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
Sunday, March 30, 2008
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
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
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
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
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
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
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