An Unfinished Life: John F. Kennedy 1917-1963 (18 page)

By the late fall, however, he was weary of the war and ready to go home. He wrote Inga that the areas over which they were battling were “just God damned hot stinking corners of small islands in a group of islands in a part of the ocean we all hope never to see again.” And the war itself now seemed “so stupid, that while it has a sickening fascination for some of us, myself included, I want to leave it far behind me when I go.”

EVEN MORE IMPORTANT
than the war-weariness stimulating Jack’s desire to go home were his continuing health problems. He now had almost constant back pain and stomachaches, which added to his normal fatigue from riding the boat at nights and struggling to sleep in the heat of the day. But unless he brought his medical difficulties to the attention of the navy doctors, he doubted that they would send him back to the States. “I just took the physical examination for promotion to full Looie,” he wrote his brother Bobby. “I coughed hollowly, rolled my eyes, croaked a couple of times, but all to no avail. Out here, if you can breathe, you’re one A and ‘good for active duty anywhere’ and by anywhere, they don’t mean the El Morocco or the Bath and Tennis Club, they mean right where you are.” He wrote Billings: “I looked as bad as I could look, which is ne plus ultra, wheezed badly, peed on his [the doctor’s] hand when he checked me for a rupture to show I had no control, all to no avail. I passed with flying colors, ready ‘for active duty ashore or at sea’ anywhere, and by anywhere they mean no place else but here. . . . Everyone is in such lousy shape here that the only way they can tell if he is fit to fight is to see if he can breathe. That’s about the only grounds on which I can pass these days.”

By November 23, however, his stomach pain had become so severe that he had to go to the navy hospital at Tulagi in the Solomons for an examination. X rays showed “a definite ulcer crater,” which indicated “an early duodenal ulcer.” It was enough to compel Jack’s return to the States. On December 14, his commander detached him from the PT squadron and ordered his return to the Melville, Rhode Island, PT training center by the first available air transport. Once back in the States, where he didn’t arrive until January, he was entitled to thirty days’ leave before reporting for duty.

He went first to Los Angeles to visit Inga, who saw him as “definitely not in good shape,” and then to the Mayo Clinic for an examination. Joe Sr. joined Jack in Rochester and thought he was “in reasonably good shape, but the doctors at Mayo’s don’t entirely agree with me on this diagnosis.” The doctors suggested that he consider having surgery to relieve the constant pain in his lower back, but, Joe wrote Rose, “Jack is insistent that he wants to get going again, so he left here Saturday to go and see his brothers and sisters and then report for duty.” Before heading to Rhode Island, however, he visited Palm Beach and New York for some R and R. “He is just the same,” Rose wrote his siblings, “wears his oldest clothes, still late for meals, still no money. He has even overflowed the bathtub, as was his boyhood custom.” The rest did not ease his ills, which now compelled him to take additional leave from duty for further medical evaluation in Boston’s New England Baptist Hospital. There, in February, the doctors also recommended back surgery.

But Jack was in no hurry to have an operation. He delayed, perhaps in the hope that the problem would let up or that it could wait until the war ended and he got out of the navy. His reluctance rested partly on the concern that it might raise questions about his failure to disclose his pre-service back, stomach, and colon problems and lead to a medical discharge under a cloud. In the meantime, the navy had reassigned him to a PT base in Miami, Florida, where he did nothing of consequence. “Once you get your feet upon the desk in the morning,” he told John Hersey, who was writing
The New Yorker
article on
PT 109,
“the heavy work of the day is done.” With no work of importance and his pain too great to delay further treatment, however, he agreed in May to have surgery. Occasional high fevers, coupled with a yellow-brown complexion—which was later diagnosed as malaria—underscored his need for medical attention. He joked that he would get through the war “with nothing more than a shattered constitution.” The navy now gave him permission for back surgery at New England Baptist by a Lahey Clinic doctor.

He entered the Chelsea Naval Hospital on June 11 and was diagnosed as having a ruptured disk. On June 22, he was transferred to New England Baptist, where the following day a Lahey surgeon operated on him. The surgery disclosed not a herniated or ruptured disk but “abnormally soft” cartilage, which was removed. A subsequent “microscopic report showed fibrocartilage with degeneration.”

Jack did well for the first two weeks after the operation, but when he began walking, he suffered severe muscle spasms in his lower back that “necessitated fairly large doses of narcotics to keep him comfortable.” The surgeon noted that only nine other patients out of more than five hundred had exhibited similar symptoms. Jack continued to have considerable pain when standing, and the physician predicted that it would be at least six months before he could return to active duty.

It was an overly optimistic prognosis. When Jack transferred back to the Chelsea Naval Hospital in August, a neurosurgeon described the case as “an interesting complication of disc surgery where the surgeon at the Lahey Clinic may well have failed to get to the bottom of the situation. . . . The pathology seen at operation was not evidently a clear cut disc.” Jack was “obviously incapacitated,” and the navy physician had no answer to his problem, as he believed “there is some other cause for his neuritis.”

Jack’s back difficulties were only one of several medical problems afflicting him. He was also described as having “a definite doudenal ulcer which recently was healed by x-ray, but he now has symptoms of an irritable colon.” Sara Jordan, the leading gastroenterologist at Lahey, told the navy doctors that Jack had “diffuse duodenitis and severe spastic colitis.” Though prior to entering the navy he had suffered “abdominal pain, sometimes of a dull nature and sometimes acute,” he had been in “good condition for some time, having had no abdominal symptoms, but using considerable discretion in his diet and some times resorting to antispasmodic medication.” He told Dr. Jordan that his current distress had begun after his ordeal in the Solomons. Jordan’s report said nothing about the extensive Mayo Clinic workup and treatment ten years earlier. By the middle of July, Jack had almost constant abdominal pain that only codeine could relieve.

During September and October, his back symptoms eased up, but the intestinal troubles continued. “The main difficulty,” the navy doctors noted on November 6, “is now failure to gain weight and strength with continuation of spasmodic pain” in the left side of his abdomen. Since Jack’s recovery was going to take “an indefinite amount of time,” his surgeon declared him “unfit for service.” The doctors now changed his diagnosis from “hernia, intervertebral disc” to “colitis, chronic.” By the end of November, the medical team at Chelsea Naval Hospital declared him permanently unfit for service and recommended that he appear before a retirement board.

Jack was now at the end of his patience with doctors and their treatments. In August, after eight weeks of hospitalization, he wrote a friend: “In regard to the fascinating subject of my operation, I . . . will confine myself to saying that I think the doc should have read just one more book before picking up the saw.” In November, he wrote Lem: “Am still in that god damned hospital—have had two ops. and Handsome Hensen, who is now in charge of my case, wants to get cutting again. He is the stupidest son of a bitch that ever drew breath. . . . He’s a mad man with a knife.”

The chief of the navy’s medical bureau, a Dr. B. H. Adams, now also temporarily frustrated Jack by raising questions about the origins of his disability. Jack’s restricted diet before he entered the navy seemed to “clearly indicate that the subject officer suffered some type of gastro-intestinal disease prior to his appointment in the U.S. Naval Reserve.” Adams disputed the conclusion that “‘the background of his present physical status is an exhausting combat experience . . . .’ This opinion would appear to be not supported by the past history as set forth above.” Prior to Jack’s appearance before a retiring board, Adams wanted “the history relating to the gastro-intestinal disease . . . clarified.” But other medical officers overruled Adams, declaring that Kennedy’s “present abdominal symptoms started” after “he spent over 50 hours in the water and went without food or drinking water for one week.” They took at face value Jack’s statement that “his present abdominal discomfort is different than that noted previous to enlistment.” After interviewing Jack on December 27, the retiring board concluded that his incapacity for naval service was permanent and was “the result of an incident of the service . . . suffered in [the] line of duty.” He was placed on the navy’s retirement list as of March 1, 1945.

Perhaps Jack experienced a different type of abdominal pain from what had plagued him before entering the navy, but his difficulties were all of one piece. The colitis had been afflicting him since at least 1934, when he was only seventeen, and his back problems had begun in 1938 and had been a constant source of difficulty since 1941. The steroid treatment for the colitis, which apparently began in 1937, may have been the principal contributor to his back trouble and ulcer without curing his “spastic colitis.” Because they could not identify the origins of his back miseries, the doctors now called it an “unstable back.”

The available evidence suggests that adrenal extracts in the form of implanted pellets used to control his colitis may have been the basis of his stomach ulceration and back difficulties. Jack apparently used these drugs episodically, relying on them when his colon disease flared up and stopping when he felt better. No doubt circumstances—the difficulty of consistently having so new a drug available during his nine months in the Pacific, for example—also made his use of them erratic. One expert on steroids says that regulating dosages was initially a serious problem, especially as DOCA was given intramuscularly or inserted under the skin with the expectation that it would be effective for a period of eight to ten months. Considerable uncertainty as to how much or how little was appropriate for a patient suggests that even under the best of circumstances Jack’s use of them was uneven.

What makes assertions that Jack’s stop-and-start use of steroids was a source of his stomach and lumbar diseases more convincing is the events in his medical history between 1945 and 1947. At the beginning of 1945, Jack went to Castle Hot Springs, Arizona, to recover his health. It was an elusive quest. Although Jack refused to complain to his father about his continuing maladies, Dr. Lahey saw him in Phoenix and reported to Joe that he was not “getting along well at all.” His back remained a source of almost constant pain and he had trouble digesting his food. A companion in Arizona remembered that “he looked jaundiced—yellow as saffron and as thin as a rake.” After a month in the desert, he told Billings that his back was “so bad that I am going to Mayo’s about the first of April unless it gets a little better.”

It did not, and so in mid-April he went back to Rochester, Minnesota. Since his doctors had nothing new to recommend, he decided against additional medical workups. Instead, in May, as the war ended in Europe, he went to work as a correspondent for the Hearst newspapers covering the United Nations conference in San Francisco and then the British elections and the Potsdam Conference in Germany. When friends saw him in San Francisco, he looked sickly and spent a lot of time in bed resting his back. In July he was down with a fever in London, and then in August, after returning to London from Germany, he became terribly ill with a high fever, nausea, vomiting, “vague abdominal discomfort,” and “loose stool.” Doctors at the U.S. Navy Dispensary in London noted “a similar episode in 1942” and a previous history of malaria in 1944, but recorded his current illness as “gastro-enteritis, acute.” In June 1946, after marching in a parade in Boston on a blistering hot day, he collapsed. One witness to the onset remembered that he “turned very yellow and blue” and looked like someone having a heart attack.

Dr. Elmer C. Bartels, an endocrinologist at the Lahey Clinic who subsequently treated him for his Addison’s, recalled that Jack was negligent about taking his medicine with him on trips. During his 1947 visit with Kathleen in Ireland, Jack became ill and cabled home asking that prescriptions be filled and sent with either his younger sister Patricia or a friend sailing to England. Before his sister or friend arrived with the medication, however, he became very ill in London. Seen at Claridge’s Hotel by Dr. Sir Daniel Davis, a prominent physician, Jack was immediately hospitalized at the London Clinic, where he was diagnosed with Addison’s. His nausea, vomiting, fever, fatigue, inability to gain weight, and brownish yellow color were all classic symptoms of the disease. (Because malaria had similar symptoms and because Jack’s long history of stomach and colon problems suggested that his difficulties were related to an ulcer or colitis, his previous doctors had not diagnosed the Addison’s.) Jack’s failure to take his medicine probably triggered this Addisonian crisis.

Kennedy’s Addison’s disease, like the ulcer and osteoporosis and degeneration of his lumbar spine, was likely the result of the supplemental hormones he had apparently been taking on and off since the 1930s. It is now also understood that sustained treatment with steroids can cause the adrenal glands to shrivel and die. Doctors who had treated Jack’s Addison’s or read closely about his condition have concluded that he had a secondary form of the disease, or a “slow atrophy of the adrenal glands,” rather than a rapid primary destruction. Because his sister Eunice also suffered from Addison’s, it is nevertheless possible that the disease had an inherited component.