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CNN Live Event/Special
Sanjay Gupta Reports: Saving Gabby Giffords
Aired May 08, 2011 - 19:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
(BEGIN VIDEOTAPE)
UNIDENTIFIED FEMALE: What a beautiful day it was. It's such a beautiful morning that has turned so tragic.
UNIDENTIFIED FEMALE: 911. Where is your emergency?
UNIDENTIFIED FEMALE: There was a shooting at --
UNIDENTIFIED MALE: We have breaking news for you. Several people have been shot. Among those shooting victims was Congresswoman Gabrielle Giffords.
UNIDENTIFIED MALE: The gentleman came up and asked me if he could talk to the congresswoman. And before I knew, he was barging through the -- through the tables.
UNIDENTIFIED MALE: I heard about 15 to 20 gunshots. I saw people running and screaming. Everyone screaming that it was Gabriel Giffords.
UNIDENTIFIED FEMALE: Gabriel Giffords, she was breathing.
UNIDENTIFIED MALE: The way that she was communicating was by grabbing my hand and just squeezing.
UNIDENTIFIED FEMALE: We do not know her condition right now. I was told that it was, quote, "pretty serious".
UNIDENTIFIED MALE: She was shot point-blank in the head.
UNIDENTIFIED FEMALE: He went in and he just started firing. And then he ran.
UNIDENTIFIED MALE: He was ready to kill people. He came there with a purpose.
UNIDENTIFIED FEMALE: I was just frozen and screaming my mom's name.
UNIDENTIFIED MALE: And this wasn't a joke. This was actually happening.
UNIDENTIFIED MALE: I heard this out, so I ran outside to see if I could do something there to help.
UNIDENTIFIED FEMALE: It was just unthinkable. UNIDENTIFIED MALE: Such acts of violence have no place in our society.
UNIDENTIFIED FEMALE: Eleven others also shot today. Six people are confirmed dead.
UNIDENTIFIED FEMALE: Most of the victims were stuck behind a table that had been set up for this event, so they were sitting ducks.
UNIDENTIFIED MALE: In a senseless act of violence.
UNIDENTIFIED FEMALE: Investigators have the suspected shooter in custody.
UNIDENTIFIED FEMALE: The two men that secured him were the heroes.
UNIDENTIFIED MALE: I put my legs on his -- behind his knees and my arm on the back of the small of his back.
UNIDENTIFIED FEMALE: But I was able to grab it before he did and get the magazine.
UNIDENTIFIED FEMALE: And there's other people that are injured?
UNIDENTIFIED FEMALE: There are people -- there's multiple people shot.
UNIDENTIFIED FEMALE: Ok.
UNIDENTIFIED FEMALE: Oh my God.
DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT (on camera): What police say is that shady looking gentleman was Jared Loughner and the table that they're talking about was right over here. This is where he barged through. The congresswoman and the judge were standing right around there, and this is where he shot them.
But then he proceeded down the line shooting people at random. By the time the paramedics got here Jared Loughner had been taken down, but there were literally bodies strewn all across the ground here.
DANIEL HERNANDEZ, REPRESENTATIVE GIFFORDS INTERN: There were people who had been injured. I then tried to see who had -- who had a pulse still and see if people were still breathing. I was only able to check two or three people before I noticed that Congresswoman Giffords had been injured severely.
GUPTA: People from the Safeway came out with white smocks to help. Daniel Hernandez was right around here. He was actually holding Gabby Giffords up propping her up against this area to try and keep her airway open. Those white smocks, they were used to hold pressure against her wounds.
Colt Jackson, Aaron Rogers, and Wes Magnotta, they were among the first medical responders on the scene. AARON ROGERS, SOUTHWEST AMBULANCE TUCSON: We were actually at a gas station, and we heard the call go out, and we heard the trucks rolling by. And we weren't sure of the full effect of what was going on.
GUPTA: So you guys were driving along and you're coming here literally as quickly as you can. Constant talking back and forth, you two?
ROGERS: Absolutely.
GUPTA: What is -- what is the conversation?
ROGERS: We talk about -- we have something we call staging, you know, when we're being told to help and hold off by the sheriff's department because of the gunman on the scene.
WES MAGNOTTA, SOUTHWEST AMBULANCE TUCSON: We talked about what we think we're going to see and what we should have ready, what we should prepare.
COLT JACKSON, NORTHWEST FIRE RESCUE TUCSON: We're trying to get as close as we can without being in harm's way, but we want to make sure we get close enough that we're -- we'll have real quick response times.
GUPTA: Have you ever gotten a call like that before?
JACKSON: No, that was my first one.
GUPTA: Look at that. They are young -- young medics, rookies, only two years of experience between them when they were dispatched to the chaos.
UNIDENTIFIED FEMALE: Twelve people shot, including Representative Gabrielle Giffords.
GUPTA (voice-over): Their task? Saving Gabby.
(on camera): We see your ambulance parked right over there. Is that where you guys decided to park?
ROGERS: That's correct, we pulled in and we got as close as we could. There was a caution tape and a sheriff's car park there.
GUPTA: So you're sitting in the ambulance and looking out at this. We have some idea of what it must have looked like. Was it chaos? Or were there people running around? What did you see?
ROGERS: You know there -- there wasn't a lot of people running. There was a lot of bodies, a lot of people doing work. The first thing I noticed was the banner for Gabrielle Giffords. So in my mind I started recognizing that this was a political event.
There was not a lot of shouting. There was not a lot of pandemonium. And when we walked up, I remember smelling blood.
GUPTA: You have your bags with you, and you're starting to cross over the tape now, and --
ROGERS: We're pulling our gurney in, and we've got our back board and our supplies, and we see that there are people working over here, and there's crews over here, and there's bodies laying around, and then --
(CROSSTALK)
GUPTA: All through here there's bodies --
ROGERS: -- all through here there's bodies and there's quite a bit of blood on the ground. And about the time we get here, we see Colt sitting in the back against the glass, and there's a patient laying here that has a sheet over him. And this person was deceased.
We had to step over this person to get to the back in here with Colt. I knelt down with Colt. And he looked up at me, and he said this is Gabby. Gabby Giffords.
JACKSON: And her and Danny Hernandez were right in here.
GUPTA: So he was sort of propping her up at that point?
JACKSON: Yes he was kind of holding her in his arms when I walked up.
GUPTA: And then -- and then, were there more people? There was a line of people?
JACKSON: Yes, basically just the bodies were spread out going back -- back up to across here towards the Walgreens.
This is the first time I have been back since the shooting, so -- it's different. That was definitely different.
ROGERS: This is my first time as well. I'm glad to talk with Colt again and kind of revisit it and, you know, I walked up, and you can immediately see the scene in your mind, but --
GUPTA: And flashback. For sure.
ROGERS: Sure. Sure, nothing -- not a traumatic flashback, but you just remember, and like I said, for me the smell was the big thing.
GUPTA: The smell of blood.
ROGERS: Sure.
GUPTA: And then you were there, and now we're standing here. Is that -- does that worsen those flash backs.
MAGNOTTA: Well as he said he had the smell. For me it was about the silence. I couldn't really hear anything until we saw Gabby -- I had no idea who it was. We just saw that she had a gunshot wound to the head, and she was priority.
GUPTA: And what did you see? What were you looking for when you're starting to evaluate a patient? JACKSON: Basically the basic signs of life. Are they breathing? Are they conscious? What's -- what's their mental status at the time? With her she had the basics -- the basics of life. She was breathing. She could respond.
GUPTA: When people talk about responding, it's significant because it indicates someone can hear you. They can also process up to some extent. Were you doing basic neurological exam? Or what were you -- how do you determine that?
JACKSON: Basically I asked her if she could hear me. She squeezed my hand. She could communicate. She was alert to that sense.
GUPTA: But not talking, Wes is that right?
MAGNOTTA: Right, not talking. She was moaning a little bit. I do remember that. I just remember that telling her to squeeze -- to squeeze her hands. She was able to respond to that, so she was able to follow a command.
ROGERS: We were loading up Giffords and we were instructed by personnel on the scene to put her in a helicopter. And I remember that Colt and I looked at each other, and we looked in the air and we didn't hear a helicopter, we didn't see a helicopter.
GUPTA: So was that a tough decision, Colt, to not wait for the helicopter? Because that was I think surprising to people that she -- she came in by ground.
JACKSON: We did not want to delay care not knowing the exact ETA of our helicopters, so we -- it was a decision that to me at the time just seemed like the right decision to go with.
GUPTA (voice-over): What happened inside that critical 13-minute ambulance ride? That's next.
ROGERS: We could see her kind of wincing in pain and kind of moving. I don't know if anybody had told her she had been shot.
(END VIDEOTAPE)
(COMMERCIAL BREAK)
(BEGIN VIDEOTAPE)
UNIDENTIFIED MALE: Several people have been shot. Among those shooting victims was Congresswoman Gabrielle Giffords.
UNIDENTIFIED MALE: Such acts of violence have no place in our society.
UNIDENTIFIED FEMALE: Eleven others also shot today. Six people are confirmed dead this evening.
UNIDENTIFIED MALE: That was a senseless act of violence. UNIDENTIFIED FEMALE: We do not know her condition right now. I was told it was quote, "pretty serious."
GUPTA (voice-over): Shot at point-blank range in the head. The clock was ticking to save Gabby. She had been down 30 minutes. The medics faced a critical decision.
ROGERS: We were instructed by personnel at the scene to put her in a helicopter. And I remember that Colt and I looked at each other and we looked in the air and we didn't hear a helicopter and we didn't see a helicopter.
GUPTA (voice-over): The rookie paramedics triaging Gabby ultimately made that split second decision to just go.
(on camera): So what happened? So her head is over here, is that right?
ROGERS: That's right.
Colt initially was initiating an IV in her left arm, and we were continuing checking on her responsive level. And we decided that we wanted to start another IV. So that's when I came over to this area just a frequent thing for us to do, and I stood here and during the entire transport we were -- I was working on this part of her body trying to get an IV established in her other arm.
When we have trauma like this, we like to have two IVs. One with just normal saline running on just a regular line, and we also like to set up what we called a blood set so if she needs to have blood when she gets to the hospital, there's no delay in that. They can hook it right up and get it going.
GUPTA: So these are big IVs.
ROGERS: Big IVs. They were 16, 18 gauge IVs, and we were doing -- he was, like I said, he was working here. I was working here. We had her on oxygen, constantly monitoring every -- every minute or so having us respond to her -- having her respond to us by squeezing her hands.
JACKSON: I had to put my hand -- her hand to my leg, and I just had her squeeze my leg so I knew that she was still -- still with us.
GUPTA: You guys are cruising, I imagine. Lights are going. You're flying along. Were you standing like that since the whole time?
ROGERS: Yes I was standing. There is no other access to her, the right side of her body from sitting in this position. Colt was over here working on her left side, and so this is a common place for me to go. Our adrenaline was going pretty good, and we were just focused on treating Gabby.
GUPTA: So are you measuring blood pressure constantly?
JACKSON: Blood pressure, her pulse. Making sure she got pulses in all of her extremities, not just on her fingers; making sure that she got it all the way around in case she's profusing (ph) through all of her limbs.
GUPTA: They talk about an airway-breathing circulation.
JACKSON: Right.
GUPTA: So her airway, we talk about the fact that she was propped up. How do you -- how are you assessing and making sure her airway is ok.
ROGERS: You know we look -- we constantly look inside her mouth and make sure there was no bleeding. We want to watch her tongue and make sure that -- that it's not blocking her airway.
GUPTA: You know, when you're assessing her neurologically Colt, I mean you're having her squeeze your hand and we -- we know from talking to the doctors that it was her left hand because left side of the brain was affected, and so her right side of the body was weak. But the left hand she could squeeze.
(CROSSTALK)
JACKSON: She could squeeze --
GUPTA: What else in terms of just -- comfort or you know, assessing pain and that sort of thing?
ROGERS: I mean she was shot in the head, and to have any level of response to us at all, I thought, was amazing. And how quickly she responded to it, it wasn't here, squeeze my hand, and then, she slowly did it. I said squeeze my hand and she squeezed it right away.
GUPTA: So it was clear. It wasn't a reflex.
ROGERS: Yes, it wasn't just something at random. It was always on command, always immediately. Constantly saying her name, I don't know if that helps. But she knew -- we knew who she was, and to hear your name whether we're strangers or not kind of maybe gives her a little bit of comfort.
GUPTA: With a head injury, do you think about pressure dressing versus no pressure dressings? Does it make a difference to you?
JACKSON: Well with this, I mean, you don't want to be pressing too much down on the skull because there are fragments that could be going on there, so but the bleeding had been stopped. With that --
(CROSSTALK)
GUPTA: So like the bleeding had pretty much stopped as a result of the initial pressure than just on its own?
JACKSON: I imagine.
GUPTA (voice-over): Amazing as it might seem for someone shot point- blank in the head Gabby Giffords was giving these guys glimmers of hope. They just needed her to hang on a few more minutes until they could get her to the hospital.
(on camera): Were you trying to inform her like what's going on? Are you keeping her abreast of what's happening?
JACKSON: That's something we always try to do no matter where our situation is. We just try to let the patient know I'm getting ready to stick with you an IV, we're going to get you down, we're going to take another blood pressure. We're, you know, this is what we're doing here. So the patient is aware of what we're doing. It's not a shock to them.
GUPTA: The entire time that she was going to the hospital, was she awake and alert? Aware?
ROGERS: I mean her eyes were closed, and as far as alert, we're saying she was responsive to pain or responsive to verbal. She would flinch if we poked her or if we pinched her, and she would squeeze our hands if we asked her to. She, you know, her eyes -- she had some swelling, and her eyes were closed. We couldn't assess that level of responsiveness, but for the most part, I mean we could see her kind of wincing in pain and kind of moving. I don't know if anybody had told her she had been shot. So I don't know if she knew the circumstances that she was involved in.
Not many people know this; between the two of us, there was less than two years experience as a medic.
GUPTA: Did you feel completely prepared to do what you needed to do that day?
ROGERS: I think so.
JACKSON: Yes. I agree. You rely so much on your training.
GUPTA: I mean your heart must have been racing, though. This is -- as calm as you were on the outside, there must have been a lot of adrenaline on the inside.
JACKSON: Oh, yes.
ROGERS: Absolutely. We wanted to get -- we were -- that was our thing was I think the adrenaline was wanting us to do more aggressive treatment. We were debating the second IV that we were establishing wasn't flowing properly.
Should we try to put a needle into her bone to make sure she has both of those lines? Monitoring her blood pressure and all of her vitals were so stable, we didn't want to cause her any more trauma. And so we just let it be at that. We kept it as calm and quiet in here as we could and just kept doing with just those minor basic things that were really making a big difference for her.
GUPTA (voice-over): 44 minutes after Giffords was shot and 13 minutes after leaving the Safeway parking lot, the medics arrive at the largest trauma center in Tucson. DR. RANDALL FRIESE, TRAMA SURGEON, UMC TUCSON: This was a serious gunshot wound. I saw actual brain matter that was visible. So with that information, I was very, very concerned that she was in serious condition and had a very high likelihood of not surviving.
GUPTA: Inside trauma five. That's next.
(COMMERCIAL BREAK)
HALA GORANI, ANCHOR, CNN INTERNATIONAL: I'm Hala Gorani. Here are the headlines.
An unruly passenger caused a security scare today aboard a Continental flight headed to Chicago from Houston. The plane landed in St. Louis and a man was removed. Airport officials say the passenger had to be restrained during the flight after he tried to open a forward exit door.
Well, we've had over the last 24 hours quite a look inside Osama bin Laden's life in hiding. Five different videos seized during the raid that killed bin Laden have been released by U.S. intelligence officials. Each of them had the sound removed to avoid spreading bin Laden's words.
In Memphis officials fear the Mississippi River could crest as high as 52 feet. That is well above flood stage. They don't expect it to go much above 48 feet, but they won't know for sure until at least Tuesday. In any case, residents are urged to evacuate from low-lying areas that could be engulfed by the historic flooding, which is on track to be the worst the city has seen in more than 70 years.
That's a quick look at your headlines. We now return to SAVING GABBY GIFFORDS.
(BEGIN VIDEOTAPE)
UNIDENTIFIED MALE: As far as the congresswoman, he described her as in critical condition.
UNIDENTIFIED MALE: Obviously, there is a huge sense of urgency.
UNIDENTIFIED MALE: A spokesperson there has said that the congresswoman has arrived on scene.
GUPTA (on camera): Well, we now know that Congresswoman Giffords was brought here, these ambulance bays. And this is the largest level one trauma center in the area. The first doctor to see her was Dr. Randall Friese.
FRIESE: It was about 10:00 something. I was in my office ready to have my day. The pager goes off multiple trauma patients. I come down here.
GUPTA: What do they say exactly when they called you?
FRIESE: It was a text. It was just a text page. GUPTA: You got a text message that says multiple traumas on the way.
FRIESE: It just comes on as text -- alphanumeric text -- and it said multiple gunshot wound victims. That's all I got.
And then within five minutes another text came across that said gunshot wound victims, ten. And I just said I need to go downstairs. I came downstairs, and the room was -- the entire bay was full.
GUPTA (voice-over): Yet, still, it was eerily quiet. Silence among chaos. Dr. Randy Friese was the E.R. doctor assigned to save Gabby.
(on camera): At this point did you know anything -- any other details?
FRIESE: When I got down here, I found out that they were coming from a Safeway on Oracle, which was shocking to me.
GUPTA (on camera): Because why? There's a mass shooting there?
FRIESE: Right. It's just a nice part of town. What was going on? Why would there be a mass shooting at Safeway on Oracle?
GUPTA: So this is the room here. You come into this room -- I mean what do you see?
FRIESE: There were, of course, several people in the room. Congresswoman Giffords was already on the gurney. The first thing I did was walked in the room. Some things were occurring. My first response was I grabbed her hand, leaned into her, and said Ms. Giffords, you're in the hospital. We're going to care for you. Please squeeze my hand. And she did.
GUPTA: Did she have a wrap on her head? I mean can you see the wounds at this point?
FRIESE: Yes.
GUPTA: So, you know -- you have some idea what the obvious wounds are, but you look at the rest of her body to make sure, for example, she doesn't have another gunshot wound, right.
FRIESE: Well, that's part of the trauma workup. That's part of the trauma evaluation is that you never assume that just what you see is all that is present.
So I saw the severe head injury. I saw some blood loss. Her eyes were closed. She did have a blackened right eye and swollen right eye, and she was -- she was grunting a little bit. I got the impression she was trying to communicate, but was being frustrated by the fact that she could not.
GUPTA: They had put IVs in her already in the field, so she had a fluids bag.
FRIESE: We always put new IVs in here. We were actually putting -- I think we were putting groin IVs in her because of the severity of her blood loss and we need large-bore IVs we put in femoral lines.
GUPTA: So you are here now. She's grunting, but she is clearly following commands. You are positive of that? What's your next move?
FRIESE: The first thing I said was intubate this patient. People began to prepare for that, get the tools necessary.
GUPTA (voice-over): Gabby was one of ten patients being triaged at University Medical Center. The trauma teams here move quickly especially with brain trauma.
It's a practice U.S. doctors have adapted from military doctors triaging injured troops in war zones. And the general of this team is retired navy surgeon Dr. Peter Rhee.
DR. PETER RHEE, CHIEF OF TRAUMA, UMC TUCSON: Nowadays, now that we've gotten our experience about penetrating trauma from the recent Iraq experience, we're -- including us, and we're very aggressive about getting to the operating room. Randy made that decision, needs to go -- the neurosurgeons haven't seen films or anything like that, they trust us. They know that somebody that needs to have an operation in the OR, prepped and draped.
The anesthesia already got some stuff done. I called Randy. He called. I said make sure she's lined up. We can't line her up in the OR. It will take more time.
So when we get to the operating room, she's already got the in line, central lines, and everything is done, shaved, ready to go.
GUPTA: The bullet was fired from a Glock 19-.9 millimeter semiautomatic handgun. It entered from the front left side of the Congresswoman's forehead, traveled the entire length of her brain and exited the back. It was a focused wound, meaning the damage was concentrated to one area of the brain.
RHEE: She was just exceedingly lucky, right? When I saw the trajectory of where one hole was and where the other hole was, I was, like, oh, my gosh, you know?
However --
GUPTA (on camera): Wait a minute -- because it was so far apart?
RHEE: Yes, I mean it wasn't a little skiving thing. It went through a lot.
GUPTA: Yes, because it wasn't a glancing shot. It was --
RHEE: It wasn't a glancing shot.
GUPTA: So where is the operating room from here then?
FRIESE: The operating room is actually up an elevator.
GUPTA: So, literally, the -- FRIESE: We went down there this way, in fact. In fact, I came out of the room, and there was a group of people coming in, and I actually put my hand up and said, "Stop."
GUPTA: Who were they?
FRIESE: I don't know. It was just a group of people. And then we brought the congresswoman out, and we go straight down this hallway here.
GUPTA: At this point who is with her? You're with her.
FRIESE: I'm with her. Emergency room nurse is with her.
GUPTA: Are you triaging in your mind the whole time? If someone had come in who suddenly needed neurosurgical care that was more dire; what would you have done at that point?
FRIESE: Well, I would have done the same thing. If someone needs neurosurgical care and the neurosurgeons are here, Dr. Rhee's dictum is get the patient to the operating room and they will come to the operating room. We position them on the table, we shave their heads. And the neurosurgeons come in, and they're already there. There's no delay further.
GUPTA (voice-over): Up next, we're going inside the operating room with Gabby's neurosurgeon. Could he reverse the damage?
DR. MICHAEL LEMOLE, NEUROSURGEON: It's very hard to tell what brain is going to come back on-line and what brain has been damaged. It all looks pretty bad.
GUPTA: Unlike other parts of the body, the brain has no place to swell.
I'll take you inside my operating room to show you the surgery Gabby had -- removing half of her skull.
UNIDENTIFIED MALE: That bone right out of there.
(END VIDEOTAPE)
(COMMERCIAL BREAK)
GUPTA: Congresswoman Gabrielle Giffords is headed to the operating room.
UNIDENTIFIED MALE: And then we brought the congresswoman out and we go straight down this hallway here.
GUPTA: She survived the initial gunshot wound to the head, but was still in critical condition. Neurosurgeon Michael Lemole was called in to continue the race to save Gabby.
(On camera): What did they first tell you when you first heard you were going to be operating on someone who has been shot in the head? How did they describe that to you?
DR. MICHAEL LEMOLE, CHIEF OF NEUROSURGERY, UMC TUCSON: It didn't register. I was, actually, believe it or not, at a golf lesson with my oldest boy, and we were in the pro shop afterwards, and I got the call. I'm answering that call, and I'm also looking up at the TV.
UNIDENTIFIED MALE: We have breaking news for you. It's coming out of Tucson, Arizona. Several people have been shot.
LEMOLE: And right when he said the name, I saw the face, and I knew there was something terribly wrong. So I immediately -
GUPTA: So you literally were talking and you saw the face on TV.
LEMOLE: Same time. It was the weirdest thing. It was almost like a disassociation and then, click, it all came together.
GUPTA (voice-over): Within 40 minutes of arriving at the hospital, Gabby Giffords was in the operating room. And Dr. Lemole was ready to operate.
(on camera): So she's obviously asleep now breathing tube in, all the necessary IVs. You have a plan in your mind as you're walking to the operating room? You sort of have an idea what you want to accomplish?
LEMOLE: Sure. Absolutely. The things that are going to get you in trouble in this case are bleeding uncontrollably, so if that bullet cut a major artery or vein in the brain, that's hard to clean up that kind of trouble. And fortunately here, that was not the case. And then, of course, the brain swelling we worry about.
Again, something that we can't really control, but we can try and at least lessen the impact of it and that's where we take off the bone fragments that were there and maybe even a little bit more. That's where the judgment comes in.
GUPTA (voice-over): It's a judgment call that trauma neurosurgeons are forced to make. What we know is that a through and through bullet injury causes direct damage to the brain, and that's something we can't fix. But it's the secondary damage due to swelling where you are trying to minimize the risk. The simple things they can do in the operating room, for example, simply lifting the head of the bed up. That can reduce some of the swelling on the head. Getting certain medications and to shrink the brain, that can help as well. Also, as they did in Congresswoman Giffords' case, they can remove part of the bone here to try and decrease that swelling.
So one thing to keep in mind, that the brain, unlike other organs in the body, if it starts to swell, it's really got nowhere to go. It can only go downwards, and that's what's called a herniation. So you make holes just like that one. Basically getting some access to the brain over here. One right over here, which is just behind the eye. This is a pretty classic place where you make a burl hole and try to remove this large chunk of bone. That's the first part of actually doing this. The second part is simply to try and connect these holes. You want to try and get as much bone off here as possible so that the brain has the maximum area to sort of swell. It's getting nice and hot. Looks a little bit barbaric, but the key is to protect the brain underneath as well. This is the last cut now we're making.
One of the things that's really important is when you take this bone out, you want to make sure that you're protecting the brain underneath and go ahead and lift that bone right out of there, and this is the area where the brain is actually allowed to swell now. The brain is coming out of here. You have the outer layer of the brain, and this is key to reducing that swelling.
LEMOLE: And the last bit is just finding those areas of brain that we are clear is no longer alive. Usually where the bullet went in, where the bullet came out and just clean that up a little bit, try to lower the chance of infection. But the key thing is we don't chase it into the brain. We don't try to get every piece of bullet or bone fragment out. Even if they might, might be a source for infection in the future. Because in so doing we might damage good brain by doing so.
GUPTA: Cause more harm than good?
LEMOLE: Absolutely.
MAYOR BOB WALKUP, TUCSON, ARIZONA: I'm very, very pleased to hear the doctors report that she is still alive and fighting for her life.
GUPTA: Gabby never stopped fighting, and the progress she made just days after her surgery gave her doctors hope.
(on camera): She is now sitting over the side of the bed, I understand. Is that right?
She's able to dangle her legs.
LEMOLE: That's correct.
I'm cautious, but I will tell you this. Given her recent improvements, I'm as hopeful as I have ever been for any patient.
GUPTA: That's a strong statement.
LEMOLE: Yes.
GUPTA (voice-over): Nearly 95 percent of people shot in the head don't survive. But Gabby Giffords, well, she beat the odds.
MARK KELLY, GIFFORDS' HUSBAND: She'll smile at me. She'll do some - couple of things THAT she'll only do ONLY around me like pat me in the face. She used to do that before. You know, just very gently. I can just look in ear eyes and tell.
LEMOLE: The biggest neurosurgical challenge is really fighting through the frustration of the slow recovery at her own pace. I've been trying to brace everyone for that because, as you know, it's not up to us. It's outside of our hands now. My little moment in the sun there was for the two hours in the operating room. That's where I had maximum impact.
GUPTA: Gabby's injured brain would need to heal, would need to rewire.
(on camera): Rehab, they talk about that being so important. Tell me about what is she getting rehab now?
LEMOLE: She's getting the rehab, and it's rudimentary rehab. We have sitting at the side of the bed dangling the legs. Even that simple motion is enough to start the rehab process. But rehab itself what we call the rehab hospital, that's an intensive experience.
GUPTA (voice-over): Her husband astronaut Mark Kelly knew the road to recovery would be long, but to make Gabby whole again, they would leave Tucson.
LEMOLE: Mark came to us and said I've got a list of the top five rehab centers in the country. Could you help me select these?
GUPTA (on camera): The approval for that, Michael, was that based on the conversation you had or, I mean, did you talk about that with Peter and Randy had time? How did you arrive at that?
LEMOLE: It was a dialogue between all of us and her husband, and we knew that she was going to need rehab. Especially when she started following commands within a day of surgery.
GUPTA (voice-over): "Saving Gabby Giffords" continues. Inside her aggressive rehab. That's next.
(COMMERCIAL BREAK)
HALA GORANI, CNN ANCHOR: I'm Hala Gorani, and here are your headlines. An unruly passenger caused a security scare today aboard a Continental flight headed Chicago from Houston. The plane landed in St. Louis. A man was removed. Airport officials say the passenger had to be restrained during the flight after he tried to open one of the exit doors.
In Egypt, crowds of Christians and Muslims clashed in Cairo, throwing rocks and at one point shooting at one another. Officials said the clashes started when rumors spread that a woman, a Muslim convert, was being held in a church against her will. At least 12 people were reported killed.
A frightening end to a commuter train ride this morning in New Jersey. Officials say an underground train overran its stop in Hoboken and collided with a bumper block designed to absorb the impact of collisions. 33 people suffered minor injuries.
That's a quick look at some of your top stories. Let's return now to "Saving Gabby Giffords.
(COMMERCIAL BREAK) GUPTA (voice-over): Gabby's recovery would continue a long way from the Tucson mountains.
DR. RANDALL FRIESE, TRAUMA SURGEON, UMC TUCSON: One of the last things I said to her was I voted for you once before, and I will vote for you again. So I expect her to come back.
GUPTA (on camera): How does she respond?
FRIESE: She smiled at me.
GUPTA (voice-over): Gabby was now ready for rehab. She left the Tucson hospital with those same rookie medics who had brought her there.
(on camera): It was gratifying to see her again at that point?
AARON ROGERS, SOUTHWEST AMBULANCE TUCSON: Absolutely. When she was here, she was obviously much more responsive. Her eyes were open. I was sitting in the seat over here. And as we were driving through, people were cheering and clapping and calling her name. So I opened the side window so she could hear it. And she was responsive enough that she would smile and cry every time she heard people cheering for her. So it's good to see that outcome out of something that we were able to do and help somebody with such a traumatic injury to see it progress to what she's doing now today.
GUPTA (voice-over): If it were the paramedics, nurses, and doctors in Tucson who were responsible for saving the congresswoman's life, it would be the doctors and staff at Tier Memorial Hospital in Houston that would be asked to restore function and put Gabby back together again.
(on camera): We knew that she was following commands right after her injury. Responding to people around her. But then we heard she started to ask for things, such as toast with her breakfast. She was singing. We also knew that her therapy was intensive and aggressive. For the first time we're going to take you inside the place where this is all happening and show you what her life has been like.
Let's take a look.
MAEGAN MORROW, MUSIC THERAPIST, TIRR MEMORIAL HERMANN: Twinkle, twinkle little star.
GUPTA (voice-over): For an hour just about every day Congresswoman Giffords does this. What you are.
(on camera): So you are going to sing it, and if I mouth it, then we can do that, and you can tell me what that means. Twinkle, twinkle little star.
(voice-over): It's called music therapy, and most people never see how it or much of the technology, big or small, actually works.
UNIDENTIFIED MALE: ... those rain drops into the rain. GUPTA: So I will show you, as if I, like Congresswoman Giffords, were a patient of Dr. Francisco and his team.
(on camera): It seems like a pretty long day.
DR. GERARD FRANCISCO, PHYSICIAN, TIRR MEMORIAL HERMANN: It is a long day.
GUPTA (voice-over): Every patient here has suffered a catastrophic injury and gets tailored therapy. The site of the injury in the brain is crucial.
FRANCISCO: After a brain injury or a stroke, there is a tendency for the patient to forget one side of the body.
GUPTA: Just neglect it.
FRANCISCO: Just neglect it or even if they're not neglecting it, they're not using the weak side. They tend to forget how to use it.
GUPTA: But this bike doesn't let you forget.
UNIDENTIFIED FEMALE: You doing OK?
GUPTA (on camera): Yes.
UNIDENTIFIED FEMALE: Going a little further?
GUPTA: Sure, if you want to, yes. So these little cords here are attached to my muscles in my leg, and as my leg is moving, it's sort of predicting which muscle should be using and it's giving that muscle a stimulation.
(voice-over): The brain usually sends a message to the muscle, but now the muscle is also sending its own signal, and that helps rewire the injured brain. This one over here, they call it the superman device. Learning to walk without the burden of my own body weight.
UNIDENTIFIED FEMALE: 30 percent of your body weight has been taken out.
GUPTA (on camera): This is really for somebody who has been bedridden for a long time, maybe taking their first steps to somebody who has weakness, frank weakness in one limb or the other and really needs to start walking for the first time.
(voice-over): Surprisingly, this shopping cart is also used as part of therapy.
(on camera): Take a look here. Obviously, Julie helping, for example, if I have right leg weakness really sort of moving my leg along, preventing me from falling.
UNIDENTIFIED FEMALE: I can help, again, as little or as much as I need to. So let's say you needed help to step through, I can come all the way here and help you step through it every single time. GUPTA: That's great.
It's kind of remarkable to see this sophisticated technology cost $70,000 next to a shopping cart in the same room. What is a shopping cart - what does that type of therapy do for somebody?
FRANCISCO: Do you go shopping? So when you are with a shopping cart, do you lean forward or do you stand more --
GUPTA: I try to stand upright.
FRANCISCO: I think that's what happens. As opposed to training with a walker, many people who are weak to begin with have a tendency to depend on the walker.
GUPTA: They're kind of leaning over.
FRANCISCO: They're leaning over. Whereas with the shopping cart there's no way for them to lean forward.
GUPTA: This is pretty labor intensive?
UNIDENTIFIED FEMALE: Absolutely.
SHAP SHADRAVAN, SPEECH THERAPIST, TIRR MEMORIAL HERMANN: OK. You say len. It's pen. Use your lips.
GUPTA (voice-over): Now remember, with Gabby, speech is also a concern.
(on camera): How significant is that in your world, in the speech therapy world, that she starts asking for things on her own?
SHADRAVAN: It's huge. That's one of your first goals is for somebody to be able to express their basic wants and needs.
GUPTA (voice-over): Gabby's brain function continues to improve. She can stand and write out words with her left hand, and, yes, she can speak in simple sentences.
KELLY: She's improving every day, and in the realm of brain injuries, that is a very significant and pretty rare. She's starting to walk, talk more, more every day. She's well aware of who is around her. You know, just very aware of the situation.
DR. PETER RHEE, CHIEF OF TRAUMA, UMC TUCSON: If we are going to salvage as much good as we can out of this, having Mark Kelly going into space is going to be huge for the country.
GUPTA: Up next, as her husband commands his team in his final mission to space, Gabby's team of doctors open up about her road ahead.
RHEE: I'll tell you, she's not going to be 100 percent. I know that for a fact.
(COMMERCIAL BREAK) GUPTA: As Congresswoman Giffords' husband prepares for space, her mission was to gain enough strength to travel to that launch. Gabby's intensive, often grueling eight hours of rehab a day had built her up for this moment. Look closely as the congresswoman who just months before was shot point-blank in the head slowly takes those remarkable steps.
FRIESE: I credit Mark for his extreme optimism and his resolve. I wish every single patient had someone like that at their side. It's just positive energy, positive thoughts. I think that people have nonverbal ways of communicating. I think he really was able to encourage her in very, very many different levels.
GUPTA (on camera): Do you spend much time reflecting on what happened in January?
FRIESE: Briefly. Fragments. Not a lot.
LEMOLE: Believe it or not, life actually has returned to some degree of normalcy here in Tucson.
GUPTA (voice-over): But the tight knit community of Tucson will never forget the six lives that were cut short that morning at the Safeway. Among the six killed in the attack federal judge John Role. The 63- year-old U.S. district court chief judge had served the legal system for nearly 40 years. He was a father of three and had five grandchildren. Also killed, one of the staffers of injured Congresswoman Giffords, Gabe Zimmerman. He was 30 years old. 76- year-old Dorwin Stoddard used his body to shield his wife who was wounded in the shooting. Dorwin did not survive.
Dorothy Morris and Phyllis Schneck, both also died that day, and the youngest victim was nine-year-old Christina Taylor Green, born on 9/11 2001. Christina loved politics, which is why she was there that day.
(on camera): Has life been different over the last couple of months for you?
RHEE: Yes, it's been different. I had a nine-year-old kid come to me in Home Depot the other day and ask me "Hey, are you Dr. Rhee? Are you that trauma surgeon?" So that connotates a lot of things, I think. And I'm appreciative of that.
GUPTA: You are to immersed in it when we last spoke, but now that you reflect on it, does anything surprise you?
LEMOLE: Yes, how quickly things go back to normal. How quickly everyone picks up the pieces and, obviously, lives have been irrevocably changed and we can't gloss over that fact, but here we're doing the work of the hospital every day, and businesses are back up and running, and we've all been changed, but life goes on.
GUPTA (voice-over): 14 were injured in the shooting, including Congresswoman Giffords.
(on camera): Randy, you were one of the first doctors to see her. She was brought in by EMTs, Cole, Wes, and Aaron. When you saw her first in that room, in that trauma bay, did you think that she was going to survive, or did you think there was a chance that she might not?
FRIESE: Well, she was shot in the head, and that is a very poor prognosticator not only for survival but for function. Just that history alone.
RHEE: When I was - when I got called by Randy about the situation, I think Randy was taken a little aback because he said the only word I said after he described things to me was fantastic. And that was because, I mean, we have - we have a huge head start on someone like that. Someone who can follow commands after being shot in the brain. You know you're going to do well.
GUPTA: Peter, you were optimistic almost from the start. You came out, I think, as soon as the operation was over and said she's doing as well as she could possibly be doing.
RHEE: She is in critical condition. The neurosurgeons have finished operating on her. I can tell you at the current time I'm very optimistic about recovery.
GUPTA: That's a lot of optimism.
RHEE: She was not going to die from the gunshot wound itself. Yes, something could always happen to anybody at any particular time, but she was going to live. Now, I don't know what function she was going to have later on, but I was very hopeful.
LEMOLE: After that operation I agree with Peter, there was never a doubt in my mind that she was going to survive. It was a question of how she was going to survive, and that's why I typically will be very reserved in my expectations.
GUPTA: The public has high expectations.
LEMOLE: They do. They do. Because, again, all too often we forget, and as this case sort of proved, once it's out of sight, out of mind, and then people check back in, why isn't she already back in Congress? I think it's very important to temper those expectations. It's not that she's not going to improve, not get better, not be functional, it's that we have to let her take it at her own pace.
GUPTA: Can you predict the future?
LEMOLE: I can't. Like I said always, I think the full range of functional recovery is possible.
GUPTA: You think she could be back to 100 percent?
LEMOLE: Well, no. I didn't say 100 percent. Functional recovery.
RHEE: Is she going to be the same as she was before? I think she is going to have permanent changes and thoughts and memories and feelings and emotions, so we'll have to see how that pans out in the future. GUPTA: Obviously, she's a congresswoman, Randy. Will she be a Congresswoman again, speak spontaneously, be able to address her constituents, all of that?
FRIESE: I think that's - has a lot to depend on her and her resolve and, you know, from what I gather from her family and her husband that I have met that, she's certainly very resolute.
LEMOLE: There was a lot of excitement that she was doing so well early on, but I kept on trying to drive home the point that this is a week-long, month long, yearlong recovery process. Neurologic injury is not like recovering from even a heart operation where you are up and about in a couple of weeks. I want to temper the expectations.
GUPTA (voice-over): But Giffords has defied the odds from the very beginning, giving signs to the medics, the doctors, the nurses and the therapists designed to save Gabby Giffords. She has never stopped fighting. Gabby can use her wheelchair. She can stand up on her own. She can even take small steps. She's learning to talk again as well. She says "I love you" to her husband. And often tells her doctors "I miss Tucson."
(on camera): You said (INAUDIBLE) measured by their ability to prognosticate, predict the future? What do you say?
RHEE: She's going to do pretty well, and I'll tell you, she's not going to be 100 percent. I know that for a fact. She has a scar on her head. She is going to have multiple scars on her, and what you see on the outside is also reflective of what goes on inside underneath if as well.
So while we cover it up, there are a lot of things that are permanently damaged that will not ever come back. But what she'll do is she'll adapt, and the human brain has such a capability of adapting that you will be amazed at what they can do.
