Giffords continues to find her voice

Getting better is U.S. Rep. Gabrielle Giffords' No. 1 priority right now. And the intimate new book written mostly by her husband, Mark Kelly, makes it clear that fighting her way back from a gunshot wound is the hardest work the goal-oriented congresswoman has ever done.

The book chronicles Giffords' ongoing recovery through sheer determination, intensive therapy and a level of comprehension that seems to be miraculously intact.

"Gabby: A Portrait of Courage and Hope" chronicles U.S. Rep. Gabrielle Giffords' recovery from a gunshot through the left side of her brain on Jan. 8. Six people died in the shooting and 13, including Giffords, were injured.

Most of the book is written by Giffords' husband Mark Kelly and collaborator Jeffrey Zaslow. The last chapter, a single page, is written by Giffords.

While doctors have described Giffords' recovery as "miraculous" and Kelly writes that her comprehension is near 100 percent, communication remains a challenge.

The following excerpts, reprinted here with permission from publisher Scribner, a division of Simon & Schuster, Inc., follow Giffords' ongoing struggle with aphasia, a condition that affects a patient's ability to communicate through the spoken or written word.

• • •

Gabby's biggest problem, besides the partial paralysis on her right side, was her inability to communicate.

Often she'd say yes when she meant to say no, or vice versa.

"Gabby, do you want to take a walk?" I'd ask.

"Yes, yes," she'd say, and when I'd stand up to help her, she'd tell me, "No, no, no!"

She knew what she wanted to say. It's just that the wrong words came out - often the opposite of what she wanted to say.

• • •

My 47th birthday was February 21, and the day before, Gabby was in therapy with Angie, her speech therapist, and they were singing together.

"You are my sunshine, my only sunshine …"

Gabby was singing softly, but she seemed to be hitting every word. She looked tired, but she was trying.

Then Angie asked her to practice "Happy Birthday" so she'd be ready to sing for me.

Angie and Gabby sang together, but when they got to the third line, Gabby sang, "Happy birthday, dear chicken."

"You'd better not say that on Mark's birthday," Angie said. "It's 'Happy Birthday, dear Mark.' "

Gabby tried again. Again she said "chicken" instead of "Mark." Angie wrote my name on a piece of paper and held it up for Gabby. Again she sang "chicken."

You could see how frustrated Gabby was. Angie decided to move on to looking at photos. She held up a photo of a hairbrush.

"Comb," Gabby said.

"It's not a comb, it's a brush," Angie told her.

Gabby said the words "boo hoo" and seemed ready to cry. She looked miserable.

"Gabby, you've been amazing," Angie told her. "It's just been five weeks since you were hurt. It's a long road but we can do it. Are you a fighter?"

"Yes," Gabby said, and used her left arm to deliver a positive fist pump.

• • •

One Sunday afternoon in July, I found her in the bedroom. "Sit down," she said. "Shut the door."

It occurred to me that she should have told me to shut the door and then sit down, but I didn't correct her. I saw by the expression on her face that she was serious. I closed the door. I sat down.

"Shot," she said.

"Yes, you were shot in the head," I said. She knew that, of course, but sometimes it helped a conversation if I provided a sentence to get started.

"Questions and answers," she said, very seriously.

I could sense what was coming. It had been more than six months since her injury, but now she was ready to find out.

"Who died?" she asked.

• • •

I heard good things from several people in the brain-injury field about Dr. Nancy Estabrooks, an expert in neurological communication disorders at Western Carolina University. I invited her to spend the day with us, getting to know Gabby and testing her.

Gabby did well on almost all of Nancy's tests. Nancy laid out photos of various U.S. presidents in random order. Without being asked, Gabby began arranging them, left to right, chronologically. She eliminated the "ringer," Ben Franklin, knowing he didn't belong. She held up the photo of Franklin and said, "Wonderful. Electricity."

Nancy scribbled in her notes: "For FDR, she spontaneously commented, 'Roosevelt,' 'wheelchair,' 'braces.' For Jimmy Carter she said, 'Habitat for Humanity.' "

Nancy was also impressed to see that Gabby was up on the news. Gabby looked at Arnold Schwarzenegger's photos and said, "Messin' around. Babies." When she looked at a photo of Michele Bachmann, she said, "tea party" and "running for president."

Nancy wrote on a dry-erase board: Scotland, Ireland, Holland, England. "Which doesn't belong?" she asked Gabby.

"Holland," Gabby said, correctly.

Then Nancy wrote: "Cake, cookies, bread, pie."

Gabby looked at the words. Nancy expected her to choose bread as the item that didn't belong, since the other three words referred to desserts. But Gabby picked "cookies" instead. When we told her that "bread" was the correct answer, Gabby pointed to the "s" in cookies, and then erased it. That was impressive, too. Gabby noticed that "cake," "pie," and "bread" were singular nouns. "Cookies" was a plural noun.

"Gabby is paying better attention to everything than we are," Nancy said.

•••

The last chapter in the book is penned by Giffords. In short sentences, she writes of her sadness for the victims of Jan. 8 and her frustration at the slow speed of her recovery. She also speaks to her constituents.

"Trying to get back to work. Back to work for Arizona. Back to work for the American people. I love the people of my state. I'm so sorry I'm unable to work right now."

•••

One day, Gabby and I were alone and she said to me, "Voice in my head."

"Whose voice?" I asked her. She didn't answer. She was struggling to find the words to explain herself, but couldn't.

"Is it someone else's voice?" I asked.

"No, no, no," she said.

"Is it your voice?"

"Yes," she said. "Hear my voice."

"So you can hear your voice, but you can't get your voice out. Is that what you're trying to say?"

"Yes," she answered. "Very frustrating."

•••

© 2011 Gabrielle Giffords and Mark E. Kelly, to be published by Scribner, a division of Simon & Schuster, Inc. Printed by permission