Mrs. Reagan expressed concern because the President was still occasionally disoriented about time. Gens explained to her that many patients sealed away inside a room with the curtains drawn and without clocks lose track of time.
Assistant Secretary of State William Clark, longtime friend of the President's, was there complaining that he'd just had a terrible day on Capitol Hill. He said he felt useless and wanted to do something to feel useful, so he'd buy the President a clock.
He did. A big Mickey Mouse clock hung in the President's room for the remainder of his stay.
That first Wednesday, the President's blood-oxygen level dropped dramatically. He was put back on oxygen, now given to him through nose prongs instead of a mask. IVs still came into his arm. A picture of the President and Mrs. Reagan, taken that first week, showed the President smiling as he stood in his robe. Cropped out of the picture was a nurse, standing to his immediate left, holding the Pleur-evac connected to the chest tube, which came out from under his robe. Mrs. Reagan was very particular about that photo: She did not want her husband to be pictured as an invalid.
Forty-eight hours after surgery, the President was taken off precautionary antibiotics. Standard procedure. He had an emotional visit from Sarah Brady. He expressed sorrow, and she told him that her husband was doing better, that she was hopeful. Every night when Dr. Ruge came by, the President would ask how Jim Brady was doing.
When Dave Gens arrived back in the on-call room across the street from the hospital late that Wednesday night, his first night on the President's watch, he sat on the bed for a few moments and realized that with all the security arrangements, it would take him three or four minutes to get back to the President's bedside if there were an emergency. Too much time would be lost.
He promptly got up, walked back to the hospital, and went to sleep on the sofa in Mrs. Reagan's sitting room, adjacent to the President's room. He did this every night he was on duty. He made certain, however, that he was always up very early. He didn't want to be caught sleeping in the First Lady's room.
Thursday morning, April 2, the abdominal stitches from the President's peritoneal lavage were removed, and it was learned that a "devastator" bullet had been used by the assailant. Hurried calls were made to determine whether lead azide, a component of that type of bullet, was dangerous. An authority in Colorado assured the GW doctors that it was not.
The President had been awakened twice each previous night, for respiratory therapy, and it was now decided to let him sleep through. His spirits were high. He still kidded with the nurses and doctors, watched TV, and read everything he could about his shooting. He seemed to prefer entertainment on TV, one night passing up a documentary on El Salvador to see The Birds, an Alfred Hitchcock movie. He continued to confer with his aides--Meese and Baker, among others--daily.
On Thursday night the President's recovery came to a halt; a fever was detected. His temperature ranged between 102 and 103 and was soon accompanied by other problems. Tylenol helped somewhat, but the moment its effects wore off, the fever would peak again. His color worsened, and he became more tired. His white count went up. Colombani, on duty that night, called Ben Aaron at home. Aaron said to continue with the Tylenol. The President's one remaining chest tube was examined as a possible infection source. It was "clean." The few people who knew about the fever were disturbed by it. It was a setback.
The President's fever continued, and on Friday night he began to experience chills. He asked about the source of the new problem, but no one knew what was causing it. The daily x-rays continued to indicate that there was some fluid in the lungs, which could mean pneumonia. Concern about his condition grew. Aaron decided to do a bronchoscopy to try to clear up the bronchial tubes. To prepare a patient for a bronchoscopy, a spray solution of Xylocaine is used to deaden sensation in the throat, and often Valium is administered to relax the patient. Edward Yob, a White House physician, approached Dave Gens and asked whether Valium was going to be used. Gens said it probably was.
Yob asked if they could hold off giving the President major sedatives. Gens asked why. Yob said he didn't know but something very important was going on in the world, and unless it was absolutely necessary to sedate him, the President was to be kept fully alert. Gens never learned the nature of the crisis.
Valium was not necessary. Aaron suctioned out some old, clotted blood with the bronchoscope and, through the eyepiece, viewed the bronchi. He found no pus or other sign of infection.
There was no change in the President's fever that night. His appearance and spirits continued to sag. One doctor remarked to another, "The President looks terrible." President Reagan's fever was being described to the public as "moderate." There was no public hint that his doctors thought it possible that he had a lung infection.
On Saturday, five days after the shooting, another complication developed. The President had been coughing up blood all week, but the color was dark--it was obviously old, clotted blood and thus not alarming. However, the color of the blood he coughed up Saturday morning was bright red--fresh blood. Taken in combination with the fever and chills, it was "an ominous sequence of events," Aaron said later. The President had been put back on his original antibiotics, but to no avail. The fever persisted. So did the red blood coming up.
Aaron told Dennis O'Leary and Ruge Saturday that he thought the President was very vulnerable, that the new blood coming up could be a prelude to a major lung bleed. At one point, Aaron considered the possibility of going back in and surgically removing the left lobe, the source of the President's problem.
"It was a terribly depressing time," one doctor recalls of that period. "The President was a lot sicker than most people realize."
Aaron was more worried about the new bleeding than the fever. But at about the time his worry was deepening, the bleeding stopped. He suspected that a small clot had let go, causing the bleed; at any rate, he was relieved of the risky task of operating a second time.
Yet the fever persisted. What was causing it? No one knew; opinions of internists and surgeons divided sharply. The head surgeon, Aaron, held that the fever was a result of an inflammatory process, a natural consequence of the injury. Gens and Colombani agreed.
Internists such as Spagnolo and Rockoff had a darker worry--that the President had developed an abscess within the lung. If this proved to be the case, surgery might be required to remove it.
These two factions continued to disagree--not angrily but firmly. The surgeons argued that they were seeing the President daily and that he did not appear to be seriously ill. Rockoff at one point countered by saying, "I'm here to keep you from getting too optimistic."
That same Saturday there was good news. A new series of small x-ray pictures called tomographs gave a detailed picture of the suspicious shadow on the President's vertebra. Rockoff now determined that the suspicious lesion was not invading the bone, as cancer would. The diagnosis was that it was sclerotic in origin--benign.
Rockoff, who had downplayed the possible significance of the shadow on the vertebra in discussions with the President, now told him that everything was fine. The President looked wearily at Rockoff and said of this latest series of x-rays: "Could we make picture postcards out of them so I can send them to my friends?"
The fever continued. A pivotal meeting was held early Sunday morning in Rockoff's radiology office. Besides Rockoff, physicians on hand were Gens, Colombani, Ruge, O'Leary, Aaron, and Carmelita Tuazon, director of infectious diseases at GW. When they reviewed the week's x-rays of the President's lung, they noted that those taken on the large, stationary machine were of a much higher quality than previous x-rays and revealed the lung densities clearly. Whether these densities had been there earlier or were new was not the major question. The major question was what could be done to get rid of the fever.
Tuazon, who had not been called in to consult until Sunday--a day or two too late, some doctors complained--had studied the sputum slides and the blood and urine cultures and suspected that the President had a bacterial infection.
After discussing a number of treatment possibilities, the consulting physicians decided to take the President off his present antibiotic and put him on two new ones, penicillin and aminoglycoside, to deal with the suspected bacterial infection.
They waited Sunday and Monday for the fever to break; it didn't. On Tuesday, eight days after the shooting, there was a little optimism because the President's peak temperature was lower than it had been for several previous days. It dropped further on Wednesday. Gens and Colombani now plotted a temperature curve and boldly predicted that his fever would be gone by Friday. They were off by a day; it ended Thursday. The President looked better, felt better, was better. The crisis had passed.
On Thursday of the President's second week at GW, he was doing so well that some thought was given to taking him off penicillin. But Tuazon, wanting to take no chances with a possible infection, dug in her heels and insisted that he remain on penicillin for another ten days. He did.
The President's strength continued to return. Ben Aaron noticed the change: "He slowly emerged from being the perfect patient to a restless man, anxious to get back to work."
In high spirits, the President made a practice of walking "laps" in the hallway and telling Maria Blaz, one of his nurses, how many he had done each time he approached the nurses' station. Once, after he had done three, he turned to her and called: "That's eight." She glanced up to catch him smiling.
Blood, urine, and sputum cultures continued to be negative. The patient was almost healthy enough to be discharged.
James Brady's condition was improving. He was responding to questions, remembering details about his life, and showing a sense of humor. Mobility on his right side had improved. His left side showed little motor movement. On Saturday morning, April 11, all the physicians involved in the President's treatment met for a last time, in Rockoff's radiology office. The President's x-rays were very encouraging; his lungs sounded and looked better. He would remain on intravenous penicillin one more day and then be switched to oral. There seemed no further need to keep him at the hospital. They decided to discharge him that morning.
Gens and Colombani, the doctors who had the most contact with the President while he was at GW, went to his room to say goodbye. The President shook their hands and thanked them. Gens, who had spoken often with Mrs. Reagan during the President's 12-day stay, joined Colonibani in seeking her out. They found her in the corridor talking with Sarah Brady. She thanked them, hugged them, and kissed them on the cheek.
Doctors and nurses were asked to line up in the hallways so that they could wave to the President as he left. As he was heading out, at about 10:30 that morning, he kept stopping and reaching out to touch or shake hands with the people who had cared for him. Many were touched by his warmth.
At the 23rd Street entrance, the President, wearing a cardigan sweater over his bulletproof vest, said his goodbye:
"From the time we came here, in confusion, until now, you have made us all welcome. God bless you all."
Several days after the president's release, Doctors Aaron, Gens, and Colombani went to the White House to make a house call. They were ushered upstairs to the President's working office on the second floor.
Ronald Reagan greeted them by holding out his arms in the fashion of a man accustomed to having needles inserted, smiled, and said, "Here, is this what you guys want?"
They laughed, examined him, and found him well.
This article first appeared in the August 2004 issue of The Washingtonian.