Medical team recalls saving Reagan in 1981

Washington -- There aren't many physicians who can say they've helped change the course of history, but Joseph Giordano, MD, chair of the Dept. of Surgery at George Washington University Medical Center in Washington, honestly can. On March 30, 1981, Dr. Giordano led the surgical team that removed a bullet lodged one inch from the heart of President Ronald Reagan.

Soon after the presidential limousine pulled up to the emergency department a quarter of a century ago, it became apparent just how seriously Reagan had been wounded in an assassination attempt at a hotel a few miles away. Although he insisted upon walking through the ED doors, the president collapsed about 20 feet inside and was carried to trauma bay number 5.

"There was no time to get nervous," Dr. Giordano recalled 25 years later during a forum hosted by the medical center to commemorate those events. Others who cared for the president and a panel of doctors who have had experience treating high-profile patients also spoke at the meeting.

The president's survival might be as much a tribute to the evolution of trauma care as the skill of the surgeons involved, Dr. Giordano said. The fact that a single physician, Dr. Giordano, was placed in charge of the president's care rather than a team of doctors was itself a sign of the changed thinking that had transformed emergency medicine.

"Just do it the way you always do it," Dr. Giordano was told. So he did. "We never had a VIP syndrome at GW," he noted, referring to a higher standard of care or special treatment sometimes reserved for influential people.

The fact that Reagan made a good recovery also could be due in part to the patient's sense of calm and realism, said Sol Edelstein, MD, a GW professor of emergency medicine and anesthesiology.

The former actor's quips, some of which were widely quoted at the time, were real, noted Dr. Edelstein, who stayed with the president through the night after surgery. While still intubated, for example, Reagan responded to a query as to how he was doing by quoting W.C. Fields, "On the whole I'd rather be in Philadelphia," Dr. Edelstein said.

The concept of trauma care, which had been a neglected area of medicine until the early 1960s, began to evolve after the Vietnam War, Dr. Giordano said. The benefit of a rapid response and ready access to top-notch care was a lesson learned during that conflict and took hold in the civilian sector during the 1960s and 1970s, he said.

It was during the 1970s that Dr. Giordano was asked to take over the GW emergency department. He was told, "By the way, trauma's a mess. Will you please straighten it out?"

By 1978, a trauma team was in place, and, when the wounded president arrived in 1981, the team was well-trained, he said. "That's one of the reasons everything went so well."

The importance of the combined effort was evident, said Robert Shesser, MD, MPH, professor and chair of GW's Dept. of Emergency Medicine. He was a junior member of the emergency staff when Reagan was admitted.

Team members then and now extend to radiologists and administrative support, he said. For instance, without fast, efficient clerical work to fill out the paperwork needed to obtain blood, the situation could have deteriorated. Doing the job well requires constant drilling by trauma staff.

Thus, on that day, when the president arrived, they were ready to do what had to be done. They "pulled out their trauma shears and sheared off his [expensive] suit," Dr. Shesser said. "It probably took a little bit of guts, but that's ... standard procedure."

And carrying out standard medical procedures when your patient is the president, regardless of the situation, requires serious preparatory steps, said two other doctors at the forum.

Capt. Gerard Cox, MD, of the Navy Medical Corps, and Capt. Robert Darling, MD, director of the Navy Medicine Office of Homeland Security Bureau of Medicine and Surgery, both served as White House physicians. Dr. Cox served in the administrations of Presidents Bill Clinton and George W. Bush, and Dr. Darling was a physician for Clinton.

The job entails training with Secret Service agents and having lifesaving equipment available wherever the president might be, whether on a helicopter, at the White House, in Air Force One or when visiting a foreign country. Dr. Darling, for instance, went to more than 40 countries to scout out medical care for Clinton.

And no longer is the physician relegated to the last car of the presidential motorcade as was the case when Reagan was shot. Now they are always close enough to quickly provide help, but they also are cautioned to remain "out of the kill zone," Dr. Cox said.

Navy Rear Adm. John Eisold, MD, the attending physician to Congress, also spoke and stressed that there is no such thing as VIP medicine, only "good medicine and bad medicine." He serves as physician to 550 patients who are members of Congress or other officials who work on Capitol Hill. He functions almost as a primary care physician. Getting his patients to take preventive health care seriously is one of his top jobs, he said. And confidentiality is paramount. "If no permission to speak to others is given, I talk to nobody."

He says patients are often impatient. "These are potentially intimidating people because they are very powerful, but the physician has to be in charge," Dr. Eisold said. "You can't corrupt your medicine; you can't cave in to their demands."