaker Heights, comes for an hour of patterning every Friday afternoon. Now a Chicago actress, Affelder heard of Meg's accident from a mutual friend. "I do it," she says, "because I think it improves the quality of Meg's life and it helps Mike and Judi. They just won't believe there's such a thing as false hope. Besides, it's only one hour. How many hours a week can you say you did something like that--something that made even a little difference?"

She is convinced that Meg remembers her and many of the old classmates she talks to Meg about. When she first saw Meg in the wheelchair she felt deep sadness; but now, she says, "I see real improvement--nothing tremendous but she's more aware, she moves better. All I know is that somewhere in there is a person who is trying to get out."

In early March, Meg and her parents returned to Philadelphia to check on her progress. The came home encouraged. Since the intensive program began, they were told, Meg's neurological age, as measured by Doman's complex developmental profile, had risen from 7 months to more than 15 months. Her motor reflexes, in other words, are more like those of a 15-month-old baby than a 7-month-old infant. Meg's patterning and masking routines were then intensified to their present levels, and other more challenging "reading" activities were introduced into her schedule.

Mike and Judi, of course, do not know how long they can continue this level of devotion to a cause. They don't have money, and Meg's insurance converage, which has been outstanding thus far, is reaching its limits. Soon the nurses will have to be laid off. "We'll wait and see," says Judi in a confident tone. "We won't give up trying."

At the conclusion of a patterning session, Meg is lying on her stomach on the workout table. Then slowly her head rises, her left arm bends, and she begins pushing down against the table with all her might. She wants to turn over and her body is trying to respond. "You can do it," say the patterners. "Come on, Meg, do it!"

Meg bellows ("like an elephant in labor," says her father) and her face is contorted with effort. For a suspenseful 30 seconds it seems that she might succeed but she can't quite make it and she flops down on the table panting. "Great job!" says her father. "Next time for sure."

Art accompanying story in printed newspaper (not available in this archive): photos/Jon Randolph.

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