Congressman Giffords Moves to Rehab
KATHLEEN PARKER, CO-HOST: Good evening. I'm Kathleen Parker.</s>ELIOT SPITZER, CO-HOST: And I'm Eliot Spitzer. Here are the questions we'll dig into tonight. Earlier today, Congresswoman Gabrielle Giffords was transferred to Houston, where her rehabilitation will begin. We'll ask two brain surgeons exactly how much will she recover, what specifically will it take to rebuild her brain? Plus, President Obama's State of the Union is just days away. What crucial issue will he almost certainly dodge? I'll tell you in a moment. And a Palin-free media? Is it possible? One Washington columnist is challenging his colleagues to ignore Mama Grizzly, including our very own Ms. Parker.</s>PARKER: Well, but first, it's been an amazing recovery so far for Gabrielle Giffords. Shot at point-blank range and in the head just less than two weeks ago, she's now out of the ICU and in Houston for rehabilitation.</s>DR. DONG KIM, MEMORIAL HERMANN: We're talking about a four to six-month process, regardless of how quickly somebody recovers, because it's a lot to do. And Joad (ph) will verify that, I think. There's still issues over the next week or two that we're going to be addressing. And so I think, overall, we're looking at months.</s>PARKER: What does the congresswoman's progress say about her hopes for recovery? The key question -- is a full recovery even possible?</s>SPITZER: Joining us from Los Angeles to discuss her injury and her treatment is Dr. Keith Black, head of neurosurgery at Cedars Sinai Medical Center and author of the book "Brain Surgeon." And here in New York is Dr. Stephan Mayer, head of neuro-critical care at Columbia University Medical Center. Welcome to you both.</s>DR. STEPHAN MAYER, NEUROINTENSIVIST: Thanks.</s>SPITZER: Dr. Black, let me ask you the question that we really haven't wanted to confront. We have seen this miraculous development in her capacity to walk and to respond to people. Cognitively, what can we hope will happen? Will she become once again fully functioning, a member of Congress, delivering those passionate speeches she used to deliver?</s>DR. KEITH BLACK, NEUROSURGEON: Well, we know that she's only 13 days out from her initial injury. And you know, the brain heals very slowly. I think that she's made progress over the last 13 days, with some very positive prognostic sign. I think that bodes very well for her future progress. And one would expect that over the next weeks and months, she will continue to improve. Obviously, you know, the doctors in Texas will need to evaluate her language abilities, her motor skills and will work on that in rehab hospital. But I think that we will continue to see progress. And the important thing to remember is that the brain heals very slowly. How she's doing a month from now I think will be a very important indication of how well she will do in the future. But she's going to continue to improve for one year, 18 months, two years out.</s>SPITZER: Show us what happened and what this recovery might be.</s>MAYER: Yes, well, you know, at the beginning of this compelling story -- remember, it was chaos. First we thought she was dead. And then I remember the first thing I was reading, they thought she got shot from behind.</s>PARKER: Right.</s>MAYER: And the military guys came and they figured she had been shot from the front. So we haven't seen the scans, right? Nobody's actually seen her yet because it's a very private time for her. And believe me, working with these patients, she doesn't look her best, right? But based on what we've been told, what I would guess is that the bullet really went up here and really was high up, right, out here in the left hemisphere of the brain, involving damage to the cerebral cortex as that bullet creates a wave of damage passing through. Critically, it avoided the brainstem down here, avoided key structures at the core of the brain, like the thalamus and the basal ganglia that are central. So what do these parts of the brain do? Well, this is the motor strip. This moves the right side of the body. This is century (ph) cortex here. So it's probably been undercut. And she's probably going to have some degree of paralysis or weakness or numbness on the right side. The language areas that we hear so much about are here and here, speech production and speech perception. That's what we don't know. Are these areas damaged or not? Actually, their precise location in individuals can be variable. Then there are other things we can expect to see. The frontal lobe here, a lot of this parietal lobe is what we call association cortex. So it doesn't do anything specific in terms of movement or sensing pain or something like that. It's a place where connections are made. But it's important, for instance, for planning what you want to do or for understanding where your body is in space or something like that. So to give you an idea, somebody, for instance, may have some weakness on the right. And they want to drink a cup of tea, and they're sitting there, looking at that cup of tea. They've got another extremity that works, and they're thinking, How the heck am I going to get that tea into my mouth. The simple act of picking it up and going like that you need this premodal (ph) cortex to do. And so these are some of the possible kinds of issues that she'll be confronting as she works with physical, speech and occupational therapy.</s>SPITZER: Dr. Black, we heard so much at the very beginning about the importance of time and speed, her getting to the trauma center so quickly. What role does that play in the day-to-day surgeries that you're seeing from a trauma perspective and the quality of care that most patients get?</s>BLACK: Well, we know that time is brain. And you know, the ability to get to a patient very quickly on the scene so that they're not left not breathing, so that they deprive the brain of oxygen, which will cause more brain damage, the blood pressure is maintained so that the brain continues to have blood flow -- those are all very critical. You know, as in the congresswoman's case, to be able to get to a level 1 trauma center, where neurosurgeons are available, to alleviate the pressure and bleeding inside the brain will save that precious, critical brain tissue so that, you know, the patient will have the maximum opportunity for recovery. I think those were all very, very positive factors in this case, and it's part of the reason why we're seeing such a good recovery, I believe, at this point.</s>PARKER: Part of her recovery depends on sort of being in a stimulating environment and having the brain connect again in certain ways. How important is that? And how do you create that environment? What are we talking about? Are we talking about listening to music? Are we talking about colorful environments? What exactly do we mean by that?</s>MAYER: Well, what you're talking about is what we call neuroplasticity. Parts of the brain are missing. They're gone. And what we haven't appreciated as well before that we do now is the brain can reconnect. It can regrow, sometimes to a remarkable capacity. Parts of the brain that are preserved can learn how to take over the function of areas that are now missing in her brain. But in order for that to happen, you have to be, as you're saying, in a really integrative, stimulating environment, what I call a recovery environment. And that's exactly what she's going to be starting now at Hermann Hospital in the rehabilitation setting.</s>SPITZER: Dr. Black, from the perspective of a neurosurgeon, somebody who has done procedures on the brain so many times, as you have, what happens now from a surgical perspective? What do you want to do to encourage or to help the brain regrow?</s>BLACK: Well, I think, just as was previously indicated, what you want to do is to put her in a situation where the brain gets a certain amount of stimulation, to allow the areas that are able to take over the function for the areas that have been injured, to have a maximum amount of recovery of those functions. You want to begin to sort of stimulate those language areas, those motor areas so that she can begin to make the maximum amount of improvement. The other thing, you know, from a surgical, you know, perspective is that, you know, we still are only 13 days out. We still have to worry about, you know, the risk of infection. We want to keep a very close eye on that that, that she's not developing any infection post- op. And the bone flap that was removed to allow the pressure not to increase will have to be replaced at some point in the future.</s>SPITZER: Is the concern about swelling -- the first couple days, we heard so much about swelling and the concern that that would put pressure on the brain and the skull. Has that now receded to the point where that is no longer the concern? And I know you have...</s>BLACK: Yes, that is really no longer a risk. You know, the maximum amount of swelling will occur on about day three to five after injury. At about day 13, 14, you know, the risk of that is very, very small at this time.</s>PARKER: Dr. Mayer, we know -- we've heard so many amazing things about Gabrielle. I feel like I know her -- Gabby. She reached out to her husband, who was sitting on the bed, and rubbed the back of his neck. So obviously, she has command of her limbs. She can tell her arm what to do, assuming that's what she intended to do. What else does that tell us about her recovery thus far?</s>MAYER: That story -- and another one I heard is that shortly after getting a tracheostomy, with some help, she stood up and looked out a window. I think that there's a lot to work with, basically. Another key thing we don't know is she's got this tracheostomy here, so right now, without the use of a special valve, we don't know how much aphasia she may have. Aphasia is difficulty understanding what words mean and knowing how to say what you mean, how to create speech. And we're only going to get that figured out as the rehabilitation team at Hermann starts to evaluate her spontaneous speech by putting a special cap on the trach and engaging her in conversation.</s>PARKER: One last question. How important is emotional support, and how is that perceived when you've got this kind of a situation?</s>MAYER: That's a great question, and I think it's important for people to know about this, as well. We do the job, and what we're really looking for are when the patients come back into the ICU smiling, back to themselves, rebuilding their life around their disability. And sometimes we see incredible, remarkable recoveries, and there's a common denominator. And what that is is a present, loving and supportive family. I can't say enough about how important it is to have your loved ones around there, helping you battle through and get better. And you know, we're seeing it all play out now with her husband and moving her home, I guess, to Houston and everything else. That's so important. And what we're seeing played out so dramatically now with Congresswoman Giffords -- the thing to remember is this happens every day to people with strokes and other forms of traumatic brain injury. But it's a great opportunity for people to learn about what happens, the importance of urgent treatment. Important to know that not all hospitals are alike for treating severe brain injuries. You need neurosurgery. You know need a neurological intensive care unit. You need specialty care, and then the rehabilitation, which, of course, at the end of the day, gets you where you want to be, which is back living your life with some good quality of life.</s>PARKER: All right. Dr. Mayer, Dr. Black, thank you both for being with us. So interesting.</s>BLACK: Thank you.</s>MAYER: Thanks. Coming up: Who is Paul Ryan, and why is he talking back to the president? We'll find out next.