Supporting Robert Maull's Recovery

Our son, Robert Maull, was the victim of a brutal assault on February 28, 2008 in Cusco, Peru. Robert remained in a coma for the first six days. He is now able to talk and has all physical movement, but remains sedated in the ICU unit for his own protection, because his brain function is still very confused and he doesn't know where he is or why he needs to remain in the ICU and in bed. Robert suffered severe head injuries including two skull fractures, two brain contusions, a subdural hematoma, brain edema, and defuse brain lesions.

Robert's medical expenses alone (not including legal bills and his father's travel expenses) have already reached $15,000 (as of March 12th) and are continuing at a rate of about $350 - $500 per day. We do not know how much longer Robert will need to remain in the ICU or the hospital, but it could be several months.

We have set up this website for Robert's family and friends who would like to contribute a Medical Fund for Robert's care, follow Robert's progress and enjoy Robert's art. We sincerely appreciate all the concern, support, prayers and strong intention for Robert's recovery expressed by so many of you already.

If you would like to donate to Robert's Medical Fund, you can use the Chip-In feature at right which involves a PayPal transaction. This will not be a tax deductible donation.

If you would like to make a tax deductible donation, please email me at: fleetmaull@comcast.net and I will send you the information on how to make a donation to a Community Foundation that will accept donations on Robert's behalf.

With love and appreciation,
Fleet Maull and Lola Solis de Maull (Robert's Parents)

Sunday, August 3, 2008

Update on Robert's recovery

Hi Everyone,
I apologize for being silent for so long. No news has been good news. Robert returned to Boulder from Montana in June and returned to work several weeks ago, working in a restaurant where he worked previously for many years. He's headed back up to Montana today for a visit and to explore a possible job there. It appears that Robert's recovery from the head injury is 100% at this point, so we are extremely grateful and feel incredibly fortunate. I can't even begin to express how much we appreciate the kind support and generosity we received from all of you. I feel like I will be able to rest in a profound state of gratitude (hopefully) for the rest of my life. We have finally paid all of Robert's outstanding medical bills, and I'm starting to get the credit cards paid down. We could not have done it without such wonderful and loving generosity from all of you.

Many of you have asked if Robert has continued his drawing. He has done a little, but hasn't really jumped back into it yet as far as I can tell. At any rate, I am looking forward to seeing his next drawings when they emerge.
Love and blessings to you all,
Fleet

Sunday, May 11, 2008

Robert Improving in Montana

Dear Friends,
I apologize for taking so long to update you all on Robert's progress. I finally fell apart and came down sick with a bad cold/cough etc. I'm still trying to get over it.

Robert has been in Montana for over three weeks now. The first week was quite rough with Robert not wanting to be there at all. The second week was a little easier, but still very challenging. Just about a week ago things began to shift for Robert. He had refused to go to therapy the week prior but has now asked to schedule therapy appointments every day. He has also joined a health club where he is doing yoga and pilates. There are certainly still challenges, but Robert is improving steadily. This is obviously a great relief.

So Robert is seeing a speech therapist, occupational therapist, physical therapist and psychotherapist weekly. Actually he sees the speech and occupational therapists two to three times a week. All this if of course costly, but nothing like what inpatient hospital care was costing.

I am hopeful that Robert will be okay with staying at the ashram and doing his therapies in Bozeman for as long as needed. He still verbalizes a very strong desire to get back to his projects in Peru ASAP though. We are just taking it day by day.

Lola and I want to express our most profound appreciation and thanks to all of you. Your love, concern and support have made a huge difference and allowed us to provide Robert with the care and support he needs.

I need to do a new accounting, but Robert's overall expenses have reached somewhere between $60,000 and $70,000 and we have raised approximately $30,000 through your wonderful generosity. Robert's current expenses are running about $3000 a month, which is much better than $3000 a day.

Please keep Robert in your prayers and meditation practice.

Love and blessings,
Fleet and Lola

Tuesday, April 22, 2008

Robert's in Montana!

Robert and I arrived at our friend Purna's ashram outside of Bozeman, Montana yesterday. Transitions are somewhat difficult for Robert so the first evening was a little difficult with Robert uncertain about wanting to be there, but today Robert seemed to relax more about being there. Robert has friends there and everyone loves him and wants to support his recovery. Robert went to his first session with the speech/cognitive therapist there this morning. Her name is Cathy Fisher and I like her a lot. Robert said it was tolerable, which is saying a lot for him at this point. We said goodbye this afternoon at the Bozeman airport, as Robert and one of the members of the community there dropped me off for my flight back to Denver. I'm going to miss being with Robert, but I think the ashram is going to be an ideal place for Robert to continue his recovery for now. Robert was on the phone with his mom, Lola, today and she was very relieved to know Robert had arrived safely at the ashram and was settling in there. Robert got a drawing table set up in his room there today, so he can begin working on his art. Robert still has challenges, but he seems to be getting a little better each day. Please keep Robert in your thoughts, prayers and practice in support of his full recovery.
So many thanks and blessings from Lola, Robert and me,
Fleet

Friday, April 18, 2008

Robert's Progress in Boulder

It's been a tough week in Boulder. The minute we arrived on the 4th floor of the Boulder County Hospital where the inpatient unit of the Mapleton Center rehab program is located, Robert decided he did not want to be there and a pitched battle ensued for about six hours until Robert finally feel asleep exhausted and I crawled home to do the same. It was equally rough on Tuesday evening, resulting in a psychologist placing a 72 hour legal hold on Robert. Robert settled down on Wednesday participating in his rehab but didn't sleep well Wednesday evening and Thursday was again a difficult day with Robert refusing to take the antibiotics he needs for his pneumonia. All week it has been so painful to see Robert struggling like this. I just can't imagine waking up from a coma with a brain that isn't working completely having no idea why he was in a hospital or even where he was, much less why he was being kept locked up and being given all these intense drugs and now he's in another hospital with people telling him he can't leave when he thinks he's fine. My heart just breaks every moment.

Then on top of that he had a positive skin test for TB. I was just beside myself last night when I received that news after hardly sleeping all week. I had spent the entire afternoon unsuccessfully trying to convince Robert to take the antibiotic for his pneumonia and now I needed to convince Robert to move to a respiratory isolation room while they did more tests. He didn't even believe he had pneumonia and insisted he was completely healthy, demanding to leave the hospital. We did not want to sedate him again, as that is very counterproductive to his recovery from the brain injury and traumatizing as well; and I couldn't imagine letting him walk in his condition with pneumonia and possibly TB to boot. Some how though, much to my surprise and great relief, one of the doctors and I finally got through to Robert last night and he took his antibiotics and was willing to move to respiratory isolation while they ran more tests. I left the hospital again exhausted and sleep deprived at about 2 am when Robert finally fell asleep in his new room.

Today, Robert was much improved and more relaxed. It seems he is improving daily, which may have as much to do with getting all the intense drugs out of his system as it does recovering from his brain injury. Fortunately the second round of TB tests came back negative tonight and Robert was released from respiratory isolation. The plan has been for Robert to go on Monday, if he had made enough progress, to live in Bozeman, MT at the Sat Loka ashram with our friend Purna Steinitz and the community members there ... an ideal place for Robert's continued recovery. The TB scare almost put this on hold for quite some time. We are back on track though, and I am actually taking Robert out of the hospital tomorrow morning. Robert will stay with me in a hotel or with friends here in Boulder the next two nights before leaving for Montana with me on Monday.

I have been very disappointed in the Mapleton Rehab program. Other than the fact that I agree with their approach of getting him off all the drugs the doctors were giving him in Peru to control his behavior, I don't see that they have done much for him here at all. I liked the doctor, but she sees him 10 minutes a day. Some of the nursing staff on the unit appeared to have some experience working with brain injury patients, but most were completely inexperienced. He was getting about three hours of mediocre quality physical, speech, and occupational therapy a day and just left to hang out in his room the rest of the day. This was certainly not worth $1,400 a day (the discounted price I got by paying cash in advance -- normally $2000 a day). And that doesn't include the doctor's fees that we'll be billed for later. I would have been just as well off to rent a hotel suite and take care of Robert myself. Live and learn.

I think we will have a much better set of rehab services set up for Robert in Bozeman, from talking to the professionals we have lined up there. At the very least, he will be living in a very positive and nurturing environment with great people who care about him. Anyway, I am very eager to get Robert out of the hospital tomorrow and put that part of the medical system behind us.

In terms of Robert's current progress, using the Rancho Los Amigos scale of cognitive functionality, Robert shifts from level IV to level VII depending on whether he is rested and relaxed or tired and agitated. Level I is the lowest level of functionality and Level X is normal. Robert may even be at Level VIII at times. The main thing he is lacking is awareness or insight into his own condition, which is very common with head injuries. This however makes treatment and rehab a challenge as you find yourself constantly negotiating with a person who doesn't think they need any treatment or rehab. Robert does have glimpse of insight into his condition though and the doctor's feel this will continually grow over time, until he fully realized his condition and can willingly participate in completing the work of his rehab and recovery.

I'll write another post once we get Robert settled in at the ashram outside of Bozeman on Monday and I return to Boulder on Tuesday.

Lola and I want to continue to express our most profound appreciation to all of you who have supported Robert and us with so much kindness and generosity.

Love and blessings,
Fleet and Lola

Monday, April 14, 2008

Robert's Expenses & Fundraising Update

As of today, Robert's overall expenses with the travel and everything have reached approximately $50,000. The amazing kindness and generosity from so many wonderful friends, family and sangha has raised approximately $22,500 for Robert's medical fund. I have put the remaining $27,500 on credit cards. At the BCH Mapleton Center Robert expenses will run somewhere between $2000 and $2500 a day. We are not sure how long Robert will be on inpatient status, but I can't imagine it will be less than 10 days. Now that Robert is here in the states, we will put in his applications for SSI and Medicaid, but these will be very difficult to get, if possible at all. We are moving forward with getting Robert the care he needs though, trusting that somehow this will all work out. Lola and I cannot begin to appropriately thank all of you or find the words to express the profound gratitude we feel for all the love and support coming our way from so many wonderful people. Thank you, thank you, thank you and many, many blessings,
Fleet, Lola and Robert

Robert is back in Boulder!

Robert and I safely arrived back in Boulder today after a fairly harrowing journey. We were accompanied by a wonderful Paramedic based in Houston named Joe Barnes. I am so glad I decided to bring Joe along. He was indispensable and accompanied us all the way to the the hospital in Boulder before returning to Houston. Robert was admitted today into the Mapleton Center inpatient rehab program at the Boulder Community Hospital (BCH) on Broadway and Balsam. They recently moved the inpatient rehab program from the Mapleton Center at 4th and Mapleton to the main hospital on Broadway. It was a difficult trip with Robert on drugs that both sedated him and left him very agitated and jumpy and even hallucinating at times. I'm not sure how the clinic in Lima felt this was the best combination of drugs.

It was quite an adventure getting through the very complicated and crowded airline check-in, airport tax payment, and immigration processes at the Lima airport. Having Robert in a wheelchair helped a lot, although it was quite a task to keep him in the wheelchair and not over stimulated as we went through all this. The six hour 15 minute flight, 12 midnight to 6:15 am was very difficult. The plane was packed. Robert, who's a big guy, couldn't get comfortable enough to sleep even though he was tired and sedated, so this left him agitated and wanting to get up all night. Suffice it to say I didn't sleep. We couldn't get Robert to take any more medication until shortly before arriving in Houston. Getting through immigration and customs in Houston was another adventure, somewhat facilitated by wheelchair transport.

Robert was calmer and slept most of the 2 hour flight from Houston to Denver. He seemed even more relaxed on the drive to Boulder from the Denver airport. Nonetheless, upon arriving at the 4th floor rehab center at BCH, Robert decided he didn't want to be there and fairly loud pitched battle of wills ensued for 5 hours with Robert, I and the hospital staff all involved until Robert finally fell asleep around 4 pm. Having not slept in over 30 hours, it took everything I had to hang in there with it. Robert was calmer tonight after sleeping a couple of hours, but still not happy about being in the hospital.

I am very relieved though to have Robert at a facility where I know they will get him on the right program for his recovery and rehab. At the Mapleton Rehab Center they are committed to getting him off all the powerful sedative and psychoative drugs they had Robert on in Peru and supporting his recovery through effective rehab. At this point, we don't know how much of Robert's challenging behavior is related to his brain injury and how much is the result of the powerful drugs they have had him on in Peru. Robert's doctor at BCH is Dr. Julie Stapleton. She has headed up the rehab program their for over 20 years and has really good reputation nationally. I met her for the first time today and felt very comfortable with her.
Many thanks again from Lola, Robert and I to all of your for your amazing support, kindness and love,
Fleet

Thursday, April 10, 2008

Latest on Robert

This has been a tough week for Robert. He doesn't want to take the medications they are giving him at the clinic in Lima. He feels they are making him sick and he's probably right. Evidently they forcibly medicated him on Tuesday, holding him down for an injection. I can only imagine how violated and traumatized he feels by all of this on top of everything else. They are treating him with tranquilizers, anti-psychotic drugs, etc. down there because they don't know another way to work with him. He doesn't understand why he needs any meds. I'm not sure how much insight he has into his situation and brain injury challenges and related behaviors. The good news is that he has been clearer on the phone every time I have spoken with him this week. I encouraged him to try to accept the situations as best he can for the next few days until I can get him out of there. He was more relaxed today. I am flying to Peru on Saturday and will hopefully return with Robert on Monday morning to Boulder, Colorado, where Robert will enter the Mapleton Rehabilitation Center, an excellent facility for brain injury treatment and rehab. Please keep us in your practice and prayers for a successful and safe journey.
Blessings,
Fleet

Sunday, April 6, 2008

Change of Plans

This past Friday, April 4th, the anniversary of my teacher, Trungpa Rinpoche's passing (parinirvana), I was preparing to leave for Peru the next day to bring Robert back here to Colorado to be evaluated at the Mapleton Rehabilitation Center in Boulder. I was and am feeling a great deal of urgency to get Robert back here, because in Lima they are trying to control his brain injury related behavioral issues with anti-psychotic drugs and other tranquilizers. This is contraindicated for Robert's recovery. He needs to be in a quality rehab program and not on these drugs.

I received a call from Peru that evening letting me know that Robert's doctors at the clinic in Lima had decided it was too risky for Robert to fly commercial back to the U.S. with me, given that he still has episodes of confusion and agitation, and that they would not authorize the trip. I spent the rest of the evening until about three am on the phone with doctors, air ambulance services, air paramedics, and so on trying to come up with a new plan. Air ambulance was quickly ruled out ($60,000 - $80,000). I did find an EMS organization in Houston, very experienced in international medical evacuation and travel, both air ambulance and commercial. I had it set up for the head of that organization, Joe Barnes, a very experienced Critical Care and Air Paramedic to fly down with me and bring Robert back. He was confident that we could do it, even without the doctors' authorization and without informing the airlines. Talking with friends and family here we all decided, I would try to have one more conversation with the doctor at the Mapleton Clinic here before deciding to go or not before leaving for the airport at 8:30 am in the morning.

I got up at 7:30 am with less than four hours sleep and started trying to reach the doctor at the Mapleton Rehab Center. Due to poorly conveyed messages by the staff there, the doctor never really got the reason for my call and didn't call back until 9:30 am. Confused and exhausted I decided to put the trip off a week. I had to postpone it an entire week, because unless I fly over a Saturday, the fare's triple. With the paramedic's fee and three airfares, the trip is going to cost approximately $6000. If I we don't travel over a Saturday, the cost would go up to $12,000.

I still don't know if I made the right decision. I spent a good part of Saturday beating myself up for not making the right decision and then finally fell into bed exhausted and slept 14 hours.

At any rate, we now have a new plan. I will fly down to Peru on Saturday, April 12th.
The paramedic, based in Houston, will join me on the Houston to Lima leg. The paramedic and I will then fly back with Robert, leaving Lima at 11:45 pm on Monday, April 14th and arrive in Denver at 9:07 am on Tuesday, April 15th. We will have a 6-hour flight from Lima to Houston and a 3-hour flight from Houston to Denver. Arriving in Denver, we will go directly to the Mapleton Rehab Center with Robert. Then the plan is still for Robert to go and live at the Trimurti community ashram with our friend, Purna, outside of Bozeman and continue his rehab program with outpatient services in Bozeman organized in collaboration with the Mapleton Rehab Center in Boulder.

I spoke with Robert by phone twice today. He was more clear than on any previous phone call. I'm pretty sure that if I'd gone, we could have successfully got him back this week, but so it goes. We'll get him back here next week.

Lola and I wish to continually express our profound appreciation to everyone--family, friends and sangha--who have been so kind, supportive and generous since this all began back on February 28th.
Love and blessings,
Fleet

Friday, April 4, 2008

Bringing Robert to Colorado

After a lot of confusion and anxiety, we finally have what looks like a good plan in place for Robert. I am flying to Peru again tomorrow (Saturday) and will return to Colorado with Robert on Tuesday if all goes well. Robert will go to the Mapleton Rehabilitation Center in Boulder, which is part of Boulder Community Hospital: http://www.bch.org/aboutbch/mapletoncenter.cfm. This is and excellent rehab facility for brain injury under the direction of a wonderful physician named Julie Stapleton, M.D. Robert will be at the Mapleton Rehab Center for 5 - 7 days for a complete evaluation and rehab program development. Then I will fly up to Bozeman, Montana with Robert where he will live at the Trimurti community headed by my very close friend, Purna Steinitz, who is also a very close friend of Robert's. The Trimurti community ashram is about 15 miles outside of Bozeman and will be an ideal living situation for Robert where he can return to the normal routines of life in a very nurturing and structured setting with wonderful people who all know and love him. I have discussed all this extensively with Robert's doctors in Peru and with Dr. Stapleton and other program directors at the Mapleton Center, and everyone agrees that this is an ideal living arrangement for Robert. Bozeman doesn't have a rehab center with all the services of the Mapleton Center here in Boulder, but there are individual practitioners in the area who provide the same services. With the assistance of the Mapleton Rehab Center here in Boulder, we will put together a team of practitioners that Robert will see in Bozeman on an outpatient basis.
We of course considered having Robert stay in Boulder and go to the Mapleton Center on an outpatient basis, but with our home organized around Denise's hospice care, we couldn't really bring Robert here and while we considered setting up an apartment for Robert in Boulder with dedicated caregivers, the ashram in Boulder will be a much better and safer living situation for him. Robert will also have dedicated companions at the ashram as needed as well as the loving attention of the whole community there. Robert will have his own room at the ashram and be able to work on his art and begin to take on some work responsibilities at the ashram as appropriate. The diet at the ashram is also very healthy, with wonderfully prepared organic food.

The week of evaluation at the Mapleton Rehabilitation Center will be very expensive, but we feel it is really important to get Robert fully evaluated and make sure we get the best resources in place for his recovery and rehabilitation. Once Robert is in Montana, he will apply for Medicaid there, but it may be difficult to get it as Robert is physically able to get around fine.

Robert's mom, Lola, is also very happy with this plan even though it means Robert will be far away. Lola, like all of us, just wants Robert to be in the best possible situation for his recovery. Lola and I cannot begin to express our profound gratitude to everyone who has been so kind and supportive, for everyone's generosity, and to our friend Purna and the Trimurti community for inviting Robert into their community and making this very generous commitment to Robert's recovery.
Love and blessings to everyone,
Fleet & Lola

Tuesday, April 1, 2008

Robert's Medical & Other Expenses as of 3/31/08

Robert’s Medical & Other Expenses
As of March 31, 2008

Robert is currently being treated at the Clinica Ricardo Palma in Lima, Peru:
http://www.crp.com.pe/

Cusco Medical Clinic Bill (2/28 to 3/26): $14,361

Pharmacy, Fees, & Other Medical Related Expenses: $2,371

Advance Deposit for Lima Medical Clinic (3/26 to …): $3,617

Robert’s Travel Expense, transfer to Lima Medical Clinic: $1,040
(accompanied by Lola, doctor and friend)


Living Expense for Robert’s mom to stay with him in Cusco & Lima: $1,500
(Lola usually lives in the Sacred Valley and
supports herself producing hand-made clothing
and specialty food items)

Fleet’s Travel Expenses for Peru Visit (2/30 to 3/13): $4,169
(includes airfare, hotel and meals)

Legal Expenses paid to date: $3,000
(lawyer’s fees to pursue criminal investigation)
___________

Total Out of Pocket Expenses to date: $30,058.00


Current daily expense at the clinic in Lima: approximately $500 per day or $3,500 per week.

Legal Expenses: We are committed to spending another $7000 in legal expenses. The only way to make a real criminal investigation happen in Peru is to hire a lawyer to push it and to pay for much of the investigation expense. The good news is that with the help of pressure from the U.S. Embassy and Senator Ken Salazar’s office a real investigation is happening and we expect there to be arrests soon. The police who were involved in the initial cover-up and who witnessed Robert being beaten without doing anything to stop it are also being investigated. We will of course consider a lawsuit against the owners of the discothèque whose employees assaulted Robert, but we have no idea of our chances of being successful or actually winning damages or any compensation through such a lawsuit in Peru.


Flying Robert up to Colorado as soon as possible: $2500
(I will need to fly down, stay over night, and accompany Robert on the flight back from Lima to Denver the next day)

Note: We need to get Robert to the best possible brain injury rehabilitation center as soon as possible to avoid as much as possible serious lasting side effects from his very severe brain injury and apparent permanent damage (scar tissue in the frontal lobes). These kinds of rehabilitation services are not available in Peru.

Robert’s Care, Treatment and Rehab, and Living Expenses in Colorado: We have no idea at this time. Robert will need to apply for SSI and Medicaid, but this is a very difficult process and there is no guarantee he will get it. In patient care at the Mapleton Rehab Center in Boulder or at the Craig Hospital in Denver (one of the best rehab centers for brain injury in the country) will be very expensive, but I don’t have the numbers yet. Outpatient therapy will be very expensive as well, and in this case, we will have to set up some kind of living situation for Robert with caregivers for an indeterminate period of time … months, a year. We have more questions than answers at this point. I will provide more information as soon as we have it.

Fundraising: So far through your wonderful generosity we have raised approximately $4,800 through the Chip-In feature on this blog along with a matching grant of $2,500. I know others have contributed through the Community Trust, but I don’t have those numbers yet. On behalf of Robert and ourselves, Lola and I want to thank all of you from the depths of our heart for your kindness and generosity. Please keep Robert in your prayers and meditations.

Love and blessings,
Fleet and Lola

Letter from Lola, Robert's Mom

Especially for those of you who can read Spanish, I am posting this beautiful letter I received from Robert's mom, Lola, this evening. I wanted to share the strength Lola's words have given me with all of you. I will attempt a rough translation below.

Querido Fleet. los medicos pueden decir mil cosas, no?, lo unico que te pido es qie no te preocupes, por lo menos trata de no preocuparte demasiado, tenemos que vivir el dia a dia con esto y se que es una prueba muy dificil, dolorosa, pero que tenemos que saberr sobrellevarla, a veces me siento como que estoy viviendo al filo de dos abismos y que cualquier rato puedo caer pero siento que algo mas fuerte que mis propias fuerzas, algo mas alla de esta realidad me soporta y alienta, y entonces se qie todo esta bien.............porque Robert va a volver a ser ese muchachio feliz que siempre es, ya lo veras, acuerdate tendremos d e nuevo su sonrisa y ya tenemos la dicha de tenerlo con nosotros verdad? confia piensa que es asi y lo lograremos, miralo lo mas que puedas en tu mente, sano fuerte lleno de animo, y lo lograremos porque el puede y nosotros tambien. Te amo Fleet y se que estas pasando momentos muy dolorosos con Denise pero
esa es la voluntad de Dios y solo nos queda resignarnos, ademas es solo que ella se adelanta al tomar el tren pronto o mas tarde nos tocara tambien partir............verdad?Cuidate y recibe mi cariño de siempre:Lola

Dear Fleet,
The doctors can say lots of things no? (referring to the negative prognosis we just received about Robert's brain injury and resulting side effects). The only thing I ask is that you don't worry, or at least try not worry too much. We have to live day to day with this. I know this is a very difficult and painful test/challenge, but we have to find a way to get through it. Sometimes I feel like I am living on the edge of two abysses and that I could fall at any moment, but then I feel that something more powerful than my own strength, something beyond this world, is supporting and encouraging me, and then I know everything will be all right. Because Robert will once again be the happy young man he has always been. You'll see ... remember that we again have his smile, and we have him with us, right? Trust and believe this to be true, and it will. Visualize or hold Robert, as much as you can, in your mind healed, strong and full of spirit and this will be achieved, because Robert can and we can too. I love you, Fleet. I know you are going through very painful times with Denise, but if this is the will of God, all we can do is surrender. And besides, Denise is just taking this train ahead of us that we will all be taking sooner or later, isn't that so? Take care of yourself. Warmest regards always, Lola

Sunday, March 30, 2008

Latest Update on Robert's Condition -- Lima

Robert transferred from Cusco to a hospital in Lima on Wednesday. He was able to fly commercial accompanied by a doctor, his mom, and a friend. He is now at the Clinica Ricardo Palma: http://www.crp.com.pe/ His mom Lola is staying there with him and his friends Surya (from Lima) and Hernan (from Cusco) are visiting daily.

I just had a phone consult tonight with the neurosurgeon there, Dr. Gallegos, who is Robert's primary physician and a neurologist friend here in Colorado, Dr. Paula Mendes. There is good news and bad. The good news is that Robert has been improving daily and the doctors feel he will be able to go home by this weekend. They have taken him off of all the heavy sedatives and other drugs they had him on in Cusco. He is now just taking a small dose of Tegretol, an anti-seizure drug that is also give for nerve calming or control of agitated behavior. Robert is tranquil with relatively normal cognition and speech much of the time, but he still has periods of agitation and confusion. When I speak with him on the phone, it is like speaking to someone you know well who wavers between fairly normal and as if slightly drunk. Nonetheless, there has been dramatic improvement over the past week.

The bad news is that the MRI and electroencephalogram show that Robert has some permanent brain damage in the frontal lobe, primarily the right front lobe, that is causing side effects now and could leave him with permanent challenges -- personality and behavioral issues. The doctors informed me that it is very important for Robert to receive the best therapy possible during the coming months, as his situation will likely be much more static after a year. They don't have the kind of cognitive rehab and therapy facilities or practitioners in Peru that Robert needs, so I am going to work to get him up here as soon as possible. I'm not sure where Robert will live yet or how we will pay for his treatment, but we will find a way.

Some of you may know that my life partner and sweetheart, Denise Thornton, has been dealing with a terminal cancer for almost three years. Denise is now on hospice care here at home. She is doing well and we are doing everything possible to support her and provide her the best possible quality of life. Denise, as many of you know, is a very amazing person and has been and continues to be a great inspiration to all of us. These are challenging times for our families to say the least. The love and support we have received from so many has made a world of difference in our lives and we can't begin to express how much we appreciate all of you.

Robert's mom, Lola, and I want to thank all of you from the bottom of our hearts for all your concern, support, prayers and practice for Robert. We also appreciate all the kind and generous donations to Robert's medical fund. I will be posting a financial report in the next few days here on Robert's blog.
Love and blessings,
Fleet

Saturday, March 22, 2008

New Update on Robert

Robert has improved a little but still faces many challenges and remains sedated much of the time in the medical clinic in Cusco, Peru. We are working to get Robert transferred to a medical clinic in Lima where they will be able to do a more sophisticated neurological evaluation and determine the next steps in Robert's care and rehabilitation. We are trying to determine if Robert will be able to fly accompanied on a commercial flight or whether he will need to go by medical air charter, which of course will be extremely expensive. Right now it looks like Robert will go to Lima on Wednesday.
A dear friend has just offered a challenge matching grant, and will match, dollar for dollar, the next $2500 dollars received through the online Chip-in donations. We have no idea how high Robert's medical bill will go, but it's still running around $500 per day. Robert, unfortunately has no medical insurance and no financial resources of his own. We are investigating getting Robert on some kind of medical plan in Lima that may provide a 25% discount in his medical bills at the medical facility in Lima, but we are not sure if he is eligible. We are also trying to get Robert enrolled in Medicaid, in case we are able to bring Robert to the U.S., but this is a very difficult process and we don't even know if Medicaid will cover the kind of rehabilitation services Robert will need. At any rate we are working on all fronts to get Robert the best care and figure out how to pay for it as the medical bills mount. Please keep Robert in your thoughts, prayers and meditations. We appreciate all of your concern and support so much.
Many thanks,
Fleet & Lola

Wednesday, March 19, 2008

Latest Update on Robert

Robert's latest CT-Scan showed that his brain injuries have largely healed, at least at the level of resolution of the scan. There are likely still diffuse lesions in the neural tissue of the brain which cannot be seen with the scan and which are still causing Robert problems. The clinic where Robert has been does not offer rehabilitative services and is asking us to transfer Robert to another facility, as they don't know how or are unwilling to manage the agitation that he sometimes experiences, a common effect of head injuries. Since there is no appropriate facility in Cusco for the next phase of Robert's healing, treatment and rehab, we will be transferring him to Lima as soon as possible. We have located a good private neurology clinic in Lima, and I will be talking to the neurosurgeon there tomorrow. We have a great doctor friend in Lima, Dr. Maria Isabel Manrique, who has been helping us all along ... truly an angel. Dr. Manrique will help us manage Robert's care in Lima and will arrange his transfer by air ambulance from Cusco to Lima. She is a surgeon who specializes in air evacuations from remote parts of Peru in addition to her surgical practice.
Another angel appeared here in Colorado yesterday. A doctor friend named Julie Goldstein, who is a graduate of the Being With Dying program at the Upaya Zen Center, is in Boulder visiting a friend. She called to get together for coffee, and when I told her about Robert, she told me her friend her is a really great neurologist. So I did a phone consult with Julie's friend, Dr. Paula Mendes and then arranged a phone consultation with her and Robert's doctors at the clinic in Lima. She is completely fluent in Spanish and was extremely helpful. I hope she can work with Robert if and when we bring Robert to Colorado.
Lola is holding up very well, but it has been really hard with the clinic insisting every day his week that we move Robert immediately and wanting to keep him sedated all the time. Hopefully, we will get Robert into a much better situation in Lima in the next few days or by Monday at the latest.
Lola and I want you all to know how much we appreciate all your concern, support, prayers and meditation practice.
Love and blessings,
Fleet

Letter from U.S. Ebassy and Senator Ken Salazar's Office

Mr. Maull,

I received a response from the U.S. Embassy today when I got in. Here is what they stated:

“Dear Lexie Herbert:

We are responding to your email of March 18 regarding the sad case of Mr. Robert Maull and his unfortunate assault and hospitalization in Cusco, Peru on February 28.

Our records indicate that at the time of the incident, Robert Maul was residing in Cusco with his Peruvian mother, who we understand continues to assist him. As soon as we were notified about his hospitalization, our Consular Agent in Cuzco visited Mr. Maull at the Clinica Pardo to provide information and guidance to the family. Our Regional Security Office also contacted the local police to obtain information on the incident.

It is our understanding that Mr. Maull has retained legal representation and plans to press charges once the culprits are identified. Our Chief of American Citizen Services here in Lima had already called the parties listed in your email to ensure that they were taking the appropriate steps to identify his assailants and file charges. In conversations with the police officials, she clearly expressed the U.S. government’s interest in this case.

We understand how difficult this incident is for Mr. Maull and his family. Please be assured that the Embassy is monitoring this case closely.

We hope this information is helpful.

Sincerely,

Consul General and Counselor for Consular Affairs
U.S. Embassy
Lima, Peru”


I hope this provides some reassurance that they are indeed looking into your case. If I can be of further assistance or answer any questions you may have, please let me know.

Thank you,

Lexie Herbert
Regional Representative/ North Central Region
U.S. Senator Ken Salazar
11 Old Town Square Ste 260
Fort Collins, CO 80524
(P) 970-224-2200
(F) 970-224-2205
Lexie_Herbert@salazar.senate.gov

Monday, March 17, 2008

Update on Robert's condition

Dear Friends and Family,
I spoke with Robert by phone yesterday. It was a bit difficult to understand him due to the phone connection and to his sedation, but he sounded better. He new I had been there with him and wanted to know when I would be back. I spoke with Lola today. She said that Robert is doing better each day, but that they are still keeping him very sedated. She also relayed that the medical clinic where Robert is now wants him transferred to another facility. I called one of the doctors at the clinic and he told me they feel Robert's injuries have healed but that he is still suffering from psychiatric/psychological problems not related to the injuries but possibly caused by Post Traumatic Stress Disorder. He also stated that they don't have the kind of room or staffing to handle a patient in Robert's condition. I asked him if they had done another CT-Scan since the last one on March 4th. They hadn't. I asked him how they knew Robert's brain injuries had healed without doing a CT-Scan. He didn't have a good answer, but agreed to have another CT-Scan done right away. My sense is they just want to get rid of someone they perceive as a difficult patient. I asked him when the last incident of agitated behavior had taken place. He thought it was Saturday. Lola tells me she feels Robert is more relaxed and understanding and accepting of his situation each day. The problem with transferring Robert is finding an appropriate facility. They are suggesting a mental institution in Cusco, which we hear is an awful place. There may be no appropriate facility in Cusco. We are looking into Lima, but I believe the answer is bringing Robert back to the U.S. as soon as possible. I am researching Medicaid and Victims of Crime Compensation programs trying to find a way to financially support Robert's care here in Colorado. The clinic wants to move Robert right away, so this is a very disturbing situation. The good news is that Robert is improving; at least, it appears that way to his mom, Lola. Please keep Robert in your thoughts, prayers and meditation practice. Robert's mom and I appreciate all of your concern and support more than you could imagine.
Very best,
Fleet Maull

Friday, March 14, 2008

Update from Fleet

Hi Everyone,
I just got back home this morning. I was not able to get reports out the last few days in Peru, just too much going on and too much to do. Robert is progressing steadily and when awake can talk very clearly and normally. His brain has not reorganized itself though and he does not realize where he is, wants to get up and leave, get's very agitated when restrained, and so on. His rational brain has not kicked in yet. He's just pure impulse and reaction, gentle and funny at times and agitated and agressive at other times. This is a common pattern with head injuries. The clinic had moved him to a private room with a round the clock private nurse on Sunday, but the nurses and we could not handle him in this state well enough to assure he wouldn't fall and injure himself, so we moved him back into the ICU unit on Tuesday. He is under what they call "intermediate" rather than intensive care, but in the ICU nonetheless and fairly heavily tranquilized and sedated to keep him from getting out of bed and falling. The last two days with Robert in this state of confusion and periodic agitation were really hard. Saying goodbye and leaving on Wednesday was even harder. I will be monitoring Robert's situation daily from here for now, until we figure out what the longer term path looks like, or even the mid-term path. I'm also pursuing the legal case against his attackers and their employer as well and keeping pressure on the local police through the State Department and U.S. Embassy in Lima.

Robert's mom, Lola, is doing a good job being there with Robert, and I probably won't go back down until it looks like he will know and remember that I'm there, unless some kind of emergency calls me down there. Right now I have to figure out how to pay for all this. I've already spent close to $25,000 on Robert's medical and legal situation along with my travel expenses. At the moment his care is costing somewhere around $350 and $500 a day, inexpensive by U.S. standards but $10,000 to $15,000 a month out of pocket for me nonetheless. I am exploring various kind of available aid and we are putting up a website to request donations from friends and family who would like to contribute to a medical care fund for Robert. I'll keep you all posted.

Lola, wants me to let you all know how profoundly she appreciates all of your love, concern and prayers for Robert and us at this time. She asked me again and again to be sure to let you all know how appreciative and touched she is by all your love and support. We both appreciate all of you so much. I have no doubt that Robert will be fine in time, we just have to hang in there with him and be patient.

Love to you all,

Fleet