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Image: Mark Kelly and Gabrielle Giffords
U.S. Rep. Giffords' office
Mark Kelly, the husband of Rep. Gabrielle Giffords, is seen holding his wife's hand in the congresswoman's hospital room at University Medical Center on Sunday. The photo was made available by Giffords' office on Tuesday.
NBC, msnbc.com and news services
updated 1/14/2011 7:37:35 PM ET 2011-01-15T00:37:35

The neurosurgeon treating U.S. Rep. Gabrielle Giffords said Friday doctors are "actually confident" she's making progress in her recovery.

Dr. Michael Lemole said her eyes are opening more frequently and she can carry out more complex sequences of activity in response to commands and on her own.

She remained in critical condition with a breathing tube still in, though it is expected to be removed Friday. The wounded congresswoman may also sit up in a chair.

Once the breathing tube is removed, "they'll be able to hear her speak and evaluate her brain," Dr. Nancy Snyderman said on TODAY Friday.

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The medical team at University Medical Center in Tucson, Ariz., aren't as concerned about brain swelling at this point, Snyderman said, but are watching for signs of pneumonia and blood clots.

"She is progressing normally without any complications or setbacks. She's on schedule as we had hoped," said trauma chief Dr. Peter Rhee on MSNBC cable. "She’s progressing at a good speed for this time period. Even overnight, she’s made significant progress."

Rhee said the UMC medical team may at some point perform a tracheostomy, a surgical procedure to create an opening through the neck into the windpipe, in order to clear an obstructed airway.

Earlier, doctors reported Giffords has been sitting up, dangling her legs on the edge of the hospital bed and moving her limbs in response to commands. That's after she spontaneously opened her eyes during visits with her colleagues Wednesday night. She is able to lift both of her legs on command and is yawning and starting to rub her eyes, doctors said.

"She's becoming more aware of her surroundings," Rhee, who has treated soldiers in Iraq and Afghanistan, saidThursday.

But moving forward, Rhee expects changes to be less dramatic than they've been this week. "We’ll see a lot of things in the next two months," the surgeon said on MSNBC cable Friday. "Then the changes will be more subtle for the next year ... and after that.”

Six people were killed when gunman opened fire outside a Safeway store in Tucson on Saturday. Giffords, who investigators say was the primary target, was among 13 people wounded. Giffords remains critical and four patients are in fair condition. One patient was to be discharged Thursday.

"Everybody is making fantastic progress forward," Rhee said.

Giffords' neurosurgeon, Dr. Michael Lemole, said after five days of pushing for caution, "We're wise to acknowledge miracles."

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'Gabby opened her eyes'
At the memorial service Wednesday evening for the victims of the Tucson shootings,
President Barack Obama went off-script to announce Giffords' latest medical triumph.

"Gabby opened her eyes," Obama said to a loud cheer from the audience on the University of Arizona campus, adding that the congresswoman "knows we are here." Although the president wasn't in the room at the moment Giffords' eyes opened, he said her husband, astronaut Mark Kelly, had given him permission to break the news.

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House Democratic Leader Nancy Pelosi of California, Rep. Debbie Wasserman Schultz of Florida and Sen. Kirsten Gillibrand of New York, three of Giffords' close female friends in Congress, were in Giffords' hospital room when she opened her eyes, NBC News confirmed.

"She was rubbing our hands and gripping our hands so ... we knew she could hear and understand what we were saying and she moved her leg, and so we knew she was responding," Gillibrand said.

Giffords' husband realized the significance of the moment. "Gabby, open your eyes, open your eyes," he said, according to Gillibrand. "And then she's struggling, struggling. And she opens her eyes," Gillibrand told NBC News. "And then he's just almost beyond himself, because he's so excited. And he said, "Can you see me?  Can you see me?" ... If you can see me, give me a thumbs up.

"And she doesn't just put a thumbs up, she raises her entire arm," Gillebrand continues.
So, it was the biggest thumbs up she could have given.

"(T)he doctors couldn't believe what they were seeing," she said, adding later that "it was truly the most inspiring moment that I'd ever witnessed."

Story: Bullet to the head can be overcome, survivors say

Gillibrand said on CNN that Giffords signaled by raising her hand that she was able to see.

'A glorious, glorious experience'
Speaking on "Countdown with Keith Olbermann" on MSNBC cable, Pelosi said: "We witnessed almost a miracle. We saw the power of prayer, the power of the effect of the excellence of her medical care and we saw a little girl power too because we were trying to amuse
Gabby, trying to get through to her about how much she was loved and missed in the Congress and what was waiting for her when she came back."

"And being there with her parents and her husband and when she opened her eyes was quite remarkable. ... It was a glorious, glorious experience. We thought we brought a little fun to the room and she reacted," she said.

Associated Press

Giffords' husband has remained by her bedside. Kelly is supposed to command shuttle Endeavour's final mission in April. NASA says Kelly remains commander of the mission while veteran astronaut Rick Sturchow will serve as a backup commander for the launch.

"I recommended to my management that we take steps now to prepare to complete the mission in my absence, if necessary," Kelly said. "I am very hopeful that I will be in a position to rejoin my crew to finish our training."

The difference between life and death
The path of the bullet that struck Giffords' brain, quick and quality medical care, and luck meant the difference between life and death, say her doctors and brain experts.

Doctors think the bullet pierced the front of Giffords' head and exited the back, slicing the left side of the brain, which controls speech abilities and muscles on the right side of the body.

Had the bullet damaged both sides of the brain or struck the brain stem, which connects to the spinal cord, the outcome would likely be worse — extensive permanent damage, vegetative state or death.

"So far, she's passed with flying colors of each stage" of her recovery, said neurologist Dr. Marc Nuwer of the University of California, Los Angeles, who is not involved in the congresswoman's treatment.

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When Giffords arrived at the hospital, doctors first checked to make sure she didn't have any other injuries. They took a brain scan and wheeled her to the operating room in a swift 38 minutes.

The same attack in the desert many miles away from a trauma center may have led to a different ending.

It's too early to tell the extent of damage Giffords suffered, but experts say it's rare for people with gunshot wounds to the head to regain all of their abilities. Damage to the left side of the brain can result in memory loss, difficulty reading and hand-eye coordination problems. Giffords' doctors have not been able to determine how well she can speak since she still has a breathing tube.

"Her full-time job now for the next year is working on her recovery and rebuilding her life around her disability whatever it may be," said Dr. Stephan Mayer, professor of clinical neurology at Columbia University Medical Center in New York, who has no role in Giffords' care.

About 1.7 million people in the United States suffer traumatic brain injuries every year, with about 20 percent of them caused by violence, including gunshots. About 52,000 people die as a result of their injuries and about 275,000 are hospitalized, according to the Centers for Disease Control and Prevention. Of the deaths caused by traumatic brain injury, perhaps 35 percent to 40 percent are attributed to gunshots.

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This article contains reporting from NBC News, msnbc.com staff and The Associated Press.

Video: Rep. Giffords’ recovery ‘miraculous, lucky’

  1. Transcript of: Rep. Giffords’ recovery ‘miraculous, lucky’

    VIEIRA: That's good news. NBC 's Miguel Almaguer , thank you very much . Dr. Nancy Snyderman is NBC 's chief medical editor. Nancy , good morning to you.

    Dr. NANCY SNYDERMAN reporting: Hey, Meredith.

    VIEIRA: Hard to believe just six days ago...

    SNYDERMAN: Hm.

    VIEIRA: ...Congresswoman Giffords was shot in the head. And had that bullet penetrated her brain in just a slightly different direction she would probably be dead. But since then, she has put up two fingers, she's moved her arms and her legs...

    SNYDERMAN: Mm-hmm.

    VIEIRA: ...she's opened her eyes. Doctors say they seem now to be tracking.

    SNYDERMAN: Right.

    VIEIRA: Is what we're witnessing miraculous given someone in her condition?

    SNYDERMAN: It's a combination of miraculous, lucky that the trajectory of the bullet is what it was, and I think we have to give a lot of credit to this stellar medical crew. They had her from a battlefield through the ICU , I mean, and into the OR and then back to the ICU within 38 minutes. I mean, they treated this like it was, you know, a typical war zone. The physicians and everyone on the faculty there, it's made a huge difference in her recovery. But what they said yesterday was her ability now to follow commands. They're simple commands, but it shows that things are firing in her brain and connections are being made. And the fact that she can now track a little bit with her eyes means that she's cognizant of some things around her.

    VIEIRA: You know, when she opened her eyes for the first time she was surrounded by some of her female colleagues.

    SNYDERMAN: Right.

    VIEIRA: Senator Gillibrand spoke so eloquently about that. Afterwards, one of the others was in there, Representative Debbie Wasserman Schultz , was in the hospital room. She said it shows you what a little girl power can do. She was kind of joking, but there's merit in those words, isn't there?

    SNYDERMAN: Yeah, I -- look, I think she's joking but we know it's true.

    VIEIRA: Yeah.

    SNYDERMAN: When people are stand -- sitting vigil and her husband is there and the television is on, you recognize, patients will tell you afterwards, that they were surrounded. But then there's sort of a new voice, it's familiar, and it makes your brain work a little harder. And if it's a deep girlfriend, yeah, there are chemical changes, there are emotional changes. So there's -- we don't -- it's what I would called soft science. There's something to it. But something pushed her a little bit. It was that familiar voice in an unfamiliar setting and then of course the doctors asked them to leave because they didn't want to exhaust her.

    VIEIRA: Yeah.

    SNYDERMAN: But a phenomenal sign.

    VIEIRA: And the doctors are saying now that they're going to start aggressive physical therapy with her. I know they've...

    SNYDERMAN: Right.

    VIEIRA: ...sat her up and they're going to, I think, put her in a chair today, sit her in a chair today?

    SNYDERMAN: Yeah. They're not so worried about the brain swelling at this point. Now they move into just normal stuff. They don't want her to throw a blood clot, they don't want her to get pneumonia. That tube down her throat is to protect her airway. They would like to get that out sooner than later so they...

    VIEIRA: They can hear if she can speak?

    SNYDERMAN: They want to be able to hear her speak and evaluate her brain. Now I just want to caution everyone, now the baby steps happen. A little bit every day that will be cumulative. Will she be walking out of this hospital next Friday? No. She's under -- she's looking frankly at months and years of rehabilitation both mentally and physically and psychologically. And we'll learn more every day, but a real shootout again to those surgeons for being so frank and yet not being pushed into saying things that they really don't mean. But this is really quite wonderful.

Photos: Former Ariz. Representative Gabrielle Giffords

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  1. Gabrielle Giffords, the former congresswoman who was shot and left handicapped after a gunman opened fire at an event in Tucson, Ariz., and her husband retired Navy Capt. Mark Kelly prepare to testify before a Senate Judiciary Committee hearing on gun violence in Washington, D.C., on Jan. 2013. (Jim Lo Scalzo / EPA) Back to slideshow navigation
  2. U.S. Senator Richard Blumenthal, D-Conn., former U.S. Rep. Gabrielle Giffords and her husband, former astronaut Mark Kelly, leave the Newtown Municipal Building in Newtown, Conn. on Jan. 4, 2013. Giffords met with Newtown officials on Friday afternoon before heading to visit with families of the victims of the Sandy Hook Elementary School massacre. (Michelle Mcloughlin / Reuters) Back to slideshow navigation
  3. Gabrielle Giffords waves to the Space Shuttle Endeavor with her husband, former astronaut Mark Kelly as it flies over Tucson, Ariz. on its way to Los Angeles, on Sept. 20, 2012. Kelly served as Endeavour's last space commander months after Giffords survived serious head injuries because of a 2011 shooting. (P.K. Weis / Southwest Photo Bank via AP) Back to slideshow navigation
  4. Gabrielle Giffords blows a kiss after reciting the Pledge of Allegiance during the final session of the Democratic National Convention in Charlotte, N.C. on Sept. 6, 2012. (Eric Thayer / Reuters) Back to slideshow navigation
  5. Gabrielle Giffords stands on top of a peak in the French Alps with her husband Mark Kelly, right,, and mountain guide Vincent Lameyre, July 23, 2012. On her first trip out of the country since her injury in 2011, she rode a two-stage cable car to a station for spectacular views of Mont Blanc. (Denis Balibouse / Reuters) Back to slideshow navigation
  6. Ron Barber, right, celebrates his victory with Giffords, left, prior to speaking to supporters at a post election event, Tuesday, June 12, 2012, in Tucson, Ariz. Barber, Giffords' former district director, won her seat in a special election after she resigned to focus on her recovery. (Ross D. Franklin / AP) Back to slideshow navigation
  7. Democratic Florida Rep. Debbie Wasserman Schultz, read Rep. Gabriell Giffords resignation speech on the House floor on Wednesday, Jan. 25, 2012. The day after President Obama's State of the Union speech, Giffords formally offered her resignation to Speaker John Boehner. Weeping, Shultz applauded the strength of her friend and colleague, "I'm so proud of my friend." (MSNBC) Back to slideshow navigation
  8. President Barack Obama hugs retiring Congresswoman Gabrielle Giffords as the president arrives to deliver his State of the Union address on Tuesday, Jan. 24, 2012. (Pool / Reuters) Back to slideshow navigation
  9. Rep. Gabrielle Giffords, D-Ariz., left, and Pelosi, right, posing with Giffords husband, former astronaut Mark Kelly of the Navy, at his retirement ceremony with Vice President Joe Biden in the Old Executive Office Building on the White House complex in Washington, Thursday, Oct. 6, 2011. (House Leader Nancy Pelosi's office / AP) Back to slideshow navigation
  10. Rep. Gabrielle Giffords returns to the House for the first time since she was shot, making a dramatic entrance on Monday, Aug. 1, 2011, during a crucial debt vote. She drew loud applause and cheers from surprised colleagues. (NBC News) Back to slideshow navigation
  11. Rep. Gabrielle Giffords poses for a photo the day after the launch of NASA space shuttle Endeavour and the day before she had her cranioplasty surgery, outside TIRR Memorial Hermann Hospital May 17, in Houston, Texas. Aides of Rep. Gabrielle Giffords posted two recent photos of the congresswoman to her public Facebook page, the first since the January 8 shooting that killed six people and wounded a dozen others. (P.K. Weis / Giffords Campaign / Getty Images) Back to slideshow navigation
  12. Emergency workers use a stretcher to move Rep. Gabrielle Giffords after she was shot in the head outside a shopping center in Tucson, Ariz., on Saturday, Jan. 8, 2011. (James Palka / AP) Back to slideshow navigation
  13. In this Jan. 5, 2011 file photo, House Speaker John Boehner re-enacts the swearing in of Rep. Gabrielle Giffords on Capitol Hill in Washington. (Susan Walsh / AP) Back to slideshow navigation
  14. Rep. Giffords, left, speaks during a candidates debate with Republican candidate Jesse Kelly at the University of Arizona in Tucson, Ariz., on Oct. 18, 2010. Kelly is an Iraq War veteran and was the Tea Party favorite for the 8th congressional district seat. (Joshua Lott / The New York Times via Redux Pictures) Back to slideshow navigation
  15. Rep. Gabrielle Giffords meets with constituents in Douglas, Ariz., in 2010. Giffords, 40, took office in January 2007, emphasizing issues such as immigration reform, embryonic stem-cell research, alternative energy sources and a higher minimum wage. (Reuters) Back to slideshow navigation
  16. Rep. Giffords speaks during a press conference in Washington, D.C., where members of Congress called on the President to secure the border with the National Guard on April 28, 2010. (James Berglie / Zuma Press) Back to slideshow navigation
  17. This picture provided by the office of Rep. Gabrielle Giffords on Monday, March 22, 2010, shows damage to her office in Tucson, Ariz. The congressional office was vandalized a few hours after the House vote overhauling the nation's health care system. (AP) Back to slideshow navigation
  18. Rep. Gabrielle Giffords, D-Ariz., center, gives a tour of Statuary Hall in the Capitol to Shuttle Discovery STS-124 astronauts Mission Specialist Akihiko Hoshide, of Japan, and her husband, Commander Mark Kelly, on Thursday, July 17, 2008. (Bill Clark / Roll Call Photos) Back to slideshow navigation
  19. From right. Rep. Ken Calvert, Rep. Dennis Moore, Rep. Gabrielle Giffords, and Rep. Heath Shuler, attend a House Ways and Means Subcommittee on Social Security hearing on current and proposed employment eligibility verification systems on May 6, 2008. The hearing provided a forum for lawmakers on both sides of the immigration debate, focusing on a system to verify the legal status of workers and job applicants. (Scott J. Ferrell) Back to slideshow navigation
  20. Gabrielle Giffords with U.S. Navy Cmdr. Mark Kelly, a NASA astronaut, at their wedding in Amado, Ariz., on Nov. 10, 2007. Kelly's twin brother, also an astronaut, is a commander on the International Space Station. "We have a unique vantage point here aboard the International Space Station. As I look out the window, I see a very beautiful planet that seems very inviting and peaceful. Unfortunately, it is not," said Scott Kelly of the tragedy that befell his sister-in-law. (Norma Jean Gargasz for The New York Times / Redux Pictures) Back to slideshow navigation
  21. Representatives-elect including Dean Heller, top right, and Gabrielle Giffords, next to Heller, prepare for the freshman class picture for the 110th Congress on the House Steps on Nov. 14, 2006. (Tom Williams / Roll Call Photos) Back to slideshow navigation
  22. Rep. Gabrielle Giffords rides horseback in 2006. In an interview with NPR last year, she recalled working with horses during her adolescence in Tucson. "I loved cleaning out the stalls, and I did that in exchange for riding lessons. And I continue to ride most of my life. And I learned a lot from horses and the stable people ... I think it provided good training, all of that manure-shoveling, for my days in politics ahead." (Reuters) Back to slideshow navigation
  23. A page entitled, "Just do it!" in La Semeuse, the Scripps College yearbook in 1993. The photo at right shows Giffords in traditional Mennonite clothing. That same year, she won a Fulbright award to study Mennonites and other Anabaptist groups in Northern Mexico. Gifford's senior thesis was titled "Wish Books and Felt-Tipped Fantasies: The Sociology of Old Colony Mennonite Drawings." (Scripps College) Back to slideshow navigation
  24. Gabrielle Giffords' senior portrait from the 1993 Scripps College yearbook. Giffords double-majored in Latin American studies and sociology. A Dean's List student, Gifford won several awards during her time at Scripps. (Scripps College) Back to slideshow navigation
  25. Gabrielle Giffords, right, laughs with her mom, Gloria Kay Fraser Giffords, in a photo published in the Scripps College yearbook. Gabrielle received a B.A. in Sociology and Latin American history from Scripps College in Claremont, Calif. in 1993. (Scripps College) Back to slideshow navigation
  26. University High School portrait of Gabrielle Giffords, class of 1988. Dr. John Hosmer, taught history to the future lawmaker. He tells msnbc.com, "Gabrielle sat in the front row. She was inquisitive ... She was a very mature person from the moment she walked in the door." (University High School) Back to slideshow navigation
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