Connie Mariano: Doctor to the president
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(CNN) -- Dr. E. Connie Mariano knows what it's like to keep up with the most important man in America. Until Dr. Richard Tubb, an Air Force colonel, took over the White House medical unit, Mariano addressed the health issues of presidents George H.W. Bush, Bill Clinton, and George W. Bush.
Now an executive health physician at the Mayo Clinic in Scottsdale, Arizona, Mariano spoke with CNN's Dr. Sanjay Gupta about being the president's doctor.
GUPTA: "Former physician to the president." That job has a lot of different titles. What are some of them?
MARIANO: The president's doctor, the White House doctor, senior White House physician. I tell people that you know who is in charge because you are the physician who gets blamed if something happens to the president.
GUPTA: What is a typical day like?
MARIANO: It varies ... It depends on his schedule, because the medical unit has 24-hour coverage, seven days a week. You have a medical provider with him, and if he has a major event or a trip that day, the doctor is always within a few feet away. So you essentially shadow the president.
GUPTA: You write that you are always a heartbeat away, outside the kill zone, for the president. What does that mean?
MARIANO: Where the president is, in the unfortunate use, that's the kill zone, that's where the bad guys want to hurt him. The medical unit really exists to take care of the president in those scenarios where his life is in danger. The president's life is always in danger, unfortunately, in this day and age. The role of White House physician is to be close enough to him so that if he needs to be resuscitated, you are there with him as a first responder.
GUPTA: Your primary patient is no typical patient. He's also a target. How do you deal with that?
MARIANO: You prepare. One of the things that really helped me early on in my job at the White House was advice given to me by [one of] President [George H.W.] Bush's Secret Service agents ... He told me essentially, it isn't 'if' it is going to happen ... it is 'when' it is going to happen. So you prepare, because it will happen eventually, the scenario where something bad will happen to the president. The medical unit focused on the scenarios and contingency planning for the bad outcomes.
GUPTA: When President Clinton took office and you were the doctor, what sort of challenges did President Clinton offer up?
MARIANO: He was younger than the previous president. He was predictably unpredictable. He had a lot of energy. He was always on the go. So the template that was used for the previous president didn't apply to the new president.
With the previous presidents, the medical unit essentially went home in the evening. There was no medical care at night and that bothered me, because if the president had a heart attack or fell down and needed care you would have to call someone to come into the house. That had been done for about a hundred years before, but we were entering a new era, when you really needed 24-hour on-site assistance. As a result we said, 'listen, from now on, from this day forth, you will have 24-hour coverage.'
GUPTA: What would you do if there wasn't a hospital close by when he was traveling?
MARIANO: You bring your hospital. I think one of the fascinating, challenging things about being a White House doctor was making the assets happen, creating assets to support him. The beauty of the military is you say, 'listen, we need help, we need a hospital,' and the military will provide one -- in the sense that they will give you a 707 [airplane] with a surgical team with an anesthesiologist, a trauma surgeon, what have you, that would follow your airplane where you needed to go.
GUPTA: I'm sure as a doctor, you have a patient-physician relationship that should not be breached. So there are things that you may know about the president that the rest of the public does not.
MARIANO: Therein lies the challenge of [being a] White House doctor. You have to respect the patient's privacy, but this is a patient like no other. Their decisions impact millions of lives.
Very similar, for example, is the role in the military. You have a jet pilot who is a pilot on an F-14 or a jet plane, and if that pilot is incapacitated, they will crash their plane. They will kill people. You are obligated to ground them. So in the role of the president's [doctor], we're obligated, No. 1, to take care of the patient. You do what is appropriate medically to get them clear, but then you also enlist the aid of their spouse and the people in their circle.
Then you have to be honest and say, 'I am obligated to also notify the appropriate people because I don't think your condition will allow you to do your job.' And you have to be forward about that.
GUPTA: Did you ever want to ground the president, but didn't?
MARIANO: I think one of the challenges was when [Clinton] tore his quadriceps tendon in 1997. We were at Bethesda [Naval Hospital] and he announced to the world that he was going to Helsinki [Finland] in a couple of days. And you just think, 'Oh my goodness, we don't let anybody do that.' You risk infection, blood clots, or what have you. You are getting on an airplane, flying across the world, and he was insistent.
You wish you could ground him. 'You know, you're on crutches. You should be resting. You should be doing what most patients do.' And he was very insistent. 'I'm going. I'm going to Helsinki. I'm meeting with the Russian president there.' We said, 'OK, then we're going to bring our medical team.'