Giffords looks ahead to leaving hospital

Giffords' chief of staff, Pia Carusone, said outpatient therapy is the 40-year-old congresswoman's next major medical goal, and ideally it will happen over the summer.

Though she misses Tucson, she'll remain in Houston, continuing with the medical team at TIRR Memorial Hermann rehab hospital, Carusone said.

Giffords, who is recovering from an assassination attempt, went through 3 1/2 hours of surgery Wednesday.

She was well enough by Thursday afternoon to take a cellphone call from her husband, Capt. Mark Kelly, from the International Space Station, where he is commanding the space shuttle Endeavour.

Giffords watched the shuttle launch from Cape Canaveral, Fla., Monday morning. On Tuesday she wrote Kelly an email as part of her speech rehabilitation.

And on Wednesday doctors in Houston gave Giffords an artificial skull implant, as well as a permanent shunt to remove fluid buildup in her brain.

She is expected to remain hospitalized at Texas Medical Center as she recovers from the surgery. Doctors briefing reporters here Thursday said they are watching closely for signs of infection, which occurs in 5 percent to 10 percent of such surgeries. Barring any complications, Giffords will return to rehabilitation at TIRR Memorial Hermann in about a week.

The skull-implant surgery, called cranioplasty, replaced a piece of skull that was removed Jan. 8, after Giffords was shot point-blank through the left side of her brain. The piece was removed to allow for swelling after the injury.

The flap of Giffords' skull that was removed at Tucson's University Medical Center was not used. Rather, doctors made her a synthetic skull flap using computer technology that exactly matches the missing bone.

Doctors deemed using Giffords' own skull flap as an implant too risky as it had been damaged by the bullet.

"Plus, parts of that bone had been contaminated with the bullet coming in, so there may be germs. So we didn't want to take the chance of increasing the infection risk," said Dr. Dong Kim, a Texas Medical Center neurosurgeon.

Now that she's had the surgery, she'll no longer need a helmet to protect her head. And she's very pleased about that, Carusone said.

"She hated the helmet," Carusone said.

The shunt is to control mild hydrocephalus that Giffords developed, in which the fluid that bathes the brain is not properly reabsorbed into the body.

"It's a condition that develops in many patients who have a brain injury," Kim said. "When there is injury that reabsorption can be partially clogged, just like having a partially clogged drain. When that happens, that fluid can build up and that's something that can be treated with a shunt."

"It doesn't impede anything," Kim said. "Patients often even forget they have it after a while."

Giffords' medical team says it has a tentative discharge date from rehabilitation for her, but said it's not a date they will disclose. It's also a date that can change.

"Once she goes back to TIRR we're going to do another reassessment and we'll decide whether we'll merely continue with the program that was interrupted by the surgery or maybe even upgrade it," said Dr. Gerard Francisco, chief medical officer at TIRR Memorial Hermann.

Francisco said he's been having increasingly "meaningful" conversations with Giffords. "She's cracked me up several times," he said.

But there's no timetable on her recovery, her medical staff stressed. "In terms of her returning to work, it's really difficult at this juncture to make any guesses as to when she will go back to work."

Kim said he's spoken to Giffords' husband via email several times this week. Kelly wanted his wife's care to be at the optimal time, not around his shuttle schedule, Kim said. "I just felt that this was the right time to do the procedure," he said.

He also said Giffords looks good. Her head was shaved to prevent infection during surgery but she otherwise looks as she always did, with no facial swelling, her staff and doctors say.

"She looks great. I started calling her Gorgeous Gabby today," Kim said. "She hasn't looked in the mirror yet but when she does she'll be very pleased."

There are also bullet fragments in Giffords' brain, but Kim said those are not a long-term concern and she's not expected to need further surgery.

Carusone said Giffords still has the same tastes and habits that she did before the shooting - she is extremely disciplined, eats only healthy food and still has little interest in television, except for NASA TV and an occasional episode of "30 Rock." She's always interested in news and politics, and in talking about Tucson.

Her discipline and focus on reaching medical goals may be part of the reason she's made a recovery that Kim characterized Thursday as "almost miraculous."

But Giffords has more hard work ahead. Because she was shot through the left side of the brain, which controls speech and right-sided movement, she's writing only with her left hand, though she is right-handed. Her right arm, particularly the lower arm, was seriously affected. Her right leg was also affected, which is why walking is challenging for Giffords, who was an avid athlete and cyclist before the shooting.

And while Carusone says she knows Giffords understands just about everything, the congresswoman is still searching for words. She prefers quiet environments where she can focus on speaking and saying what she wants. She often corrects herself, and will say, "no, that's not right," until she finds the right word, Carusone said.

Carusone said Giffords is in great spirits, having achieved two of her major medical goals - watching her husband launch into space and getting her skull bone replaced. "It was an exciting week for her and she's been looking forward to this for a while," Carusone said.

Contact reporter Stephanie Innes at sinnes@azstarnet.com or 520-572-4134.