Emergency in Room 5A

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But during the 45 minutes of peritoneal lavage, blood continued draining out of the chest tube, an unusual occurrence. In the majority of bullet wounds to the chest, bleeding stops soon after the lung is reinflated. By now Reagan had required a transfusion of five units of blood; that meant he had lost about 2% quarts of blood, almost half the total amount circulating in his body. Continued bleeding can be a sign that a bullet has caused major damage to organs and blood vessels in the chest cavity. To assess the extent of the injury and to locate the source of bleeding, doctors decided to operate. "It was a major bleed," said Hospital Spokesman Dr. Dennis O'Leary. "That was why surgery was required." If Reagan had not bled so heavily, surgery might not have been done immediately. But an operation would probably have been necessary eventually. Though bullets are frequently left inside the body when they do not threaten further damage, a bullet in the lung can travel to the heart and obstruct the flow of blood.

Reagan was rolled next door into an operating suite. Under the watchful eyes of two scrubbed and gowned Secret Service agents and the President's personal physician, Dr. Daniel Ruge, doctors began anesthetizing the President. They inserted a tube into his mouth and down his windpipe and put him on a mechanical respirator. Then he was gently turned onto his right side and placed at a 45° angle. In the operation, called a thoracotomy, surgeons made a 6-in. incision extending from just below the left nipple, along the ribs to just below the left armpit. Spreading the ribs and the overlying muscles apart, they first noticed a massive blood clot and removed it. Then they checked the heart and major blood vessels for damage but found none. They tried to follow the path of the bullet to locate the slug. This proved difficult so another X ray was taken.

The doctors finally retrieved the bullet from the lower lobe of the left lung. Said Aaron: "It was flattened almost as thin as a dime, and about the size of a dime too."

From their examination, doctors concluded that the bullet plowed through the chest wall at an angle, struck the seventh rib and ricocheted down 3 in. into the lung. Its oblique path kept it a good 3 in. away from the heart.

Reagan was fortunate that his assailant used a small-caliber, low-velocity gun. A .45-cal. bullet, twice as wide and five times as heavy as a .22, would have torn up the President's flank and probably killed him quickly, if not instantly. But he could have been luckier: if his arm had been hit, the bullet might not have reached his torso; if the bullet had not glanced off the rib, it might have just passed on through the chest wall and out of the body without hitting any internal organ.