We Were There

by Allen Childs

  Occasionally, you will see a trauma patient come in and . . . who has just arrested or had their heart stop, and maybe if their injuries are not severe—so severe as this was—you can immediately start resuscitation and bring them back. And we thought maybe that was a possibility. When I went down there, I had assumed that he had probably been shot in the stomach or the chest, and that he was OK. Or he had been shot in the arm. It was just a matter of taking care of him, of taking him to the operating room if need be, and he was going to be all right. And it wasn’t until I went into the Trauma Room 1 that I realized the [nodding] seriousness of this injury. Most of the gunshot wounds that we saw at that time were relatively low caliber—.22, .32, occasional .38 caliber injuries. And that was because most people were shot with small handguns or stabs . . . stab wounds and so forth occurred. So, we didn’t see a lot of high velocity injuries, as far as the method of injury is concerned.

  But as we worked on the president for a little bit, we realized that there was a head wound, but even then, we hadn’t had time to assess the severity of that injury. And were still working for the first two or three minutes [smiling and nodding] with the idea that maybe there was a possibility of resuscitating the president. But that doubt [nodding] dissipated fairly quickly as we got started.

  As Dr. Perry made the tracheotomy incision, and I made the cutdown incision, those two procedures were going along reasonably well and reasonably quickly. I’d . . . I could not reach the cutdown tray—or the venous section tray, as it was called—which was just a matter of six or eight feet away from me because of the number of people that were in the room. And one of the nurses handed me the tray which had the knife and the catheter in it to perform . . . and the [word indecipherable] to perform a cutdown to establish an IV. And I couldn’t get to gloves, and so I did the cutdown barehanded and just quickly made an incision. I could see the vein right here in his left arm and then took the catheter and threaded it very quickly into the vein, and we got IV fluids going immediately.

  About the time I had finished that, Dr. Perry was doing the tracheostomy . . . performing the tracheostomy with Dr. Charles Baxter, and they thought they heard a gush of air come from the neck. And they didn’t know whether there could have been an injury to the chest through this neck wound, and perhaps the lung had collapsed. And so, I asked Dr. Perry, “Do you want to have a chest tube placed?” And he said, “Yes.” And so, I then made a . . . got another tray to insert a chest tube and made a short incision in the left front chest just below the collarbone about two or three finger breadths and placed a trocar and then put a chest tube in place. And as I recall, Dr. Carrico had come around to that side of the table at that time. He was, I believe, a second-year resident, and he put the tube into the water suction bottle, which was the method that we used of expanding a pneumothorax if that happened to be the case at that time. And we did not get any blood at that time, nor did we see any air bubbling.

  Not knowing which side that might have occurred on, we went to the left side and because I couldn’t go around the table and Dr. Paul Peters, the chairman of urology, was on that side of the table. He had come into the room by that time, and Dr. Baxter was at the head of the table performing the tracheotomy with Dr. Perry. So, Perry and I were on the president’s left, Dr. Peters and Dr. Baxter were on the president’s right side. So, the three of us sort of put in the chest tube in the right side.

  By the time we had done that, we had an EKG—a portable electrocardiogram—brought into the room and leads were placed on the chest. And all we had on the tracing was just a straight line, so there was no heart activity. There was no heartbeat. And I think from the time we walked into the room until that time was probably no more than ten minutes. We thought that we came . . . I thought that we came in the room about twenty-five minutes until 1:00. And within ten minutes, the tracheotomy had been performed. Dr. Jenkins and Dr. Carrico had the tracheal tube in. We had chest tubes in. We had the cutdown going, IV fluid going, and probably another IV going in the lower extremity—in the lower leg.

  And then, Dr. Perry and Dr. Jenkins and by then Dr. Kemp Clark had come in the room, as I recall. They could look at the head wound a little better, and they could see the extensive injury to the brain. And that’s when it really became apparent that there was no use in attempting any additional effort to save his [life] because, number one, there was no evidence that he had been alive during the time that he had been in the emergency room that I could tell or that Dr. Perry, I think, could tell, and with that type of injury, you were almost certain that even if he did have a heartbeat, he could not maintain life with that degree of brain injury. I could not look up over the head because I was down at this level of the body and could not see over the head back here [indicating top and back of head] as he was flat on the cart, to see the extensive head injury that he apparently had, at least enough to get a real accurate description of what that injury looked like or the size of the defect that that missile had caused.

  We didn’t turn him over either because Mrs. Kennedy was in the room. He obviously had expired. And we felt at the time because of . . . perhaps of her presence that we didn’t want to appear to be inquisitive or overly inquisitive, and yet in retrospect, that obviously should have been done. And he should have been looked at both front, back—detail measurements made of everything. But as I said at the beginning, we had never witnessed an assassination before, and I think even then, we did not appreciate the impact that this had already had on the world. And that came to light as I walked out of the room at about fifteen minutes until 1:00 or so.

  When we stopped performing any additional procedures on the president, we still were not totally sure that all was lost and very quickly, the question came up, should we open his chest and try to do open heart massage? And I think, at that point, you have decide[d] is this something that you want to do? Do you want to do any more surgery on someone who has no chance of living? She’s in the room, and that question briefly surfaced. And I think the decision was that with the extent of the brain injury that we might do some closed chest massage, which had become fairly popular at that . . . shortly before that period of time. And Dr. Perry started closed chest massage. We thought that we needed to cut the clothes off to see if we were getting a palatable pulse, and as I recall, we cut the coat, shirt, and the trousers off without trying to lift him up and take it off. So, we cut the clothes away, and that was when we noticed the Ace bandage wrapped around the abdomen, the stomach, and the back, which . . . apparently he had a back brace and went down one leg. And so, I tried to feel for a pulse to see if the closed chest massage was effective, and we also got the word at that time that Mrs. Kennedy, I think, wanted a priest called and that we probably were not to pronounce him until the priest arrived. And in the meantime, I think Dr. Carrico had administered some steroids IV, and that was about the time that I walked out. Whoever spoke to Mrs. Kennedy—and I did not—did so after I left the room.

  Robert McClelland, MD

  (from D Magazine, November 2008)

  The first thing he saw was the president’s face, cyanotic—bluish-black, swollen, suffused with blood. The body was on a cart in the middle of the room, draped and surrounded by doctors and residents. Kennedy was completely motionless, a contrast to the commotion around him. McClelland was relieved there were so many other faculty members there. . . .

  McClelland put on surgical gloves. None of the men in the room had changed clothes. At their wrists, the surgical gloves met business suits and pressed white shirt cuffs.

  Jenkins had his hands full, but nodded down to Kennedy’s head. He said, “Bob, there’s a wound there.” The head was covered in blood and blood clots, tiny collections of dark red mass. McClelland thought he meant there was a wound at the president’s left temple. Later that gesture would cause some confusion.

  McClelland moved to the head of the cart. “Bob, would you hold this retractor?” Perry asked. He handed McClelland an army-navy retractor, a straig
ht metal bar with curves on each end to hold back tissue and allow visibility and access. McClelland leaned over the president’s blue face, over the gape in the back of his head, and took the tool.

  For nearly 15 minutes, McClelland held the retractor as blood ran over its edges. As the other doctors labored on Kennedy’s throat and chest or milled around the room, McClelland stood staring at the leader of the free world. His face was 18 inches from the president’s head wound. Kennedy’s eyes bulged slightly from their sockets—the medical term is “protuberant”—common with massive head injuries and increased intracranial pressure. Blood oozed down his cheeks. Some of the hair at the front of his head was still combed.

  McClelland looked into the head wound. Stray hairs at the back of the head covered parts of the hole, as did bits of bone, blood, and more blood clots. He watched as a piece of cerebellum slowly slipped from the back of the hole and dropped onto the cart.

  Shown here holding the dress shirt he wore during the resuscitation effort, Dr. McClelland has preserved this bloodstained artifact for posterity. Still teaching at the age of eighty-four, he is a treasure of Southwestern Medical School.

  Robert McClelland, MD

  (oral history courtesy of the Sixth Floor Musuem)

  A huge big crowd just filled the emergency room. And I thought, “Well, something’s going on here.” And then the crowd parted enough that I saw Mrs. Kennedy sitting there on a chair in that famous pink suit, and I thought, “Oh my God.” And at that point, see, I knew Dr. Shires was in Galveston at a meeting. I didn’t know where anybody else was, and here I was [chuckling], a thirty-four-year-old instructor in surgery and here I may be . . . maybe I’m it, for all I knew. And I had to almost force myself to not turn around and run and to keep going back toward that room, you know. And Doris Nelson, who was the head nurse in there, was telling people, you know, the Secret Service, who to let by, and so she said, “Let him by, he’s one of the doctors.” And I went on into the room, the rear of the room, but that meant that I saw his face, and as I came in, that was the first vivid impression I got. So, I walked on around to the . . . between the gurney he was lying on and the wall and walked up toward the head of the gurney where Dr. Jenkins was, and they had . . . and Dr. Carrico had intubated him, and they had him hooked up to an anesthesia machine, and Dr. Perry, who was standing out there when I arrived today, and Dr. Baxter had started doing a tracheotomy on the president.

  And so, I didn’t see anything I could do, but I went up to the head of the gurney, and they seemed to be having a little difficulty seeing, and so I said, “Well, here, let me hold the retractor for you.” And I took a . . . what we call a metal . . . a so-called Army/Navy retractor, just a little straight piece of metal, and it was retracting the upper edge of the tracheal incision, leaning over the president’s head doing that. So, I had not much to do other than that. While they continued the tracheotomy and everybody else was running around in the room,

  I stood there for, I guess ten or fifteen minutes, looking right into the head wound. And as I stood there, you know, part of the cerebellum fell out on the . . . on the cart there. And I knew that I thought to myself . . . I still remember thinking, “Well, gee, that’s part of the cerebellum.” And of course, Pepper Jenkins said that in his original testimony, but he denied later that he said it, even though it was in the record, and that it was cerebral tissue. Well, it wasn’t cerebral tissue, it was cerebellar tissue, and I’m as certain of that as my name, even though that was not apparently thought to be the case later. I know it was, and so anyway, this hole that I was looking at . . . I could sit here now and almost draw it in detail for you, thirty-some odd years later because I looked at it and I was that far from it [holding hands a few inches from his face]. Everybody else was just kind of moving around catching glimpses of it, and I was sort of burning it into my visual field.

  You’re just reacting. You’re not really thinking about, well, what am I going to do next? You’re just kind of going from one immediate impression to the next. It’s a moment of reactions, not thoughts and reactions and . . . and, of course, I think the immediate reaction was that once he’s pronounced dead, it was none of our business. That we then weren’t, you know, going to go over him carefully because it was clear that they wanted . . . everybody wanted to get out of there, and so you didn’t delay anything. And we, in fact, almost everybody left the room . . . the doctors. The only two people that were left in there were Dr. Baxter and myself, and the president’s body and the reason we were still in there is that before we could get out of the room where we happened to be standing when he was pronounced dead. We were, again, between the gurney and the wall, and about the time that Dr. Baxter and I were gonna walk around that head of the gurney and leave the room behind everybody else, the door came open and Father Hubert came in, and we’d almost have to knock him down or push him out of the way to get out of the way, so we just kind of melted back up against the wall. And so, he came in then, you know, and put his little thing around his neck, and we stood there while he gave the president his Last Rites.

  Kemp Clark, MD

  (excerpted from his testimony at the Warren

  Commission Hearings)

  Mr. SPECTER.What did you observe the president’s condition to be on your arrival there?

  Dr. CLARK. The president was lying on his back on the emergency cart. Dr. Perry was performing a tracheotomy. There were chest tubes being inserted. Dr. Jenkins was assisting the president’s respirations through a tube in his trachea. Dr. Jones and Dr. Carrico were administering fluids and blood intravenously. The president was making a few spasmodic respiratory efforts. I assisted in withdrawing the endotracheal tube from the throat as Dr. Perry was then ready to insert the tracheotomy tube. I then examined the president briefly. My findings showed his pupils were widely dilated, did not react to light, and his eyes were deviated outward with a slight skew deviation.

  I then examined the wound in the back of the president’s head. This was a large, gaping wound in the right posterior part, with cerebral and cerebellar tissue being damaged and exposed. There was considerable blood loss evident on the carriage, the floor, and the clothing of some of the people present. I would estimate 1,500 cc. of blood being present.

  As I was examining the president’s wound, I felt for a carotid pulse and felt none. Therefore, I began external cardiac massage and asked that a cardiotachioscope be connected. Because of my position it was difficult to administer cardiac massage. However, Dr. Jones stated that he felt a femoral pulse.

  Mr. SPECTER. What did the cardiotachioscope show at that time?

  Dr. CLARK. By this time the cardiotachioscope, we just call it a cardiac monitor for a better word. . . .

  Mr. SPECTER. That’s a good word.

  Dr. CLARK. The cardiotachioscope had been attached and Dr. Fouad Bashour had arrived. There was transient electrical activity of the president’s heart of an undefined type. Approximately, at this time the external cardiac massage became ineffectual and no pulsations could be felt. At this time it was decided to pronounce the president dead.

  Mr. SPECTER. At what time was this fixed?

  Dr. CLARK. Death was fixed at 1 p.m.

  Mr. SPECTER. Was that a precise time or an approximate time, or in what way did you fix the time of death at one o’clock?

  Dr. CLARK. This was an approximation as it is, first, extremely difficult to stage precisely when death occurs. Secondly, no one was monitoring the clock, so an approximation of one o’clock was chosen.

  Mr. SPECTER. Who was it who actually fixed the time of death?

  Dr. CLARK. I did.

  Michael Ellsasser, MD

  Don Gilliard and I went to the ER cubicle where they had attempted resuscitation and pronounced the president dead. The room had yet to be cleaned and Jackie Kennedy’s bouquet of blood spattered roses rested in a waste can. Don and I each took a rose, and later had them encased in plastic. They didn’t come out very well, but I still have that piece
of history.

  The door to Trauma Room 1 bore this wreath for many days after our president died there.

  Chapter 7

  MEMORIES OF THE

  FIRST LADY

  The Secret Service and hospital personnel tried to prevent Jackie Kennedy from entering Trauma Room 1, but she jerked free from their restraining hands, saying, “I’m just as competent as you are.” An article in the Journal of the American Medical Association published three decades later reports the searing memories of Pepper Jenkins, the chief of anesthesiology, who was ventilating the president during the frantic resuscitation effort.

  Norman Borge was working in the psychiatric emergency room adjacent to the Pit when the dying president was brought into the ER. Seeing Jackie standing in the doorway of Trauma Room 1, Borge found her a chair in which she sat rigidly, her hands folded in her lap. She seemed to him to be “staring at the crowd without seeing them.” He thought to do the human thing by bringing her a cup of water. When he handed it to Jackie, she smiled at him and said, “Thank you very much, I appreciate it.” Borge’s memories of the First Lady were published in the Fort Worth Star-Telegram in 1965 and they tell of her remarkable graciousness during the worst moments of her life.