In an incident that set off intense national debate, Rep. Gabrielle Giffords (D-Ariz.) was shot in the head by alleged gunman Jared Lee Loughner in Tucson on January 8. The bullet fired at Giffords, 40, tore through the "entire length" of her brain's left hemisphere. Remarkably, the congresswoman not only survived, but continues to make unpredictably swift progress in her rehabilitation, defying fears that she might not speak again. Here, a chronological guide to the major milestones in her recovery:
After the shooting, Giffords is taken to Tucson's University Medical Center, where Dr. Randall Friese is the first to treat her. Giffords responds to the doctor's command to squeeze his hand. Dr. Michael Lemole operated on her, removing a portion of her skull to accommodate the swelling caused by her injuries.
Though Giffords remains in a medically induced coma designed to let her brain heal, doctors "adjust the level of sedation" to perform tests. Neurosurgeons say Giffords can respond to a verbal command to show two fingers, indicating that she is not paralyzed and that the portion of her brain responsible for processing such instructions is intact.
Giffords can move her arms and breathe on her own, though she still has a breathing tube "as a precaution." Dr. Peter Rhee, the trauma surgeon responsible for Giffords' care in the ICU, says she has a "101 percent chance of survival." He adds: "She will not die. She does not have that permission from me."
At a memorial service in Tucson for victims of the shootings, President Obama notes that Giffords had opened her eyes that day. After doctors reduce her level of sedation, she is also making "spontaneous movements," such as feeling her wounds and adjusting her hospital gown.
Doctors perform two more operations on Giffords: A tracheotomy to place a breathing tube in her neck and surgery to remove bone fragments and relieve pressure from fractures in her right eye socket.
After the congresswoman is taken off a ventilator, her condition is upgraded from "critical" to "serious."
A hospital spokesperson says Giffords is able to stand with help from medical staff.
The congresswoman is transferred from Tucson to the Memorial Hermann Texas Medical Center Hospital in Houston.
Doctors remove a tube used to drain excess fluid from Giffords' brain.
Giffords is moved to the TIRR Memorial Hermann rehabilitation facility. With her recovery progressing at "lightning speed," doctors upgrade Giffords' status from "serious" to "good."
Giffords is speaking "more and more," her spokesperson says, and recently asked for toast for breakfast. "Gabby's appetite is back," her husband, Mark Kelly, writes in a post on the congresswoman's Facebook page, adding that "even though it’s hospital food — she's enjoying three meals a day."
Giffords is walking with the help of a shopping cart, playing tic-tac-toe, and and mouthing the words to songs, the congresswoman's mother wrote in an email to friends obtained by the Houston Chronicle. "As you may expect, little Miss overachiever is healing very fast," Gloria Giffords wrote.
Giffords continues to improve, says Peter J. Boyer in Newsweek, but "a more measured assessment of her progress is warranted." In the early weeks of her recovery, Giffords apparently thought she had been involved in a car accident, but her husband recently told her that she had actualy been shot, according to Boyer. The congresswoman still struggles to speak, and is just beginning to formulate whole sentences. But her personality is intact. "When we say her personality is there, I mean, she’s like 100 percent there," says Giffords' Chief of Staff Pia Carusone, as quoted in Newsweek.
Giffords can stand on her own and walk a little, according to The Arizona Republic. Her left side is functioning normally — it's "perfect," says Pia Carusone, the congresswoman's legislative chief of staff — and she is now left-handed. But Giffords has also begun to use her right arm and leg, which were more affected by the bullet wound to the left side of her brain. Her therapy includes pushing a grocery cart up and down hospital hallways, as well as games of bowling and indoor golf. Doctors say she is in the top five percent of patients recovering from this type of traumatic brain injury. Still, Giffords' speech remains limited, and longer sentences can "frustrate" her, so she typically communicates with short statements like "love you," "awesome" or "get out." But she has made enough progress to be able to attend her husband's space shuttle launch on Friday, Kelly says in an interview with CBS.
Giffords undergoes surgery to repair damage to her cranium and to insert a permanent tube to drain fluid from her head. Doctors had saved the portion of Giffords' skull that they removed months earlier, but they opted to use a ceramic substitute instead. They say new bone will form in the porous ceramic over time. The operation means that Giffords will no longer have to wear a helmet to protect her brain during physical therapy. "She hates the helmet," says Pia Carusone, her chief of staff, as quoted by Tucson Weekly. "So it was an exciting week for her. She’s been looking forward to this for awhile." Husband Mark Kelly got reports about the surgery in space, where he is commanding the space shuttle Endeavour after its delayed liftoff.
Giffords' ability to walk, though not quite back to normal, is "much improved," says C.J. Karamargin, her communications director, as quoted by The Arizona Republic. "She walks with determination." The congresswoman is also able to ride a bike with support wheels down the hospital hall. "She's ready to become an outpatient," says husband Mark Kelly, just after reuniting with Giffords after he returned from his space mission. "She's made that very clear."
Giffords is still struggling to communicate in complete sentences. The congresswoman relies on a combination of gesturing, facial expressions, and short phrases to express what she wants or needs. Turning complex thoughts into words is "where she's had trouble," says Pia Carusone, her chief of staff, as quoted by The Arizona Republic. It's still unclear just how much damage has been done to Giffords' brain. An MRI is the best way to get a clear picture, but the shards of bullets that are almost certainly still in her head make the magnetic test too risky. The "blunt assessment" of her current condition, according to Carusone, is that "if she were to plateau today," Giffords would not have "nearly the quality of life she had before."
The first photo of Giffords is posted on Facebook by her staff. The Arizona Democrat's hair is cropped, and she looks "vibrant and happy," despite the long rehabilitation road that lays ahead.
Giffords is discharged from the Houston hospital where she had undergone several months of rehabilitation. She will return to her husband, astronaut Mark Kelly, and family in League City, Texas, where she will begin daily outpatient treatment. The hospital's chief medical officer expressed confidence in Giffords' continued improvement, saying there is no doubt she will make "significant strides in her recovery."
This article was originally published on February 10, and last updated on June 16.