An Unfinished Life: John F. Kennedy 1917-1963 (14 page)

Physicians in the 1930s and 1940s did not realize what today is common medical knowledge: namely, that adrenal extracts are effective in treating acute ulcerative colitis but can have deleterious long-term chronic effects, including osteoporosis with vertebral column deterioration and peptic ulcers. In addition, chronic use of corticosteroids can lead to the suppression of normal adrenal function and may have caused or contributed to Jack’s Addison’s disease.

It is also possible that the DOCA had little impact on Jack’s back or adrenal ailments. Unlike synthetic corticosteroids, which did not become available until 1949, the initial DOCA compounds did not have the sort of noxious side effects associated with the later compounds. Nevertheless, by 1942, twenty-eight varieties of DOCA or adrenal extracts had become available, and since no one can say which of these Jack may have been using or exactly what was in them, it remains conceivable that the medicine was doing him more harm than good.

Jack could also have been suffering from celiac sprue, an immune disease common to people of Irish ancestry and characterized by “intolerance to gluten, a complex mixture of nutritionally important proteins found in common . . . food grains such as wheat, rye, and barley.” Although Jack would manifest several symptoms associated with the disease—chronic diarrhea, osteoporosis, and Addison’s—other indications of celiac sprue—stunted growth in children, iron deficiency anemia, and family history—were absent. The presence of persistent, severe spastic colitis (now described as irritable bowel syndrome) and the possibility that he had Crohn’s disease (an illness marked by intestinal inflammation and bleeding as well as back and adrenal problems) also diminish, though do not eliminate, the likelihood that Jack had celiac sprue, a disease of the small intestine, not the colon. Moreover, despite many hospitalizations at some of the country’s leading medical centers after 1950, when celiac sprue was first identified, none of his doctors suggested such a diagnosis. However, the fact that physicians in the fifties and sixties did not readily recognize the disease in adults leaves such a diagnosis as a possibility.

From September 1934 to June 1935, Jack’s senior year, the Choate infirmary had kept close watch on Jack’s blood count. In turn, Joe passed the results on to the Mayo doctors. At that time, there was also concern that Jack might be suffering from leukemia, a fatal disease resulting from uncontrolled proliferation of the white blood cells. With the benefit of current knowledge, it seems likely that the changes in Jack’s blood counts were a reaction to the drugs he was taking. When he fell ill the following year, Dr. William Murphy of Harvard advised that Jack had agranulocytosis, a drug-induced decrease of granular white blood corpuscles, which made him more susceptible to infections.

Some of Jack’s hospitalizations were brief. Except for his short stay in the infirmary in April 1935, he enjoyed good health during his final year at Choate. While in London in October for his post-Choate courses at the London School of Economics, he had to be hospitalized, but a quick recovery allowed his enrollment at Princeton for the fall term. Jack’s relapse probably resulted from an inconsistent use of the medicines or a reduction of dosage when his health showed improvement.

But sometimes Jack’s visits were lengthy. When he had to withdraw from Princeton to enter Peter Bent Brigham in Boston, he spent most of the next two months there. Uncertain as to whether they were dealing strictly with colitis or a combination of colitis and ulcers and worried that his medicines were playing havoc with his white blood cell count, his doctors performed additional tests. Jack told Billings it was “the most harrowing experience of all my storm-tossed career. They came in this morning with a gigantic rubber tube. Old stuff I said, and rolled over thinking naturally that it would [be] stuffed up my arse. Instead they grabbed me and shoved it up my nose and down into my stomach. They then poured alchohol [sic] down the tube. . . . They were doing this to test my acidosis. . . . They had the thing up my nose for 2 hours.” The test measured Jack’s acid levels to see if he was prone to stomach ulcers. The doctors were concerned anew about his blood count. According to what Jack wrote Billings, it was 6,000 when he entered the hospital and three weeks later it was down to 3,500. “At 1500 you die,” Jack joked. “They call me ‘2000 to go Kennedy.’”

By the end of January, he was more worried than ever about his health, though he continued with more biting humor to defend himself against thoughts of dying. “Took a peak [sic] at my chart yesterday and could see that they were mentally measuring me for a coffin. Eat drink & make Olive [his current girlfriend], as tomorrow or next week we attend my funeral. I think the Rockefeller Institute may take my case. . . . Flash—they are going to stick that tube up my ass again as they did at Mayo.” His frustration with and anger at medical experts who seemed better able to inflict painful and humiliating tests on him than explain and cure what he had was evident when he wrote Billings: “All I can say is it’s bully of them or more power to my smelly farts.”

And yet behind the jokes was Jack’s fear that he was slated for an early demise, making him almost manic about packing as much pleasure into his life as he could in the possibly short time remaining to him. His letters to Billings are full of frenetic talk about partying and having sex. He was frustrated at having to stay in Boston, even though he left the hospital on weekends to socialize. He heard that there were “‘millions of beautiful young misses arriving in Palm Beach daily,’ so am getting rather fed up with the meat up here, if you know what I mean,” he wrote Billings. He gave him a scorecard of his actions: “Got the hottest neck out of Hansen Saturday night. She is pretty good so am looking forward to bigger and better ones. Also got a good one last night from J. so am doing you proud.” “Flash —,” he added in another letter, “B.D. came to see me today in the hospital and I laid her in the bath-tub.” As for another date, he declared: “The next time I take her out she is going to be presented with a great hunk of raw beef, if you know what I mean.”

Jack’s seeming indifference to the young women he was using for his sexual pleasures was not entirely due to his sense of urgency. It was also a measure of the times in which Jack came to manhood. In the thirties and forties, Jack’s “catting about” was accepted practice among well-off college boys “sowing wild oats.” What became anathema in the last third of the twentieth century with the rise of women’s liberation and the change in social mores was little frowned upon by men in that bygone era. Jack certainly had genuine regard for his sisters Rosemary and Kathleen. He treated Rosemary with great sensitivity and had only respect for Kathleen, who, like Jack and unlike elder brother Joe, had a rebellious streak. She was the sibling he felt closest to. But under the influence of his father’s example, contemporary male behavior, and the appeal of hedonism to a teenager facing a possibly abbreviated life, glaring contradictions toward women became a mainstay of his early and later years.

In preparation for attending Harvard in the fall of 1936, Jack had spent that spring recuperating in Arizona, where he enjoyed improved health. But he remained worried that it would not last. “Plunked myself down for an injection after reading of Irving Carters’ [sic] death from the same thing I have, to the Dr.’s office,” he wrote Billings in May. “This morning I awoke with a hacking cough which Smokey [James “Smokey Joe” Wilde, a Choate friend with him in Arizona] assures me is T.B. in the more advanced stage. It will be the fucking last straw if I come down with T.B.” He did not, and the rest of his stay in the desert and then at Cape Cod in the summer gave him a renewed sense of well-being. During his first year at Harvard there were no serious medical crises, which allowed him to compete on the freshman football and swimming teams. In the summer of 1937, however, during his trip to Europe, he was stricken by swelling, hives, and a reduced blood count. Billings, who was with him, said later, “Jack broke out in the most terrible rash, and his face blew up, and we didn’t know anybody and had an awful time getting a doctor.” Exactly what accounted for his symptoms is unknown, but at least one doctor suspected an allergic reaction to something Jack ate, although the reduced blood count suggests continuing agranulocytosis.

Whatever he had cleared up quickly, but it did not signal an end to his medical problems. On the contrary, from the beginning of 1938 to the end of 1940, stomach and colon problems continued to plague him. In February 1938, he had gone back to the Mayo Clinic for more study. The Mayo treatment for ulcerated colitis now consisted of blood transfusions, liver extract, nicotinic acid, thiamine chloride, and Neoprontosil, a sulphur drug, but the clinic itself acknowledged that its therapy was of limited value. At the end of the month, Jack found himself in the Harvard infirmary suffering from grippe, and at the beginning of March he had “an intestinal type infection” that lasted two weeks and forced him to enter New England Baptist Hospital. Though he was able to return to school to finish out the term, he spent another two weeks in New England Baptist in June for the same complaints.

By October he was still “in rotten shape,” but he refused to reenter the hospital for what now seemed like additional pointless tests. At the end of his fall term in February 1939, however, he gave in and went back to the Mayo Clinic. It was the same old routine: a diet of rice and potatoes three times a day and another inspection of his colon and digestive system. By November, under the care of Dr. William Murphy of Harvard, the Nobel laureate who co-discovered the treatment of pernicious anemia and had an uncommon faith in the healing power of liver extracts, Jack recorded that he was going to “take my first liver injection today and I hope they work.” It did not. A year later, he was still wrestling with abdominal pain, a spastic colon, and low weight. If the adrenal extracts were limiting the effects of his colitis—and it is not clear that they were—it certainly was worsening his stomach problems. Nevertheless, it did not stop him from attending to the crisis that had engulfed the world. “For a man with a weak stomach,” his father wrote him in September 1940, “these last three days [the Battle of Britain] have proven very conclusively that you can worry about much more important things than whether you are going to have an ulcer or not.” In fact, whatever the effects of the parathyroid hormone and then adrenal extracts on his colitis, they were almost certainly contributing to the onset of a duodenal ulcer. Though such a condition remained undiagnosed until November 1943, when “an x-ray examination reported an early duodenal ulcer,” current medical knowledge suggests that the extracts were a prime cause of this condition. In 1944, a gastroenterologist concluded that Jack was still suffering from a spastic colon. Moreover, there was evidence of “spasm and irritability of the duodenum [or small intestine] . . . which was suggestive of a duodenal ulcer scar.” But there would be no public acknowledgment of any of this, nor any privately evident self-pity. Stoically refusing to let health concerns stop him became a pattern that would allow Jack to pursue a political career.

The onset of serious back problems in 1940 added to Jack’s miseries. In 1938 he had begun to have “an occasional pain in his right sacro-iliac joint. It apparently grew worse but at times he was completely free from symptoms,” a medical history made in December 1944 recorded. “In the later part of 1940 while playing tennis he experienced a sudden pain in his lower right back—it seemed to him that ‘something had slipped.’ He was hospitalized at the Lahey Clinic . . . for ten days. A low back support was applied and he was comfortable. Since that time he has had periodic attacks of a similar nature.” Although he had suffered football injuries and other mishaps that could help account for his emerging back pain, the onset of his back problem could have been related to his reliance on adrenal extracts and/or parathyroid hormone to control his colitis; they may have caused osteoporosis and deterioration in his lumbar spine. Back surgery in 1944 showed clear evidence of this condition. During the surgery “some abnormally soft disc interspace material was removed and . . . very little protrusion of the ruptured cartilage present” was noted, which would make him vulnerable to progressive back injury. It was, as it had long been with Jack, one thing after another.

IN THE FALL OF
1940, Jack, at age twenty-three, was among the first slated for induction into the U.S. Army. Because he was enrolled at Stanford for 1940-41, he was not to be called until the end of the academic year. His colon, stomach, and back problems, however, promised to give him an easy out. “The only humorous thing in my life to date,” a Harvard friend at law school wrote Jack in the fall of 1940, “has been you getting drafted. I swear to God Jack I thought I’d die of exhaustion from laughing. . . . Christ of all the guys in the world. . . . It’s a lucky thing you’ve got your stomach.”

But Jack wanted to serve. “This draft has caused me a bit of concern,” he wrote Billings. “They will never take me into the army—and yet if I don’t [serve], it will look quite bad.” He wanted to keep his medical problems as quiet as possible, and failing to qualify for service would subject his difficulties to public discussion. In addition, it would add to the criticism already leveled against his father for being adamantly opposed to American involvement in the war. There was also the fact that he remained uncertain about a career. Thoughts of attending law school did not excite him. A stint in the military seemed like a challenging alternative, especially alongside a desire not to let Joe Jr., who was becoming a navy pilot, outshine him.

Yet none of these reasons seem sufficient to explain his readiness to enter the military in spite of his medical difficulties. It was an impressive act of courage. His intestinal and back problems would make a military regimen a constant struggle and seemed likely to further undermine his health. When, in 1941, Jack failed the physical exams for admission to first the army’s and then the navy’s officer candidate schools, he turned to his father to pull strings on his behalf. Although he followed an exercise routine all summer to prepare himself for another physical, no program of calisthenics was going to bring him up to the standards required for induction into either service. Only a denial of his medical history would allow him to pass muster, and he was able to ensure this through Captain Alan Kirk, his father’s former naval attaché at the American embassy in London and current head of the Office of Naval Intelligence (ONI) in Washington, D.C. Kirk had arranged for Joe Jr. to enter the navy as an officer in the spring of 1941, and now at Joe Sr.’s request he did the same for Jack that summer. “I am having Jack see a medical friend of yours in Boston tomorrow for physical examination and then I hope he’ll become associated with you in Naval Intelligence,” Joe wrote Kirk in August.