Because the cancer had metastasized to lymph nodes, postoperative therapy was required. Chemotherapy in the form of a “little brown bottle of pills” was supplied by White House doctor Lukash. The regimen called for this treatment five days in a row every five weeks for two years. In addition, a bone scan was scheduled for every six months to determine whether the tumor had spread. Mrs. Ford’s treatment was a success; there was no recurrence. Her physicians never discussed reconstructive surgery, but she wore a prosthesis.14
The public effect of Betty Ford’s candor was enormous. During her hospitalization thousands of letters and cards inundated the White House. Many were written by women with mastectomies and many from women who were encouraged to have breast examinations. One year later, there was a six-fold increase in breast screening examinations. Happy Rockefeller, the wife of Ford’s vice president, credited the publicity for her own examination, which detected cancer.15
Mrs. Ford was personally responsible for increased public awareness of this serious issue. She shrewdly acknowledged the value of a White House podium: “I’d come to recognize more clearly the power of the woman in the White House. Not my power, but the power of the position, a power which could be used to help.”16 Moreover, her openness was critical in changing the discussion of cancer of the breast from a private and stigmatized medical condition to a publicly acknowledged illness. No longer were breast cancer and mastectomy taboo topics for open discourse. Now susceptible women were encouraged to approach these issues without shame or embarrassment.17 For her efforts, the first lady received an award from the American Cancer Society in November 1975 and was named a “Communicator of Hope” by the American College of Surgeons in December 1976.18
Drug and Alcohol Dependency
Betty Ford’s medical story has a second chapter. Its subject matter is alcoholism and analgesic drug dependency. These dependencies were long in developing, and were substantially masked during her residency in the White House. However, these problems, long simmering, detonated shortly after the Fords retired to Rancho Mirage, California. Subsequently, the former first lady wrote two autobiographies to tell her story.19
Betty Ford’s environment predisposed her towards alcohol dependency. Her father and her brother, Bob, were both alcoholics. Her first husband, Bill Warren, an itinerant salesman, also was a heavy drinker.20 Congressman Gerald Ford and his wife lived in Washington, D.C., for many years prior to his presidency. Betty referenced its social environment: “In Washington there is more alcohol consumed per capita than in any other city in the United States.”21
A successful politician’s wife frequently leads a lonely existence. Mrs. Ford’s expected tasks were homemaker and mother of the couple’s children—four in the Ford family. Gerald Ford’s absences were commonplace. His wife lamented: “Jerry ended up being gone from home two hundred days a year throughout much of the time when our kids were growing up.”22 Mrs. Ford continued: “During the time that Jerry was gone so much I developed a problem, and I quit drinking entirely for a couple of years.” She was unable to set a date when she descended from just drinking socially to alcohol addiction, but she thought that her descent was quite gradual.23
At some time in 1965 or possibly later, Betty Ford was hospitalized for pancreatitis. Her presenting complaint was “stomach trouble.” After her physicians excluded the stomach, gallbladder and kidneys as a source, a specialist diagnosed her illness as pancreatitis. He said, “Young lady, if I were you, I would just stay on the other side of the room from the bar for a while.”24
Cervical Spine Osteoarthritis and Depression
In August 1964 the congressman’s wife was awakened by excruciating neck pain that was referred down her left arm. A diagnosis was made of cervical spine osteoarthritis with impingement of the nerve to the left arm. Betty Ford was hospitalized in the National Orthopedic Hospital, placed in traction, and given gold injections and cortisone shots. The pain continued despite traction at home for several weeks, thrice weekly visits to the hospital for massage, and heat therapy. She consulted doctor after doctor as the pain continued. Subsequently a neurosurgeon admitted her to George Washington Hospital for ten days of testing and manipulative treatment. Unfortunately, Mrs. Ford was informed that an operation was not indicated since an operable lesion could not be located. Instead, she was prescribed increasing doses of pain-killing drugs.25
The future first lady was depressed; loneliness and physical pain had exacted a price. Depression has a familial component. Many years earlier her alcoholic father probably committed suicide by carbon monoxide poisoning.26 A crisis in 1965 dramatized her depression. She lost control and cried uncontrollably on her bed. Clara, her close friend and longtime housekeeper, summoned Representative Ford home from a meeting with President Lyndon Johnson. A physician was called and Mrs. Ford said she “started seeing a psychiatrist twice a week.”27 At some time thereafter, a psychiatrist prescribed valium, which she continued to use in the White House.28
As First Lady
Mrs. Ford wrote that her addictions were “better in the White House,” since her husband was around and she was an important person as the First Lady of the Land. Her family and friends were concerned about her dependencies but acted as her enablers since they were allied in suppressing any news of her problem. Her drinking continued after she returned from her breast surgery. She and her close friend Nancy Howe would drink: “The two would sit for a cocktail hour that was viewed with displeasure by the president.”29 A link between the first lady’s medical and dependency afflictions and Ford’s performance as chief executive has not been found.
Betty Ford, the wife of Gerald Ford. She survived breast cancer, alcoholism and prescription drug addiction (Library of Congress).
After the White House
When Betty departed the White House for the Ford retirement home in Rancho Mirage, her psychological support vanished. Her husband, as ex-president, was much in demand and he resumed his frequent political travels. Her children were grown and gone; she was no longer prominent and in the public spotlight. She reacted by drinking more and consuming more pills than when she was in the White House. Betty visited her physician twice a week for her arthritis but the doctor “was unaware or didn’t want to recognize my dependency on the drugs. I don’t think that he knew anything about my use of alcohol.” Her family could no longer ignore the slurring of speech, frequent appearances at cocktail parties, and absences at previously scheduled appointments.30
Daughter Susan Ford and her gynecologist, Dr. Joseph Cruise, a recovering alcoholic, organized an intervention. The initial attempt failed, but a second, attended by the entire Ford family, was successful. Mrs. Ford checked into the Long Beach Naval Hospital’s Alcohol and Drug Rehabilitation Service on April 10, 1978.31 Mrs. Ford then publicly acknowledged her alcoholism and drug dependency. In July 1979, Jerry Ford stopped drinking in support of his wife.32 As a result of her prodigious efforts, on October 3, 1982, the Betty Ford Center for the treatment of alcohol and drug dependency was dedicated at Palms Springs, California. Vice President George H. W. Bush was the principal speaker.
Mrs. Ford died on July 8, 2011, at the age of ninety-three. The Betty Ford Center is a direct and lasting result of her victory over alcoholism and drug dependency.33
Nancy Reagan
“Perhaps Nancy Reagan’s largest and most important work as First Lady, however, was her role as the President’s personal protector.”34
Early Life and Marriage to Ronald Reagan
Nancy Reagan was the only child of the marriage between Edith Luckett and Kenneth Robbins. She was born Anne Francis Robbins in New York City on July 6, 1921. Edith Luckett, an actress, divorced Robbins and bequeathed her daughter, among many other gifts, the new surname of Davis, after remarriage to prominent Chicago neurosurgeon Dr. Loyal Davis. The future first lady also inherited from her mother a strong interest in acting, and more important, longevity. Edith Davis is the longest-lived mother of a first lady; the actress d
ied in Phoenix, Arizona, on October 26, 1987, at the age of 99 years, 3 months.35
A Hollywood acting career introduced Nancy Davis to actor Ronald Reagan. The thirty-year-old bride was wed to the forty-one-year-old groom on March 6, 1952. Their marriage of fifty-two years (1952–2004) was an enduring romance and Mrs. Reagan’s greatest joy. The Reagans had two children, Patti and Ron. Two miscarriages occurred during the six-year interim between Patti’s and Ron’s births. Ronald Reagan also had two children from his prior marriage to actress Jane Wyman.36
Breast Cancer
Nancy Reagan was the bastion that buttressed President Reagan during three significant medical crises during his eight-year presidency (1981–89). An assassination attempt, a colon resection for cancer of the right colon, and prostate surgery marked his presidential tenure. Mrs. Reagan’s sole illness was breast cancer that was detected in October 1987.
Annual mammograms have been recommended by the American Cancer Society for women fifty years of age and older since 1976.37 Nancy Reagan abided by this schedule and a routine mammogram at Bethesda Naval Hospital on October 5, 1987, detected a tiny malignant tumor in her left breast. She was accompanied to the hospital by the respected White House physician John Hutton. Hutton informed the first lady: “We think we’ve seen something…. There is an outside chance it isn’t malignant, but it probably is.”38 Nancy Reagan became a beneficiary of the escalating advances in medical technology; a single mammographic examination detected a tiny breast cancer while the diagnosis of Betty Ford’s much larger malignancy thirteen years earlier required examination by four physicians.
Her initial response to Dr. Hutton was, “Please call Ollie Beahrs. I want him to be involved.” Mayo Clinic surgeon Dr. Oliver Beahrs flew to Washington almost immediately, met the patient in the White House physician’s office on the mansion’s first floor, reviewed the breast X-rays, and examined the patient. He discussed treatment options with Mrs. Reagan and a decision was made to enter Bethesda ten days later with surgery the next day, October 17.39
The first lady immediately reached out to Beahrs out of respect for his skill as a physician and for his comfort and support as a dear friend. The doctor previously had consulted with and supported the Reagans during the president’s colon surgery. Beahrs was an internationally renowned surgeon, and a leader both at the Mayo Clinic and the American College of Surgeons. He had been a student of Loyal Davis, Nancy’s stepfather, at Northwestern University School of Medicine. Another bond was a result of the doctor’s skill as a magician, which he practiced for fun and sometimes for profit—to pay his medical school bills: “Throughout medical school, he continued to hone his skills as a magician and became so in demand that he actually had a booking agent, Mrs. Edith Luckett Davis,” Nancy’s mother.40
Nancy Reagan, the wife of Ronald Reagan. Her transparency about her choice of treatment for breast cancer was met with much disapproval (Library of Congress).
During the Reagans’ final years in the White House, significant elements of their medical diagnoses and treatment were delegated to teams of physicians from the Mayo Clinic of Rochester, Minnesota. Dr. Hutton apparently acted as liaison with the Mayo physicians, and the Washington military/civilian medical establishment thereby was bypassed. One reason, among others, for this strategy may have been Mrs. Reagan’s desire to control the flow of medical information. Mayo doctors flew to Washington on at least four occasions to perform a colonoscopy, a cystoscopy, and a major prostate surgery on the president, and a (modified) radical mastectomy on the first lady.41
Nancy Reagan determined that she would hold to her public schedule during the ten days between her diagnosis and hospitalization. Only the day prior to entering the hospital did she inform the press secretary and discuss and approve the statement to be released when she entered Bethesda. In two ways, chronicled above, the narrative did not depart from the norm for first ladies’ medical treatment. First was the principal-practiced secrecy which revealed only the minimum information when necessary. Secondly, the wife of an American president is able to select the most renowned and expert medical consultants to participate in her care, a privilege attainable by only a minuscule minority of her constituents.42
Mrs. Reagan preoperatively directed her physicians to perform a modified radical mastectomy under general anesthesia with no interval wake-up between biopsy and definitive therapy. Dr. McIlrath from the Mayo Clinic was the lead surgeon. The cancer measured 7 millimeters and was defined as “noninvasive,” that is, it was confined to the breast ducts and had not invaded into the breast tissue itself. John Hutton reported that the lymph nodes were free of cancer as expected. He further announced that no further treatment was necessary beyond regular follow-up. The cure rate for this type of breast malignancy is close to, if not at, 100 percent.43
The publicity surrounding this news event initiated a rush by women towards doctors’ offices and mammography clinics for breast exams, as did news of Betty Ford’s cancer thirteen years previously. Immediately after the news reports, there was a 30–50 percent increase in mammography screening. A retrospective analysis published two years later noted a lower twelve percent increase. This surely cheered the first lady, who, while still in the hospital, released he following statement through a spokesperson: “I can only hope and pray that women everywhere are calling their doctors for appointments.”44
The first lady returned to the White House after six days in the hospital. Advances in medical care had significantly reduced hospital stays; Mrs. Ford’s hospitalization for breast cancer surgery lasted two weeks. A one-year follow-up examination on Mrs. Reagan was negative for tumor, and there has been no recurrence twenty-six years later.45 The thirteen-year interval between the surgeries of these two first ladies saw dramatic changes in the surgical approach towards this cancer. The destructive and excessive radical mastectomy had been replaced by the modified radical mastectomy for most tumors. In this procedure only a small amount of chest muscle is removed. A further advance was the substitution of a lumpectomy for small cancers similar to Mrs. Reagan’s. A lumpectomy excises the tumor with an adequate margin of uninvolved breast tissue; this surgery is usually supplemented with radiation or chemotherapy.
The first lady’s treatment option was widely criticized by the press and medical “experts” on two counts: First, her choice of a more extensive operation than was necessary, and second, her avoidance of an interval between biopsy and definitive surgery to allow an opportunity for the patient to carefully review treatment options. The headline in the New York Times the day after the surgery shouted, “Mastectomy Seen as Extreme for Small Tumor.” A lay expert was quoted that Nancy Reagan’s decision “set us back years.” Contemporary articles in both the Washington Post and the Chicago Tribune also second-guessed Nancy Reagan. The furor came close to negating the beneficial publicity that her surgery had evoked.46
This controversy deeply troubled and frustrated the patient involved. Five months later in a television interview Nancy Reagan responded that a lumpectomy probably would have required radiation or chemotherapy, and both would have interfered with her schedule as first lady. She elaborated: “I couldn’t possibly lead the kind of life I lead and keep the schedule I do.” She added that doctors who were not involved in her case had no business criticizing the treatment choices she made. She stressed “it was she, and not her husband or her doctors, who had made the decisions about which treatment to follow. It was my choice to make, so don’t criticize me for making what I thought was the right choice for me.”47
The carping may have had a small element of merit. In the six months after Mrs. Reagan’s surgery there was a documented 25 percent reduction in the use of breast conserving surgery (lumpectomy) as opposed to mastectomy among women with local or regional breast cancer. The effect was greatest among women who were demographically related to her. But this reduction was transient and disappeared after about six months.48
Nancy Reagan has been healthy but increasingly fra
il in the quarter-century after leaving the White House. A basal cell carcinoma was removed from beneath her left nostril during a 1990 physical examination at the Mayo Clinic. Her sense of balance has deteriorated; she experiences frequent falls, and she has been hospitalized for a fractured pelvis and fractured ribs. A recent visit to a favorite Beverly Hills restaurant shocked customers with her frailty and noticeable leg bruises due to her falls.49
Rosalynn Carter
Rosalynn Carter, first lady to President Jimmy Carter (1977–1981), was the second of three successive first ladies to undergo a biopsy for a breast lesion. A lump was detected in her breast during a routine six-month physical examination at Bethesda Naval Hospital in April 1977. Navy captain Dr. William Fouty removed the lesion. Pathological examination confirmed its benign nature. Mrs. Carter remains free of breast tumors thirty-seven years later.50 The first lady again had minor surgery at Bethesda Naval Hospital in August 1977. Navy captain Dr. Douglas Knab performed a dilatation and curettage (D&C) of the uterus. Mrs. Carter’s press secretary gave a succinct and unrevealing report to the press: “It is a routine procedure and a private matter.”51
Chapter Sixteen
Modern-Day First Ladies
Barbara Bush, Hillary Clinton, Laura Bush and Michelle Obama
Introduction
This quartet of first ladies served in the White House from 1989 to the present. All four were relatively healthy; their illnesses were either underemphasized in the press or concealed from the public: Their diseases were neither nettlesome to their presidential husbands nor disruptive of the presidential routine. All were under the constant medical care of a modernized and upgraded White House Medical Unit (WHMU), the military organization responsible for the wellness and medical treatment of the first family.
The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama Page 26