A Year At The Circus

by Jon Sopel

  The green, parka style coat she wore when she went to the southern border had written, graffiti like, in large letters on the back: ‘I really don’t care. Do u?’ Was it a dig at the press, who, like her husband, she views with disdain? Did it mean nothing? (Hard to believe you would pick that jacket out of the wardrobe without being conscious of the message you wanted to convey.) Or was it, as many Washington insiders surmised, a dig at her husband? Was she saying she didn’t care what he thought about her going? She would later claim it was aimed at ‘the left-wing media’ – but she also made clear her displeasure at the child separation policy. ‘It was unacceptable for me to see children and parents separated. It was heart-breaking. And I reacted with my own voice. I went to the border and met with the Border Patrol.’

  A timid, lost soul does not go and do this. This was one of the few occasions when public opinion was running so strongly against the President that he changed course. You can be sure his wife’s intervention would have played a big part in an uncharacteristic U-turn. Indeed, Chris Christie, the former New Jersey governor – and a close friend of the family – says she is a not to be underestimated player in the White House court. ‘She’s the most powerful ally you can get if you’re attempting to influence Donald Trump,’ he says. ‘No one influences Donald Trump more than Melania Trump. Nobody.’

  And some have underestimated her to their cost. Ask the one-time deputy national security advisor, Mira Ricardel. She fell out with the First Lady on that trip to Africa, over disparaging remarks she was alleged to have made behind the scenes about two of Mrs Trump’s staff travelling with her. She queried the way government expenditure was being used. False claims, said the First Lady. Mrs Trump raised the matter when she got back to Washington, but got nowhere. The First Lady was being fobbed off. No one was listening. So, she borrowed from her husband’s playbook. She had her communications director, Stephanie Grisham, put this out on Twitter: ‘It is the position of the Office of the First Lady that she [Mira Ricardel] no longer deserves the honour of serving in this White House.’ Mrs Trump was ignored no longer. Ms Ricardel’s boss, the powerful, formidable, not to be trifled with National Security Advisor, John Bolton, went into battle on Ms Ricardel’s behalf. To no avail. Ricardel, the long-time political insider, was now an outsider.

  Melania Trump may be a political novice, an unwilling recruit to the position of First Lady; she may hate the publicity and the unwanted scrutiny; she may define herself as a mum first and everything else second; she may yearn for her days in New York; and may occasionally despair at her husband’s behaviour and some aspects of his policies, but in Washington she had shown she knew what to do in a knife-fight. The most vital survival skill in this cruel town.

  Chapter 6

  The Surgery

  In the rooms around the White House and in Washington DC where moments of national drama have unfolded, the White House Medical Office has rarely even been a footnote. It has not been a place where historians have sat with pen in hand, poised to inscribe a new chapter in America’s national story. Room 91 in the Eisenhower Executive Office Building, next door to the White House, and a doctor’s office with two consulting rooms, positioned between the Palm Room and the Map Room in the basement of the East Wing, are hardly places to get the pulse racing (even when the man in the white coat is wearing a stethoscope). If the vice-president is only one heartbeat away from becoming the president, well, crudely speaking, it is the White House physician’s job to ensure that the VP never gets any closer than that. Yes – the uncontroversial job of the president’s doctor is to keep his patient alive and that heart beating.

  The president’s physician is a man typically who lives in the shadows. These people are drawn from the military and stand outside the normal White House command structure, where everyone answers to the president’s chief of staff. The doctor treating the president is not part of that organogram. He answers to his service superiors. Admiral Ronny Jackson had treated George W. Bush, been the physician to Barack Obama, and in an exceptionally rare piece of continuity the 45th president agreed that he should continue in that role. Under Obama and Bush, Jackson was rarely more than a few feet away from the president, travelling with them around the world, the permanent presence ensuring the Commander in Chief’s health. But though never more than a couple of steps away, they were never in the spotlight. They would be anonymous, and unknown to the public, a figure who would be seen in the corner of camera frame emerging from Air Force One, or walking behind the president, as they get into a motorcade.

  Occasionally he or she would be seen in a medical white coat, which was a bit more of a giveaway about who they were, but generally they were able to get on the metro at Farragut North, near the White House, and no one would be asking for selfies. That would change, however, with the Donald-Trump-life-is-a-reality-TV-show presidency. And as everyone knows who watches that genre of television, anyone can become an overnight star. Everyone has their fifteen minutes of fame. That is where for a brief second things went dizzyingly right for Dr Jackson, and where soon afterwards things went spectacularly wrong for this lifelong member of the military.

  His story is akin to a modern morality tale. He wasn’t so much Icarus who flew too close to the sun. Icarus had ignored the remonstrations of his father when he went on his ill-fated flight and saw his wings melt before crashing into the sea. This is more about succumbing to the dangers of flattery, of coming into the orbit of something attractive but which is simultaneously destructive. This was a doctor who would eventually have to swallow a very bitter medicine.

  Where presidential physicians have been in the news before, it has tended to be over their role in keeping their patients’ medical history secret – something you would normally want from any physician. Doctor/patient confidentiality is of course a bond that should not be broken. But where does the effort to maintain confidentiality tip over into dissembling? Where does saying little become misleading? Often – undoubtedly under political pressure – the doctors would release medical bulletins about the president whose care they were entrusted with that were at best euphemistic and, at worst, downright lies.

  After Woodrow Wilson fell ill, his doctor released a vague, optimistic statement saying that he was suffering from ‘exhaustion’, but it was ‘not alarming’. In fact Wilson had collapsed from a serious stroke, and was paralysed. Wilson and his formidable wife Edith ran the government for more than a year while he remained bedridden. There was no real mechanism for removing a president from office if he insisted he was fit to carry on. And it was not terribly surprising, at a time when life expectancy was between 60 and 65, and politicians rarely ascended to the presidency until well into their fifties, that the doctors had a lot to be secretive about.

  Franklin Delano Roosevelt projected an image of strength and decisiveness. For the best part of 12 years, the American public had no idea that the New Deal president could barely walk. He had contracted polio comparatively late in life, when he was 39, and was invariably photographed sitting down. Secret Service agents were tasked with ensuring that no photos emerged revealing the extent of his incapacity. When he had to be filmed walking, he would be wearing leg callipers, he’d have a cane in one hand, and his other would be resting on his son’s arm for support. Weakness is never a good look in politics, and so every effort was made to shield the public from the difficulties he was struggling with on a daily basis. But his re-election in 1944 came as he was suffering from congestive heart failure, and even though Ross McIntyre, the White House physician from his first term, was fully cognisant of his condition, he assured worried members of the Democratic Party – and the American public – that the President was in fine health. Not strictly true. He would die three months into his fourth term.

  It was a similar story with President Eisenhower. In 1955 he had a heart attack, and though the public was assured that he had made a full recovery, he was discouraged from running for re-election by a prominent cardiologist – advice
he chose to bat away. In 1956 he was diagnosed with Crohn’s disease, a serious gastrointestinal disorder, which required surgery. Shortly after that, Eisenhower suffered a stroke, but managed to complete his term in office.

  And then came the very picture of health and vitality, vim and vigour: John F. Kennedy. Decorated war hero, young, dashing, Hollywood good looks, stunning and stylish wife – and as we would discover long after his death, racked by the most chronic and debilitating back pain, so much so that at times he could barely walk; he was a sufferer from Addison’s disease, and had so many pills inside him – uppers, downers, steroids – that if you shook him he would rattle.

  Kennedy’s assassination in 1963 shook the world. It rocked America to its core, and the reverberations are still felt today. And there would be two important, intertwined side effects whose relevance would prove important in 2016, when Donald Trump assumed the presidency. The first was a sense that while America’s written and codified constitution covers nearly everything, it was fuzzy and unclear on questions about the succession in the event of the president’s serious illness, sudden death or mental incapacity. The other thing it brought – and this was a culmination of decades of unease – was a demand for greater transparency and much more public disclosure about the health of the president.

  JFK’s killing that bright November day would four years later result in the ratification of the 25th Amendment to the US Constitution. When Lyndon B. Johnson was sworn in on Air Force One as it stood on the tarmac at Love Field Airport in Dallas, hours after the shooting, his ascension to the presidency meant that – for the 16th time – the country had no vice-president. There was no tested way of dealing with a severe presidential illness, like the one Woodrow Wilson suffered – which in effect, left his wife running the country. LBJ had previously suffered a heart attack, and the next two people in the line of succession were the Speaker of the House – aged 71, and the 86-year-old President of the Senate.

  The 25th Amendment also clarified a set of procedures to be followed if the president became, in the judgement of his most senior cabinet colleagues, incapable of executing his duties – whether because of physical frailty, or because of mental incapacity. As Donald Trump fired off endless volleys of irascible tweets, or seemed to ramble incoherently in broadcast interviews – so the stability of the man with his finger on the nuclear button became a subject of serious, if whispered, discussion. And that in turn led to all manner of people revisiting the provisions of the 25th Amendment, in particular Section 4. It states:

  Whenever the Vice President and a majority of either the principal officers of the executive departments or of such other body as Congress may by law provide, transmit to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office, the Vice President shall immediately assume the powers and duties of the office as Acting President.

  Stripped of legalese, and put simply, the vice-president and cabinet officials decide on the removal of the president. If the majority votes for him being forced out, then a letter is sent to the president pro tempore of the Senate and Speaker of the House, informing them of their vote.

  The president could send a counter-letter saying he is fine and capable of performing his duties. That would allow the president to continue in office, unless the vice-president and cabinet send another letter within four days restating their case. Then, the vice-president would become the acting president while it is then sent to Congress to decide.

  Both houses of Congress would have to vote within 21 days, and a two-thirds majority from each chamber is required to remove the president from office and fully institute the vice-president as the replacement. If the vote in either chamber falls short, the president resumes his duties. That section of the 25th Amendment remains unused. That said, when George W. Bush had to undergo surgery he used the provisions of the 25th Amendment to put the Vice-President, Dick Cheney, temporarily in charge.

  The demand for disclosure and transparency around the president’s health was one that grew and grew. Once upon a time, in an age of deference, a gruff ‘he’s in fine health’ from an estimable physician would have been enough to satisfy the American public, but those days have gone. In an information rich age, where panels of ‘experts’ can sit round the table on cable television pontificating on whatever the latest medical intricacy in the news that day was, that will no longer do.

  Just as Americans view the White House as the ‘people’s house’, so they view the health of their president as ultimately a public matter. He is after all ‘the people’s president’. There is no statute requiring presidents to release their health records, just like they’re not required legally to release their tax information. But in the modern era, many have done so anyway. So in 1992 came the revelation that Bill Clinton suffered from allergies, had mild hearing loss, and a left knee ligament strain.

  If you go onto the White House website and navigate your way to the archive section, you will find a memorandum sent from Dr Jackson (then physician to Barack Obama) to Josh Earnest, the press secretary, in March 2016. It sets out in extraordinary detail the results of the annual physical the President had recently undergone. And this would be released to the press.

  Vital Statistics

  Age: 54 years, 6 months

  Height: 73.5 inches

  Weight: 175 pounds

  Body Mass Index: 22.8 kg/m2

  Resting heart rate: 56

  Blood pressure: 110/68 mm Hg

  Pulse-oximetry: 98% room air

  Temperature: 97.8 degrees

  Physical Examination by System

  Eyes: Visual fields were normal. Uncorrected bilateral visual acuity was 20/20. Fundoscopic exam was normal bilaterally. No ocular pathology was discovered.

  Head/Ears/Nose/Throat: Normal exam of the head, ears, nose, and pharynx.

  Neck: Normal thyroid exam. No noted lymphadenopathy. Auscultation of the carotid arteries normal.

  And on and on it went: pulmonary this, cardiac that, neurological, cranial, cerebellar something else. We had his lab test results – his HDL cholesterol, his LDL. You name it, it was all set out. And a conclusion which read: ‘All clinical data indicates that the President is currently very healthy and that he will remain so for the duration of his Presidency.’

  Two things are immediately striking about this health report: the first is the extraordinary amount of detail the then president was happy for his physician to disclose to the rest of the world about the inner workings of the Obama corpus. The second is that for a man of 54, how extraordinarily healthy Barack Obama was after the strains of nearly eight years in office. But what if the report had been carried out four years earlier, when the President was about to seek a second term, and had perhaps turned up a few ‘nasties’? Would the President and his press secretary have been as happy then to disclose Dr Jackson’s report, warts (though probably something worse than warts) and all – with all the political consequences that would flow from it?

  Or what about when Hillary Clinton collapsed in New York during the campaign in 2016 as she was on her way back from commemorating the victims of 9/11? Then, a doctor released a statement saying the cause had been pneumonia. The candidate had been prescribed Levaquin for treatment. She’d also had a recent sinus infection. But in this case, she had little choice but to disclose what had happened. Then 68 years old, the mix of her age and being caught on film keeling over, and eventually caught by her Secret Service detail just before she hit the deck – and then filmed, seemingly semi-conscious, having to be bundled into her limo – was not a good look for a candidate. At any time it would be bad; when she was running against her take-no-hostages opponent, Donald Trump, it was disastrous.

  It was inevitable that serious – and legitimate – questions about her health would arise and take centre stage. Throw into that mix a good dollop of misogyny – the idea that women are not re
ally strong enough to be president – and you have a fairly perfect storm. That she disclosed details of her pneumonia and the medication she was taking should not be interpreted as an act of openness. The Clintons’ reflex after so many bruising encounters is to be anything but open – just look at how much easier life would have been for her if she’d been more candid, far earlier, about her use of a private email server when she was Secretary of State. The phrase ‘Clinton candour’ in Washington is viewed as an oxymoron. No, the information her team made public was born out of political necessity; not out of a Damascene conversion to transparency and a commitment to freedom of information.

  Donald Trump didn’t succumb to the temptation to release his tax returns. That little treasure trove of mystery and speculation he would keep to himself. But he did release a health bulletin from his then New York physician during the presidential election campaign. It really should be read in full, as it was released to the press.

  To Whom My Concern:

  I have been the personal physician of Mr Donald J. Trump since 1980. His previous physician was my father, Dr Jacob Bornstein. Over the past 39 years, I am pleased to report that Mr Trump has had no significant medical problems. Mr Trump has had a recent complete medical examination that showed only positive results. Actually, his blood pressure, 110/65, and laboratory test results were astonishingly excellent.