MICHAEL MCCURRY, WHITE HOUSE PRESS SECRETARY
DR. DAVID WADE, BETHESDA NAVAL MEDICAL CENTER
MCCURRY: Good afternoon, everybody. I got the paper on the school construction announcement that the vice president made for the president today. And I'm sure you'll all want that.
Now I'm happy to have with me Commander David Wade, who's the chief of clinical services here at the National Medical Center, and -- National Naval Medical Center. He'll tell you a little bit about the procedure that the president is just now going into.
The president at 1:30 was scheduled to go into surgery and feeling very good about it and was anxious to get it done. Let me tell you a little bit about what he's done since he arrived here at approximately 12:15.
He was led immediately to the medical evaluation treatment unit here, the ME-TU, as they call it here at Bethesda. It is, in effect, the presidential suite here at the Naval Medical Center and, as the president described it, America's nicest hospital room.
He, as you might have guessed, immediately turned on the television, immediately tuned into Miami-Clemson and happily watched the game with the first lady and Erskine Bowles while the doctors consulted and reviewed some of the MRI imagery that they -- that Dr. Mariano brought up from Florida.
While the doctors consulted, the president joked around with some staff and others. He said he was absolutely convinced that this was his good-luck day, because he was confident he was going to break 80. So he was disappointed that other events intervened.
The doctors and the surgical team that will treat the president, Dr. Wade can tell you more about. But the went in to give the president a briefing and actually show him some of the pictures of the damage done to his knee.
And the president asked questions that I imagine they consider pretty typical questions for most of their patients, like when is he going to be able to run again, when is he going to be able to play golf again. They chatted a bit about the procedure.
The president then informed the doctors that he will be going to Helsinki on Tuesday, and they said, yes, sir. They understood that. The president also -- the president and first lady also chatted about her trip. The president considers that a very important trip. And she fully intends to go ahead with her travels as well, although they'll consult on the schedule after the procedure.
Dr. Wade can tell you more about what we expect. I think it'll be a while before we can report back to you on the results or outcome of the surgery. That probably won't be until, indeed, dinner time tonight.
So I would expect maybe, you know, he'll have some time this afternoon.
QUESTION: Can you tell us how the president is feeling? Is he in an pain? Is he taking any medications?
MCCURRY: He's -- Dr. Wade can tell you about any pain killers that he's taking. He is in a little bit of pain when the leg moves but he's in very good spirits. He's joking around with a lot of us. He's anxious. He kept saying, you know, I've got work to do. I want to get back to work. Clearly, that's his intent with respect to heading for the summit in Helsinki on Tuesday.
Some of you may know, partly because of King Hussein's schedule and then obviously partly now because of the president's schedule, both the Jordanian side and the U.S. side felt it was better to postpone King Hussein's scheduled visit here to Washington on Monday. We'll advise you when that's rescheduled.
But the president mostly is looking forward to watching a lot of basketball.
QUESTION: Mike, did the doctors find any other injuries (OFF- MIKE)
MCCURRY: I'll let Dr. Wade brief you on that. Not that I am aware of, but he seems to be fit. They were doing all the normal work up for the procedures he's got to have done.
QUESTION: Did the president give his usual staff briefing?
MCCURRY: The president had talked during the evening with the chief of staff, with the first lady. We had several meetings at the White House this morning directly with the vice president's staff and have been in close contact with them, although there's been nothing about the medical procedures today that have triggered anything related to the 25th Amendment.
But we were prepared and appropriately should have been prepared to deal with that and had close coordinate with the vice president's staff. The president has -- the only other phone call he's made that I'm aware of is that he talked to Treasury Secretary Rubin because he had actually had an item of business that he wanted to follow up on with him.
They talked a little bit about economic matters and the president has been getting updates on the situation in Albania and the work that's underway to try to evacuate U.S. personnel and dependents and other American citizens.
QUESTION: You told -- we were told earlier that the surgery might last one to two hours. When would you anticipate the surgery will be over and you will be able to come back and tell us more.
MCCURRY: Well, as I said -- my guess -- Dr. Wade knows this procedure and he himself is a surgeon and has performed this surgery, this knee surgery himself, so he could tell you more and describe more of the procedure.
But I suspect it will be 5 o'clock or so at the earliest before the president will be safely in the post op and we'll be able to come down and tell you how it went and our intent is to make available some of the doctors who actually did the work, so I'd look maybe in the neighborhood of 5 o'clock as a rough guess.
QUESTION: Mike, does the president's Helsinki schedule leave open in any way, depending on medical advice, if he goes ahead with the trip?
MCCURRY: His schedule?
QUESTION: Will his Helsinki schedule be altered in any way?
MCCURRY: The morning jog out in the beautiful Helsinki morning is probably going to have to be canceled, obviously. We'll had to adjust the president's schedule to reflect the fact that he will not be quite as mobile as he otherwise would be. But most of the work that they were doing involved face to face conversations with President Yeltsin and I don't think that'll be affected at all.
QUESTION: Doctor, will you describe the procedure...
MCCURRY: If you will let me get him up here, yes. Rita?
QUESTION: If the president has to be on any kind of pain killers or any kind of drugs, might that change his mind about going forward with the summit?
MCCURRY: I haven't heard anything from any of the doctors that have been describing procedures to me that would indicate that would be a problem. I don't want to speculate on his medical work up, post surgery because that's better for the doctors to do later.
QUESTION: Could you describe again how he fell? How he hurt himself?
MCCURRY: Most of you have already heard what happened. He was saying farewell to Greg Norman last night and walked down a short flight of wooden stairs. There were four dark colored wood stairs that led to a stone landing. The stone landing connected to a stone walkway. And it was late at night obviously. There was some lighting but in the shadows apparently the president thought he was on a walkway but in fact he had one more step to go. And so he lost his balance coming off that step. And the leg decelerated.
QUESTION: Was he outside the house?
MCCURRY: Yes. He was on his way out the door. All right let me thank Dr. Wade for being here and he'll tell you more about the medical procedure itself and take any questions you have.
WADE: Yes ma'am.
QUESTION: The procedure, how long will it take? How complicated is it? And what will the president (OFF-MIKE) be in during the surgery?
WADE: The operation will probably take about an hour to an hour and a half to perform. And it is anticipated at this time that he's going to have an epidural anesthetic to make him numb on the lower half of his body during the procedure so he will not be suffering pain when they're doing the actual incision and repair of the tendon.
QUESTION: And how long -- or when is this procedure actually going to start, do you know?
WADE: Well they were planning to start around 2 p.m. I'm not up there right now so I can't comment if that will happen or not.
QUESTION: Could you just describe the injury and what the procedure will be and just lay it all out for us?
WADE: Yes, ma'am. What he had done was, the insertion of the quadriceps tendon into the kneecap.
QUESTION: I think you're off-mike, is the problem.
WADE: The insertion of the quadriceps tendon into the kneecap has been disrupted from the fall. And the operation will be intent on reattaching the tendons so that he can again extend his leg.
QUESTION: How difficult a procedure is this? I understand, in orthopedic terms, it's really not a big deal. Is that true?
WADE: Any operation is a moderate big deal, but this is not a terribly severe injury, and not a terribly complicated operation to perform, no, sir.
QUESTION: How do they actually perform it? What, how do they go about reattaching it, do they drill a hole or something?
WADE: They will expose the disrupted tendon, which is disrupted very near the kneecap, and they will then drill holes in the kneecap and pass sutures through the tendon and through the kneecap, securing those sutures and then reattaching that. And then over the following weeks to months, that tendon will heal, and he will regain the unlimited use of his leg.
QUESTION: Doctor, the doctor in West Palm Beach said that the tendon was at least 50 percent torn. Is that correct from your diagnosis, and is it possible he may need a Teflon graft? Is that...?
WADE: From the review that was going on upstairs, prior to the president going to the operating room, they concurred with the findings of the, Dr. Cohen, I believe his name was, down in Florida, and felt that there was a greater than 50 percent disruption of the tendon, but it was not completely disrupted.
QUESTION: Doctor, what can you say about the recovery period?
WADE: I'm sorry?
QUESTION: What can you say about the recovery period, and might that depend to some extent on the surgery itself?
WADE: It is hoped that this will be a very short operation with a short recovery period in the hospital. Lord willing and all things going well, he would hopefully be home tomorrow or Sunday morning.
QUESTION: But the long-term recovery, once he leaves here?
WADE: Long-term recovery, he should be able to be up and about very soon, at the time he leaves, as a matter of fact. In terms of when can he regain all of his normal activities, i.e., jogging, golfing, that sort of thing, that's going to be a little bit dependent on how he should recover. But if you take the average patient with this injury, it'll be probably four or five months before he's on the golf range, and perhaps as long as six months before he's jogging again.
QUESTION: How about the cast? There will be a cast, sir, as I understand it. How many weeks in a cast?
WADE: There, actually, as I understand from Dr. Atkinson, who's the primary surgeon, there probably will not be a cast.
There will be a brace that allows the president to have some mobility of the knee but guards it from reinjury.
QUESTION: Will he be on -- when he's under this epidural -- what are the kinds of pain killer or any other sedatives?
WADE: I don't believe he plans to be under any other pain killers or sedatives...
QUESTION: Will the president require crutches?
WADE: Say it again.
QUESTION: Will the president require crutches?
WADE: He may have them for some short while but that's somewhat depends on how he feels he's able to get around with the brace and the degree of mobility he needs to have.
QUESTION: Will he be conscious during the whole procedure?
WADE: That's anticipated, yes sir.
QUESTION: What are his chances that he won't be -- what are the chances that they will to render him unconscious (OFF-MIKE).
WADE: I would say they are very slim. As a matter of fact the president asked us that question when we were discussing that with him. And he voiced an opinion he would not like to be put to sleep if at all possible. And I think that they can probably say with 90, 95 percent assurance that this can be completed without the need for general anesthetic.
MCCURRY: One reason that Chief of Staff Erskine Bowles accompanied the first lady and he came out here today is for precisely that reason. We have a procedure that is in place. And a plan if anything about the 25th Amendment is indicated. And that's why I indicated earlier we'd been very close contact with the vice president's staff. It's not anticipated now, but it would be irresponsible for us not to at least anticipate that situation. If that need arises we can very quickly act to deal with the situation. But that's not anticipated at this time.
QUESTION: (OFF-MIKE) You made reference to the president (OFF- MIKE) at one thirty. Do you mean that the overall procedure has started, not the actual surgical portion?
MCCURRY: Doctor Wade can answer too, but they were taking them in to surgery at one thirty and planning to start the anesthesia with the intent to beginning the surgical procedure itself at roughly two. Is that correct doctor?
QUESTION: Would there automatically be a transfer of powers if the (OFF-MIKE).
MCCURRY: I'm sorry, say it again.
QUESTION: Would there automatically be a transfer of powers if the ...
MCCURRY: There is a procedure in place and if it becomes necessary to brief you on that I will.
MCCURRY: ...need to adjust his schedule because of this. Would he have the capacity to do anything he needed to irrespective of where he was.
QUESTION: Would you be able to let us know when the surgery is over even though they're not ready to come down and brief, the doctors?
MCCURRY: We'll try to give you an update when we know it's been completed so you can release a report that it's over with. With that breathlessness with which you're all reporting this.
QUESTION: Will you let us know when it begins?
MCCURRY: Yes, it's supposed to begin minutes from now.
QUESTION: Would you tell us about the doctors who are going to perform the surgery?
QUESTION: Doctor, what is the incision that's going to be made (OFF-MIKE) Will there be a lot of scaring, scar tissue (OFF-MIKE)?
WADE: Hopefully not, the incision will probably be on the order of four to five inches in length and will run longitudinal along the leg.
QUESTION: What about rehab? After the cast and the brace is removed, is that going to be -- well, let's say six weeks from now, and then he'll go into some rehabilitation situation?
WADE: They'll be starting rehab probably tomorrow, as a matter of fact. I can't -- don't quote that for certain, but very soon. I mean, it's a graduated response where you start very simply and progressively become more complicated in that.
But they are going to be actively involved in that very soon after that. And as a matter of fact, the team that was up there prior to the operation included our -- one of our physical therapists, who will be working the president.
QUESTION: What is the exact grade and title of the lead surgeon? And how many people will he be assisted by?
(UNKNOWN): (OFF-MIKE), why don't you just run through...
WADE: Oh, OK. The primary surgeon is Commander David Adkison, who is a chief...
WADE: I believe so, yes. They have a list that's coming here. And he is the chief of orthopedics at this institution. He is a sports medicine-trained orthopedic surgeon.
MCCURRY: We've got a copy of this that we'll make available.
WADE: Yes. And the second, or the assistant surgeon is Lieutenant Commander Marlene DeMello (ph). And again, this is coming out, I believe, in print for your edification. She is also a sports medicine-trained orthopedic surgeon.
QUESTION: Dr. Wade, normally would it be advisable for a patient if you just had kind of operation to take a trans-Atlantic flight two or three days later?
WADE: The president was very firm that he was going to Helsinki. And while we probably say, you know, wouldn't necessarily always recommend that, certainly it can be done very safely. And those issues have been discussed prior to the surgery also, in terms of things that we can do minimize risk of complications, et cetera.
QUESTION: Have you advised him that there could be complications and this might not be a good idea?
WADE: As part of informed consent that we always give to patients, yes, we covered the potential complications. The complications that he could develop from this surgery are really no different whether he's in Helsinki or whether he's right here in Washington, D.C.
QUESTION: But it's not so much to be in Helsinki or to be in Washington. It's being on a long airplane flight, which does immediately sink to the kind of thing that's advised after surgery.
WADE: I think that we have covered those with him. He is satisfied that we have mechanisms that we can minimize that risk related to that. And I certainly, as a surgeon myself, don't feel that that's an unrealistic thing to ask, for certainly we have transferred patients via air evacuation on very long flights soon after surgery as part of what we do in military medicine.
QUESTION: So will you be sending a team of doctors from here with the president?
WADE: That one's also discussed. There will be some augmentation of the White House medical unit with some personnel from this command. I believe, including potentially a physician and a physical therapist.
QUESTION: How many patients undergoing this procedure have general anesthesia versus epidural? And to what extent was the epidural choice related to questions of the 25th Amendment? In other words, he wouldn't have to go out completely?
WADE: I would say that probably most patients that would have this operation would have it done under a regional anesthetic, of which an epidural is one of the various ways that can be delivered. It doesn't require that the person be insensate and totally unconscious to do the operation.
QUESTION: Doctor, would you walk us through that demonstration one more time, please, and show us the areas that will be affected?
WADE: Well (OFF-MIKE)
MCCURRY: I'll narrate. the doctor is reaching down and touching his knee, pointing the area of the kneecap, just above the kneecap, four or five inches above. There. You got your photo for the evening news. Just what you need.
All right. Thank you very much, everyone.
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