But when Reagan saw his wife as she reached out to comfort him, his spirits seemed to lift. Even though he was still struggling to breathe, he pulled up the oxygen mask and reprised a famous remark made by boxer Jack Dempsey after he lost the heavyweight championship in 1926.
“Honey,” the president said, “I forgot to duck.”
Reagan then turned to Laxalt. “Don’t worry about me, I’ll make it.”
Mrs. Reagan gently put the oxygen mask back on. “Please, don’t try to talk,” she said.
The first lady kissed the president’s cheek and left the bay. It was time for the trauma team to get back to work.
* * *
THE CHEST TUBE wasn’t stopping the bleeding; the Pleur-evac now held 1.8 liters of the president’s blood. Looking down at his patient, Ben Aaron knew it was time to make a decision. Should he operate or not?
As he considered his options, Aaron was particularly concerned about two issues, neither of them medical. First, the surgeon wanted to get Reagan out of the trauma bay. It was too crowded and too noisy, and he had too little control. Aaron had dominion in only one place: the operating room. Reagan would be safer there because Aaron would be in full command, and the throng of spectators and hangers-on would be much smaller. Second, even if the bleeding stopped and the bullet seemed secure, Aaron felt queasy about the political ramifications of leaving a fragment of metal lodged in the president’s chest. The knowledge that a bullet remained just an inch from the commander in chief’s heart and near so many other important organs would almost certainly cause intense anxiety in the country and the world.
Aaron made up his mind: he would operate. He informed Joe Giordano and the other doctors on the team, and then bent down to the president.
“Mr. President, there is a lot of blood coming from your chest tube,” Aaron said. “We know the bullet is in your chest. But we don’t know what has been injured. Because the blood continues to come, we think it would be safest to take you to the operating room. We don’t think you are in any immediate danger. But we think that is the safest course, going to the operating room.”
The president nodded. “Whatever you think is best,” he said from behind his oxygen mask. “I leave it up to you.”
By now, the surgeons knew that the second X-ray revealed no shrapnel in the president’s abdomen. Even so, Giordano and Gens worried that the bullet might have penetrated Reagan’s diaphragm, a muscle less than a half inch thick that separates the abdomen from the chest cavity. If it had pierced the diaphragm, it could have penetrated an organ such as the stomach or spleen before passing back through the diaphragm and lodging in the chest. The doctors also feared that a seventy-year-old being thrown violently into a limousine might have sustained a rupture of his liver, appendix, or kidneys. The only way to find out whether there was bleeding in the abdomen was to administer a peritoneal lavage, or “belly tap.” In this procedure, a surgeon would cut a small slit near the belly button, open up the abdominal cavity, insert a small plastic catheter, pour in a liter of saline, and let it swirl around before draining it. If there was even a drop of blood in the abdomen, the saline would turn pink.
Giordano and Gens advocated a belly tap, but Aaron wasn’t sure it was necessary. The X-ray showed the bullet was lodged in the chest, not the abdomen. If he detected a problem in the president’s belly during surgery, he could fix it through the chest incision. But he also respected Giordano and Gens and wanted to avoid dissension among the trauma team, especially since they had been working together smoothly thus far. Because Aaron was now Reagan’s primary surgeon, it was his call whether the team should perform the procedure. In the scheme of things, a belly tap was rather harmless; also, the president was currently stable and his vital signs were decent. Aaron kept his doubts to himself and consented to the lavage.
Gens tried to take Reagan’s blood pressure, but the ER was still so noisy that he couldn’t hear anything through his stethoscope. As he inflated the cuff and slowly let out the air, he placed a finger over the radial artery in the president’s left wrist and waited to feel the tell-tale thump. The president’s blood pressure was still 160, high but acceptable under the circumstances.
As Gens prepared to leave for the operating room, he suddenly wondered whether anyone had told the president why he was in the hospital. The surgeon—a loquacious and earnest man who often lost track of time while talking to patients about everything from their conditions to sports—leaned close to Reagan’s ear and asked, “Mr. President, do you know what happened?”
“No,” Reagan said.
“First of all, you were shot in the chest, and the bullet has torn your lung apart and you are leaking blood and air,” Gens said.
Reagan looked surprised.
“We have to do two things,” Gens went on. “First, we have to do what we call a peritoneal lavage to see if there is any blood in your belly. If there is blood in your abdomen, we will do an abdominal incision to see what is bleeding. If there is no blood in your abdomen, then we turn you to your side, and Dr. Aaron will perform what we call a chest incision. He will then fix your lung. You are going to be okay. You are short of breath because of your injury, but you are going to be all right.”
Before being taken to the operating room, Reagan got the attention of Cyndi Hines, a technician who was monitoring his IVs, fluids, and blood pressure.
“What do you think?” the president asked her.
Hines smiled. She was pretty sure she knew what he was really asking: Am I going to be okay, or am I going to die? Patients, afraid to pester the doctors, asked her that question all the time. “I think you are doing all right,” she replied gently. “They are taking you to the OR. If you were really bad, they would be opening you up right here. I really think you are doing fine.”
The president grinned at her through his mask.
CHAPTER 11
OPERATING ROOM 2
At 2:57 p.m., exactly thirty minutes after the assassination attempt, doctors and nurses began wheeling President Reagan feetfirst out of the trauma bay. A Secret Service agent had already surveyed and secured the route to the operating room: it led down a hallway, past the urology department’s examination rooms, through the sprawling recovery room, and then down another corridor. The president would be taken into Operating Room 2, which was at the far left side of a hallway running between a total of thirteen operating rooms.
A couple of minutes earlier, Ben Aaron had informed Mrs. Reagan of the imminent surgery. Meeting with the first lady, Mike Deaver, and several family friends in the small office where they had been waiting for further news, Aaron explained that although the bullet had apparently not touched the president’s heart, it had come to rest in his lung.
“Here’s what we’re going to do,” Aaron said. “We’re going to take him and do an abdominal tap to find if there’s any blood in the abdomen. If there is, that’s a serious problem. If that is negative, we’re going to roll him over and open him up and check everything out, including his heart, because you can’t really be sure until you get in there, and try to get the bullet out and stop the bleeding.”
“How do you stop the bleeding?” Mike Deaver asked.
“Well, we’ll clamp it or suture it, or if it isn’t necessary, it could be a wound that would heal itself,” Aaron replied.
After telling Mrs. Reagan he would keep her informed, Aaron politely excused himself and left to change into his surgical scrubs. The first lady was escorted to the trauma bay, where doctors were getting ready to move the president. She walked straight to her husband’s bed and clasped his left hand, despite a recently inserted arterial line that jutted from the top of it.
Now, as the trauma team began rolling their patient toward the OR, Dr. Sol Edelstein, the director of the emergency room, took his place at Reagan’s feet, his back to the hallway down which they would be traveling. Edelstein, who had just arrived at the hospital after racing from his home in suburban Maryland, deliberately shuffled backward
as slowly as he could. Partly, he wanted to act as a speed brake to prevent IV and blood lines from being jostled as the gurney moved down the hallway. But he also hoped to instill calm and a sense of purpose. Rushing led to mistakes, and there could be no errors today.
As the procession moved slowly down the narrow hallway, Mrs. Reagan continued to hold the president’s left hand. David Gens clasped the first lady’s waist and pulled her close to the gurney so she wouldn’t bang into objects in the hallway. “Watch your legs, they might get hit,” he said protectively. “Watch your legs.” He could see that Mrs. Reagan was frightened.
The gurney inched between the nurses’ station on the left and the examination rooms on the right. Rounding a corner, the procession encountered Jim Baker, Ed Meese, and Mike Deaver, as well as two other aides. Baker and Meese had arrived at the hospital only a few minutes earlier; upon entering the emergency room, they had spoken to a doctor who told them that the president was in bad shape and might be bleeding to death. Shell-shocked, they were waiting anxiously for a chance to see him for themselves.
Despite his condition and all the commotion, Reagan spotted his Troika immediately. Speaking through his oxygen mask, the president got in the first word. “Who’s minding the store?” he asked.
Then he winked at Baker.
The gurney rolled on, its route to the OR crowded with doctors, nurses, Secret Service agents, and police officers. The trip seemed to take a long time, and when the procession finally reached Operating Room 2, an anesthesiologist couldn’t find a handhold on the gurney that would enable him to guide it through the doors. In the end, he grabbed one of Reagan’s feet to pull him into the room.
At the door to the OR, David Gens turned to Mrs. Reagan and gently told her that she had to say goodbye. “You can’t go any further,” he said.
The first lady leaned over and kissed her husband on his forehead. “I love you,” she said.
* * *
ONLY A FEW minutes before the president’s trip to the OR, Arthur Kobrine had visited the radiology suite, where a CAT scan machine was taking X-rays of Jim Brady’s brain. Kobrine, who would soon be operating on the press secretary, carefully studied each image of his patient’s head as it appeared on a small monitor in the lab. Halfway through the CAT scan’s run, he stopped it; he had seen enough. The images revealed bullet fragments scattered across the front of Brady’s brain and a huge blood clot forming in the right frontal lobe. The damage was devastating, and Kobrine didn’t want to waste any more time before getting Brady to the OR.
Brady’s wife, Sarah, had rushed to GW from the couple’s home in Arlington; now a social worker opened the radiology suite door and told Kobrine that she was waiting outside. The surgeon found Mrs. Brady sitting in a chair in the hallway and took a seat next to her. Speaking very directly, Kobrine informed Mrs. Brady that the bullet had passed through her husband’s brain; he then described the operation he was about to perform and spelled out its dangers. Calmly, he told her the prognosis wasn’t good: her husband might not survive the operation.
“You have to save him,” she said, holding back tears. “He has a little boy. Please.”
For a moment, Kobrine turned away. He knew the situation was too dire to make any promises. Instead, he simply said that he would do the best he could.
Returning to the radiology suite, the surgeon marshaled his troops and exhorted them to move quickly. Turning to a Secret Service agent standing nearby, Kobrine told him, “You are going to push through the crowd. We’re going to go down the hall, turn left, and go down to the operating room. We are not stopping. We are just going. Just push people out of the way.”
While Kobrine steered the gurney carrying the press secretary from behind, the agent took a position in front and began to stiff-arm and block people, moving them aside. Just as they began making good progress, the agent abruptly stopped, and Kobrine nearly toppled over Brady.
“God damn it, I told you not to stop for anything,” the surgeon yelled at the agent.
“Sir, that is the president rolling in front of us,” the agent replied. “We have to let him go first.”
* * *
SITTING ON A wooden bench in a locker room after donning his green surgical scrubs and blue Nike running shoes, Ben Aaron adjusted his eyeglasses and mapped out the operation in his mind. It was not a particularly demanding procedure: he would make an incision in the president’s side, cauterize and suture any wounds, and probe the left lung in search of the bullet. But no chest operation is simple. Even healthy patients die from unexpected complications, and Reagan’s surgery presented its own challenges. The patient was seventy years old, and he had been thrown roughly into the limousine, had been in or near shock, and had lost a significant amount of blood. Given all the stresses the president had endured in the past half hour, Aaron worried that he might go into a rapid decline after being put to sleep.
Aaron stood up, took a deep breath, and headed for the operating room. With his years of experience, he knew how to block out any apprehensions and focus entirely on the task at hand. When he entered the OR, he would be all business. His approach to surgery left no room for doubt, earning him comparisons to the advisory on a jar of mayonnaise: he kept cool and didn’t freeze.
Joe Giordano had taken time to gather his thoughts as well. Shortly after inserting the tube into Reagan’s chest and turning the case over to Aaron, Giordano took refuge in the doctors’ lounge and sat down at one of its tables. He tried to absorb what had happened over the past few minutes; at one point he turned to another doctor—an ophthalmologist—and said, “I just put a chest tube in the president of the United States.” He said nothing more before getting up and walking back to the ER.
David Gens didn’t wait to reach the locker room to put on his scrubs—to save time he removed his street clothes and donned his surgical greens inside the closet in which the scrubs were stored. He washed his hands and arms thoroughly and then hurried into the operating room, the first surgeon to arrive. It was always a good idea to have one surgeon scrubbed and ready as soon as a patient had been wheeled into the OR—that way, someone would be on hand in case the patient suddenly began to fail.
Jerry Parr and several other agents were also in the OR. With the help of a surgeon, the agents screened everyone entering the room so that no spectators could slip in. The agents amused the doctors and nurses: Parr had put his scrubs on backward over his suit, and other agents had put their scrubs on incorrectly as well. Hair peeked out from under their surgical caps; pant cuffs jutted from under the scrubs. At least one agent was wearing surgical booties over his bare feet instead of his shoes.
From his position just a few feet from Reagan, Parr surveyed the room. A large adjustable lamp hung overhead, and the shelves on the walls were filled with medical equipment. Metal tables with rollers carried trays upon which surgical instruments had been neatly arrayed. Parr noticed a windowed observation deck overlooking the operating room. He sent another agent to investigate; the door to the deck was locked and a police officer had already been stationed behind it.
By the time the surgical team had assembled, the crowd of doctors, nurses, and agents was so large that some of those present couldn’t see the patient through the throng. The room quickly became quite warm, and the noise level rose as several conversations occurred at once and equipment was prepared for the surgery.
Gently, doctors transferred the president from the gurney to the operating table. A nurse squeezed Reagan’s hand. Manfred “Dutch” Lichtman, an anesthesiologist, leaned down and said, “We’re going to be putting you to sleep now.”
“How are you going to put me to sleep if I can hardly breathe now?” Reagan asked. The tone of his question was almost academic, as if he were trying to figure out the mechanics of how he’d be able to breathe once he was put to sleep.
Lichtman assured the president that he would have no difficulty breathing during the operation and then prepared to administer the anesthetics.
As if responding to a cue, the president rose up on one elbow and dramatically pulled the oxygen mask from his face. Salvaging a line that had fallen flat in the emergency room earlier, he said, “I hope you are all Republicans.”
Nervous chuckles quickly became laughter; the tension in the room evaporated. Standing near the foot of the operating table was Joe Giordano, who happened to be a die-hard liberal. “Today, Mr. President,” Giordano said, “we are all Republicans.”
An ophthalmologist was summoned to pluck out Reagan’s contact lenses. He found one in the president’s right eye and removed it by hand. He saw nothing in the left eye. Perhaps Reagan had not replaced it after his speech; it might also have popped out when the president was pushed into the limousine, or it might have been removed in the ER.
An anesthesiologist injected drugs into an IV line and within seconds Reagan was unconscious. Lichtman began the intubation process, which would make it possible for a machine to breathe for the president. First, he pressed his thumb and forefingers on a small ring of cartilage near Reagan’s Adam’s apple to close off the esophagus; this prevents vomit from getting into the windpipe and lungs, an important precaution because the president had just eaten lunch. Next, another anesthesiologist, George Morales, inserted a breathing tube into the president’s throat and slipped it into his trachea. A small balloon was inflated at the tip of the tube, sealing it into place. Using bags, anesthesiologists began pumping air into Reagan’s lungs; as surgery progressed, a machine could also be used to supply air.
For a moment, silence filled the room.
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