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      Doctors optimistic about Arizona congresswoman's recovery

      Rep. Gabrielle Giffords, D-Ariz

      Sunday 3 P.M. Update:

      Recovering from a gunshot wound to the head depends on the bullet's path, and while doctors Sunday are optimistic about Rep. Gabrielle Giffords' odds, it can take weeks to months to tell the damage.

      Doctors say the bullet traveled the length of the left side of the Arizona congresswoman's brain, entering the back of the skull and exiting the front.

      Fortunately, it stayed on one side of her brain, not hitting the so-called "eloquent areas" in the brain's center where such wounds almost always prove fatal.

      Importantly, Giffords was responding nonverbally to simple commands in the emergency room - things like "squeeze my hand."

      That implies "a very high level of functioning in the brain," said Dr. Michael Lemole of Tucson's University Medical Center, Giffords' neurosurgeon.

      Now, her biggest threat is brain swelling. Surgeons removed half of her skull to give the tissues room to expand without additional bruising, Lemole said.

      That bone is being preserved and can be reimplanted once the swelling abates, a technique the military uses with war injuries, added his colleague and trauma surgeon Dr. Peter Rhee.

      Adding to Giffords' good prospects is that paramedics got her to the operating room in 38 minutes, her doctors said. Now she is being kept in a medically induced coma, deep sedation that rests her brain. It requires a ventilator, meaning she cannot speak. Doctors periodically lift her sedation to do tests and said she continues to respond well to commands.

      The brain's left side does control speech abilities and the movement and sensation of the body's right side, Lemole noted. But he wouldn't speculate on lasting damage, saying, "we've seen the full gamut" in such trauma.

      That's the mystery of brain injury: There's no way to predict just how much disability a wound that traverses multiple regions will leave, because our neural connections are so individual.

      "The same injury in me and you could have different effects," said Dr. Bizhan Aarabi, chief of neurotrauma at the University of Maryland's Shock Trauma Center, who has long studied penetrating brain injuries.

      "The belief is if you get shot in the head, you're dead, but it isn't like that," agreed the University of Miami's Dr. Ross Bullock, chief of neurotrauma at Jackson Memorial Hospital. He cared for a man shot in the head with an AK-47 who two years later is back to work full-time and "a normal person."

      "Every patient is an individual and more so with a gunshot than anything else," he said.

      There are few statistics, but doctors agree that well over 90 percent of gunshot wounds to the head are fatal. Aarabi cited his own study of 600 Maryland cases that found 95 percent were dead before arriving at the hospital. Survivors have something in common with Giffords, Aarabi said: A good "Glasgow coma score," a way to measure responsiveness, upon arriving at the hospital.

      That pre-surgery outlook is important because doctors can't reverse the bullet's damage, just remove fragments to fight infection and swelling. Giffords' surgeons said they didn't have to remove a lot of dead brain tissue.

      The amount of disability depends on how much damage is done to what brain region. A bullet that crosses into both sides, or hemispheres, can leave extensive lasting damage. That's what happened with James Brady, President Ronald Reagan's press secretary, who was left with slurred speech and uses a wheelchair after being shot during the 1981 assassination attempt on Reagan.

      In contrast, one of neurology's most famous cases was Phineas Gage who in 1848 survived a 3-foot iron rod blasting into his skull but suffered personality changes from damage to the prefrontal cortex.

      It can take weeks to tell the extent of damage, and months of intense rehabilitation to try to spur the brain's capacity to recover. In addition, more than half of survivors go on to suffer seizures and need anti-epilepsy medication, Miami's Bullock said.

      "We talk about recovery in months to years," said Griffords' surgeon Lemole.

      Previous Coverage:

      A gunman unloaded a semiautomatic weapon outside a busy supermarket Saturday during a public gathering for Democratic Rep. Gabrielle Giffords, killing Arizona's chief federal judge and five others in an attempted assassination that left Americans questioning whether divisive politics had pushed the suspect over the edge.

      The shooting targeted Giffords and left the three-term congresswoman in critical condition after a bullet passed through her brain. A shaken President Barack Obama called the attack "a tragedy for our entire country."

      Giffords, 40, is a moderate Democrat who narrowly won re-election in November against a tea party candidate who sought to throw her from office over her support of the health care law. Anger over her position became violent at times, with her Tucson office vandalized after the House passed the overhaul last March and someone showing up at a recent gathering with a weapon.

      Police say the shooter was in custody, and was identified by people familiar with the investigation as Jared Loughner, 22. U.S. officials who provided his name to the AP spoke on condition of anonymity because they were not authorized to release it publicly.

      It's still not clear if Loughner had the health care debate in mind or was focused on his own unique set of political beliefs, many outlined in rambling videos and postings on the Internet.

      Pima County Sheriff Clarence Dupnik described the gunman as mentally unstable and possibly acting with an accomplice. He said Giffords was among 13 people wounded in the melee that killed six people, including a 9-year-old girl, an aide for the Democratic lawmaker and U.S. District Judge John Roll, who had just stopped by to see his friend Giffords after celebrating Mass. Dupnik said the rampage ended only after two people tackled the gunman.

      The sheriff blamed the vitriolic political rhetoric that has consumed the country, much of it centered in Arizona.

      "When you look at unbalanced people, how they respond to the vitriol that comes out of certain mouths about tearing down the government. The anger, the hatred, the bigotry that goes on in this country is getting to be outrageous," he said. "And unfortunately, Arizona, I think, has become the capital. We have become the mecca for prejudice and bigotry."

      Giffords expressed similar concern, even before the shooting. In an interview after her office was vandalized, she referred to the animosity against her by conservatives, including Sarah Palin's decision to list Giffords' seat as one of the top "targets" in the midterm elections.

      "For example, we're on Sarah Palin's targeted list, but the thing is, that the way that she has it depicted has the crosshairs of a gun sight over our district. When people do that, they have to realize that there are consequences to that action," Giffords said in an interview with MSNBC.

      In the hours after the shooting, Palin issued a statement in which she expressed her "sincere condolences" to the family of Giffords and the other victims.

      During his campaign effort to unseat Giffords in November, Republican challenger Jesse Kelly held fundraisers where he urged supporters to help remove Giffords from office by joining him to shoot a fully loaded M-16 rifle. Kelly is a former Marine who served in Iraq and was pictured on his website in military gear holding his automatic weapon and promoting the event.

      "I don't see the connection," between the fundraisers featuring weapons and Saturday's shooting, said John Ellinwood, Kelly's spokesman. "I don't know this person, we cannot find any records that he was associated with the campaign in any way. I just don't see the connection.

      "Arizona is a state where people are firearms owners - this was just a deranged individual."

      Law enforcement officials said members of Congress reported 42 cases of threats or violence in the first three months of 2010, nearly three times the 15 cases reported during the same period a year earlier. Nearly all dealt with the health care bill, and Giffords was among the targets.

      The shooting cast a pall over the Capitol as politicians of all stripes denounced the attack as a horrific. Capitol police asked members of Congress to be more vigilant about security in the wake of the shooting.

      Giffords, known as "Gabby," tweeted shortly before the shooting, describing her "Congress on Your Corner" event: "My 1st Congress on Your Corner starts now. Please stop by to let me know what is on your mind or tweet me later."

      "It's not surprising that today Gabby was doing what she always does, listening to the hopes and concerns of her neighbors," Obama said. "That is the essence of what our democracy is about."

      Mark Kimball, a communications staffer for Giffords, described the scene as "just complete chaos, people screaming, crying." The gunman fired at Giffords and her district director and started shooting indiscriminately at staffers and others standing in line to talk to the congresswoman, Kimball said.

      "He was not more than three or four feet from the congresswoman and the district director," he said.

      Doctors were optimistic about Giffords surviving as she was responding to commands from doctors. "With guarded optimism, I hope she will survive, but this is a very devastating wound," said Dr. Richard Carmona, the former surgeon general who lives in Tucson.

      Giffords spokesman C.J. Karamargin said three Giffords staffers were shot. One died, and the other two are expected to survive. Gabe Zimmerman, a former social worker who served as Giffords' director of community outreach, died. Giffords had worked with the judge in the past to line up funding to build a new courthouse in Yuma, and Obama hailed him for his nearly 40 years of service.

      A former classmate described Loughner as a pot-smoking loner, and the Army said he tried to enlist in December 2008 but was rejected for reasons not disclosed.

      Federal law enforcement officials were poring over versions of a MySpace page that included a mysterious "Goodbye friends" message published hours before the shooting and exhorted his friends to "Please don't be mad at me."

      In one of several Youtube videos, which featured text against a dark background, Loughner described inventing a new U.S. currency and complained about the illiteracy rate among people living in Giffords' congressional district in Arizona.

      "I know who's listening: Government Officials, and the People," Loughner wrote. "Nearly all the people, who don't know this accurate information of a new currency, aren't aware of mind control and brainwash methods. If I have my civil rights, then this message wouldn't have happen (sic)."

      In Loughner's middle-class neighborhood - about a five-minute drive from the scene - sheriff's deputies had much of the street blocked off. The neighborhood sits just off a bustling Tucson street and is lined with desert landscaping and palm trees.

      Neighbors said Loughner lived with his parents and kept to himself. He was often seen walking his dog, almost always wearing a hooded sweat shirt and listening to his iPod.

      Loughner's MySpace profile indicates he attended and graduated from school in Tucson and had taken college classes. He did not say if he was employed.

      "We're getting out of here. We are freaked out," 33-year-old David Cleveland, who lives a few doors down from Loughner's house, told The Associated Press.

      Cleveland said he was taking his wife and children, ages 5 and 7, to her parent's home when they heard about the shooting.

      "When we heard about it, we just got sick to our stomachs," Cleveland said. "We just wanted to hold our kids tight."

      High school classmate Grant Wiens, 22, said Loughner seemed to be "floating through life" and "doing his own thing."

      "Sometimes religion was brought up or drugs. He smoked pot, I don't know how regularly. And he wasn't too keen on religion, from what I could tell," Wiens said.

      Lynda Sorenson said she took a math class with Loughner last summer at Pima Community College's Northwest campus and told the Arizona Daily Star he was "obviously very disturbed." "He disrupted class frequently with nonsensical outbursts," she said.

      In October 2007, Loughner was cited in Pima County for possession of drug paraphernalia, which was dismissed after he completed a diversion program, according to online records.

      "He has kind of a troubled past, I can tell you that," Dupnik said.

      Giffords was first elected to Congress amid a wave of Democratic victories in the 2006 election, and has been mentioned as a possible Senate candidate in 2012 and a gubernatorial prospect in 2014.

      She is married to astronaut Mark E. Kelly, who has piloted space shuttles Endeavour and Discovery. The two met in China in 2003 while they were serving on a committee there, and were married in January 2007. Sen. Bill Nelson, chairman of the Senate Commerce Space and Science Subcommittee, said Kelly is training to be the next commander of the space shuttle mission slated for April. His brother is currently serving aboard the International Space Station, Nelson said.

      Giffords is known in her southern Arizona district for her numerous public outreach meetings, which she acknowledged in an October interview with The Associated Press can sometimes be challenging.

      "You know, the crazies on all sides, the people who come out, the planet earth people," she said with a following an appearance with Adm. Mike Mullen in which the chairman of the Joint Chiefs of Staff was peppered with bizarre questions from an audience member. "I'm glad this just doesn't happen to me."

      EARLIER VERSION:

      Rep. Gabrielle Giffords of Arizona, a Cornell University graduate, was shot in the head Saturday when an assailant opened fire outside a grocery store during a meeting with constituents, killing at least five people and wounding several others in a rampage that rattled the nation.

      Giffords was among at least 10 people wounded, and the hospital said her outlook was "optimistic" and that she was responding to commands from doctors. The hospital said a 9-year-old child was among the killed, and a U.S. Marshal said a federal judge was also fatally shot in the attack.

      Giffords spokesman C.J. Karamargin said an unspecified number of her staff members were injured in the shooting. Congressional officials said an aide to the Democrat was killed, and President Barack Obama said five people died in all.

      Police say the shooter was in custody, and was identified by people familiar with the investigation as Jared Loughner, 22. Pima County Sheriff's officials said he used a pistol to carry out the shooting spree. U.S. officials who provided his name to the AP spoke on condition of anonymity because they were not authorized to release it publicly.

      The shooting prompted an outpouring of sympathy from politicians and people around the country. President Barack Obama called the shooting "an unspeakable tragedy" and that such "a senseless and terrible act of violence has no place in a free society." Obama sent his FBI director to oversee the investigation.

      "It's not surprising that today Gabby was doing what she always does, listening to the hopes and concerns of her neighbors," Obama said in a nationally televised news conference. "That is the essence of what our democracy is about."

      Federal law enforcement officials were poring over captured versions of a MySpace page that belonged to Jared Loughner and over Youtube video published to the Internet weeks ago under an account "Classitup10" and linked to him. The MySpace page, which was removed within minutes of the gunman being identified by U.S. officials, included a mysterious "Goodbye friends" message published hours before the shooting and exhorted his friends to "Please don't be mad at me."

      In one of several Youtube videos, which featured text against a dark background, Loughner described inventing a new U.S. currency and complained about the illiteracy rate among people living in Giffords' congressional district in Arizona. Two spellings of his last name were given in the aftermath of the shooting - Loughner and Laughner.

      "I know who's listening: Government Officials, and the People," Loughner wrote. "Nearly all the people, who don't know this accurate information of a new currency, aren't aware of mind control and brainwash methods. If I have my civil rights, then this message wouldn't have happen (sic)."

      Three hours after the shooting, the L-shaped shopping center in Tucson was blocked off by police and had fire trucks and other vehicles in its parking lot that blocked the view of the store's front door. No shell casing could be seen from the area 500 yards from the store where reporters and photographers were kept.

      Outside Giffords' office on Capitol Hill, a handful of congressional staffers could be seen walking into her office without comment, some with roller bags and one who was in tears. About a half dozen yellow flowers, placed by one mourner, sat outside the door.

      U.S. Marshal for Arizona David Gonzales confirmed to the Associated Press that U.S. District Judge John Roll also died in the attack.

      Giffords, 40, was re-elected to her third term last November. She was a member of the Arizona House and Senate before coming to Washington.

      Giffords tweeted shortly before the shooting, describing her "Congress on Your Corner" event: "My 1st Congress on Your Corner starts now. Please stop by to let me know what is on your mind or tweet me later."

      Giffords is married to astronaut Mark E. Kelly, who has piloted space shuttles Endeavour and Discovery. The two met in China in 2003 while they were serving on a committee there, and were married in January 2007.

      In a statement of condolence, Sen. Bill Nelson, chairman of the Senate Commerce Space and Science Subcommittee, said her husband is training to be the next commander of the space shuttle mission slated for April. His brother is currently serving aboard the International Space Station, he said.

      Giffords was first elected to Congress amid a wave of Democratic victories in the 2006 election, and she won a narrow victory against a tea party favorite in the 2010 election.

      She has been mentioned as a possible Democratic nominee in 2012 for the U.S. Senate seat held by Republican Jon Kyl, who has not said whether he'll run again, or for the governor's office in 2014.

      She is a 1996 graduate of Cornell University where she received a master's degree in regional planning.

      The shooting comes amid a highly charged political environment that has seen several dangerous threats against lawmakers but nothing that reached the point of actual violence.

      A San Francisco man upset with House Speaker Nancy Pelosi's support of health care reform pleaded guilty to threatening the Democratic congresswoman and her family, calling her directly on March 25 and threatening to destroy her Northern California home if she voted for health care reform.

      In July, a California man known for his anger over left-leaning politics engaged in a shootout with highway patrol officers after planning an attack on the ACLU and another nonprofit group. The man said he wanted to "start a revolution" by killing people at the ACLU and the Tides Foundation.

      Giffords herself has drawn the ire of the right, especially for her support of the health care bill from politicians like Sarah Palin.

      Her Tucson office was vandalized a few hours after the House vote to approve the health care law in March, with someone either kicking or shooting out a glass door and window. In an interview after the vandalism, Giffords referred to the animosity against her by conservatives. Palin listed Giffords' seat as one of the top "targets" in the midterm elections because of the lawmakers' support for the health care law.

      "For example, we're on Sarah Palin's targeted list, but the thing is, that the way that she has it depicted has the crosshairs of a gun sight over our district. When people do that, they have to realize that there are consequences to that action," Giffords said in an interview with MSNBC.

      In the hours after the shooting, Palin issued a statement in which she expressed her "sincere condolences" to the family of Giffords and the other victims.

      Capitol police responded to the shooting by advising lawmakers and their staff to "take reasonable and prudent precautions regarding their personal security.

      "Despite her clashes with the right, Giffords describes herself as a former Republican and current Blue Dog Democrat.

      "You know, actually as a former Republican, you know, I consider myself someone who is pretty in the middle, I'm a blue dog Democrat, and one that is interested in making sure that our country maintains our prosperity and frankly, our superiority over other countries and that's where we look at these threat, obviously our defense budget, our level of education," she said in an interview with Fox News Channel this week.

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