By Marie-Anne Hogarth

Dennis Ryan emerged from his coma, a dazed hero returned from battle.

When nurse Robyn Hansen picked up the phone in the Rush-Copley Medical Center ICU, she was surprised to hear the voice of the North Central College swim coach who had spent six weeks in the coma after suffering a massive stroke.

"Hello, Robyn," he said. "This is Dennis."

"We cried," she said of the nurses. "Usually when people are that bad, they pass away or they go to somewhere where they never wake up."

Together with the doctors, nurses and therapists, Dennis' wife Vee Ryan and the rest of their family had helped battle the assault inside Dennis' brain, when his own body turned against him, when his skull held his swelling brain in a siege until it almost suffocated.

They had averted death, but for what kind of life?

Most of Dennis' right brain was decimated. He was like a victor with his homeland destroyed.

Would he be able to coach swimming again? Live in the log home he had built with his own hands? Would he need a wheelchair or a walker, or somebody to look after him?

Would he have the same personality? Be the same man?

Damaged brain

With half of Dennis' right brain so damaged, most of his left side was paralyzed.

The stroke impacted the ability to feel fine sensation and sense of spatial orientation. Dennis would forget where he had placed his arms and legs. He couldn't say if he had been poked with one or two fingers.

The coach could see out of his left eye, but his brain no longer told him to look at the left visual field. He ignored the left side of pages, didn't notice people on the left side of the room, forgot to turn his head in that direction.

Other functions — memory, reasoning and intelligence — were less damaged. They existed in duplicate form in the salvaged half of Dennis' brain, which also enabled him to control the right side of his body.

It was with this left brain hemisphere that the coach could still think, remember, feel emotions.

It was these surviving portions of the brain that could eventually take over the jobs of the parts that died.

It was in here where hope still existed.

Fighting fatigue

Vee Ryan took the helm of her husband's ship. But even as the couple began their journey, pain, fatigue and fear often threw them off course.

Sometimes it seemed a powerful undertow threatened to pull Dennis into lethargy. With one of his major arteries blocked, less oxygen reached the brain. It was as if he were a four-cylinder car operating on three cylinders. He needed to work harder to do the simplest things — chewing, speaking without sounding mechanical, holding up his weakened neck.

But Vee couldn't communicate that urgency to him.

The system demanded Dennis show progress before he could have more therapy. Rehab programs reserve their limited space for those who will most likely succeed. But often the coach stagnated — wanting to do nothing but lie in his bed and be cared for.

Vee needed to convince the professionals her husband could do more if only they pushed him harder.

Stormy seas

After two months of lobbying to have Dennis transferred from the DuPage Convalescent Center in Wheaton to Marianjoy Rehabilitation Hospital, Vee succeeded. There, she knew, her husband would receive more aggressive therapy.

Dr. Richard Krieger, in charge of Dennis' care at both facilities, agreed the change in environment might spur the coach. But two weeks later, Krieger discharged Dennis from Marianjoy because he felt the patient wasn't motivated.

"We tried. The family tried," said Krieger. "They used guilt, fear and love. They tried all of those things. But you can't make somebody do something."

Vee, exhausted from marathon days divided between work and hospital, became enraged upon hearing this news, insisting doctors were giving up on her husband.

"If he doesn't walk, I'd love to know it wasn't because of the insurance or money or because a doctor wrote him off," she said. "I can't think I'm so out of touch that I imagine Dennis improved."

But Krieger argued the decision was not about money. "If the Saudi king came here, ethically we would not take his money if he did not show improvement," the doctor said. "Dennis lost half his brain. Families forget that."

His intention, he added, was not to give up on the patient. "My last words to Dennis were that I hoped he would prove me wrong."

Finding motivation

Dennis' apathy remained a mystery.

The area damaged in his brain — the frontal lobe — prompts a person to initiate action. And many times the chemical imbalance after a brain injury causes depression.

But doctors don't know why some patients work through pain, fatigue and fear while others don't.

Dr. Ramsis Ghaly, the neurosurgeon who had operated on Dennis after his stroke, says the brain does not heal on the same clock as the health-care system. For that reason, patients often slip through the cracks navigating its maze. That's why he believes families become more important than hospital charts in passing on details about patient care — doubly true for those with massive brain injuries.

But Krieger lived in the more tedious world of rehabilitation, which sets standards so patients aren't warehoused endlessly. Dennis was an exceptional patient. But then again, he had already received more therapy than most.

Krieger recommended a nursing home or convalescent center. And while Vee insisted that would be short-changing Dennis, she wasn't ready to provide the 24-hour-nursing care he needed at home.

Streams of people visited, but only a few could be relied upon to help out.

It was the way of a death-obsessed society, said Krieger. People were often more willing to attend a funeral than do the hard work of rehabilitating a person.

Facing fear

The Ryans found safe harbor at Rush Copley Medical Center, where Dennis returned for another surgery. Ghaly would replace the skull piece he had removed from Dennis' head during the efforts to save the coach's life after the stroke.

The weary travelers had come a long way, Ghaly told them. Many never made it this far.

Still, the Ryans were terrified.

On the night before the surgery, two dozen people from the First Presbyterian Church in Rochelle packed into Dennis' room. Vee held tightly to her husband's fingers and wept while the visitors prayed for his recovery.

"You are the greatest of physicians, healer of all," one man called to God. "We pray that you will guide the hand of the doctor in surgery, that it be a successful operation."

As emotions in the room surged, Dennis told his supporters how he heard God's voice when he was in the coma.

"I will heal you," the voice had said. "But you and your wife must spread my word to the young people."

Working through pain Physical therapist Rious Manabat is a young athletic man with a smile that sets his patients at ease from the start.

But to Dennis, therapists were inflictors of pain. And pain had become Dennis' companion. His damaged brain no longer released the chemical necessary to keep his muscles from becoming stiff and spastic, so they hurt whenever moved or touched. Meanwhile Dennis' weakened joints barely supported his paralyzed limbs. His left arm and leg weighed so heavily that the arm eventually dislocated from its socket.

Drugs might have masked the pain and lulled him to sleep. But Dr. Dennis Keanne, the medical director of Copley's rehabilitation program, felt the patient would never get better if he slept through therapy.

The suffering made it hard for Dennis to recognize his therapist for the kind man he was.

"Please give me a break. Let me off easy," Dennis shouted, "I don't want to swear at you ..."

Fighting fatigue

Fatigue was like a whirlpool that swallows the sea and spits it up again.

When it wore on Dennis, even his wife couldn't skirt her husband's dark moods.

"You don't love me anymore," Dennis said one morning when Vee refused to let him take a nap before therapy at Copley. "You've given up on me because . . . you're going to leave me."

It wasn't true, but Vee was sucked in.

"I stood by you through not being able to have a baby, you going on vacation without me because you were with your kids," she reminded him. "So you think I will leave you now? I would never leave you."

Keanne had said Dennis' stroke meant he lacked even the awareness that he needed to improve. That made Vee's journey all the lonelier.

"I love you more than anything in the world, but I can't motivate you," she told her husband.

"You motivate me each time you see me," he replied. "Now I need a nap."

Under greater pressure

Through it all, Vee struggled to manage the couple's finances.

One morning, working to pay off a mountain of medical bills, Vee and her mother, Pat Hoffmann, worked the hospital phone lines, promising creditors minimum payments.

One call brought Vee to tears.

"It's OK," said Pat, watching her daughter collapse in a chair.

"It's not OK," said Vee, sobbing on her mother's shoulder.

The insurance company had approved as much as $1 million a year — an amount the Ryans had exhausted by December — and up to $5 million lifetime coverage.

But it wasn't enough.

Dennis' Social Security and disability payment totaled only a third of what he earned teaching at North Central College and running swim classes in the summers. Medical costs aside, the Ryans still owed $1,500 each month after they paid back their monthly construction loan and daily living costs.

Watching his wife cry, Dennis said, "Everything is going to be OK, Vee."

Carefully balancing herself so as not to unsettle the mattress where her husband lay, Vee climbed into bed next to him.

Dennis turned away.

Pushing for healing

The staff at Copley propelled the coach with small victories.

In speech therapy with Joan Blasingame, Dennis typed and sent an e-mail to Ghaly, a significant achievement since Dennis often ignored his entire left visual field.

In occupational therapy, Sherrie Giles told Dennis of their shared faith in God to encourage him to relearn activities like brushing his teeth.

And Manabat joked through the painful physical therapy session, so that Dennis called him "the best guy here."

Still, no one could unleash the motivation that would push Dennis forward.

Vee waged her own campaign.

She barbecued Dennis' favorite pork chops, tailgate-style on a grill in the back of her truck in the hospital parking lot. She drove an hour each way to Paw Paw to bring the coach's favorite dog to therapy.

And she prodded her husband to remember details about their past — that they liked to eat burgers by the river when they dated, that he nicknamed her Betty Boop, that it rained on their wedding day.

"Why did it rain," Vee asked.

"I don't know," Dennis answered.

"What time of year was it?" she hinted.

"December," he answered. "It was the 19th of December."

Dealing with depression

When Dennis wasn't motivated, Vee spiraled into her own darkness.

Maybe Dennis was apathetic because he knew his 33-year career as a coach was finished, she thought. Or maybe he'd be doing better if he hadn't been shuttled between hospitals and care centers.

Had she failed him?

As depression set in, Vee resurrected old doubts that she wasn't smart enough for Dennis' academic world.

"You do such a great job," Dennis comforted her.

"I don't," she told him.

"Yes, you do," he answered. You do such a great job taking care of me. Now cut my sandwich in quarters."

Helping him with these everyday tasks made her feel better — but she knew she shouldn't.

"Dr. Ghaly isn't going to be happy about me feeding you," she said. "That's why he doesn't want me around so much."

She blamed Dennis, too, for using his newfound faith as an escape.

"Dennis, what would make you good?" she asked.

"God would make me good," he answered.

"I'm asking you to try harder," said Vee.

Celebrating progress

When Dennis pulled himself to a standing position using the parallel bars one morning, it was as if they had touched the shore.

"Oh my God," said Vee. "I can't believe it."

"Rious pulled me up," said Dennis.

"No, it was you," said Vee. "You basically did it."

While the therapists were excited, they also were cautious. Dennis had never tried pulling himself up from between the parallel bars, only from either side. It was easier this way, they pointed out.

Vee knew Dennis wasn't taking steps on his own. One therapist supported Dennis from behind while another moved the coach's legs.

Still, she saw a glimmer of excitement in her husband that day and her imagination ran away.

If Dennis could stand in a pool, he could go to water therapy. And if anything, water therapy would flip the switch inside the swim coach's brain.

Fearing the future

When Dennis' discharge day arrived three weeks after he began the Copley program, Vee was disappointed.

Dr. Keanne didn't believe the coach's rate of progress was sufficient enough to warrant staying in the inpatient program. He said Dennis would benefit as much from receiving 15 hours of therapy a week by coming to the hospital during the day. Now that he could move to and from his wheelchair with the help of one person, he could travel by car. There also was home-based therapy.

Keanne said these options would be a good bridge into a self-sufficient life at home.

But despite meetings to prepare her for this day, Vee wasn't ready.

She would miss the attention Dennis received at the hospital. She hadn't finished making all of the necessary arrangements for his care at home. Her co-workers from Home Depot had built a ramp to their house, but she hadn't figured out who would care for her husband when she was at work.

Nurse case manager Jayne Wallers had written a letter to the Department of Rehabilitation Services, which could provide minimum-wage home-health workers who could visit the Ryans' home when Vee was working. But there were financial parameters. And it would be considered double-dipping to go to therapy at Copley and also have somebody come to the home.

Most of Dennis' relatives lived far away. And Vee's sister nearby was caring for her husband who suffered from kidney failure. Vee didn't call upon a church or community group to step in with volunteers. It wasn't realistic, said Vee's mother, to ask Dennis' swimmers to come out to the country and care for a sick man. And Vee wasn't prepared to move closer to the hospital and her work.

Selling their dream home — despite its $3,000-a-month construction loan — would destroy about any hope her husband might have left, Vee said.

At least temporarily, the Ryans decided, Dennis would go to Alden of Waterford, a nursing home.

Looking for meaning

Their journey never-ending, Vee kept hope alive with the smallest of signs. The white underbelly of a hawk flying over the pond outside Alden was enough to lift her spirits.

"Dennis, today is going to be a good day," Vee told her husband one morning. "Remember, this day is Oct. 19. You were born May 19. We were married Dec. 19. This is going to be another great 19th."

That day Dennis "walked" again, as he had at Copley before, with the help of physical therapists. Over the days that followed, the Ryans counted each step — as many as 85 in one session.

Vee hoped these victories meant Dennis was moving toward self-sufficiency. In the meantime, she enjoyed sitting outside with him at the pond while he practiced bird-calls."

"Hey guys," Dennis called out to the geese and mallards. "Go for a fly. Fly the coop."

Long way to go

Dennis' long-awaited homecoming finally arrived after three weeks at Alden — six months after the stroke.

Vee and her parents would take turns caring for Dennis, conserving precious insurance dollars.

As the Jeep pulled onto the farm road leading to his log home, Dennis was welcomed by a small group of relatives who had just finished sweeping up dead flies, the remains of a summer when chores mattered little.

"We'll have to have a barbecue to make you fat again," his nephew, Kenny Rygh, told him.

Pushing his son-in-law up the ramp, Don Hoffmann reminded the coach to look to his left. Precariously attached to the front-porch railing was a "welcome home" banner and a single helium-filled balloon, blowing with each gust of October wind.

"That's nice," said Dennis, his voice catching.

Inside the house, Vee stood close to her husband for a long time. She lifted up their cat and dangled it above his face so that he could touch its warm fur.

"My Pepper," Dennis stroked the cat, his pained words mixing with his tears as he talked. "Meow."

Feeling his wife's fingertips running through his hair, Dennis looked up at her red and weepy face.

"It's good to come home," he said. "But it's hard at the same time."

A matter of perspective

Much would happen in the months that followed.

Dennis was hospitalized again for common but potentially fatal complications: a blood clot in his leg, severe dehydration and other difficulties. He struggled with depression, also frequent in stroke patients.

Vee often grew discouraged, blaming her husband's setback on the diminished therapy hours at Copley. Dennis never gained enough strength to pull himself up on the parallel bars. Disappointed therapists said their work wasn't reinforced with exercises at home.

As the year anniversary of Dennis' stroke passed this week, he has made strides in reading, short-term memory and motivation. He is starting to move his paralyzed left leg consistently. Images of Dennis' brain also show blood flow returning to the damaged areas, a sign the neurosurgeon interprets as the beginning of long-term healing. And Dr. Ghaly talks of other options for the future — vocational therapy and hope in new technologies.

Dennis once said he did not want to live if he couldn't walk in the fields with his dogs. He still can't.

But in a therapy program closer to home he has a new goal: taking steps inside his house. He goes out to dinner with his wife, hosts a Bible study for those who prayed at the hospital when he was sick, and he saw friends married in his home a few days ago. Twice he has conquered a new enemy — fear of being trapped in his wheelchair and falling into water — to watch his swimmers compete.

At an invitational meet in December at Wheaton College, he hid in an office until Vee convinced him to come onto the pool deck.

As he was wheeled out, glimpses of the old Dennis Ryan shone through. He waved to the crowd and tearfully accepted a standing ovation from his team. A stopwatch in one hand, he kept track of split times for the swimmers, a habit so significant to him even the stroke could not steal it.

And when he wasn't looking, a favorite swimmer, Molly Foote, whispered in his ear.

"You are my motivation ...," she said. "Work hard for me."

"I will," he replied. "And you work hard for me."