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Saving President Reagan

En route to the emergency room at George Washington University Hospital, Dr. Paul Colombani noticed a black limousine emblazoned with the presidential seal in the driveway.

He told fellow surgical resident Dr. David Gens to look, but the significance didn't immediately register as they headed toward the waiting trauma patients.

In Colombani's bay was James Brady, Ronald Reagan's press secretary, shot in the head. In Gens' bay was the 40th president of the United States, shot in the chest just two months on the job.

Brady's death was erroneously reported in the hours after the shooting at the Washington Hilton, but the public was reassured that Reagan's injuries were not so severe. In reality, Reagan was bleeding to death and it would take some skill, and luck, to save the man and his historic presidency.

But doctors were treating him like any other patient on March 30, 1981, almost 30 years ago.

"When you take their clothes off, they're all the same," said Gens, now an associate professor of surgery at the University of Maryland School of Medicine and an attending physician at Maryland Shock Trauma. "They're just people."

Gens and Colombani, now chief of pediatric surgery at Johns Hopkins Children's Center, were 31 and 29, respectively, at the time and in the fifth year of their surgical residencies, the first jobs outside medical school. They were part of a team that worked on Reagan, Brady and Tim McCarthy, a Secret Service agent who threw himself in the line of fire.
The pair said they don't regularly think about the shooting and told their full story publicly for the first time in a newly published book called "Rawhide Down" Rawhide was Reagan's Secret Service name. The two men met recently in Colombani's office, one of about a half-dozen times they'd seen each other since they left George Washington at the end of that year for the hospitals in Baltimore.

Over the years, many other dignitaries have crossed their paths, from senators to Arab princes, and all got the same care as everyone else. "If you start making exceptions for VIPs, you start making mistakes," Colombani said. But some things were definitely different about the 12 days they treated Reagan, when snipers crouched on the hospital roof, when items ranging from salt to saline were considered potential poisons, and when a 70-year-old president nearly died on their watch.

Reagan had just given a speech when John Hinckley Jr., in a misguided attempt to impress actress Jodie Foster, got off six shots from his revolver before he was subdued.

Jerry Parr, the agent in charge of Reagan's security detail, immediately pushed the president into his car. Reagan was shaken and had blood on his lips, and Parr, unaware of the gunshot wound, worried he'd cracked a rib. The source of the attack wasn't completely clear to Parr, but he decided to forgo the security of the White House for medical care at George Washington, according to the book, written by Del Quentin Wilber, a Washington Post reporter who formerly worrked for The Baltimore Sun.

A half-hour after the shooting, Gens and Colombani were in the emergency room, Reagan's suit had been cut off and doctors could see the bullet hole. Reagan, likely in shock, said he was having trouble breathing.

"When someone says he can't breathe after being shot, he's in trouble," said Gens. Then, he and Colombani both concluded, "If they had taken him to the White House, he would have died."

The bullet, officials now believe, had hit the limousine, flattened like a dime and ricocheted into Reagan. The .22-caliber shell had been fired by a small revolver and had just enough strength to penetrate and partially shred Reagan's left lung. The doctors now say if it had been fired by a higher-powered rifle or was a larger bullet, it could have traveled farther and done more damage or even killed Reagan on the spot.

As it was, the bullet hit a vessel, causing internal bleeding. On a more stable patient, doctors would have ordered X-rays to look for fluid, but the troubled breathing was a telltale sign that blood was filling Reagan's lung and fast.

He was pumped full of fluids and blood in an effort to boost his blood pressure. It was part of a detailed and highly choreographed protocol developed at George Washington by Dr. Joe Giordano, head of the trauma teams, who had spent time a few years before in Baltimore at Shock Trauma, then one of the nation's limited number of sophisticated trauma hospitals. There are now some 470 trauma hospitals in the nation, which Gens and Colombani say are preventing many more deaths.

"I learned there weren't a lot of real trauma centers in the '60s and '70s, but GW decided to ramp up its care, and by 1981 Reagan was benefiting," said Wilber. "It was one of the key decisions that saved Reagan that day. Parr's gutsy decision to take him there was another."

It had become clear that Reagan's bleeding was not going to stop on its own. The doctors believed he'd lost close to half his own blood, and a half-hour after arriving he was headed to the operating room.

Reagan, the doctors confirmed, quipped, "I hope you are all Republicans."

After quickly confirming there was no blood in his belly, Dr. Ben Aaron, chief of cardiovascular and thoracic surgery, and Gens repaired the torn vessel in his chest and stopped the bleeding. Reagan was taken to a room prepared for him, with bulletproof buffers and a guard equipped with a long, heavy flashlight and an Uzi housed in a briefcase with one clasp open. Gens and Colombani, who had operated on both Brady and the Secret Service agent, said they were given pins to show they were authorized to enter.

Brady, who had the pieces of bullet extracted from his head, survived but never fully recovered. McCarthy fared better (though the Secret Service insisted that Colombani break with practice and search for his bullet, because Reagan's was flattened and Brady's was destroyed and of no use in the ensuing investigation).

For nearly two weeks, Reagan would become the two doctors' primary mission. Colombani told his wife to forget dinner together. Gens had his wife bring fresh socks and underwear and napped in the comfortable chairs of the dialysis unit.

The duty even landed them in strategy sessions with Nancy Reagan and Michael Deaver, who served as Reagan's depurty chief of staff and image maker. They discussed how Reagan would walk, against policy and perhaps common sense, out of the hospital and wave. "One grimace, and the Russians would know," Gens said they believed.

Gens said he also had the uncomfortable duty for three days of refusing the first lady's request to remove the oxygen tube in Reagan's nose for a press photo.

Aside from suffering a fever, Reagan made a remarkable recovery for a man of his age, said the doctors, who saw the president at the White House about a month later and again in a year.

Today, Gens and Colombani, who still operate on all sorts of traumas, said little has changed in emergency care. Machines that monitor heart and lung function are more sophisticated and scanning equipment is more readily used. But patients, from those shot on the streets of Baltimore to royalty, are all still the same once they have their clothes off.

Source: By Meredith Cohn, The Baltimore Sun

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