Gabby

by Gabrielle Giffords

  “But President Lincoln was a big believer in fate. He said, ‘The Almighty has his own purposes.’ He believed there was a larger plan. I can only hope, as I told Gabby, that maybe it’s possible that this is just one small part of that same plan. This event, horrible and tragic, was not merely random. Maybe something good can come from all this. Maybe it’s our responsibility to see that something does.”

  I talked about what I’d seen: “From space you have a different perspective of life on our planet. It’s humbling to see the Earth as it was created, in the context of God’s vast universe.”

  I also described the growing memorial outside the hospital in Tucson. People had left all sorts of angels and other religious items on the lawn. “It isn’t a formal religious site, but Arizona has turned it into a place of prayer. It’s like stepping into a church, a place with heaven itself as a ceiling. That reminded me you don’t need a church, temple, or mosque to pray. You don’t need a building or walls or an altar. You pray where you are, when God is there in your heart.”

  I concluded with a short prayer that Gabby’s rabbi had said at her bedside days earlier. Then I told the three thousand people in attendance, “Please keep Gabby in your prayers and in your hearts. It is really helping. Thank you.”

  When I think back to that first month after the shooting, perhaps the most bittersweet moments were on Friday, January 21. That morning, Gabby left Tucson’s University Medical Center to begin rehabilitation at TIRR in Houston.

  She had arrived at the hospital in Tucson near death. Now here she was, very much alive, and ready to start the second phase of her recovery.

  She left the hospital in an ambulance, accompanied by a large contingent of police and an escort of motorcycle riders from the Veterans of Foreign Wars. This was the same group that Gabby had ridden with in 2009, when they escorted the newly discovered remains of fifty-seven Civil War veterans from Tucson to a cemetery in Sierra Vista, seventy-five miles away.

  This time, Gabby was in the ambulance, not on a Harley, but the old vets said she needed an honor guard, and they wanted it to be them.

  Hundreds of Gabby’s constituents lined the streets, applauding, cheering, blowing kisses, and waving American flags as the motorcade made its way to Tucson’s Davis-Monthan Air Force Base. Gabby couldn’t see them, but her ambulance driver rolled down his window so she could hear and feel their emotions. She understood. She cried.

  I was in a different vehicle, and I rolled down my window to feel it as well. As I waved to people, I caught glimpses of the signs they were holding, with messages such as “Godspeed Gabby” and “Tucson goes with you. Come home soon!” I deeply appreciated their support and affection for Gabby.

  On the flight to Houston—on a twelve-seat Challenger jet—Gabby and I were joined by her mom, Dr. Friese, her staffers Pia and C.J., her intensive-care nurse Tracy Culbert, two flight nurses, two pilots, and Lu Cochran of the Capitol Police. As a precaution, we flew at just 15,000 feet to prevent Gabby’s brain from further swelling, which is a risk at higher altitudes. Gabby wore her helmet, decorated with an Arizona flag. There were IV bags hanging from the ceiling, and Gabby was on a stretcher-bed, hooked up to monitors.

  Gabby’s father, Spencer, stayed behind. He later said that watching the plane depart from Tucson was the loneliest moment of his life.

  Gabby couldn’t articulate how she was feeling. She mostly slept or gazed out the airplane’s window as the clouds went by and the town she loved drifted farther into the distance. For what seemed like the millionth time that month, I thought about that question: What would Gabby want?

  I knew the answer because I knew Gabby. Someday up the road, sooner than later, she’d want to find her way back to Tucson, healthy and whole. She’d want to return to the Safeway at the southeast corner of Oracle and Ina. She’d want to set up a table and put out a flag and reach out her hand. She’d want to host a Congress on Your Corner to say thank you to her constituents and to ask them what was on their minds.

  CHAPTER SEVENTEEN

  The Parameters of a Miracle

  When Gabby arrived at the Texas Medical Center two weeks after she was shot, she was first taken to the Neuro Trauma Intensive Care Unit, where doctors evaluated her. Hours later, they told me that the medical team in Tucson was right: Gabby’s progress so far had been stunning. “Miraculous” was not an inappropriate description.

  The Texas doctors were relieved that the advance word on Gabby’s condition was so accurate, and they were pleased to see how alert and aware she seemed to be. Several of the doctors said she was recovering with “lightning speed,” but I was quickly learning that when it comes to a brain injury, speed is relative. The doctors were comparing her with others shot in the head, 95 percent of whom die almost immediately, and with the few who survive, most of whom are seriously impaired for life. Some never come out of a coma. Against those markers, Gabby’s recovery appeared to be in the top 1 percent. Still, she had a long, excruciating slog ahead of her.

  Intellectually, I understood this. I listened carefully to every doctor, trying to interpret the nuances of their word choices. They promised that Gabby would improve, but I wanted answers: By how much? By when? They resisted speculation. I let them know that my goal, and the goal of all of Gabby’s loved ones, was clear: We wanted 100 percent recovery.

  Doctors and therapists spoke of “the new normal.” We spoke of the old Gabby. We wanted her to get all the way back to the woman she was on January 7, 2011.

  Gloria, Gabby’s mom, was the constant optimist. Spencer, her dad, had great faith, too. Meanwhile, I’d taken on the role of taskmaster. I tried to make sure that all of us—hospital staffers, friends, immediate and extended family—were doing whatever we could to help Gabby fully recover. I wanted no impediments.

  From the start, Dr. Gerard Francisco, TIRR’s chief medical officer, tried to keep our expectations in check. The good news, he said, was that Gabby had a lot going for her. She was fit and healthy before the shooting, which would help in her recovery. She had already made phenomenal progress in the hours and days after her injury. And given her spirit and tenacity, she’d likely take the lead eventually and chart her own course.

  “It’s possible that she’ll return to herself in every way,” Dr. Francisco said. “But at the same time, we all should be realistic. That’s my mantra. We need to hope for the best and prepare for the worst. It’s always good to have a goal, but as we learn about a patient, we may have to revisit our goals to be successful.”

  Dr. Francisco, a native of the Philippines, was patient and soft-spoken. We were newcomers to TIRR, and he wanted to help initiate us into the language of brain-injury rehab. He warned us that patients who can’t live up to their families’ high expectations can feel like they’ve disappointed them. Patients often get depressed, worrying that they’re not trying hard enough. They blame themselves for their inability to recover physically and cognitively at the speed their loved ones want. As a result, some suffer setbacks. To be of help to a brain-injury patient, we were told, families need to find a way to balance pragmatism and optimism.

  “It’s vital to be positive,” said Carl Josehart, the chief executive officer at TIRR. “You have to remain hopeful. You have to push for greater recovery. But it can be problematic if you set expectations beyond what a person is physically capable of achieving.”

  I had trouble accepting the idea that Gabby might have limitations. But her journey through rehab, and her perseverance, would teach me that recovery is a step-by-step process. Brain-injury patients tend to improve, then they plateau for days or weeks, then they take another step up. None of us, including Gabby, could afford to lose hope during the plateaus. It was possible that the next step would be a very large and exciting one. But we had to recognize that this was a long-term process. It would take months. Maybe years.

  None of it would be easy. Gabby had to struggle to overcome her most daunting fears—that she’d end up forever locked inside herself,
unable to communicate. And I had to admit to myself that I had my own fears to face: Would my caregiving skills meet all of Gabby’s needs? Would our life together be severely diminished for decades to come?

  Perhaps the lowest moment at TIRR came in early February, before Gabby had even spoken her first word. One morning, she was in her bathroom and I was in an adjacent room, reading. Gabby’s nurse, Kristy Poteet, yelled for me. “Mark, you’ve got to come here! This isn’t good!”

  I rushed into Gabby’s room and then into the bathroom. She was sitting in her wheelchair, tears running down her face. She was hyper-ventilating, absolutely panicked.

  I saw how scared she was. I got scared, too. Through her tears, Gabby motioned with her left hand, waving it by her mouth. It didn’t take me long to figure out what was wrong.

  She had tried to speak, and she couldn’t. No word came out. She tried again to say something, anything. She was making some sounds, consonants and vowels, but they were few. She was mostly just stuck. It was an extreme version of what we all experience sometimes when we are looking for the right word but can’t find it. In her case, she couldn’t find any words at all and she knew it.

  She was having this panic attack because she had just figured out that she was trapped. Trapped inside herself. Her eyes were as wide open as I’d ever seen them and the look on her face was one of absolute fear. I could tell what she was thinking: that this was what her life would be like from now on, that she’d never be able to communicate even the simplest word.

  She cried and I cried with her. All I could do was reassure her. “It’ll get better,” I said. “I promise you. You’re going to get better.”

  I held her as the tears ran down her face. We were learning the parameters of her “miraculous” survival.

  What helped? I found it lifted Gabby’s spirits when I talked to her about how far she had come. I’d go over each positive step in her recovery, and she’d nod her head.

  She had virtually no memory of her two-week hospitalization in Tucson—the emergency room, the intensive-care unit, the presidential visit. Her only recollection was a faint one, of the day we took her on a gurney to the roof of the hospital so she could breathe some fresh air, get some sunlight, and enjoy the view of Tucson and the Catalina Mountains.

  By the time she arrived in Texas, she was more awake and aware. Her health was improving and her mind was clearing.

  On her third day at the Texas Medical Center, doctors were able to remove the tube from her head that had been draining excess cerebrospinal fluid. They said the buildup of fluid was no longer dangerous to her. They also arranged to insert a valve into her tracheotomy breathing tube so that when she was ready, she’d be better able to talk. She was capable of breathing on her own, but doctors wanted to wean her off the tube slowly. They also said she could swallow safely, and would soon be able to eat without a feeding tube.

  By Wednesday, January 26, Gabby was well enough to be transferred across the hospital complex to TIRR. She’d remain there, in rehab, for the next five months.

  Physical therapy began on the very afternoon she arrived at TIRR. Gabby wasn’t speaking, but she could follow commands. Her therapists worked with her to improve her conditioning and strength. She was asked to move her good left arm and fingers, to lift her left leg, to turn her head. It was clear that she had almost no ability to move the right side of her body. Doctors called it “weakness” rather than “paralysis,” and promised that some of the loss would be recovered over time.

  Within a couple of weeks, physical therapists had Gabby walking very slowly in the hallway, leading with her left leg, a brace on her right leg. They held on to her as she moved, and she often moaned in pain as she took each step. But she walked farther every day. Eventually, she’d push a shopping cart up and down the hallways.

  Gabby always had to wear her helmet, which she disliked. It was uncomfortable, hot, and awkward, but she needed to have it on her head whenever she wasn’t safely in bed or sitting in her wheelchair. Her missing piece of skull—it’s called a bone flap—was about the size of a person’s hand. Besides the dura mater, the membrane closest to the skull, only a thin layer of skin, stitched together, was protecting Gabby’s brain. Though her risk of having a seizure or a blood clot decreased every day, the risk of a fall remained. If she were to hit her head, the impact could set her back—or even kill her. (The skull pieces that had been removed on January 8 were stored in a freezer, but doctors thought they were too damaged to be reinserted. They’d likely have to use a ceramic implant when it was time to surgically replace the missing section of her skull.)

  Because of security concerns, Gabby had her own private room at TIRR, with the ever-present Capitol Police outside her door. It was a weird way to live, but over time, we all tried to help make her room feel like home.

  Gloria and Gabby’s friend Raoul placed a rock from Arizona on the nightstand by her bed. I placed another rock from her district underneath her bed and told her that, in a way, she was in Arizona. She liked that.

  Raoul and Gloria decorated the walls with photos that had been blown up into posters—our wedding, a shot of us posing at the Grand Canyon, Gabby and her Chevy Corvair. There were photos displayed of Gabby with her parents and other loved ones. She seemed to recognize every scene. Gloria, meanwhile, began passing the long hours she spent with Gabby painting portraits, in oil, of the hospital staff—doctors, nurses, therapists. It was exciting watching her work—Gabby’s bathroom was her art studio—and many of her paintings were displayed in the room. Eventually they were given to her appreciative subjects.

  Between 8 a.m. and 5 p.m., I’d head down to NASA to train for my space shuttle mission. Gloria and Spencer remained at the hospital, usually fourteen hours a day, and they reveled in each improvement they noticed in Gabby. On days when Gabby’s progress seemed to slow, hospital staffers encouraged her parents to be patient. Gloria said they’d try, but made no promises. “Of course we’re impatient,” she said. “We want our daughter back!”

  After the shooting, we had decided not to release any photos of Gabby publicly. We wanted to wait until she was looking and feeling better—even if that took months. I was nervous about media reports that the first photo showing the extent of Gabby’s injuries might be worth $200,000 to the paparazzi. I asked those who visited her not to bring cameras. For a while, I requested that hospital employees with cell-phone cameras leave them at the door before entering Gabby’s room. Everyone understood and complied.

  When people came to visit Gabby for the first time, I’d usually talk to them in the hallway. “You don’t need to speak loudly,” I’d say. “Gabby can hear just fine. And please don’t talk down to her.” My most important request: “Be positive.”

  One early visitor was an old friend of Gabby’s whom she has known for years and really loves. He’s funny, but a bit over the top, and he likes to be thought of as a rebel. Occasionally, I could be sensitive to how people interacted with Gabby. Maybe too sensitive at times, but this particular friend was too much.

  Gabby hadn’t even said her first word yet, and he seemed set on making sure that the word was “bullshit.”

  “Hey, Gabby,” he said. “If a nurse asks you to do something, you tell her, ‘Bullshit!’ When doctors talk to you, tell them all the same thing: ‘Bullshit!’”

  I’m not sure whether he was hoping the media would one day report that Gabby had chosen “bullshit” as her first word. I ignored the request the first time, but after hearing it to the point where I thought his efforts might work, I told him to knock it off and keep his bullshit suggestions to himself.

  The media announced that Gabby’s first word, uttered on February 7, came at breakfast time. She was eating yogurt and oatmeal and asked for “toast.” That update had been supplied by Gabby’s congressional office as a word she had said, and the media wrongly assumed it as her first word. Yes, Gabby did say “toast,” but a day or so before that she had actually said the word “what”—
flatly, as a statement, not a question. She said something that sounded like “whatwhatwhatwhat.” It appeared to me that the speech part of her brain was just beginning to boot up and that was the place it picked as a starting point. Gabby’s neurologists said the words that patients seize on initially are impossible to predict, but the repetition of words is very common.

  When Gabby said those first early words, it wasn’t as if a lightbulb went off in her head: OK, now she’d just start speaking. It was more a case of her willing one word, haltingly, out of her mouth. The next one would need to be willed with equal determination. But soon, she had a few dozen words. Within a couple months, she had perhaps a thousand words she could say. It just took great patience, for her and for the rest of us.

  She could mimic a word we said far more easily than she could initiate one herself. Doctors said that was an appropriate first step, and that her ability to repeat our words was an excellent sign of neurological recovery. That meant the area of her brain that controls primary language was working.

  By March, Gabby started creating phrases she deemed worth repeating. Sick of being confined in the hospital, she’d say, “Want out of here!”

  “Where would you like to go?” Gloria would ask her.

  “Tucson, Arizona!” she’d say.

  She also started saying, “No more Mr. Nice Guy!” It was her way of announcing that she was going to be more assertive. She wanted to make her own decisions about what she ate, what she wore, how long visitors stayed.

  Gabby was good at finishing familiar phrases. I’d say, “Thank God Almighty I am . . .”

  “Free at last,” she’d say. (This later became her mantra every time she walked out the door at TIRR. “Free at last, free at last. Thank God, I am free at last!”)

  If I gave her a hint, she could say the amendments to the U.S. Constitution. I told her, “The first amendment is free—”