G. Michael Lemole Jr., M.D., chief of neurosurgery at the University of Arizona Department of Surgery and University Medical Center, found himself in the media spotlight after he performed brain surgery on U.S. Rep. Gabrielle Giffords after she sustained a gunshot wound to the head in Tucson on Jan. 8.
As the keynote speaker at Health Journalism 2011, he recounted the treatment of the congresswoman earlier this year and his experience working with the media:
Everyone made a big deal of what we did, but it’s what we do everyday … This is academic medicine at its best
In the operation, Lemole and Martin E. Weinand, M.D., removed part of Gifford’s skull to allow her brain to swell, as well as removing dead brain tissue and skull fragments caused by the bullet.
“We basically take part of the skull off and let the swollen brain relax,” explained Lemole. The procedure can relieve pressure on the brain but it can also worsen edema – the build-up of fluid that can cause an “outward herniation.” They also had to remove damaged parts of the brain to “save the good brain underneath.”
The procedure is informed by data gathered during surgery on soldiers injured in the Iraq war, he said. At some point, surgeons will replace the bone or use a prosthetic.
On Jan. 15, Lemole repaired Giffords’ orbital roof fracture through a skull base approach. The last surgery that Giffords received was a ventriculostomy, which measured intracranial pressure and drained fluid in the brain. He credits the use of growing use of simulation in surgical training for allowing doctors to successfully perform operations like the ventriculostomy. In addition to simulation training, Lemole said the “flawless” EMT response and the multidisciplinary nature of trauma team combined to improve Giffords’ odds.
Lemole supervised the congresswoman’s care until she was released to a Houston rehabilitation hospital on Jan. 21 and during this time, was available to the media. “We strategized with ourselves, administrators, and with the family. The family asked us to get the correct information out,” he said. Lemole said he chose his words carefully. “I don’t think I gave a rosy account,” he said, describing his careful use of the term “functional recovery” instead of terms like “full recovery” or “back to normal.”
Giffords outcome was impossible to predict at the outset of her injury. Generally, the odds of dying from a gunshot wound to the head range from 56 to 94 percent, Lemole said. If the path of the bullets goes through the geographic center of the brain, through the ventricles or through multiples lobes, the prognosis is not good. In Giffords’ case, the bullet did not cross from one side of the brain to the other, but travelled through the left side. The patient’s level of consciousness at admission is another factor – at the time, Lemole was quoted as saying that Giffords was able to follow simple commands from the doctors.
The Arizona Republic newspaper reports “that she can stand on her own and walk a little but is working to improve her gait.” The use of her right arm and leg “is limited but improving” . Longer sentences frustrate her and she speaks most often in a single word or declarative phrases. She longs to leave the rehab center, repeating “I miss Tucson” and wheeling herself to the doors at the end of the hall to peer out. When that day comes, Giffords told her nurse, she plans to “walk a mountain.”