It is day 976.

Paul Archer explains to his 33-year-old daughter that she has a brain injury and has been in the hospital for almost three years.

Mary stares at her father through the bottom half of her glasses. Her eyebrows furrow and she whimpers. She lifts her left arm, the only arm that works, and moves her shaking hand over a laminated piece of paper with the alphabet on it.

“I have not been here that long,” she spells out, pointing to each letter.

The hundreds of other times she was told this information, she spelled out “I have?” on the board.

“It’s okay, Mare, your memory isn’t quite what it used to be,” Paul explains, holding her hand. “But we remember for you.”

With short-term memory loss, Mary Archer lives perpetually in the present tense. She thinks a family dog that died last year is still alive. She feels like she just arrived at the hospital. She constantly wants to go to the bathroom because she forgets she went already.

Mary wasn’t born like this. She was a social worker and soon-to-be mom debating baby names with her boyfriend, Bob Crocker.

It was April 8, 2009 when everything changed following a surgery at St. Michael’s Hospital. The events surrounding that moment and the years afterward are reconstructed from recollections by her family members and, where possible, hospital records the family has obtained. The hospitals involved would not comment on the specifics of the case.

Her condition worsened, so she went to the emergency department of Toronto Western Hospital on April 1. Her parents thought the problem might be the shunt in her head. A shunt had been successfully inserted three years earlier when doctors diagnosed her with Chiari malformation, a structural defect in the lower rear of the skull that blocks the flow of cerebrospinal fluid.

She stayed at Western overnight and a CT scan showed the shunt was working.

Mary went home the next day but returned to Western by ambulance on April 4. She got worse by the hour and began to hallucinate visits from childhood friends. By Monday night another CT scan was arranged. This one, her parents say, showed a blocked shunt.

She was monitored in a critical-care unit overnight and the next day was transferred to St. Mike’s for surgery, since it had an obstetrics department to monitor the fetus during the operation.

On April 8, the surgery appeared a success. By evening, she was back in her room, talking and laughing with her parents, drinking grape juice through a straw. Finally, after a week of bedside vigils and trips to the ER, the worst seemed to be over. Her exhausted parents went home. So did Crocker.

A few hours later, Mary forgot she had a catheter and tried to walk to the bathroom. She fell and hit her head. Doctors did a CT scan and everything looked fine.

At their home in Scarborough, Heather MacDonald-Archer had a feeling something wasn’t right. Her husband, Paul, called the hospital and was told about Mary’s fall but was reassured that everything was fine. They went back to bed.

What happened is unclear, but contentious. The family says they have never been given the “full story.”

According to Mary’s clinical history on a hospital record, “Following the successful revision (surgery), she fell and had a cardiac arrest leading to anoxic brain injury.” The family says they were told that sometime after her fall, Mary had vomited and aspirated into her lungs and suffered complete respiratory arrest, that she was found on her side, her skin a deep purple hue.

At 1 a.m. the hospital called Crocker.

Minutes later, the hysterical boyfriend called the Archers.

In the ICU, Mary had tubes in her throat and was hooked up to a ventilator. She did not respond to a battery of tests. Her body twitched with each breath. A few days later, the family was told she had extensive brain damage and was unlikely to breathe on her own again. “She will be kept alive four more weeks to give baby chance to grow in womb,” Paul scrawled in his day planner on April 15.

Mary awoke from the coma after about five weeks, but nearly three years later there is no happy ending. That single event has changed the lives of Mary and her family forever. Her parents have been decimated by grief. Her twin brother, Alastair, is missing his champion. Her daughter, Isabella, delivered by C-section on June 25, has grown up in a world where her mother lives in hospital. And her boyfriend is a tired single parent, who visits the hospital every day.

A few friends still come to visit, but many have stopped. Mary doesn’t notice. She always feels like she just arrived in hospital. To her parents, it is a bittersweet benefit of the brain damage that has destroyed her life.

A St. Mike’s hospital record from May 2010 calls Mary’s history “long and unfortunate.”

Since the incident, “she has required significant care due to her overall limited neurological function,” her clinical history states.

Anoxic brain damage occurs when the brain is deprived of oxygen. The parts of the brain furthest from the three main arteries are most vulnerable to damage, says Dr. Mark Bayley, director of the Neuro Rehabilitation Program at Toronto Rehab.

The prefrontal cortex, important for planning movements, the temporal lobe, important for storing memory, and the basal ganglia and cerebellum, both key in co-ordination and balance, are some of the areas typically affected, he explains. At a microscopic level cells are stunned and, in some cases, die.

Mary’s anoxic brain damage affects her motor skills, short-term memory, vision, speech, problem-solving skills and balance.

Every day, the Archers drive in from Scarborough to visit their daughter, parking in a by-the-hour lot on Queen St. E.

Heather MacDonald-Archer, 59, styles her hair in a short blond bob and always looks smartly dressed. Underneath, she is tired from the trials of this new life. She wonders why the hospital wasn’t watching Mary more closely that night. Their daughter had been ill for days, was pregnant and had fallen after surgery. She feels that a watcher could have run out and alerted a nurse or physician that something was wrong.

“There was nobody there,” she says.

The hospital declined to comment on the events of that night.

The Archers blame themselves for going home. They were exhausted. They had been with their daughter for days and finally thought she was okay.

“If we’d known it was going to happen we would have sat there all night,” Paul says.

Mary is hiding somewhere inside herself. Some days, the family sees flashes of the old Mary; other days she is not there.

She was receiving physiotherapy at St. Mike’s nearly every day until this past summer, when she had physio once a week. Now, she receives only occupational therapy at St. Mike’s, the family says. The hospital did not comment on the frequency of rehab.

Because she hasn’t been accepted into a more intensive, publicly funded rehab program and the Archers can’t afford to pay for a private option, they worry the old Mary Archer will be locked inside her body forever.

“We miss her,” says Heather.

The family eventually moved to Scarborough, where the kids grew up. Paul and Heather both worked at the Toronto Star (they are no longer on staff), saving up money for their retirement and renovating a vacation home in St. Andrews, N.B. That house is now for sale.

At her home in the Upper Beach, 91-year-old Patricia Archer looks through an old photo album of her grandchildren that is falling apart at the seam. As she flips the pages, the premature twins grow into busy toddlers. Mary’s hair gets curlier and longer as the years pass, the shoulder pads grow larger as the ’80s march on.

“They were great friends,” Archer says of her grandchildren. “She was (Alastair’s) guardian angel. He was happy — he really needed her help.”

When Mary applied to Ryerson’s social work program, she wrote about her brother and how important it was to help people who needed it. She worked at group homes, volunteered at a crisis line and, most recently, was intake co-ordinator at Project Work, where people with intellectual disabilities are taught job skills and find entry-level work.

Now, she is the one who needs help. She can’t walk on her own, has especially poor motor skills on the right side of her body and can’t see very well. She struggles to speak.

But quality of life is subjective. Mary smiles and laughs as daughter Isabella sings “The Wheels on the Bus.” She does the crossword with her dad. She can remember facts from childhood and nearly everything leading up to the surgery. When she has moments of clarity, she apologizes to her parents for being the way she is. She thanks them every time they bring her a coffee. She breaks their hearts.

Every day, Crocker arrives after work with a big yellow stroller, their daughter tucked inside sleeping. “Bob has stood by you forever,” Paul tells his daughter in the hospital cafeteria one day before Christmas. “You chose a good guy.”

When Mary was in a coma, Crocker read his own poetry to her. Friends marvelled that he was sticking around, with an apparently brain-dead wife and unborn child.

“If I were you, I’d commit suicide,” one person told him.

Crocker feels he owes it to Mary not to abandon her, and he wants their daughter to know who Mommy is.

When he talks about the situation, he sighs often but never complains. He survives by thinking only of the present: making sure his daughter grows up healthy and happy, bringing Mary back to life, and work.

“Outside that, I’m a zombie,” he says.

Crocker, 46, used to brag that he never cried. He had been through deathbeds and eulogies. Crying was a wasteful, unproductive, useless response.

He was sitting on the couch once, when Isabella was about six months, thinking about the first time he had changed her. He was happy for a few seconds before Mary’s absence bore down on him. He started bawling.

“I’ve learned crying is what you can do when there’s nothing left to do,” he says.

Crocker’s apartment is strewn with toys. Mary’s bookcase stands against the wall, untouched. A pack of diapers sits on the table.

He is wearing plaid flannel pants, nursing a glass of red wine and trying to talk about Mary, but he is distracted by his daughter, a Shirley Temple look-alike with curls and blue eyes.

“Don’t rip your book,” he says to her.

Every night after the hospital visit he makes dinner for Isabella, puts her to bed around 10 p.m. and then cooks dinner for himself. Every other Saturday night she is with Mary’s parents. Crocker’s mother stays over once a month; his father visits every few days.

He wants Mary and Isabella to have a relationship, so he rolls the stroller through the Queen St. entrance of St. Mike’s every day.

“We’re going to see Mom, make her feel better,” he tells her.

Crocker always leans in to kiss Mary, then lifts his daughter in the air and flies her in for kisses, since Mary can’t easily hold her. All the nurses on the ninth floor neurotrauma unit know the little girl. In the cafeteria, employees also know Isabella by name. She is lightness in a dreary place, waving at people through Plexiglas windows.

One grey December evening, as Isabella dozes, Crocker feeds Mary a coffee. “Take a few big breaths, the first one is always tricky,” he says before bringing the cup to Mary’s mouth.

Mary murmurs.

“You can’t talk while you’re drinking,” he tells her. “What do you want to say?”

He brings out the letter pad and Mary’s finger goes to the T.

“Don’t say thank you,” he says, as she spells exactly that.

“One time I kind of gave her hell for thanking me so much she spelled out, ‘I will thank you every time,’ ” he says.

Mary moans. It is the frustration of wanting to speak but being hobbled by a brain that knows something is wrong.

At this point Crocker recites a phrase he says every time she gets frustrated: “You have to make a big effort to calm everything down, with your lips together, breathe through your nose, calm down all the muscles and find the patterns of calmness.” Mary stops moaning and stares at him, transfixed.

“Once you start speaking from a calm position, you’ll have your voice back,” he says.

It sounds official. When asked where he learned it, Crocker laughs. He just made it up.

He talks about how they first met in 2008, at their housing co-op on Scadding Ave. Mary initially thought he was gay. Mary is listening, and smiles as the coffee dribbles down her chin.

“Remember that Mare?” he asks.

No, she intones through a little shake of her head.

“It’s okay. I’ll remember for you.”

There have been days when she mistakes him for her first husband, a marriage that ended years ago in divorce. He asks her to point to the letter of his first name. Today, she points to B, and looks annoyed.

“I know you know Mare — just checking,” he says.

Her brother, Alastair, is there too. Aside from his job at a grocery store bakery, this is where he spends most of his time. Apologetically, he tells Crocker he has to go. As he waits for the elevator, Mary moans. Crocker gets out the pad of letters and she starts to spell goodbye.

“Mary says goodbye!” Crocker shouts before Alastair gets on the elevator.

Alastair laughs. “Bye Mary,” he says before he disappears behind the closing elevator doors.

Since he was diagnosed with cerebral palsy as an infant he has undergone surgeries on his foot, his brain and his eyes. At 23, he was diagnosed with testicular cancer. But through it all, his best friend was his twin sister.

As a teenager with a disability, people weren’t keen on being his friend, he says. Mary took him to parties, cottages and clubs. She even oversaw his first drink, a bit of a disaster with wine, beer and peach schnapps.

“Because of her, I had friends. I had a blast.”

It was the kind of relationship that made everyone in the family proud.

Alastair now has to face the world by himself. He now comforts Mary when she cries, calls her sweetie and holds her hand when she gets too loud in the hospital cafeteria.

“Mary is still there, but her life is over,” Alastair says.

He knows his parents and Bob won’t give up and want to see her get better, but he says he is more realistic.

“I live a different side of the coin than Mom, Dad and Bob,” he says. “If a doctor came to me and said, ‘What do you want to do?’ I would let Mary have her baby, put her in a palliative care unit and let her pass on.”

He feels the hospital is giving up on her. They should be doing everything they can for her, including physiotherapy, he says.

“I have to be the big brother now because my sister doesn’t have a voice.”

The day before the baby was born, Mary had been squirming uncomfortably with contractions. Her mother reminded her she was eight months pregnant. Mary looked at her, confused.

“I was taking the pill,” she blurted out.

There were other instances of Mary speaking. When her friend Karen Curtis came to visit, Curtis looked at Mary and said, “Do you know what this is?”

“CWW?” Mary said.

Cheap white wine, an old inside joke.

After Isabella was born, Mary asked, “Who is her mother?”

“You are, Mary,” her parents replied.

“I’m so sorry,” she said.

But soon after Isabella was born, Mary lost the ability to speak in sentences. Words occasionally pop out when she is distracted or trying to make a point. This past Monday, she was doing the crossword puzzle with her father. He asked for an eight-letter word for insanity, starting with a D.

“Dementia,” Mary moaned.

Since last March, the Archers have taken their daughter to neuro-based physiotherapy in Yorkville twice a week, paid for by their daughter’s pension.

Physiotherapist Darryl Tracy tries to connect with Mary’s nervous system at these hour-long sessions. He taps his fingertips on her unresponsive right hand to try to wake the brain up.

He puts an ankle brace on Mary’s right leg for lateral stability before they try walking. Her right foot, like her right arm, doesn’t respond to the brain’s commands. When she walks, Mary’s brain feels unsafe because her ankle rolls, Tracy says. Through repeated use of the ankle brace, Tracy hopes to correct the rolling so Mary’s brain will feel safe on her feet so she can walk more confidently.

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The purpose of rehab is to see what parts of the brain are functioning and recovering. Over the long term, the brain can reorganize itself, finding new ways to accomplish tasks.

“You can get to Sudbury through Orillia, or you can go another way,” explains Toronto Rehab’s Bayley, who is not involved in Mary’s care.

Bayley says there is optimism that over time people may improve, especially with ongoing research into different kinds of nerve medication.

“We’re determined she will walk again, somehow,” Heather says as she watches Mary lean on Tracy. “Even if it’s with a walker. That’s our goal.”

“She’s not 70 years old with nothing ahead of her.”

They worry she will only get worse without daily rehab.

Since her first fall after the shunt-revision surgery, her family says she has fallen four other times, the last leading to two craniotomies in May 2010.

The family has hospital records that detail the craniotomies. The first was done to remove blood that had collected on the surface of the brain, a subdural hematoma discovered after “she fell and bumped her head,” the record states. The surgery went well, according to records, but that night her condition deteriorated, and a CT scan revealed more blood pooling, this time between the skull and the brain. The fresh staples and stitches were taken out as doctors operated again.

She requires constant supervision, something St. Mike’s has provided one-on-one since the fifth fall, according to the Archers.

Mary has been to the Toronto Rehab Institute three times but returned to St. Mike’s due to urinary tract infections. Other rehab institutions, like Bridgepoint, have turned her down. Her family says the length of time that has passed since the incident, her need for 24-hour one-on-one care, and her short-term memory all work against her.

Bridgepoint wouldn’t discuss patient specifics.

“Patients referred for admission who have problems falling outside of our scope of practice are redirected to institutions better able to address specific clinical needs,” a spokesperson wrote in an email.

The family has visited nursing homes at the urging of the hospital. At one place, the youngest person was 59 and most were in their 80s and 90s with dementia. Aside from a nursing home being, as Heather says, “no place for a young woman,” the Archers would have to pay for one-on-one overnight care out of pocket, which would cost at least a thousand dollars a week. The same would be true at rehab facilities. At St. Mike’s there is no additional cost for overnight monitoring, but the Archers worry that cannot last forever.

“Presumably Mary could stay here for the rest of her life,” her father says, sitting in the hospital cafeteria with yet another coffee.

At 12 days old, she went to work with her dad in the basement office of the downtown co-op he manages. The early days are a haze, but Crocker remembers Tony Moffat-Lynch popping in for a visit.

Moffat-Lynch, who lives in the building, saw the baby in the basement office and suggested he take care of her for a while. As chair of the building’s maintenance committee, Moffat-Lynch was a friend of Crocker and felt terrible about what had happened.

His child-care experience was not robust. Born in England, he has acted, directed and designed drama-based rehab programs. He worked with renowned stage director George Luscombe, portrayed Group of Seven artist Frank Carmichael in a two-part CBC series, and was killed off as “David,” an angry student agitator in the 1970s horror movie Dr. Frankenstein on Campus.

Video: Uncle Tony and Isabella

At first, Crocker checked in on the unlikely duo every few minutes. Now, Moffat-Lynch is known as Uncle Tony, a beloved member of the extended family, a host of birthday parties, a reader of stories.

He never had children, and never thought he would be changing diapers in his mid-60s. His apartment is beautiful, with yellow tulips resting gently in a vase, a print of a pencil sketch by pre-Raphaelite artist Dante Gabriel Rossetti, and a framed finger painting by Isabella. His bedroom has become her playroom, with teddy bears and an easel overtaking his floor.

After Christmas, Isabella comes into the apartment in a snowsuit.

“Hello beautiful!” he says.

Crocker and Moffat-Lynch begin to take off the snowsuit as she squirms. Within minutes crayons are scattered on his hardwood floors.

Crocker goes out to get a coffee for Uncle Tony, and when he comes back, Isabella has grabbed her favourite CD, Max Raabe and the Palast Orchester’s Das Carnegie Hall Konzert and inserted it into the stereo. The jaunty, German big band music reminiscent of the 1930s fills the room as she begins piling books up on the table for Uncle Tony to read.

Isabella has grown very cultured in Tony’s one-bedroom apartment while her dad works downstairs to pay the bills. “When she was a baby, I said to Bob, ‘Let’s spoil her, she deserves it,’ ” he says, with a laugh.

Every day, they sing and dance. Some days, he takes her to the Royal Ontario Museum to see the dinosaurs. He delights in showing her the world. Whenever Uncle Tony gives Isabella a dress, she insists he made it himself.

“My days are hers now,” he says. “I can’t remember before.”

Everyone knows Mary would have been a terrific mother. Isabella is the only part of life since the incident that Mary doesn’t forget.

“It hurts to the core to watch her watch Isabella and see her realize she can’t be the mother she wanted to be,” Heather says.

But Isabella is loved, by an extended family of grandparents, aunts, uncles, parents and this particular maintenance committee-chairman-turned-uncle.

People tell Tony he will get his life back when she goes to school.

“This is my life,” he says.

Isabella is wearing a pink shirt with jewels splashed on the front, the one Uncle Tony calls “Bollywood bling.”

Alastair ordered the cake, but he is working and can’t be here. Mary has a slice, forgets and asks for another 30 minutes later.

The Archers are tired. Most of the heavy-lifting of parenting seemed finished back in 2009. Now they have to feed their grown daughter and wipe her face. They love her just the same — more, if that’s possible.

On day 1,012, so many questions are still left unanswered. What happened on April 8, 2009? If she was monitored more closely after surgery, would they be celebrating Paul’s birthday at home with a healthy daughter? How will Mary be five years from now?

They say they haven’t received a prognosis and feel ignored. They say the doctor assigned to Mary’s case is a busy neurosurgeon who spends most of his time in the operating room. But they do describe the medical staff who work with their daughter as wonderful, caring people who treat Mary like a sister.

“It just never should have happened in the first place,” Paul says.

“She wasn’t drinking and driving, she wasn’t hurting anybody,” notes Heather. “This didn’t happen because she did some dreadful thing. It happened here.”

The experience has made Heather and Paul philosophical about life, and about quality of life.

Both agree that if either of them was gravely ill without hope, no extreme measures should be taken to save them.

“For Mary’s sake, a lot of times Heather and I say to each other, ‘We kind of wish she did die,’ because it’s horrible to watch her like that, but then Mary doesn’t seem to realize the extent of it in a lot of ways,” Paul says. “Kids dying before you is horrible, but your kid dying in front of you and half coming back to life, living and partly living and not really living, it just goes on endlessly, it never ends.”

When it comes to supporting Mary, there is no choice for the people who love her.

“Knowing Mary is still fighting, I gotta stick by her,” Crocker says. “Today I felt like I could see hope for rehab, other days I think, ‘What am I doing?’ ”

Outside of her family and friends, no one wants to talk about Mary Archer. Toronto Western Hospital, where the family says Mary’s condition worsened prior to the surgery, says it “cannot speak about any patient who has received care at one of our sites,” and urged the family to contact its patient relations office for a complete investigation.

The Archers signed consent forms so a doctor familiar with Mary’s case at Toronto Rehab Institute could speak about her condition, but that interview was cancelled by TRI because the doctor did “not wish to discuss the case except with the patient’s family or her care team.” A more general interview was arranged.

St. Mike’s also had signed consent forms from the Archers and a list of detailed questions from the Star, and responded with a statement:

“We are committed to providing the best possible care to Mary Archer. As part of providing that care, it is crucial to maintain a relationship of trust with Ms. Archer and her family. Therefore, we will only discuss the details of Ms. Archer’s prognosis and care with her and her family.

“Ms. Archer has been admitted to St. Michael’s Hospital four times since February 2009 and has been here continuously since February 2010. Since her last admission, St. Michael’s has consulted with a large number of health-care facilities, including rehabilitation centres. None of these contacts resulted in successful discharge.

“We will provide the best care possible as long as Ms. Archer is here and will continue to work with her and her family to find the best possible, long-term, health-care arrangement for her.”

The Archers feel there should be a probe, committee or advisory group set up to examine options for patients like Mary, who are turned down for care at rehab centres and left to stagnate in hospital unless they can afford private options.

They have written twice to Health Minister Deb Matthews, describing the case in detail and asking if there is a suitable place for their daughter where costs are taken care of.

“Is there anything at all — in this obviously un-universal health care system — that can be done to help a vulnerable and once vital young woman like Mary?”

The Archers never got a reply. Matthews said her office called a family member who had reached out, but neither Heather, Paul nor Bob received a call.

In an interview with the Star, Matthews said the ministry is working hard to provide care to patients who are turned down for complex care at OHIP-funded rehab centres and can’t afford private rehab.

“We know we have people in hospital who could be cared for in a different setting that might well be a higher quality of care. That is the highest priority of our (local health integration networks) right now, to resolve the (alternate level of care) issue, and what that means is creating appropriate places, because they don’t always exist now.”

Matthews said she couldn’t speak specifically to Mary Archer’s situation, but had read the letters and called it “a tragic, tragic case.”

“I would say to people to please work with the patient advocate at the hospital, to work with the (community care access centres). We’re all motivated to find the right care for people.”

The Archers feel the system is broken, with the most vulnerable people not getting the help they need.

They believe the right care is at the Neurologic Rehabilitation Institute of Ontario, a private option that would cost $26,000 a month for round-the-clock care and rehabilitation, with extra charges for equipment, prescriptions, meetings, special foods and therapy supplies. Doctors from NRIO have met with Mary and consider her a good candidate.

But the family doesn’t have the $30,000 a month they think it would cost with all the extras.

The Archers have a lawyer, but pursuing legal action is a lengthy process. They are more worried about their daughter’s immediate health-care concerns.

For Paul, who doesn’t think Mary will ever come back fully, the only joy he gets is trying to find her help.

“We would like St. Mike’s to step up to the plate and say, ‘Okay look, this is a grey area, but harm came to Mary while she was in here, we’ll give you some money to send her to NRIO for a year and see what happens,” he says. “Then after a year, presumably she’d be way better and we could do something else.”

Mary is staring at her parents. She will forget this conversation soon.

They will remember for her.