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Post-Operation Briefing, March 14, 1997

SPEAKERS LIST:
MIKE MCCURRY, WHITE HOUSE PRESS SECRETARY
CAPT. CONNIE MARIANO, WHITE HOUSE MEDICAL UNIT
DR. DAVID ADKISON, CHIEF ORTHOPEDIC SURGEON, BETHESDA NAVAL MEDICAL CENTER
WILLIAM J. CLINTON, PRESIDENT OF THE UNITED STATES
DR. ALVIN MANALAYSAY, ANESTHESIOLOGIST

FDCH Transcripts

MCCURRY: Good evening, everyone. I want to start by paying a special White House tribute and thanks to Admiral Dick Ridenour, the commander of the National Naval Medical Center here at Bethesda. He and his team have done a very good job serving all of us and all of you today, and we appreciate their help, and certainly the president appreciates all the support and help that he's gotten here today.

The president's medical team, here with you right now, successfully concluded their treatment of the president today at 4:43 -- excuse me -- successfully concluded the surgical procedure at 4:43. And of course, they're tending to him in post-operative procedures now.

So the president was in surgery for roughly two hours and four minutes. They're here. They can tell you more about it. The president, after the surgery was taken back up to the medical evaluation and treatment unit, the ME-TU unit here at Bethesda, and came in to the room to find Mrs. Clinton and Chelsea watching a Carey Grant movie.

And of course, his first words were, "Where's the basketball?" So I expect he'll be watching a little bit of the tournament now. I'd like to start by introducing Dr. Connie Mariano, the president's personal physician.

And she, in turn, will introduce the team that worked on the president today. And they can tell you in as much explicit detail as you think you need what they did to the president today, and why the president is happy about it. Dr. Mariano.

MARIANO: Thank you, Mike. We're fortunate today to have a team of excellent physicians who had treated the president and his surgery and who will be involved in his post-operative care. First of all, I'd like to introduce to you Dr. Dave Adkison -- Dr. Adkison. He is the chairman of orthopedics, and he's a specialist in sports medicine. His assistant in this surgery was Dr. Marlene DeMayo (ph). And she's the assistant department head. Also, specialists in the field of sports medicine, the president's anesthesiologists, who are Dr. Robert Petty (ph) and Dr. Alvin Manalaysay, is the chairman of anesthesia.

I know you're very interested in learning about a little bit more details of the surgery, so without further ado I'll introduce you to Dr. Dave Adkison and he can give you the details about that.

ADKISON: Thanks, Connie. Last night, while the president was descending some stairs at Mr. Norman's house in Florida, he slipped on a stair and sustained a twisting injury to his knee, where his knee actually thrust to the side. He said he heard a loud snap in his leg, and Mr. Norman fortunately caught him.

He was seen at a local hospital in Florida, where he was evaluated by an orthopedist -- Joel Cohen I believe was his name -- who evaluated him and referred him back up here to us. So what happened with the president last night, if I can walk over to these -- I can illustrate, or how would you want to do that? Is that --

QUESTION: Can you have someone else point?

ADKISON: We'll have Marlene point. How's that? OK.

(UNKNOWN): We need to do a sketch on the (OFF-MIKE) so we

can see it.

ADKISON: The quadricep tendon is a -- actually a group of four muscles that go through one tendon that extend the leg, the thigh muscle. It's in three layers, and the president had a very unusual form of tear. Instead of tearing transversely, which it usually does, this one actually had torn fairly high in his thigh, headed down towards his kneecap and then split and sort of like de laminated the tendon and then came around to the inside of his knee, a little more of a complex tear than, again, is usually seen.

So we repaired it in layers as, you know, essentially got an anatomic repair on the tendon.

As the repair was done, one of the things that we do is bring sutures through bone, through the kneecap, to bring the tendon back into place, and then suture the remainder of the tendon together, and after we had done that, we were very pleased that he was able to achieve nearly a full range of motion of his knee. We didn't stress it beyond a certain point, but we had -- very happy with our repair.

He tolerated the procedure very well, very comfortable, and I'll be glad to answer any questions.

QUESTION: Dr. Adkison, if this were not the president of the United States, would you want this patient to go to Helsinki on an overseas trip in the next few days?

ADKISON: But he is the president of the United States.

(LAUGHTER)

I mean, I think that he can travel. He should be out of the hospital reasonably soon. It'll depend on his pain control. It'll depend on how comfortable he is with his post-operative regimen and how he feels.

Flying on Air Force One, I understand, is not like flying on a commercial airline, so I don't know that you could take those rules and apply them. I don't think you could.

QUESTION: Will he be taking any painkillers (OFF-MIKE).

ADKISON: There will be some -- not narcotics -- but some analgesic that we use. It'll depend. I'll actually leave the issues about pain control to the anesthesiologist, who have done some fairly special things for him so that he can be fully alert and fairly comfortable as well. That's their purvey, and I'll let them talk about that.

QUESTION: How has the more complicated nature of the tear affect the (OFF-MIKE) tendon?

ADKISON: Any time you tear the tendon, you have to go slowly to start with. The fact is that it was not an unfavorable tear. It was rather unusual, but in fact, we don't anticipate that it would slow him down over the average recovery.

QUESTION: And will he have full recovery of the knee, do you believe?

ADKISON: I'm sorry, when?

QUESTION: Do you believe that he will eventually have or regain full use of his knee?

ADKISON: Most people will lose a little bit of motion, a little bit of flexion in the knee. That varies. And again, that's all comers, that isn't healthy 50-year-olds who do this. And I suspect that, you know, given the repair that we got, he has an excellent chance to regain full motion in his knee.

QUESTION: We were told that he actually dozed off a few times during the surgery. Was he ever really unconscious?

ADKISON: No. No. We were playing some very nice music for him. But, no.

QUESTION: Could you tell us a little bit of what he was doing during those two hours?

ADKISON: Talking for the most part. We chatted a bit. He and I share a common interest in music, and we listened to some. So I think he laid back and enjoyed it.

QUESTION: (OFF-MIKE)

ADKISON: Lyle Lovett.

QUESTION: How long will you keep the president here?

ADKISON: How long will we keep him here?

QUESTION: Yes.

ADKISON: I can distill it down very quickly, as I've told the family. When you don't hurt, when you don't have a fever, when you're able to get around and eat OK, then it's OK to go.

QUESTION: (OFF-MIKE) tonight, tonight at least?

ADKISON: No. He'll be (OFF-MIKE) at least tonight, oh, yeah. He'll be here tonight, yeah.

QUESTION: (OFF-MIKE)

ADKISON: Certainly, yeah.

We would anticipate on average about a 48-hour stay for this. On average, again. But it varies.

QUESTION: He'll probably go home on Sunday? You think he'll go home Sunday?

ADKISON: I would think that that is not an unreasonable estimate.

MCCURRY: Let me interrupt.

ADKISON: Please do.

MCCURRY: Since we're talking about him, I thought maybe you'd like to hear from the president. So he just wanted to say hello, we connected him in here.

Go ahead, sir.

CLINTON: Mike, can you hear me?

MCCURRY: Yes, sir, we can hear you fine. Go ahead.

CLINTON: Well, I'm enjoying this press conference.

(LAUGHTER)

MCCURRY: First one in a long time you've probably enjoyed.

CLINTON: It's wonderful not to be asking -- answering the questions. But I want you guys to quit giving my doctor a hard time about letting me go to Helsinki. We're all going to Helsinki. We have to go to Helsinki.

(LAUGHTER)

ADKISON: Thank you, sir.

CLINTON: I feel great. They did a terrific job.

And let me say, I just had an unlucky break. But I've had almost no injuries in my life, and you know, 25 years of running and a lot of other athletic activity, I've been remarkably free of injuries. I had one skiing accident once. And, you know, this was just an accident. Accidents happen to people.

But I was very fortunate that Greg Norman being a better than I am immediately heard my knee pop and turned around and caught me before I fell on the ground.

And then the hospital down in Florida did a wonderful job, Dr. Cohen and the other people. And my team did a good job here.

I feel great. And don't worry about it. I'll just spend a little time here and get home and go back to work.

Thank you.

MCCURRY: We were trying to get a -- work out a way he could do some questions, but we weren't able to do that.

Dr. Adkison, let me turn it back to you.

ADKISON: Thank you.

QUESTION: Doctor, did you ever ask the president to not go? Did you bring up (OFF-MIKE)?

ADKISON: No. No. I didn't bring the topic up.

QUESTION: Did he ever ask you, should I go, should I not? (OFF- MIKE)

ADKISON: On the table, you mean, with whether we would do the surgery or not?

QUESTION: No. Did he ask you medical advice as to whether or not he should go?

ADKISON: No, not really.

QUESTION: Doctor, (OFF-MIKE) rehabilitation process how long it will take and exactly what he will be doing to get his knee better?

ADKISON: It depends on what you mean by rehabilitation. The -- we'll start range of motion in the knee within the pain tolerance fairly quickly -- tomorrow. He'll be on crutches for some period of time, anywhere -- eight weeks, plus or minus a little bit of time.

We'll -- we won't let him start strengthening the muscle for about three months. Again, it depends on how well he's doing. The -- he wants to know when he can swing a golf club, and we'll see.

QUESTION: What about a brace for his leg? You're not going to put it in a cast or anything?

ADKISON: Absolutely no cast. No. No, indeed.

QUESTION: What will you use to stabilize the leg?

ADKISON: Well, we'll put him in a brace. We can put him in a lockable brace, one that's adjustable to allow the knee to go into full extension and to a few degrees of flexion. Again, his knee in surgery tolerated flexion very nicely, and we'll progress him as tolerated. We'll use the brace to control his motion.

The main thing we don't want to have happen to him is for him to fall without some kind of protection, because then again, he might -- he might re injure this.

QUESTION: Doctor, could you give a recitation of what happened immediately following the twist? Did he try to walk on it? Did he hobble? Was he writhing in pain? What was happening to him?

ADKISON: I think he was pretty much in pain. I think his staff and Mr. Norman helped him into a vehicle and he took off.

QUESTION: Did he have to wait there (OFF-MIKE)?

ADKISON: Connie -- yes, let me defer to Connie. I wasn't there.

MARIANO: That was in West Palm Beach after we were at Greg Norman's house and he was in pain at the time. They immobilized him. Dr. Lang, William Lang, was the White House physician with him at the house, held on to the leg and mobilized him, got him in an ambulance with Secret Service and proceeded to St. Mary's Hospital, where this all began.

I'm sure some you have some questions for the anesthesiologists. Dr. Petty (ph), do you want to entertain any questions they might have?

MANALAYSAY: My specialty is regional anesthesia and I primarily do anesthesia for orthopedic procedures, so that's why I was selected to take care of the president today.

Our primary concern with the anesthetic was, number one, that we gave him an anesthetic that the surgeon can do the procedure with, but we also tried to give him an anesthetic that wouldn't alter his mental status in any way so that he could stay alert at all times and, according to the 25th Amendment, I guess we were trying to uphold.

And he had an epidural anesthetic, which is still running. We will basically run that anesthetic continuously with low dose, low strength, local anesthetic while he's in the hospital and he should really have no pain, post-operatively, while that epidural is running.

QUESTION: What's it like working on the president of the United States?

MANALAYSAY: It's fairly intimidating but you have to treat him like every other patient and do a good job.

QUESTION: Were you nervous?

MANALAYSAY: Yes, sir.

QUESTION: Doctor, how will you control the pain once he leaves here?

MANALAYSAY: We will primarily control it with PO (ph) medicine, medicine by mouth.

QUESTION: And what will that be?

MANALAYSAY: We will try to -- try to stay away from narcotics or opioids (ph) as much as we can, non steroidals, extra strength Tylenol.

The most pain will be in the first 24 hours. If we can continue the epidural and relieve his pain for the first 24 hours, he shouldn't require a lot of pain medicines after that time period.

QUESTION: Dr. Adkison, you were sort of in mid-question when the president was piped it. Were you saying it's more likely that he'll be released on Sunday than Saturday?

ADKISON: Again, a lot of this depends on what I said, you know. It depends on how comfortable he is. And we would anticipate for most people, if you did this, it would be about a two-day stay.

QUESTION: Doctor, how was he during the operation? What did he say to you? What kind of questions did he ask?

ADKISON: I think we mostly enjoyed talking about music. I mean, he told me about some great CDs I should buy, and -- not the monetary kind but the music kind -- and we've, you know, we, it was just chit chat. He's very pleasant to deal with.

QUESTION: Doctor, how long did you say the president will be on crutches, and if he would...?

ADKISON: On crutches?

QUESTION: Yes. Did he have any walks without them? Would you recommend that he walk without them?

ADKISON: We wouldn't recommend it. And we've, again, we would estimate about eight weeks, plus or minus a couple. I mean, a lot of this varies on how well you regain your motion, what the signs are of healing, how the swelling goes away, how the soft tissues around the kneecap move. A lot of things that play into that.

QUESTION: If you were to spot him on television without crutches within eight weeks, would you be concerned?

ADKISON: I'd call Connie.

QUESTION: Doctor, was there anything you did differently than you would do for a regular patient, given the fact that he is the president?

MARIANO: There's (ph) a press conference. That's different.

ADKISON: Yeah. That's the big difference.

MARIANO: And the Secret Service.

ADKISON: No, we gave him a standard operation.

QUESTION: How would you compare it another, similar repair, in other words, in terms of degree of difficulty, is this kind of a standard (OFF-MIKE)?

ADKISON: They're each, have their own personality, the injuries do. The -- I would say the most important thing is to clearly identify the extent of the tear and the characteristics of the tear.

And his was rather unusual. I mean, just -- it tore in a way where there actually still was some of the tendon attached to the bone, which is uncommon. And where there was a fairly large amount still attached to bone.

QUESTION: Is that good or bad?

ADKISON: Well, we'll see where it goes. It actually, it made the reapproximation technically easier, which is nice. And it helped put it back together a little bit easier. QUESTION: (OFF-MIKE) rehab problem, (OFF-MIKE)?

ADKISON: No, I don't think it'll change his rehab that much. Again, we'll see. The rehab interesting enough, it was more a factor of how you individually heal. I think some people lay down a scar if you scratch them with a razor blade. I mean, and some people you couldn't get them to scar no matter what you did to them.

QUESTION: Are there risks of keeping in the epidural that long, with the blood pressure, for example?

MANALAYSAY: No, ma'am. The local anesthesia that we use is so dilute that it just barely makes his leg numb and doesn't really have any affect on his blood pressure.

QUESTION: What are the potential post-operative complications for this kind of surgery?

ADKISON: Any time you open the skin, there are certain risks, whether it's taken care of, you know, a quadriceps rupture or you're doing a simple hand incision or something.

Infection, very low rate. The biggest concern of this operation, of course, will be stiffness, as I mentioned earlier. Potential complications otherwise are generally more related to your health.

Blood clots anytime you operate on the leg are a concern. And we've taken precautions about that.

QUESTION: (OFF-MIKE)?

ADKISON: No. No, he's not.

QUESTION: Doctor, we were told there would be an augmented medical team going to the president to Helsinki. Could you describe how that augmentation will play out.

ADKISON: Connie can.

MARIANO: Wherever the president goes, he's within a few heartbeats away from a physician and a nurse or a medic. And I will be that physician on the trip to Helsinki.

In addition, I have a critical care nurse on board that airplane. I will bring Dr. De Maio with me to assist me should there be any problems. In addition, we'll have a physical therapist to help augment our team.

Also, wherever he goes overseas, we send an advance team out to survey that hospital or hospital we may use should problems arise, routinely on trips like -- such as these. So we will have a medical advance in place in Helsinki, like we do for all our overseas trips.

So we have people prepared, should any problems arise. QUESTION: How many physicians were involved in the procedure?

ADKISON: (OFF-MIKE).

MARIANO: It took a village to put the president together. (LAUGHTER)

It was quite a group. We didn't count how many. I mean...

QUESTION: Can you approximate?

ADKISON: Six to eight.

MARIANO: Six, eight. I mean...

ADKISON: Dr. De Maio and I were the operating surgeons. So...

QUESTION: How long before the president can jog again under normal conditions?

ADKISON: Under normal conditions?

QUESTION: Normal conditions.

ADKISON: We would anticipate somewhere in the six-month range. We'll be working with them to do some other things otherwise to stay aerobically fit. And...

QUESTION: Like what?

ADKISON: Upper body work. When he can get in the pool, we can work with that. Stairmasters, those kinds of things. There are other ways to stay aerobically fit without running.

QUESTION: And what about golf?

ADKISON: Again, it will depend on whether you're talking going out pitching and putting or whether you're talking about taking a full turn. Full turn, about the same amount of time. There's some unusual sheer forces that occur when you swing a golf club, especially when you take a big turn. And we want to make sure that he's perfectly healthy before we let him do that. But his three quarter game will be good. Yes, I'm sorry.

QUESTION: Will the president be able to do all these (OFF-MIKE)?

ADKISON: I'm sorry, I didn't understand you.

QUESTION: Will the president be able to do his regular work OK?

ADKISON: Thank you. Sorry. We had the Lyle Lovett turned up real loud. Yeah. Yeah, he should be fine to do his work. Thank you for asking that.

QUESTION: (OFF-MIKE)

ADKISON: I don't think so.

MCCURRY: Thank you. I want to again thank the team here. They did a great job today, and I thank them for coming in briefing you. If you don't have anything else for me, our intent is to declare a full (OFF-MIKE) at the conclusion of this briefing. We'll let you know what we plan tomorrow. My guess is very low key tomorrow. At some point we'll give you some sense of who's going to visit the president, what the first lady's plans are, we'll give you some kind of update on what he's up to, and then call it -- try to shut things down here as early as we can tomorrow, too.

QUESTION: (OFF-MIKE) Tuesday?

MCCURRY: We are going ahead with the plans as scheduled for Tuesday, as you can tell. We will be adjusting in, you know, what the president's mobile requirements are. They'll reflect the fact that he'll be a little less ambulatory than regular, but they intend just to go ahead with that schedule.

The vice president's going to chip in -- and let's see where my folks are, I think that's right.

QUESTION: Is the family staying in the hospital tonight?

MCCURRY: I think the -- they are going to chip in and do -- the vice president's going to chip in and do the radio address for him, I believe. Let me grab one of my folks and get the answer for you on that.

QUESTION: Is the family staying here tonight?

MCCURRY: No, Chelsea left because she's going, I think, as maybe some of you read before, she's going to the Viennese waltz ball tonight. So she was looking forward to that. The vice president is -- the vice president, I believe, is going to do the address, and the subject is education.

We're going to try to, you know, sell that school construction funding story that you really missed selling today.

QUESTION: (OFF-MIKE)

MCCURRY: The vice president was, I think, scheduled back later on this evening, right?

QUESTION: (OFF-MIKE)

MCCURRY: I'll have to check on that. I believe she's going to back to the White House.

QUESTION: Can we get a picture or photo op of...

MCCURRY: She's not going tonight. McNeilly (ph), I think, shot a picture of the president as he was talking to us just now, and he's trying to move that out to the wires digitally, so be on the lookout for that.

QUESTION: ... member of the Gridiron Club earlier today.

MCCURRY: Well, the Gridiron Club is an occasion that the president very much sort of was looking forward to. We are playing around with some ideas on a way that he might still make a contribution to the dinner, and I think the vice president might be going, too. So he will certainly miss the opportunity to give back the little that he was probably going to get.

QUESTION: Were you satisfied with the pool notification procedures last night? Or are you working on those?

MCCURRY: I looked at them. I looked at them. I walked through them with Mary Ellen very closely. It took -- normally, when we're at the pool, and they're at a remote location, it takes some time to assemble them. It took some time once the president -- once the doctors made the determination that he needed to go to St. Mary's, and once he got to St. Mary's to know exactly what he would be doing, or whether or not he'd be turning right around coming back after an x-ray back to the cottage.

And I have confidence that Mary Ellen and Chris served all of you very well in getting you together as soon as they could. She was alerted right away.

Everyone in Washington that needed to be alerted was alerted, and we were able to assemble the pool, get them there, and you were able to cover the story. And America got to wake up to the news. That's the way it should be.

QUESTION: Mike?

MCCURRY: Yes.

QUESTION: The first lady's going to leave for Africa when?

MCCURRY: We haven't -- I don't believe her staff has announced her schedule yet. They will review it, look at it. I think that obviously they're going to want to see -- she's going to want to see the president tomorrow.

And the president just is -- feels it's very, very important for her to take this trip. This is a trip that those in the countries she will visit have been looking forward to, and it's something that she wants to do. And it's something the president very much wants her to do. So he was already, I think, even at 4:00 this morning was telling her that she should plan to continue on her journey.

QUESTION: ... said earlier that they were going to postpone it until Sunday at 7:00.

MCCURRY: Well, they're still looking -- they're looking at -- she was scheduled to arrive and have some downtime when she arrives. So they're playing with their schedule. I know some of you are asking because you're scheduled to travel with her, and we'll do the best to get you her itinerary when we have it.

QUESTION: Do you plan to have any staff here?

MCCURRY: We'll have a kind of a regular minimal pool staff here in the morning, and we'll give you some -- we don't plan to do any briefings or anything here early in the morning. Whatever we do, I think we'll likely do more around midday so that people don't have to worry about rushing in here Saturday morning.

We'll give you an update. If the doctors have anything to report from over night, we'll arrange for them to do that if they're willing. And we will -- just remember proportionally what we're talking about here. There are a lot of important news in the world today.

And the president, in fact, was already planning tonight to see if he couldn't get an update on Albania and talk to Mr. Bowles further about some of the conversations we've had with the Hill today. I know you're very excited about this, but let's keep things in some perspective.

QUESTION: (OFF-MIKE)

MCCURRY: Yes, as the pool was briefed on the plane, he did call the school, promised that he would try to return and see them. Did, in fact, announce his $5 billion school construction initiative, and the vice president talked about it at greater length out in California today.

And I hope at some point we can kind of bring that back into focus for all of you because it's an important element of the president's overall education challenge.

QUESTION: (OFF-MIKE) at the fundraiser, planning a fundraiser to sell who (ph) gets to sign his cast.

(LAUGHTER)

MCCURRY: Well, no. I mean, he must have been practicing his Gridiron material. Can I excuse the doctors? They've worked very, very hard today, and I thank all of you for your help today and for your treatment of the president.

Admiral, thank you very much to your very talented staff and to the staff here. Thanks, guys.

QUESTION: Can I ask you one more question?

MCCURRY: Yes, one more.

QUESTION: The president is aware that 48 hours is a normal stay for this procedure. Do you think he's willing to go along with that, that we can assume he will?

MCCURRY: He's, for all his feistiness, he does rely very closely on the advice he gets from the team here at Bethesda, who he's come to know through his annual exams. He respects them a lot. He's got enormous faith and confidence in Dr. Mariano, as you all know, and they'll make a recommendation to him that I think that he will follow.

At the same time, he alerted them to the importance he attaches to Helsinki, and I think they will -- they're certainly aware of that, and they will understand that priority, but they'll make a recommendation in the best interest of their patient. Is that fair to say, doctors?

OK.

And then the president will do whatever he wants to -- no.

(LAUGHTER)

No, but I think he -- look, you all understand that he attaches great importance to them and I think I can safely say there's been nothing about the treatment today or the analysis that doctors have made that would complicate him going on Tuesday, given complication that already existed dealing with a patient who has just gone through a procedure like this.

And certainly, it's not prohibited, and the president, if it's not prohibited, the president would very much want to go ahead with what is a very important summit between the two presidents.

Anything else? Can we call it quits for the day? Thank you for your patience today. We will see you tomorrow. You can all go home and enjoy the weekend. Thanks.

Thank you.

Copyright © 1997 Federal Document Clearing House

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