Nearly one year after a bike accident paralyzed him, Brooke Hopkins found himself once again being rushed by ambulance to University Hospital.

This time Hopkins was coming from the Bountiful rehabilitation center he has called home for the past nine months. A spreading infection was ravaging his body, sapping his strength and prompting bouts of depression. He had trouble pushing through the breathing exercises he had mastered and, for the first time, even fantasized about starving himself to death.

In an emergency procedure near midnight Tuesday, University of Utah doctors cleaned out a tangerine-sized abscess in his scrotum and poured antibiotics into his system. Then they returned him to the hospital floor where he had spent weeks in 2008.

Surrounded by familiar and friendly faces, Hopkins felt like he was back where he began -- sleep deprived in a hospital unit that is always active, brightly lit, with endless intrusions and the constant beeping of monitors.

Today marks one year since that terrible Nov. 14, 2008, afternoon, when he and another biker collided in City Creek Canyon near downtown Salt Lake City, leaving Hopkins with a broken neck and almost no movement. Much has happened in 12 months.

After strenuous physical therapy and practice, the retired U. English professor now can talk and eat, move a few fingers and toes, breathe on his own for hours at a time and drive his wheelchair with a joystick. He dictates his writing with a voice-activated computer program and takes calls from friends on a voice-activated phone.

Still, progress is excruciatingly slow and painfully frustrating for Hopkins, a once lively teacher and outdoorsman, as well as for his family.

"We've been forced into running a marathon, and we've just completed the first 500 meters," says stepson Mike Battin, who owns a medical-software company in Seattle. "We get closer by inches to the finish line every day."

To some skeptics, the one-year anniversary is the finish line.

Traditionally, doctors believed patients with spinal cord injuries would see all their potential recovery in the first year. After that, it was nothing but a plateau.

Dale Hull doesn't buy it. Neither did Christopher Reeve.

With unlimited resources and determination, Hollywood's "Superman" displayed unprecedented movement some seven years after he broke his neck during an equestrian competition in 1995. He died in 2004 of complications from an infection caused by a bedsore.

Hull, an obstetrics and gynecology doctor in Utah, suffered a spinal cord injury while jumping on a trampoline in 1999, rendering him a quadriplegic. At the one-year mark, he saw no reason why he couldn't continue to improve.

By researching the medical data, he noted that most patients didn't receive any more therapy after a year. Thus, he says, the plateau became a self-fulfilling prophecy.

Hull felt liberated by that discovery. After 2½ years of intense therapy, he carried the Olympic torch for 2002 Winter Games in Salt Lake City. Today, he runs Neuroworx, which provides rehab as well as physical and aquatic therapy for spinal cord patients.

"The central nervous system does heal," Hull says, emphatically, "but at a different pace and mechanism than we are accustomed to seeing with other parts of the body."

Will insurance companies be that patient, though?

Peggy Battin, Hopkins' wife of 23 years and a nationally recognized medical ethicist, estimates that so far her husband's recovery has cost more than $250,000. University Hospital charged $147,163.24, for his three months there, but settled with the insurance carrier for $35,178. The South Davis Rehabilitation Center billed an estimated $46,000 a month and settled instead on $11,000.

The couple are insured by the U., where Battin still works, and by Medicare, because Hopkins is 67. Together the two policies cover most procedures, with a lifetime ceiling of $2 million. They have case managers at the rehab center and at the insurance company who scrutinize every item of care.

So does Sheila Steiner.

Vice president of business development for World Trade Center Utah and a longtime friend, Steiner was among the first to show up at the hospital after the accident.

Sitting outside Hopkins' room, Steiner had one recurring thought, "This could be me -- either in the bed or in the waiting room. "

Not good at casseroles, cleaning or lawn care, the detail-oriented Steiner offered the one thing she could do: organize the bills. So every week from that day to this, she has picked up and tracked the piles of notices from various providers. She has met with hospital representatives, insurance case managers and billing staff. She has spotted errors and worked to correct them.

"I have a giant loose-leaf binder, all organized by provider," Steiner says. "Honestly, my agenda is to fight for every penny because there may come a time when there aren't any more pennies."

Unfortunately, the couple's insurance case manager was among those let go this week because of downsizing, leaving them without a strong advocate while the company decides whether Hopkins' progress meets the criteria for continued therapy, or whether his support should be reduced to mere maintenance.

This has been "the most extraordinary year of our lives with the highest highs and lowest lows," Battin says. "We have come to a greater realism, balancing the tension between outrageous optimism and the risk of resignation."

For his part, Hopkins is exhausted but free of infection and back to the rigors of rehab. On Friday, he spent two hours breathing off the respirator.

"I'm not gleeful at the moment," he says. "But I don't see any reason why I couldn't continue to improve."

After all, he says, one lives on hope.

Continuing coverage

A year ago today, Brooke Hopkins, a retired University of Utah English professor, was paralyzed after a bike collision in City Creek Canyon. The Salt Lake Tribune has been chronicling his rehab as well as the accident's effect on his wife, Peggy Battin, a nationally recognized medical ethicist.