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CNN LIVE EVENT/SPECIAL
The First Patient
Aired October 3, 2004 - 21:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. E. CONNIE MARIANO, WHITE HOUSE PHYSICIAN 1982-2001: This is a patient like no other. Twenty-four hours a day, seven days a week.
DR. JOHN HUTTON, WHITE HOUSE PHYSICIAN 1984-1988: Like being part of their family.
MARIANO: Anything can happen, and you're there.
CAPRICIA MARSHALL, WHITE HOUSE SOCIAL SECRETARY 1992-2000: The constant demand from everyone and everywhere.
DR. JERROLD M. POST, PROFESSOR OF POLITICAL PSYCHOLOGY, GEORGE WASHINGTON UNIVERSITY: (UNINTELLIGIBLE) of the United States is an extremely stressful job.
LYN NOFZIGER, AIDE TO PRESIDENT REAGAN: The president has been shot.
DR. JOSEPH GIORDANO, HEAD OF TRAUMA TEAM, GEORGE WASHINGTON UNIVERSITY HOSPITAL: He had lost nearly half his blood volume.
UNIDENTIFIED MALE: Has the president turned over control?
EDWIN MEESE III, COUNSELOR TO PRESIDENT REAGAN: He said, who's minding the store?
UNIDENTIFIED MALE: Medical cover-ups.
UNIDENTIFIED MALE: They were shooting him up with (UNINTELLIGIBLE) ...
UNIDENTIFIED MALE: (UNINTELLIGIBLE) cortisone.
UNIDENTIFIED MALE: Prostatitis, urethritis.
UNIDENTIFIED MALE: It's weird.
UNIDENTIFIED MALE: They don't want to be sick.
DR. RICHARD TUBB, PHYSICIAN TO GEORGE W. BUSH: The president continues to be in outstanding health.
JOHN KERRY, DEMOCRATIC PRESIDENTIAL CANDIDATE: One hundred percent clean and cured of any cancer.
UNIDENTIFIED MALE: All of the symptoms of clinical depression.
DAVID GERGEN, FORMER PRESIDENTIAL ADVISER: He had some very bad nights.
UNIDENTIFIED MALE: There's all degrees of Alzheimer's.
UNIDENTIFIED MALE: He is incapacitated. What do you do?
POST: To whom is the physician responsible?
ROBERT E. GILBERT, AUTHOR, "THE MORTAL PRESIDENCY": They want the president to be heroic, and therefore, they want the president to be strong.
(END VIDEO CLIPS)
DR. SANJAY GUPTA, SENIOR MEDICAL CORRESPONDENT, CNN NEWS: Hello. I'm Dr. Sanjay Gupta in Washington.
Welcome to THE FIRST PATIENT.
The president of the United States has the most powerful job in the world. Over the next hour, we're going to show you the physical and mental toll it takes, as well as all that goes in to keeping the president healthy.
First, though, everybody knows the Secret Service protects the president. But did you also know that there's a White House doctor just steps away from the commander in chief at all times?
GUPTA: No matter where the president is, a White House doctor is close by.
DR. E. CONNIE MARIANO, WHITE HOUSE PHYSICIAN 1982-2001: The doctor is always within a few feet away. So you essentially shadow the president.
UNIDENTIFIED MALE: We kind of meld into the Secret Service.
DR. JOHN HUTTON, WHITE HOUSE PHYSICIAN 1984-1988: We were always on call.
UNIDENTIFIED MALE: At any time, anywhere in the world.
GUPTA: Dr. Connie Mariano ran the White House medical unit under President Clinton. Five military doctors, five nurses, five physician assistants, three corps men or medics and three administrators.
The mission - executive medicine. Keep the president healthy day to day.
And protective medicine. Treat the commander in chief in a worst case scenario, like an assassination attempt. The nerve center for White House medical care since President Hoover is an office next to the map room, across from the elevator the president takes to get to the West Wing from his residence upstairs.
HUTTON: We would just greet him as he got off the elevator.
MARIANO: It's beautifully situated, because it's right opposite the elevator, so the president and first family can just walk across.
GEORGE W. BUSH, PRESIDENT OF THE UNITED STATES: How are you?
GUPTA: President Bush's doctor is Air Force Colonel Richard Tubb, a family physician. He's in charge of the White House medical unit.
The White House communications office declined to let us speak with Dr. Tubb.
COL. RICHARD TUBB, PRESIDENT BUSH'S PHYSICIAN: The president continues to be in outstanding health.
MARIANO: This is one of those moments you pinch yourself. The president says, come walk with me. You just make sure you don't want to trip as you're walking in front of the world.
GUPTA: But Dr. Connie Mariano, now at the Mayo Clinic's executive health program in Scottsdale, Arizona, agreed to give us an insider's view of presidential health care.
GUPTA: But how would you rate the medical facilities at the White House?
MARIANO: At the White House itself, it's very much your typical doctor's office. It's got a private exam room on the ground floor, which has a crash cart.
GUPTA: A crash cart is used for emergency resuscitation. The goal - stabilize the president and get him to a hospital.
Air Force One also comes equipped with tremendous medical capabilities.
MARIANO: In this compartment we have an operating room table that can be brought out and placed in the center of the room.
There's an operating light that can be brought forward around to the front of the table. All of this is all contingency planning, in case we ever are in a worst case scenario.
UNIDENTIFIED MALE: How do you feel?
BILL CLINTON, FORMER PRESIDENT OF THE UNITED STATES: Great.
MARIANO: This is a patient like no other. Their decisions impact millions of lives.
GUPTA: An ailing president potentially affects world diplomacy, public policy and the economy.
Consider this. News of President Eisenhower's heart attack on Saturday, September 24, 1955, caused the Dow Jones Index to drop 6.5 percent the following Monday.
JERROLD M. POST, PROFESSOR OF POLITICAL PSYCHOLOGY, GEORGE WASHINGTON UNIVERSITY: An illness to the president is not just a personal matter. It is a devastating public crisis.
GUPTA: When we asked in a CNN Gallup poll, 96 percent of Americans - 96 percent - say the health of the president is important or very important to his ability to be a good president.
ROBERT E. GILBERT, AUTHOR, "THE MORTAL PRESIDENCY": And so this puts a tremendous burden on presidents, because, obviously, they're human beings. They're not - they're not gods. They're human beings.
They do become ill, the way the rest of us become ill. They do get the colds. They do get the flu.
And many presidents have had much more serious illness. And if they really have to continue to exude the fact that they are optimistic, that they are well, that they're able to meet any challenge that possibly comes their way.
GUPTA: Coming up, medical care in the moment of crisis.
(BEGIN VIDEO CLIP)
GUPTA: Your primary patient is no typical patient. He's also a target. How do you deal with that?
MARIANO: You prepare, because it will happen eventually - the bad scenario, where something will happen to the president.
(END VIDEO CLIP)
UNIDENTIFIED FEMALE: When we come back, we'll take you inside the hospital and the White House situation room in the tense hours after President Reagan was shot.
And later, a health checkup on George Bush and John Kerry.
Plus, the biggest medical cover-ups in White House history.
UNIDENTIFIED MALE: He gave Kennedy shots in the throat, which is almost horrible to think of, because you don't know what he was putting in there.
JUDY CHELNICK, NATIONAL MUSEUM OF AMERICAN HISTORY: President Garfield was shot July 2, 1881. Alexander Graham Bell, the inventor of the telephone, offered his services to find the bullet. They took the balance and placed it over the area of the wound. The induction balance is like a metal detector. And this is the one that they used to find the bullet.
You were supposed to be able to hear a sound. But when they did it on President Garfield, it did not work.
They were supposed to remove all the metal that was surrounding the president. But they forgot about the bed that President Garfield was lying on. The mattress had spring coils, and that was interfering with the induction balance.
UNIDENTIFIED FEMALE: Now, Dr. Sanjay Gupta.
GUPTA: Less than three months after taking office, on this very spot, President Reagan came face-to-face with a deranged young man with a 22-caliber handgun.
The lessons from that tense and tragic afternoon have prompted presidents and their doctors to prepare for the worst.
March 30, 1981, 2:25 p.m.
Six shots ring out as President Reagan leaves a Washington hotel. A Secret Service agent pushes President Reagan into his limousine as would-be assassin John Hinckley is wrestled to the ground.
The limousine races down Connecticut Avenue, first toward the White House, until the president coughs up blood. And then toward George Washington University Hospital, six blocks away.
DR. JOSEPH GIORDANO, HEAD OF TRAUMA TEAM, GEORGE WASHINGTON UNIVERSITY HOSPITAL: As he collapsed, his blood pressure was 70 - very, very low. And we put him on the gurney, and the residents immediately started IVs and got fluid in him.
LYN NOFZIGER, AIDE TO PRESIDENT REAGAN: The president has been shot once in the left chest.
EDWIN MEESE III, COUNSELOR TO PRESIDENT REAGAN: As I got to the hospital with a couple of others there, the president saw us. And he looked up and he said, "Who's minding the store?"
GUPTA: Minding the store at the White House - cabinet members and a number of top aides. They gather in the situation room, trying to determine if a larger attack is under way.
FRED FIELDING, FORMER WHITE HOUSE COUNSEL: But that was one of the major concerns we had was, you know, what was this? Who was it? Was it a lone gunman? Was it a conspiracy? Was it a start of something really significant?
GUPTA: Remember, this is the height of the Cold War.
RICHARD V. ALLEN, FORMER NATIONAL SECURITY ADVISER: There was double the number of Soviet submarines off our coast within a very short flying time, as we would say. If you had a missile, it was four to five minutes from the White House.
GUPTA: As a precaution, Secretary of Defense Caspar Weinberger orders an increased alert of Strategic Air Command forces, putting B- 52 pilots at the ready.
Reagan's uncertain health triggers other responses.
Directors of the New York Stock Exchange shut down trading, and the Treasury announces plans to buy back dollars to maintain the stability of U.S. currency overseas.
DAVID GERGEN, FORMER WHITE HOUSE COMMUNICATIONS DIRECTOR: There was a great deal of tension in the room that day, because the vice president was gone.
The president was incapacitated. And basically, the president's top three advisers - the so-called "troika" of Baker, Meese and Deaver - were all at the hospital.
GUPTA: Outside the hospital, presidential aide Lyn Nofziger downplays the seriousness of Mr. Reagan's injuries.
NOFZIGER: And the president's condition is good, remains good and remains stable.
GUPTA: However, inside, President Reagan is suffering from serious internal bleeding.
GIORDANO: We were watching the blood come out of the chest tube, and a very significant amount came out. And there was no question in my mind that he had to go to surgery.
GUPTA: 3:24 p.m. President Reagan is wheeled into the operating room.
At the White House, a desire to show the world there is no leadership vacuum that might be exploited by an enemy.
GEN. ALEXANDER HAIG, FORMER SECRETARY OF STATE: As of now, I am in control here, in the White House.
GUPTA: 6:45 p.m. President Reagan emerges from a successful operation to stop his internal bleeding and remove the bullet lodged near his heart.
DR. WILLIAM KNAUS, TREATED PRESIDENT REAGAN: He was very, very tired. He had pain in his chest from his incision and the surgery itself.
GUPTA: Seven o'clock. Vice President Bush, having rushed back from Texas, meets in the situation room and decides no transfer of power is necessary.
National Security Adviser Richard Allen is recording the meeting.
GEORGE H.W. BUSH, FORMER VICE PRESIDENT OF THE UNITED STATES: My view is, the more normal everything is, the better it is.
GUPTA: 8:20 p.m. Bush and Deputy Press Secretary Larry Speakes give a press briefing. The vice president paints a rosy picture of the president's post-operative health.
GEORGE H.W. BUSH: But he's emerged from this experience with flying colors, and with the most optimistic prospects for a complete recovery.
UNIDENTIFIED MALE: Has the president turned over control or authority to the vice president?
LARRY SPEAKES, FORMER WHITE HOUSE SPOKESMAN: There has been no cause for that to take place.
GUPTA: But there was a need in the 48 hours following surgery. According to Dr. William Knaus, an intensive care physician who treated President Reagan.
KNAUS: He was disoriented. He had to be reminded periodically of where he was and what time it was. I mean, remember, any surgery patient loses concept of time and date and sort of place, because they really - the effects of anesthesia.
So, he had to be reminded what day it was, when he was shot, how long ago that was. And he had to be reminded frequently.
GUPTA: Even so, chief of staff James Baker, deputy chief of staff Michael Deaver, and counselor to the president, Edwin Meese, arrive in the president's hospital room at 6:45 the next morning.
They get President Reagan to sign a bill restricting federal price supports for dairy products.
MEESE: I brought the bill over to him, as I remember, then. I think it was worthwhile and useful to let the public know that he was OK, that he was not serious - not more seriously injured - and that business was as usual, or as much as usual it could be, with the president in the hospital.
GUPTA: After suffering a stroke in 1957, President Eisenhower thought there should be a way under the Constitution to transfer power to the vice president temporarily.
In 1967 - 10 years later - the 25th Amendment was ratified, authorizing the vice president to assume command when the president is incapacitated.
When President Reagan was shot in 1981, then vice president Bush chose not to invoke the 25th Amendment, a position endorsed by Reagan's top advisers.
GERGEN: In retrospect, I think it was the right decision not to invoke. The tendency was, why do we want to rock the boat this way?
As I say, there is a - there is, I think, a natural, built-in tendency to want to present the country with a - put things in the best light and to reassure people that things are in good hands.
But I do think Vice President Bush would have been prepared to step up to it, had the recommendation come from the group.
KNAUS: I think if, that day after surgery, you know, Vice President Bush had walked in and said, you know, I'm taking over now, I think it would have been absolutely appropriate.
I don't think any medical person - I certainly would not have questioned it. I would think that is was absolutely the logical thing to do.
There would have been no question at all in our minds.
GUPTA: Presidential historians have criticized the Reagan White House for not invoking the 25th Amendment when President Reagan was shot.
GILBERT: I think the 25th Amendment certainly should have been invoked. There was a period of hours - 10 to 15 hours - when Ronald Reagan could not respond to a crisis.
KNAUS: The consideration of transferring presidential authority or invoking the 25th Amendment were never raised with any of the medical staff, as far as I was concerned. They certainly were never raised with me.
GUPTA: Four years later, when President Reagan needed cancer surgery that required general anesthesia, he signed a letter transferring power temporarily to Vice President Bush.
But some historians, and even members of the Reagan White House disagree over whether he ever actually invoked the 25th Amendment.
GEORGE H.W. BUSH: I, George Herbert Walker Bush ...
GUPTA: When he took over the Oval Office, President Bush established elaborate and classified contingency plans covering medical emergencies. He never needed them.
President Clinton also drew up contingency plans when he took office.
MARIANO: One of the earliest meetings is with a physician, chief of staff, legal counsel present - actually first lady - regarding the 25th Amendment. And goes into effect, this is what we would do if something like this happened.
GUPTA: President Clinton was planning to invoke the 25th Amendment after tearing a quadriceps tendon, if his operation required general anesthesia. It didn't.
GEORGE W. BUSH: Good morning, everybody.
GUPTA: President George W. Bush made history on June 29, 2002, when he had a colonoscopy. ARI FLEISCHER, WHITE HOUSE SPOKESPERSON: At 7:09 a.m., Article 25 of the Constitution was invoked, temporarily transferring the power of the presidency to Vice President Dick Cheney.
At that time, anesthesia was administered to the president.
GEORGE W. BUSH: And I did so because we're at war. And I just want to, you know, be super, you know, super cautious.
DR. RICHARD J. TUBB, WHITE HOUSE PHYSICIAN: The procedure lasted for 20 minutes, and was completely uncomplicated. No polyps were found. No abnormalities were found.
GUPTA: The White House released this picture of President Bush later that day at Camp David.
Mr. Bush resumed his presidency two hours and 15 minutes after invoking the 25th Amendment.
Connie Mariano gave us this laminated copy of the 25th Amendment. If you look inside the medical bag of any White House doctor, you'll find a copy just like it.
UNIDENTIFIED FEMALE: Next, ...
ADLAI STEVENSON, FORMER DEMOCRATIC PRESIDENTIAL CANDIDATE: Would you children like to be president of the United States?
UNIDENTIFIED FEMALE: Be careful what you wish for.
GILBERT: Over the last 150 years, about two-thirds of presidents have failed to reach their life expectancy.
UNIDENTIFIED FEMALE: When we return, we'll look at the toll the presidency takes on the person.
GUPTA: Welcome back. I'm at the Carter Presidential Library in Atlanta, in a replica of President Carter's Oval Office.
Now, the person in the Oval Office probably has the toughest job in the world. With all that power, all that responsibility comes intense stress - a proven risk factor for death and serious illness.
ADLAI STEVENSON, FORMER PRESIDENTIAL CANDIDATE: Would you children like to be president of the United States? We'll start with you, Frankie. Would you?
FRANKIE: Well, I think I would like to be president, because I think it's a great honor to be president. And I could help the poor people and maybe try to stop all the wars.
And my - I think my mommy and daddy and my brother would be very proud.
GUPTA: It's great to believe anyone could grow up to be president. But the job itself is probably the toughest in the world.
CAPRICIA MARSHALL, WHITE HOUSE SOCIAL SECRETARY, 1992-2000: The demands are on you all day, all night, every single day of the calendar year.
GUPTA: It's not only a tough job, it can be a real killer.
GILBERT: Just looking at presidents who have died of natural causes, they have tended to do badly.
Over the last 150 years, about two-thirds of presidents have failed to reach their life expectancy, despite the fact that they have the best medical care that you can imagine.
GUPTA: Professor Robert Gilbert is a leading scholar on presidential health.
GILBERT: People who run for president tend to have type A personalities. And type A personalities tend to be more prone to illness.
GUPTA: While our last few presidents seem to have defied the odds and live long lives, historians have determined that many of our leaders were seriously ill - while in office.
Dwight Eisenhower suffered from both a heart attack and a stroke. Lyndon Johnson had gall bladder surgery and also had heart problems.
Kennedy's health - well, we'll get to that later.
Besides cardiovascular illness and stroke, just in the last century, U.S. presidents have suffered from high blood pressure, cancer, diabetes, respiratory illness, gall bladder disease, kidney disease, prostate disease, Addison's disease, Grave's disease, pneumonia, ileitis and obesity.
STEVENSON: Brenda, would you like to be president? And don't you think it's time we ...
BRENDA: Well, I haven't quite figured up my mind yet, but I think it is a great honor to be a president.
POST: The job of the president is immensely difficult, because he is under the constant glare of the public spotlight.
GUPTA: Dr. Jerrold Post, an expert in political psychology, says the toll of the job can be seen in their faces.
POST: The pictures of the president, and how he ages from the day of inauguration, show a really disproportionate amount of aging in response to that stress.
GUPTA: Hardest job in the world, they say. It's because of what, specifically?
MARSHALL: The constant demand. And from everyone and everywhere. It's - it's not just the issues that we're dealing with in our country, or within the White House walls.
GUPTA: A day in the life of the president can be grueling.
Well, these are some of President Bush's daily schedules - meetings, receptions, briefings, gaggles.
Day in, day out, the pace can be unforgiving.
Still, as with anyone, it's the stress of personal sadness that often causes the greatest burden.
Capricia Marshall spent eight years in the White House as social secretary during the Clinton administration.
A close adviser to the first family, she was often there during the trying times.
MARSHALL: I was awoken in the middle of the night at my home by the White House operator, to be informed that Mrs. Kelley, his mother, had just passed away.
And so, I went to the White House then. And - which was very hard on him, even though he knew that his mother was very, very ill.
But he was also going through so many other things - issues, larger issues - that the country was facing. It's something that not many of us can ever comprehend.
POST: When President Clinton's mother died, I think the public really would have understood, had he taken a few days off to privately grieve.
GUPTA: But he didn't. He went from the funeral to a NATO summit in Brussels.
For most people under stress, a vacation is often the best medicine.
GERGEN: The presidency, in particular, requires someone who is - who's got internal reserves that are replenished on a regular basis.
GUPTA: Gergen was an adviser to presidents Nixon, Ford, Reagan and Clinton.
GERGEN: I happen to believe that we're better served by someone who is willing to take some vacation time, and not be there 24/7.
GUPTA: But even when the president gets away, the presidency follows.
MARSHALL: A vacation never was truly ever a vacation. And even Christmas with them was also work. I mean, you know, being the president and first lady, you never get to go home and turn it off. It's on 24/7.
GUPTA: And that may be the biggest risk to the leader's health. DR. MICHAEL IRWIN, UCLA NEUROPSYCHIATRIC INSTITUTE: Stress is just as serious as these other factors, such as smoking, alcohol use, lack of physical activity.
GUPTA: Dr. Michael Irwin studies the effects of stress on the body's immune system.
IRWIN: We know that stress accumulates and affects one's body and one's mental health over time. And it's the accumulation of this chronic stress that is important.
GUPTA: Every president has to find his own way of coping with stress.
In the early 1900s, Theodore Roosevelt took to rugged hikes and outdoor adventure to keep his mind and body healthy. Herbert Hoover became known for his 10-pound medicine ball.
President's have done pretty much everything to stay fit to lead, whether to prevent illness, or in spite of it.
GERGEN: Roosevelt was someone who knew how important it was to not be there at the desk every hour of the day.
Every afternoon, punctually, there would be a cocktail hour in which people were invited into the White House. His friends and family would be there. And it was against the rules to talk about politics.
DR. LAWRENCE MOHR, WHITE HOUSE PHYSICIAN 1987-1994: During my time at the White House it was very clear that each of the presidents had the ability to deal with the stress remarkably well.
HUTTON: He said, there comes a time in the day when you're not on the newsreel any more, and you can turn it off. He says, because there's nothing I can do about this overnight.
IRWIN: Social organization can also make you immune to stress. Good - having a wide social support network to provide support for you.
GUPTA: But even so, the presidency carries a unique burden.
UNIDENTIFIED MALE: In the final analysis, the president is the only one that makes the decisions. I mean, he relies on his aides, but he has to decide what advice to take.
MARSHALL: I think it's probably one of the loneliest jobs there is. And you have so many people around you all day long, and yet, everyone depends and looks to you. But you very - you have very limited people that you can look to and depend upon.
There are people around you all day long, and yet, you're really by yourself.
UNIDENTIFIED FEMALE: Coming up in the next half hour, secrets in the White House. Medical cover-ups.
And just ahead, what about the First Patient's mental fitness?
GUPTA: Did President Reagan have Alzheimer's when he was president?
UNIDENTIFIED MALE: I think he did.
ROBERT E. GILBERT, PRESIDENTIAL HISTORIAN (voice-over): In the summer of 1924, Calvin Coolidge had underwent a devastating personal tragedy, the death of his favorite child, his 16 year old son, a boy who played tennis on the White House tennis courts and who developed a blister on one of his toes and it became infected, and he was dead within a week. Calvin Coolidge's presidency changed after that. He was withdrawn, he slept 15 hours a day, he worked about four hours every day. He demonstrated all of the symptoms of clinical depression.
(on camera) From the time of the death of his son until Coolidge left office, he was an incapacitated president.
SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: I'm here at the National Museum of American History in an exhibit called "The American Presidency: A Glorious Burden." What happens when a friend or a colleague thinks the president is suffering severe depression or Alzheimer's? On those particularly touchy issues, there is no formal protocol, no special branch of the White House medical unit.
(voice-over) In the winter of 1974, as the Watergate investigation zeroed in on the White House, presidential aide David Gergen, who has worked for both Republicans and Democrats, says Nixon felt the pressure.
DAVID GERGEN, FORMER PRESIDENTIAL ADVISER: I don't think we'll ever know clinically what his condition was in the final throes of Watergate, but we have enough accounts and I was there to know that he had some very bad nights.
GUPTA: A group of senators, led by New York's Jacob Javits worried that Nixon was wearing down under the stress, so they called Dr. Burt Brown, a psychiatrist and director of the National Institutes of Mental Health. He had treated many people in high level positions.
DR. BERT BROWN, FORMER DIRECTOR, NATIONAL INSTITUTES OF MENTAL HEALTH: It was sort of a withdrawal from social contact. One of the senators mentioned that there wasn't a week that had gone by for four years where he didn't get a phone call on some point or other and he had not received a phone call for several weeks.
GUPTA: And Dr. Brown had no official responsibility for President Nixon, but he told the senators this: Look for warning signs like increased drinking, mood swings or an uncontrolled temper. GERGEN: This is a man who had wonderful lucid and far-reaching insights, and when he was under all that pressure, under all that stress, it's a close call whether the president is right there and should be there making decisions, say, on an international crisis.
GUPTA: At the time, no one suggested publicly that the stress was too much for Nixon, but political pressure was too much and he resigned, avoiding impeachment.
RICHARD M. NIXON, FORMER PRESIDENT (video clip): We don't have a good word for it in English. The best is "au revoir." We'll see you again.
GUPTA: In 1964, "Fact" magazine quoted dozes of liberal psychiatrists analyzing Republican presidential candidate Barry Goldwater. Some examples: "A dangerous lunatic..." "a result of rigid toilet training..." Goldwater sued for libel and won.
(on-camera) Since then, the American Psychiatric Association tells its members not to analyze public figures from a distance. Of course, some psychiatrists still do, with varying degrees of scientific rigor.
(voice-over) In 1984, Dr. Louis Gottschalk, a prominent neurologist and psychiatrist, studied the debates between then President Ronald Reagan and his challenger, Walter Mondale. Gottschalk is 88 years old now. He goes to work every day in the building that's named after him at the University of California in Irvine. He works with the Gottschalk-Gleser(ph) scale, also named for him. It's a neurologic test of a person's ability to think clearly -- by looking at speech - does that person repeat himself? Does he lose focus on what he's saying - you derive a score. A score between zero and one is considered normal.
RONALD REAGAN, FORMER U.S. PRESIDENT (video clip): The system is still where it was with regard to the progressivities I've said...
GUPTA: In the presidential debates that year, 1984, Mr. Reagan's score was 2.14, out of the normal range, signaling moderate impairment.
REAGAN (video clip): I have no hesi - hesitancy in saying so, and - the prayers are answered.
GUPTA (on camera): He looked a little lost there.
DR. LOUIS GOTTSCHALK, NEUROLOGIST, UC IRVINE: I think so, too. He'd repeat himself so much, and sometimes wouldn't finish sentences.
GUPTA: Did President Reagan have Alzheimer's when he was president?
GOTTSCHALK: I think he did. Some form of it.
GUPTA (voice-over): Ridiculous, say those who were close to the president. They say symptoms never appeared while he was still in office. They point to major triumphs of his second term. Landmark arms control deals and the crumbling of the Soviet Union. Alzheimer's creeps into a person' mind over a period of many years. In the president's case, the process likely started well before 1994, when he announced his condition publicly in a handwritten letter. But that doesn't mean he showed symptoms in office. And it may not have affected him at all for years.
DR. JOHN HUTTON, WHITE HOUSE PHYSICIAN, 19841988: I never, absolutely never - as the expression goes, he had forgotten more than I ever knew. You know, it was the type of thing that I never really noticed anything of any sort.
EDMUND MORRIS, REAGAN BIOGRAPHER: The unshakeable evidence is his diary entries. Every night this man wrote an account of his day as president. Every night for eight years. And the entries of his last days in office are as lucid and controlled and logical as they were when he became president.
GUPTA: But with Reagan in his mid-70s, there was speculation, even at the White House. In 1987, the deputy to new chief of staff Howard Baker said that several White House staffers came to him with concerns.
JAMES CANNON, FORMER WHITE HOUSE AIDE (video clip): They used, repeatedly, the words, "He's out of it." Meanings with - and suggesting that he was not really up to the job.
GUPTA: James Cannon now says the information was no good, but at the time he did warn Baker. Baker didn't consult the doctor, but instead had a conversation with Reagan and decided he was fine.
HOWARD BAKER, FORMER WHITE HOUSE DEPUTY CHIEF OF STAFF (video clip): I've never seen Ronald Reagan more energetic, fully engaged and more in command of difficult circumstances and questions that we were dealing with throughout this day. He has never been better.
DR. JERROLD M. POST, DIRECTOR, POLITICAL PSYCHOLOGY PROGRAM, GWU: This is clearly a decision where not only the White House physician should be involved, but some specialists should be involved as well. From neuropsychology and psychiatry and so forth.
GUPTA: Why should someone believe this, that President Reagan, while president, had Alzheimer's?
GOTTSCHALK: Well, the clinch(ph) word is "should." I don't know that I would go that far. I don't believe that everybody will believe scientific findings.
GUPTA: Gottschalk, who didn't publish his study until Reagan's term was ending, denies any political motivation. Democrats also faced questions about their mental state. The minds of presidents Woodrow Wilson and FDR were slowed by serious illness. Republican Dwight Eisenhower suffered a stroke and Lyndon Johnson's biographer, Michael Beschloss said Johnson struggled with depression and paranoia.
Do you think top officials such as presidents or leaders at various states should be tested in some way for cognitive dementia?
GOTTSCHALK: I think so. But whether it can ever be done, I doubt.
BROWN: Well, as the former director of the NIMH and forty years of psychiatry, I think it's a terrible idea. I don't think any set of psychiatric and psychological examination would tell us any more than a person of wisdom and maturity would say about the president's status.
GOTTSCHALK (voice-over): It's all right to have a physical abnormality, but to have a mental problem is very touchy.
ANNOUNCER: An exclusive CNN Gallup Poll. Should the president have to get an annual checkup for mental conditions like depression or Alzheimer's? 79 percent said yes. And what about a physical checkup? 84 percent said yes. When we come back...
SENATOR JOHN KERRY, PRESIDENTIAL CANDIDATE: I am as fit and as healthy, if not more so, than any 60 year old in the country.
ANNOUNCER: We'll hit the campaign trail. A checkup on the two men in the race for the White House.
CAROL LIN, CNN ANCHOR: Good evening, I'm Carol Lin. Good news for John Kerry. A new CNN/"USA Today" Gallup poll shows the Democratic candidate has closed the gap with President Bush. Tonight at 10 o'clock, both campaigns join me live with their strategy to punch through and win the next crucial debate.
Plus, our rap sheet. Is Kobe Bryant trying to drag another superstar into his legal mess. And shooting into space again to grab a $10 million prize. All this and our Last Call question, tonight at 10 o'clock Eastern. So please join me.
GUPTA (voice-over): Just off the state floor of the White House residence is a place even most staffers don't get to see.
CHEF ROLAND MESNIER, WHITE HOUSE PASTRY CHEF: The dress of the lady, it makes it look like an hydrangea flower.
GUPTA (on camera): For nearly 25 years, Chef Roland Mesnier has been cooking pastries here at the White House. What is it like to cook for the president?
MESNIER: Well, it's very exciting, very scary. Sometimes we use 10-20-30-40 pounds of cherries. But every single cherry are checked for pits.
GUPTA: Do you talk to the doctors, the nutritionists, or anything about a meal plan for the president?
MESNIER: Sometimes it's necessary. I don't believe that any food is bad for you, any at all. I don't care what - even fat. It's needed in your body to function correctly. But, of course, it should be taken in moderation. All the recipes I use, either I substitute sugar with honey or even glucose in some areas, which reduces the calories. We have also switched the regular flour, using another flower called spelt, which is very good for you.
GUPTA: You know, there's a lot of diets out there like the South Beach Diet...
MESNIER: Oh yes, yes...
GUPTA: The Atkins Diet. How does pastry chef fit into that? Is that...
MESNIER: Well, I consider them two attacks against me. You know, when they go like this, he tries to kill us with his beignets(ph).
GUPTA: So how do President George Bush and John Kerry stack up in terms of health? Well, it wasn't an issue at the first debate here in Miami, and throughout the campaign, both men have guarded their personal medical information very carefully.
(voice-over) President Bush and Democratic challenger John Kerry are athletic. There's no doubt about that. But how healthy are they really?
DR. RICHARD TUBB, WHITE HOUSE PHYSICIAN (video clip): The president continues to be in outstanding health.
GUPTA: That was last year. A White House spokesman says President Bush remains in great shape. But his busy schedule and the presidential campaign means his annual physical, usually conducted in August, will wait until after the election.
Here's what we know. President Bush, 58, is avid about exercise and has an extremely low resting heart rate, about 45 beats per minute. Normal is 60-100.
DR. JOHN BESHAI, EMORY UNIVERSITY HOSPITAL: I think his resting heart rate is attributed to his excellent condition. I don't think his low resting heart rate should be any concern to the public.
GUPTA: Doctors call this abnormally low heart rate bradycardia, a condition that may have contributed to a feinting episode two years ago. Alone, watching football, the president choked on a pretzel and passed out briefly, hitting his head on a table. The president made light of the incident.
PRESIDENT GEORGE W. BUSH, U.S. PRESIDENT (video clip): My mother always said, "When you're eating pretzels, chew before you swallow." Listen to your mother.
GUPTA: President Bush, a lifelong runner, came into office running seven minute miles. "Runner's World" magazine called him the fastest president. But the commander-in-chief has switched to mountain-biking, pool workouts and an elliptical trainer after he tore the meniscus in his right knee late last year.
Challenger John Kerry is 60, two years older than the president. He had shoulder surgery this spring after tearing a tendon when he braced himself on a campaign bus that stopped suddenly.
Kerry's father, Richard, died of prostate cancer at the age of 85 four years ago and the candidate himself was diagnosed with prostate cancer in December of 2002, but his cancer was detected early and he underwent successful prostate surgery last year at Johns Hopkins Hospital.
DR. PATRICK WALSH, KERRY'S SURGEON (video clip): The bottom line is everything went well.
I mean, it just was by the book.
KERRY: I am as fit and as healthy, if not more so than any 60 year old in the country. I have not one single restraint on my health with respect to being President of the United States. I am 100 percent clean and cured of any cancer.
GUPTA: Doctors says the senator's prognosis, outstanding.
DR. JOHN LYNCH, GEORGETOWN UNIVERSITY HOSPITAL: The survival rate is excellent, the cure rate is almost 95 percent to 100 percent.
GUPTA: The Democratic presidential candidate's bout with cancer does not bother most Americans. In an exclusive CNN/Gallup poll, 92 percent said they were not concerned Senator Kerry had cancer.
Kerry's physical fitness has been but to the test in a year of intense campaigning.
CANDY CROWLEY, CNN SENIOR POLITICAL CORRESPONDENT: There certainly are times when he says he's tired. There are times when he looks tired. But generally for 14 and sometimes 18 hour days he holds up pretty well.
GUPTA: There's a lot the public doesn't know about the health of the president and his challenger. Neither President Bush nor Senator Kerry have released their full medical records, but there isn't much public pressure for either man to release more details. Americans may want a healthy commander-in-chief, but 61 percent say the president has the same rights as other citizens to keep medical records private, compared to just 38 percent in favor of releasing all information that might affect his ability to serve.
GUPTA (on camera): Of course, records are no guarantee of health. President Clinton's doctor said he had no history of heart problems. Then he had to undergo quadruple bypass surgery last month. We'll be right back.
ANNOUNCER: Just ahead.
ROBERT FERRELL, PRESIDENTIAL HISTORIANThere's only one word for it. It's weird. ANNOUNCER: Some of the strangest, most dramatic medical cover- ups in presidential history.
ANNOUNCER: You're watching "The First Patient." Once again, Dr. Sanjay Gupta.
GUPTA (on camera): As the columnist William Safire once wrote, "The President's body is not wholly his own." Of course, that hasn't stopped many presidents from zealously guarding their medical privacy. And in several situations it has crossed the line and become a genuine cover-up.
JOHN F. KENNEDY, FORMER U.S. PRESIDENT (video clip): I John Fitzgerald Kennedy...
GUPTA (voice-over): America's youngest elected president, 43 year-old John F. Kennedy. A veil of secrecy has often shrouded the Oval Office, and when it comes to Kennedy's medical history, there was something lurking beneath the surface.
FERRELL: There is only one word for it is weird.
GUPTA: Presidential historian Robert Ferrell says Dr. Max Jacobson, known for his work with high society was never officially the president's doctor, but treated him nonetheless. Ferrell says his research found that Jacobson, known as Dr. Feelgood, gave what he called, quote, vitamin injections to the president.
FERRELL: With dirty hands he would spill pills out on a desk and he would take whatever suited his fancy. When Kennedy went to meet with Khrushchev, Jacobson was along and he gave Kennedy shots in the throat, which is almost horrible to think of because you don't know what he was putting in there.
GUPTA: What was in there, Ferrell says, were amphetamines. Dr. James Young was on the White House medical team with Kennedy. He showed us the medical briefcase he used to carry. He's kept it in a closet for nearly four decades. Darvon compound, morphine, equinel(ph), controversial today, but ready if the president or anyone in his entourage should need them. But Young says the president was fit and says the only drug he ever gave the president was a daily dose of steroids for his Addison's disease.
A second briefcase was kept under the White House in a secret bunker in case of nuclear attack. The combination, 5-29.
UNIDENTIFIED MALE: JFK's birthdate.
GUPTA: Some 40 years after the president's assassination, the JFK Library granted historian Robert Dallek access to Kennedy's medical records. Dallek says the records paint a very different imaged from what many Americans thought of the young president, revealing a man in almost constant pain from a bad back. ROBERT DALLEK, HISTORIAN: He was shooting him up with procaine. He couldn't go up the staircase the way a normal person might. He couldn't roll over on the bed at night. He couldn't pull his shoe and sock on his left foot.
GUPTA: Kennedy flatly denied his Addison's disease, a hormonal deficiency that can cause fatigue, low blood pressure and weight loss. But he had it.
DALLEK: He was on so many medications to deal with the Addison's disease, to deal with the back pain and to deal with the continuing colitis, diarrhea he suffered from, he would take antispasmodics to deal with prostatitis, urethrits, soniacitis(ph), lots of antibiotics that he had to take - and the country never knew about this.
GUPTA: Yet Dallek believes President Kennedy showed sound judgment in the face of great suffering.
DALLEK: I set his medical records alongside the Cuban missile crisis and other crises, but principally the Cuban missile crisis and what I found was that he was as cogent, as on top of things as you'd ever want a president to be. The man had an iron will. There really was something heroic about him.
KENNEDY (video clip): Ask what you can do for your country.
PRESIDENT FRANKLIN ROOSEVELT, FORMER U.S. PRESIDENT (video clip): The only thing we have to fear is fear itself.
GERGEN: A fascinating question of history is whether the country would have elected Franklin Roosevelt in 1932 had people known that he couldn't walk.
GUPTA: Franklin Roosevelt served from a wheelchair. While he couldn't raise himself to his own two feet, he made every effort to raise the country out of the Great Depression. He coerced reporters into helping him shield his disability.
FERRELL: The reporters were a little careful with him. There's no question about that. But had they not been careful, the Secret Service men would have taken their cameras and removed the film.
GUPTA: But when he ran for a fourth terms, the doctors didn't even tell him that he was dying of heart failure. And the public certainly didn't know. President Roosevelt died a month after his inauguration.
(on camera) Our next cover-up began here, New York Harbor, in the summer of 1893. President Grover Cleveland had secret surgery on a friend's yacht while the country was embroiled in a financial crisis. Sounds more like a Hollywood script, but it happened here, just months after Grover Cleveland won his second term as president.
FERRELL: He was on the yacht for two or three days. It went up to Massachusetts and what happened there was that he was secluded from the public for perhaps six weeks. GUPTA (voice-over): The president had an operating to remove cancer in his jaw. The operation was covered up from the public for 24 years.