CHICAGO -- Mailo Chavez is on edge these days. When he goes out, he doesn't tell people where he's going. At restaurants, he sits with his back to the wall. He doesn't stay in one spot for long.
He used to spend his days installing fences and his nights partying. Now he exercises every day to coax more strength out of his numb left leg. At night, his mind races so fiercely that he can't sleep more than three hours.
He is easily distracted. His balky leg doesn't allow him to drive. He lacks the coordination and balance to resume construction work. He is 26, but in the morning his muscles feel as stiff as an old man's.
But he can walk and even jog a bit. He can go up and down stairs. He lifts weights in his man-cave bedroom. Which makes him a brain injury rehabilitation success story.
Nearly three years ago, Chavez, who lives with his parents and sisters in Berwyn, Ill., survived a gunshot wound in the head, then began his journey toward recovery at the Rehabilitation Institute of Chicago.
In a Houston hospital, U.S. Rep. Gabrielle Giffords is traveling a similar path. Her progress is being watched for answers to the question that has been asked since she was shot by a would-be assassin Jan. 8 in Tucson: Can she come back?
In the world of brain injury, it is everyone's question. Rehab is where they get their answers.
In the early morning hours of Oct. 5, 2008, Chavez and two friends were standing on a Greektown corner trying to hail a taxi. Two men in a red Dodge Charger stopped at a light, Chavez's friends told police, and tried to engage them in gang talk. They told the men they had nothing to do with gangs, according to the police report. As the car drove off, the passenger leaned out his window and fired a single shot from a handgun, hitting Chavez in the head. No arrests have been made.
Chavez remembers none of it. He remembers waking up in Stroger Hospital with a headache so agonizing that no drug could break its hold. He remembers his body feeling so heavy it was like someone was lying on top of him. He remembers trying -- and failing -- to wiggle his toes.
The bullet had left bleeding in both the left and right occipital lobes, the part of the brain at the back of the head involved in vision. And there were bone fragments in the right parietal lobe, which processes nerve impulses related to the senses of touch, pain, pressure and temperature.
But the effects of gunshot wounds in the head often extend beyond the functions handled by the part of the brain that is physically damaged.
"It's not an injury to one area," said Dr. James Sliwa, the institute's chief medical officer. Bullets that travel through one part of the brain send fragments of metal and bone into others, affecting all manner of physical and mental abilities.
The brain is so complex that the damage from an injury is unpredictable, said Eric Larson, a neuropsychologist at the institute who worked with Chavez. Sometimes the loss of a single connection wreaks havoc. Other times different parts of the brain take up the slack left by the damaged section.
Chavez's gunshot wound left him so weak on the left side of his body that at first he could barely move. He also had problems with memory and other cognitive functions. His eyes were crossed, which worsened his headaches. At his stepfather's suggestion, he began wearing an eye patch, which helped.
Ten days after the shooting, he left Stroger for the institute and began the work of rehab. It was a full-time job. He was up every day at 7 a.m. He had physical therapy, occupational therapy, lunch, then more therapy.
"It was very hard," he said. "I had no upper body muscles. I was a lazy guy."
Asked to set goals for his rehab, Chavez had kept it simple: He wanted to dress, shower and otherwise be able to take care of himself. But with half his body barely mobile, even those basic tasks seemed impossible.
When he was learning how to move from his wheelchair onto the toilet, he feared falling. Carolyn Williams, his patient care technician, was unfazed. "I'm not a big fan of diapers," she told him before showing him how to pivot between the wheelchair and the toilet seat.
Williams became his drill sergeant, coach and cheerleader. "If you want to be a little kid and stay where you are, then stay where you are," she told him. "But if you want to work, I'll help you."
"She gave me little pep talks," he said. "She said, 'Don't be a lazy ass.' ... She really saved my life."
He had another motivation: "No girl is going to marry a fat dude in an eye patch," he said. Even so, when his legs flopped the first time he tried to walk with crutches, he felt like giving up. He swore to himself, and got into bed.
Then he saw another patient walking painstakingly down the hallway. "I said, 'You know what, Mailo? If that kid can do it, you can, too.' "
A few days later his sisters watched as he hauled himself forward, stiff-legged, with a walker. They called their mother to report that Chavez was "doing the Herman Munster walk."
After four weeks at the institute, he was sent home. He barely recognized it.
"It did not feel like my home," he said. And when he slowly made his way down the stairs to his garden-level bedroom, he flew into a rage. His sisters had rearranged the furniture to accommodate a wheelchair.
"They were treating me like a cripple," he said. He made them move the furniture back.
Three mornings a week, his stepfather drove him to the institute's Day Rehabilitation Center in Willowbrook for continuing therapy. Within days he was using a walker instead of a wheelchair. He worked to improve his balance and endurance.
And then he was ready to focus on his cognitive deficits. Memory, concentration, problem-solving, reading comprehension -- they had all been compromised. At Willowbrook, a speech language pathologist taught him memory strategies -- word associations, drawing pictures, making written notes.
He did problem-solving worksheets that posited situations like a fire alarm going off, and asked what he would do. His therapist would give him three words or tasks to be repeated or done at the end of the session, then pepper him with distracting questions. What had he done that day? What had he eaten the day before? What had he worn?
Determined to "graduate," he focused hard, and by the end of his stint he could recall the words or tasks with 80 percent accuracy.
"He did really well," said Dr. Stacy McCarty, attending physician at the Day Rehabilitation Center. The only area where he didn't meet his goals, though he improved, was "divided attention" -- the crucial ability to, say, drive a car and also notice something on the side of the road.
After two months, he graduated to outpatient physical therapy. After that, his official rehab was over.
But in a way, one of the hardest parts had begun.
The intense demands and visible progress of inpatient rehabilitation can be highly rewarding, Larson said. "Some people really like having the work to do," he said. "They like the fact that they're better and that they know if they really put enough energy into their therapy that it's going to make a difference."
At the end of rehab, brain injury patients are a good way toward the answer to their initial question: Will they ever return to the way they were? Buy they do not always get the answer they want.
"People get better, but it's never the way it was," Sliwa said.
There are patients who return to work, McCarty said, even to demanding jobs as lawyers or scientists.
"But not everyone succeeds," she said. "With a brain injury, your endurance is not the same -- not just physical endurance, but mental. These patients will go to work for four hours and be exhausted."
"Their ultimate outcome is not just a function of what their CT scan looks like or what their memory scan looks like," Larson said, but of factors like family support, job flexibility and the ability to work around limitations.
Chavez lists the ways he has changed: His inability so far to work, leaving him dependent on his parents; his fears of being attacked again; his sleeplessness; the way his longtime penchant for organization has intensified into a near-obsessive need for precision.
"It took so much out of me -- emotionally, physically, spiritually," Chavez said. "It changed everything."
But it also made him determined not to waste time. "I am going to live life to the fullest," he said. "Life is short. In a minute, it can be gone."
Chavez finds himself thinking back to the night he was shot, replaying everything.
"All that hits you in the middle of the night," he said. "Why was I there? Should I have waited five more minutes before I went out that door?"
He thinks Gabrielle Giffords will end up with the same late-night questions about what happened and why.
"She can go through all the therapy she wants," he said, "but the real therapy doesn't start till you're alone."
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