Gabrielle Giffords' chief of staff updates her condition: "There's so much that is unknown"

In an interview with the Arizona Republic, Gabrielle Giffords' chief of staff, Pia Carusone, gave new insights Thursday into the congresswoman's recovery.

Giffords, who has been recuperating at Houston's TIRR Memorial Hermann and traveled to see her husband's shuttle launch in Florida on May 16, has made amazing progress, according to all accounts, but she still has a long way to go. In the most extensive account of where Giffords stands at this point, Carusone said that the congresswoman has trouble forming complex sentences and becomes frustrated at not being able to find the right word or sentence to convey what she wants to say.

"We do a lot of inferring with her because her communication skills have been impacted the most," Carusone said. "Her words are back more and more now, but she's still using facial expressions as a way to express."

Giffords' Houston doctors have called her improvement from a Jan. 8 gunshot wound to the head "remarkable," with director of Memorial Hermann's Mischer Neuroscience Institute, Dr. Dong Kim, reporting that Giffords was able to walk with assistance, complete sentences and interact in extended conversation.

Although Giffords continues to improve, Caursone said, "She's alive. But if she were to plateau today, and this was as far as she gets, it would not be nearly the quality of life she had before. There's no comparison. All that we can hope for is that she won't plateau today and that she'll keep going and that when she does plateau, it will be at a place far away from here."

She notes that Giffords is only about halfway through the all-important 12 to 14 months after her injury, when most of the recovery milestones are typically reached. "In the doctors' minds, it's not even close to when you begin to make the final prognosis for the quality of her life."

Caursone also said that Giffords' decision about whether she will return to congress is a long way off. "The only firm timetable is the legal timetable, and that is May of 2012, when petitions are due for re-election."

Doctors have not been able to determine the damage to Giffords' brain done by the bullet because she cannot undergo an MRI, Caursone said. (Giffords has bullet shards in her head, and the MRI is magnetic.)

There's so much that is unknown. With cancer or a heart issue, doctors can tell you a lot more. With brain injuries, they can't. ... A lot of this is a waiting game. That is a difficult thing to explain when speaking to the public. But she was a perfectly healthy 40-year-old who was injured on the job. I'm hoping that buys her a little more patience. But it's a brutal world out there."