Rawhide Down (21 page)

The anchor paused and looked at the paper again. “He was wounded!” Reynolds said, slapping his right hand to his forehead. “My God. The president was hit?” The question was directed to a producer off camera. “He’s in stable condition. All of this information … The president was hit. He was hit in the left chest, according to this. But he is in stable condition.”

After another pause, Reynolds continued. “The information we have been telling you is incorrect. We must redraw this entire tragedy in different terms. The president was hit today. He was hit in the left chest. But we are told he is all right. He is at George Washington University Hospital.”

*   *   *

A
CROSS THE STREET
from the hospital, Dr. Benjamin Aaron, head of GW’s cardiovascular and thoracic unit, was at his desk, filling out paperwork. His office, on the tenth floor of the building where the medical center’s physicians worked when not operating or on rounds, was entirely free of decoration. On the wall behind him, the shelves were filled with slide carousels and various medical books, including
Grant’s Atlas of Anatomy,
a classic text that he had picked up in a remainder pile back in medical school. The only personal touches, if they could be called that, were on the desk: a black coffee mug decorated with a bright red heart and a paperweight in the shape of a duck.

Aaron had returned to his office at about two p.m. Except for a short nap, this was his first moment of peace since early that morning. Just after midnight, he had received an urgent call at home and returned to the hospital for emergency surgery on a male patient who was bleeding badly two weeks after receiving a new heart valve. Aaron opened the man’s chest, drained the blood, and stopped the hemorrhaging; afterward, he caught some sleep on a hospital cot. Next he performed a five-hour coronary bypass operation, followed by two hours of rounds, during which he checked on his patients.

Despite a grueling schedule of surgeries and clinical work, Aaron didn’t look or feel the worse for wear. While serving as a surgeon in the U.S. Navy for twenty-two years, he had become superbly disciplined. He had honed his body into the human equivalent of a surgical machine: he jogged at least four miles nearly every day and, by willing himself not to be tired, he could work for forty-eight straight hours without sleep. He had conquered hunger in much the same way. A few years earlier, Aaron had realized that although he was always famished at lunchtime, he never had time to eat. His solution was to simply force himself to forget about lunch, and he was never again hungry for a midday meal.

Now, as Aaron worked on his reports, he turned on a small radio on his desk and heard an announcer say that there had been a shooting at the Washington Hilton involving the president, but that Reagan had not been hurt. Aaron wondered whether some of the victims might be coming his way; sure enough, he soon heard sirens and a few minutes after that his pager started beeping. When he called the operator, she told him he was needed immediately in the emergency room.

Aaron threw on a lab coat, took the elevator to the ground floor, and strode across the street to the hospital. Entering the emergency room, he found pandemonium. Walking down a narrow hallway toward the trauma bay, he turned to his left and spotted a man being treated in Room 3. Even from a distance of ten feet, Aaron could see a neat bullet hole in the victim’s right chest. Ahead of him and to his right, in Trauma Bay 5B, he saw a second victim lying quietly on a gurney, his head wrapped in bandages. His years in the military had trained Aaron to quickly triage patients; he gave this one little chance of survival.

A surgeon grabbed Aaron’s arm and steered him toward Bay 5A. Secret Service agents stepped aside as he slipped through the bay’s curtains. Glancing at this third victim, Aaron recognized him right away.

Aaron could see that the president was in a good deal of pain. Joe Giordano told him that Reagan’s blood pressure was improving and that they had inserted a chest tube a few minutes ago.

“He’s responding very nicely,” Giordano said—but, he pointed out, Reagan was still bleeding profusely. Checking the Pleur-evac, Aaron saw that it held 1.2 liters of blood.

As Aaron surveyed the situation, he thought of the doctors who had treated President Kennedy in Dallas. He also thought about the physicians of the three earlier presidents who had been shot and who had died, either from a devastating wound or from appallingly poor care. A born-again Christian, Aaron believed that everything happened for a reason, and now, as he studied the president, he uttered a silent prayer. He didn’t ask for a miracle or ask God to spare Reagan. Instead, he simply asked for a chance to save the president’s life.
God,
he prayed,
please don’t let the president be irretrievable.

*   *   *

A
S THE TRAUMA
bay buzzed around him, Aaron watched the blood pouring from Reagan’s chest. He touched the tube leading to the Pleur-evac; it was warm. He looked up and exchanged a knowing glance with David Gens: the blood was obviously coming from deep within Reagan’s chest. And the blood was not only warm but also dark. That meant it was probably streaming from a pulmonary artery. These arteries, which directly connect the heart with the lungs, are large and if breached tend to bleed until surgically repaired.

Since the president was stable and responding well to fluids and transfusions, Aaron decided to allow a few more minutes to pass in the hope that the bleeding would stop on its own. He asked whether anyone had ordered an X-ray; Giordano said that one had already been taken and that it should be coming back from the radiology suite momentarily.

Standing next to Aaron, Gens looked closely at Reagan’s lips through the clear oxygen mask and for the first time saw the blood on them. Gens also noticed spots of blood on his teeth. Leaning close to the president’s ear, Gens asked him what had happened.

“I coughed up blood in the car ride over,” Reagan said through his mask. “I am still having trouble breathing, but it is better since you inserted the tube.”

“You are going to be all right, Mr. President,” Gens said.

As a precaution in case Reagan’s condition began deteriorating rapidly, the trauma team attempted to insert a large-bore IV line into his right jugular vein. This would allow them to quickly pump more fluids into the president.

Again Gens leaned close to Reagan and spoke to him. “We’re going to put a line into your jugular vein in the neck, and in order to do that, I’m going to lay you flat.”

Earlier, the president’s gurney had been elevated to a 45-degree angle, which alleviated some of the pressure in his chest. The plan to lower the bed again seemed to make Reagan anxious. “But I’m short of breath,” he said. “If I’m lying down, it’ll be more difficult to breathe.”

“It’s only for two minutes at the most,” Gens said.

Once the gurney had been lowered and the president was horizontal, a surgeon tried to slip a needle into the neck vein. When he couldn’t find the vein on the first attempt, he tried a second time and failed again. Reagan began complaining of increasing chest pain. After two minutes, the surgeon abandoned the attempt, and nurses returned the president to the 45-degree position.

By now, the X-ray image of Reagan’s chest had been developed and brought to the trauma bay. Back in the radiology suite, Dr. David Rockoff had closely studied the film. The left lung seemed to have re-expanded, which was good news. But when Rockoff examined the image of a bean-shaped piece of metal that was presumably the bullet, he couldn’t determine its precise location. The bullet might be lodged in the lung, near the heart, or even in the heart itself. There was also the terrifying possibility that the bullet had nicked and weakened the aorta. If that had happened, the artery could rupture at any moment.

Now, holding the image aloft for Aaron in the trauma bay, Rockoff commented that the chest tube was in a good position. But the metal fragment seemed small and deformed, which suggested that the bullet might have fragmented either before entering the president or upon impact. If it had somehow broken apart inside the president, there could be other pieces of shrapnel somewhere in his body.

Rockoff also told Aaron that he didn’t know the caliber of the round. Turning to a Secret Service agent, Rockoff asked: “What caliber bullet was it?”

The agent, who hadn’t heard any specifics about the weapon or the bullet, asked another agent to find out. Using a phone near the trauma bay, that agent called the FBI, which had confiscated Hinckley’s gun.

After the agent hung up a few moments later, he reported—erroneously—that it was a .38-caliber bullet. Rockoff was shocked: a .38 is a sizable shell, and the object on the X-ray was too small to be a .38. This suggested that it was indeed just a fragment. Rockoff and Aaron believed that if there was more shrapnel inside the president, it was most likely in his abdomen, where any number of organs and blood vessels could be hemorrhaging. Concerned, the trauma team ordered another X-ray, this one of the president’s belly.

*   *   *

E
VER SINCE ARRIVING
at the hospital, Nancy Reagan had been politely pestering doctors and nurses about when she would be permitted to see her husband. The hospital’s acting chief of surgery, Dr. Neofytos Tsangaris, was deputized to act as the liaison between the first lady and the trauma team; when Tsangaris asked whether Mrs. Reagan could come to the trauma bay, he was told that the president’s doctors needed more time. For one thing, they hadn’t completed their evaluation of their patient. But they also wanted to clean up some of the blood and fluids on the floor and cart away some of the cut-up clothes. They didn’t want the messy and chaotic scene to upset the first lady.

Once the doctors decided to allow Mrs. Reagan to see her husband, Tsangaris retrieved the first lady and led her to the far corner of the ER and the trauma bay. Accompanying her were Paul Laxalt and George Opfer.

When Mrs. Reagan entered the bay through its parted curtains, she was badly shaken by the sight of her wounded husband lying on the gurney. IV lines stretched from his arms and a clear oxygen mask covered his face. His skin was shockingly pale, and the first lady immediately spotted the caked blood on his lips. She also noticed that his new blue suit—the one she had had made for him—was a shredded mess, crumpled in the corner of the bay. Laxalt, beside her, saw a frightened look in Reagan’s eyes; Opfer thought the president looked terribly gray.

But when Reagan saw his wife as she reached out to comfort him, his spirits seemed to lift. Even though he was still struggling to breathe, he pulled up the oxygen mask and reprised a famous remark made by boxer Jack Dempsey after he lost the heavyweight championship in 1926.

“Honey,” the president said, “I forgot to duck.”

Reagan then turned to Laxalt. “Don’t worry about me, I’ll make it.”

Mrs. Reagan gently put the oxygen mask back on. “Please, don’t try to talk,” she said.

The first lady kissed the president’s cheek and left the bay. It was time for the trauma team to get back to work.

*   *   *

T
HE CHEST TUBE
wasn’t stopping the bleeding; the Pleur-evac now held 1.8 liters of the president’s blood. Looking down at his patient, Ben Aaron knew it was time to make a decision. Should he operate or not?

As he considered his options, Aaron was particularly concerned about two issues, neither of them medical. First, the surgeon wanted to get Reagan out of the trauma bay. It was too crowded and too noisy, and he had too little control. Aaron had dominion in only one place: the operating room. Reagan would be safer there because Aaron would be in full command, and the throng of spectators and hangers-on would be much smaller. Second, even if the bleeding stopped and the bullet seemed secure, Aaron felt queasy about the political ramifications of leaving a fragment of metal lodged in the president’s chest. The knowledge that a bullet remained just an inch from the commander in chief’s heart and near so many other important organs would almost certainly cause intense anxiety in the country and the world.

Aaron made up his mind: he would operate. He informed Joe Giordano and the other doctors on the team, and then bent down to the president.

“Mr. President, there is a lot of blood coming from your chest tube,” Aaron said. “We know the bullet is in your chest. But we don’t know what has been injured. Because the blood continues to come, we think it would be safest to take you to the operating room. We don’t think you are in any immediate danger. But we think that is the safest course, going to the operating room.”

The president nodded. “Whatever you think is best,” he said from behind his oxygen mask. “I leave it up to you.”

By now, the surgeons knew that the second X-ray revealed no shrapnel in the president’s abdomen. Even so, Giordano and Gens worried that the bullet might have penetrated Reagan’s diaphragm, a muscle less than a half inch thick that separates the abdomen from the chest cavity. If it had pierced the diaphragm, it could have penetrated an organ such as the stomach or spleen before passing back through the diaphragm and lodging in the chest. The doctors also feared that a seventy-year-old being thrown violently into a limousine might have sustained a rupture of his liver, appendix, or kidneys. The only way to find out whether there was bleeding in the abdomen was to administer a peritoneal lavage, or “belly tap.” In this procedure, a surgeon would cut a small slit near the belly button, open up the abdominal cavity, insert a small plastic catheter, pour in a liter of saline, and let it swirl around before draining it. If there was even a drop of blood in the abdomen, the saline would turn pink.