Opinion: What Ronald Reagan knew about being a VIP patient

The date was March 30, 1981. John Hinckley Jr. had fired six shots with a .22 revolver. One bullet ricocheted off the presidential limousine and hit the President in the chest, fracturing a rib and tearing through a pulmonary artery. Without rapid intervention, Reagan would have bled to death.
Dr. Joe Giordano was the trauma team leader at the time and received a stat call to the emergency room. He found the President on a gurney surrounded by many people.

When the limousine arrived, Reagan had insisted on walking in, his arms draped around two Secret Service agents. Once inside, he collapsed. Giordano and the rest of his team rapidly evaluated the President using the established protocols. They quickly identified his chest injury and he was stabilized and taken to the operating room.

I worked at George Washington University Hospital years later and had the opportunity to get to know Giordano a little. I told him he had won the Cold War. The resuscitation of Reagan stands out as an example of what can happen when medical treatment unfolds according to the standard of practice. What might be hard to understand is that instead of getting the best care, famous people tend to get care that can be scattered, inconsistent and sometimes even harmful.

We call it VIP syndrome. It occurs primarily because the normal doctor-patient relationship is upended by a famous patient with a complex and demanding case and a star-struck doctor.

Celebrity culture is all around us and President Donald Trump is a vainglorious adherent. When he was suddenly and briefly hospitalized for Covid-19, he apparently received the sort of care reserved for seriously ill patients. I speak from experience, as my practice is full-time critical care and like many of my colleagues, I have become expert in the care of patients suffering from Covid-19.

The truth about Trump’s health remains unknown. We have all, by now, witnessed Dr. Sean Conley, the White House physician, giving the awkward and opaque briefings arrayed in a white coat at Walter Reed Army Medical Center, with details later walked back because they were untrue (he finally claimed that medical privacy laws prevented him from revealing the facts).

Sometimes the doctor-patient relationship can simply not go forward. Legal precedent and bioethical conduct permits the severing of the relationship. Sometimes, patients become intractable and we become complicit in a series of patient-demanded maleficent choices. We winced when we watched Conley use language about Trump’s health that we know is nonsense.

We crave something less craven. The practice of medicine needs to reclaim itself.

Reagan was responsive during the entire resuscitation and at one point said that he hoped all in attendance were Republicans. Giordano (who was not) later recalled that he said under the circumstances, at that moment, they all were. It was an elegant answer but did not bespeak Giordano’s political leanings nor any desire to share Reagan’s limelight.

Rather, it would serve as a reminder that physicians do their best work when they put such concerns to the side and focus on the patient as an embodied being whose persona and social status are in some ways irrelevant.

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