A Medical Miracle

I believe that Congresswoman Gabrielle Giffords’ recovery, so far, is a medical miracle. This conclusion is not based on a single fact or observation, but rather a compilation of unlikely events that needed to come together quickly, in exactly the right way. for her to not only be alive but also responding to her doctor’s commands.

First, she was fortunate enough to have an intern who knew the rudiments of the emergency first aid that he learned in high school. But Daniel Hernandez went way beyond just clearing away the Congresswoman's blood and making sure that she was stable and still breathing, he also, somehow, knew to keep pressure on the wound and keep blood (and perhaps parts of her brain) from escaping.

Second, she was brought to the hospital within the “golden hour,” the first hour after the trauma, and was actually brought to the operating room within 38 minutes from the time of the shooting.

The hospital she was brought to, University of Arizona Medical Center in Tucson, happened to be a level one trauma center, with a top trauma surgeon with combat experience, Dr. Peter Rhee, and the great neurosurgeon who operated on Giffords, Dr. Michael Lemole.

Third, the path of the through and through gunshot appears to have been somewhat superficial, high up in the brain, (causing fractures of the upper skull), missing the so-called “eloquent” areas of the brain that control speech and movement. The surgery also reportedly revealed little blood, bone, fragments of the bullet or debris of brain, all of which can lead to swelling and worsen outcome. 5 % of patients with gunshots to the head survive, but most of these are unresponsive and stuck in comas. Prognosis is much better (after many months of rehab) in cases like Giffords, where vital structures deep in the brain are spared and the bullet only passes through one side.

Finally, the greatest concern in the post-operative period is swelling of the brain itself. The neurosurgery team is expertly treating this concern by having removed a portion of the skull to allow the brain room to expand, while at the same time ventilating her rapidly to blow off carbon dioxide which helps keep the brain from swelling. In such cases, diuretics can also be useful.

Through it all Congresswoman Giffords continues to respond to commands. A striking and optimistic fact in and of itself, as divine intervention when viewed in the larger context; a sum of all the great luck and skill she's experienced so far.

Marc Siegel M.D. is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News Medical contributor.