Anxiety over an Ailing President

By GEORGE J. CHURCH, Evan Thomas

As the patient was coming out of sedation Friday afternoon, he got an unpleasant surprise. What had started out as routine minor surgery had turned into a serious problem. One small polyp had been removed from his colon, but in the process doctors discovered another, larger one. They knew that such growths very often become malignant. He would have to undergo major surgery: a three-hour operation, involving a deep abdominal incision, to be performed under general anesthesia, never a happy prospect for a 74-year-old man. The doctors offered him a choice: wait two or three weeks, or go ahead as quickly as possible. Go ahead, said the President of the U.S.

Thus began a period of suspense and anxiety that gets no easier to endure no matter how many times the nation goes through it. Ronald Reagan, chief of state, head of Government and Commander in Chief of the armed forces of the world's ranking superpower, would be unconscious for more than three hours on Saturday and, in his own words, "incapable of discharging the constitutional powers and duties" of his office. At best, he would be confined to Bethesda Naval Hospital for a week to ten days of postoperative recuperation after that. Even after he returned to the White House, it might take as long as two months for him to regain his full strength, and there would be continuing concern about the health of the oldest man ever to occupy the Oval Office.

The Government, though, would go on functioning, and somewhat more smoothly than in similar past crises. As his last official act before being wheeled into the operating room, Reagan at 10:32 a.m. Saturday signed letters authorizing Vice President George Bush to "discharge powers and duties in my stead commencing with the administration of anesthesia," which began 1 hr. 16 min. later. Though Reagan injected some caveats about the application of the 25th Amendment, the message marked the first official transfer of power from a President to his Vice President in the nation's history. Even after he reassumed his official powers almost eight hours later, a system was being put into place by Chief of Staff Donald Regan to run the daily operations of Government and reduce demands on the President while he recuperates (see following story).

Fortunately, there proved to be no need for more sweeping measures. The operation, which took 2 hr. 53 min., went smoothly. A team of six doctors headed by Navy Captain Dale Oller, chief of general surgery at Bethesda, snipped out a 2-ft.-long portion of Reagan's colon, the section containing the 2-in.-long polyp, and sewed the intestine back together. "Our patient, our President is doing very, very, very well," Oller announced about an hour after the surgery was completed. "The operation went absolutely perfectly." There were no signs of the complications that sometimes develop during or shortly after major surgery, such as excessive bleeding or infection of the wound. More important, there was no sign of cancer outside the intestine. "We don't know whether there was cancer in the polyp," said Oller. A definitive answer would be disclosed by the full biopsy tests, which were to be completed on Monday. "But," said the surgeon, "there was no sign of cancer in the patient." In other words, whether any cancer is ultimately found in the excised polyp, no malignancy appears to have spread in the President's body (see box).

However rapidly Reagan may recover, though--and he made a remarkable snap back from his brush with death when an assassin's bullet felled him in March 1981--his health from now on will need close monitoring. Polyps have a tendency to recur; the one removed Saturday was the third detected since Reagan became President. Moreover, as many doctors put it, the kind of intestine that repeatedly grows polyps is the kind that has to be watched for signs of cancer.

No such concerns were foreseen when the President and Nancy Reagan arrived by helicopter at Bethesda Naval Hospital from the White House about 1:30 Friday afternoon. A routine checkup in March-had disclosed a polyp in the President's colon, and his doctors thought it prudent to remove it and make a thorough examination of the entire intestine at the same time. But they were in no rush and told the President he could schedule the procedure just about any time he chose. He eventually selected July 12, a day when there was nothing much on his calendar.

The White House did take the unusual step of prerecording the weekly radio speech that Reagan normally delivers live at noon Saturday, Washington time, but not because anyone had anticipated any problems with the relatively routine procedure. No one at the White House, in fact, had any doubt that Reagan and the First Lady could get away for a relaxing Saturday and Sunday at Camp David. As the President and Nancy were walking from the helicopter into the hospital Friday afternoon, a reporter called out, "How do you feel?" Reagan spread his arms and cried, "Fine!"

By 2:15 p.m. Reagan was in an operating room for what was a minor surgical procedure that did not even require a general anesthetic. Doctors inserted into his colon a tube with a wire snare attached to remove the polyp they knew about, and an optical device to allow close examination of the intestine. The second polyp they discovered was too large (about the size of a baby's finger) to be removed in that manner; all they could do then was scrape off some cells from the polyp's periphery for a biopsy. Though Reagan was conscious, he knew none of this at the time. By 3:20 p.m. he was being wheeled to a recovery room, Nancy walking alongside, and assayed a one-liner. "Now, what is your name again?" he asked his wife, with a big grin.

Then came the bleak surprise. At 3:35 the President's personal aide, Jim Kuhn, phoned White House Chief of Staff Regan from an office near the recovery room. Regan groaned inwardly. Two other doctors took turns at the phone, while Nancy Reagan at the hospital listened on an extension. They discussed what would have to be done if the major surgery were delayed. Reagan would have to go on a preparatory regime again: restricted diet, enemas. Nancy, who seemed upset, interrupted to say, "Let's let the President make the decision," and hurried down the hall to the recovery room to consult her husband. He decided to get the operation over with.

Regan made two immediate calls of his own: to Bush, whom he reached as the Vice President was touring the high-tech Teradyne plant in Boston, and to National Security Adviser Robert McFarlane, who in turn notified Secretary of State George Shultz and Secretary of Defense Caspar Weinberger. A Regan staffer apprised the rest of the Cabinet, while Regan consulted with White House Counsel Fred Fielding about the legal implications under the 25th Amendment of the President's being incapacitated even temporarily. Meanwhile, reporters had packed into the briefing room for what was expected to be a routine report on Reagan's condition, to begin at 4 p.m. They waited for almost two hours.

Shortly before 6 p.m., White House Spokesman Larry Speakes entered, mounted the podium and began reading woodenly from a prepared text. Reporters visibly stiffened to attention at his first words: "The procedure lasted just over an hour . . ." They had been told earlier that it would take 30 to 40 minutes. Then came a barrage of medical terms--villous, cecum, colectomy--each of which Speakes had to spell out painstakingly. When he reported that the newly discovered polyp was "described as precancerous," his audience immediately demanded clarification. Trying to calm the reporters, Speakes urged, rather too casually, "O.K., let's tune up now, let's tune up." In fact, the term precancerous is not as frightening as it sounds. It means that the polyp is the kind that might become malignant if it were not removed and were allowed to grow larger.

Speakes' stress was on maintaining a business-as-usual atmosphere. Bush, he reported, would go to his vacation home in Kennebunkport, Me., on Friday night and spend the weekend there as previously planned. Nancy Reagan would return to the White House, stay Friday night and carry on her normal schedule after the President's operation. (Among other things, she was planning to preside Monday night at a White House reception for the Washington diplomatic corps and to read a speech that her husband had prepared.) Chief of Staff Regan, caught by reporters as he bustled down a White House corridor shortly after Speakes' briefing and asked about a transfer of power to Bush, admitted that "the lawyers are looking into it." Pointing to his gums, he added that the White House staff "didn't want to set a precedent anytime [the President] gets an anesthetic for his tooth." Of course, Reagan was facing something considerably more serious than that.

Back at Bethesda, Reagan checked into the finest suite in time to catch the 7 p.m. TV network news-show bulletins. Watching the news again at 11, he was treated to detailed diagrams of colons and polyps, as well as hastily assembled panels of doctors discoursing to the world on his condition. Said a senior Administration official dryly the next day: "He learned a lot from it."

Nancy stayed with the President until about 6 p.m. and then returned to the White House, leaving him to read briefing reports. She placed calls to Reagan's four children. Ron, Patti and Michael, reached at their homes in California, decided not to come to Washington but to get reports on their father's condition by phone. Maureen Reagan was in Nairobi, Kenya, heading the U.S. delegation to an international women's conference, and Nancy could not get her on the phone until Saturday morning. She too decided to go ahead with business as usual.

One of the First Lady's last calls Friday night was to Donald Regan, at about 10:15. Her voice suggested that she was on the verge of tears, "but she kept her composure," says one White House insider. Bush phoned about the same time from Kennebunkport, where he had gone after addressing a Republican fund-raising dinner in Boston. The Vice President complained to Regan that "it looks like Disneyland outside" because of the TV crews camped around his vacation home. Bush was aware of the preparations to make him in effect acting President, but had not participated in them. White House aides, following their instinctive urge to do everything possible to avoid raising public concern about their Chief, had been urging Bush to stay in Maine, but the Vice President would have none of it. "I just don't feel right sitting up here," he told Regan. "I would rather be close."

The President had settled down in his suite of five large, airy but rather impersonal rooms. It is furnished with several comfortable armchairs, but the President slept on a standard metal hospital bed. Before dropping off, he was put through the battery of tests drearily familiar to anyone who has been prepared for major surgery: chest X ray, electrocardiogram and CAT (computerized axial tomography) scan, a kind of super X ray of a large portion of the body. The scan showed no sign of cancer outside the colon. The tests ended about 11 p.m.; Reagan then read for a while (what, no one would say) and fell asleep a bit after midnight. He was awakened at 5 a.m. Saturday for an antibiotic, and went back to sleep for another three hours.

The Bethesda hospital on Saturday morning became a mini-White House, with a full complement of Secret Service and military guards and a hastily rigged press and TV briefing room. Donald Regan arrived at around 7 a.m., an hour before his boss woke up to shave. Nancy got there about 9, wearing an Adolfo dress in her favorite cheery red. National Security Adviser Robert McFarlane had slipped in a side door a bit earlier. He gave Reagan, clad in lime green pajamas, his regular morning intelligence briefing, and several aides dropped by to discuss the weekly legislative calendar.

The budget battle dogged Reagan all the way to the hospital. Reflecting the ire of other Senate Republicans, Majority Leader Robert Dole on Friday had publicly attacked the White House for "surrendering to the deficit" by dropping its support for the Senate's plan to freeze Social Security benefits for one year. Dole's remark, quoted in the Saturday-morning papers, stirred Reagan's wrath as he lay in bed only two hours away from surgery. He adamantly insisted to Regan that the Senate majority leader, and the public, be disabused of the notion that the White House was caving in. The chief of staff later called Dole to express the President's unhappiness with what Regan described as the Senator's "unkind remark."

At 9:15, Speakes appeared in the press room for another briefing. He appeared nervous this time, mispronouncing the names of some of the doctors who would operate on the President. But his stress was still on business as usual, even if that meant running the Government from Reagan's bedside. Said Speakes: "I think the President, to some extent Sunday and to a greater extent Monday and to an increasing extent through the week, will be able to conduct business from his hospital room here . . . I'm sure he'll be fully able to work the phones during the first part of the week. If he needs to do some congressional arm-twisting, I'm sure he'll be up to that."

Speakes did report that Bush had changed his plans and was on his way to Washington. Pressed repeatedly about a possible transfer of power, the White House spokesman kept repeating variations of the phrase, "an orderly procedure for making any decisions that may be required," as if it were a soothing mantra.

In fact, the transfer was on the point of being made. At 10:20 a.m., an extraordinary gathering convened in the President's suite. Regan, McFarlane, Fielding and Nancy Reagan crowded around the bed in which the President was sitting upright, with the back raised. Fielding had brought drafts of the two letters, to the president pro tempore of the Senate (South Carolina Republican Strom Thurmond) and House Speaker Tip O'Neill, in effect naming Bush the acting President until Reagan proclaimed himself capable of resuming his duties. A senior Administration official later implied that the drafting had in a sense begun shortly after the 1981 assassination attempt, when White House aides vowed not to repeat the confusion that reigned briefly then. Serious drafting began early last week, just in case the supposedly minor surgical procedure Friday afternoon turned out to be more than that, and the wording was polished Friday night after it indeed did. The bedside conference discussed the wording, and Reagan signed at 10:32 a.m.

Two and a half hours later, however, confusion broke out anyway, and on live TV. Speakes appeared in the hospital press room at 1 p.m. to announce that the President had gone into surgery at 11:48. As press aides handed out the letters, Speakes began summarizing them; some shocked reporters thought he was saying that Reagan had resigned. Speakes urged them over and over to read the letters but repeatedly refused to read them aloud himself, apparently out of fear of alarming the national audience. Radio and TV journalists in the front row were trying to broadcast live and Speakes, who could not make himself heard over their clamor, refused to continue until they piped down. Some reporters, apparently irritated by their electronic colleagues, began booing loudly. Speakes disgustedly observed that the affair was turning into an "Amal press conference," a reference to the mob scene in Beirut 23 days earlier when Shi'ite captors of American hostages from TWA Flight 847 produced five of them for TV interviews.

However untidily, the news was out: for the first time a Vice President was officially assuming the powers of the presidency, albeit briefly, while his boss was still alive. Bush's prudent response was to do as little as possible and say nothing at all. He left Kennebunkport at 9:30 a.m. Saturday and arrived in Washington aboard Air Force Two at about noon. He merely waved to cameras as he climbed down from the plane and jumped into a limousine that carried him, not to his White House office but to his Washington residence, where he stayed out of public view.

On the third and top floor of the south wing of the Bethesda hospital, where both the President's suite and the operating room are situated, Reagan rested a bit after signing the transfer letters. At 11:15 a.m. he was wheeled on a stretcher down a long and twisting corridor to the operating room. Nancy walked along side, holding the President's hand. "I love you," she said at the operating-room door. "Love you back," replied Reagan. "See you later." The same breezy quipster as ever, Reagan remarked to doctors as he was being prepped for surgery, "After all you did yesterday, this ought to be a breeze."

Not exactly, but the operation, though major, is relatively straightforward. Since the colon is so large, some surgeons say that removing a piece of it is less complicated than taking out a gallbladder, though both are exacting procedures.

At 4 p.m., an hour after the operation had been completed, the President's six surgeons lined up at the press-room lectern to deliver their report to the world. All wore white surgical coats and green operating-room trousers; one or two still had blue masks slung around their necks. This briefing was a sort of populist version of a medical seminar; the doctors, who took turns answering questions, spoke first in precise medical terms, then quickly rephrased them in laymen's language. From the first words spoken by Dr. Oller, a slim, bespectacled figure with a bushy gray mustache, it was obvious that their report was a bit better than just good.

The burden of the doctors' findings, in fact, was that Reagan's luck, to that point at least, had held yet again. A bit more than half of all polyps the size of the one removed from the President turn out to be cancerous. But the doctors had observed no indication of cancer in Reagan. Though that was a good sign, it was far from decisive. The doctors conceded that they could not rule out cancer until microscopic laboratory studies of the tissue taken from his body were complete, expected to be about noon Monday.

But even if cancer were to be found then, the most likely prognosis still would be for complete recovery. All the President's organs outside the colon appeared to be normal. Thus chances were very strong that any malignancy that might be detected in the polyp would prove to be confined to the excised matter and that the surgery would have removed it entirely before it had a chance to spread. As Dr. Edward Cattau, a specialist in internal medicine at Bethesda, phrased it, "If there is cancer in the specimen, then there is a reasonable chance that this operation could, in and of itself, be curative." His recommendation for what to do next: "Careful follow-up examinations at regular intervals . . . but probably no further therapy."

How long the President will be hospitalized will depend on how soon his bowel activity returns to normal, but the surgeons did not change the initial estimate of seven to ten days. During that time, said Dr. Oller, he could transact some presidential business and return to a normal diet. Cattau and Oller both estimated that complete recovery would take six to eight weeks, but Oller added that he was "enthusiastic" about Reagan's resuming "vigorous activity" even earlier. Said Oller: "He is hoping to be in California, on the ranch, on a horse, around the 14th of August. I think that's a very good possibility."

From a second-floor office overlooking the recovery room, Nancy Reagan had watched her husband sleep after he was wheeled in from surgery. To comfort him through his hospital stay, she had brought a canvas bag filled with family photos that she placed around the President's bedroom. She also hung a watercolor of the Reagans' Rancho del Cielo opposite his bed so he could gaze at it as he mended in the days ahead.

When Mrs. Reagan, accompanied by her brother, Dr. Richard Davis, entered the recovery room at 4:30 Saturday afternoon, she found her husband alert and as irrepressible as ever. "Why don't I give a press conference right now?" he quipped. The First Couple chatted amiably for 20 minutes.

The doctors told Mrs. Reagan that they had found the President's insides like those of "a man of 40." Assured that the operation had gone well, the First Lady let go with a sigh of relief and a few tears. She declared herself "happy, relieved, grateful." Only on the half-hour drive back to the White House did she finally show the fatigue and strain of her long vigil, but she reassured aides that she looked forward to dinner with her brother and a good night's sleep.

A few minutes after 7 p.m., Chief of Staff Regan and White House Counsel Fielding entered Reagan's suite bearing letters informing House Speaker O'Neill and Senate President Pro Tem Thurmond that Reagan was "able to resume the discharge of the constitutional powers and duties of the office of the President of the United States." An aide solicitously asked if Reagan wanted to rest a little while longer before taking on once again the burdens of Chief Executive. "No, gimme a pen," replied the President. "I feel fit as a fiddle," he was reported to have jauntily declared, showing almost unnatural good cheer for a man who had a fresh incision in his abdomen and had lost 2 ft. of his intestine to the surgeon's blade. At 7:22 Reagan signed the letters restoring his presidential powers; he was now officially back in command.

A weary but relieved Speakes gave reporters an update shortly before 8 on the President's recovery. It was a far less tense session than his midday briefing. The President, he began, "is conversant and oriented and has no fever." Just about out from under the anesthetic, Reagan was resting comfortably and dozing occasionally, as is normal for a patient after surgery. The President was feeling no pain, added Speakes. He was receiving morphine through a needle implanted in the sheath of his spinal cord. Speakes quoted Dr. Oller's assessment of Reagan's capacity to do his job: "If the President were needed to make a decision, he could make it."

On Sunday morning, Speakes reported that Reagan had slept well, despite being roused several times during the night by hospital staffers to monitor his progress. By 7:30 a.m., according to Speakes, Reagan was awake, virtually free of pain, and telling his doctors, "I'm amazed at how good I feel." Forty-five minutes later, the President was wheeled from the recovery room to his suite. He asked for the Sunday papers, joking, "I got them only for the comics." Regan briefed Reagan for ten minutes about overnight international developments and the ongoing budget battle. Later, Mrs. Reagan visited her husband and read him some of the telegrams of good wishes sent by world leaders. Dr. Oller, who remained by Reagan's side through the night, could not have been more pleased. Said Oller: "The President is on a post-operative course that surpasses by 99.9% all patients who undergo this type of surgery."

Reagan will not be given a clean bill of health until the results of the biopsy on his polyp are known early this week. But if, in fact, Reagan beats the worse-than-even odds on cancer, his Irish luck will be further enshrined in presidential mythology. Like any patient recovering from major surgery, particularly abdominal surgery, he will no doubt feel a bit shaky for a week or two or even longer. Yet he is a remarkably resilient 74-year-old, and few will be surprised if he is chopping some brush at his ranch in Santa Barbara in a few months.

Elderly men with polyps in their bowels are by definition at risk, and Reagan's condition will require close scrutiny. If the polyp that was removed turns out to have cancerous cells, the nation may face a prolonged period of nervousness, despite the fact that there are currently no signs that the malignancy has spread. Even the prospect of Reagan's spending weeks recovering is bound to translate into a dampening of the country's spirits, which for the past five years have seemed to reflect Reagan's own natural buoyancy.

To a public accustomed to Reagan on horseback, robust and vibrant, the image of the President temporarily bedridden, with a tube inserted in his nose, is disquieting. Nonetheless, for a nation that felt a twinge of dread when it heard that its President would go under the knife for a possibly cancerous growth, the news from the operating room last weekend that he seemed to be out of immediate danger was a source of great relief . --By George J. Church and Evan Thomas. Reported by Laurence I. Barrett, Barrett Seaman and Alessandra Stanley/Washington

With reporting by Reported by Laurence I. Barrett, Barrett Seaman, Alessandra Stanley/Washington