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May 5th, 2011
12:49 PM ET

Gupta: How did Giffords survive?

Don’t miss “Dr. Sanjay Gupta Reports: Saving Gabby Giffords,” on Sunday, May 8 at 7 p.m. ET. The documentary reveals exclusive details of the extraordinary efforts by paramedics and doctors credited with saving the life of the congresswoman. You can also join Dr. Gupta for a LIVE chat on Twitter during the program.

While traveling around the country the last few months working on an upcoming documentary about Congresswoman Gabby Giffords, people would often stop me and ask questions. “How exactly did she survive?” was a common one. “Will she return to Congress?” was another. One woman stopped me at an airport by gently grabbing my forearm. “Gabby -  isn’t it a miracle," she stated, more than asked

As a neurosurgeon, I have taken care of many patients with gunshot wounds to the head. If you look at national statistics, only around 5 to 10% survive

From the moment Giffords was shot, the odds were stacked against her. So, how did she survive?  I want to take you through the critical analysis that takes place in the trauma team’s minds.

According to a recent article in the Journal of Trauma, there are three things that are most important when predicting survival in a patient like Giffords.

The brain's amazing ability to heal

First of all, was her blood pressure stable when she arrived at the hospital? According to her paramedics, Aaron Rogers and Colt Jackson, who cared for her within minutes of the shooting, Giffords' blood pressure did not drop, and there wasn’t continued significant bleeding. They told me they were able to place large IV lines in Giffords’ veins, and replace fluids while she was being transported to the hospital. Having enough fluids and a normal blood pressure means her traumatized brain was not simultaneously being deprived of oxygen.

Second, were Giffords' pupils reactive to light? You have likely seen doctors shining a light into a trauma patient’s eyes. Normally, your pupils shrink in response to a bright light, and dilate in darkness. That is why you squint when walking out into a bright day, until your pupils accommodate. If a patient has significant brain swelling, one of the early consequences is pressure on the nerve that controls your pupils. In that case, the patient’s pupils will not constrict in response to a bright light. Gabby Giffords had a badly swollen right eye, so it was difficult to examine. Her left pupil though, responded normally.

Another factor is something known as the Glasgow Coma Scale or GCS.

This is an important neurological exam that can be performed in less than a minute, in the field. It takes into account, motor movements, verbal capabilities and eye opening. A normal score is 15, and score of 3 is the worst. Anything above a score of 8 is favorable for survival. Take a look at the chart at the link above; Giffords scored around a 10. She was following motor commands, such as squeezing a hand or raising two fingers. 6 points for that. She wasn’t opening her eyes, so only 1 point there. She was, however, making grunting noises or incomprehensible words, and that was another 3 or 4 points.

There are a few other things Giffords doctors immediately noted when she arrived at the hospital. The gunshot wound was “through and through.” That can be a positive sign for two reasons. A relatively small exit wound means the bullet likely didn’t tumble significantly, nor “explode” in the brain. Also, if you consider a bullet has a finite amount of energy, you would like more of that energy to be dissipated into space, rather than inside the skull.

Even more importantly, the injury to Giffords was only on one side of her brain. Trauma neurosurgeons will always be quick to point out: A bullet that crosses the midline of the brain (left to right or vice versa) is a much worse injury.

Dr. Michael Lemole, the neurosurgeon who cared for Giffords, also made a critically important decision. He realized that although Giffords had not yet shown signs of brain swelling, it was inevitable given her injury. The brain, unlike other organs in the body, has no place to swell, given the rigid casing of the skull. So, Lemole addressed that problem by removing the left half of Gabby Giffords' skull, and leaving it off.  In the world of neurosurgery, it is a commonly performed procedure and to some degree is an example of medical lessons learned on the battlefields.

Of course, everything I just described gives you some real background on what helped Congresswoman Giffords survive. The other question, though: Can she return to Congress? Difficult to know at this point, but tomorrow, I will take you inside TIRR Memorial Hermann rehab hospital to try to give you an answer.


soundoff (37 Responses)
  1. dr umesh sharma

    an excellent article, very practical and full of facts which are easy to understand even for a lay person.

    May 5, 2011 at 15:20 | Report abuse |
  2. calvin

    Only by Go'd Grace and Mercy-None Other!!!!1

    May 5, 2011 at 15:45 | Report abuse |
    • Ben

      Sure wish God would have saved the 9-year old girl that died. Or any other the other hundreds of thousands of people who die every single day.

      May 5, 2011 at 15:54 | Report abuse |
    • Bert in UT

      Or that he had stopped the shooter in the first place. Why give god credit for good things, but not blame for bad? Lucky fellow, he gets to have it both ways.

      May 5, 2011 at 16:21 | Report abuse |
    • Mike, Cleveland OH

      I'll take talented neurosurgeons over a prayer circle any day.

      May 5, 2011 at 16:32 | Report abuse |
    • Slick

      God gave those neurosurgeons the gifts that they possess. God gave the shooter the free will to do the right thing. Unfortunately, the shooter took his free will and let a darker force influence his decision. Unfortunately, there was death and destruction. He'll get his just rewards...eventually.

      May 5, 2011 at 16:35 | Report abuse |
    • Dave

      Sure thing, Calivin ... just like it was by "God's grace" that she got shot in the first place, or that several other people were killed, including a 9 year old girl. Hallelujah!!

      What a crock ...

      May 5, 2011 at 16:47 | Report abuse |
    • Rhea

      Slick, if you saw one of your children about to kill or seriously harm another, would you let them exercise their free will, or would you stop it? Seems to me a decent parent would stop it.

      May 5, 2011 at 16:52 | Report abuse |
    • Michael

      @Slick – You are exactly right. God/Creator/Us puts us here with as much absolute free will as possible, given the forces around us. While I am also a believer in random chance, its also possible that Giffords was MEANT to survive this attack. We cannot know the exact details of the arrangement, but on a soul level Im betting she agreed to be shot in order to shine a light into the darkness. Bless her for that.

      May 5, 2011 at 16:55 | Report abuse |
    • Michael

      I feel like you guys are muddling up the idea of free will and Creators control over events. I beleive that life on this Earth is a school, and we are kindergarteners down here compared to our true soul selves. The most horrific events on this planet are Lessons to us on the higher planes. When someone says God protected Giffords but why not the little girl... it may well have been that it was in Giffiords soul contract to survive, but at a soul level the child decided to return to the higher planes. Hard stuff to grasp, but do a little research on the ideas.. some good stuff out there.

      May 5, 2011 at 17:00 | Report abuse |
    • erik

      @Slick ; So we're going to go ahead and just say, God gave those neuro surgeons the skills. We're not going to allow ANY of the credit to just go to the neuro surgeons for being talented and dedicated without influence of forces that may or may not exist? It's truly amazing she lived, and I'm not one to sway the Athiest ban-hammer here, but give credit where it's due, and why bring God into everything like this? If God exists, chances are has hasn't been doing much in a long time here or else he's just ignoring everything. If he doesn't, then you take away the credit these neuro surgeons rightly deserve, the aide who helped, and Gifford's own will power and health to fight through it.

      May 5, 2011 at 17:57 | Report abuse |
    • Brian

      The neurosurgeons executed their free will to go to medical school, study for most their lives, and apply that skill to this case. If some little kid came up and operated on her brain...that would be a miracle.

      May 5, 2011 at 18:09 | Report abuse |
    • Joe

      And by the grace of our evil god a kid with no political views on guns died. Some god you believe in or do you not know a kid died!!!!!!!

      May 5, 2011 at 18:31 | Report abuse |
    • CAW

      The world will never be truly free until the handcuffs of religion are disposed of once and for all.

      Why is it GREAT that she lived if you are religious? Is that punishment from god? I mean Heaven is supposedly a MUCH better place so isn't dying better?

      May 5, 2011 at 18:41 | Report abuse |
    • Anon

      If god gave us true free will he would be unable to anticipate our decisions and actions, therefore he would not be all-knowing or all-powerful, and therefore he would not be god. If god does know all of our thoughts, decisions, and actions, then choice and free will are simply an illusion-in which case do whatever you like, because you're already judged, damned or saved from the moment you're born.

      May 5, 2011 at 18:51 | Report abuse |
    • Bsquared59

      Who is this Go'd you speak of? Sell your computer and go back to school.

      May 5, 2011 at 19:56 | Report abuse |
  3. Johnny

    Yes, an excellent article, though we mustn't forget what the fellow, an aide I believe, did after she had been shot. He had had some medical training, and knew to keep her sitting up so that the blood didn't rush to her head and cause swelling. He is also a hero in this, and the whole outcome may have been different if he hadn't known what he was doing.

    May 5, 2011 at 16:12 | Report abuse |
  4. Katie

    The Congresswoman had luck and good training on her side – kudos to the aid who was on her team as well as to the medical team that attended to her.

    May 5, 2011 at 16:26 | Report abuse |
    • Joe

      How about no encouraging weapons of mass destruction at your rally?

      May 5, 2011 at 18:24 | Report abuse |
  5. chioma

    dis explanations were explicit and simple to undersatnd. She will recover fully by the grace of God.

    May 5, 2011 at 17:06 | Report abuse |
  6. Chris

    She didn't survive. It's a liberal conspiracy. Show me the photos! I have yet to see Mrs. Giffords since the supposed "incident", so where is she? If someone doesn't fly to my house with proof I will expose the whole conspiracy. Yes, this is how these start.

    May 5, 2011 at 17:09 | Report abuse |
    • manditorian

      So sad, but so true.

      May 5, 2011 at 18:06 | Report abuse |
    • CAW

      That actually made me smile.

      May 5, 2011 at 18:46 | Report abuse |
  7. Alex

    she survived due to the brilliant efforts of her aide, her existing health (generally good) and the skilled surgeons/doctors/medical staff/ thereafter...that's why!

    May 5, 2011 at 17:20 | Report abuse |
  8. NamCbtVet

    I have never seen Chris, therefore he/she does not exist nor deserves to.

    May 5, 2011 at 17:31 | Report abuse |
  9. Daveil

    Nice story, Gupta, but it would have made more impact a month ago.

    May 5, 2011 at 17:41 | Report abuse |
  10. mary

    Lets not forget the biggest reason she survived, is that she has access to the best medical care our tax dollars can provide.And on going rehabilitation.
    Something too many of us could never expect , because we simply couldn't afford it.
    The issue is not that I am not glad she has access to it.. The issue is that I am angry that the average person does not.

    May 5, 2011 at 17:45 | Report abuse |
    • Joe

      Lets forget the dead who cares about them, she is responsible for their deaths who cares if she lives.

      May 5, 2011 at 18:27 | Report abuse |
  11. Jean

    Money for the best health care 99% of us can't afford. Next question.

    May 5, 2011 at 18:09 | Report abuse |
    • Joe

      She Brought it on herself like a smoker, she loves guns, too bad!

      May 5, 2011 at 18:26 | Report abuse |
  12. Joe

    No the real answer is cause others got it worse. The real question is will she change her stance on guns? She got shot by the products she supports, too bad.

    May 5, 2011 at 18:11 | Report abuse |
  13. Joe

    And let the kid die. The kid with no opinion on gun control. Who cares let them die as long as our evil law makers live!

    May 5, 2011 at 18:29 | Report abuse |
  14. Randy

    God gave us Paramedics the hands that can save a life. Did it just the other day and I'm 52.

    May 5, 2011 at 18:38 | Report abuse |
    • CAW

      So it was god? You didn't have to do any training? No education on how to use the medical machinery? You can just miraculously save lives? WOW!!!

      May 5, 2011 at 18:48 | Report abuse |
  15. Padmanabham

    IIn the middle of a big desert, if you are standing next to an oasis you are a lucky one. Similarly, she happen to to be taken care by the right set of people all the way till today. She is a lucky one to be in the hands of the talented ones.

    May 5, 2011 at 18:51 | Report abuse |
  16. rob

    can she return to congress of course,they have proved over and over again you don't need a brain to be a congress person or senator just a low morale standard,be able to sell out your fellow americans and a bank in the bahama's.

    May 5, 2011 at 18:51 | Report abuse |
  17. zzzz

    God's blessings and technology.

    May 5, 2011 at 19:57 | Report abuse |
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About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.