Thursday, April 14, 2011

Walking Back the Breezy Optimism on Gabrielle Giffords' Medical Recovery

It's a pretty candid essay, impressive even, given Newsweek's recent history. But Tina Brown's editor now, and the last of the old Jon Meacham team has finally left the magazine. See, "What's Really Going On With Gabby Giffords."
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.”
It's worth reading the entire article.

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