"There are Consequences"

[gailkate]

The killing spree in AZ is something some of us need to discuss, so I'm starting a separate thread to keep the other threads peaceable. If I'm the only one who posts anything, I can just talk to myself.

From the News thread:
[I've listened to so much discussion - on all the cable networks, including FOX, which was the first to report some of Jared's jumbled internet posts - and I value insights from a broad range of people. I think it's CNN that has a former FBI profiler who now comments on stories like this. He takes very seriously the environment that helps trigger insane actions. I find that a fascinating discussion, so I'm going to start a thread on that, and people can just ignore it if they're going to get mad, ok?

In addition to inflammatory media and political figures, I think we do have to consider movies, TV and music, even though we all hate the idea of censorship. A sidelight that interests me is the circumstance of Jared apparently being disruptive in his CC classes and spouting off on the 'net about bits and pieces from history and English classes. It's a minor point but I can't help feeling for his teachers as they now wonder what they should have done, what might have been said in their class that he mixed into his mental stew.]

I think a culture is changed by what it tolerates in public discourse. What Palen did with her chart of "targets" in "crosshairs" and "don't retreat - instead reload" was a sign of the heightened level of ugly imagery that can encourage unstable people to violent acts. I also think people like Glenn Beck, Limbaugh and others are right on the edge of inciting violence all too often. But there is ugly rhetoric on the left as well. Last night Ketih Olbermann came down hard on this new rhetoric, and he blamed himself as well.
You can listen or read here.
www.msnbc.msn.com/id/40981503/ns/msnbc_tv-countdown_with_keith_olbermann/

[doctork]

I certainly agree with you gk.

Yes the alleged shooter is a nut job, but Sheriff Dupnik has a valid point. Nut jobs are easily swayed by hateful political rhetoric. I do not see a place in our society for responsible political or entertainment figures to advocate elimination of those they disagree with by violent means. And putting a photograph of Gaby Giffords in the cross hairs on a map that highlights her location, and that of other "enemies," constitutes the encouragement of violence IMHO.

To ascribe the whole event to a single nut job, and to assert that the political and media environments have absolutely nothing to do with such events is hopelessly naive IMHO.

I used to admire Sarah Palin for being gutsy and "walking the talk.' Once she hit "the big time," her head swelled even without the benefit of GSW trauma, and I am sorry that I might have in the past done anything to encourage her destructive behavior, even if it was only to state that I thought she was a woman of principle who did not deserve the bad press she was receiving.

I was wrong in that assessment, and even if she were to have principles, she lacks the judgment to use them responsibly, as do the rest of her radical spouting colleagues on both the right and the left. At least Olbermann has the decency to apologize, and perhaps he will even reform his ways, even if he loses a few rating points. A pox on all their houses.

Frankly, I don't read or watch those hate-filled shows with all their shouting - either right or left slanted. And I will not be reviewing the perpetrators rantings either except to the extent they are quoted in news stories. Junk food for the brain, no thanks.

[BoatBabe]

There ARE consequences. Sometimes they come from the Law of Unintended Consequences, which is usually the exact opposite of what was originally anticipated or expected, but consequences nonetheless.

The hateful speech, finger-pointing and pictures we have been pummeled with from ALL sides will have and has had an impact.

There are more sides than Democrats and Republicans: Tea Partyers, Libertarians, Independents, Constitutionalists, Green Partyers, etc. Every time I go to the post office there is a table outside displaying Obama's picture with a Hitler mustache painted on his face and rabid, screaming young people, "Come talk to us! What are you afraid of?!? You should be afraid of Obama! Help us get rid of him!"

What does that mean?

Does some unhinged person take that to mean, "kill him?"

Do cross hairs on a map make "crazy" people shoot other people? Do cross hairs on a map help to stop "crazy" people from shooting other people?

I have lots of questions, and no answers.

I don't believe the heated, caustic rhetoric has been helpful.

[gailkate]

I've been sort of watching CNN much of the afternoon while boxing up Christmas stuff. One positive thing that's happened is that a conference call was organized for 800 people this morning - all members of Congress, their spouses, staff and families. One of the dead was a staffer, and those people are as stunned as those who are the prominent targets. In fact, one witness said Gaby and her staff were sitting ducks, because they were working with a table - I'd guess using it for literature, constituents' requests for help - so it was sort of a jumble of people, hard to get out of the way. Staff members are sort of invisible, but they're equally at risk.

On the conference call, they were updated on the dead and wounded, and also talked about all they can do for security while still going out among constituents. I didn't know that Fed. Marshalls are charged with protecting judges, but now they're talking about expanding that support to Congress. Apparently the tone was very subdued and collegial, so maybe this will make a difference in the kind of language they use themselves and what they condemn in their supporters.

Did you all hear that the murdered judge was not just there to say 'hi' but to discuss judicial overload at the state level? Because he was there working, this is a federal charge of 1st degree murder, so I imagine the death penalty is a possibility. Maybe that will be used to get the kid's cooperation. It doesn't seem possible that such a deranged person would be executed, but that will all be a matter for psychiatrists. His parents must be devastated.

[doctork]

Agree with your point about many sides BoatBabe. In fact, there are people who are on no discernible "side" at all who are prompted to take action - which may well be the case with Jared Loughner. It's my clinical impression that mentally unbalanced individuals are among the most likely to take up the media's or a specific person's suggestion of mayhem.

I am ashamed of both the right and left wings for jumping in a la Rahm Emmanuel: Never let a good crisis go to waste. Let's use this tragedy ASAP to promote our cause.

It is something of a relief that both R and D members of Congress are meeting today via conference call in a bipartisan fashion, maybe even hearing the voters' message: We want you all to work together for our (that's "we the people") benefit, as well as the crazy's message that your own personal hide is in danger. If an appealing centrist such as Gabrielle Giffords can attract lethal attention, then no member of Congress is safe.


I'm not endorsing censorship, but I do think adult behavior, restraint, and common sense (now there's an oxymoron if there ever was one) should be employed. And yes, certainly the arts can be culpable as well as political commentators. After all, IIRC, the guy who nearly assassinated Ronald Reagan was inspired to do so by the movie Taxi Driver, in an attempt to impress actress Jodie Foster.

I believe political commentary is especially apt to be misused inappropriately and end in catastrophe (those unintended consequences BoatBabe mentions). That is because the attempted assassination of Gaby Giffords has a much more global damaging effect upon our nation than the death or near-death of a single politician; good people become fearful of running for office and serving; those in office fearful of going out and meeting with their constituents, which is the essence of their job, and the very essence of our democratic government.

[BoatBabe]

Having been an elected official I can tell you that elected officials need to stay in touch with the people who voted them into office. It is not easy, and sometimes it is scary, even at the community level I served. I can't imagine how the dynamics and danger have changed and exacerbated in ten years and at the federal level.

Having never been a celebrity, I can still tell you that some of those folks don't leave their compounds without a huge security detail, time lines and private planes.

When was the last time John McCain advertised and then did a meet-n-greet with his constituents on the street corner in front of a Safeway?

[gailkate]

Apparently a lot of my guesswork was wrong. The NYT reports that prosecutors have charged jared with 5 federal counts including the attempt to assassinate a US Congresswoman.
www.nytimes.com/2011/01/10/us/politics/10giffords.html?hp

TUCSON — Prosecutors charged Jared L. Loughner, a troubled 22-year-old college dropout, with five federal counts on Sunday, including the attempted assassination of a member of Congress, in connection with a shooting rampage on Saturday morning that left six people dead and 14 wounded.

Evidence seized from Mr. Loughner’s home, about five miles from the shooting, indicated that he had planned to kill Representative Gabrielle Giffords, Democrat of Arizona, according to documents filed in Federal District Court in Phoenix.

Special Agent Tony M. Taylor Jr. of the F.B.I. said in an affidavit that an envelope found in a safe in the home bore these handwritten words: “I planned ahead,” “My assassination” and “Giffords.”

Mr. Loughner, who is believed to have acted alone, is in federal custody and is scheduled to make his first court appearance before a magistrate judge in Phoenix on Monday.

Ms. Giffords was in critical condition after surviving, against the odds, a single gunshot wound to the head at point-blank range. Her doctors were cautiously optimistic that she would survive, and said on Sunday that they had removed nearly half of her skull to prevent damage from the swelling of her brain.

K, I'm apprehensive about this "guarded optimism" they keep talking about. Saying she'll survive doesn't mean she'll recover. Like the TBI cases we've read about among soldiers, isn't she likly to be at least somewhat impaired? This story went on to say the bullet went thru the left side of her brain (which the news has emphasized all day) and not through some "critical areas," which would make recovery harder. Isn't the left side the one controlling speech and verbal comprehension? It seems promising that she could obey commands, but they said something like that this week about Israeli PM Sharon, and he's been in a coma for 5 years. I know you're not a neruosurgeon, but can you read between the lines?

Babe, I came to the old CB after you'd explained your political office - was that in Montana? What did you do and for how long? I'd like to hear the story.

[doctork]

gk, Much of what you mentioned from today's NYT was known locally yesterday afternoon, which was why it was obvious the attack was directed toward Congresswoman Giffords, not a random shooting or even an anti-government/politicians shooting.

I've noticed stuff gets out a lot faster on a local event - and in AZ pretty much everything is "local" because it is geographically large, but has a small population. There will be a lot of judicial recusals if there is a trial in AZ by an AZ judge - everybody knows everybody in the legal system and in the neighborhood.

I think that is why Sheriff Dupnik got so emotional. He's an experienced professional but he is also a human being.

I do not think they are finished listing the charges - only 5 federal charges, possibly with more to come. The state has not yet filed any charges, and just in case the feds don't go for the death penalty, the senseless killing of a 9 year old girl will not sit well with AZ jurors. There will be additional charges - at least from AZ if not the feds.

The judge going to meet with the Congresswoman is a method to be sure to get the maximum charges against the alleged perp. It was a spontaneous visit on his part, to stop in after attending mass, but also, he and Giffords did do a lot of legal business together. That district is rife with immigration and drug smuggling problems. Same thing for the aides and Gifford herself - they too were assaulted/killed "in the line of duty," a more serious crime.

As to Giffords' injury, the stories have been in the news about how it was through and through, from the left back of the skull, to going out the left front above the left eye. Or possibly the reverse, I believe they are not yet sure of the path. Since the bullet did not cross the midline, or affect the brainstem, there is the possibility she will survive with critical functions intact.

The left side does control speech and verbal ability, as well as motion on the right side of the body. The doctors have said she responds to simple commands such as "squeeze my hand," but she has not said anything. Her intern (an incredibly poised 20 yo college student) said that immediately after the shooting she was not able to verbalize though she could follow commands, as he stanched her bleeding. Now she is on a ventilator and cannot talk. Nothing has been said about any other movements; it is possible they are limited due to brain damage to the motor nerves.

She may not be able to talk because of brain damage, though brain function is there to follow commands; reception and expression are different areas and functions. This could be due to damage to motor nerves which could prevent talking.

Right now the big concern is brain swelling as that could be quickly lethal, or cause very severe damage to what would otherwise be recoverable function. To those caring for her, that is all that matters right now, and anything more than the next 12 - 24 - 48 hours is way long term, cant worry about it now. She is really very critically ill (anyone in the ICU is labeled critical even if they're not), and her condition can change by the minute.

BUT she does seem to have a best case scenario for her injury, and she is young and otherwise healthy. The possibility of full recovery exists, depending on where the damage was from the bullet path. Nobody really knows what will happen. Some residual impairment would be expected, but she may make a full recovery.

Some code words - "critical but stable" is a code for bad spinal cord injury or what sometimes appears to be "chronic vegetative state." Person is very sick, badly damaged but nothing can be done to change the fate.

We'll all just say our prayers, or whatever your personal preference.

[Jane]

www.nytimes.com/2011/01/10/opinion/10krugman.html?_r=1&src=ISMR_HP_LO_MST_FB

Krugman, as usual, gets it right.

[gailkate]

Yes the papers are full of very good pieces and Krugman is among the best. This one from the McClatchey syndicate references a book that came out before any of this happened, so it obviously can't be accused of a political bias. The author talks about rising anger over several years. I confess I didn't take anti-Bush imagery as seriously as I should have. I guess hanging in effigy is so old-hat that we're used to it, but we need to be more responsible about all violence before it influences a psycho.
www.twincities.com/ci_17052497?nclick_check=1

Much of that was in national news, K, probably with less detail. Some of it changed over the course of the day, which always happens in a frantic news situation. Gupta on CNN was giving very clear descriptions with models of the brain and skull, but he still played it close to the vest on outcomes. Everyone focuses on survival, and I guess I want to hear better than survival. That's what i meant about Sharon. I'm not afraid to die, I'm afraid to "survive" on machines. One of her docs is quoted as saying it could be months to years of rehab, but noted that parts of the brain can learn the work of damaged parts.

[doctork]

Everyone plays it close to the vest when it comes to predictions, because there is no way to predict.

There is so much individual variation in brain structure and function, and also variation in any one brains ability to re-learn a damaged function in a new part of the brain. The standard "map" of brain function is an average, and one person may have a modestly different structure. A once centimeter change in direction of the bullet's trajectory can make a huge difference in outcome, but so can a small variation in where the language function is centered, or where right arm/leg function is located.

I saw one report from the director of Trauma Surgery that Christine Green (the 9 year old girl) was actually DOA but she was taken to surgery and massive attempts were made to resuscitate/save her. Probably one reason is that a very young child has a more plastic brain that can recover from anoxia better than an adult, and can also transfer function more readily from a damaged area, to an area of the brain that would not normally perform that function.

Right now everyone is focused on Giffords' survival because it is too early to tell anything about the long-term prognosis, and there is no way of assessing her higher brain function because she is anesthetized ("medical coma") and on a ventilator.

Many times one must opt to make efforts toward life without knowing if the outcome will be full recovery or persistent vegetative state. I would imagine that in the case of Sharon, there has been a deliberate decision to continue life support, likely based on his prior requests or religious belief, or his medical proxy's determination of what he would want.

Except in unusual circumstances, if it is your expressed wish not to survive on machines, then once it is apparent you will not recover, you can be taken off the machines and allowed to continue toward a natural death. IV fluids and feeding tubes can also be discontinued upon request, though that can be a little trickier.

[gailkate]

There is so much individual variation in brain structure and function, and also variation in any one brains ability to re-learn a damaged function in a new part of the brain. The standard "map" of brain function is an average, and one person may have a modestly different structure. A once centimeter change in direction of the bullet's trajectory can make a huge difference in outcome, but so can a small variation in where the language function is centered, or where right arm/leg function is located.

I had no idea of this variation. Of course it's been decades since I actually studied anatomy (and that was purely at the introductory level). Still, whenever you see one of those textbook illustrations, the brain is shown with the same sort of exactness as the body and all its systems - seemingly fixed and immutable. The variability is fascinating, but it makes neurosurgery sound even dicier than I had thought.

This story includes a tape from Gd. Morning America with Bob Woodruff discussing his care after the IED explosion that he recovered from. I've been wondering about how her brain is being protected without the piece of skull they removed. Is the mock-up he shows actually like what is used?
Also, he says the time for leaving the skull open is up to 4 months. Does that mean the pt is in an induced coma all that time?

www.thedailybeast.com/blogs-and-stories/2011-01-10/gabrielle-giffords-condition-and-latest-signs-of-hope/?om_rid=NsfmjE&om_mid=_BNLFgoB8XMdBk7

[rogesgallery]

How credible are the opinions, of the people we hire to voice, the opinions we wish to hear. I mean really. Is it possible for a person to be objective when they are being paid to postulate upon the ultimately unexplainable question of election to, or even the existence of, perdition? If the number of people one pleases, with the answer that they proffer, means the difference between driving a Neon and a new Mercedes could the mind resist the potential for one pleasure over... aneon?

[doctork]

Jan 11, 2011 13:32:38 GMT -5 rogesgallery said:

How credible are the opinions, of the people we hire to voice, the opinions we wish to hear. I mean really. Is it possible for a person to be objective when they are being paid to postulate upon the ultimately unexplainable question of election to, or even the existence of, perdition? If the number of people one pleases, with the answer that they proffer, means the difference between driving a Neon and a new Mercedes could the mind resist the potential for one pleasure over... aneon?

Gee I dunno Roger. Could you please translate into English? I do get the difference between a Neon and a Mercedes..I mean everybody knows that doctors do unnecessary operations in order to make the money for the Mercedes payment!

"Being paid to postulate." Well now, tonight's AC360 News coverage (I got home late, so that's the only news show on late), Anderson Cooper displayed two emails from Senator Bernie Sanders (I-VT) on the left, and the Tea Party Express on the right. Both used the AZ shooting to fire up the base and ask for money.

As if most of us had any doubt that both "sides" of the partisan political spectrum will take an extremely crass approach to make the most of the crisis as an opportunity to line their coffers. As AC asked: Have you NO decency? The victims aren't even buried yet!

[doctork]

Gail, those anatomy "maps" are generally accurate, but there are many people with small variations and a few people with larger variations. That is one reason that neurosurgeons do some operations with the patient awake, so they can test an area where invasive surgery is proposed with a thin probe, and ask the patient their response. Thus damage of "eloquent areas" can be avoided.

Did you know that there is a rare condition called "dextrocardia," in which the chest configuration is reversed, with the heart on the right side of the chest? Talk about individual variation!

During the time when there is a portion of the skull "missing," the brain has alternative covering and protection. Safe in the ICU, but with the possibility of more emergency surgery, they probably use a tough fabric-like sterile covering that approximates the natural consistency of the dura mater.

Later when she is mobile, she would get some temporary but hard insert for protection (might be like Woodruff's), and many such patients will also wear a "football helmet" for protection. In any pediatric neurosurgery clinic you will see quite a few such football-helmet-wearing toddlers and older kids.

I'd have to look it up, or at least think about it a while, to determine why I see kids like that, but adults rarely wear them. Kids recover from the surgery/injury faster so they are active before they are fully healed? Kids are more prone to injury to begin with so they need a more conservative approach to protection? Adults more commonly die from such devastating injuries, while children survive to wear helmets? Adults go to in-patient rehab, while kids are at home with their families?

I was surprised that the average duration of temporary protection is 4 months, seems long to me. There are many factors that determine when the permanent surgical remediation occurs - risk of swelling (not only the brain but surrounding facial/scalp areas) and bleeding, recovery from other injuries that occurred at the same time as the head trauma. Also, most such TBI patients have a complicated course with multiple setbacks that delay the closure of the defect. Replacing the skull is elective surgery that should wait until heart, lung, kidney, infectious and other injuries have healed enough that elective anesthesia and surgery are safe.

But no, the patient isn't in a medically-induced coma that whole time, as that is too dangerous to continue for any longer than absolutely necessary. But the docs will institute one of those temporary protective mechanisms until the "real thing" is ready for prime time

[BoatBabe]

Jan 11, 2011 23:11:11 GMT -5 doctork said:

Jan 11, 2011 13:32:38 GMT -5 rogesgallery said:

How credible are the opinions, of the people we hire to voice, the opinions we wish to hear. I mean really. Is it possible for a person to be objective when they are being paid to postulate upon the ultimately unexplainable question of election to, or even the existence of, perdition? If the number of people one pleases, with the answer that they proffer, means the difference between driving a Neon and a new Mercedes could the mind resist the potential for one pleasure over... aneon?

Gee I dunno Roger. Could you please translate into English? I do get the difference between a Neon and a Mercedes..I mean everybody knows that doctors do unnecessary operations in order to make the money for the Mercedes payment!

"Being paid to postulate." Well now, tonight's AC360 News coverage (I got home late, so that's the only news show on late), Anderson Cooper displayed two emails from Senator Bernie Sanders (I-VT) on the left, and the Tea Party Express on the right. Both used the AZ shooting to fire up the base and ask for money.

As if most of us had any doubt that both "sides" of the partisan political spectrum will take an extremely crass approach to make the most of the crisis as an opportunity to line their coffers. As AC asked: Have you NO decency? The victims aren't even buried yet!

Isn't that what roges just said, doc?

[doctork]

//Isn't that what roges just said, doc? //

I wasn't sure, so I asked.

[gailkate]

sometimes i think rog is a master at encryption - maybe I watch too much TV

Thanks for the detailed reply yesterday, K. i wrote a long (2 paragraphs!) series of comments and questions, but lost the whole thing. Too frustrated to try again. I'm much more mobile, but this splint catches the little Windows key and pops me out into the void. Just when i was at my most brilliant

[rogesgallery]

I'm still suffering some problems with my MBP, I wrote a long clarification of my post and it POOFED. For now it will have to be sufficient to say that I am happy, Doc, that you believe that Ms Gifford will survive with the single hemisphere damage, but this is not a George Wallace injury and I fear it will end her political career.

No small loss— A Democrat in Arizona!

[doctork]

// I fear it will end her political career.//

It is what we all fear, but we really don't know; there is the possibility of full recovery to normal function. Every doctor has seen a patient that everybody thought was surely a goner, but then weeks later, they walk out of the hospital alive and well.

When my patients face a grim prognosis, only 2% survival or whatever, then it is our job to work together to be sure that my patient is in that 2%. Somebody has to be.

[rogesgallery]

www.godlikeproductions.com/forum1/message1322184/pg1

Jesus Beware we have not grown in these two millennia

Obviously we are a damaged species banished to this tiny rock on the outskirts of the Milky Way for our own safety——for the safety of the rational species of the universe.

[gailkate]

Good grief, how did you find this site? I'm always taken aback by people's willful ignorance. We live in a world where information is at our fingertips - which obviously posters on the 'net know - and yet some people seem to try not to confront actual facts. It must be a very frightening world to inhabit, thinking that literally everything is fake.

[rogesgallery]

The friend of my friend is my enemy. The sick deserve a forum also

[gailkate]

Here's what's RIGHT about this country:

sports.yahoo.com/nhl/news?slug=yhoo-ept_sports_nhl_experts-306789

I saw it first on MSNBC, that lousy pinko liberal network. As Dylan Ratigan said, it's not often you cry at a hockey game if there isn't a fight.

[rogesgallery]

That was great gail! The father in the wings waiting to rescue his daughter from her fears was touching.... but exclusive to this country?

Maybe it was the nefarious flicker rate of the conservative broadcast, where you first saw the video that makes you think that acts of compassion, are exclusive to our country, rather than a part of the human experience in every part of the world.

Certainly it wasn't the impulsive and thoughtless laughter that erupted from one woman, in the silence of the little girls stage fright— that must have been a visiting Arab or a Frenchy too full of freedom fries.

Don't take offense Gail, I'm just making a point that if you want to look for something exclusive to the US Tele-Evangelism might be a better place to start... or Snake Oil.

[rogesgallery]

OOps I thought you said you were watching conservative tele. sorry. The flicker rate still applies though— anything to get you from one commercial to the next. eh

[gailkate]

And I didn't mean exclusive to this country, only that it was a lovely contrast to the "sick [who] deserve a forum, too." I hadn't inferred that the guy waiting to rescue her was her dad - probably true - but I noted the swell of voices was largely male. An arena full of dads and brothers who jumped in to help a little girl and weren't at all shy about singing the national anthem.

[rogesgallery]

Did you notice the woman that started to laugh and the momentary pause before the singing. That is a very interesting video— there is far more going on than a little girl with stage fright and the stunning display of hockey fans showing empathy.

[BoatBabe]

Jan 14, 2011 17:11:56 GMT -5 rogesgallery said:

Did you notice the woman that started to laugh and the momentary pause before the singing. That is a very interesting video— there is far more going on than a little girl with stage fright and the stunning display of hockey fans showing empathy.

Roges, I'm afraid that you are showing far more intelligence than you have a piece of paper to prove you can portray!



;D ;D ;D

[doctork]

Today the doctors at UMC announced that Gabrielle Giffords has been taken off the ventilator, as she has been breathing on her own for several days now.

But they have placed a tracheostomy tube (tube directly into the windpipe) as well as a g-tube (a feeding tube placed through the skin, into the stomach). The endotracheal tube connecting her ventilator machine to her trachea/lungs cannot remain in place longer than 7 - 10 days without causing lasting damage, so when it is expected that the patient will need the breathing tube for a longer period of time, the trach tube is placed surgically, "to protect her airway."

That avoids aspiration pneumonia, where food/drink is accidentally inhaled into the lungs and can cause infection. Also, being on the ventilator itself can cause infection. Patients who can't swallow well, but whose intestines can function normally to absorb nutrition, can have g-tubes placed directly into the stomach so they can eat "normal food" (it is actually pureed) needed to heal and meet normal body metabolism needs. Though the nutritional needs "can be met" with IV solutions, it is much better to give patients real food into the stomach.

So that all seems to indicate that Congresswoman Giffords can't eat/swallow/protect her own airway adequately, and is likely not to be able to do so for quite some time.

Everyone says "With the trach tube in place in her windpipe, she can't talk because the tube is in the way." But if she can't swallow properly, one might infer that her tongue, jaw and throat aren't working properly, so she would have difficulty speaking even if the tube were not in her throat. It looks like she has a a long rehab ahead, although she may well recover all those functions and more through speech therapy, occupational therapy, and physical therapy.

Her miraculous recovery so far, and great good fortune in the path the potentially deadly bullet actually took, may bode well for continued recovery. Faster recovery generally correlates to more complete recovery, but it will be those "baby steps."

And some people can talk, even with a trach. "It depends."