Malala Yousafzai's survival from a bullet wound to the head and early signs of hope bear a strong resemblance to the case of former U.S. congresswoman Gabrielle Giffords – and if anyone knows, it's the doctors who treated the American politician shortly after she was shot in the head and helped her through a gruelling rehabilitation.
"There are some very strikingly similar features: the left-sided gunshot wound, the fact that the reports are that [Malala] was moving everything and responding to commands by the initial triage doctors out in Swat [Pakistan]. These are all good things – so that should give some real optimism to everyone involved," said Dr. Michael Lemole, the neurosurgeon who operated on Ms. Giffords at the University Medical Center in Tucson.
An injury resulting from a bullet passing through the head – hitting the left and right sides of the brain – almost certainly would have been fatal. But like Ms. Giffords, the 14-year-old champion of girls' rights appears to have been spared that scenario.
Shot last week by a Taliban assassin, Malala can expect a "good recovery," according to her British medical team. The effect of any brain damage on her ability to move, speak or remember remains unclear.
The surge of optimism felt by Dr. Lemole and others during those early stages is no doubt what Malala's British medical team is experiencing today after news that the Pakistani girl was able to stand with assistance, write and communicate.
Some of the early signs are that things are heading in the right direction for Malala in terms of her survival and recovery. Are you surprised by that?
No, it all depends on a lot of facts. What was the calibre of the bullet slug, what was its velocity? If it had imparted enough force to the brain that swelling immediately started, she might not have survived to get to that first military hospital where they could perform the decompression.
How much does Malala's case remind you of the case of Ms. Giffords?
There are some very strikingly similar features … But without knowing the exact trajectory of the bullet or the exact nature of the examination, it's all speculation until she comes out into the public.
Doctors in Pakistan and in Britain have described her strength and resilience. As a doctor is that something you can identify very quickly and easily?
There are those intangibles that I cannot identify. And there are those patients who have incredible drive and work with their rehab doctors and therapists and really make the most of their recovery. But I want to be careful. I don't want to imply that patients who don't recover are that way because they didn't try enough or because they didn't have the will power. That's not always the case. But certainly when you have the will power and you are able to bring that to bear on your recovery, I think it does contribute to a fuller recovery.
Ten or 20 years ago, I imagine someone being shot in the head would be considered a very difficult case to treat. How is it different today?
The difference is our mindset regarding this. In the 1980s and 1990s, there were a couple of studies that said if you have a through-and-through gunshot wound to the head, you were not really salvageable. And there was a lot of pessimism and I think a lot of patients went untreated. And now we're starting to realize, partly because of the conflict in Lebanon in the 1980s and partly because of the Gulf wars – and then the most recent wars in the Middle East – that if you can get these patients very quickly to a place where you can perform neurosurgical decompression, and if they are salvageable in the first place – in other words if you had any signs of life – then we can actually help these patients survive and some of them will make a decent functional recovery. What will be a game-changer in the future is when we start having the ability to introduce regenerative capacity in to the brain, whether it is through some chemical matrix or something derived from stem cells.
Take us back to January, 2011, when you got involved in the case of Ms. Giffords – what were those key moments in the neurosurgery in that case early on?
It was the fact that she was following commands right before the surgery and very quickly afterward we got her to wake up gain. Those were the most important key moments.
And then those little poignant vignettes you hear from in the press: when Mark Kelly, her husband, came and sat next to her, she started fiddling with his ring – little things like that that I can't measure but that he told me and subsequently told others, that were very meaningful because it implies a much much higher level of cognition, much much higher level of brain processing than the simple rudimentary test that I can do.
There is an element of "case-by-case" in all of this. In the case of Ms. Giffords, it was that the bullet entered the left side of the brain and it if it had gone through the brain – from right to left, or left to right – then it would have been a very different outcome?
Correct. That's why I said there were so many things we couldn't control: how she presented, the trajectory of the bullet. And then there were things we could control.