Doctors' Chilling Tale Of Reagan Shooting -- Physicians Agonized Over Retrieving Bullet

CHICAGO - In a landmark report yesterday, the doctors who treated former President Reagan after he was shot in an assassination attempt 13 years ago present a chilling medical account of one of the closest calls in American political history.

The report notes that the bullet in Reagan's left lung stopped only an inch from his heart and attributes his survival to fast thinking by the Secret Service, a dedicated medical team and a remarkably courageous patient.

But neither speed nor valor, it turned out, could prevent post-surgical complications - including a fear that Reagan had received tainted blood - that threatened the only incumbent president ever to survive having been shot.

The "special communication," which appears in this week's Journal of the American Medical Association, along with accompanying articles by former President Carter and others, is likely to rekindle the debate about presidential succession in the face of physical or mental disability.

Writing with the "permission and encouragement" of the former president, chest surgeon Benjamin L. Aaron and radiologist S. David Rockoff of the George Washington University Medical Center in Washington reported they spent two hours trying to find the bullet lodged in Reagan's left lung after John Hinckley shot him at 2:25 p.m. on March 30, 1981 outside a Washington hotel.

NO CT SCANS THEN

"We didn't have CT scans then, and the first X-rays failed to give us the exact location of the bullet," Aaron said. "I think what was happening was that I'd squeeze the lung between my fingers and the bullet would scoot away - like pushing toothpaste out of the tube."

Worried about overstressing a 70-year-old patient, the physicians agonized over whether to stop the operation without retrieving the bullet.

They decided to keep working. "If we couldn't find the bullet," he said, "there was a possibility that it had migrated into the heart. Then it could have been ejected into the bloodstream and gone anywhere in the body."

But they also were concerned about obtaining the missile for ballistics tests and evidence in court. "A less important and non-medical consideration for continuing," they wrote, "was the perception that to leave a would-be assassin's bullet in the chest of the president of the United States might be poorly accepted by the public."

Fortunately, a few minutes later Aaron found the flattened fragment. The .22 caliber bullet was a "devastator," designed to explode on impact. It contained poisonous lead azide.

FEAR BEHIND ROBUST IMAGE

The devastator bullets failed to explode in Reagan, or in Secret Service Agent Timothy McCarthy or Washington police officer Thomas Delahanty, who also were shot by Hinckley. But the bullet that struck Press Secretary James Brady in the head did explode, leaving him permanently disabled.

Soon after his surgery, Reagan presented a robust image to the public. But behind the scenes, the physicians reported, matters were less certain.

Fever and chills set off warning alarms. Reagan had received eight units of blood. The ultimate nightmare loomed: Perhaps the president of the United States had received tainted blood during surgery.

"We didn't know about HIV infection back then," Aaron said. "But we sure knew about hepatitis."

In a frenzy of chemical analyses, the Centers for Disease Control quickly found that three of the eight empty blood bags were "suspicious," and one was in a "possible" category for hepatitis B. Doctors immediately treated the president with drugs that provided antibodies to the hepatitis virus.

The authors quoted Reagan's recollections of the incident:

"What the hell's that?" said Reagan, reacting to what sounded like firecrackers as he emerged from the hotel. The head of his Secret Service unit hurled him into the limousine and jumped on top of him.

"Get off," he begged the agent. "I think you've broken one of my ribs."

As the limousine changed its course from the White House to the hospital, the president coughed up blood.

"You not only broke a rib," he told the agent, "I think the rib punctured my lung."

When he walked through the emergency room doors at 2:35, the president dropped to one knee and gasped for air. Then he collapsed and was carried to the trauma room.

Doctors noted blood in his mouth. But they didn't realize he had been shot until his clothing was removed.

As earlier accounts have documented, Reagan soon regained his sense of humor. When the first lady arrived at the hospital, within 15 minutes, her husband told her: "Honey, I forgot to duck," a reference to Jack Dempsey's famous line after being knocked out by Gene Tunney.

X-rays revealed the bullet had lodged near the president's heart.

After the doctors finally found the bullet, it was removed and handed to a waiting Secret Service agent.

Reagan, on a ventilator, gradually awakened by 7:30 p.m. and soon was scribbling messages.

"Am I dead?" read one.

Then his notes became more serious, the doctors reported.

"What happened to the guy with the gun?" Reagan asked. "What was his beef? Was anyone hurt? . . . "Will I still be able to work on the ranch?"

CALL TO IMPROVE POWER TRANSFER

After the hepatitis scare, Reagan's recovery proceeded normally.

In a related JAMA article, former President Carter called for efforts to address weaknesses in the 25th Amendment to the Constitution, which allows a president to certify a disability, transfer responsibilities to the vice president and then resume them when healthy.

Carter has proposed that a nonpartisan medical panel help make the determination, rather than the president's staff and members of the Cabinet.