“Dr. Giordano, stat to the ER, ”blared the speakers. As head of the trauma teams at George Washington University Medical Center, I was used to being called to the emergency room—by phone, that is. I couldn’t remember the last time I had been paged over the intercom. Whatever was happening, I thought, must be big.
It was. Our patient was the president of the United States, Ronald Reagan. He had just been shot, a mile away outside the Washington Hilton hotel, by John Hinckley Jr. At first, no one realized a bullet had penetrated the president’s side. But Secret Service agent Jerry Parr had noticed blood on the president’s lips. Fearing Reagan had been injured when thrown into the limo amid the gunfire, Parr rushed him to our ER. That’s where I found him, surrounded by doctors, nurses, and agents. I asked the president how he was feeling. “I’m having trouble breathing,” he said, his voice muffled by an oxygen mask.
Our team had already located the gunshot wound below the left armpit, and was getting ready to insert a tube that would drain away the blood collecting in the 70-year-old president’s chest. As senior doctor, I took over—slicing into the president’s skin with a No. 10 scalpel, forcing in the tube, and watching blood flow into a plastic container. From there Reagan went on to emergency surgery, a painful recovery—and, ultimately, back to the Oval Office for a historic presidency.
It’s been 30 years since that awful day. We now take for granted this kind of swift, lifesaving response. But it wasn’t always that way. When President Reagan came through the doors at GW, I had spent four years setting up the trauma system there. Back then, emergency care was in the midst of a revolution. Surgeons returning from Vietnam saw the ineffectiveness of trauma care compared with battlefield methods. The epicenter for new approaches was the Baltimore Shock Trauma Unit, where I had spent a month when getting ready to revamp the system at GW.
That month was an eye-opener. Well-trained surgeons with fixed protocols and all equipment at their fingertips provided excellent care. I realized that the trauma care at GW—and most other U.S. hospitals—was inadequate. Clearly I had work to do, starting with convincing doctors in all specialties that change was needed. Then we constructed a state-of-the-art resuscitation area and sent our surgical trainees to Baltimore Shock Trauma for three months. We also participated in efforts to devise a regional trauma approach, relying in part on seed money from the federal Emergency Medical Services Act.
We can learn a few lessons from these events. The way we deliver medical care can change, even if change is slow. But today trauma care on a national level is markedly improved compared with more than three decades ago. This should give us hope that we can continue to improve the delivery of—and access to—medical care in this country. But we must pursue those changes. Government funds helped build the national trauma system. For those who want to slash government budgets indiscriminately, consider this: Ronald Reagan’s life was saved by a system initiated by a government program.
Indeed, when the president arrived at GW that day, his blood loss was so severe that he collapsed with barely discernible blood pressure. Fortunately, Dr. Dan Ruge, the president’s personal physician, had insisted we treat Reagan like any other patient rather than overthinking our decisions. Our trauma team delivered the president to the OR in less than an hour with normal blood pressure. It could not have gone better. The president even had the presence of mind to ask the team if we were all Republicans. I was an old-fashioned liberal Democrat, but my reply came easy. “Today, Mr. President,” I told him, “we are all Republicans.”
Giordano is chairman of surgery at George Washington University Medical Center. His recollections and others are chronicled in a new book, Rawhide Down, by Del Quentin Wilber.