I’m feeling really hopeful that Rep. Gabrielle Giffords will make a very substantial recovery. According to her physicians, she can breath on her own but they are still giving her an oxygen tube to avoid the possibility of her taking on fluid in the lungs. She is also able to move her right arm (which is controlled by the left side of the brain), albeit a little less well than her left arm. One of the physicians said that she has a 101% of surviving and will not die. And she also can understand spoken language which is allowing her to respond to simple commands. Language is usually controlled by the left side of the brain, too. On top of all this, there is no serious swelling of her brain. As far as I can tell, other than the somewhat diminished mobility in her right-arm, she is showing no real neurological damage of a kind that would indicate a major diminishment of her overall capacity.
The surgical team also has revised its initial assessment of the bullet’s trajectory, which the doctors had thought entered from the rear and exited over the left eye. They now say it looks as if she was shot in the top part of her face and the bullet exited out of the back of her head, Rhee said.
Lemole said Gifford was still following simple commands. The team has backed off on her sedation so that she is alert more, he said, but he would not make any predictions about the rate of her recovery. “She’s going to take her recovery at her own pace, not ours. I’m very encouraged that she has done so well. She has no right to look this good.… We all have to be extremely patient.”
Rhee said she was over the hump in terms of survival. “I think she has a 101% chance of surviving. She will not die,” he said. He also does not think she will be in a prolonged coma. “As far as a vegetative state, I don’t think she will be in a vegetative state at all.”
With any luck, she’ll be fully mobile, won’t have any major speech impairment or inability to understand the written or spoken word, and won’t suffer any other major effects. It’s at least in the realm of possibility. And I consider that a major miracle.
Consider the case of Jim Brady, Reagan’s press secretary, who survived a head wound to the left side of his brain but was left with a permanent speech impediment, was wheelchair-bound, and many other serious infirmities. The following excerpts are from the Sept. 27, 1981 edition of the New York Times Magazine:
I first saw Mr. Brady on bed 5B. ER nurses scissored away his blue business suit and stashed the pieces in a plastic bag underneath the gurney. The press secretary was comatose and a quick look at the wound on the left–center of his forehead produced a neurological assessment that was straightforward and clearly catastrophic. His face was distorted, his forehead shattered open and his eyes swollen shut by the dissection of blood beneath the skin. Part of his brain was visible. When doctors tested his reaction to a painful stimulus, a standard diagnostic maneuver on comatose patients, Mr. Brady had no movement on his left side and his right side moved only in response to the deepest pain administered…
…Mr. Brady’s left forehead and frontal sinus were shattered by the impact and possible explosion of the “devastator” bullet fired by the assassin as the press secretary strode at the President’s side into the line of fire. The shock waves of the impact had formed air bubbles inside both his eyes. The bullet, whose track was marked by a train of bone fragments, metal and air, tunneled through the tip of the left frontal lobe, severed the front part of the corpus callosum, (a major nerve structure connecting the right and left halves of the brain), and passed through the fluid–filled lateral ventricle on its course to the right frontal lobe. Brain swelling was evident, and a large blood clot was present in the right temporal lobe. Fortunately, the hemorrhage was close enough to the surface not to have destroyed the deep collections of nerve cells in the midline of the brain, although the sheer site of this “foreign” mass was causing distortion and compression of the brain stem. In short, Mr. Brady’s injury was grave, but not an automatic death sentence if he could be treated quickly enough.
Less than a year after being shot, he was making a remarkable but painful recovery.
James Brady has largely ceased to be a surgical patient, and his story now focuses more and more on the drama of his struggle to regain as much of his former physical and mental self as is humanly and medically possible. My prognosis for recovery must be measured within the framework of his injury and the uncertainty of how much compensation for the irreplaceably lost cells can occur. It is a recovery clouded not so much by the physical complications — such as the seizures and paralysis Mr. Brady has suffered — as by the question of how much an injured brain can regain its ability to integrate psychomotor functions, abstract reasoning and personality.
At the moment, physical and occupational therapy take up a good part of Mr. Brady’s day. He undergoes physical therapy twice a day, at times in his hospital room, but more and more frequently in the physical–therapy department. In addition to paralysis of Mr. Brady’s left arm and the partial paralysis of his left leg, he developed spasticity — the stiffening of muscle that leads to jerky and awkward movement and follows the loss of cerebral tissue. The more frontal the injury, the more severe spasticity is. The aim of therapy is to reduce spasticity so that whatever normal movement remains or returns will be as useful as possible.
Mr. Brady’s therapy regime is a rather involved program that consists of a combination of passive and active maneuvers designed to “fool” the body’s monitoring of proprioception, that kinetic awareness of where the body parts are and what they are doing from moment to moment, and thus reduce the abnormal spasticity. Rotational exercises, weight bearing, standing and walking are some examples of these maneuvers. Mr. Brady took his first steps on July 22, 113 days after the wounding, which was a tremendous psychological boost. A long leg bract provided stability to his left knee and ankle joints, and assistants helped him walk between narrowly spaced parallel bars. He quickly graduated from this contrived situation to a point where he can now walk short distances with the aid of his brace and Lofstrand crutches (the kind that wrap around the forearms), and with an assistant at his side.
Brady was lucky to live and have significant functionality. But there is a lot of reason to be optimistic that Gifford’s future will be much brighter. I’ll keep my fingers crossed.
