Giffords critical after 'devastating' wound, doctors 'cautiously optimistic'

For an update on Giffords' condition Thursday, and a report on her opening her eyes spontaneously for the first time following the shooting, see Giffords opens eye for first time after Obama visit.

The bullet that plowed through the left side of U.S. Rep. Gabrielle Giffords' skull from back to front Saturday morning left the congresswoman responsive but still in critical condition Sunday.

The surgeon who operated on Giffords for two hours Saturday, UMC neurosurgery chief G. Michael Lemole, Jr., M.D., called the gunshot wound "very devastating" and warned that there is no way to predict how fully Giffords will recover. But he remains optimistic.

"We're all very happy at this stage," he said during a 10 a.m. news conference Sunday.

Giffords was able to respond to simple commands when she came to the emergency room shortly after 10:30 a.m. but couldn't speak and remains unable to. 

"She did not say any words," said University Medical Center trauma chief Peter Rhee, M.D.

Giffords is in a drug-induced coma in intensive care. Doctors frequently awaken her to check her responsiveness, and she could open her eyes and respond to simple commands Sunday - an encouraging sign, said Rhee said.

Despite Giffords' ability to follow commands, "We know that brain swelling can take a turn, so we remain cautiously optimistic,” said Lemole.

He described simple commands as: "can you open your eyes?" or "can you raise two fingers." Such simple tasks can tell doctors much about her condition, he said.

Giffords cannot speak because she is on a ventilator, and cannot see because of the area of her injury and the surgery requires her eyes be kept closed, the doctors said.

The FBI on Sunday confirmed that Mountain View High School graduate and former Pima Community College student Jared Lee Loughner, 22, is under arrest in the rampage that killed six people and left Giffords and 12 or 13 others wounded.

Loughner faces five federal charges, with additional federal and state charges possible.

Eleven of the victims were taken to UMC, the region's only Level One trauma center, where only Giffords remained in critical condition Sunday morning. One UMC patient had been released, three were in serious condition and the rest were in good or fair condition Sunday, Rhee said.

Six surgeries were performed on victims, Rhee said. "It was a combat, trauma type of scenario," he said.

When paramedics brought Giffords to the medical center barely half an hour after the shooting, she was whisked to surgery where doctors removed portion of skull covering the left side of her brain to relieve pressure from swelling. The bone was preserved and can be replaced after the threat of swelling passes, Rhee said.

The surgery included removal of some "devitalized brain," Lemole said.

"Fortunately we didn't have to do a lot of that," he said.

The bullet passed through the entire length of her brain but missed some critical areas that would have made recovery much more difficult.

The projectile did not cross the central dividing line between her brain's hemispheres, which would have been a much worse injury. Recovery from injuries such as this are often measured in years, Lemole said.

Although doctors are optimistic, Giffords has not yet escaped the most serious threat at this point: swelling. Although her level of response is encouraging, the congresswoman's condition could change dramatically very quickly, Rhee said.

"When you get shot in the head, the chances of your being alive are very small," he said.

"It's still very precarious at this time," he said.

Recovery from such an injury can take months or years, Lemole said.

"I don't want to go down that speculative road," he said.

Giffords' condition can be attributed to the short time it took to get her to the hospital and into surgery, and to luck, Rhee said.

The UMC staff plans daily news conferences to update Giffords' and others' conditions.