A bullet to the brain is a solemn finality. A bullet to the brain is fate sealed. It is unstoppable, penetrant, bruising, blistering, and bisecting. I dread the possibility. There is a certainty that comes with shooting someone in the head, be it murder or suicide. Let’s not forget assassinations. Presidents Lincoln and Kennedy met their end similarly, slain by a gunman. Mortality is largely guaranteed with a headshot wound. But Gabrielle Giffords would not succumb to it. Not that day.

On a fateful Saturday, Gabrielle “Gabby” Giffords, a then U.S. Congresswoman, was shot point blank in the head in an unprovoked shooting rampage. According to reports, six lives were lost and 19 people injured in the incident that took place outside a shopping market in Arizona. And yet Giffords survived an injury that severe. Luck? I think not.

When the bullet struck Giffords in the back of her skull, traveled the length of the left half of her brain, then exited near her left eye for good measure, she suffered traumatic brain injury (TBI). TBI is an injury experienced by the brain due to penetrative mechanical impact. It affects aspects such as consciousness, an alteration of the senses and higher-order functions like planning, memory, and complex motor activity. The bullet also ruptured some blood vessels—arteries and veins spanning the entirety of her brain—hence the bleeding needed to be contained. Fortunately, that pesky, insidious bullet was extracted in time.

TBI results in the swelling of the brain in reaction to mechanical impact. This can be lethal when enclosed in such a finite space. Surgeons removed the left half of Giffords’ skull to permit room for swelling. The skull segment was restored two weeks later once the swelling had ceased.

The path the bullet traveled through her brain included the visual cortex in the occipital lobe (rear aspect), the sensory, motor, and auditory cortices of the temporal lobe (lateral aspect), and the dorsolateral and prefrontal cortices (frontal aspect). These serve a myriad of functions. Giffords could have lost her sight, hearing, touch, short- or long-term memory, or even have had paralysis. In fact, if the bullet had traversed the center of her brain rather than the left, the news headlines would have been more somber. The bullet would have struck the cerebellum, a brain organ that regulates functions like heart rate and breathing. Giffords would have met her end. But she survived a gunshot at point blank range and a bullet lodged in her brain for a few critical hours, despite what modern medicine holds true. She defied the odds. She defied death.

But there were scars. Giffords suffered deficits in fine motor movements and a speech deficit called non-fluent aphasia. She was able to make general movements like turn her head, stretch her limbs, and even walk (she was reported to have climbed some plane stairs to board the plane to see off her husband at a rocket launch, months after her initial surgery). Finer movements, like maintaining gait while walking, were more strenuous. Non-fluent aphasia is a disorder of speech that affects a person’s reading, writing, and speaking. The syntax and meaning of speech are not immediately apparent to the sufferer. The aphasia results from injury to the left dorsolateral frontal and medial temporal cortices. The latter senses speech while the former executes it. Giffords was reported to be speaking in short, disjointed sentences with labored pronunciation. She appeared to think hard about what the words meant before assembling them into sentences.

Part of Giffords’ therapy has been re-learning how to read and write. I wonder if, given her re-education, Giffords might opt for a different accent than she sported before. Perhaps she could go New England or Midwestern. Just because. She does make light of her speaking troubles in interviews.

Perhaps fate placed Giffords in that bullet’s path. I think it malice’s doing. Jared Loughner was the gunman that exacted barbarism on 27 people. His motive was unknown. Spurred by paranoia and suffering from schizophrenia, his actions were too irrational to understand and culpable enough to merit life imprisonment.

And yet Giffords persists in her fierceness and resilience: ever hopeful, ever defiant, ever optimistic, ever grateful.