Trump’s Illness and the History of Presidential Health

On Monday evening, President Trump left Walter Reed National Military Medical Center, where he was being treated for the coronavirus, and returned to the White House, after tweeting that he was “feeling really good.” But, since Trump was hospitalized, on Friday, Americans have heard a steady stream of contradictory and confusing information. This weekend, the White House doctor, Sean Conley, was evasive about Trump’s condition but eventually admitted that the President had run a high fever and that his oxygen levels had dropped below the normal range. Trump received supplementary oxygen and was treated with REGN-COV2, an experimental antibody drug, and the steroid dexamethasone—all of which indicate that his disease is serious and potentially worsening. Trump will continue treatment at the White House, but Conley did not give a clear answer as to whether he will remain in his residence. When Trump returned to the White House, where numerous staffers, including two members of the housekeeping department, have been infected, he immediately removed his mask.

Earlier on Monday, I spoke by phone with Lawrence Altman, a physician who has been writing for the Times for more than fifty years, with a focus on the health of political leaders. His interview with Ronald Reagan in 1980 marked the first time a candidate had extensively discussed his health with a reporter. Altman is currently a global fellow at the Woodrow Wilson International Center for Scholars. During our conversation, which has been edited for length and clarity, we discussed the media’s coverage of Reagan’s dementia, the pressures faced by White House doctors, and how transparent a President is obligated to be about his own health records.

How did you get interested in political leaders and their health?

I think from reporting on it for the Times. In 1972, [Senator George McGovern’s Vice-Presidential running mate, Senator Thomas] Eagleton had to disclose that he had been hospitalized three times for depression, and had had electroshock therapy on two of those occasions. And Bob Boyd and Clark Hoyt, with the Knight chain, found out and were ready to report on it. The McGovern-Eagleton team just called a press conference, and denied them their scoop, but they disclosed Eagleton’s problems. And I got called in immediately to work on it.

I went out to St. Louis and reported that the Washington University main teaching hospital, Barnes Hospital, had moved Eagleton’s medical records. And I wrote a story about that for the Times, and raised the spectre that anybody [who was working at the hospital] could have examined his records—and it later was known that the Nixon White House had Eagleton’s records.

Could you talk a little bit about what the media environment was like for Presidents or politicians, but Presidents especially, with regard to their health, before 1972, and certainly before 1980?

I talked to [the political columnist] Russell Baker at one point, and other reporters who were there at the time. They were working before 1972, and were covering Eisenhower. And I think it was like how reporters didn’t cover Kennedy’s escapades. There was a feeling that Presidents and political leaders were entitled to their privacy, and reporters didn’t dig into them unless there was some major reason. And, therefore, they took at face value whatever was said and didn’t do what today we would call investigative journalism. I would call it doing their homework, just digging in and looking for the facts.

Why did Reagan agree to do an interview, and how did that come about?

That came about because, in 1980, during the campaign, Reagan was going to be the oldest person to become President, if elected. People questioned why he was saying one thing at one time of the day and another at another time of the day. And some people raised the question, more from political scuttlebutt rather than on the basis of any fact, that he might have senility. In those days, Alzheimer’s was not a household word. Senility was the predominant word. And Reagan had, during the campaign, said his doctors would attest to his health.

So I and the Times challenged him on it. And he agreed. And I had requested that I not only interview Reagan but do so after interviewing his doctors. I wanted to talk to them directly. And he agreed to that after some time. His staff, from what I gather, opposed it for a long time. But he finally agreed, and I went out to California and interviewed all the doctors he said he had seen, interviewed them as I would any doctor regarding a patient I had.

From that information, I learned that his mother had senility in the few years before her death. And then, with that information, I asked him about his mother. He told me that, and senility was his word. I told him about Alzheimer’s, and he didn’t know about Alzheimer’s. And, at one point in the interview, I asked him, “Well, if you had any question with your mental status, or became senile like your mother, or in any way”—and I probably used the word dementia—and I said, “What would you do?” He immediately said, “Step down. Resign.” I asked him how he would know, and he said his doctors would be following him, and he would listen to whatever his doctors told him. And that became a story that I wrote in 1980. It was the first interview that I know of, certainly in recent times, asking a political candidate or a Presidential candidate prospectively about his health. And he was quite open in the sense I’ve just described.

Did some people think that this was poor form, or impolite to ask such things? Was there any sort of backlash?

In a strange way, there was from his White House doctor, who was not his White House doctor at that time. He was his urologist in Santa Monica. He didn’t say anything to me at the time, but he wrote a book in which he took me to task because he said I went out there purposely to show that Reagan had dementia or Alzheimer’s. And he wrote that even though it turned out that Reagan had declared after he left office that he had Alzheimer’s. But he never mentioned that fact. And it was also that doctor, the urologist—his name was Burton Smith—who said he would never ask questions like “Who’s President of the United States?,” because he thought that was demeaning, but it was never clear what mental-status test Smith used on Reagan. Other doctors said they went through the usual routine.

How forthcoming were Reagan’s doctors after he was shot, in 1981, and what role did the media play in trying to get information?

I happened to be driving between Seattle and Vancouver for a story on the Shah of Iran and his medical care. I got to Vancouver, and then I had to come back to Seattle and fly back to Washington, D.C. And I picked up on the coverage the next morning. I went over to the hospital. I interviewed one of the doctors who had seen him in the emergency room, and wrote that. Certainly, no one stopped me from doing that, journalistically or medically. The hospital probably would have if they had found out that I had found the doctor to talk to.

But I think that in the hours to days that occurred thereafter, all the questions arose, and they had arisen in my mind. Why hadn’t they imposed the Twenty-fifth Amendment, or at least considered it? And it hadn’t been considered. And Dr. Dennis O’Leary, who was in a dual capacity of being a spokesman for George Washington University Hospital as well as for the White House, was painting a very rosy picture about Reagan, when he hadn’t seen Reagan and was only taking the word of doctors who had been treating him. But he didn’t say anything about the location of the bullet being near Reagan’s heart. It was in his lung, but it stopped short of his heart. That came out later. They were downplaying the state of his health, and apparently Nancy Reagan had done a lot to dampen what the White House spokespeople were saying. And they went through the usual public-relations episodes of pictures and visitors and so forth.

But, in those initial hours, he was seriously ill, much more than they told people. And that became more important when it was realized later. I spoke to Dan Ruge, who was the White House physician, and he said he had made a mistake. He carried the Constitution with him, and he knew the Twenty-fifth Amendment. And he knew that it should have been brought up, but it wasn’t. He took that upon himself as something that he should have done. And then Reagan recuperated.

In answer to your earlier question, I’m not sure that there was any further impediment. They held news conferences, but I don’t think there were any barriers that I can think of forty years later that stood in the way of trying to get the story. I do remember that it made no sense to me as to how many units of blood were transfused at a surgery and pre- and post-operation. And it didn’t fit with the picture.

And then I did my own homework overnight and found out that Reagan had received many more units of blood than O’Leary had said he got pre- and post-operatively. And he attributed that to not knowing that anesthesiologists could order blood during surgery, which to me was a heck of an admission of the dean in a medical school and a hematologist. But be that as it may. And I reported that.

How do you think, in hindsight, the press dealt with Reagan clearly aging toward the second half of his Presidency?

You have to go back in time and try to picture what things were like in 1984, when he was running for reëlection, and during the 1984-88 period, when he was there. One, his doctors said they saw no evidence of his mental deterioration. Two, I don’t think the medical profession at large, and the public, were as perceptive as they are now about the early stages of dementia, whether it’s Alzheimer’s or any other form of dementia, and they may not have been attuned to picking up some of the early signs.

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