Two Books Bolster My Thoughts About Gabrielle Giffords

Although I had to play catch up like everyone else in Atlanta this week after last week’s version of The Snow That Wouldn’t Go, the violent tragedy in Tucson Arizona has been on the periphery all week. For the last few days, whenever I heard the name Gabrielle Giffords, I was reminded of an old black and white photograph of the skull of Phineas Gage, a nineteenth century railroad worker who survived being pierced cleanly through the brain by a thirteen pound iron bar. Amazingly, Gage was conscious enough after sustaining the injury to talk to his caregiver about what had happened.

On September 13, 1848, 25-year-old Gage was foreman of a work gang blasting rock while preparing the roadbed for the Rutland & Burlington Railroad outside the town of Cavendish, Vermont. After a hole was bored into a body of rock, one of Gage’s duties was to add blasting powder, a fuse, and sand, then compact the charge into the hole using a large iron rod.^{[n 4]} Possibly because the sand was omitted, around 4:30 PM:

the powder exploded, carrying an instrument through his head an inch and a fourth in [diameter], and three feet and [seven] inches in length, which he was using at the time. The iron entered on the side of his face…passing back of the left eye, and out at the top of the head.^{[n 5]}

Phineas Gage, from Wikipedia

I first saw a picture of the unique injury to Phineas Gage in Consciousness by Harvard psychiatry professor J. Allan Hobson. It was my experience with Hobson’s explanation of the brain’s functions and Another Day In The Frontal Lobe by neurosurgeon Katrina Firlik, two of the many impulse purchases from the remainder tables I’ve made over the years, that have undergirded my thoughts about the horrific injury Congresswoman Giffords suffered to her brain.  

The differences between the superheated tip of the bullet that cleaved through Giffords skull and brain tissue and the relatively cool iron of the bar that punched through Gage’s cranium may translate into different outcomes, but in both cases, it appears that the victim’s core brain functions remained relatively unscathed.

The subdivision of recent and remote memory parallels the distinction between the brain’s older, more reflexive, mostly unconscious and automatic survival mechanisms-that is, primary consciousness-and its newer, more elective, mostly conscious-cognitive mechanisms, those which constitute a secondary level of consciousness.

J. Allan Hobson, Consciousness    

Dr. Firlik’s no nonsense memoir, back when I first read it, went a long way towards demystifying the world of brain surgery. She wrote about her thought processes during a case where a man working on a roof had been nailed in the brain accidentally by a friend whose arm slipped while wielding a nail gun, describing herself more in terms of a mechanic than a scientist.

I am still at the stage where every time I see a story about Ms. Giffords on TV, I become angry and upset and afraid at the thought of an innocent human being losing a part of their brain, that most precious and vital tissue too many of us, myself included, take for granted. It has been publications like Consciousness and Another Day In The Frontal Lobe, which I have pulled off the shelves in recent days to revisit, that have slightly lessened the horror.

Phineas Gage ended up working successfully at several jobs, including stage coach driver, that demanded great physical dexterity. And the man Dr. Firlik operated on walked home with the friend who accidentally put a nail two inches through his skull. We can only hope that Representative Giffords has an outcome that is similarly triumphant.