The Arizona Republic held a heartbreaking Q&A with Gabrielle Giffords' chief of staff Pia Carusone, a series of questions that the reporter calls "indelicate." Contrary to the sunny reports of Giffords improvement, Carusone gives the most detailed public description of the congresswoman's recovery process so far. Giffords continues to have difficulty speaking; she resorts to pointing and gesturing often. She's also likely going to spend the rest of her life recovering from her injury. From the newspaper's E.J. Montini on Giffords' struggle to speak:

Does her struggle to communicate mean that she's not using complete sentences?

"Exactly," Carusone said. "She is borrowing upon other ways of communicating. Her words are back more and more now, but she's still using facial expressions as a way to express. Pointing. Gesturing. Add it all together, and she's able to express the basics of what she wants or needs. But, when it comes to a bigger and more complex thought that requires words, that's where she's had the trouble."

Is that frustrating for her?

"Absolutely," Carusone said. "When she is trying to come up with a word or a sentence and she's clearly struggling, putting everything she's got into it, and sometimes she's not successful. When she is, there's a relief that comes across her face that she has found the word. But when she can't come up with that, it is absolute frustration."

On the road to recovery:

How clearly have doctors been able to determine the damage done by the bullet?

"An MRI is the most complete way to look at someone's brain, but she cannot ever have an MRI," Carusone said. "She has bullet shards inevitably in her head, and because MRI is magnetic, that obviously would be bad. That is a problem that shooting victims have. They have to use a CT scan. If she had suffered a stroke, they could do an MRI and get a much better picture of the damage to her brain. But that will never happen."

Carusone and the rest of Giffords' staff are in uncharted territory. While they continue to battle the emotional burden of having lost a friend and colleague, Gabe Zimmerman, and nearly losing Giffords, they must carry out the responsibilities of a congressional office, work with Giffords' husband and family, satisfy the curiosity of the media and answer the concerns of the public.

Read the full report here.