The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (36 page)

Bess Truman had no great affinity either for Washington, D.C., or her role as first lady in the White House. She cried when informed that her husband would succeed Franklin Roosevelt as president.
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She assiduously avoided attention: “She never made a speech. She never gave a personal interview and never held a press conference. She was determined to keep her private life private…. Mrs. Truman never gave an opinion on a public issue—except once…. [S]he thought that the historic walls ought to stand.”
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Mrs. Truman much preferred to live in Independence, Missouri, and, more particularly, to reside in the Gates Mansion, the home she had known all her life. During her husband’s presidential tenure, Bess Truman spent as much time as possible there, including the summer months and holiday seasons.
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Bess Truman, the wife of Harry Truman. At this writing, she is the longest-lived first lady (Library of Congress).

As Harry Truman’s presidency was drawing to an end, her cheerfulness was much remarked upon, and most political reporters acknowledged that the first lady, although proficient in fulfilling her social and ceremonial duties, would rather be dwelling somewhere else.
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Mrs. Truman’s medical history while first lady was uneventful. Only a single episode of ill health is recorded. In early December 1948, the first lady traveled to Norfolk, Virginia, for a presentation aboard the battleship USS
Missouri
: “In the middle of the ceremony she developed a severe nosebleed. Back in Washington, Dr. Wallace Graham … took her blood pressure and discovered it was extremely high.” Graham, the Trumans’ White House physician, first applied pressure to control the hemorrhaging. When this procedure was unsuccessful, the doctor cauterized the bleeding site. He then treated the patient’s hypertension by prescribing an unknown antihypertensive drug and instituting a no-salt diet. His treatment worked; Bess Truman’s blood pressure reverted to normal and she shed twenty pounds of weight.
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The Trumans had a long personal and professional relationship with Dr. Graham. Wallace Graham was the son of Dr. James Walter Graham, a military colleague of Harry Truman from the First World War. The president looked up Graham’s military physician son when in Germany for the 1945 Potsdam Peace Conference and brought Wallace back to the White House to serve as the Trumans’ personal physician. Graham’s excellent medical care for the first family was rewarded by promotions first to brigadier general and then to the temporary rank of major general in the air force reserves. Graham departed both the White House and the air force when the Trumans returned to Missouri, where he entered private practice. The doctor continued as the Trumans’ physician for the remainder of their lives.
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Doctor Graham attended Harry Truman’s death on December 14, 1972.
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He also attended the ex-first lady’s multiple hospitalizations in her later years: hypertension
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; breast tumor surgery
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; right hip fracture
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; and stroke.
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In late 1958 Bess Truman discovered a lump in her left breast. She decided to delay any medical evaluation, using Harry’s 75th birthday celebration and the birth of their second grandchild as rationalization for her procrastination. Finally on May 16, 1959, after the tumor had grown to grapefruit size, she was admitted to the Kansas City Research Hospital. A mastectomy was performed; the tumor turned out to be benign. It was an “unusual type of tumor known medically as a benign myxoma.” Mrs. Truman was discharged on her eighteenth hospital day. It took Bess a long time to recover from the operation.
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Graham made house calls to the Truman home and was quoted in Mrs. Truman’s obituary: “The Trumans’ family doctor, Wallace Graham, said Mrs. Truman, who was hospitalized for 22 days in September with a bleeding ulcer, had been battling pulmonary congestion since that hospitalization and had been in a coma-like state since Friday.”
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Bess Truman remains the longest-living of the first ladies. She died at 97 years of age.

“She was a stoic, rarely admitting pain, a trait her husband characterized as perhaps her only fault. She had four miscarriages but never indulged in self-pity.”
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Lady Bird Johnson was gifted with the three essentials for survival, and success, in the White House: Strength, courage and excellent health.
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And she was indeed very healthy, before, during and, for many years, after her residence in the White House. She suffered several miscarriages during the pre–World War II era, but delivered healthy daughters in 1944 and 1947.
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Mrs. Johnson died in 1997 at age 94 and is the second longest-lived first lady.
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Four years earlier, in the summer of 1993, there was a slight stroke which later caused recurrent episodes of dizziness. Subsequently, macular degeneration impaired her vision and eventually made her legally blind. In 2002, a second cerebrovascular accident destroyed her ability to speak. Another consequence was an inability to swallow; a nasogastric feeding tube was inserted to provide nutrition.
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Lady Bird and Lyndon Johnson were married for thirty-nine years and formed a very effective political, social, and financial team. This first lady was well prepared for her expected social and ceremonial duties, as she had acquired a quarter-century of Washington political experience. Moreover, as the wife of the vice president, she often substituted at events for first lady Jacqueline Kennedy, who was not at all interested in attending political or routine social affairs.

“To a greater degree than Eleanor Roosevelt, Lady Bird Johnson devised and developed the staff, procedures and tactics that subsequent First Ladies have employed when they entered the public arena.”
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Her success as the wife of the president has been acknowledged consistently in polls that assess first ladies. She is always ranked in the top ten wives for effectiveness.
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Betty Ford, Rosalynn Carter and Nancy Reagan

Two first ladies, Betty Ford and Nancy Reagan, the wives of Presidents Gerald Ford (1974–1977) and Ronald Reagan (1981–1989), suffered in public through the diagnosis, treatment, and aftermath of breast cancer, the most emotionally and physically frightening disease for females, which eventually strikes one in eight American women.
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It is stunning that it was not until the third century of the American Republic that cancer became a part of the conversation about the first ladies’ health. It is especially a surprise since in 2010 cancer was the second leading cause of death of American women.
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Cancer (except for innocuous skin cancers—mostly basal cell carcinomas—in several, and lymphoma and lung cancer as the causes of death in two others—Jackie Kennedy and Pat Nixon respectively—long after their residencies in the White House) did not attack a first lady until September 1974. The shadow of a breast malignancy twice previously had darkened the mood of a president’s spouse. Abigail (Nabby) Smith, the only daughter of John and Abigail Adams, died from breast cancer, despite a mastectomy. Ex-first lady Bess Truman had a large benign mammary tumor removed with no further ill effects.
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Mrs. Ford also suffered from a second severe ailment—painful osteoarthritis of the neck that compounded her chronic depression. Alcoholism and drug dependency resulted from the pain and the depression. Her heroic recovery and its benefit to the public is presented at the end of the chapter. First lady Betty Ford was the first of the first ladies to publicize the problems in her medical history for the public good.

“Two weeks after her admission to Long Beach, Betty Ford admitted she was an alcoholic.”
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This first lady was born Elizabeth Ann Bloomer in Chicago on April 8, 1918, the youngest, and the only girl, of three siblings. At the age of twenty-four she wed salesman Bill Warren. They divorced after five years of marriage. Betty became the third first lady, after Rachel Jackson and Florence Harding, to previously have been divorced.
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She married the rising politician Gerald Ford in 1948. Four healthy children arrived in the following nine years.
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The Ford White House endorsed complete transparency in its reporting on the first lady’s breast cancer—its diagnosis, treatment and recovery. Mrs. Ford believed that the public would benefit from a frank discussion about this dread disease. A second compelling reason was an attempt to recover from the widespread alienation attached to the Nixon presidency. Nixon’s resignation a few months earlier made the unelected Gerald Ford the 38th President of the United States (1974–77).
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Florence Harding, a predecessor as first lady, allowed full medical disclosure of her illness to dissipate the political cynicism that resulted from the secrecy of Woodrow Wilson’s disability.

The diagnosis of Betty’s breast cancer was serendipitous. On September 26, 1974, the first lady accompanied her personal assistant, Nancy Howe, to Bethesda Naval Hospital for Mrs. Howe’s previously scheduled breast examination. On the spur of the moment Betty Ford decided to undergo an examination as well.
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There is no record when she last had a complete physical examination. The
New York Times
reported that a gynecological check-up, probably a limited exam, six weeks previously was normal. The first breast mammogram machine was introduced in the 1960s and it was only in 1976, two years after Mrs. Ford’s diagnosis, that the American Cancer Society recommended annual mammograms for women over the age of fifty.
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Navy captain Douglas Knab, the chair of Bethesda’s Department of Obstetrics and Gynecology, was the first to examine Mrs. Ford at Bethesda; he detected a marble sized lump in the right breast. Captain William Fouty, chief of surgery, was asked to corroborate Knab’s finding. Fouty determined that the lump was “suspicious.” The caution that is a hallmark of VIP medicine was observed; the physicians desired additional consultation. As a result, the patient left the hospital without being informed of her probable diagnosis.

Both physicians contacted the White House physician, William Lukash. Lukash in turn scheduled an examination to be preformed at the White House by Dr. Richard Thistlethwaite, Bethesda’s civilian consultant and chief of surgery at the George Washington School of Medicine. Thistlethwaite, the fourth doctor involved, after his examination joined Lukash in informing President and Mrs. Ford that the breast lump required immediate surgery. Betty Ford decided to fulfill her scheduled commitments the following day. The
New York Times
soon broke the story: “Mrs. Betty Ford … entered Bethesda late this afternoon [9/27] for surgery tomorrow to determine whether a nodule in her right breast is benign or malignant.”
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On Saturday morning, September 28, under general anesthesia, a two centimeter cancer was excised from the outer upper quadrant of Betty Ford’s right breast. After a malignant diagnosis was established, by advance consent surgeon Fouty performed a standard radical mastectomy. Bill Fouty was a navy specialist in female surgery; previously he had performed hundreds of mastectomies. Two of thirty regional lymph nodes that were removed contained metastatic cancer.
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Cancer of the breast was the most feared disease of women. Contemporary 1974 statistics showed 90,000 cases and 33,000 deaths annually from female breast cancer. Mrs. Ford, in good health and not overweight, was judged to have a favorable prognosis with a 75–90 percent ten-year survival.
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The first lady was released from Bethesda on the thirteenth post-operative day. She soon resumed her social duties as a hostess at the farewell dinner party for retiring White House chief of staff brigadier general Alexander Haig.
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Because the cancer had metastasized to lymph nodes, postoperative therapy was required. Chemotherapy in the form of a “little brown bottle of pills” was supplied by White House doctor Lukash. The regimen called for this treatment five days in a row every five weeks for two years. In addition, a bone scan was scheduled for every six months to determine whether the tumor had spread. Mrs. Ford’s treatment was a success; there was no recurrence. Her physicians never discussed reconstructive surgery, but she wore a prosthesis.
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The public effect of Betty Ford’s candor was enormous. During her hospitalization thousands of letters and cards inundated the White House. Many were written by women with mastectomies and many from women who were encouraged to have breast examinations. One year later, there was a six-fold increase in breast screening examinations. Happy Rockefeller, the wife of Ford’s vice president, credited the publicity for her own examination, which detected cancer.
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