Emergency in Room 5A

• Share

As the world watched, calm doctors performed their ritual

It is the kind of emergency familiar to trauma teams across the nation, particularly at places like New York City's Bellevue Hospital Center and Chicago's Cook County Hospital. The difference this time was the victim: not some dope dealer or faithless lover, but the President of the U.S. But even with the world watching, the medical ritual was the same.

As soon as Ronald Reagan was carried into Room 5A of George Washington University Hospital's emergency unit, a hastily assembled team of more than a dozen doctors plus paramedics, nurses and aides swung into action. Seemingly in disorganized fashion, but actually with speed and precision, they moved toward one goal: stabilizing the patient as quickly as possible. Oxygen was administered to aid the President in breathing, and fluids were given intravenously to raise his blood pressure. A reading indicated that the systolic pressure (when the heart contracts) had dropped below 100, alarmingly low. Simultaneously, his clothing was cut away; as soon as the jacket and shirt were off, an oozing, slitlike bullet hole was discovered just under the left armpit.

Because Reagan was coughing up bright red blood and complaining of chest pain on his left side and difficulty in breathing, doctors immediately suspected that his lung had been injured and probably collapsed, a common result of gunshot wounds to the chest. Normally, the pressure in the space between the lung and the chest wall is less than atmospheric pressure, and this keeps the lung expanded; when the chest wall is pierced, air enters and forces the lung to collapse. To reinflate it, doctors made two small incisions, one just below the collarbone and the other between the seventh and eighth ribs, and inserted tubes to suction off air and any blood that might have accumulated from damage to the heart, lungs or major blood vessels in the chest. About two pints of blood spilled out. Immediately doctors started transfusing blood, using O negative, a blood type any person can accept. (Later they began using Reagan's own type, O positive.) All this was accomplished within five minutes of his arrival.

That done, the trauma team could proceed more deliberately. X rays of the chest and abdomen were taken to try to lo cate the bullet; blood samples were analyzed for gases to help determine how much oxygen was getting into the blood. To see whether there was bleeding in the abdominal cavity as well, the team performed a procedure known as peritoneal lavage. Surgeons Benjamin Aaron and Joseph Giordano, who headed up the trauma team, made a small incision just below the President's navel, inserted a tube and infused several liters of fluid, filling the abdominal cavity. Then the fluid was withdrawn and examined for blood. It was clear, indicating that Reagan had suffered no injury to abdominal organs.