This event documented Boone’s medical competence, his sensitivity to patient confidentiality, and a predilection to employ experts from the Johns Hopkins Medical Institutions as consultants. In summation, Boone wrote: “Mrs. Hoover enjoyed good health—certainly better than Mrs. Harding’s—but was such a busy person and so caught up in activities of her husband that her health could suffer.”10
Eleanor Roosevelt
“Claiming that her wheelchair-bound husband, crippled by polio, needed her as his eyes and ears, hands and feet, she became the most ubiquitous First Lady in history.”11
Eleanor Roosevelt was a very different type of first lady, one who doffed the social and ceremonial roles previously deemed essential in a first lady’s job description. Also absent were the traditional wifely activities of companion and protector. Mrs. Roosevelt, psychologically damaged by an earlier affair between her husband and her own social secretary, embraced an exaggerated political role, often tinged with hostility towards, and frequently disruptive and distracting for, President Roosevelt.12
Mrs. Roosevelt remains the longest-serving American first lady (twelve years, two months), and is the most admired. Polls consistently rank her as the nation’s most successful first lady.13 Her public persona, if anything, increased after her husband’s death in April 1945. She was a dominant actor upon the national and international stage for the remaining seventeen years of her life as she energetically pursued goals of peace, civil rights, and women’s enrichment.
Excellent health, with few exceptions, was her companion before, during, and after her White House years, Her maternal grandmother, Mrs. Hall, entrusted with Eleanor’s upbringing after the early deaths of both parents, alerted the headmistress of London’s Allenswood finishing school that the teenage Eleanor was in delicate health. Mlle. Souvestre disagreed: “She does not any more suffer of the complaints you told me about. She has a good sleep, a good appetite, is very rarely troubled with headaches and is always ready to enjoy her life.”14
Mrs. Roosevelt was pregnant six times. Her first child, Anna, was born after a difficult nine months, and the pregnancy was marked by nausea. All the other children were boys. The third child and second son perished from heart disease before his first birthday.15
A rare exception to her good health occurred in 1912. Both Eleanor and Franklin were downed by typhoid fever. Its usual symptoms are high fever, abdominal pain, weakness and loss of appetite. The future first lady’s symptoms are unrecorded other than that it was a week before her temperature began to subside.16
Eleanor Roosevelt, the wife of Franklin D. Roosevelt. To date she is the longest serving first lady (Library of Congress).
Eleanor Roosevelt lived for seventeen years after FDR’s death and died at age seventy-eight in December 1962. She was prodigiously active well past her seventieth birthday; her energy began to wane only in early 1960. She was knocked down by a driver who “carelessly backed a station wagon into her as she was crossing a Greenwich Village, Manhattan street to a charity meeting. David Gurewitsch taped up her leg, but despite torn ligaments she continued with her engagements for the day.”17
Dr. David Gurewitsch was “Eleanor Roosevelt’s friend, confidant, personal physician, housemate, and traveling companion during her post–White House years.” She met the doctor in 1944 in New York City. After she relocated to New York from Washington, she asked Gurewitsch to become her personal physician. Their relationship was briefly interrupted when the doctor required overseas treatment for tuberculosis.18 In early 1960 David Gurewitsch diagnosed aplastic anemia as the cause of his patient’s decreased energy. “The illness would flicker and subside—infections, fevers, chills, and aches. She dealt with them by ignoring them.”19 The cause of aplastic anemia is often unknown. Approximately six months before her demise, Mrs. Roosevelt was treated with steroids because the anemia had worsened to affect platelet formation. The platelet count decreased to such an extent that internal bleeding became a possibility. Steroid therapy has frequent side effects, and it reactivated an old tuberculosis scar in Mrs. Roosevelt’s lung. Tuberculous bacilli spread throughout her body. She realized that death was imminent and demanded release from the hospital to die at home, which she did three weeks later.20
It is fitting that one of the final decisions of this most political of presidential wives be placed in a political context. Dr. Barron H. Lerner, writing for the liberal Huffington Post, used Mrs. Roosevelt’s resistance to very expensive terminal care within a hospital as an argument in favor of the Affordable Care Act (ACA), aka Obamacare. Lerner wrote in October 2012: “Hospitals remain full of elderly patients as or more ill than Eleanor Roosevelt receiving aggressive and expensive medical interventions ranging from ventilators to hemodialysis to intensive care. Even when they prolong life, they often cannot reverse terminal conditions. The ACA is a wonderful opportunity for us to reassess the true value of medical treatments…. There is something to be said for dying at home like Eleanor Roosevelt did—unattached to any machines.”21
Bess Truman
Upon hearing from her husband, the vice president, that President Roosevelt had died, “Bess put down the telephone and began to cry. She made her way down the hall to her daughter’s bedroom, sobbing so hard that she could barely speak.”22
On June 28, 1919, 34-year-old Bess Wallace married 35-year-old Harry Truman in the small Trinity Episcopal Church in her hometown of Independence, Missouri. It was the first and only marriage for both; the Trumans embarked on a happy and very successful partnership that terminated with Harry’s death fifty-three years later on December 26, 1972.23
Bess experienced two miscarriages, in 1920 and in 1922 when she was 35 and 37 years old. Unhappy about the losses, she feared that she had waited too long for a pregnancy. However, nearing the advanced maternal age of forty, “Bess gave birth to Mary Margaret Truman in an upstairs bedroom at 219 North Delaware and made a bed for her in a bureau drawer.”24 Margaret’s happy delivery on February 17, 1924, concluded her mother’s obstetrical history.
Excellent health, Midwestern common sense, and a deeply respectful and honest relationship with her husband permitted the first lady to be a reliable and effective sounding-board for President Harry Truman (1945–1953). The president publicly referred to his wife as “the boss.” Although she had a passion for anonymity, Bess was a full partner in Harry’s presidential decisions.25
Bess Truman had no great affinity either for Washington, D.C., or her role as first lady in the White House. She cried when informed that her husband would succeed Franklin Roosevelt as president.26 She assiduously avoided attention: “She never made a speech. She never gave a personal interview and never held a press conference. She was determined to keep her private life private…. Mrs. Truman never gave an opinion on a public issue—except once…. [S]he thought that the historic walls ought to stand.”27 Mrs. Truman much preferred to live in Independence, Missouri, and, more particularly, to reside in the Gates Mansion, the home she had known all her life. During her husband’s presidential tenure, Bess Truman spent as much time as possible there, including the summer months and holiday seasons.28
Bess Truman, the wife of Harry Truman. At this writing, she is the longest-lived first lady (Library of Congress).
As Harry Truman’s presidency was drawing to an end, her cheerfulness was much remarked upon, and most political reporters acknowledged that the first lady, although proficient in fulfilling her social and ceremonial duties, would rather be dwelling somewhere else.29
Mrs. Truman’s medical history while first lady was uneventful. Only a single episode of ill health is recorded. In early December 1948, the first lady traveled to Norfolk, Virginia, for a presentation aboard the battleship USS Missouri: “In the middle of the ceremony she developed a severe nosebleed. Back in Washington, Dr. Wallace Graham … took her blood pressure and discovered it was extremely high.” Graham, the Trumans’ White House physician, first applied pressure to control the hemorrhaging. When this
procedure was unsuccessful, the doctor cauterized the bleeding site. He then treated the patient’s hypertension by prescribing an unknown antihypertensive drug and instituting a no-salt diet. His treatment worked; Bess Truman’s blood pressure reverted to normal and she shed twenty pounds of weight.30
The Trumans had a long personal and professional relationship with Dr. Graham. Wallace Graham was the son of Dr. James Walter Graham, a military colleague of Harry Truman from the First World War. The president looked up Graham’s military physician son when in Germany for the 1945 Potsdam Peace Conference and brought Wallace back to the White House to serve as the Trumans’ personal physician. Graham’s excellent medical care for the first family was rewarded by promotions first to brigadier general and then to the temporary rank of major general in the air force reserves. Graham departed both the White House and the air force when the Trumans returned to Missouri, where he entered private practice. The doctor continued as the Trumans’ physician for the remainder of their lives.31 Doctor Graham attended Harry Truman’s death on December 14, 1972.32 He also attended the ex-first lady’s multiple hospitalizations in her later years: hypertension33; breast tumor surgery34; right hip fracture35; and stroke.36
In late 1958 Bess Truman discovered a lump in her left breast. She decided to delay any medical evaluation, using Harry’s 75th birthday celebration and the birth of their second grandchild as rationalization for her procrastination. Finally on May 16, 1959, after the tumor had grown to grapefruit size, she was admitted to the Kansas City Research Hospital. A mastectomy was performed; the tumor turned out to be benign. It was an “unusual type of tumor known medically as a benign myxoma.” Mrs. Truman was discharged on her eighteenth hospital day. It took Bess a long time to recover from the operation.37
Graham made house calls to the Truman home and was quoted in Mrs. Truman’s obituary: “The Trumans’ family doctor, Wallace Graham, said Mrs. Truman, who was hospitalized for 22 days in September with a bleeding ulcer, had been battling pulmonary congestion since that hospitalization and had been in a coma-like state since Friday.”38 Bess Truman remains the longest-living of the first ladies. She died at 97 years of age.
Lady Bird Johnson
“She was a stoic, rarely admitting pain, a trait her husband characterized as perhaps her only fault. She had four miscarriages but never indulged in self-pity.”39
Lady Bird Johnson was gifted with the three essentials for survival, and success, in the White House: Strength, courage and excellent health.40 And she was indeed very healthy, before, during and, for many years, after her residence in the White House. She suffered several miscarriages during the pre–World War II era, but delivered healthy daughters in 1944 and 1947.41
Mrs. Johnson died in 1997 at age 94 and is the second longest-lived first lady.42 Four years earlier, in the summer of 1993, there was a slight stroke which later caused recurrent episodes of dizziness. Subsequently, macular degeneration impaired her vision and eventually made her legally blind. In 2002, a second cerebrovascular accident destroyed her ability to speak. Another consequence was an inability to swallow; a nasogastric feeding tube was inserted to provide nutrition.43
Lady Bird and Lyndon Johnson were married for thirty-nine years and formed a very effective political, social, and financial team. This first lady was well prepared for her expected social and ceremonial duties, as she had acquired a quarter-century of Washington political experience. Moreover, as the wife of the vice president, she often substituted at events for first lady Jacqueline Kennedy, who was not at all interested in attending political or routine social affairs.
“To a greater degree than Eleanor Roosevelt, Lady Bird Johnson devised and developed the staff, procedures and tactics that subsequent First Ladies have employed when they entered the public arena.”44 Her success as the wife of the president has been acknowledged consistently in polls that assess first ladies. She is always ranked in the top ten wives for effectiveness.45
Part III: Modern Times and Into the Twenty-First Century
*
Chapter Fifteen
Breast Cancer and Other Maladies
Betty Ford, Rosalynn Carter and Nancy Reagan
Introduction
Two first ladies, Betty Ford and Nancy Reagan, the wives of Presidents Gerald Ford (1974–1977) and Ronald Reagan (1981–1989), suffered in public through the diagnosis, treatment, and aftermath of breast cancer, the most emotionally and physically frightening disease for females, which eventually strikes one in eight American women.1 It is stunning that it was not until the third century of the American Republic that cancer became a part of the conversation about the first ladies’ health. It is especially a surprise since in 2010 cancer was the second leading cause of death of American women.2
Cancer (except for innocuous skin cancers—mostly basal cell carcinomas—in several, and lymphoma and lung cancer as the causes of death in two others—Jackie Kennedy and Pat Nixon respectively—long after their residencies in the White House) did not attack a first lady until September 1974. The shadow of a breast malignancy twice previously had darkened the mood of a president’s spouse. Abigail (Nabby) Smith, the only daughter of John and Abigail Adams, died from breast cancer, despite a mastectomy. Ex-first lady Bess Truman had a large benign mammary tumor removed with no further ill effects.3
Mrs. Ford also suffered from a second severe ailment—painful osteoarthritis of the neck that compounded her chronic depression. Alcoholism and drug dependency resulted from the pain and the depression. Her heroic recovery and its benefit to the public is presented at the end of the chapter. First lady Betty Ford was the first of the first ladies to publicize the problems in her medical history for the public good.
Betty Ford
“Two weeks after her admission to Long Beach, Betty Ford admitted she was an alcoholic.”4
This first lady was born Elizabeth Ann Bloomer in Chicago on April 8, 1918, the youngest, and the only girl, of three siblings. At the age of twenty-four she wed salesman Bill Warren. They divorced after five years of marriage. Betty became the third first lady, after Rachel Jackson and Florence Harding, to previously have been divorced.5 She married the rising politician Gerald Ford in 1948. Four healthy children arrived in the following nine years.6
Breast Cancer
The Ford White House endorsed complete transparency in its reporting on the first lady’s breast cancer—its diagnosis, treatment and recovery. Mrs. Ford believed that the public would benefit from a frank discussion about this dread disease. A second compelling reason was an attempt to recover from the widespread alienation attached to the Nixon presidency. Nixon’s resignation a few months earlier made the unelected Gerald Ford the 38th President of the United States (1974–77).7 Florence Harding, a predecessor as first lady, allowed full medical disclosure of her illness to dissipate the political cynicism that resulted from the secrecy of Woodrow Wilson’s disability.
The diagnosis of Betty’s breast cancer was serendipitous. On September 26, 1974, the first lady accompanied her personal assistant, Nancy Howe, to Bethesda Naval Hospital for Mrs. Howe’s previously scheduled breast examination. On the spur of the moment Betty Ford decided to undergo an examination as well.8 There is no record when she last had a complete physical examination. The New York Times reported that a gynecological checkup, probably a limited exam, six weeks previously was normal. The first breast mammogram machine was introduced in the 1960s and it was only in 1976, two years after Mrs. Ford’s diagnosis, that the American Cancer Society recommended annual mammograms for women over the age of fifty.9
Navy captain Douglas Knab, the chair of Bethesda’s Department of Obstetrics and Gynecology, was the first to examine Mrs. Ford at Bethesda; he detected a marble sized lump in the right breast. Captain William Fouty, chief of surgery, was asked to corroborate Knab’s finding. Fouty determined that the lump was “suspicious.” The caution that is a hallmark of VIP medicine was observed; the physicians desired additional consultation. As a result,
the patient left the hospital without being informed of her probable diagnosis.
Both physicians contacted the White House physician, William Lukash. Lukash in turn scheduled an examination to be preformed at the White House by Dr. Richard Thistlethwaite, Bethesda’s civilian consultant and chief of surgery at the George Washington School of Medicine. Thistlethwaite, the fourth doctor involved, after his examination joined Lukash in informing President and Mrs. Ford that the breast lump required immediate surgery. Betty Ford decided to fulfill her scheduled commitments the following day. The New York Times soon broke the story: “Mrs. Betty Ford … entered Bethesda late this afternoon [9/27] for surgery tomorrow to determine whether a nodule in her right breast is benign or malignant.”10
On Saturday morning, September 28, under general anesthesia, a two centimeter cancer was excised from the outer upper quadrant of Betty Ford’s right breast. After a malignant diagnosis was established, by advance consent surgeon Fouty performed a standard radical mastectomy. Bill Fouty was a navy specialist in female surgery; previously he had performed hundreds of mastectomies. Two of thirty regional lymph nodes that were removed contained metastatic cancer.11
Cancer of the breast was the most feared disease of women. Contemporary 1974 statistics showed 90,000 cases and 33,000 deaths annually from female breast cancer. Mrs. Ford, in good health and not overweight, was judged to have a favorable prognosis with a 75–90 percent ten-year survival.12 The first lady was released from Bethesda on the thirteenth postoperative day. She soon resumed her social duties as a hostess at the farewell dinner party for retiring White House chief of staff brigadier general Alexander Haig.13
The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama Page 25
