The initial part of this account is from
except where noted. After Reagan enters the operating room, the account
Times, shown in the leftmost column, start at 2:30 p.m. on March 30.
||Shots are fired outside the Hilton Hotel in Washington, DC.
Reagan is pushed (hard) into his limosine and swears
when Secret Service agent Jerry Parr lands on top of him. The limo heads for the
White House (at high speed, one would presume), ten minutes away.
At first joking about his "flying entrance"
into the car,
Reagan starts coughing up bright red blood and becomes distressed as the limo
passes through the tunnel under Dupont Circle. He later recalled feeling
"the most paralyzing pain... as if someone hit you with a hammer."
Because he felt the pain only after entering the car, he thinks it's a rib
fracture caused by Parr. "But when I sat up on the seat and the pain
wouldn't go away and suddenly I found that I was coughing up blood, we both
decided that maybe I had broken a rib and punctured a lung."
(Agent Parr must have been feeling pretty low at this point!)
In a crucial (and correct) decision,
Parr tells the driver, agent Drew Unrue, to head for George Washington
University Hospital (GW). Reagan recalled "By then my handkerchief was sopped
with blood and he [Parr] handed me his. Suddenly I realized I could barely
breathe. No matter how hard I tried, I couldn't get enough air. I was frightened
and started to panic a little. I just was not able to inhale enough air."
The ER staff at GW is notified that three victims of gunshot wounds are
inbound, but identities are not mentioned.
The path to GW passes within a block of the White House.
||Reagan's limosine arrives at the entrance of the GW Emergency Room.
No stretcher is waiting. Helped
by Secret Service agents, Reagan walks about 45 feet into the building,
whereupon his "eyes rolled upward, and his head went back, his knees
buckled and he started to collapse," according to a witness. Gasping for
air, Reagan fell to one knee and said "I can't breathe."
He is placed on a stretcher, nurses start cutting his $1000 suit off, and he is
wheeled into the emergency room.
Nurse Kathy Paul notes blood on Reagan. An intern,
Dr. William O'Neill,
observes that Reagan is in "acute distress" and believes it is a
"life-threatening situation." A resident,
Dr. Wesley Price,
sees a clean slit-shaped bullet hole, slightly larger than 1 cm,
below Reagan's left armpit -- in the fourth interspace of the posterior
No exit hole is visible, so it is assumed the bullet remains inside.
Nurse Wendy Koenig tries to take Reagan's blood pressure, but cannot,
because of the noise caused by Secret Service agents and members of the
trauma team. About 15 or 20 people are in the ER.
Reagan's personal physician,
Dr. Daniel Ruge,
was in the motorcade. He arrives in the ER and stays by Reagan's side
Reagan later recalled "It was a very close call. Twice they could
not find my pulse." Ruge, however, had his finger on Reagan's dorsalis
pedis artery (on the top of the foot) and has said that Reagan's pulse never
By palpation, Reagan's systolic blood pressure (i.e. "the
top number") is 78. His usual blood pressure is 140/80.
His pulse is rapid, he looks pale, and he is clammy.
(Another reference says blood pressure was 80, pulse was 80 (which is not
rapid), and respirations were 30/minute (which is rapid)
The trauma team, now led by
Dr. Joseph Giordano,
inserts IV lines in both arms and starts infusing fluid (Ringer's lactate and
normal saline). The team also places an arterial line in the left wrist and a
Foley catheter in the bladder
[To come: Name of person who put in Foley
At some point, someone listens with a stethoscope to Reagan's chest and finds
breath sounds are fainter on the left side
This suggests the left lung has collapsed. Reagan gets oxygen through
a plastic tube below his nostrils.
||With three IV lines now in place, blood transfusion begins, apparently
with two units of O-negative blood. (In other words, the trauma team did
not wait to check Reagan's blood type -- they used "universal donor"
An anesthesiologist administers oxygen to Reagan by facemask, but
Reagan still complains of breathlessness and continues to cough up
blood. His breathing is fast and labored. His blood pressure starts rising.
Reagan is now aware he has been shot. His wife, Nancy, arrives from the
White House. She later remembered, "Ronnie looked pale and gray. ...
Underneath the oxygen mask, his lips were caked with dried blood. He saw me,
and pulled up the mask and whispered, `Honey, I forgot to duck.'"
|2:45 - 3:00
||Dr. Giordano inserts two plastic tubes into Reagans left chest cavity, one through
a small incision just beneath the collar bone, and one through an incision
between the seventh and eighth ribs. A large volume of blood comes out through
the chest tubes.
Another reference says Giordano inserted one Argyle No. 36 straight chest
tube in the anterior axillary line, which was then hooked to suction
||Reagan received 900, then 1200, then 1800 cc of blood. Dr. Giordano
recalled: "The man had a blood pressure of 70/0.... He had an enormous
amount of blood in his chest, more than I have seen in most injuries of
this type.... He had initially something like 2200 or 2400 cc of blood that
came out [through the chest tubes]. There is no doubt in my mind that
another five or ten minutes and he may have been at the point of no return."
||A chest x-ray shows the bullet behind the heart and blood in the left chest
cavity ("a hazy left hemothorax"). An x-ray of the abdomen is also obtained, because it was not clear
that the bullet in the chest matched the gun used, but no bullet was seen.
||Blood loss continues.
Dr. Benjamin Aaron,
the chief of thoracic surgery at GW, decides surgery is necessary to stop it.
||Reagan is made ready for surgery.
||Reagan is wheeled into the operating room. To this point he has lost
2100 cc of blood and has received 4 1/2 units of blood.
says he had lost 2275 cc of blood, and had been given 3 liters of Ringer's
and saline, and 2 3/4 units of packed red blood cells of types O-positive and
It further says his
vital signs were now: blood pressure 160 systolic, pulse 90, respirations 25.
As Reagan is moved from his stretcher to the operating table, he says to the
surgeons "Please tell me you're all Republicans." (Reagan was a
Republican.) Giordano answers: "We're all Republicans today."
Dr. George Morales and
Dr. Manfred Lichtman
anesthetize Reagan with intravenous sodium Pentothal (thiopental). They also
give a muscle relaxant. They then put a breathing tube into Reagan's airpipe
(trachea) and connect it to a mechanical respirator.
To ensure there is no damage in the abdomen,
Dr. Joseph Giordano,
Dr. Wesley Price, and
Dr. David Gens
perform a "peritoneal lavage" through a 3 cm incision in the skin
just below the umbilicus (belly button), as follows:
A liter of Ringer's lactate fluid
is run into the abdomen. Reagan is tilted head-up, then head-down, and the
fluid is then drained out. No blood is
in the drained-out fluid, making it unlikely that any of the abdominal organs are
bleeding. This takes 40 minutes.
Reagan is turned on his right side.
Dr. Benjamin Aaron,
Dr. Kathleen Cheney, and
Dr. David Adelbery
perform a left anterior thoracotomy: they open the chest through a six-inch
incision in the fifth interspace (the groove between ribs 5 and 6). Retractors
spread the ribs. Aaron can feel that the seventh rib was splintered.
He removes a clot of blood from outside the lung (apparently about 500 cc worth),
bringing total blood loss to 3100 cc at this point.
With the clot removed, Aaron determines the site where the bullet entered
the lung. The heart, great vessels, and esophagus appear undamaged.
Aaron recalled: "At the time we loooked in, there was a lot of blood in
the chest -- mostly clotted -- maybe a liter or more. The entrance hole in
the lung, out of which dark dark red blood was trickling fairly briskly, was
very large. ... The major bleeding was occurring right there locally, at a
point not too far from the pulmonary artery. We were able to take a suture
locally and control the bleeding; we didn't have to do anything major. That
was it as far as the lung bleeding was concerned."
Aaron is concerned about the amount of destroyed lung tissue, however, and
considers removing the lower lobe of the lung. He elects not to, because
"it wasn't bleeding that bad [and because] most of the lung looked pretty
good." This is a "calculated risk," in Aaron's words.
Aaron is unable to see or feel the bullet. He almost gave up trying to
remove it. Dr. Zebra recalls reading (somewhere) that the surgeons (and others?)
discussed the medical necessity of removing the bullet.
The symbolic effects of allowing a President to walk around carrying an
(attempted) assassin's bullet is raised, and so the decision is made to find
it and remove it.
An angled x-ray is taken. It shows a metal fragment in the lower part of the
lung, just behind the heart. With this information, Aaron finds the
bullet, flattened into the size and shape of a dime,
lying in tissue about one inch from the heart.
Aaron recalled: "The bullet had traversed the lung and was lying against the
pleura on the other side; rather than fish clear through the lung, we made an
exit hole for it."
|6:00 - 6:20
Aaron begins closing the chest. The operation ends with placement of chest
tubes in the apex and base of the chest.
While in the operating room, Reagan had received
an additional 2700 cc of Ringer's lactate and normal saline, along with 5 1/4 units
of packed red cells, 3 units of fresh frozen plasma, and 290 cc of pheresed
platelets (to stem bleeding).
All told, Reagan had lost 3400 cc of blood -- over half of the blood in his
body. A total of eight units of packed red cells had been transfused.
|6:20 - 6:45
Closely watched in the operating room. Is still on the ventilator.
Almost 3 1/2 hours after entering the operating room, Reagan is moved to the
recovery room. A chest x-ray shows the lower lobe of the left lung is
collapsed, plus blood in the chest cavity, and patches of unexpanded lung.
He is still connected to the respirator, which is delivering oxygen via
positive pressure (a sign that his lung function was poor).
At perhaps this time, Reagan is breathing 80% oxygen, but has a blood oxygen
level of only 115. Aaron attempts to bronchoscope him through the endotracheal
(breathing) tube, but fails because of a bend in the tube. (This is confusing in
because it also says Reagan was getting oxygen nasally, which makes no sense
when an endotracheal tube is in place.)
Dr. Samuel Spagnolo
Dr. Jack Zimmerman
consult. Hyperinflation (probably meaening positive pressure), saline
lavage (perhaps this refers to 8:50 events, below), and tracheal suction are
all tried, and improve Reagan's oxygenation somewhat.
The administration of cefamandole (an antibiotic) at a dose of one gram
every six hours, intravenously, is started. (It goes for 48 hours.)
||Regaining consciousness as the anesthetic wears off. Visits briefly
with his wife (but is unable to speak because of the breathing tube).
||Given morphine for chest pain.
||To loosen mucus plugs in his large airways (bronchi), fluid is put into
his breathing tube. This causes coughing. Reagan scribbles "All in all,
I'd rather be in Philadelphia."
Sleeps little during the night. Requires morphine for chest pain.
||His oxygen and carbon dioxide levels improve, so he is disconnected from
the ventilator. The breathing tube remains in his airpipe. it is not clear
that Reagan understands he has had surgery.
||The endotracheal (breathing) tube, the nasogastric tube, the arterial line,
and the Foley (bladder) catheter are all removed.
Shortly before this time, one of the medical team
members says "This is it." Hearing this,
Reagan "blanched, clutched a pad
of paper and scribbled a note to a nearby nurse: `What does he mean -- this
is it?'" The situation is explained, and Reagan calms down.
||Awake much of the rest of the night. Talking to recovery room staff.
||Is moved to intensive care unit. Is getting oxygen through his nose. Is
prescribed deep-breathing exercises. Gets physical therapy.
||Propped up in bed. Brushes his own teeth.
||Gets morphine for chest pain. Not long afterwards, signs farming legislation.
|9:00 p.m. (Day 2) (Mar. 31)
||Moved from intensive care unit to a suite in the hospital.
One of the surgeons remembered: "We pushed
to get him out of the ICU because we knew he'd be better some place that was
quieter. The environment was getting him a little disoriented."
|Bladder catheterization performed because he has been unable to urinate.
Continues to cough up blood. Oxygen therapy re-started in the morning.
Appetite good -- ate a normal breakfast and lunch. Falls asleep about
9:00 p.m., and sleeps until 6:00 a.m. the next morning.
|Intravenous tubes are removed in the morning. Surgeons remove the stitches
in the abdomen. Chest tubes and nasal oxygen continue. Is able to walk a bit.
Late in the day, less than 24 hours after going off antibiotics,
Reagan's temperature rises to 102-103 degrees F. His white
blood cell count was high, his color was poor, he felt tired, and is couging up
"a little" blood.
views this fever "with great alarm." Chest x-ray shows haziness
in the left lower chest. The two leading diagnoses are infection and bleeding.
Aaron was prepared to remove the lower left lobe of Reagan's lung if the
bleeding became "aggressive."
Instead, Reagan is started on new antibiotics.
(Either that, or cefamandole is restarted.)
No organism is ever cultured from him.
|Fever is up and down in the 101-102 degree range. A portable chest x-ray
is of inadequate quality.
Dr. David Rockoff,
the chief of chest radiology, urged a chest x-ray be taken in the radiology
department. This is done after the Secret Service sweeps the area. The x-ray
shows a problem in the left lower lung, but yields no specific diagnosis.
Dr. Aaron performs bronchoscopy, and removes bronchial casts.
Reagan gets chills in the evening, raising the
probability of infection. A broad-spectrum antibiotic is added.
(Possibly cefamandole is restarted.)
Reagan's breathing exercises are increased, and his schedule cut back.
He sleeps well.
|Reagan is tired. Sleeps much of the day.
A coughing fit brings up bright red blood, different from the dark blood of earlier.
Fever is lower.
|Temperature is 39.3 C, white cell count rises to 16,100, and chest x-ray shows
patchy densities along the bullet track.
The chief of infectious diseases,
Dr. Carmelita Tuazon,
is consulted. Cefamandole is stopped. Penicillin (1 million units every
four hours) and tobramycin (80 mg every 8 hours) are given intravenously.
Hyperimmune B. globulin (? beta globulin) (5 cc) and gamma globulin (5 cc)
are given intramuscularly (i.e. a shot in the buttocks). Respiratory
therapy is increased.
Because the bullet was lead, a blood lead level is checked. It is
"normal" for an adult.
The normal blood lead level for a human is zero (or darn close), so it
would have been better to say the blood lead level was unremrakable.
|Temperature nearing normal. Antibiotics continue. Chest x-ray shows improvement.
|Reagan is able to work about two hours per day. He has been signing
documents without fully reading them. Briefings have been condensed for him.
|Temperature is normal. Reagan feels much better. Tobramycin is stopped.
It is obvious that Reagan has lost weight.
|Temperature is 36.6 C (within normal range), hemoglobin 11.6, hematocrit 33.2%,
white cell count was 10,000.
Reagan is discharged from the hospital at 10:44 a.m. At the White House, he
walks from the limosine into the building and into an elevator. At close
quarters, he appears weak and drawn.
|Reagan awakens at 6:50 a.m. to watch the first flight of the U.S. space shuttle
(R.I.P. Columbia). He rests most of the day and works for about two hours.
To a visitor, and to Secretary of State Alexander Haig, Reagan is
"pale and disoriented ... walking with the hesitant steps of an old man."
When Reagan sits in a chair, he goes down heavily. He can remain attentive
for only about an hour a day.
Intravenous penicillin is switched to oral penicillin, which continues for a week.
George H.W. Bush
is performing various official duties of the President, including leading
|About this time, Reagan increases his work to 4-5 hours a day.
It is claimed he can now do as much paperwork each day as he did before the shooting.
|Dr. Aaron sees a pajama-clad Reagan for about 30 minutes. Reagan favors
his left side when breathing and says it hurts a little. Aaron recalled,
"maybe he did reflect a lack of stamina and a lack of concentration."
|Attends first Cabinet meeting since the shooting.
|Reagan is not well enough to attend his daughter's (third) marriage.
|Goes on his first trip outside Washington since the shooting (to Indiana).
|Holds his first news conference since the shooting. States he feels well.
considers that Regan did not fully recover until October, recalling:
"We were at the ranch in October, and the president said to me, `Now I
really feel like I am all the way.' He felt better than he did in June."
||Ultimately, Reagan was left with
stable, mild dyspnea associated with moderately
severe exertion. On subsequent examinations, the results of expansion of the
chest appear to be normal. A well-healed left anterior axillary thoracotomy
scar is present with a barely audible pleural friction rub under the area of
the scar... Air movement is good bilaterally without rales, rhonchi or wheezes.
||The donors of the blood products infused into Reagan, and the blood products
themselves, were checked for hepatitis; all tests were negative
(It is unclear to Dr. Zebra if these donors were contacted in person; this
would be very unusual, but the language in the reference does not rule it out.)