Rachel Feltman: For Scientific American’s Science Shortly, I’m Rachel Feltman.
Being a physician is difficult sufficient, however think about having a affected person whose well being has direct implications for nationwide safety and world politics. Presidential physicians face distinctive medical challenges, from making ready for gunshot wounds to managing the well being care of somebody with a grueling schedule. After which there’s the query of transparency: How a lot ought to the general public find out about a president’s well being?
Jeffrey Kuhlman served as doctor to the president from 2009 to 2013. He additionally held different medical roles on the White Home, like Director of the White Home Medical Unit, White Home Doctor and Senior Medical Officer for the Marine One squadron, for greater than a decade earlier than that. His current e-book Remodeling Presidential Healthcare presents a uncommon inside have a look at what it takes to maintain commanders in chief wholesome. He just lately chatted with Scientific American affiliate editor Lauren Younger. Right here’s their dialog.
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Lauren Younger: Inform me the way you turned a doctor to the president. How does one discover themselves in such an essential medical position?
Jeffrey Kuhlman: Like many issues in life it’s being in the fitting place on the proper time. I might say it in all probability began a decade earlier or two. I used to be a highschool senior, March 30, 1981, and I heard on the radio, “Pictures fired,” for President Reagan—his code signal was “Rawhide,” so: “Rawhide down”—and so they had taken him to the hospital, to George Washington [University Hospital]. And that’s the place they handled him like a trauma affected person as an alternative of like a VIP and saved his life.
In order that was that set up within the mind of, “Hey, there’s truly medical doctors and nurses that maintain the president.” I didn’t assume a lot of that. I went to varsity, went to medical faculty—the Navy paid for my manner. And I had hardship excursions in Pearl Harbor and in London for Naval Forces Europe, after which I discovered myself being assigned to the president’s helicopter squadron in Quantico, Virginia.
And President [Bill] Clinton, his second time period, he was in just a little hassle at house, so he spent numerous time going abroad, so I did 18 overseas journeys that point. We maintain everybody that’s on these journeys. And that’s when the White Home physicians on the time have been simply extraordinarily glad that I used to be caring for everybody and stated, “You’re gonna work right here,” so they really despatched me orders. So I used to be sort of in the fitting place on the proper time with the fitting schooling, the fitting expertise and, most significantly, a supportive household.
And one of many hardest issues is getting the top-secret Yankee White clearance. And in order that’s—you’ve gotten unimpeded entry to the president and, with that, their schedule. You may be in a room alone with them with life-and-death medicines. And getting that top-secret clearance—fortunately, I’ve lived a fairly boring life, so I didn’t get into hassle. I used to be privileged to maintain 5 and a half presidents, and a few decade later I wrote a e-book, just lately out, Remodeling Presidential Healthcare, and principally, it’s guaranteeing continuity of the presidency to the commander in chief.
Younger: Wow, what a journey. You point out that you simply’ve served 5 and a half—I believe you stated, proper—5 and a half presidents. Who’s the half [laughs]?
Kuhlman: For those who learn the e-book Remodeling Presidential Healthcare, it goes by way of the 5. So it goes by way of: President Clinton—I received to the White Home on the tail finish of his presidency, in his final months. President Clinton, although I simply met with him a pair instances for, like, a minute or two, he has a presence about him that, at that second in time, he makes you are feeling such as you’re crucial particular person on the earth, that he’s centered on you. After which after I interacted with him 10 years later he remembers your title. He remembers what you talked about. He remembers, like, the household if you happen to introduced that up. And so he has that present of connecting with individuals personally.
Then I used to be there for President George W. Bush. So he was president for eight years, and he’s the one which gave me the nickname “Leno.” So he simply favored to provide individuals nicknames. I don’t know if it’s my monologues. Some individuals assume it is likely to be simply how I’m constructed—my white hair or my protruding jaw. And it simply caught, that lots of people wouldn’t even know my title. They might simply say, you understand, “Doc Leno.” And it continued on with President [Barack] Obama.
So President George H. W. Bush, former president, he was round. I took care of him, like, at Camp David, Kennebunkport, Prairie Chapel Ranch, and he was probably the most gracious particular person I’ve ever met. And at Camp David he would come play volleyball with us, which is fairly good as an 80-year-old. And took care of him for a power downside, and per week later a handwritten letter got here to my house handle. So he was the third president.
President Obama, when he got here into workplace he was 47; he was a teen. Michelle Obama was 44. That they had two school-aged youngsters. And President Obama sort of stated, “I don’t actually need a physician, however Michelle and the women do, and so I’m going with you,” which I believed, you understand, it’s in all probability the very best praise a father can provide you. After which throughout that point Vice President [Joe] Biden was round, in order that’s who I’d name the fifth president.
After which additionally, when Hillary Clinton was first girl, we’d maintain her. And when she was senator from New York, she could be taken care of by [the] Workplace of [the] Attending Doctor of Congress. However then when she was secretary of state, throughout President Obama’s first time period; that’s after I was round. She had some medical circumstances on among the overseas journeys that we went on—she was typically current—and so I rendered assist to her. In order that’s who I rely because the half president ’trigger she got here fairly shut within the historic election of 2016.
Younger: I used to be studying your e-book, Remodeling Presidential Healthcare, and also you give such a captivating inside have a look at White Home drugs, and also you speak about, like, the prices, the issues that go into the medical care of the president. A extremely fascinating theme that appeared to return out of the e-book and, you understand, your work is how the president’s care is just not, quote, unquote, “VIP care.” Are you able to elaborate just a little bit on that?
Kuhlman: So what I discovered in life is, typically, those who you assume have the very best entry to care—Michael Jackson, Steve Jobs, you understand, celebrities, rock stars, ultrahigh-net-worth people—they’ve horrible entry to care. They typically assume that they’re smarter. They don’t have the time of their schedule. They’ve limitations that they put between them and others. After which they are typically surrounded by sycophant medical doctors that simply wanna please them. So I, I might say I might run away from VIP care, however the care that we tried to supply the president and the primary household and the senior workers and, truly, anybody that works on the 18 acres is personal, safe, that meets their schedule.
So the physician’s workplace has been there since in regards to the early 1900s. The primary full-time physician was a Navy physician, Presley Rixey, and he had taken care of the McKinley household. And he truly wasn’t at Buffalo when a president was fatally shot there; he was tending to Mrs. [Ida] McKinley, who was invalid from a seizure dysfunction. So when Teddy Roosevelt got here in he truly made Dr. Rixey full time: “You’re gonna be the White Home physician.” And that’s after they began calling it the White Home, ’trigger earlier than that it was the Govt Mansion.
In order that’s principally what we attempt to do, is personal, safe, and what I advised every president is: “For me, no politics, no coverage, simply trusted medical recommendation. Fortunately, in case you are pink or blue as a president, fortunately, you’re all the identical inside, so I might maintain the biology.”
Younger: So then what would you say are the most important variations in serving most of the people medically versus serving the president of the U.S.?
Kuhlman: So the most important distinction is the logistics round it. , the number-one menace to an grownup is a out-of-hospital cardiac arrest; we all know day-after-day within the U.S. [roughly] 1,000 People drop useless. So if we will get an AED [automated external defibrillator] on them—it helps to have a educated particular person however, extra importantly, begin defibrillating with tools that works and that you simply’ve educated with. And in order that’s the number-one menace to a president of the U.S., in order that’s why the physician is inside two minutes always: each minute that you simply wait their survival drops by 10 p.c. The second set of palms is a vital care nurse and she or he with tools that, like, compliments the AED.
After which the opposite occupational hazard is gunshot wounds, knife stabbings. So in our historical past, if we’ve had, you understand, 47 presidents, perhaps there’s 45 people of that 47, however 4 of them have been assassinated. So we’re ready anyplace on the earth—the physician and the nurse and a tactical medical officer—to principally do what I coined “care beneath hearth,” and so it’s: preserve the blood within the physique, and get to definitive care. So get to that level-one trauma heart. Know the place it’s. Get there by any means doable. After which realizing, with Secret Service, they’re gonna get us there, however we’re gonna preserve the blood within the physique, we’re gonna get to that trauma heart, after which they’re gonna save the president’s life.
The opposite massive distinction: if you happen to’re not the president, you simply name 911 …
Younger: Proper.
Kuhlman: However 911 doesn’t actually work if you’re touring with the president.
The opposite factor that we’re ready for is—what I specified by Remodeling Presidential Healthcare is asymmetrical threats, so take into consideration chemical, biologic assaults. So realizing stop them, realizing diagnose them, realizing deal with them.
After which if you happen to get to the sort of the extra routine: you understand, they’re human, so that they’re gonna have upset abdomen or totally different basketball accidents that—perhaps they get their lip cracked open or tooth damaged or one thing.
Younger: I do know, too—and I’ll simply chime in for the viewers—I do know that you simply talked about that basketball harm to the lip. I believe that was President Obama. Is that proper [laughs]?
Kuhlman: That was …
Younger: Yeah [laughs].
Kuhlman: So it was, truly, on Black Friday, the day after Thanksgiving, and I truly occurred to be on the White Home evaluating different relations of the primary household. And on the time the Air Pressure physician, Dr. [Jeffrey] Kueter, he was over overlaying President Obama, and he known as me, and he had by no means known as me from a web site earlier than, and I stated, “Okay, what you bought? What’s the harm?” And so he advised me a, a lacerated lip and needed to know what he ought to do with him. And I stated, “Carry him again right here to the White Home.”
And they also got here again to the White Home. He got here proper in. We evaluated the accidents and sewed ’em up and gave him the everyday ice pack and anti inflammatory ache medicine. And I in all probability had 100 individuals contact me that day telling me why they have been the specialists on the earth to stitch up any person’s lip.
Younger: [Laughs.]
Kuhlman: And by chance, we did it proper; he later took his daughters to, I believe, a Georgetown basketball sport.
Younger: I really feel like it’s important to be prepared for completely something that will get thrown at you on this place. One factor you talked about: you introduced up age. How a lot of the general public’s concern round a political determine’s age is definitely warranted from a medical perspective?
Kuhlman: Properly, I might state the plain: age is the number-one danger issue for coronary heart illness, it’s the number-one danger issue for most cancers, and it’s the number-one danger issue for neurodegenerative circumstances or cognitive decline.
So after I look again at historical past James Madison was 36 years previous when he submitted his remaining draft of the Structure; he was the lead writer. And, you understand, the primary president, George Washington, he was thought of an elder statesman, and he was president from age 57 to 65. After which when he left workplace he died a yr and a half later. Through the late 1700s only a few of them lived to age 60. So when the Structure was written it doesn’t checklist any bodily or psychological {qualifications} to be president.
I believe that age is essential. We now have a gerontocracy. We now have the oldest particular person ever elected to be president as the present president, and he’ll be 82 when he completes his second time period. We now have a senator who’s 91. New York Occasions invited me to put in writing an essay about neurocognitive evaluation. It’s a truth of science, it’s not a political assault, that people previous the age of 60, [nearly] each single human begins to have cognitive decline—now, some individuals sooner than others, however each single human previous the age of 60 they begin to have decline with reminiscence, reasoning, pace of processing, spatial visualization. These are the 4 elements of cognitive decline. The fifth one, vocabulary, is fascinating; they really keep the identical or some truly enhance just a little bit ’trigger you’ve simply been round longer, so your vocabulary truly expands.
My opinion could be—President George W. Bush, he’s in all probability the fittest president in historical past. He was within the prime 2 p.c [in] cardiovascular health. He might run three miles in [about] 18 and a half minutes throughout his first time period. And when it was President Biden in opposition to former President Trump, he famously stated, “I’m youthful than each of them, and I’m too previous for the job,” so he is aware of the bodily demanding a part of the job.
That’s the place we’d profit from neurocognitive evaluation on a periodic foundation. And perhaps you don’t launch each consequence to the general public, however you no less than give it to the president, their household, the medical doctors caring for them, to be able to see over time. The present president, who’s 79, he would profit from a neurocognitive evaluation. And that’s testing that does reminiscence, reasoning, pace of processing, spatial visualization. So it simply must be [a] extra complete evaluation for these senior residents which can be in elected positions of nice decision-making on the earth.
Younger: So when the president shares medical data with the general public, what’s your position because the doctor in that course of?
Kuhlman: What I at all times advised every of the presidents is: “I’ll do my greatest to respect your private privateness and your medical privateness.” For instance, the annual bodily: with President Obama we have been at Martha’s Winery the primary yr, and I stated, “Hey, your bodily’s developing. We’re gonna do it to benefit from you getting evaluation of the correct medical [condition] of a 48-year-old male.” So we did his first colonoscopy and launched that, however he stated to me—we have been standing by a golf cart, and he stated, “I’ve discovered: by no means misinform the American individuals; they’re gonna discover out the reality in the long run anyway.”In order that was the strategy that we took.
Younger: Mm-hmm.
Kuhlman: So I laid out, “Listed here are the issues that we wish to assess throughout your bodily,” and the report that I wrote up, I did submit it to him and submitted it to the press secretary on the time, and so they each learn by way of it, and they didn’t change one phrase. After which similar factor—I used to be concerned with a few of President Bush’s, and neither of these presidents modified any phrases.
Younger: Proper. When is it helpful for a president or, you understand, any political chief, to be clear a few medical prognosis? On the one hand, I’m certain, you understand, there’s circumstances wherein, you understand, a pacesetter opens up a few situation, it might convey constructive consciousness to it. On the flip facet, it opens the particular person as much as criticism. I’m curious what your ideas are on that.
Kuhlman: I believe it comes right down to: Are you able to do the job? And so how I might assess that’s: when you’ve got an impairment—such as you’re exhausting of listening to; you’ve gotten hassle seeing; perhaps certainly one of your physique organs don’t work; you’ve gotten hassle strolling, ambulating—we’ve had presidents all through historical past which have had all of these issues. We will make affordable lodging, and so then these don’t grow to be a incapacity to be president or to no matter workplace they’re holding. The one impairment that we can’t compensate for is vital decision-making, so we’ve had historical past of individuals overlaying that up.
Younger: Mm.
Kuhlman: So Woodrow Wilson had an enormous stroke, he stayed up in his bed room for months, and it was lined up by his spouse, and it was lined up by his physician, Cary Grayson, who had launched the 2 of them. And so Cary Grayson was that younger, dashing lieutenant physician that unexpectedly turned a rear admiral due to his friendship with President Wilson. So if you happen to’re the doctor to the president and also you cross the road into that non-public friendship, you’ve gotten a fiduciary obligation not simply to the president that you simply’re caring for but additionally to the American individuals. And a few historians would say, you understand, World Battle II grew out of among the issues from that.
Younger: And my final query for you: What recommendation would you give to the present doctor to the president?
Kuhlman: I believe you’ve gotten a, a novel affected person. There’s a well-known saying in historical past that, you understand, when you’ve got your self as your physician, then you’ve gotten a idiot not solely because the physician, however because the affected person. So Dr. [Sean] Barbabella, I believe if he sticks to “no politics, no coverage, simply trusted medical recommendation,” that can be what’s greatest for the president and greatest for the American individuals.
Younger: Nice, thanks a lot for being on the present.
Kuhlman: Good to be with you, Lauren, and good luck.
Feltman: That’s all for right this moment’s episode. We’ll be again on Monday with our weekly science information roundup.
Science Shortly is produced by me, Rachel Feltman, together with Fonda Mwangi and Jeff DelViscio. This episode was co-hosted by Lauren Younger and edited by Alex Sugiura. Shayna Posses and Aaron Shattuck fact-check our present. Our theme music was composed by Dominic Smith. Subscribe to Scientific American for extra up-to-date and in-depth science information.
For Scientific American, that is Rachel Feltman. Have an incredible weekend!
