http://www.thedailybeast.com/blogs-and-stories/2011-04-10/gabrielle-giffords-recovery-details-3-months-after-arizona-shooting/full/#it is a very long piece .... here are some high points ....
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Dr. Peter Rhee, the trauma surgeon in Tucson who early on announced that "she has a 101 percent chance of surviving," determined in February that Giffords was ready to be transferred to the Memorial Hermann hospital in Houston. Her new neurosurgeon there said she "looked spectacular," and soon, after she moved to The Institute for Rehabilitation and Research in Houston, came word that Giffords was conversing and even singing.
One effect of all of this good news was to dampen overt speculation about Giffords's political viability. In March her Washington friends held a political fundraiser for her, fetching about $125,000 in pledges to support her 2012 reelection campaign. The New York Times reported that the Giffords team was actively advancing the prospect of a run for departing Republican Jon Kyl's U.S. Senate seat. One of Giffords' Democratic House colleagues, Rep. Shelley Berkley of Nevada, visited Giffords in Houston and emerged to say that she was eager to return to the House. "She's raising money now," Berkley told a Las Vegas television reporter. "She's running a campaign from the hospital." Earlier this month Daniel Hernandez, the young Giffords intern who rushed to her side after the shooting and accompanied her to the hospital, told the Arizona press that he'd had several telephone conversations with his boss, some of them "lengthy."
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When members of the Giffords medical team discuss her progress with reporters, they are constrained by patient-privacy laws and by the specific instructions from Giffords' family and staff. Before the team held a press conference last month (the first since February), the boundaries of permissible information had been carefully negotiated, and the result was a generally upbeat report featuring many superlatives but few details. Dr. Dong Kim, the neurosurgeon who drained excess fluid from Giffords' brain when she arrived from Tucson, reported that she was progressing in "leaps and bounds," and that she was starting to walk and show an ability to express herself that was "a constant and wonderful thing."
Reflecting on that media event, Kim tells Newsweek, "I can understand how somebody listening to us might say they expected her to show up and be normal. But if you polled a bunch of neurologists or neurosurgeons as to what we were saying," he goes on, "they would understand exactly what we were describing and what we think a good recovery means."
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First and foremost, the nonspecialist should understand that when Kim and the other doctors on the team speak of progress, it is in relative terms, given that the patient has suffered severe brain damage. "'Leaps and bounds' means much faster recovery than the average patient from a similar type of thing," Kim says. When he says that he is having conversations with Giffords, he means that he has asked her a question ("How are you today?") and that she has answered ("I'm better"). Kim adds that there is a bottom line for all such patients, whatever their recovery curve. "If somebody has a severe brain injury, are they ever going to be like they were before? The answer is no. They are never going to be the exact same person."
Dr. Gerard Francisco, the physiatrist in charge of the Giffords medical team, says he is quite pleased with his patient's progress, although he acknowledges that outsiders, especially the media, might be misinterpreting what the doctors and therapists are trying, however circumspectly, to describe. "It's how we measure the change," Francisco says. "Some people will expect changes to be big. I'm happy with small changes, as long as I see these changes every day, and that's why I'm very encouraged. Some people would like things to get better within an hour, within a day, within a week. Rehab is not measured that way. It is a long-term process."
What Francisco and his rehab team aim for is an optimized "new normal" for each patient. "Everyone around her needs to understand, hey, this is a different situation," says music therapist Meagan Morrow, who is working with Giffords. "After you have a brain injury, you are a different person. It doesn't matter who you are."
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Because of the near-mystical way in which the brain heals itself, it is impossible for doctors to predict precisely what the new normal ultimately will be for a given patient. Even so, Kim, the neurosurgeon, remains optimistic. This is partly because the bullet that went through Giffords' brain injured the left hemisphere, which controls speech and movement on the right side of the body. Partial paralysis may result, but in the context of recovering from brain injury, doctors place less emphasis on that than on other factors. "Motor weakness, for example, is not that big a deal, compared with cognitive things," Kim says. "So, first of all, is your personality going to be like it was before? Are you going to have the same kind of mental abilities, and think through things, and understand? And the social-relationship part—how sensitive are you to other people's emotions? Do you want to relate? A lot of that function, it turns out, is in the right side of the brain."
In Giffords' case, the answer to Kim's questions about cognitive ability is an emphatic yes. "We joke around, and I tell her all the funny things that happen in Washington, and she laughs," says Pia Carusone, Giffords' chief of staff. "When we say her personality is there, I mean, she's like 100 percent there." Carusone, who travels to Houston each week, says that Giffords communicates with her through "a combination of body language, personality, and speech. It's some words, it's expressions on her face."
much more at the link ....
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