Gabrielle Cliffords was an American Congresswoman for Arizona when she was shot in the head in an attempted assassination. Her partner Mark Kelly was an astronaut and flight commander on the Space Shuttle. Given their high level jobs and public personae, their book is inevitably much more than the account of a head injury and its aftermath, including their pre-injury stories, and their life together. But for the clinician, and for the relative of anyone with a severe brain injury, there are some particular important sections. ‘Sunrise’ (chapter 15) is the account of the first few days after the injury when ‘Gabby’ was in coma, told from Mark’s perspective. It is not a typical account from some points of view – Mark has to say a few words at the funeral of one of those killed at the shooting, and President Obama visits Gabby in hospital. But the essentials of what Gabby and her nearest went through are similar to what many go through after traumatic brain injury (TBI). Examples include the fact that surgeons removed a portion of Gabby’s skull to allow for cerebral swelling; uncertainty about prognosis is disconcerting; and Mark finds he has to be Gabby’s advocate while important decisions are (or are not) taken. He asks for the second opinions about treatment that he feels Gabby would have asked for were she able to. Emotions run high when Gabby briefly opens her eyes and gives a thumbs up gesture.
‘The parameters of a miracle’ (chapter 17) concerns the continued period on ITU when Gabby is more awake but still fighting a life-and-death battle. Gabby is severely upset and panicked when she realises that she cannot speak. Physical therapy takes place daily. At this stage Gabby has a dense right hemiplegia, but is soon walking hesitantly with the aid of the therapists. She utters her first words, struggling to will each of them from somewhere remote in her brain. She expresses her frustration with the language difficulties. Mark describes Gabby’s desperate need for sleep, 13-14 hours a day, as the brain went through a very slow healing process.
‘Great signs of progress’ (chapter 20) deals with the later period of rehab, as Gabby starts to spend weekends away from the rehab hospital in Houston, and then moves out to stay in a friend’s house while continuing treatment as an out-patient. Discharge from hospital was a time of anxiety, as Gabby realises the enormous challenges ahead of her. Mark describes their continuing misunderstandings as the aphasia limits Gabby to telegrammatic circumlocutions. She is able to answer other people’s questions, or to finish off sentences, but asking her own questions or starting a new subject intelligibly is very difficult.
The perspective of these chapters is that of a descriptive 3rd person, or in Mark’s voice as the observer of events. Mark tells us at the end that Gabby checked the chapters and corrected anecdotes. The final brief one-page chapter is in Gabby’s own words. Short but expressive sentences, marked by her continuing language problems but also by her characteristic determination.
This is a very useful insight into recovery from severe brain injury, and says much more about the period of coma and rehabilitation than, for example, I am Malala. It is highly recommended.
There is also a TED talk interview with Mark and Gabby, in which Mark is the main speaker, but Gabby stands to deliver a short prepared message to the live audience. It shows graphically her continued mobility and language problems, but more than that, it shows her positivity and determination.
Gabrielle Cliffords and Mark Kelly (2011) Gabby: a story of courage and hope, London, Simon & Schuster UK
Audiobook (read by Mark Kelly) available: https://www.audiobooks.co.uk/audiobook/gabby-a-story-of-courage-and-hope/117181
TED talk (March 2014) Mark Kelly and Gabby Cliffords in conversation with Pat Mitchell, ‘Be Passionate. Be Courageous. Be Your Best.’ (18min 48 sec)