Hence, four times in three years confidence in the office of the President's physician was undermined -- a low ebb in its history. Even if one credulously believes that the President's medical team has been completely and honestly forthcoming, all this sturm und drang is itself dangerous, as it can easily detract from substantive medical issues -- as it already seems to have done with Trump's sleep.
In reporting for this book, I learned that in the hours leading up to Trump’s trip to the hospital, word went out in the West Wing for the vice president to be on standby to take over the powers of the presidency temporarily if Trump had to undergo a procedure that would have required him to be anesthetized. Pence never assumed the powers of the presidency, and the reason for Trump's trip to the doctor remains a mystery.Asked about this, Pence said he didn't recall being told to be on standby 14 -- a rather incredible statement 15.
The President has not had any chest pain, nor was he evaluated or treated for any urgent or acute issues. Specifically, he did not undergo any specialized cardiac or neurologic evaluations.The sentences actually do not rule out some of the most serious medical concerns if careful parsing is applied:
This is a horrible statement that attempts to say the President had no symptoms suggestive of a heart attack (myocardial infarction) or similar conditions of inadequate blood flow in the heart (cardiac ischemia):
- "Pain" is completely the wrong word. Few patients with cardiac ischemia complain of pain. Words like "pressure" and "squeezing" are more common. This is why physicians are taught to ask about, and report, "discomfort" rather than pain. So, the statement does not eliminate the possibility that Trump had the chest discomfort that is classic for cardiac ischemia.
- "Chest" is too limited. The discomfort of cardiac ischemia is not limited to the chest. People with cardiac ischemia can feel nothing in their chest but instead have discomfort in their left arm or jaw. So, the statement does not eliminate the possibility that Trump had the jaw or left arm discomfort that is classic for cardiac ischemia.
- The symptoms of cardiac ischemia can vary widely. For example, some people with cardiac ischemia have symptoms very similar to indigestion. As might be imagined, this is a diagnostic challenge. So, the statement does not eliminate the possibility that Trump had difficult-to-diagnose symptoms of cardiac ischemia.
The words "urgent" and "acute" are slippery to the point of meaninglessness because they do not have standard definitions in the medical profession.
- This sadly cynical view is proven by White House comments in 2001 when then-Vice President Richard Cheney was experiencing unstable angina and underwent a coronary angioplasty -- "a non-emergency precautionary procedure" according to the White House creative writers. (Hospitals put patients with unstable angina into the coronary intensive care unit.)
- The phrasing also leaves open the possibility that the acute part of the illness had occurred at the White House, but had resolved before Trump arrived at Walter Reed. Examples include chest discomfort from cardiac ischemia, or a neurological deficit from a TIA, or a cardiac arrhythmia, or an acute confusional state.
- Though well outside common use in the medical profession, White House creative writers could take the stance that a previously diagnosed disease can never be "urgent" or "acute" because it is so long known. So a cancer diagnosed six months ago, but undisclosed to the public, could today cause a bowel obstruction or a high blood calcium level or a clot or pain or whatever, and none of this would be urgent or acute because the cancer is old news to the physicians.
There are several slippery points here:
- The statement says nothing about the coronary arteries because the statement says "cardiac," not "cardiovascular." That is because, strictly speaking, "cardiac" refers to structures of the heart proper, such as valves and muscle, but not to the all-important coronary arteries located outside the heart, on its surface. Thus, the statement does not rule out the possibility of specialized testing related to the coronary arteries.
- The statement says nothing about the brain arteries. Similar to the "cardiovascular" note above, the statement says "neurologic," not "neurovascular" (or the more common term "cerebrovascular.")
|Comment: Also includes annotations by Cillizza and Blake. Their interview transcript is archived here: MORE|
|Comment: Dr. Bornstein became Trump's physician in 1980. Bornstein's letter is linked to by Frizell (op cit) and is archived here --> MORE|
|Comment: This articles relates to the first of Dr. Bornstein's letters, reprinted here --> MORE|
|Comment: The document is archived here --> MORE. Also highly informative is the press briefing where the report was delivered: MORE.|
|Comment: A transcript of the press briefing is archived here --> MORE|
|Comment: The document is archived here --> MORE|
|Comment: The document is archived here --> MORE|
|Comment: The document is unacceptably vague about dates. For example, it is not possible to determine on what date between Nov. 2019 and April 2020 the President's weight was measured. The document is archived here --> MORE|