Laura Welch married George W. Bush, the oldest child of George H.W. and Barbara Bush, when they were both thirty years old. Laura was an only child; her mother’s three other pregnancies ended in failure. Laura taught elementary school and, after attaining a graduate degree in library science, she worked as a school librarian.48
Despite the couple’s desire for children, Mrs. Bush’s one and only pregnancy was delayed until the age of thirty-four years. “I was anxious the entire time that I was pregnant. The memories of Mother’s late miscarriages hung over me.” The prospective parents flew to Houston, Texas, to undergo suturing of the expectant mother’s uterine cervix, a maneuver to prevent an aborted pregnancy. A subsequent sonogram diagnosed a twin pregnancy.49
Laura Bush, the wife of George W. Bush. Her small skin cancer caused a controversy with the White House press corps (Library of Congress).
The future first lady’s obstetrician, Dr. Charles Stephens of Odessa, Texas, diagnosed preeclampsia at seven months of pregnancy; he referred her to Baylor Hospital in Dallas, noted for its excellent obstetrical and prenatal care. Mrs. Bush was placed on bed rest, but toxemia-related hypertension increased to a degree that a caesarean-section was mandated. Healthy twin girls were born five weeks early.50 Laura Bush certainly was not the only first lady to undergo a difficult pregnancy, though she was more fortunate than her predecessors due to the progress and advances in medical care.
Mrs. Bush was healthy during six years as the wife of the governor of Texas and eight years as first lady of the United States. She experienced two medical problems in the White House, one more consequential politically than medically. The second required surgery.
An observant reporter noted a bandage on Mrs. Bush’s right pretibial region (shin) at a Hanukkah ceremony and asked if she had been bitten by Barney, her pet dog. Press speculation boiled over, leading to heated inquiries that evening to Susan Whitson, her press secretary, and the following day to Tony Snow, President Bush’s press secretary. In high dudgeon and in anticipation of a nefarious motive during a slow news day, the denizens of the White House press corps demanded answers. They were informed that five weeks previously, a biopsy was taken from a non-healing irritation on the skin of the leg. The pathologist reported a diagnosis of a skin squamous cell carcinoma. The lesion, the size of a nickel, was widely excised.51
Squamous cell carcinoma is the second most frequent “cancer” of the skin, but is much less common than its cousin, basal cell carcinoma. (“Cancer” is in quotation marks since this disease almost never spreads or causes death.) Press secretary Snow defensively asserted to the hectoring reporters that Mrs. Bush was not an elected official and that the problem was trivial. He added, “Perhaps if there’s something major, this would be discussed.”52 Snow added to the questioners: “She’s got the same right to medical privacy that you do.”53
Some constituents criticized Laura Bush on the grounds that she had missed an opportunity to educate the public about the various kinds of skin cancer and the importance of regular dermatologic examinations.54 The first lady summed up the issue during a December 24, 2006, interview on CBS’s Face the Nation: “It just didn’t occur to me. Also of course, I am a private citizen. I mean, I have to say that as well. I don’t release the results of my regular physicals, like the president does, of course. And so it never really occurred to me. But I’m glad it’s out, because I’m glad that people will pay attention. If they have spots, if they don’t know what they are, certainly, people like me who are very fair-complected and who grew up in the southern part of the United States and in west Texas where I grew up, where the sun is pretty intense.”55
The second medical incident was more significant. The first lady developed a seasonal affliction over several Decembers, a pain in her left forearm. Since the problem resolved with the New Year, she discounted it and reasoned that the pain was a result of many hours spent standing and holding the left arm by her side during the numerous White House Christmas social events. However, in 2007, the pain continued into the spring; it worsened after a hiking trip to Zion National Park.56 Her physical impediment became public in an August 27 Los Angeles Times article. The newspaper reported that the first lady cancelled a trip to Australia due to commence on September 4, 2007. The reason was identified as a pinched nerve in her neck and shoulder. She had received physical therapy for several months; nevertheless her symptoms persisted.57
Laura underwent a two-and-a-half-hour operation on September 8, 2007, at the District’s George Washington University Hospital. The surgical team was led by Dr. Anthony Caputy, chairman of its Department of Neurosurgery and codirector of its neurological institute. Colonel Richard Tubb, the Bush White House personal physician, was responsible for the first lady’s care. When physical therapy was not successful in eliminating the pain, Dr. Tubb recommended several surgeons to his patient. Mrs. Bush had the final say in the selection of the surgeon.58
The diagnosis was osteoarthritis of the cervical (neck) vertebral column. Bone spurs and calcifications impinged upon the opening of the nerve to the left arm. These were removed, thus opening up the course of the nerve. Since the procedure was performed on an outpatient basis, Mrs. Bush returned to the White House that afternoon. The arm pain disappeared and she resumed full activity. “The calcifications and bone spurs don’t necessarily occur with repetitive motion, so Mrs. Bush’s First Ladies duties could … not explain the pain.”59
Forty years previously Betty Ford suffered greatly from the same disease. Osteoarthritis of the neck produced excruciating neck and arm pain that were responsible for her prescription drug addiction. Precise radiological instrumentation, e.g., the MRI employed in Mrs. Bush’s case, was unavailable at the time. Laura Bush was the fortunate recipient of continuous medical observation and had her choice of many very talented neurosurgeons. She remains well five years after the Bushes departed from the White House. There is no evidence that this incident affected the president’s performance of his responsibilities.60
The White House revealed Laura’s medical malady only after months of physical therapy because her absence on a planned international trip required an explanation. The pending surgery was announced the day before by her press secretary. In a curious fashion, “[Sally] McDonough would not reveal where the surgery would be performed, saying that Mrs. Bush is a private citizen and not an elected official.”61
Michelle Obama
Michelle Obama was forty-five years of age when Barack Obama, her husband, took the oath of office as the 44th president of the United States. The Obamas are the parents of two daughters. Mrs. Obama has been healthy both before and during her days in the White House. There is no public record of any significant disease. The record of this first lady’s health remains to be written.
Chapter Seventeen
The Diseases, Burdens and Confidentiality of First Ladies
It is not possible to summarize the illnesses and the resultant consequences of America’s forty first ladies in a concise and comprehensive fashion. However, a few conclusions are appropriate.
The Incidence of Diseases Changes with Time
In general, America’s first ladies were affected by the same categories of diseases that afflicted their peers in American society. In the early republic and for most of the nineteenth century infectious and contagious diseases were dominant.
Yellow Fever epidemics in Philadelphia during the 1790s disrupted the operations of the infant United States government and influenced the travel plans of Martha Washington and Abigail Adams. The disease felled the first husband of Dolley Payne Madison and one of her two sons. The new widow also may have been infected. Malaria became almost a first lady’s occupational hazard. Sarah Polk, Lucretia Garfield, and possibly Elizabeth Monroe were infected while their husbands toiled amidst the fever swamps of Washington, D.C. Abigail Adams likely was infected when John Adams was vice president, in New York City. Margaret Taylor almost died from the disease when she lived in subtropical Louisi
ana. Public health measures subsequently eliminated this disease, which is no longer endemic in the United States.
Tuberculosis was the “White Plague” of urban America during the latter part of the nineteenth century. It caused the death of first lady Caroline Harrison in 1892 during her husband’s presidency. It persisted as a chronic illness for both Eliza Johnson and Jane Pierce and killed the latter. Tuberculosis remained dormant for decades within the lung of Eleanor Roosevelt, was reactivated possibly by steroid treatment, and contributed to her death in 1962.
Nondescript bacterial infections targeted the urinary tracts of Florence Harding and Grace Coolidge when they resided in the White House. Abigail Fillmore became ill when she attended the inauguration of Franklin Pierce on a cold March morning; pneumonia and death soon followed. A childhood streptococcal infection sickened Mamie Eisenhower; its immediate symptom was Saint Vitus’ dance (rapid, irregular, aimless, involuntary movements of the limbs, neck, and trunk that resemble continuous restlessness), and its long-term consequence was rheumatic damage of her cardiac valve. Over the past sixty years antibiotics have controlled and often eliminated the consequences of bacterial infections.
Morbidity related to pregnancy was prevalent until the introduction of modern obstetrics at the beginning of the twentieth century. Toxemia of pregnancy struck Ellen Wilson, Lucy Hayes, Ida McKinley and possibly Letitia Tyler. Mrs. Wilson developed chronic renal failure, Ida McKinley epilepsy, and Lucy Hayes probable hypertension. Although toxemia cannot be documented for Mrs. Tyler, it is likely that pregnancy-induced hypertension was a factor in her debilitating and deadly strokes. Alice, the first Mrs. Theodore Roosevelt, died from acute toxemia of pregnancy. Caroline Harrison underwent surgical correction of a likely vesicovaginal fistula, a consequence of a difficult vaginal delivery. Postpartum depression became a problem for several of the women, usually prior to living in the White House, but it was most pronounced in Jackie Kennedy. Her malaise and depressed mood after John Jr.’s birth in late 1960 were the circumstances for receiving Dr. Feelgood’s amphetamine injections during 1961 and later.
Hypertension and stroke afflicted several first ladies. Although hypertension now is recognized as a leading cause of cerebrovascular accidents, the sphygmomanometer, the device employed to measure a patient’s blood pressure, was not widely used until the early 1900s.1 Therefore it may be reasonable to theorize that the strokes suffered in retirement by Dolley Madison, Louisa Catherine Adams, Lucy Hayes, and in the White House by Nellie Taft, were hypertension-related. Pat Nixon’s blood pressure was elevated significantly at 175/100 when she was admitted to the hospital with a hemorrhagic cerebrovascular accident. Both Bess Truman and Lady Bird Johnson were afflicted by strokes in their old age; in neither case were their blood pressure readings released to the press.
Two classes of disease appear, at first glance, to be less frequent than expected: coronary artery disease and cancer, the former, perhaps, because the recognition of coronary artery disease and its relationship to heart attacks were not acknowledged until the early years of the twentieth century.2 Edith Wilson died from the complications of unspecified heart disease. Grace Coolidge had heart trouble during the last five years of her life; it was listed on her death certificate as kyphoscoliotic heart disuse. Her markedly twisted and curved spinal column allegedly restricted the normal pumping of her heart.
The near absence of cancer is less explicable. It cannot be due entirely to better preventative medicine and screening. This diagnosis has been surprisingly uncommon before and during the subjects’ White House years. First ladies Ford and Reagan had well-publicized breast cancers and Nancy Reagan and Laura Bush innocuous skin cancers. Jackie Kennedy and Pat Nixon died from cancer years after living in the White House. In contrast, the American Cancer Society recently reported that one in three American women will develop invasive cancer during their lifetime.3
Conversely, the medical histories of presidential wives may include rare disorders. Mamie Eisenhower suffered from Menière’s disease, which affects only two per thousand American citizens.4 Graves’ disease is even less common: Only 0.3 persons per year are diagnosed with that disease.5
Problems and Prestige. The Burdens of a Public Life
Although the status of first lady may bring prestige, praise, and political power, it also brings problems, some of them physical. Nellie Taft coveted the White House but was unable to savor it. Both Eleanor Roosevelt and Hillary Clinton delighted in a first lady’s prestige and podium. The former used these for social and international causes both during and after her husband’s presidency; the latter employed her eight years of White House residency to construct her own political career.
Profound grief assailed several first ladies. The office of the president triggered the assassinations of four of its occupants, Lincoln, Garfield, McKinley, and Kennedy. Mary Lincoln and Jacqueline Kennedy were first-person witnesses to their husbands’ murders. Nancy Reagan was permanently rattled by John Hinckley’s near-fatal attempt on President Reagan’s life.
Some first ladies experienced the loneliness of a spouse of an ambitious public figure. John Quincy Adams’ personality and political ambition took precedence over any intellectual or emotional intimacy with Louisa Catherine Adams. However, physical intimacy was not eschewed; Louisa’s twelve pregnancies were the proof, but loneliness and depression were her rewards. Mrs. Betty Ford acknowledged marital isolation from Gerald Ford both before and after the White House. Paradoxically, her abbreviated White House residence was somewhat beneficial. However, the cumulative years of loneliness resulted in depression and alcoholism. Barbara Bush, the epitome of assurance and composure while a president’s spouse, became lonely and depressed when George Bush previously was director of the CIA.6
A president’s career can sometimes place the first lady in a place or a situation disadvantageous to her health. Geography may have been instrumental in the malaria of Abigail Adams (New York City swamps), Sarah Polk and Lucretia Garfield (the District’s stagnant waterways), and possibly for Caroline Harrison’s tuberculosis (long hours in the dank basement of the executive mansion as she catalogued its furniture and furnishings). Last, why would Abigail Fillmore attend Franklin Pierce’s inauguration in Washington’s dismal March weather other than as the departing first lady? Pneumonia and death were her compensation.
As a public figure, the privacy of their medical history is subject to challenge. Only Florence Harding, Betty Ford, and to a lesser extent, Nancy Reagan, were transparent. Many, like Laura Bush, resented the intrusion.
Is the First Lady Merely a Private Individual or Should Her Health Be Transparent?
Both tradition and contemporary medical ethics believe that confidentiality is the best way to protect the well-being of a patient. The principle that the physician-patient relationship is sacrosanct, requiring that all patient medical information must remain private, is both respected and followed. Medical confidentiality has its basis in the Hippocratic oath, which states, “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken of.”7
White House physicians have adhered strictly to complete confidentiality of a first lady’s medical information. Burt Lee, President George Bush’s personal physician, directed Dr. Connie Mariano upon her selection as a White House physician: “The health of the First Lady is off limits completely to the press.”8
Tony Snow, then President George W. Bush’s press secretary, defended first lady Laura Bush’s nondisclosure of a skin cancer. He posited that she was not an elected official, and as a result, had the same right to medical privacy as an ordinary citizen.9 An analyst agreed, admitting that, although the first lady is a public figure, she has no policy role and the removal of the skin lesion had no bearing on the commonweal.10
However, modern society acknowledges several exceptions to complete medic
al privacy. These include a personal waiver by the patient; specific diseases, injuries or treatments; threats of self-harm including suicide; and danger to third parties.11
This author proposes that the practice of strict confidentiality afforded to a first lady’s health be reexamined. The first lady is usually the president’s closest confidante and intimate. History has demonstrated that her illness may affect the performance of her husband. Examples include the following: (1) the depression of Jane Pierce damaged the effectiveness of antebellum president Franklin Pierce during the country’s drift to civil war; (2) Caroline Harrison’s fatal disease severely limited Benjamin Harrison’s campaign for reelection, which he lost; (3) Ellen Wilson’s terminal disease, her death, and its aftermath led to President Wilson’s apathy and delayed decision-making during early World War I. Is it not possible that a wife’s illness may present a danger to a third party, i.e., the citizens of the United States?
Moreover, a first lady cannot candidly be considered a “private citizen,” as claimed.12 She is housed, fed, transported, and protected at public expense. Moreover, she is provided constant and continuous medical care by the many members of the White House Medical Unit. A president’s wife occasionally intrudes into policy-making. The most striking example was Hillary Clinton’s attempt in the early 1990s to rearrange America’s health care system. As a result, on June 22, 1993, the United States Court of Appeals for the District of Columbia ruled that Hillary Rodham Clinton was a fulltime government official.13
In addition, the revelation of a first lady’s illness may benefit the public. The publicity attached to Mrs. Ford’s and Mrs. Reagan’s breast cancers encouraged their peers in the public to arrange for early breast screenings.14
Unfortunately twenty-first century practices by the United States government,15 as well as widespread abuse and mishandling of Internet-obtained personal information,16 have made the confidentiality of personal information, including medical, nearly obsolete.
The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama Page 28
