CRITICALLY WOUNDED: Arizona Rep. Gabrielle Giffords survived a point blank gunshot to the head on Saturday
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People rarely survive gunshot wounds to the head, but so far Arizona Rep. Gabrielle Giffords, shot point-blank in the back of her head on Saturday, has held on. Monday morning her doctors indicated they were "slightly more optimistic" about her prognosis. In the wake of this brutal tragedy it is worth recognizing the series of highly fortunate events that led to Giffords's continued survival.
The most important predictors for how well a victim will recover from a gunshot wound to the head are the type of bullet and its travel path once inside the brain, and Giffords was fortunate on both counts, says Keith Black, chairman and professor of neurosurgery at Cedars–Sinai Medical Center in Los Angeles. The bullet, reportedly fired from a Glock 19 9-millimeter, semiautomatic handgun, entered the left side of the back of her head and traveled through her brain, exiting through her forehead. This "through and through" path indicates that the bullet was probably not of the variety designed to expand or break into smaller fragments once inside the body, which would have caused a much severer injury. Further, the wound would have been much more damaging had the bullet ricocheted off the inside of her skull or if it had remained lodged in her brain matter where it could "migrate around" and cause additional harm, Black says.
As the projectile traveled forward, it remained in her brain's left hemisphere, avoiding crossing through the middle to the other side, which, according to Black, could have caused catastrophic injury. The bullet's trajectory was also high enough to apparently avoid certain crucial left-hemisphere structures, including areas responsible for language processing—a notion reinforced by reports that Giffords has been responsive to commands.
Immediately following the injury, it was not only the quality but also the speed of the care Giffords received that probably saved her life. "As we say in neurosurgery," Black says, "time is brain." Crucially, one of Giffords's aides positioned her so that blood did not impede her breathing. Subsequent transport to the level 1 trauma center at the University of Arizona’s University Medical Center in Tucson, and the care given once she arrived, was very rapid. Reportedly, only 38 minutes transpired between the time she was injured and when she entered surgery.
That the facility was fully equipped to handle such an traumatic injury was key. "It was very important that there was no delay," once she arrived at the hospital, Black says, adding, “If she would have had to be transferred to another facility, her prognosis probably would not have been as good"—a fact, he notes, that speaks to the need for more level 1 centers across the country.
Once in surgery, neurosurgeons removed bone fragments, worked to stop the bleeding, and then performed an operation called a decompressive hemicraniotomy. The procedure, which has become popular in the past decade or so, especially in the context of battlefield brain injuries, entails the removal of a portion of the skull to allow room for the brain to swell. Brain swelling creates increased pressure inside the cranium, and if part of the bone is not removed the pressure disrupts a vital differential between blood pressure and the pressure in the brain. When it comes to swelling, Black explains, "minutes count," and the fact that the pressure in her brain was relieved so quickly is essential to her relatively positive prognosis.
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19 Comments
Add CommentIt is not clear that the trajectory missed the speach center.
Reply | Report Abuse | Link to thisThe info we currrently have only indicates that she is 'command responsive' which does not require the speech center although it may indicate good cognitive function.
I suspect that if the path were high enough that little damage would be done although the exit damage is said to be in the pre-frontal and that could be an issue.
To vendicar - this is probably not the right place to post complaints about politcal behavior. It is not clear what you might mena by 'She is dead and another woman exists in her place.'
This seems like a fairly unfeeling statement. Think of her family.
The concern here is for a woman unfairly injured by someone who appears to be quite unstable. The discussion is for and about the hope that she will recover completely. Politics can wait.
I think vendicar was referring to the effect of a traumatic brain injury of this magnitude causing a profound and irreversible change in personality; such that the original personality is gone (dead), and the remaining personality is a new composite of the old, the altered, and the new.
Reply | Report Abuse | Link to thisHaving observed this effect in many people, I have to agree with him. The Gabrielle Giffords we all knew and admired is most likely dead, and a new personality (person) will arise in her body; assuming she survives. Her husband, and immediate family will likely be the persons most adversely effected by the change.
My point exactly - there is not enough information to assume this. Besides, the description of the damaged areas would pretty much preclude this type of injury.
Reply | Report Abuse | Link to thisWe really need to not second guess the doctors. We have to accept their statement of 'cautious optimism'.
I understand your statements but I, personnaly, feel they are not helpful at this time. We have enough half-baked stories running around at this time.
I'm not worry about bullets and brain damages in this case. I'm worry about peace and security for us and our children. No peace and security. Gabrielle Giffords herself would think like that. And anyone in this country should.
Reply | Report Abuse | Link to thisAccording to the writer there are several coincidences associated with Ms. Gifford’s severe injury.
Reply | Report Abuse | Link to thisWe learn that the bullet that entered the Congresswoman’s head was of the “right variety”, travelled through the “right part of her brain”, kept going, “neither ricocheting off her skull nor lodging in her brain”, “remained” in the left hemisphere, and “avoided” certain “crucial structures” on the left side of the brain.
The writer admits that “people rarely survive gunshot wounds to the head”, and adds tellingly that “immediately following the injury, it was not only the quality but also the speed of the care Ms. Gifford received that “probably” saved her life. This seems to imply that had Ms. Gifford been living in any number of other places where there is no “Level 1 trauma center” like that at Tuscon’s University Medical Center she would almost certainly not have survived. Another major coincidence.
I am aware that scientists leave no room for “miracles” hence the writer of this article would probably tend to accept Ms. Gifford’s initial survival of the injury as a very fortunate confluence of coincidences. I wonder how Ms. Gifford will see it if/when she pulls through (and I am praying that she will).
Of course, we know prayer is not scientific either, but what is one more coincidence when innocent life is at stake?
Since when does a coincidence = act of god?
Reply | Report Abuse | Link to thisThink of it this way; how many people have died of gunshots to the head? Thousands, if not hundreds of thousands. How many people have survived a gunshot wound to the head? Not many compared to those who died.
So everytime someone survives a shot to the head, we assume God saved them? Why didn't he save the others? How do you know it was God? If you look at it statistically, there has to be a number of people who survive gunshot wounds to the head on average, this is one of them. God does not exist.
You may as well relate your 100% success rate at not being killed by a car to God as well.
If she had died, you wouldn't be invoking God. I wonder why. On that point, why does the Pope need a bullet proof car? Surely if God wants him dead, he'll be killed no problem. That, in itself, is admittance that there are no deities.
You sound kinda like the person who prays for a job promotion thinking God will help him even though at the same time millions of starving children of all faiths the world over are praying and they never receive any help. Even though this is an emotional issue, there's no need to invoke superstition Steve.
Reply | Report Abuse | Link to thisThose of you who graciously responded to my comments believe Congresswoman Gifford is just plain lucky to be alive, and as I intimated in my comments, if that is your position I have no quarrel with you.
Reply | Report Abuse | Link to thisYou may agree with me that people on both sides of this ageless philosophical divide often see exactly what they are looking for, or else let us agree to disagree without being disagreeable.
My final word on this is, call it what you will there may be more to events like these than you are prepared to see. As for me, whenever a series of coincidences are strung together the way they were in Ms. Gifford's tragedy I, respectfully, prefer to see it the other way.
Some people look at all the suffering in the world and ask where is God? Others look at all the good things in the world, and believe me there are many, and say thank you God! Whatever gets you through the day, yes?
Permit me to relate two stories. One is about a man who fell off a construction scaffold some three storeys and ended up with a stell rod through his body. "Coincidentally", this rod missed every vital organ. It was as though someone had carefully threaded the rod through his body. He, being a religious person claimed a miracle.
The other story concerns a friend of mine who stands in a crowd watching the total wreck which was once her prized possession and from which she had survived without a scratch a few days earlier. The crowd that had gathered, knowing that the driver had escaped unscathed from the ball of metal before them, scratched their heads in bewilderment wondering how in the world anyone could have gotten out of the car, and offering their opinions.
The concensus of the scientific was that the driver must have been thrown or jumped out before the car struck, since there was no other possible way to escape the ball of metal the car had become. The driver though, remembered being in the car right up until impact.
She stood in the crowd, listened and laughed to herself. Up to the time of her spectacular escape she, too, believed only in coincidences. However after her great escape she told me she had started believing in other "realities".
Have a great day guys! I appreciate the feedback.
When tragedy strikes, people often wonder: « If God exists, why did he allow this to happen? »
Reply | Report Abuse | Link to thisIt is good to remember that sometimes, we allow some level of injury to prevent further injury. Precipitous action might affect ongoing solutions. In the same vein, God’s permission of evil is paralleled by positive actions aimed at saving millions of lives.
Mike, great article. Very interesting point especially about the type of bullet -- an example of how an unsophisticated (I presume) assailant may be preferable to a craftier one.
Reply | Report Abuse | Link to thisReading your piece I am reminded of the opening line from Woody Allen's "Matchpoint" - "The man who said "I'd rather be lucky than good" saw deeply into life. People are afraid to face how great a part of life is dependent on luck. It's scary to think so much is out of one's control..."
Based on the way bullets tend to behave when shot into skulls, those that enter the skull case tend (if adequately energized) to blow out the other side taking most of that side of the head with it (like JFK)... or tend to bounce around inside grinding up brain. Both scenarios are seldom survived.
Reply | Report Abuse | Link to thisHowever, lower energy rounds or a glancing shot from a more highly energetic bullet can pass through the skin, fracture the skull, bounce laterally and dissect between skull and skin before exiting via a fairly small exit wound often on the opposite side of a victim's head.
Because she's doing so well and wasn't unconscious immediately, it's my guess that the latter is what happened to Giffords. Indeed, only today we find that what they thought was the exit wound on her forehead was actually the entry wound, and vice-versa, so both are likely small. So what brain injury incurred may have from fractured and imploded skull fragments... in which case she may recover entirely because of good docs, prompt cranial decompression and top-tier supportive care. If this is the case she was also lucky she wasn't hit in the lower face -- shots in the lower face are often survived, albeit usually with lasting functional and esthetic morbidities.
Worth praying for this latter scenario anyhow; the clinical signs she's been reported to have exhibited seem to support this scenario. And happily this could result in minor or no lasting morbidity to Giffords.
Yet I too share others' concerns about the amount of media given the Giffords' drama (as well as the widespread messaging unfairly implicating conservatives... Jared was a Marxist if anything at all -- that compared with that given the other victims, dead or injured.
Obama gave a good speech tonight, but it's uncomfortable that he used Giffords' early signs of recovery ("... I'm told she opened her eyes for the first time shortly after my visit..." ... ah, maybe she's increasingly less sedated now that she no longer has a breathing tube in place, Barack...) seems more than casually opportunistic.
But what to we expect, I suppose. Snakes tend to bite and politicians like Barry are always all about #1.
Steve, you seem like a nice guy. Now that your friend believes in other "realities" has she managed to find out from god why he wrecked her car? Maybe it's just showing off? cdey20 explained it nicely, have another read. Not to be 'disagreeable', as you rightly suggest but superstition does hamper progress in a serious way
Reply | Report Abuse | Link to thisYou say: "Crucially, one of Giffords's aides positioned her so that blood did not impede her breathing."
Reply | Report Abuse | Link to thisCould you give more details about how to do this, and also how to know when it is urgently needed to move a victim vs. the usual advice to avoid moving them in case there is any kind of spinal or neck injury?
If there's a positive, practical lesson to take from this, let's at least do that.
Hi, TruthHound. Thanks for the response.
Reply | Report Abuse | Link to thisI know many people who do not believe in God, and I am happy that I can count some of them among my many friends.
Since no one has yet been able to give my friend a believeable or indeed a "scientific" reason for why she survived a car which she says impacted while she was still in it and was a total wreck, she believes, and I concur, that in all likelihood there probably are some things science cannot explain fully if/or at all.
Coincidence? Luck? Chance? Just one of those things that happens to one in a million people? Are these not all guesses? And if we are going to play guessing games what makes one person's instinctive, educational or philosphical guess better than another's?
P.S. I said that since her survival my friend now believes in other "realities" not that she now talks to and/or receives answers from God.
Steve, I've got an allegory for you.
Reply | Report Abuse | Link to thisA now well-known internet investment scam involves the eventual victim getting an unsolicited email from a "broker" telling him to watch Acme Company's stock for the week. The following week, another email comes, pointing out that Acme's stock went up that week and telling him to watch Consolidated Company's stock for the following week. This continues for another few months, until the "broker", having shown 100% success rate, asks for funding for the following week's big winner. Of course, whether that company's stock goes up or down doesn't matter, because the "broker" is long gone with the money.
How does it work? The "broker" sends out thousands of emails, half stating that Acme will go up and half stating that Acme will go down. Depending on what Acme does that week, he sends out the follow-up email about the next company's stock, but only to the right half. After a couple of months, he's down to maybe only 250 email addresses, but what those people have seen is that he's been amazingly right every single time.
We are all lucky to still be alive and conversing on this comment thread. Everyone has had incidents in their past that could have killed them but didn't. You might believe that a "broker" in heaven is calling the shots, and your luck is in being on his short list, but in reality you've just gotten the answers you like so far (like staying alive), so you want to believe in him.
Thanks for the "allegory" nerdygirl. The kind of internet scam you related are a dime a dozen.
Reply | Report Abuse | Link to thisBut do you really believe that gullible persons being duped over the internet is equivalent to someone walking out of a smashed up vehicle scar free?
If you do then I want to respectfully suggest that you are the stuff of which real "superstitious" people are made.
A couple of things. Only the left brain has a speech center, but both sides can understand language, though they interpret it somewhat differently.
Reply | Report Abuse | Link to thisI haven't read all the comments, but I recommend Jill Bolte Taylor's book My Stroke of Insight. She had a left brain stroke, so her experience is probably a lot like Giffords'.
Reading comprehension fail. Cognitive thinking fail. If you're not willing to read or think at an adult level, there's no point having a discussion with you.
Reply | Report Abuse | Link to this@jvsciguy - two areas in the left hemisphere participate in language processing and speech (brocca's area and werneke's area, respectively). in order for a human to respond to verbal commands their brocca's area must be functioning correctly. so the doctors are correct that at least some of her language comprehension capabilities are intact. also, there is strong scientific evidence that some people process language in the right lobe of their brain (though this is rare).
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