At about midnight James Brady slowly to come out of anesthesia. Small tremors rippled over his body--a good sign. Often in cases of serious brain damage the patients do not have these postanesthesia tremors because the neurologic damage is so great. Brady started to move one of his toes. And then a nurse insisted that he had squeezed her hand.
Kobrine had realized during surgery that Brady's left side was not going to be as good as his right. The right hemisphere of his brain had taken most of the damage, and it controls the left side of the body. The major vessel damage was to vessels that led to areas of the brain involved in motor function. It became clear watching him in the recovery room that the motor functions of Brady's left side were substantially damaged.
But Kobrine found another hopeful sign. The swelling around Brady's eyes had now abated enough for Kobrine to put a light to them, and he found that they were not fixed and dilated.
Postoperative CT scans showed marked improvement over those taken just before Brady was wheeled into surgery.
Maybe he's going to do better than we all anticipated, Kobrine thought.
At 1:30 in the morning the president thought it was 6:30 in the evening, but other than that, he was experiencing little disorientation. Doctors explained to him what had gone on in the OR. He was now given morphine for pain, but his blood gases came closer to normal.
Slowly the attending physicians began to wean him from the respirator, and, as they did, he began to "buck"--to get out of sync with it. He started coughing and became agitated.
At 2:30 in the morning, the President had another scare. As doctors began removing the endotracheal tube, they kept say-ing, "This is it," meaning that the time had come to take him off the respirator.
Marisa Mize saw the fright in his eyes. "What do they mean, 'This is it?' " the President scribbled.
She explained, and he calmed down.
By 2:45 AM the President was off the respirator for the first time in nearly 12 hours. He had an oxygen mask on but was able to speak. His voice was hoarse.
He expressed concern for the others who were wounded and asked about the motives of the assailant.
No one in the recovery room dared to say anything about the other victims.
The President continued to talk with his doctors, nurses, and aides. They soon realized he had a partial hearing loss in his right ear that predated the shooting. By 4:30 the recovery room had pretty well thinned out, and several lights were turned off so the President could sleep. Joanne Bell, a recovery-room nurse, put a gauze pad over his eyes to block the light and moved away to let him sleep. Within seconds he had the pad off and was talking again. She walked back to the President's bed, took the pad in her hand, and said: "Mr. President, in the most polite way I can tell you, when I put this over your eyes, that means I want you to shut up."
He looked up at her, winked, and took a 45-minute nap.
Ben Aaron went to sleep on a stretcher. Gens and Colombani found beds in the kidney-dialysis unit, but it was so hot that Gens woke up at 3 AM and returned to the recovery room, where, with Zimmerman, Spagnolo, Edelstein, and Price, he stayed until early morning.
At 6:15 Tuesday morning the President was wheeled from the recovery room to the intensive-care unit (ICU) on the fourth floor. His room's curtains had been drawn. The room was crowded with people and medical equipment.
The ICU nurses now began giving him respiratory therapy, which consisted of having him cough and breathe deeply and of pounding him on the back.
Nurse Carolyn Ramos helped the President brush his teeth, and then she brushed his hair. "Now you can tell everyone I don't dye my hair," he said. Indeed he doesn't, a fact that his nurses and doctors can confirm and one that, to their surprise, several members of the President's staff took pains to point out.
What also surprised those who took care of the President was his ability to put them at ease--to kid with them, talk with them, to give them the impression that he was a totally accessible and secure man. Republicans and Democrats alike came to admire him.
In the ICU, where the President was to remain that day, Carolyn Ramos felt enough at ease to joke with him. Sometimes, she told him, patients who have undergone surgery are asked questions to determine how oriented they are. Typically, she said, they are asked the year, their whereabouts, and the name of the incumbent president. "In your case," she said, "we'll skip the last question.''
The President laughed.
Then she told him that a recent patient, when asked who the President was, said: "That actor fellow . . . Jimmy Stewart."
He laughed again.
The President's aides visited early that morning, a practice they would continue throughout his stay at GW. The President said to them that he'd known that missing a staff meeting would be too much to hope for.
The same morning the President signed into law a bill eliminating a scheduled increase in dairy price supports. He'd been given a total of 30 milligrams of morphine for pain over the last several hours, and some of the nurses wondered how a man who'd taken that much morphine could understand what he was signing. They kidded among themselves that they should put the student-loan bill in front of him to sign.
The President showed a persistent curiosity about who had shot him. And although he seemed satisfied when told that the others were not hurt badly, he continued to ask about them.
Later that morning Dr. Ruge finally told the President about the seriousness of the injuries to James Brady and the others. He appeared shaken by the news and said he felt guilty because he realized he had been the target. He didn't need a supporting cast, he said. That morning Ruge talked to members of the Cabinet and spoke very optimistically of the President's condition.
The President's room in intensive care became hot because of the large number of people now gathered there. It was unseasonably warm and the hospital's air conditioning was not yet turned on. Nancy and Ron Reagan visited in the morning; daughter Maureen came in the afternoon. Mrs. Reagan wanted him moved as soon as possible. But because the suite on Three South that he was to occupy had yet to be prepared and made secure, the President had to wait all day in this little room in intensive care.
That afternoon x-rays of his lung showed that his left lower lobe, which had collapsed after surgery, had fully expanded. But he was in pain and was given codeine.
The next day, Wednesday, it was decided to cut back the number of medical people with access to the President, in part because the President and Mrs. Reagan were being made uncomfortable by people in such number in such a space.
Ben Aaron, pulmonary specialist Sam Spagnolo, and Gens and Colombani, the chief surgical residents, were to be the only physicians with direct access. It would be Gens and Colombani, both in their thirties, who would write the President's chart, give him his IVs, draw his blood, change the dressings on his wound, and otherwise look after him on a day-to-day basis. Aaron was in overall charge. Ruge kept Reagan informed. They would all meet early each morning to examine the President and then, after the chest x-ray was taken, would confer with Rockoff, head of chest radiology. Later that first week, the list of GW doctors with direct access would be narrowed further, with Spagnolo acting as a consultant.
By 9 PM Tuesday, the President's second night at GW, the Three South hallway was secured and turned into a miniature presidential compound, with a sitting room for Mrs. Reagan, a room for Ruge, two rooms for Secret Service agents, and a conference room. The President's room had two easy chairs and a sofa, and a Secret Service agent was there at all times. The windows were bulletproof.
Although chest-surgery patients are normally kept on the sixth floor, the Secret Service did not want the President on the top floor, for security reasons. In every move the President made at the hospital, the Secret Service took all security precautions, checking halls, doors, anything that could present a problem. The agents moved quietly through the hospital, their identity made clear by the small button in the lapel and the jacket bulge. The hospital staff realized that some carried Uzi submachine guns in their briefcases. A SWAT team remained on the hospital roof. All hospital entrances except the one on 23rd Street were sealed.
The Secret Service agents, the doctors and nurses said, were unfailingly courteous and professional. They came to be admired by the GW staff.
With the President's arrival imminent, Sylvia LeBlanc, a young nurse on duty at Three South, felt her hands growing cold. She knew that she'd have to pound the President's back as part of his respiratory therapy. She decided to wash with warm water just before the therapy because she wouldn't want to hit a president with cold hands.
That first night in Three South was uneventful, but in the early-morning hours of Wednesday Colombani realized that the President had not urinated since the Foley catheter was removed Tuesday afternoon. Colombani had no choice: He woke up the President and told him he'd have to get out of bed and walk around. Colombani hoped the movement would stimulate urinary output. It didn't. Now Colombani was faced with the unpleasant task of telling the President of the United States that the Foley catheter would have to be reinserted.
The President had dealt cheerfully with most of his medical problems, but he did not cheerfully accept the news Colombani now had to give him. Gens and Colombani took alternate nights on the presidential watch, and it became a running joke between them that the bad things always happened on Colombani's shift.
In general, the President's recovery continued to go well. However, while reexamining the President's abdominal x-rays, Rockoff saw an abnormality that disturbed him. It was not in the chest but in the back. What he detected was a small, gray shadow on a vertebra in the President's lower spine--a lesion of some kind, about the size of a pencil eraser. He was unsure of what it was, and there was some fear it might be malignant. This information was shared with very few doctors. They did not tell the President. They wanted to study it further.
The President continued to cough up blood, but it was dark blood, a natural consequence of his injury. Dave Gens told the President, who was concerned about it: "It's good--you're coughing up old blood."
"Don't you know what they said about me during the campaign?" the President answered. "l'm full of old blood."
The one-liners kept coming. And the President did a good Jimmy Stewart impersonation.