The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (40 page)

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.
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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.
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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.
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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.”
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Snow added to the questioners: “She’s got the same right to medical privacy that you do.”
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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.
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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.”
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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.
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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.
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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.
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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.”
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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.
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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.”
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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.

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.

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 Louisiana. 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 vesico-vaginal 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.
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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.
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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.
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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.
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Graves’ disease is even less common: Only 0.3 persons per year are diagnosed with that disease.
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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.