Gabrielle Giffords's Road to Recovery

The scheduled launch this month of the space shuttle Endeavour has aroused public interest at a level not seen since NASA's glory days—not because of the mission itself, but because of one potential spectator at the Florida liftoff. Since the Jan. 8 shooting spree in Tucson that killed six people and gravely wounded Rep. Gabrielle Giffords, it has been the goal of her family and doctors that she attend the launch of the Endeavour, commanded by her astronaut husband, Mark Kelly. For Gabby (as she is now known by all), it would be a symbolic moment of triumph. For the country and the world, waiting expectantly and hopefully, it would be the first glimpse of the convalescent who has become America's Congresswoman.

Over these last months, Giffords's difficult path to recovery became that rarest thing: an ongoing good-news story that the public devoured and the media were happy to provide. From the start, details of her actual condition were scant, but her family and staff, colleagues and friends provided enough fresh tidbits to feed the news cycle. The first big news was delivered by the president himself—"Gabby opened her eyes for the first time," Obama announced at a Tucson memorial service, which had the feel of a pep rally—and in the weeks that followed, stunningly good news came forth from Tucson in a steady flow. Giffords touched her husband's face and reached up to give him a neck massage. She spoke her first word, asking for "toast" for breakfast. She was reading get-well cards and scrolling through her iPad. She was able to stand and was even taking a few steps.

Dr. Peter Rhee, the trauma surgeon in Tucson who early on announced that "she has a 101 percent chance of surviving," determined in February that Giffords was ready to be transferred to the Memorial Hermann hospital in Houston. Her new neurosurgeon there said she "looked spectacular," and soon, after she moved to The Institute for Rehabilitation and Research (TIRR) in Houston, came word that Giffords was conversing and even singing.

One effect of all of this good news was to dampen overt speculation about Giffords's political viability. In March her Washington friends held a political fundraiser for her, fetching about $125,000 in pledges to support her 2012 reelection campaign. The New York Timesreported that the Giffords team was actively advancing the prospect of a run for departing Republican Jon Kyl's U.S. Senate seat. One of Giffords's Democratic House colleagues, Rep. Shelley Berkley of Nevada, visited Giffords in Houston and emerged to say that she was eager to return to the House. "She's raising money now," Berkley told a Las Vegas television reporter. "She's running a campaign from the hospital." Earlier this month Daniel Hernandez, the young Giffords intern who rushed to her side after the shooting and accompanied her to the hospital, told the Arizona press that he'd had several telephone conversations with his boss, some of them "lengthy."

In fact, a number of NEWSWEEK interviews—with Giffords staffers and friends who've visited her, doctors in Arizona and Houston who have treated her, and her husband, Mark—suggest that a more measured assessment of her progress is warranted.

Michael McNulty—scion of a prominent Arizona Democratic family (his father, James, was the last Democrat to hold Giffords's seat), a close Giffords friend, and chairman of her last campaign—describes an atmosphere of concern and hope that has led at times to wishful thinking within the Giffords circle. "I don't know how prevalent this is, but I skip straight to this space, which, like some 6-year-old kid that thinks believing in something hard enough will make it come true, believes that she will come back and that she will make a difference in our lives," McNulty says. "And, probably for my own self-defense, I am unable to entertain any other scenario." McNulty and his wife, Linda, have visited Giffords in Houston, and he knows that all the rosy reports have raised public expectations. "It does seem to me, trying to be objective, that the reports of her recovery are so cheery and optimistic that people are going to have this expectation that it won't be another 18 months before they see her," he says. "They're going to want Gabby to show up in front of the cameras sometime. I don't know when that is."

Mark Kelly has been steadfastly optimistic about his wife's healing, voicing confidence from the earliest hours after the shooting that she would somehow achieve a complete recovery. It was Kelly who raised the prospect of Giffords attending his launch, now scheduled for April 29, and he remains hopeful that she will be able to make the trip. In a conversation with NEWSWEEK, however, Kelly seemed inclined to cast his wife's recovery in a more realistic perspective than has been suggested by news reports. He noted that her doctors have not yet approved the trip to the Kennedy Space Center, and that, even if they do, Giffords will be kept behind a wall of privacy, away from the eyes of the public and press.

Asked when he thought his wife might make her first public appearance, Kelly responded, "I don't know. You know, that's going to be up to her." He then added, "I think that's months—and not weeks—away."

When members of the Giffords medical team discuss her progress with reporters, they are constrained by patient-privacy laws and by the specific instructions from Giffords's family and staff. Before the team held a press conference last month (the first since February), the boundaries of permissible information had been carefully negotiated, and the result was a generally upbeat report featuring many superlatives but few details. Dr. Dong Kim, the neurosurgeon who drained excess fluid from Giffords's brain when she arrived from Tucson, reported that she was progressing in "leaps and bounds," and that she was starting to walk and show an ability to express herself that was "a constant and wonderful thing."

Reflecting on that media event, Kim tells NEWSWEEK, "I can understand how somebody listening to us might say they expected her to show up and be normal. But if you polled a bunch of neurologists or neurosurgeons as to what we were saying," he goes on, "they would understand exactly what we were describing and what we think a good recovery means."

First and foremost, the nonspecialist should understand that when Kim and the other doctors on the team speak of progress, it is in relative terms, given that the patient has suffered severe brain damage. " 'Leaps and bounds' means much faster recovery than the average patient from a similar type of thing," Kim says. When he says that he is having conversations with Giffords, he means that he has asked her a question ("How are you today?") and that she has answered ("I'm better"). Kim adds that there is a bottom line for all such patients, whatever their recovery curve. "If somebody has a severe brain injury, are they ever going to be like they were before? The answer is no. They are never going to be the exact same person."

Dr. Gerard Francisco, the physiatrist in charge of the Giffords medical team, says he is quite pleased with his patient's progress, although he acknowledges that outsiders, especially the media, might be misinterpreting what the doctors and therapists are trying, however circumspectly, to describe. "It's how we measure the change," Francisco says. "Some people will expect changes to be big. I'm happy with small changes, as long as I see these changes every day, and that's why I'm very encouraged. Some people would like things to get better within an hour, within a day, within a week. Rehab is not measured that way. It is a long-term process."

What Francisco and his rehab team aim for is an optimized "new normal" for each patient. "Everyone around her needs to understand, hey, this is a different situation," says music therapist Meagan Morrow, who is working with Giffords. "After you have a brain injury, you are a different person. It doesn't matter who you are."

For a politician such as Giffords, one key ambition of the rehabilitation process is helping to restore the ability to speak. Giffords speaks haltingly, stringing together three- or four-word responses to questions, and is beginning to formulate entire sentences. Morrow is working to help her recapture the ability to use language through song—the rhythmic strains of a familiar tune, such as "Happy Birthday," triggering compensatory language activity in undamaged parts of the brain. "Language is messed up…But the brain can make up for itself. What doctors have found is that whenever you sing a song, the motor areas are lighting up, the emotional areas—all these different parts of the brain are working to get that song out. So, I'm going in through another way, to create a new pathway to language."

Because of the near-mystical way in which the brain heals itself, it is impossible for doctors to predict precisely what the new normal ultimately will be for a given patient. Even so, Kim, the neurosurgeon, remains optimistic. This is partly because the bullet that went through Giffords's brain injured the left hemisphere, which controls speech and movement on the right side of the body. Partial paralysis may result, but in the context of recovering from brain injury, doctors place less emphasis on that than on other factors. "Motor weakness, for example, is not that big a deal, compared with cognitive things," Kim says. "So, first of all, is your personality going to be like it was before? Are you going to have the same kind of mental abilities, and think through things, and understand? And the social-relationship part—how sensitive are you to other people's emotions? Do you want to relate? A lot of that function, it turns out, is in the right side of the brain."

In Giffords's case, the answer to Kim's questions about cognitive ability is an emphatic yes. "We joke around, and I tell her all the funny things that happen in Washington, and she laughs," says Pia Carusone, Giffords's chief of staff. "When we say her personality is there, I mean, she's like 100 percent there." Carusone, who travels to Houston each week, says that Giffords communicates with her through "a combination of body language, personality, and speech. It's some words, it's expressions on her face."

At times, members of her family and staff have had to try to surmise her wishes, asking themselves, "What would Gabby want?" They also have had to decide what to tell her about what happened and when. In the early weeks of her recovery, Giffords apparently believed that she'd been involved in an auto accident. Her family, friends, and staff carefully censored themselves when visiting her, avoiding any talk of the horrific events of Jan. 8. When her Arizona staff made a best-wishes video to send to Giffords, her district director, Ron Barber, who was severely wounded in the attack, carefully positioned himself on-camera to disguise his injuries.

Soon after Giffords was transferred to Houston, Kelly consulted with the doctors there about what he should tell her. ''Her neuropsychologist at TIRR early on talked to us about the importance of her knowing what happened to her," he recalls. "I mean, it's important for her recovery." But Kelly still grappled with how much to tell her. He visits his wife every morning, and, when she has a break from her rehab routine, he reads her the newspaper. His custom had been to censor himself as he read. But one morning a few weeks ago, Giffords could see that Kelly was skipping over some material, and she grabbed at the paper. He decided then to tell her that she had been shot.

"So she knows why she's there, and what her injury is, and some of the details about her situation,'' he says.

But Giffords still doesn't know everything. She doesn't know that among the dead were a 9-year-old girl, her beloved young staffer, Gabe Zimmerman, and her friend, federal Judge John Roll. "When she starts asking for more details, we're going to tell her," Kelly says. "But she hasn't asked that specific question yet."

"The doctors just basically said it seems as though she's able to understand everything, but she's not able to speak at the level she wants to yet," says Carusone. "So telling her something as tragic as this, without her being to formulate the exact, complex follow-up questions she wants to, is not fair."

She is surprised to hear that she is an international news story. "When I tell her what the level of interest is in how she's doing and her recovery, she looks at me like I'm crazy," Kelly says.

With time, the Giffords circle has been able to elicit a response from her on one key matter: whether she wants to attend Kelly's shuttle launch. "There are some things that you can get out of her that are very clear," says Carusone. "You can talk to her about this: 'Do you want to go see Mark's launch?' 'Yes.' She wants to go."

The fact that Kelly will command the mission is, in itself, a piece of good news. Immediately after the shooting, NASA put a backup crew member in his place. "I figured Gabby would be in a coma for four to six months, and it never would have been discussed," he says. But during that period, his team held on to the hope that he would rejoin them. "They were the ones who were optimistic and saying, 'Oh, yeah, you're gonna be back, and this is somehow gonna work itself out.'?"

Giffords's political future was a topic of conversation on the evening of Jan. 6, after she was sworn into the 112th Congress. Over supper with Carusone and her political consultant, Rodd McLeod, she reflected that it was a bad moment to be an Arizona Democrat. The party had lost every statewide race in November, and the 5–3 Democratic advantage in Arizona's congressional delegation flipped in favor of Republicans. Giffords had barely held on to her House seat after a bruising campaign against her Tea Party–backed challenger. Looking ahead to 2012, she said she was not inclined to challenge Republican Jon Kyl for his Senate seat, and with good reason: a Democratic poll a few months earlier had shown Kyl beating her by 14 points.

The next day, Giffords headed to Tucson, where, on Jan. 8, the calculations all changed.

She had come home to attend a friend's memorial service and planned to return to Washington on Sunday, Jan. 9. Because of the quick turnaround, her staff hadn't arranged any political events for the boss, but Giffords, with Saturday morning free, didn't want to waste it; she asked her Tucson staff to schedule a "Congress on the Corner" meeting with constituents.

The chore of quickly pulling it together fell to her district chief, Ron Barber, and his young protégé, Gabe Zimmerman. They chose a familiar venue, the Safeway store near Casas Adobes, where Giffords had held her first such event. There'd be no notice of the event in the local papers, so the staff sent out a Giffords robo-call to area residents, including Amy and Randy Loughner, who lived five miles from the Safeway with their son, Jared.

On Sunday, with their boss in a coma, and Zimmerman among the six dead from Jared Loughner's killing spree, Giffords's team convened at a staffer's house and considered how to proceed. Barber, who'd taken two bullets in the shooting, called from his hospital bed, down the corridor from Giffords. "I said, 'You know, we have to be open on Monday morning,'?" Barber recalls. "And they all laughed. They had already planned to do it." The Giffords district office opened at 8 a.m. Monday, and the staff has been going full-bore ever since.

An entity called "the office of Gabrielle Giffords" (as the steady flow of press releases referred to it) effectively became the representative for the Eighth District of Arizona. The staff's caseload actually increased after the shooting. On the Hill, the staff suggested questions that could be asked on her behalf by Rep. Adam Smith, her colleague on the House Armed Services Committee, and helped to shape legislation that another colleague, Rep. Ted Poe, introduced, crediting Giffords.

The Giffords team also began to consider the political calendar ("You never really stop thinking about it," one aide says). Giffords had already filed as a candidate for her seat in 2012, as had her last opponent, Republican Jesse Kelly. Then, on Feb. 10, Kyl announced that he would not seek reelection to the Senate. Rep. Raul Grijalva, Giffords's colleague in the Arizona delegation, voiced what many Democrats were suddenly thinking: a Giffords candidacy was "a distinct possibility…I think she would be formidable." Few Democrats, at least publicly, were inclined to disagree.

Giffords was certainly well positioned—she had an ally in the state party chair, and McLeod, her political consultant, was running her district office while Barber was mending. It was impossible not to notice that a remarkable thing had happened: although she was completely unaware of it, the wounded Gabby Giffords had become the most potent political force in the state.

Now there was an overt political component to the "What would Gabby want?" exercise. She was a Blue Dog Democrat, a fading breed, and her seat, considered endangered, was deemed by national Democrats as worthy of special attention. Three of her Washington colleagues—Reps. Smith and Debbie Wasserman Schultz, and Sen. Kirsten Gillibrand—hosted a Washington fundraiser for Giffords that was attended by most of the party's top brass.

The Giffords team began to consider the Senate race, and the position some came to was, why not? There was no way of knowing whether Giffords would be able to mount a campaign, but if she recovered enough to serve in the House, why not the Senate? As one person in Giffords's circle put it, "I think she will be unbeatable whatever she runs for."

"Let's say that she's 90 percent [recovered]," says Mike McNulty, Giffords's last campaign chairman. "Well, we've had congressmen in Arizona who didn't even have a brain. So, it's not like you have to be as talented as she is to be good at it."

While Giffords herself does not even know that she is considered a possible candidate, much less the Democratic frontrunner, her potential opponents are stymied. Jesse Kelly, who filed his candidacy papers with the Federal Election Commission before the shooting, has been extremely cautious since, giving no public indication that he means to run. A website dedicated to supporting him in the last election, which had the URL GiffordsIsLying.com, is still operating, but is now a bereavement page, urging prayer for the recovery of Giffords and the other victims.

In Giffords's own party, meanwhile, there are those who are eyeing the Kyl seat but dare not make a move until her camp's intentions are known. One such Arizona Democrat is Rodney Glassman, a young comer who took on John McCain in 2010. Glassman says that if he did run, he would do so as a placeholder for Giffords, vowing to turn over his contribution list and infrastructure to her the moment she entered the race. "Not just political sense, but decency, dictates that if Gabby enters the Senate race, any Democrat should exit," he says.

But to Mark Kelly, all such talk is premature. "We haven't discussed any Senate race with her," he says. "And I have no plans to do that for some time. She's focused on her recovery."

Some in her circle hope that Giffords will make some sort of return to public life by autumn, possibly even a return to the House floor. But Kim, her Houston neurosurgeon, will not speculate on a timetable. Carusone, Giffords's chief of staff, says some media reports have created the impression that "she was sitting in the hospital room mulling over polls and considering her political future. And she's not."

"She's not going to do a job, or even attempt to, if she doesn't think she can do it effectively and serve her constituents well," Kelly says. "I'm going to want for her what she wants for her, and I know she's going to set the bar pretty high. So she's going to have to decide what that minimum ability is."

Although the recovery process is still in the early stages, Giffords has indeed made enormous strides—authentic good news that risks being overshadowed by the exaggerated accounts of her progress to date. Her doctors stress that the focus now should be on the new normal. They say that a patient's family usually adjusts very quickly to it. At first, they are grateful that their loved one has survived, and every improvement in the patient's condition after that, however small, is considered a bonus.

Kelly seems to be asking for greater perspective in the public narrative of his wife's recovery. At the same time, his own expectations for her remain undimmed, and his conviction does not admit the notion that there is a new normal.

"The answer to that is no," he says, "because she is improving. I was gone for three days down in Florida for terminal countdown tests. I was away for three nights. And I could notice a change, and an improvement, in her ability to communicate" when he returned to Houston. "The doctors are very optimistic about where she'll be three months, six months, from now. Incredibly optimistic. So we don't know what that new normal is going to be for her."