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SANJAY GUPTA MD
SGMD Special Report: Saving Gabby Giffords
Aired May 14, 2011 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
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 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 FEMALE: Investigators have the suspected shooter in custody.
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.
(voice-over): 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 (on camera): So you're sitting in the ambulance and looking out at this. We have some idea of what it must have looked like. But 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 --
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."
COLT JACKSON, SOUTHWEST AMBULANCE TUCSON: 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.
GUPTA: And what did you see? What were you looking for when you're starting to evaluate a patient?
JACKSON: I asked her if she could hear me. She squeezed my hand. She could communicate. She was alert to that sense.
GUPTA (voice-over): 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: 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.
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.
ROGERS: 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, you know, on her fingers; making sure that she got it all the way around.
ROGERS: 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.
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, and 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.
GUPTA (voice-over): Forty-four minutes after Giffords was shot and 13 minutes after leaving the Safeway parking lot, the medics arrive at the largest trauma center in Tucson.
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.
That bone right out of there.
GUPTA (voice-over): 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 right here. GUPTA: She survived the initial gunshot wound to the head, but was still in critical condition.
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.
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.
And 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: 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, and one right over here, which is just behind the eye.
This is a pretty classic place where you make a borehole 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. And 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. And 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.
GUPTA: Cause more harm than good?
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 (voice-over): Gabby never stopped fighting, and the progress she made just days after her surgery gave her doctors hope.
LEMOLE: 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.
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 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 at this point. 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.
"Saving Gabby Giffords" continues, inside her aggressive rehab. That's next.
GUPTA (voice-over): Gabby's recovery would continue a long way from the Tucson Mountains.
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 TIRR Memorial Hospital in Houston that would be asked to restore function and put Gabby back together again.
MEAGAN MORROW, MUSIC THERAPIST, TIRR MEMORIAL HERMANN (singing): 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.
(singing): 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 (voice-over): 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: Thirty 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.
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): As Congresswoman Giffords' husband prepares for his final mission to 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.
DR. RANDALL FRIESE, TRAUMA SURGEON, UMC TUCSON: 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. And I think he really was able to encourage her in very, very, I'd say, 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 -- was 30 years old.
Seventy-six- 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 9-year-old Christina Taylor Green, born on 9/11 2001. Christina loved politics, which is why she was there that day.
GUPTA (voice-over): Fourteen others were injured in the shooting, including Congresswoman Giffords.
LEMOLE: 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? And 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.
RHEE: Is she going to be the same as she was before? I think she's 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, you know, address her constituents -- all of that?
FRIESE: I think that's -- it 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, 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, year-long 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 a doctor's worth sometimes is 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 won't ever come back. But what she'll do is she'll adapt, and the human brain has such a capability of adapting that you'll be just amazed at what they can do.