By the late 1930s, a large, unsightly dark spot had appeared over Roosevelt’s left eye. It had developed slowly from a small blemish first apparent in photos taken in 1923. It would be greatly diminished by 1940 and all but gone by 1942. There is no way of knowing whether this was a harmless age spot removed for cosmetic reasons or, as some have speculated, a deadly melanoma that disappeared as it metastasized to other parts of his body. McIntire, responding to a prominent physician who had warned of cancer, characterized it as “very superficial.”25
In 1941, Roosevelt suffered severe rectal bleeding that McIntire attributed to a bad case of hemorrhoids, a not uncommon problem in the Roosevelt family. His blood count dropped to dangerous levels, requiring medication and at least two transfusions before it stabilized. He does not seem to have experienced another such crisis but remained susceptible to low-grade infections.26
Whatever the truth about a possible cancer, by the time he began his third term Roosevelt was clearly beginning to display the effects of progressive cardiovascular disease similar to that which had killed his father. McIntire understood this and took it seriously. Roosevelt’s oddly circuitous route to Casablanca in January 1943 probably stemmed from a belief that travel in relatively leisurely installments at low altitude was much safer than the mode employed by his military chiefs: a long direct flight across the Atlantic in a high-altitude C-54 transport plane. McIntire in fact became visibly upset when he learned that a short final hop over the Atlas Mountains would have to ascend to a higher altitude than he considered safe.27
Roosevelt appears to have been an active and effective participant at Casablanca, but the long trip exacted a toll. In those final two years after his return from North Africa, Grace Tully observed “the signs of cumulative weariness, the dark circles that never quite faded from under his eyes, the more pronounced shake in his hand as he lit his cigarette, the easy slump that developed in his shoulders as he sat at a desk that was always covered with work.”28
Why did McIntire fail at the very beginning to consult with a heart specialist? Probably because cardiovascular medicine had not advanced much beyond that available to Roosevelt’s father in the 1890s. Doctors knew how to measure blood pressure, for example, but often interpreted readings that are now understood to be dangerously high as evidence of a strong, healthy heart rather than of mortal danger. About the only medication for heart trouble was the recently developed drug digitalis, the proper dosage of which was difficult to determine.
Roosevelt himself seems to have been determined to ignore his symptoms but must have connected his own condition to that of his father. Perhaps he found consolation in recalling that James Roosevelt had lived for ten years after his first heart spasm. Perhaps he was simply in denial.
In those days, many doctors avoided frank conversation with critically ill patients, but it is possible that Roosevelt and McIntire talked honestly and seriously. One can imagine Roosevelt telling his physician he would continue his duties as best he could without regard to his own well-being, like any other soldier in service to his country. Grace Tully, who spent as much time with him as any other person in those years, believed that such was his attitude.29
In this spirit Roosevelt departed Washington on November 11, 1943, for his second and third major international conferences of 1943, at Cairo with Chinese Nationalist leader Chiang Kai-shek and at Teheran with Churchill and Stalin. At Teheran on November 28, hosting Stalin and Churchill for dinner, he presided over a spirited discussion of postwar policy toward Germany. Suddenly, as his interpreter Charles Bohlen recalled it, “he turned green and great drops of sweat began to bead off his face; he put a shaky hand to his forehead.” Harry Hopkins swiftly had him wheeled out of the room and returned presently with assurances that the president was suffering from indigestion and would be all right. The next day, he seemed fully recovered. The symptoms were compatible with indigestion, but no other diner seems to have been afflicted. The president’s malaise may have been a cardiac event. Roosevelt’s medical history, as presented to Dr. Howard Bruenn soon afterward, apparently included other such episodes. Back in the United States on December 16, he was superficially in good spirits but at least as worn down by the long journey as he had been by the trip to Casablanca.30
Anna was among those who greeted him. Shortly after moving to Washington, she realized that her father was seriously unwell and her mother impervious to his condition. She insisted on a thorough medical examination conducted by specialists and got her way.
In April 1943, McIntire had obtained assignment to the Bethesda Naval Hospital of Dr. Bruenn, a noted young heart specialist who had enlisted in the navy. He may have consulted informally with Bruenn, but Bruenn did not personally examine the president at Bethesda until a year later, on March 27, 1944. He had been given a terse recent medical history. In late December, Roosevelt, just back from Teheran, had come down with influenza that produced “fever, cough, and malaise.” He had never fully recovered, suffering “several episodes of what appeared to be upper respiratory infections,” as well as “occasional bouts of abdominal distress and distension, accompanied by profuse perspiration.” Recently, he had developed a cold with a persistent cough that produced “small amounts of thick, tenacious, yellowish sputum.”31
Bruenn’s examination revealed a normal body temperature (99 degrees) and pulse (72 bpm). The blood pressure was a very high 186/108. (Roosevelt’s chart apparently had only a few earlier readings: July 30, 1935: 136/78; April 22, 1937: 162/98; November 30, 1940: 178/88; February 27, 1941: 188/105. They nevertheless revealed a pattern disturbing even to the medical science of those days.) Electrocardiograms, fluoroscopy, and X-rays indicated an enlarged heart and congested pulmonary arteries. Bruenn’s diagnosis, which he believed totally surprised McIntire, was “hypertension, hypertensive heart disease, cardiac failure (left ventricular), and acute bronchitis.” He recommended a strict treatment regime of one to two weeks in bed with nursing care, the administration of digitalis, a light diet, a program of weight reduction, and sedation as necessary to ensure restful sleep.
“You can’t do that,” McIntire responded. “This is the President of the United States!” A group consultation with Bethesda staff followed, then a White House meeting with McIntire and two eminent physicians who were honorary consultants to the navy: Dr. James Paulin, a former president of the American Medical Association, and Dr. Frank Leahy, a famed Boston surgeon. Paulin and Leahy read the president’s chart and examined him independently. They appear to have concurred with Bruenn’s overall diagnosis.
Bruenn himself made it clear that he could not attend a patient if his recommendations were overridden. He got most of what he wanted—very limited activity, a strict diet with weight-loss goals, reduction of tobacco use to six cigarettes a day, lots of sleep, and the use of digitalis as deemed necessary. Thereafter, he saw Roosevelt three or four times a week at the White House and traveled with him when he went outside Washington. Sinus treatments aside, he assumed the role of primary physician. Roosevelt, Bruenn recalled, never asked questions about his condition and made light of it in discussion with others. This was perhaps evidence of denial but more likely a demonstration of fatalism.
In line with Bruenn’s prescription, Roosevelt spent a month—April 9 to May 7, 1944—mostly relaxing at Bernard Baruch’s imposing estate, Hobcaw, near Charleston, South Carolina. The public was told only that he was on a brief vacation, expected to last about two weeks, somewhere in the South and recovering from a bout with “the grippe.” By and large, the press bought the story. FDR’s biographer, Ernest Lindley, wrote a widely syndicated column denouncing “misleading rumors” that the president was in ill health.32
By then, the invasion of Europe was widely expected, and the American “holding action” against Japan had become a relentless offensive moving from one bloody island battle to another across the vastness of the Pacific toward the Philippines. Dispatches came to Hobca
w from Washington daily. Secretary of the Navy Frank Knox died and was replaced by James Forrestal. The direction of the war was well established and required no command decisions from the White House. Roosevelt’s workload, much of which could be managed by the enlarged White House staff he had gotten from the Executive Reorganization Act of 1939, was as light as possible.
One day he started a letter to Daisy Suckley: “A lovely place—plantation for a King. . . . I am really feeling ‘no good’—don’t want to do anything & want to sleep all the time.” He never finished it. He attempted another with the same result. Revealing that he knew he had a cardiac problem, he wrote that his heart was “definitely better—does queer things still.”33
Guests came down for visits. They included Lucy Mercer Rutherfurd, whose long-ill husband had died earlier in the year. Daisy arrived for a few days in May. Warily noting the forced gaiety at every meal and cocktail hour, she thought Roosevelt’s efforts at jolly repartee stressed him. He knew, he told her privately, that “the doctors”—presumably referring to McIntire—were not telling him the whole truth. They couldn’t, he assured her, put anything over on him.34
The monthlong vacation at Hobcaw did the president some good, but his blood pressure remained ominously high. His weight fell well below the target his doctors had set, betraying a serious lack of appetite. He would have good days and bad days, but his fatigue was chronic, the result of a failing cardiovascular system that rest could not rejuvenate. After his return to Washington, he met many visitors in his bedroom, customarily spent only two hours a day in the Oval Office, and took long weekends at Shangri-la, his retreat on nearby Catoctin Mountain ridge.
According to a story told secondhand to historian Doris Kearns Goodwin years later, Senator Frank Maloney of Connecticut met with Roosevelt, probably on June 1, 1944. Seating himself in the Oval Office on the other side of the president’s desk, he confronted the vacant stare of a man who seemed not to realize a visitor was there. After a moment, he got up and went directly to presidential secretary Pa Watson. Unruffled by Maloney’s report of the president’s condition, Watson replied, “Don’t worry. He’ll come out of it. He always does.” Maloney returned to the Oval Office and found a president who suddenly seemed back to normal. For the next several minutes, they discussed the senator’s concerns in a normal and coherent fashion as if nothing had happened.
It is very possible that something like this occurred, although there seems to be no extant firsthand account by Maloney, who died just six and a half months after his only recorded White House visit. Such an event would have been consistent with Roosevelt’s condition. Neurologist-historian Steven Lomazow has suggested that such episodes—common enough that Watson could say the president always came out of them—were “seizures” or perhaps ministrokes (transient ischemic attacks, or TIAs). TIAs are usually markers on the way to a large-scale event. Whether or not Roosevelt actually experienced TIAs, that he was frequently fatigued to the point of dysfunction is beyond doubt.35
On July 12, 1944, Turner Catledge, a distinguished New York Times reporter, had a one-on-one meeting with the president. Fully as much as David Brinkley, he was “shocked and horrified” by Roosevelt’s condition—emaciated with a “vague, glassy-eyed expression on his face and his mouth hanging open. . . . Repeatedly he would lose his train of thought, stop, and stare blankly at me. It was an agonizing experience.” Other callers had similar stories; none felt free to broadcast what they had seen to the public.36
Roosevelt, grievously ill with a malady for which there was no cure, was careening toward a medical catastrophe similar to the one that had afflicted Woodrow Wilson a quarter century earlier. Did he recall the visit he and James Cox had made to the White House in 1920 and the terrible impact the sight of the incapacitated president had made on them? Perhaps. But he also knew there was a war to win and a peace to forge. He was determined to be a shaper of history, not an observer or a victim of it.
Chapter 24
War and Diplomacy
February 1943–June 1944
On January 31, 1943, the day Roosevelt returned to Washington from Casablanca, newspapers carried the first stories of the German surrender at Stalingrad. From that point, the Red Army, benefiting from generous American Lend-Lease supplies, would push steadily westward, destroying German forces ruthlessly and compensating for its own enormous losses with a seemingly limitless reservoir of manpower. Most devastatingly, the Russians would win a huge victory at Kursk in July, destroying German armored formations in the greatest tank battle ever waged. After Kursk, Germany could only manage an orderly retreat against an implacable Soviet offensive.
As Roosevelt surveyed the increasingly favorable battle maps, he surely felt that his gamble on the USSR was paying off. He also sensed that to win the peace, the United States had to establish an enduring modus vivendi with Stalin and the Soviet Union. He clearly believed that such an understanding would be far more critical than the relationship with Churchill and a Britain increasingly dependent on US support.
The Anglo-American alliance was also winning victories. In mid-May, the Axis resistance in North Africa collapsed as Allied troops captured Tunis, taking nearly 250,000 prisoners. In July, as the Russians were scoring their massive victory at Kursk, American and British forces invaded Sicily. They would take control of the island in thirty-eight days, during which an internal coup, backed by King Victor Emanuel, deposed Mussolini. Marshal Pietro Badoglio replaced him. On September 8, the new government surrendered unconditionally to the Allies. The Sicilian campaign had eliminated Mussolini and effectively cleared the Mediterranean lifeline to Suez.
In September, British and American forces landed on the Italian boot at Reggio Calabria and Salerno, but the Germans had already taken control of the country. They freed Mussolini from imprisonment and put him at the head of a puppet government. The Allies quickly found themselves in a slow, bloody campaign on a long and mountainous peninsula uniquely suited to defensive warfare.
Just as American military leaders had predicted, the North African and Italian campaigns made a 1943 invasion of northern France (code-named OVERLORD) impossible. So much the better as far as Churchill was concerned. He feared a repetition of the bloody trench stalemate of 1914 to 1918, and he remained determined to restore British hegemony over a region in which he correctly perceived that Stalin had designs of his own. Friendly governments in Italy and Greece were essential to the prime minister’s plans. The Americans, from Roosevelt down, were determined that with the Mediterranean secured, the next big move in the war would be across the English Channel into France in the spring of 1944.
From the Russian perspective, the Sicilian campaign was little more than a skirmish, but the US-British accomplishments in the wider war were far from modest. In addition to territorial gains traceable on a map, the two allies, utilizing killer aircraft launched from escort carriers and improved antisubmarine weaponry and tactics, were sweeping German submarines from the North Atlantic. American and British bombers, moreover, were pounding Germany around the clock, creating destructive firestorms and repaying many times over the terror the Luftwaffe had visited on England. And although Europe remained the top priority, US forces in the South Pacific secured Guadalcanal, then moved on against the Japanese in New Guinea, Bougainville, and, by the end of 1943, Tarawa.
By mid-1943, the momentum had shifted to favor the Grand Alliance, but only hostility to the Axis united its constituent nations. The United States, Britain, and the Soviet Union had differing outlooks and postwar objectives. If these could not be reconciled, the peace would not be won. Roosevelt saw himself as the American democrat who must serve as the linchpin in an improbable alliance with an old Tory imperialist and an old Bolshevik.
His key target was the Soviet Union. Britain was, to use Winston Churchill’s language, “in the harem,” dependent on American support. Stalin’s communications, always formal and correct and without a
trace of the joviality that characterized the president’s exchanges with Churchill, pounded constant complaints about the need for more aid and the failure to follow through on the promise of a second front. Roosevelt was anxious to meet one-on-one with the Russian dictator, take his measure, charm him, and above all assure him of American good intentions.
Developments on the eastern front created new difficulties for Roosevelt. In April 1943 the Germans had discovered in western Russia’s Katyn Forest the mass graves of some 10,000 Polish army officers, executed with bullets to the back of the head. The Soviet Union denied culpability, blamed the Nazis, and charged the Polish government-in-exile (based in London) of collaborating in the killings. The evidence against the USSR and its dictator was compelling, but neither Roosevelt nor Churchill was willing to risk a rupture with Stalin. They pressured Polish prime minister Wladyslaw Sikorski into withdrawing a request for an independent investigation by the International Red Cross.
Writing to Stalin on April 26, Roosevelt asked him to maintain diplomatic relations with the London Poles, called Sikorski’s request for an investigation “a mistake,” and offered to help in “looking after any Poles you may desire to send out of Russia.” He concluded, “Incidentally, I have several million Poles in the United States, very many of them in the Army and Navy. They are all bitter against the Nazis and knowledge of a complete diplomatic break between you and Sikorski would not help the situation.” Stalin’s response was unyielding: “It is conceivable that Mr. Sikorski himself has no intention of cooperating with Hitler’s gangsters. . . . I do, however, consider that Mr. Sikorski allowed himself to be led by certain pro-Hitler elements. . . . [A]s a result the Polish government, very possibly involuntarily, became a tool in Hitler’s hands.” That July, as he returned to London after inspecting Polish army forces in the Middle East, Sikorski was killed when his plane crashed on takeoff from Gibraltar. Inevitably, rumors, however improbable, of sabotage circulated.1
Man of Destiny: FDR and the Making of the American Century Page 51