Jeremy Laurance: A miracle recovery? Or just a long, slow road to nearly normal

Medical Life

What is sickness? What is health? What is "recovery"? Seven weeks ago the US congresswoman Gabrielle Giffords was shot in the head outside a shopping mall in Tuscon, Arizona, by Jared Lee Loughner, who went on the rampage, killing six people including a nine-year-old girl, and injuring 12 others.

In the weeks since, doctors have been impressed by her recovery, which has been described variously in press reports as "miraculous", "astonishing" and "confounding all expectations". On Sunday the Observer carried a piece headlined "Triumph of the human spirit heals the wounds of Arizona tragedy".

What will readers have made of these stories? Many, I suspect, are now eagerly anticipating Ms Giffords' triumphant return to the US congress where she will take up the baton again in defence of Barack Obama's health reforms.

In the Observer's piece, a beautifully crafted story by Ed Vulliamy, it was not until the very last paragraph that we learnt what Ms Giffords' recovery so far amounted to – she had started "lip-synching a few songs" and joined in with "Happy Birthday" to her astronaut husband Mark Kelly.

In the context of the injuries she sustained, Ms Giffords' progress is indeed remarkable – 19 out of 20 people shot in the head die as a result. Within hours of the shooting, after she had undergone emergency surgery, Dr Peter Rhee, head of the Trauma Division at University Medical Center, Tucson, said he was "very optimistic" about recovery. But he was speaking from the perspective of one who has seen most such grievously injured patients end up in a vegetative state.

According to the Sunday Telegraph, music therapy has played a key role in Ms Giffords' recovery and she has taken a few steps, spoken her first words and "added sushi and matzo ball soup to her hospital diet". All encouraging signs. And to maintain the motivation of family and patient it is essential that every step forward is celebrated. But it was for the head of Ms Giffords' rehabilitation team to sound a cautionary note, the only one I could find in the reports. He emphasised that the prognosis for every brain injury is different. "The patients may not return to what was normal for them before injury, but our goal is for them to reach a new normal."

Keeping hope alive is essential to recovery. But I wonder about the effect of such reports on the families of brain-injured patients. A "new normal" is not the same as the old normal. Unrealistic hope can end up piling misery upon misery.

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