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Before coming to Washington, Ruge, a neurosurgeon by training, had been a colleague of Loyal Davis, Nancy Reagan’s stepfather. Ruge hadn’t wanted the job of White House physician, but he accepted it after Davis, a respected neurosurgeon in Chicago, convinced him that the Reagans needed an experienced doctor to prevent anything “foolish” from being done to the president during his time in office. Now Ruge was being put to the test, and though he worried that Reagan had suffered a heart attack, he didn’t have enough information to make a confident diagnosis. But it was not his job to treat the president; his first concern was that the doctors at GW not give Reagan special care. Exotic tests, diagnosis by committee, flying in experts from another city—such measures would take time and could put the president’s life at even greater risk. As he stepped back from the gurney, Ruge was determined to ensure that Reagan wasn’t treated like a VIP. He immediately began telling doctors to handle the president exactly as they would any other patient in his condition.

Only a few feet away, Mike Deaver and David Fischer were watching the unfolding emergency in stunned horror. The leader they both revered seemed to be in terrible trouble.

Seeing Ruge, Deaver signaled him to come over. “Tell me what’s happening,” he said.

“I don’t know,” Ruge replied. “Maybe he had a cardiac.”

Deaver and Fischer were dumbstruck. They’d both watched the president’s speech at the Hilton; he had been so vibrant and alive, and now he was pale and sickly and possibly having a heart attack. It was too much for Fischer; tears streaked down his face.

Watching the frenzied efforts of the trauma bay’s doctors and nurses, Deaver recalled hearing about the chaos at Dallas’s Parkland Hospital, where John F. Kennedy had been rushed. Realizing that providing accurate information to the White House would be critical, he ran to find a phone so he could call Jim Baker; Fischer followed. Deaver had trouble getting through to the swamped White House switchboard, but an operator finally answered and transferred him to the office of the chief of staff. An assistant picked up the phone.

“Find Jim,” Deaver said. “Have someone hold this line open.”

A moment later, Baker got on the phone.

Deaver quickly recounted what had happened at the Hilton and then said, “We don’t know what the problem is. It may be a heart attack.”

Deaver turned to Fischer. “Go find out what’s going on in there.”

After Fischer hurried back to the trauma bay, a hospital worker in green scrubs approached Deaver. “Do you know the name of the patient in the emergency room?” he asked.

“Yes.”

“Would you give me his name, please?”

“It’s Reagan. R-E-A-G-A-N.”

“First name?”

“Ron.”

The hospital employee kept scribbling.

“Address?”

“Sixteen hundred Pennsylvania.”

The man’s pencil stopped moving.

“You mean…?”

“Yes, you have the president of the United States in there.”

*   *   *

T
HE VOLUME OF
noise in the trauma bay was now so high that Wendy Koenig gave up on using a stethoscope and instead placed a finger over the brachial artery in the president’s left arm, just below the blood pressure cuff. She inflated the device a third time, desperate to get a reading. Koenig released the air and waited; she sensed more than actually felt the bump as she watched the needle descend on the cuff’s pressure gauge. Reagan’s systolic blood pressure was about 60; his normal reading would be about 140. This was bad news: a reading of 60 indicated that he was in shock, and, as Koenig knew, most seventy-year-olds who came to the ER in a condition similar to Reagan’s did not survive.

Only five or six minutes had elapsed since the assassination attempt. Nurses and technicians were pumping crystalloid fluid, a salt solution, into Reagan’s body to boost his sagging blood pressure and reduce his chances of slipping further into shock. He had three IV lines running into his arms, and doctors had already ordered universal donor blood from the hospital blood bank.

Joyce Mitchell, the ER doctor, noticed the pile of clothes under the gurney and realized that Reagan’s shirt was spotted with blood. She told an orderly to rush the shirt to the laboratory so they could determine the president’s blood type. Another nurse drew blood from Reagan so it could be taken to the same lab. A moment later, another doctor turned to Jerry Parr: did he know the president’s blood type?

“O positive,” Parr replied.

By now, trauma surgeons were on their way to the emergency room. One of the first to arrive was William O’Neill, a thirty-year-old surgical intern who had been consulting with the family of a patient in a fourth-floor hallway when his pager started beeping. He politely excused himself and ran for the ER.

As he neared the nurses’ station, two men in suits grabbed the five-foot, six-inch O’Neill and lifted him into the air. “Who are you?” they demanded.

“I’m Dr. O’Neill. I’m on the trauma team.”

The agents flung O’Neill toward the trauma bay, where he found several doctors and nurses working frantically on a patient lying face-up on a gurney. His skin was gray and his lips were caked with blood. O’Neill, already experienced enough to make quick and fairly accurate assessments of new patients, thought the man might not survive.

All at once, O’Neill understood the scene around him. There was a reason the ER was so alive with activity: the well-dressed men he’d just encountered on his way here were Secret Service agents, and the man on the gurney was the president of the United States. He took a close look at the gray face of his patient and confirmed his identity.

O’Neill turned to the Secret Service agent who seemed to be in charge. “What happened?”

“There was a shooting and I shoved him into the car,” the agent said. “I think he may have broken a rib.”

O’Neill heard someone say that Reagan’s blood pressure was now 80, already 20 points better than when it was first measured. The fluids were working.

The doctor leaned over the gurney. “Hello, Mr. President, how are you doing?” he asked. “Where are you hurting?”

“I’m having a hard time breathing,” Reagan replied.

“Mr. President, do you know what happened?”

“Not really.”

Other doctors joined O’Neill at the president’s side, including Drew Scheele, another intern, who had been observing a surgery but wanted to see what was causing all the commotion in the ER. As he entered the trauma bay, he spotted the remnants of a nice blue suit on the floor.
What a waste of an expensive suit,
Scheele thought. He walked up to the gurney, made a quick assessment of the patient’s condition, and placed an oxygen mask on the man’s face.

The patient stared up at Scheele. “Am I dying?” the man asked through the mask.

“No, you’re going to be fine,” answered Scheele. In fact, he could see that the man was in serious condition; he had no idea whether the patient would live or die. He still hadn’t focused on the man’s face and so had no idea who he was.

G. Wesley Price, a surgical resident, arrived soon after Scheele. Price had already had a long night and day. A twenty-five-year-old man, shot several times in the abdomen, had died in surgery early that morning; afterward, Price had continued with his usual duties, checking on patients and working in the pathology lab. Just minutes earlier, he’d been in the lab when he heard sirens on Pennsylvania Avenue. Looking out an open window, he saw a motorcade speeding toward the hospital. He sprinted downstairs to the emergency room, where a crowd was gathering in the far corner by the trauma bay.

“Who’s the patient?” Price asked a nurse.

“It’s the president!” the nurse replied.

“You’re kidding,” Price said. He walked the final ten feet into Bay 5A and there was Reagan, now naked, lying on a gurney. Bags of fluids were suspended above him, and a urologist had already inserted a Foley catheter to remove his urine.

As he entered the room, Price spoke to Judith Whinerey, the assistant head nurse. “Who is in charge?” he asked.

“You are,” replied Whinerey. Turning, she shouted to everyone in the bay, “Everybody, Dr. Price is here.”

Price, a thirty-one-year-old fourth-year resident, was now the most senior surgeon in the room. The nurses and O’Neill told him what they knew: Reagan had walked into the ER and collapsed. His blood pressure was low, and they were giving him fluids and waiting on blood from the hospital blood bank.

“I can’t breathe,” the president said again. “My chest hurts.”

Price leaned over his patient. “Hello, Mr. President, I’m Dr. Price.” He pulled out his stethoscope and pressed it to the right side of the president’s chest. It was difficult to hear anything in the din, but Price detected a light rush of air and decided the right lung sounded normal. But when he moved the stethoscope to the left side of Reagan’s chest, he heard nothing, which meant the left lung wasn’t functioning and had probably collapsed.

“I don’t hear very good breath sounds on the left side,” Price said. “We’d better roll him over.”

As nurses and doctors gently turned Reagan onto his right side under the trauma bay’s bright lights, Price noticed what appeared to be a small slit in the president’s skin. Half an inch long, it was about five inches below the left armpit. A few drops of blood dribbled out of the wound.

Price turned to the Secret Service agent standing nearby—Jerry Parr—and asked what had happened. Parr briefly described the shooting and the chaos at the Hilton. As Parr finished, Daniel Ruge introduced himself to Price and told him that the president had coughed up blood on the way to the hospital.

Price looked again at the wound.

As he did, Drew Scheele—a Vietnam War veteran who had himself been shot in combat—leaned in. “That’s a gunshot wound,” the intern said.

Price nodded and turned to Parr and Ruge. “He’s been shot.”

Ruge leaned down and informed the president that he’d been wounded. “Everything is going to be okay,” Ruge told him.

Price had treated many gunshot wounds to the chest and knew that the first order of business was to insert a tube to drain blood and air, one or both of which must be collecting in the chest cavity. Pressure was almost certainly preventing the left lung from inflating; draining the blood and releasing the air would allow the lung to reexpand. Price thumped the president’s chest with his fingers but heard only a dull thud through his stethoscope, a sure sign that the chest was filling mostly with blood; air would have produced a hollow sound.

A gunshot wound, a collapsed lung, and a chest cavity filling with blood—there was no time to lose. Price asked O’Neill for the chest tube kit, which contained everything they needed for inserting the tube and was stored on a nearby shelf for easy access. Then he began preparing to make the necessary incision in the president’s chest.

*   *   *

E
D MEESE HAD
been conducting a meeting in his office when one of his aides burst in and told him what had happened at the Hilton. Meese and his visitors turned to see the “board,” a small computer screen that told top White House officials the location of the president. It suddenly flashed: “En route to GW Hospital.”

Meese hurried down the hall and found a cadre of staff members assembling in Jim Baker’s office. One of Baker’s assistants announced that Deaver was back on the line from the hospital. Baker put his phone to an ear; Meese picked up another line.

Deaver had terrifying news. “He’s taken a shot in the back,” Deaver said.

“Shit,” said Baker.

“Jesus,” said Meese.

A moment later, Baker and Meese heard Deaver pass the phone to Ruge, who informed them that the president seemed to be losing blood. Shocked, Baker jotted “P hit/fighting” on a slip of paper.

Lyn Nofziger, one of Reagan’s most trusted aides, entered the crowded office. “We need to tell the public that the president has not been wounded,” Nofziger told Baker, who was still on the phone and taking notes on his conversation with Ruge.

Baker gave Nofziger a stern look and held up his hand. Everyone immediately knew what the chief of staff was signaling: the president had in fact been wounded. The room went silent.

After finishing the call, Baker conferred with Meese and Nofziger. The three men agreed that they should all go straight to the hospital. A White House spokesman, Larry Speakes, would join them.

By now the phone was ringing constantly. A staff member informed Baker that Secretary of State Alexander Haig was waiting to speak to him. Baker picked up the phone and told Haig that the president had been shot in the back.

“It looks quite serious,” Baker added.

Haig said he would leave the State Department right away and come to the White House. He told Baker that he would arrange to have the other cabinet secretaries assemble in the Situation Room; he would also call Vice President Bush.

“I’ll be in touch with you as soon as I reach the hospital,” Baker replied. Then he, Meese, and Nofziger hurried toward a waiting car.

*   *   *

D
AVID
G
ENS
,
ONE
of GW’s four chief residents of general surgery, had been reviewing medical journals in the cluttered third-floor on-call room when his pager started beeping. Soon he was on the phone to the ER. A normally unflappable clerk answered the phone, and Gens overheard him screaming: “You want four units of uncross-matched blood STAT?”