The Death of a President

by William Manchester

  He was wrong. Berger was right. Nevertheless both had been spurred by the same impulse: the need for action. To active men immobility was literally intolerable; therefore they issued fatuous orders, placed or attempted to place unnecessary long-distance calls, bellowed (Yarborough), abandoned posts (Baskin). If an excuse for action didn’t come to mind, they invented one and persuaded themselves that it made sense. This was largely a male reaction—Evelyn Lincoln, Pam Turnure, and Mary Gallagher sat helplessly in the cubicles of Major Medicine—but it was a vigorous woman, Liz Carpenter, who achieved a pinnacle of rationalization. Liz and Marie Fehmer had been left in Parkland’s administrative offices with aspirin and water. They had no idea what was happening and were growing increasingly restless. A passing employee called out that Kennedy had been shot. Liz thereupon jumped to an extraordinary conclusion. The President had been scheduled to address a luncheon at the Trade Mart. If he were wounded, he obviously couldn’t talk. Therefore, she explained to Marie, the Vice President would have to speak in his place, and as members of the Johnson staff they should be present. There wasn’t a moment to spare; he might be at the lectern already. Marie, impressed by Liz’s logic, ran after her. At the hospital entrance they explained the situation to a traffic policeman. He looked doubtful, then beckoned to a cruiser, which careened into Harry Hines Boulevard at terrifying speed—the driver himself may have welcomed the chance to act—and deposited them at the Mart’s front door. To their amazement only a handful of people were wandering about. All looked dazed. It looked as though the Vice President’s remarks would be poorly attended. Liz began to have second thoughts.

  The epidemic of irrationalism wasn’t confined to the Presidential party. Parkland’s staff was also affected. A telephone rang in the emergency area. As nursing supervisor, Doris Nelson—who would presently demonstrate her own lack of immunity—picked up the receiver. To her surprise, a Parkland physician on the other end asked her what she wanted. “The President has been shot,” she replied, and he said, “Yes. What else is new?”

  Governor Connally felt fingers plucking at his clothing. A voice said, “I’ve got his coat and shirt off.” Another muttered, “I’m having trouble with his pants.” The Governor felt a painful jerking around his hips. Exasperated, he groaned, “Why not cut them off?” There was a silence. Without realizing it he had just reminded them of the hospital’s established procedure.

  The Parkland employees least in touch with reality were the clerks. The importance of paperwork had been drilled into them, and now, seeking a haven from the general disarray, they fell upon the familiar rituals of routine. “Kennedy, John F.” was neatly logged in at 12:38, identified as a white male, and assigned the emergency room No. 24740. His “chief complaint” was described as “GSW”—gunshot wound. “Connally, John,” No. 24743, had the same problem, and he was entered three spaces below, after a white female with a bleeding mouth and a colored female with abdominal pains. (The Governor, of course, had been admitted before all of them.) This sort of thing went on all afternoon. Price, enraged, threatened to fire one zealous clerk. It solved nothing. Everything had to be recorded and filed; there could be no exceptions. Larry O’Brien entered the hospital with Congressmen Albert Thomas and Jack Brooks. Taking a wrong turn, he found himself alone, facing a counter. On the other side was a bespectacled woman. “Just a minute!” she said smartly and handed him a form and a ballpoint pen. In a stupor he laboriously began to print “O’Brien, Lawrence F.” Then he came to a dead stop. Suddenly the idiocy of the whole thing struck him. Dropping pen and form, he blundered down strange corridors, searching blindly for his President.

  The body of John Kennedy lay at the center of the storm, insulated from it by the magnitude of the task which preoccupied everyone in Trauma Room No. 1. There was no need for sham activity beyond that threshold. The men and women who were gathering could not doubt the urgency of their work, and discipline invested it with a kind of peace. Blades and catheters were lifted automatically, dials spun instinctively; rubber-gloved hands reached, clenched, and moved in rhythmic pantomime. This was an old battle for them, fought with familiar weapons and with every stratagem they could summon even when they knew they could not win.

  They could not win now. The throat wound—which was then assumed to be an entry wound, because there was no time to turn him over—was small, and it exuded blood but slowly. The damage to the posterior cranium, however, could scarcely be exaggerated. That was the origin of the massive bleeding, which had begun on Elm Street, had continued throughout the ride to the unloading dock and the trip down the corridor, and which was unstanched even here. Doris Nelson was smeared; so was everyone who had been near him. By now, one would think, Kennedy would have been bled white, but his great heart continued to pump; some 1500 cc. of blood—three pints—had flecked the aluminum hospital cart, its sheeting, the floors, the walls beyond. And mingled with it were vast amounts of fine tissue.

  Diana Bowron, S.R.N., and Margaret Hinchcliffe, R.N., undressed him swiftly, removing all his clothes except his undershorts and brace and folding them on a corner shelf. Nearly nude, his long body, unmarred below the head, lay on its back across a three-inch black leather pad. The fixed eyes—dilated and divergent, deviated outward with a skew deviation from the horizontal—were raised sightlessly toward the solitary fluorescent lamp glaring overhead. The first physician to arrive, Charles J. Carrico, a second-year surgical resident in his twenties, examined him rapidly. There was no pulse, no blood pressure at all. Nevertheless he was not quite gone. His body was making slow, agonizing efforts to breathe, and an occasional heartbeat could be detected. Carrico commenced emergency treatment, inserting a tube through the mouth in an attempt to clear the airway. Lactated Ringer’s solution—a modified saline solution—was fed into the right leg via catheter. In a hurried undertone the resident inquired about blood type.

  A nurse darted out. “What’s the President’s blood type?” she asked Hill and Kellerman. Clint started to reach for his wallet. Roy said, “O, RH Positive.”9

  Returning, the nurse discovered that Trauma Room No. 1 was filling rapidly. Although Doris Nelson stood in the doorway, screening the staff, fourteen doctors surrounded the cart. That was too many. The place was less than twice the size of Kennedy’s private bathroom on the second floor of the executive mansion. Only three of the physicians were absolutely necessary: Malcolm Perry, the thirty-four-year-old surgeon who had just stumbled down the flight of steps from Parkland’s cafeteria to relieve young Carrico; Burkley, because he was acquainted with the patient’s medical history, carried his special drugs in his black bag, and knew the proper dosage levels; and Marion T. Jenkins, chairman of the hospital’s department of anesthesiology. The rest—neurosurgeons, internists, urologists—had come because they were determined to be there if needed. As it turned out, their most useful function was to mask the stark surroundings.

  The room was singularly plain. Its gray tile walls were as impersonal as IBM, which had actually manufactured the wall clock. Entering from the passageway in which Mrs. Kennedy was just now sitting down—Sergeant Dugger had found her a folding chair—one encountered a solid door, which swung to the right. Within, the initial impression was of utility and durability. This was a chamber of suffering, but it had been designed for doctors, not patients. To the layman’s eye it had the brutal functionalism of a stockyard. There wasn’t an inch of softness, nor a mote of subdued color. Apart from sheets and cotton every item was noncombustible. The pedal-operated waste can was of stainless steel. The floor was black rubber. Cabinets and drawers were gray metal. There were many electrical outlets in the gray tile walls, but there was no window, no natural light, no gentle shading; wherever one looked, only the harsh, efficient, unsubtle, bland, monolithic apparatus of modern medicine could be seen. The sterility was absolutely necessary, of course, but it made No. 1 an impersonal crypt, and the physicians, simply because they were alive, were a relief.

  Mac Perry dominated them.
Like his patient he was a bold figure of a man, and with him he occupied the center of this toneless stage. Angular, big-boned, the grandson of a Texas country physician, Perry was still chewing croquette from the hospital cafeteria when he entered, yet he was already at work. He flung his lightweight blue plaid sport coat to the blood-puddled floor and thrust his big hands into rubber gloves. There was no time to scrub in. There was scarcely time for thought. Two impressions danced across his mind: The President’s bigger than I thought he was and He’s the most important man in the world. Then everything kaleidoscoped for him. He saw the bleeding first, of course, and noted “a rapid loss of great magnitude.” Next he observed that Kennedy’s chest wasn’t moving. He felt for a femoral pulse, and his strong, probing fingers encountered only Kennedy’s rigid back brace. Blood transfusion leads, he saw, were under way. There was one venesection on the President’s right leg, and Nurse Bowron was removing the President’s gore-encrusted gold wristwatch to clear a space for another on the left arm. Burkley had produced three 100-mg. vials of the Solu-Cortef from his bag, murmuring, “Either intravenously or intramuscularly.” Everything that could be done with fluids was being done. The great need, however, was for some sort of breathing passage. The tube the resident had inserted wasn’t working, apparently because of the wound in the neck. Analgesics were unnecessary. Kennedy was in a coma. “Scalpel,” Perry muttered. A nurse slapped one in his rubber palm. Incising the President’s throat just below the mediastinal wound, he began a five-minute tracheostomy (“a mouth in the throat”). Meanwhile the tube between Kennedy’s lips had been connected to a respirator in an attempt to start him breathing again.

  It was at this point that Jacqueline Kennedy decided to enter the room. She had been in the drab hallway for approximately ten minutes, each worse than the last. Bull-necked Dugger had stared at her, Nellie Connally had drawn away, Doris Nelson had tried to take her gloves off, passing orderlies had attempted to persuade her to rest in one of the sheeted cubicles. The enormity of what had happened had just begun to hit her, but she had already determined that she would not leave here. Parkland’s staff didn’t understand the strength of the will behind that decision. They knew only her reputation, and like Robert Kennedy she was a very different person than the public imagined. He was gentler and more sensitive than he was thought to be; she was far firmer than people believed. Inevitably both had been overshadowed by the President. Until this hour that hadn’t mattered. In the void he was about to leave they would emerge, however, and for Mrs. Kennedy the time to assert herself was now.

  During the first few minutes she had been quietly watchful. She couldn’t understand why all the doctors were running in; she was certain her husband had been killed. Then she had heard the early talk about fluids. Physicians assume that laymen are awed by medical terminology. Usually they are right. This time they were wrong. The President had been ill since marriage; his wife had spent much time in hospital waiting rooms. She knew what a saline solution was, and when she heard a voice from the trauma room say “resuscitation,” she understood that, too. He’s still alive, she thought in amazement. It made no sense. She was convinced that he had been killed. Could there be a chance that he could live? she thought; and: Oh, my God, if he could, I’d just do everything all my life for him. The words “If only” crossed her mind, and “Maybe,” and “Just anything.” “Hope is a thing with feathers,” wrote Emily Dickinson, “that perches in the soul.”

  Jackie glanced up at Larry and Ken, a few feet away. She whispered, “Do you think…?”

  They said nothing. There was nothing to say. They drifted away among cubicles, and O’Donnell, stirring from his trance, whispered to O’Brien, “God, it’s a thousand-to-one chance he can live.”

  For her it had been a fleeting wish. It was followed by an impulse. She said, “I’m going in there.”

  Doris Nelson heard her and barred the way. The nurse was a starched white dragon with strong muscles, and she had been imbued with the doctrine that relatives should be kept as far as possible from patients. One purpose of the policy was to prevent the very sort of false encouragement which had just been aroused in Mrs. Kennedy. Doris said sharply, “You can’t come in here,” and set her rubber-soled shoes. Unintimidated, Jackie said, “I’m coming in, and I’m staying.” She pushed. Doris, much stronger, pushed back.

  Each time her husband had been sick Jacqueline Kennedy had been turned away by doctors. At Columbia she had heard him calling for her after his back operation; she had tried to go to him then, but no one would admit her. Then, when one specialist’s treatments had begun to fail, she had wanted to bring in a consultant. She had been persuaded to change her mind, and the President had suffered through four months of intense pain and discouragement. Until then she had bowed to medical advice. She had been young and deferential; the doctors, she had thought, must know best. But after those four months she had sworn a private vow. Henceforth she would at least be at his side when he needed her; never again would she let doctors or nurses cow her. Now, struggling harder, she whispered fiercely to Doris Nelson, I’m going to get in that room.”

  It seemed unlikely. She was much frailer than the nurse. But the commotion attracted Burkley’s attention. He came over.

  “Mrs. Kennedy, you need a sedative,” he said shakily.

  “I want to be in there when he dies.”

  He nodded understandingly, then ran interference for her. “It’s her right, it’s her right, it’s her prerogative,” he kept saying, leading her past the woman in stained white, who reluctantly stepped aside under the impression that he was a Secret Service man. Inside Burkley held an arm on either side of Mrs. Kennedy to prevent anyone from dragging her away.

  The room had become even denser with people. Cramped by the pressure, Kennedy’s wife and his doctor were forced into the corner immediately to the left of the entrance. Behind her ranged trauma room hardware: gray tile, a green oxygen tube, a steel cabinet packed with gauze. She leaned forward and rested her spattered cheek on Burkley’s shoulder. Then she dropped briefly to the floor, knelt in the President’s blood, and closed her eyes in prayer. She rose again and stood erect, her eyes intent upon the weaving hands of Mac Perry.

  It seemed impossible, but another doctor had shouldered his way in. He was William Kemp Clark, the hospital’s tall, bald chief neurosurgeon. Clark had rank; the other physicians made way for him. He and Perry exchanged desolate looks. Both knew there was no chance of saving the patient. They were merely going through the motions. Clark saw Jacqueline Kennedy and asked her, “Would you like to leave, ma’am? We can make you more comfortable outside.” Her lips moved almost soundlessly, shaping the word “No.” Perry had just finished the tracheostomy when Clark arrived; he was inserting a cuffed tube in the windpipe. Jenkins attached it to an anesthesia machine, the controls to which were more delicate than those of the respirator. Clark stood vigil over the electrocardiograph. Perry, nearly at the end of his repertoire, desperately opted for closed chest massage. He had to do something to stimulate the chest. But he couldn’t get leverage. He stood on his toes, and still the President’s chest was too high. “Somebody get me a stool,” he panted. Somebody did, and perching on it he began ten minutes of hunching and kneading.

  Everything Parkland had was going for Kennedy now. Ringer’s solution, hydrocortisone, and the first pint of transfused blood were entering his vessels through the two catheters. A nasogastric tube, thrust through Kennedy’s nose and fitted behind his trachea, was clearing away possible sources of nausea in his stomach. Bilateral chest tubes had been placed in both pleural spaces to suck out chest matter through the cuffed tube and prevent lung collapse. Now, in a treatment older than the invention of the most primitive medical device, predating even William Harvey—a technique no more sophisticated than the shaking of a stopped watch—Perry was stroking and palpating the tough, well-muscled flesh over the President’s rib cage, trying to coax a single beat from the heart until his own sinews ached and
begged for relief.

  It wasn’t working. The spasmodic respiration had ceased. The gushing from the huge laceration on the right side of the head had ended only because he had no more blood to give. The new liquids excepted, his veins were empty, his skin shockingly white. The brief flutter on the electrocardiograph had ended; the squat EKG machine stood by the hospital cart, gleaming dully. Mac Perry crouched lower, his face clenched. He was breathing harder.

  Outside the murmur of voices rose and fell in undulations. Twice before going in Jacqueline Kennedy had beckoned to Powers and said, “Dave, you better get a priest,” and over the telephone the Attorney General had made the same request of Clint. Agent Jack Ready had made the call. Twenty minutes had passed, however, and no pastor had appeared. Pointing at his watch, Dave kept pressing Ready: “What’s the story on the priest? Listen, we’re not going to make it!” Nor did it seem that they could; a cardiac pacemaker machine was being wheeled into the trauma room and prepared for use, but no one was under the illusion that it would be needed. Roy Kellerman, who had been lurking outside the door, crossed to the nurse’s station, where Clint was holding the open line to the White House. In a whisper Roy said, “Tell Jerry this is not official and not for release, but the man is dead.”

  Sergeant Dugger, standing alone by the empty metal chair beside the trauma room threshold, heard everything. The Sergeant had forgotten Chief Batchelor’s car. He was thinking of Mrs. Kennedy, and of his own inadequacy. Dugger was far more sensitive than he seemed. He was painfully aware of his appearance—big, red-necked, tough, unfeeling; a poster of police brutality. His incongruous horn-rimmed glasses didn’t help. They gave him the look of an angry owl. He had never been able to correct the impression, partly because he was so inarticulate. Repeatedly he had stood in this hospital with stricken relatives in need of a word of comfort. He had none to give. He didn’t know what to say. Afterward he would explain to his Episcopalian minister, “I was all left feet.”