by Jon Sopel
Over the past twelve months, he has lost at least fifteen pounds, Mr Trump takes 81 mg of aspirin daily and a low dose of a statin. His PSA test score is 0.15 (very low). His physical strength and stamina are extraordinary.
Mr Trump has suffered no form of cancer, has never had a hip, knee or shoulder replacement or any other orthopaedic surgery. His only surgery was an appendectomy at age ten. His cardiovascular status is excellent. He has no history of ever using alcohol or tobacco products.
If elected, Mr Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency.
Harold N Bornstein, MD, FACG
Department of Medicine, Section of Gastroenterology
Lenox Hill Hospital, New York, NY
Now let us leave to one side the heading ‘To whom my concern’ (let’s be generous: Dr Bornstein may have been having a particularly busy day, or you just can’t get the secretarial staff these days) and let us not detain ourselves on the details of his blood pressure – the results aren’t just good. They’re not even very good. They are ‘astonishingly excellent’. When have you ever seen a doctor write something like that? No, let us focus on the final paragraph; it is the one I like most: ‘If elected, Mr Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency.’
Hmm: who else do we know who has a bit of a penchant for the superlative? Someone whose conversation is peppered with the greatest ever, the best ever, the biggest ever? Could it be that the no doubt respected Dr Bornstein had – how can one put this delicately – a little help with the drafting from the person he was writing about?
Bornstein is a character born to play a role in a Trumpian drama. He is New York through and through. He drives a soft-top sports car, wears open-necked shirts revealing multiple gold chains. Though in advanced middle age, he has straggly blond/grey hair going down to his shoulders, a neatly trim blondish moustache and beard, and wears dark tinted glasses with clear rims. He looks more like a doctor of love than a doctor of medicine. Or maybe someone from a Bee Gees tribute band (‘Stayin’ Alive’ no doubt his encore song).
Bornstein, though undoubtedly flamboyant, would stay out of the limelight beyond supplying that medical bulletin on his patient. That would change after the election. And when he did speak it was nothing short of what you would expect from a Trumpian drama. It cheered up enormously a chill February day. His re-emergence into the public domain came as he claimed that three men saying they represented Trump had entered his office in February 2017, and demanded that he hand over Trump’s medical records. The three were said by Bornstein to be Trump’s former personal bodyguard who worked briefly at the White House, a Trump Organisation legal officer and a third person, whom the New York physician could only describe as a ‘large man’. The doctor told CNN that he was ‘robbed’ and described it as a raid. He didn’t claim to have been held at knifepoint, but someone ought to have prescribed the doctor a salbutamol inhaler, his description was so breathless. The ‘raid’ occurred two days after he told the New York Times that Trump took Propecia, a prostate drug often prescribed for hair loss, something that might be seen as not a massively revealing disclosure, but if it was made without the patient’s permission, then it is a breach of confidence.
The White House was not in the mood for any more drama than it was already dealing with, so played down the whole incident: ‘As is standard operating procedure, the White House Medical Unit took possession of the President’s medical records,’ press secretary Sarah Sanders told reporters, and really didn’t want to add much more to this unexpected addition to the already congested news cycle.
But Dr Bornstein wasn’t done; he had something else to say too. The medical bulletin released before the election had not been written by him after all; it had been dictated by Trump (as everyone suspected). ‘He dictated that whole letter. I didn’t write that letter,’ Bornstein told CNN. He claimed Trump read out the language as Bornstein and his wife were driving across Central Park. ‘Trump dictated the letter and I would tell him what he couldn’t put in there,’ he said.
It is fair to say that Harold N. Bornstein and Ronny Jackson are not cut from the same cloth. Indeed, let me go further – it would be fair to say that their qualifications as doctors would probably be the only thing they have in common. They’re not cut from the same anything. Harold N. Bornstein is New York City – if you cut him down the middle you would find a Big Apple core.
Ronny Jackson, on the other hand, grew up in small-town conservative Texas. His two other siblings, Gary and Stacy, still live in Levelland where he went to high school. It is a town of a few thousand people where the main industries are cotton and oil. Jackson is clean cut, with hair neatly side parted and a big white-toothed smile. He stands up straight and looks every bit the man who had spent his life in the armed services. His navy portrait looks like it could have been from any of the past eight decades. He has timeless, chiselled good looks.
After university and medical school in his home state, Jackson joined the navy in 1995 at the Naval Medical Centre in Portsmouth, Virginia, where he completed an internship and would graduate later with honours from the US Navy’s undersea medical officer programme in Connecticut. With a focus on the special needs of submariners and divers, Jackson’s next stop would be the Naval Diving and Salvage Training Centre in Panama City, Florida, before returning to Portsmouth in 2001, now to train to specialise in emergency medicine. He finished top of his class.
And with that accolade came deployment to Iraq as part of Operation Iraqi Freedom. He joined the 2nd Marines, Combat Logistics Regiment, to work with the Surgical Shock Trauma Platoon. This was the toughest, most demanding work. He was now the emergency medical doctor in charge of resuscitative medicine for a forward deployed unit in Taqaddum. His stint in western Iraq came during some of the worst months of the conflict, with Americans killed and maimed on a daily basis by roadside bombs, insurgent attacks and snipers.
The awards and accolades were now beginning to pile up. He has the Defense Superior Service Medal, the Legion of Merit, the Navy/Marine Corps Commendation Medal, their Achievement medal – as well as other individual, unit and campaign awards. And then there are the qualifications. He is designated as a diving and undersea medical officer, naval parachutist, fleet marine force qualified warfare officer. And on and on the list of achievements go. What all of this adds up to is a highly distinguished armed forces medic, meaning a sizeable chunk of the left breast of his uniform is taken up with medals and ribbons.
In 2006, while still in Iraq, Dr Jackson was selected as a White House physician, first working for George W. Bush, then Barack Obama – during whose presidency he was appointed to the most senior job as physician to the president and Director of the White House Medical Unit (WHMU). Obama would say of him, ‘Ronny’s positive impact cannot be overstated. He is a tremendous asset to the entire White House Team.’ It is one of the few judgements that Donald Trump shared. The number of senior people who stayed on in the White House after the change of administration can be counted on one hand. Admiral Jackson, as he had now become, would be one of them.
And the WHMU is not a one man and his dog operation. As with everything to do with the presidency, if you’re going to do it, you do it big. The office of the medical director is in the basement of the Residence, away from the hubbub and rabbit warren of corridors that is the West Wing. White House staff – not just the president – are treated there. Even we journalists get treated there if something bad happens to us while on the grounds. One of my White House colleagues, Jon Decker, then working for Reuters TV, was attacked by Barney, the Scottish terrier that belonged to President George W. Bush. He was given antibiotics and a tetanus booster by the then White House physician. But the unit is capable of doing far more than bandaging a journalist’s bleeding hand.
Along with the facility in the adjacent Eisenhower Executive Office Building, the doctors and nurses are capable of dealing
with medical emergencies and trauma cases. There is a crash cart in the East Wing, and they are equipped to carry out sophisticated surgery in extremis. There is 24-hour care, with at least one physician on duty at all times. Anyone joining the team has to undergo a full year of trauma care training. And though the numbers vary, Ronny Jackson would have had anything between 20 and 25 doctors and nurses working under him.
Another important aspect of the job is preparing for when the president is travelling abroad. So when the advance team of secret service personnel travel to recce a presidential trip, a number of the medics will go to set up in advance. They will establish at each location temporary emergency medical facilities – this will consist of an eight-person intensive care and surgical team, with a makeshift operating theatre at each stop. Ideally the trip is planned so that the president is never more than 20 minutes away from a level one trauma centre. But in some cases the WHMU staff will carry operating theatre equipment with them in backpacks so that emergency care can be provided on site. Likewise, look at any presidential motorcade and there will be an ambulance in it. Interestingly, the physician and nurse who accompany the president wherever they go will be positioned close enough in the motorcade to respond to an emergency, but far enough away to make it unlikely for them to be tangled up in any disastrous event.
And we haven’t even discussed Air Force One yet. It’s not like being on a conventional commercial flight, where the cabin crew has access to a bag of medication held in one of the overhead bins. Air Force One comes equipped with a full surgical suite, operating table, two beds, resuscitation equipment, different medical monitors and a fully equipped pharmacy – and of course wherever the president flies, the head of the WHMU goes too.
And just as he did for Barack Obama, it was Ronny Jackson’s job to organise the full medical examination for Donald Trump at the Walter Reed Army Medical Center in Bethesda, just on the north tip of Washington. For Jackson this came layered with an additional degree of complexity. Was he to do the standard set of tests that he had performed when Barack Obama was president, or would he address the concerns that had been mooted about the 45th president’s mental health?
The world would soon find out. Not for Donald Trump an email written by the White House physician to the White House press secretary to be released to the White House correspondents. No. Instead, Daniel would be sent into the lion’s den and give a full, on-the-record, on-camera briefing that would be broadcast live across America about the state of the President’s health.
The 16th of January 2018 would be a day few would forget. We’re used to seeing key White House staff come to the podium – the National Security Advisor, the head of the economic council, the chief of staff once or twice. But never before had the president’s physician done this. And leave aside the content of the briefing – which I will come to shortly – there was one other extraordinary aspect of all this. It was one of the longest briefings that any of us had sat through. It went on and on. And on. And it was clear this was deliberate strategy. The White House didn’t want anyone to be able to say that their questions had not been answered, that the esteemed doctor had been curt or cagey, circumspect or evasive. Admiral Ronny Jackson, in his full military uniform, had come to parlay.
He went through the President’s vitals at length, which I will spare you the full details of, but here is an important flavour of what was read out to us in the Briefing Room:
Age: 71 years and 7 months at the time of the exam.
Height: 75 inches.
Weight: 239 pounds.
Resting heart rate: 68.
Blood pressure: 122/74.
Pulse oximetry: 99 percent on room air.
Temperature was 98.4.
Physical examination, by system, to include any studies that were done, by system:
Eyes: The President’s uncorrected physical acuity is 20/30 bilaterally with corrected visual acuity of 20/20 bilaterally. His visual fields were normal. Funduscopic exam was normal bilaterally. His intraocular pressures were normal, and no ocular pathology was discovered.
Head, ears, nose, and throat: Normal exam of the head, ears, nose, mouth, and throat.
Dental exam: He has healthy teeth and gums. There were no other dental findings.
Neck: Normal thyroid exam. No noted lymphadenopathy. Auscultation of his carotid arteries was normal.
Pulmonary exam: His lungs were clear to auscultation. A screening low-dose CT of the chest demonstrated no pulmonary pathology.
Cardiac exam: Heart exam was normal. Regular rhythm. No murmurs or other abnormal heart sounds were noted. His ECG, or commonly EKG, was normal.
And then Doctor Jackson offered this conclusion:
In summary: The President’s overall health is excellent. His cardiac performance during his physical exam was very good. He continues to enjoy the significant long-term cardiac and overall health benefits that come from a lifetime of abstinence from tobacco and alcohol.
We discussed diet, exercise, and weight-loss. He would benefit from a diet that is lower in fat and carbohydrates, and from a routine exercise regimen. He has a history of elevated cholesterol and is currently in a low dose of Crestor.
In order to further reduce his cholesterol level and further decrease his cardiac risk, we will increase the dose of this particular medication. The President is currently up to date on all recommended preventive medicine and screening tests and exams.
All clinical data indicates that the President is currently very healthy and that he will remain so for the duration of his presidency.
Even this brief outline begged a lot of questions, and hands were shooting up from reporters in the Briefing Room. But Dr Jackson would show that as well as being able to use a stethoscope he knew how to deploy a sense of humour too. ‘With that, I’ll take some questions. Before we get started, let me just make one comment. I would just like to point out for all of you here in this room – many of you which know me – just, if something should happen to you over the next few months and you should fall ill at some point, that most likely I will be the one called to come to take care of you [laughter]. So when you ask your questions, please keep that in mind [more laughter].’
As the questions came thick and fast, it became apparent that maybe the President’s physician had more in common with Harold Bornstein than we had all thought. Certainly some of the answers had a certain Bornsteinian flourish.
His heart: ‘I think he had great findings across the board, but the one that stands out more than anything to me is his cardiac health. His cardiac health is excellent. And so I think, with all the other things in place – he doesn’t have, really, a family history of premature cardiac disease, he doesn’t smoke, he doesn’t have diabetes … so I think those things, in combination with the excellent cardiac results that we got from the exercise stress test, I think, are very reassuring.’ And he went on to assert that ‘he will remain fit for duty for the remainder of this term and even for the remainder of another term, if he’s elected.’
Then there was his stamina. According to Dr Jackson he has it by the bucket load. He didn’t do enough exercise, but, ‘despite that, one of the things, being with the President on a day-to-day basis, that has been impressive to me is he has a lot of energy … And the days – we’d get these 14-, 16-hour days, and the staff is just spent after a while. And you’re just like, man, when are we going to the hotel? When are we going down? Because you have all the issues of different time zones and things of that nature, too. And I’ll tell you, out of everybody there, the President had more stamina and more energy than just about anybody there.’
And of the Trump genes, the report was again glowing: ‘It is called genetics …’ Jackson said. ‘Some people have just great genes. I told the President that if he had a healthier diet over the last 20 years, he might live to be 200 years old.’
Yes, there were things the doctor wanted to change. He wants the President to exercise more and eat better. He wants the gym that
is in the residence to be used rather than just gather dust. He is going to involve the First Lady in persuading her husband to change his ways. He needs to lose weight – probably around a stone. But a year on from the debrief on the medical it was questionable how much progress was being made on the exercise front. After the death of the 41st president George H.W. Bush in November 2018, his son George W. Bush came to stay across the street at the administration guest house, Blair House, ahead of the lying in state at the Rotunda and then the state funeral. From West Wing door to Blair house is probably a distance of around 200 yards – or to put it in golfing terms that Donald Trump would find familiar, it is probably a full four-iron shot, but not much more. But on this fine, bright day, the President chose the motorcade over his feet. A dozen vehicles or so made up the convoy, with the last vehicle leaving the White House after the President in the Beast had already arrived and got out.
It is a well-known fact that the President sits in the West Wing while these sessions in the Briefing Room unfold, watching avidly and critically from the private dining room. Every now and then the sliding door between the Briefing Room and the press office will open and a note is handed to whoever is at the podium. Unless it is a piece of urgent breaking news you can be sure this is a little handwritten instruction from the President, demanding that this or that point be made. There was no need to pass anything on to Admiral Jackson. He was knocking it out of the park, as far as the President was concerned.
And there was one other issue in this briefing that was tackled head on – and that was the state of Donald Trump’s mind. Dr Jackson revealed that he had carried out a neurological exam, with examination of the cranial nerves, cerebellar function, deep tendon reflexes, motor function, and sensory system – which were all normal. In addition, he carried out a cognitive screening exam using something called the Montreal Cognitive Assessment. According to Dr Jackson, the President got top marks with a score of 30 out of 30.
