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State of the Union

Head Trauma Doctors Answer Questions About Giffords Shooting; Interview With Trent Franks

Aired January 09, 2011 - 11:58   ET


CANDY CROWLEY, CNN ANCHOR: We are awaiting a press conference at the University of Arizona Medical Center, it's in Tucson, of course. We are looking for an update on the condition of Congresswoman Giffords. We expect to hear from them right now, so we're going to take you there in Tucson.

KEVIN BURNS, CFO, UNIVERSITY MEDICAL CENTER: ... who rose to the occasion yesterday to help out in this crisis. All of our nurses and our staff. That includes our social workers, our clergy, and all of our support crew.

Yesterday was a challenging day for Tucson, the state of Arizona, and the nation, but we'll get through this. I am convinced that after I saw the way people pulled together yesterday.

In a minute, again, I'll turn the microphone over to Dr. Rhee. We plan to do daily updates at 10:00 a.m., Mountain Standard Time, and we'll hang around if you have questions afterwards. I know there are a lot of questions.

For now, I'd like to -- oh, by the way, I would like to thank Mayor Bob Walkup being with us here today. Steve Goldschmid, the dean of the College of Medicine, for being with us here today. And I would also like to introduce President Robert Shelton. He is the president of the University of Arizona who would like to make a few brief remarks, and he'll turn it over to Dr. Peter Rhee. Thanks again.


Like Kevin Burns, I will be brief, because the individuals you want to hear from are the gentlemen on my right in the white coats.

I also want to acknowledge the first responders, all who were engaged in the critical timeline that occurs from the first incident to getting people into the operating room and in the hands of these exceptional individuals.

Another individual that I want to mention here is the chair of surgery, Rainer Gruessner. He'll have a word or two to say. Dr. Gruessner joined us about three-and-a-half years ago and has built an extraordinary team in surgery and in trauma. You'll hear from them later on. I think it's safe to say that this team is second to none. And the timeline, the rapid response that they had here has saved lives, nothing short of saving lives. You will hear, as Kevin said, from Dr. Lemole, he's chief of neuroscience, neurosurgery; and Dr. Rhee, who spoke yesterday, who's chief of trauma, critical care, and emergency surgical care.

And so I offer on behalf of the entire University of Arizona community, certainly Tucson, Arizona, and beyond that, our appreciation and thanks for the remarkable skills of these individuals.

The University of Arizona is proud to be associated with UA Healthcare and to play a role in this. So now it's my pleasure to introduce Dr. Rainer Gruessner who's chair of surgery here at University of Arizona and at UA Healthcare UMC. Rainer?

DR. RAINER GRUESSNER, CHAIRMAN OF SURGERY, UMC: Thank you, Dr. Shelton. I will be very brief. This is obviously a sad day for the families, for the community, for the state of Arizona, and for the nation. Our hearts go out to the families of the victims.

This is something we are rarely prepared for, as we think, but yesterday we were fortunate enough to have doctors Rhee and Lemole here. Within an hour, six patients were in the operating room. We had four trauma surgeons in the operating rooms, two neurosurgeons were here. We had a cardiothoracic surgeon, a vascular surgeon here. It took 38 minutes for the most critical injured person to be transferred to the operating room.

And it is my great pleasure to introduce the two individuals that are crucial in the recovery of the victims to you now. Dr. Peter Rhee, who has served our nation with great distinction in foreign wars, both in Afghanistan and in Iraq; and Dr. Lemole, who is the chief of neurosurgery, who joined us a year-and-a-half ago.

It is always the readiness, the willingness of people to support us, not just the physicians but also the people in the operating room. Everyone else did a marvelous job yesterday. And I think our community and the state can be proud of what happened here within a very short time yesterday. Peter?

DR. PETER RHEE, MEDICAL DIRECTOR, UMC TRAUMA CENTER: Thank you very much. My name is Peter Rhee, I'm the trauma medical director here at University of Arizona University Medical Center.

Again, we suffered a tragedy here. I never thought I would experience something like this in my own backyard. And I have a lot of sympathy and empathy for the patients who came through here and their families. And this is a very trying time period for all of us. So, again, our condolences, especially to the patients and their families.

My update is going to be fairly short and I'm going to turn it over to Dr. Lemole, who's on my side here, one of my partners. We had a combination in total of 11 patients that we had seen here at the hospital. The first one was a 9-year-old child who came in dead.

We tried resuscitative efforts, including surgery on her, but we were not able to resuscitate her and bring her back. We had five patients who were brought to us in serious condition. Of those patients, we had additional five patients who were not in such a dire situation or critical situation, but we ended up doing six surgeries, and those surgeries included a variety of things in a trauma combat type of scenario.

It was a mini mass casualty in some senses, and we were doing things to the chests, abdomen, also vascular, cardiothoracic, and also orthopedic in nature as well.

As of this morning, we're happy to state that only one patient remains in critical condition. And I think that we'll be able to discuss that patient in a little bit more detail, give you information.

The rest have been moved out of the ICU unit. We still have three in serious condition, and the rest are in fair or good condition with one patient being discharged.

We all know that the one patient in the ICU right now in serious condition is the congresswoman, and so at this point what I'll do is I'll turn it over to Dr. Lemole, the chief of neurosurgery here, and he can give you some more information.

MICHAEL LEMOLE, CHIEF OF NEUROSURGERY, UMC: Thank you again. I'm Michael Lemole here at the University Mental Center in the University of Arizona. And I want to, again, reiterate that our thoughts and prayers go out to the families of all of those affected here.

Let me first reiterate what a lot of people have said, which is the incredible effort here. It's a team effort. It's a team effort at a level one trauma center. And that kind of resource enables this effort. Everything from the ER physicians, the support staff, and nursing, Dr. Rhee and his team who were able to triage the patient and get the patient to the OR in 38 minutes.

And then the staff that helped with the OR case, not the least of which my partner, Dr. Martin Weinand, who operated next to me, the anesthesiologists, and all of the support staff. And again, this kind of effort, this kind of outcome is really possible because of these resources.

So let me take you back to the sequence of events, to clear up some of the information out there. Congresswoman Giffords was shot in the head. When she arrived here, the reports were that she was, in fact, able to follow commands. That is to say, responsive to verbal communication.

We very quickly got her back to the OR, as you heard, within 38 minutes, and once in the OR, we went through our routine procedure for this kind of injury. And that consisted of controlling the bleeding, which thank goodness was not severe or excessive. Our next objective was to take the pressure off the brain. And that was by removing the bone fragments that were caused by the bullet fracture, as well as some additional bone to allow the brain to relax.

And lastly, we removed any small parts of devitalized brain, and I'm happy to say we didn't have to do a whole lot of that.

At that point, she returns to the ICU. Now I will tell you briefly that when we talk about gunshot wounds to the head, the things that are most concerning to us are if the bullet crosses from one hemisphere to the other, one side to the other. If the bullet crosses through the geometric center of the brain.

And I'm happy to say that those were not the case in this instance. And because of that, Congresswoman Giffords is able to communicate with us this morning through following of simple commands, and we're very encouraged by that.

We are still, still in critical condition. Brain swelling at any time can take a turn for the worse, but I am cautiously optimistic.

At this point, I'll turn it over back to Dr. Rhee, because he'll talk about the critical care management that will be so vital in her care for the next few days.

RHEE: Thank you, Dr. Lemole.

As he mentioned, she came in and was following very simple commands. Was not verbalizing at that time before the surgery. And then after surgery, she was under anesthesia, so it was hard to say whether she is in a coma-type state. But when we lightened up the anesthetics and did our examination, we were very happy and optimistic, because eventually over the course of the evening, she was able to follow simple commands.

Again, this is very early in our course. We don't know what's going to happen, what her deficits will be in the future or anything like that. And we'll be able to give you those updates as we go along. But we've been very happy with her hospital course. Her blood transfusions have worked well. She's not coagulopathic. We've been able to use hypertonic saline and other things. But things are going very well and we're all very happy at this stage.

So with that at this point, I think I'll open up the floor for questions.

QUESTION: Has she -- you said it has been simple commands. Has she verbalized at all? And we were also told that there was a reviewing of sorts with her husband last night? And she did recognize him. Can you talk about that?

RHEE: No, we can't get into too much more detail than what we already have. But I can tell you right now with the type of surgery, her eyes, she can't open her eyes at this point, mechanical standpoints, and she's also on the ventilator, so she can't speak at this time. QUESTION: Can you explain what a simple command is and what kind of process you go through?

RHEE: Michael?

LEMOLE: It could be anything as simple as please squeeze your hand or show us two fingers. Very simple. But one thing I want to emphasize here is we take those kind of simple commands for granted, but they imply a very high level of functioning in the brain.

RHEE: Yes, I mean, this -- also, he didn't mention, what this is (INAUDIBLE) -- this wasn't a little grazing wound through the brain. This was a devastating wound that traveled the entire length of the brain on the left side. And, you know, he's downplaying some of the efforts, I mean, he -- they saved their lives. The neurosurgeons, Dr. Weinand and Dr. Lemole, saved their patients' lives.

So, you know, with the functioning that she had before the surgery tells us how much injury the bullet did, but the fact that she had a lot of preservation before surgery is what is making this situation with as well as it can.

And of course, as time goes on, the cavitation effects from the bullet itself is going to have some degeneration of brain cells and matter. So we have to see what happens later on.


QUESTION: Because she has gotten through the first 24 hours, is that a vital -- is that a good sign? Everyone always talks about the first 24 hours being so critical.

LEMOLE: So let me just take you through a couple of time points. One of the most important is how she was before the surgery. In brain injury, but particularly gunshot wounds, we have a primary injury. That is the damage done by the bullet as it traverses. We cannot fix that, unfortunately.

Then there's secondary injury, and that's injury caused by the subsequent swelling and the changes. That we can try and mollify. And, again, if she comes in and is able to follow commands, that implies that those brain circuits are still working. Very important.

And the more we see them working after the surgery, particularly in that first 24, 48, 72 hours, the much more encouraged we are.

QUESTION: Where did the bullet hit in the brain?

LEMOLE: It went through on the left side from the -- basically from the back to the front.

QUESTION: What does the left side control?

LEMOLE: In most people, the left side controls their right-sided strength, sensation. In most people, it also controls their speech functions. Their ability to understand speech or make speech. And that includes the ability to understand simple commands.

QUESTION: How long was the surgery?

LEMOLE: Now the surgery took about two hours. There was a little bit of an extension at the end of the case. We had one of our ocular (ph) plastic surgeons perform a decompression, because one of the fractures was affecting the eye socket. That -- we didn't take much longer.

QUESTION: In the best-case scenario, you gentleman have been through this before, sadly, but when are we talking about prognosis and the best-case scenario of time of recovery? How long might the congresswoman have to be in the hospital? How long does recovery like this take or is it a lifetime of recovery?

LEMOLE: Well, one thing I want to be clear is that we don't speculate on the degree of recovery, because we've seen the full gamut, and it really is not productive.

But in neurosurgery, we talk about recovery on the order of months to years. And in fact, we don't even close the book on it until we're several years out. There is a general rule of thumb that the faster you recover, the better your recovery will be, but, again, that is a general rule of thumb and does not apply necessarily in all individual cases.

It is not uncommon after these kind of injuries to be in the ICU for at least a week, maybe in the hospital for two to three weeks, and no doubt there will be a rehabilitative phase, and that could take weeks to months. But beyond that, setting an actual fast date I think is not productive.

QUESTION: What kind of signs will you be looking for in her progress over the next couple of days, next couple of months?

RHEE: Well, actually, it's going to be how her brain functions. And for that, it's very important for us to be able to get a clean assessment of the brain. So the drugs that we use are very manageable and very short-lasting, so we can get a really good assessment.

And it's basically resting her in between those time periods, and then when we wake her up for the examinations, how she responds is what we'll be able to base her prognosis on.

But like -- you know, I know that Dr. Lemole just did a surgery and everybody is going to be cautious about overcalling it, but I am optimistic. I was optimistic yesterday when I saw the case and I saw the brain and the amount of injury that had gone through.

But overall, this is about as good as it's going to get. You know, when you get shot in the head and the bullet goes through your brain, the chances of you living is very small and the chance of you waking up and actually following commands is even much smaller than that.

So this so far has been a very good situation. Hopefully, it will stay that way, OK? Obviously, we don't know which direction she's going to go. It's still very precarious at this time.

QUESTION: Did she have a CT scan, and if so, what did that show?

LEMOLE: So we always do Ct scans. In fact, we had a CT scan before the first surgery. That tells us as surgeons where we have to focus our efforts. I can't go into the details for obvious patient privacy issues, but, again, the CT scan showed the track of the bullet through the left hemisphere.

It showed like I implied earlier that it was not through some of those critical trajectories that would have made recovery much, much more difficult.


QUESTION: What happens when the brain swells? Can you beat (ph) that?

RHEE: Yes, so normally in the ICU stage, when the brain swells, it's like your knee when you get -- when you sprain your knee and fluid accumulates in there. It gets very tense and there is a tremendous amount of pain.

Well, in a brain, it will go through that same situation, except when it gets real tense in there, the blood flow to the neurons and the brain cells get compromised. So in this kind of situation, Dr. Lemole took the skull off and kept it off.

So right now on half of her brain she doesn't have a skull. It's preserved in the hospital right now and we can re-implant that later on. But that's a part of the progress we've made in neurosurgery.

Also during -- in the last decade, the experience that we've learned from the military as well about letting the brain after penetrating trauma swell and not be constrained within the cavity itself has helped a lot. And I think it played a major important factor here as well.

LEMOLE: And if we do run into trouble in the next few days, we do have further tools, we can use medical agents to dry out the brain. We can literally put a tube into the center of the brain, into one of the center fluid spaces to measure pressure and then relieve that pressure if necessary.

But because she looks good right now, there's no need for that.


LEMOLE: That is -- brain-swelling is really the biggest threat at this point.

QUESTION: You said the bullet went in the back of her left side of her head. Did it come out in her forehead, above her eye or...

RHEE: Yes, so from a forensic perspective, doctors are very leery, especially later on, to be able to state for sure. But, I mean, with the experience that we've had, it looked fairly clear to me that it most likely, in my opinion, did go from the back to the front.

QUESTION: And she is not in a coma? She's awake at this time?

RHEE: She's in a medical coma right now. We have induced that coma in order to rest her during the time periods. But we very frequently wake her up to see what her progress is, to make sure that something catastrophic isn't occurring while she's asleep.

QUESTION: So she has not been awake or is this not quite awake...

LEMOLE: We turn off the sedation. That allows her brain to kick in and function at its highest level.

QUESTION: So what -- can you...

RHEE: Yes, so it puts you into a medical coma, a pharmaceutical coma. It puts you to sleep like an anesthetic does, and can turn it off and within minutes we'll be able to examine how it is. So she's not suffering in the bed from being operated on and also being on the ventilator.

There was a question back there, sir?

QUESTION: Could you try in more layman's terms explain how your brain can function at a near-normal level with kind of this hole all the way through it? I mean, is what's remaining making up -- compensating in some way? Were some of the bits just -- there's that much unimportant stuff in the brain?

RHEE: Yes, I don't want to give you my opinion, so I'll let the expert here tell you, OK? Because I'll tell you something different.

LEMOLE: Because this question sort of borders on speculation for recovery, I don't want to go into too much detail, but suffice it to say that there are obvious areas of the brain that are less tolerant to intrusion.

It does not mean that we're using 10 percent of our brain. It does not mean that the other parts of the brain are not important. It means that the brain is able to recover from those injuries as opposed to areas that we call "eloquent."

So without getting into it -- you see where I'm going though? I don't want to go down this speculation road. At the same time, we're cautiously optimistic.

RHEE: Yes, so it is -- you know, with a penetrating brain injury, it is always surprising to, let's just say, the lay people that you think any bullet going into any brain means instant death, but there is a lot of capacity that the human body has and for the ability for us to compensate.

QUESTION: Dr. Rhee, you said, in a lot of cases, bullet wounds to the head are fatal. What do you contribute her still being alive to? RHEE: Well, I attribute that to about five things. And that five is very small. One is that the -- as Dr. Kevin Burns, that paramedics got her to us quickly. They didn't do a lot of intervention. We got the helos on the ground. We have a system in place. It works like a finely tuned machine. And everything at that particular time period worked well.

We got her here quickly. Dr. Randy Friese was the trauma surgeon who treated her and did everything right. We got her quickly lined up and assessed. We knew what injuries that she had. We got her quickly scanned and then to the operating room as fast as we can.

The anesthesia staff that put her to sleep and got her ready for the surgery -- the neurosurgery personnel, all of these things including the post-operative care, the nurses that are in place, everybody gets a part of the credit. It wasn't one particular individual that put a finger in a hole.

But the other part of it is also luck and what the bullet actually hit when she first got hit.

QUESTION: (OFF-MIKE) any prognosis about the other victims?

RHEE: Yes. So, yes, there was a lot of other victims that came in here. And, fortunately, no one that shouldn't have died, died. So everybody survived this and they are doing relatively well.

Right now we were able to transfer everybody from the ICU to the ward status, which is a lesser amount of care overall, which is an indication of how well they're doing. But the people who needed surgery are all recovering well and so far, we're extremely happy with the prognosis of all those other individuals.

Again, you know, it wasn't just one person, it was a mini mass casualty that we had here in Tucson. And again, the hospital, with this preparation due to their constant practice and their experience, was able to pull this thing through and the medical community all contributed heavily to this. And we were in a good situation yesterday.

QUESTION: Dr. Rhee, I know she was on -- she's on a ventilator right now so she can't talk, but at any point upon her arrival did she try to speak at all?

RHEE: No, she could not speak. She did not say any words.

QUESTION: You've served in battlefields of Iraq and Afghanistan, what is it like for you to see what you called a mass casualty?

RHEE: This doesn't compare. This is not really a mass casualty. I have all the gear and people I could possibly want. So I mean, this is a luxury for me. And this trauma center in southern Arizona, we're the only one, and this is about as good as it gets. I'm very happy to call this my home and work here.

QUESTION: To see an act of violence like this in your... RHEE: I see acts of violence in the wars as well. I don't know how you can compare to that. I'm not a political person. You know, for me, I'm just a public servant.

QUESTION: Could you elaborate more on the skull removal procedure?

LEMOLE: Sure. Sometimes when we have these kind of injuries, we actually have to use our drills to literally relax -- take off the skull and relax the brain. In this case, a lot of those fractures had done our work for us, so it was a matter of removing the larger pieces and then extending that.

In layman's terms, that's probably about the simplest way to say it.

QUESTION: So when you actually remove it, what happens when you put it aside and when do you put it back?

LEMOLE: So we typically will protect the brain with an artificial layer and then close the scalp over it. And we'll put it back when the brain has relaxed sufficiently. That may take several months, but every case is individual.

RHEE: OK. So thank you so much for coming and your attention today. I'm going to turn this over to Dr. Greussner at this point.

GREUSSNER: Well, thank you, again, for coming. Dr. Rhee, Dr. Lemole will be available for interviews. Most of the interviews will go through Katie Riley from UMC marketing and PR, and we will have another medical bulletin tomorrow at 10:00 at the same location. We will keep you apprised...

CROWLEY: So there you have it, what we are told is going to be a daily update from the hospital. In layman's terms, I think we just quote -- the first doctor who said, it is very early but they are very happy with the response of Congresswoman Giffords to this severely traumatic brain injury, a bullet traversing her brain from back to front on the left side.

But we have Sanjay Gupta on the line here to talk to us and try to kind of interpret this in layman's terms. Very early and very happy we get Sanjay.

They said at the beginning that the first thing they did was remove some of the bone fragments. That is, that part of the bone that was shattered by the bullet. Then we heard him talk about removing larger parts of the skull, which they're clearly saving to put in later.

And then he talked about removing devitalized brain tissue and cells, but he said not much. Tell us what that all adds up to.

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Well, it's a pretty significant operation that he's describing, as you've already guessed. You know, so from the back to the front, if you think about the type of injury that a bullet can cause, through the skin, the bullet goes.

Then through the bone, then the outer layers of the brain. That bone, when it's hit, it's moving with the bullet. So those fragments are sort of missiles in and of themselves, moving through now into the brain. And that's what he's talking about with regard to moving those fragments.

The bullet, as you know, Candy, was described to be through and through, meaning the bullet itself came out of the head, but those bone fragments were removed first. That's what he was describing.

There's bleeding that's often associated with that, just because the bullet and all of these bone fragments can cause that bleeding. That bleeding needs to be stopped and that's what he's describing next.

And then this last part, where he's talking about taking away some of the tissue that's essentially damaged by the whole injury, that's that devitalized tissue that he was describing. And that was removed as well.

So that was the initial part of the operation. What he described next, Candy, very important. And you and I talked about this earlier, but this idea that the brain is likely to swell in response to this injury.

If you have swelling in many organs in your body, such as in your abdomen, there's plenty of room for it to swell. In the brain, you don't, because of the hard skull. So the objective and what the doctors are describing there is to remove a lot of other bone on that side of the injury, on the left side, and essentially leave that bone off for the time being.

And in that situation, if the brain swells, it's not going to be confined by the skull and it has room to swell. When the brain starts to heal and the swelling goes down, that bone can subsequently be placed back.

CROWLEY: Sanjay, you know, they were reluctant to give timetables, which I get, because medicine is a science but not an exact one, as you know better than any of us sitting here, but when is the danger -- is there a danger period that you can pass, for instance, with the brain swelling? Do you -- if you don't see more brain swelling for the next three days, has it passed?

And he also talked about maybe further degeneration of brain cells. When does that -- when do you pass the danger zone there?

GUPTA: Well, with regard to the first part, the swelling, you can probably more definitively predict a timetable for that. And it's usually a few days. The swelling typically is worse within the first two or three days, but doctors will usually monitor it for about a week or so. And then pretty reliably the brain swelling will start to go down. The skin and the soft tissue around that area may still have swelling for a longer period of time. As far as the degeneration of, you know, brain cells or neurons, that's a longer sort of term thing. And it's very difficult to put a timetable, both on further degeneration, and I think, more importantly, regeneration or, you know, sort of healing and restoring of function.

So he said and, you know, we have found that months is the timetable that's typically measured in. And that's a longer-term process. It's usually sometimes expedited to some extent through rehab -- rehabilitation, that is, and it just really varies, Candy, from patient to patient and injury to injury. So a little bit harder.

But the swelling, the next several days to a week.

CROWLEY: Sanjay, thanks so much for watching this with us. I know we'll talk to you later on in the day. Appreciate it.

GUPTA: Thank you.

CROWLEY: And coming up next, we're going to take a quick break, but I will be joined by my colleagues Jeanne Meserve and Dana Bash as we talk over other elements of this horrific incident in Tucson, Arizona.


CROWLEY: That, of course, is the U.S. Capitol. The flag flying at half-staff, commemorating those who have died. Also, you know, a tip of the hat to a favorite congresswoman up there at this point, who we're told is doing as well as can be expected. I'm joined now by senior congressional correspondent Dana Bash, and homeland security correspondent Jeanne Meserve.

Thanks, both. Jeanne, first to you, where are they in the investigation?

JEANNE MESERVE, CNN HOMELAND SECURITY CORRESPONDENT: Well, they're still gathering everything they can. The FBI director has been dispatched out there to Arizona to run herd over the whole thing.

They're scouring those videotapes, surveillance tapes from surrounding businesses around where the shooting took place to see if they can learn more about this individual, his movements, and also whether or not he was with this second individual.

We've seen a picture of him from surveillance tape, a guy in his 40s or 50s, white man, dark blue jacket, blue jeans. They aren't clear yet, according to law enforcement sources I've talked to, exactly what his connection is, if there's any connection at all. But they very much want to find out.

The parents are cooperating, I'm told, though to what degree we don't know. He, the suspect, is not cooperating, Jared Loughner, at this point in time. They did execute search warrants at the home where he lives with his parents and for a vehicle. We don't know yet what they found in that search. We are expecting a press conference from law enforcement in about a half an hour.

CROWLEY: They're looking. We're looking. What do we know about Jared Loughner at this point?

MESERVE: Well, he appeared to have had a bit of a troubled history. He withdrew from high school for reasons we don't fully understand at this point in time. He applied to the Army. He was rejected. He went to a community college out there in Arizona, had brushes with the police there, and finally withdrew last October.

We know that, in his past, there are a couple of brushes with law enforcement, one for drug paraphernalia, the other for vandalism. And of course, we know about his writings on YouTube, which are a bit confusing, do reference District 8 but don't say anything specific about Congresswoman Giffords at all and make no clear threats, though at one point he does say he's a terrorist; anyone who acts on political views is a terrorist.

I talked to Mark Potok of the Southern Poverty Law Center. They track a lot of groups on -- on the right. He says this individual was not on their radar at all. They had not heard about him until they heard about these shootings.

CROWLEY: Dana, one of the things we've also learned from the investigation is they believe that she was the target, that that's -- she specifically was the magnet that got him there, may have been the first one he shot, sounds like it, at any rate. This is just a fearful thing to tell to the other members up on Congress.

How are they -- in terms of the fear and the Capitol police, how is that all working?

And I know there have been several e-mails out to the congressmen. Are they feeling more reassured or what's...

BASH: I don't think so, not yet. There's actually going to be a conference call in about an hour from now with all members of the House, Republicans and Democrats. The Capitol police will be on it; the sergeant-at-arms, Bill Livingood, will be on it, to try to -- try to give some reassurance and some guidance. Whether there will be any new guidance on anything that they may be able to do differently, you know, who knows.

We did see some notices go out last night, just saying, look, if you have any suspicion at all that something might look a little weird, you've got to contact us and your local law enforcement.

CROWLEY: And one of the things, I think, that's come out of this, obviously, is not a lot of people had heard of the congresswoman. We know her from here, but we are learning more and more about her. She seems such an unlikely person to be the victim of political violence.

BASH: It's so true. Look, she -- she is, of course, one of the most moderate Democrats. She's a centrist. She was first elected back in 2006. She came in on that big Democratic wave that made Nancy Pelosi speaker, and she's had tough re-election battles, only two of them, but tough, ever since.

This past November, she won by just over 3,600 votes. And by the way, she ran against a Tea Party candidate on the other side.

But, you know, very interesting, we are, kind of, looking at some of the things that she has said. Back in 2009, she gave a speech to her alma mater, Scripps college. And she -- it was very moving, but she also said something that now, looking back, may be a little eerie.


REP. GABRIELLE GIFFORDS, D-ARIZ.: The safety of the world depends on your ability to say no to inhumane ideas.

Standing up for one's own integrity makes you no friends; it's costly, yet defiance of the mob in the service of what is right is one of the highest expectations of courage that I know.


BASH: Now, again, a little bit eerie -- obviously, she was talking about standing up to people, presumably, she meant on the right and the left. And interestingly, she is not afraid to buck her own party.

Just last week, Candy, when there was a vote for speaker, most of her Democratic colleagues voted symbolically for Nancy Pelosi. She didn't. She decided she was going to cast her vote for the civil rights leader, John Lewis.

She is very interesting. She's got a lot of interests. She's co-chair of the Motorcycle Caucus. Who knew?


And she's an expert on solar energy. She's well known on that on the hill. And she, of course, as we know now, is married to not only an active-duty officer but an astronaut who is planning on going back up to space.

CROWLEY: There's going to be lots of work on her desk for when she gets back.

BASH: Yes.

CROWLEY: Jeanne, one last question about the investigation. It's now a federal investigation. I, sort of, suspect that Mueller went out there because it seems like there's going to be a lot of people involved in this. You've got local; you've got county; you've got the FBI. And it sounds like there are other law enforcement officials. How does that work?

MESERVE: Well, he's definitely going to be the majordomo here. These are probably going to be federal charges that this individual is facing, so he's going to be the guy in charge. But, yes, it's going to be a complicated -- complicated thing to pull together. I do know, for instance, that the department of homeland security has volunteered, saying anything we can do, anything in terms of scouring databases or whatever; our resources are at your disposal. I'm sure others are doing the very same thing, trying to pitch in here to what's a complicated situation.

I will say that one interesting point that arises is the fact that a federal judge was amongst those who was killed. And a law enforcement source who I talked to this morning thought there would have to be some recusals, because of course everybody in the court system in this community would know the victim. And the impression of this individual was that they might bring in a judge or a magistrate from another jurisdiction to deal with this, that at this point in time they did not think Loughner was going to be moved anywhere at all.

CROWLEY: Homeland Security correspondent Jeanne Meserve, thank you.

Senior congressional correspondent Dana Bash, thanks both.

Up next, we'll talk with Congressman Giffords' colleague from Arizona, Republican Trent Franks.


CROWLEY: The U.S. Capitol -- actually, that may be the Supreme Court I'm looking at. Yes, all of a sudden, it -- they changed the picture on me. That is the U.S. Supreme Court with the flag still flying at half-staff because of the tragedy in Tucson.

We want to remind our listeners that we are standing by for a 1 p.m. Eastern news conference by law enforcement officials in Arizona, which will also include FBI Director Mueller, who, at the president's request, flew out there to try to coordinate the investigation.

We want to also recap just a little what we just heard from a medical news conference out in Tucson, so I want to bring in our Susan Candiotti, just for a recap of what we learned there. Susan?

SUSAN CANDIOTTI, CNN CORRESPONDENT: Yes. Some key points here, Candy. First of all, doctors came out and described the wound suffered by Congresswoman Giffords as devastating but then quickly added that they are cautiously optimistic. And in the room, you could hear gasps and almost a sense of relief from everyone listening to what was being said.

We learned some interesting details. The doctor confirmed, the surgeons confirmed that the bullet went through the left side of her brain from the back to the front. He said that, however, she has been able to follow simple commands, such as squeezing a hand or raising two fingers. He said that the congresswoman has never been able to speak throughout, and right now, however, remains in a medically induced coma. And another interesting point he raises is that they actually had to remove part of her skull, which they will preserve. This allows the brain to swell, if that happens. But so far, they said it has not, and they are later able to replace it.

Again, they are cautiously optimistic that she will recover, and -- and they say it's impossible to gauge how long, of course, that recovery process will take.

Back to you, Candy.

CROWLEY: Thanks, Susan Candiotti in Tucson with the medical update.

Joining me now, Republican Congressman Trent Franks, who represents Arizona's Second District. Obviously, you know the congresswoman as well. I think what we heard, certainly, in that medical news conference that was in layman's terms was it's very early, but we're very happy.

So I know you have been obviously have a more than personal stake in this, simply because she's in your delegation. And what have you heard from Arizona?

FRANKS: Well, pretty much the same things that you just articulated. I have to tell you, yesterday was a tremendous emotional roller coaster. I think it's been described that way by many. But you know, we were told of the tragedy, and then we were told that she had passed away. And then we had this joyful understanding that she now has a good chance of surviving this.

And so I just have to tell you, you know, this lady, oftentimes, they talk about the differences between the Republicans and Democrats, in my case, being a very conservative Republican and how the political gulf is there. But I will say to you with all of my heart that there has never been an unkind word or a terse communication or any sort of acrimony ever passed between myself and Gabrielle Giffords. And I doubt that this happened on too many occasions with anyone. She is just a very decent, precious soul. And it's just almost unthinkable that if this was going to happen to someone in Congress, you'd think it would have happened to someone who was more vitriolic or more intense, but she's just someone that everybody loves and gets along with, despite any political differences.

CROWLEY: You know, Congressman, now -- certainly, she's not out of the woods, a long way to go, and there are others who are just as seriously injured but have been upgraded to serious conditions, which doesn't sound great, but is better than critical. So -- the fact of the matter is, though, now a lot of the whys are coming out. And I wanted to play you something from the Pima County sheriff that he said yesterday. This is Clarence Dupnik, something he said about Arizona.


SHERIFF CLARENCE W. DUPNIK, PIMA COUNTY, ARIZONA: When you look at unbalanced people, how they are -- how they respond to the vitriol that comes out of certain mouths about tearing down the government, the anger, the hatred, the bigotry that goes on in this country is getting to be outrageous. And unfortunately, Arizona, I think, has become sort of the capital. We have become the Mecca for prejudice and bigotry.


CROWLEY: Wow. The Mecca for prejudice and bigotry.

FRANKS: Well, I, you know, even in these circumstances, I think, first of all, our focus should be upon the tragedy that occurred here, and I think it's unfortunate to inject the comments that the sheriff did in this case, because, you know, he has been heavily involved in the whole debate around the immigration issue, and he found himself in this case at different ends even than Miss Giffords, and I think he's sort of carrying on that debate in this tragic moment and it's probably inappropriate.

CROWLEY: And probably, we should say, as you all have been personally affected by this, and that sometimes, you know, you say things you might not want to.


CROWLEY: But the point being that there is now going to be this conversation about why.

FRANKS: Yes, there is, yes.

CROWLEY: And right now, we are saying, well, the political conversation is terrible. And it's heated rhetoric. It encourages unhinged people to do things. Do you see a link between increased sharp rhetoric, sometimes aggressive rhetoric, violent rhetoric, whatever you want to call it, in the political forum and this type of heinous activity?

FRANKS: Well, sometimes in almost any human dynamic, there are so many different factors that it becomes difficult to really analyze it. But I will say this, oftentimes you see central elements, and the central element here is this unhinged lunatic that had no respect for innocent human life, was willing to make some grand statement. I don't even know if he understands what statement he was trying to make. Is willing to take the lives of his fellow human beings to do that. And there really is the central problem. It's a lack of respect for innocent human life, it's a lack of respect for the Constitution, for freedom.

I mean, the last thing I saw Gabrielle Giffords do on the floor of the House of Representatives was to line up like the rest of us and read a part of the Constitution. And unbeknownst to her, when she got to the well, her part was the First Amendment. And that incorporated...

CROWLEY: Peaceful assembly.

FRANKS: Yes, for peaceful assembly. And while she's out there exercising that right, doing her job as a member of Congress, this degenerate shoots her down. And there is the real central core of the issue.

CROWLEY: He absolutely did this, and he is -- he is alleged to have done this. If he is convicted in a court of law, it is on him, and I understand that. But quickly in the less than a minute we have left, do you think that the political rhetoric needs to be softened up a little? Do you all need to try from all sides, forget the Tea Party, forget Sarah Palin, forget the far left, forget the far right, can all of you do a better job in choosing your words?

FRANKS: Yes, ma'am. And I think the best way for us to do that is to recognize that each person, regardless of their political persuasion, is a child of God. And when we recognize that about each other, sometimes I think it not only makes us be kinder, but it makes us really refocus the whole debate on what ways we can help this and future generations have a chance to live and to be free and to pursue their dreams, which is the dream of the founding fathers. And I think sometimes we just need to get back to those basics. And if we did that, a lot of the other issues would take care of themselves.

CROWLEY: A horrible way to get reminded of that.

FRANKS: Yes, ma'am.

CROWLEY: But I think you're right. Thank you so much, Congressman Trent Franks. We appreciate it.

When we come back, concerns about potential security threats for members of Congress.


CROWLEY: Just a little bit of news before we move on here. And that is that the president of the United States, President Obama, has, in fact, talked to Congresswoman Giffords' husband. He is, of course, the NASA astronaut, Mark Kelly. He was in Texas when his wife was shot. The president tried to get ahold of him while Kelly was in transit and was unable to talk to him. The two have now conversed and had a conversation, the president clearly expressing his best wishes for the congresswoman, who the president knows personally.

I want to get now to my conversation with former assistant director of the FBI Tom Fuentes and former Senate sergeant-at-arms William Pickle.

I began by playing them two statements, first from Gabrielle Giffords after her office was vandalized last year, the second from the Pima County sheriff last night.


GIFFORDS: The rhetoric is incredibly heated, not just the calls, but the e-mails, the -- the slurs. So, I mean, things have really gotten spun up. And you've got to think about it. Our democracy is a light, a beacon, really, around the world, because we effect change at the ballot box and not because of these outbursts of violence in certain cases.



SHERIFF CLARENCE W. DUPNIK, PIMA COUNTY, ARIZONA: It's not unusual for all public officials to get threats constantly, myself included. And that's a sad thing of what's going on in America. Pretty soon, we're not going to be able to find reasonable, decent people who are willing to subject themselves to serve in public office.



CROWLEY: First of all, let's talk about whether it is true that it is more dangerous now to work in public office than it was 10 years ago, 20 years ago. Is it?

PICKLE: Oh, I don't think there's any doubt that there is. You know, today's environment is one where, because of the electronic medium, the Internet, the availability of information and the ability of people who are mentally unstable or sick or who are just mean -- the ability for them to make an impact on society is there, and they have the weapons, the tools, the means to do it. And a lot of these people are truly sick. And I think -- we don't know the results of the investigation yet, but I think you're going to see some startling news come out.

CROWLEY: And -- and that's intriguing. I want to ask you why you think that, but let me ask you, Tom, just to, sort of, continue on this string, and that is, do you see a direct link, not necessarily in this case, because we don't know, but is there a direct link between political dialogue, not what you see in the movies or what you can get on the Internet now, but between political dialogue of politicians and of activists and the upswing in threats?

FUENTES: Well, I don't think you can say that in this case, Candy, for sure, yet. We have the readings that he posted on YouTube, and some of the other incidents in his life indicate that he was mentally unstable or not normal, to some extent.

But we don't have an indication of whether he had left leanings or right leanings or was following the political discourse and that's what exactly inspired him. Most of his writings are basically gibberish.

So you do have a situation where it could be somebody that just, you know, wants to attack a celebrity. You know, we had, in December, the specials about John Lennon's murder. And you know, someone that's deranged can look at that as, if they murder somebody that's a public figure, whether they be in the media or whether they be a political figure, they're going to become famous; they're going to become, you know, inspired by events to become famous. CROWLEY: And which -- which is it? I mean, you were up there for a very long time. I'm sure you knew about a lot of threats and you have to, sort of, what's -- you know, what's a common threat, if there is such a thing, or a nondangerous threat.

Because the fact of the matter is, Ronald Reagan was shot because somebody was trying to impress Jodie Foster, so that doesn't make sense.

PICKLE: You know, we -- we have almost 310 million people in this country, and you remember from your days at the White House, the threats and the questionable phone calls, letters, inquiries are enormous.

We do have many people who are sick on the streets today in this country. We have all these competing interests. We try to protect the rights and privacy of individuals, and at the same time, we try to protect these institutions.

President Reagan's a great example. You had a man who was fascinated, and that's a mild world, with Jodie Foster. There are many people out there like him. We don't know what makes this fellow Loughner tick. I'm sure the FBI and the other security agencies who are doing this investigation will determine that. But he's not a -- he's not the lone gunman. There are many other people out there in this society that are capable and at some point could do something like this.

CROWLEY: Let me ask you about what's feasible in terms of protecting public officials. This was something from Brad Sherman, who's a Congressman from California, who said in The Wall Street Journal today, "I hate to put this in the newspaper, but we don't have any security. The word 'balance' implies your life is a compromise between constituents and security. For most of my colleagues, there isn't any balance. You just get out there.'"

I think my question is, can there really -- I mean, we can't go protect, you know, almost 500 people, because the truth is one guard wouldn't be enough anyway. So what is -- what is there to be done in terms of enhance security, anything?

PICKLE: I'm going to be a little cynical here. You can't do anything. You know, the very nature of being a public official is one where you need to press the flesh. You've seen it at the White House with the president. You have to get out and touch people. You have to be seen. You have to hear them. And at the same time, you want as much exposure as you can possibly have.

You know the shots from rallies. You want the crowds close. You want them up close, next to the candidate. That's not going to end. We are going to fall back into being complacent again. I hate to say that, but we will. But you're right. We do not have the resources to protect 535 congressmen and senators.

CROWLEY: And, Tom, something caught my eye. This is from the U.S. Capitol police, in advice to members of Congress. They say that members should "take reasonable and prudent precautions regarding their personal safety and security."

FUENTES: That's a wonderful statement. It means nothing.


You know, what is reasonable? Call the police and say, "I'm going to be holding a rally in a parking lot; could you put a couple police officers out there to watch me?"

Are they telling the members of Congress to hire their own security at their own expense when they appear in public?

You know, so that's, kind of, a -- just a cover-yourself statement.

CROWLEY: You're -- but you have spent a long career in issues like this. If you were to advise a member of Congress in any district in America what they should do when they go to a public event, what would you tell them to do?

FUENTES: Well, I think reasonable would be to try to have some police officers out there that somebody can't walk up with a handgun point-blank and -- and shoot you the way this happened yesterday.

But even then, you have people with long-range rifles that have the training, and they could be shooting from half a mile away and do the same thing, if you have someone out in public.

We saw the rallies last year, I believe, with President Obama speaking in public and individuals walking around with assault rifles draped over their shoulders. So, I mean, people that have the training can kill somebody half a mile away with the right firepower.

CROWLEY: And so some things like -- I have to halt this, but some things are just impossible to protect against. You can always be safe. You can always take reasonable things, but...

PICKLE: Candy, this is impossible -- it's impossible to stop until candidates stops campaigning. These things tragically are going to continue to happen.


CROWLEY: Again, that was the former Senate sergeant-at-arms, William Pickle, along with former assistant director of the FBI Tom Fuentes. We are standing by for a press conference on the latest developments in the Arizona shooting, and we'll have that for you in a moment.