Human Nature

The Resurrection of Gabby Giffords

The congresswoman’s recovery, documented on video, shows how a brain reconstructs itself.

Gabrielle Giffords: Portrait of a brain being rebuilt.

(P.K. Weis/Giffords Campaign via Getty Images)

On Jan. 8, Gabrielle Giffords was shot through the head at point-blank range. Two weeks later, as she lay mute and glassy-eyed in a hospital bed, her husband, Mark Kelly, began to video-record her recovery. The result, excerpted last night on ABC’s 20/20, is one of the greatest home movies ever made: a day-by-day portrait of a crippled brain repairing itself.

The brain has powers unlike any machine. It organizes the world. It organizes itself. When it’s damaged—even when it’s transected by a skull-shattering bullet—it can regain not just knowledge, but the ability to learn. If it can’t use old circuits, it invents new ones. Where there’s a will, the brain finds a way.

Giffords was shot through her left hemisphere. The bullet took out chunks of her cortex that processed speech and language comprehension. In the opening scenes, captured in late January, she lies motionless, her skull cracked across its dome like an egg. Her eyes are glazed. Her face is blank.

Kelly and a team of therapists get to work. Their work is to make Giffords work, because that’s how the brain learns: by doing. Kelly pats her arm, clasps her hand, tells her to give him a high five. A therapist manipulates Giffords’ forearm, tapping it to a tune. The attendants constantly challenge, prod, and encourage her. “You look great,” Kelly tells her, though she looks awful. “You just got a little work to do.”

Kelly puts Giffords’ shoes on a chair. “Here are your tennis shoes,” he tells her. “You’re going out for a jog today. How does that sound?” He instructs her to hold up his wedding ring on her finger, then take it off. “Can you do that, Sweetie?” he asks. “There you go.” He gets her to make a thumbs-up gesture. Two weeks later, the therapists are pushing her to walk. They assist her useless right leg so she can exercise her left and regain her sense of balance.

There are thinking tasks, too. They show her a magazine article. They lay pictures on a table. They make her select cards from a hand. They get her to draw. Sometimes, like a child, she learns by observing her teachers. They show her how to sigh and pucker. “Watch me,” says a therapist. “Watch me,” Giffords repeats. Now and then, she closes her eyes in fatigue or frustration. It’s hard work.

Having lost some parts of her brain, Giffords has to enlist others. At first, unable to rotate her eyes, she learns to identify and remove Kelly’s ring using her sense of touch.  Her therapists feed her phrases—“Zip up your…,” “You tell time with a…”—so that she can reabsorb, through context, words that were blown away. But the chief teaching tool is music, which persists in mental regions safely clear of the devastated language centers. Through melody, she recovers lyrics and eventually spoken words.

“I love…” a therapist sings to Giffords. “You,” the patient mouths back. At five weeks, Giffords is chanting along: “Let it shine, let it shine, let it shine.” A friend playing a piano keyboard leads her: “It’s great to see you looking…” Giffords finishes the sentence: “swell.” Later, she grins from ear to ear, singing with amusement, “Girls just want to have fun.”

Since emotion and cognition are interwoven, emotional stimulation is crucial to Giffords’ recovery. “Can you smile, Sweetie?” Kelly asks. When she doesn’t respond, he teases her: “That’s not a smile!” At this, the left side of her mouth curls up. “That’s better!” he laughs.

At four weeks, Giffords speaks her first word. She learns to sigh. She gestures while talking. She reaches out in a fluid motion to gently touch her therapist. She cries but can’t find the word for what she feels: sadness.  The therapist assures her that life will get better and gives her a hug. Then the therapist accidentally knocks a water bottle off the table. Giffords begins to laugh.

At seven weeks, Giffords crinkles her nose to say no. She squints wryly at Kelly. She pokes fun at herself. “Goofball Giffords,” she says.

Finally, at 10 months, Giffords sits down for an ABC interview. Her voice is strong, her eyes full of life. She reaches over to fix Diane Sawyer’s hair. Giffords’ vocabulary is much improved. She says moving her right arm is “difficult,” despite “two hours of therapy” every day. She looks at a picture and pronounces it “beautiful.” Thinking back to the people who died at the scene of her shooting, she finds the word she couldn’t summon earlier: “sad.” She gropes for simple terms to express her feelings: “Better. Stronger. Hard.” And for her husband: “Brave.”

The interview shows how extensively Giffords has recovered. “Awful,” she snorts when Kelly jokes that she likes football. “Stinks!” she adds. But the most remarkable thing caught on camera is her struggle to regain what’s still missing. When Sawyer asks Giffords whether she really thinks she can return to Congress, Giffords, at a loss for words, shapes her hand into a gesture that conveys what she wants to say. Giffords’ face is tight with concentration and effort, her eyes locked on her hand. She seems to be speaking in sign language, but not to Sawyer or anyone else. The brain, through the hand, is rewiring itself.

What you see in Giffords is what researchers are learning about the mind. Right now, at the annual meeting of the Society for Neuroscience, 30,000 humans are swarming around the Washington, D.C., convention center, exchanging the latest discoveries about neurons, receptors, and circuits. What they’re finding everywhere is plasticity. The brain isn’t built once. It rebuilds itself, day after day, editing a network of 100 trillion synapses that absorb, represent, and manage experience. It makes us who we are. And, when necessary, it remakes us. Just ask Gabby Giffords.

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