The Health of the First Ladies: Medical Histories from Martha Washington to Michelle Obama (30 page)

It was not until two days later, February 6, when both staff doctors, very anxious and dissatisfied with the first lady’s progress, actively considered their consultants’ previous advice. Coupal urged a referral to the prominent Johns Hopkins urologist Dr. Hugh Young. The following day, February 7, Boone traveled to Baltimore to discuss Mrs. Coolidge’s medical problem with Dr. Young. The possibility that tuberculosis was the cause of the disease was discussed. Boone brought tuberculosis to the president’s attention in a private conversation.
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Young and his assistant, Dr. W. Scott, also from Johns Hopkins, examined Grace Coolidge at the Washington Naval Hospital on February 8. Strict secrecy was the desire of Mrs. Coolidge. Therefore neither the examination nor its results were announced. Consequently Boone drove the patient to the hospital in his own car without the customary accompaniment of a Secret Service agent.
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The president’s wife was three hours on the examination table. Young’s cystoscopic visualization and urinary tract X-rays disclosed an abnormal right kidney that was both enlarged and misplaced. Its drainage tube, the right ureter, was kinked. As a result of this blockage, the drainage system—closest to the kidney—of pelvis and calyces were swollen. As a result, the first lady was vulnerable to both uremic poisoning and a serious kidney infection. Both complications had occurred in the case of Florence Harding six years earlier. In contrast, surgery was performed in this case: the passage of instruments with irrigation of the kidneys was a successful treatment. An X-ray of Mrs. Coolidge’s chest was negative for any disease, including tuberculosis.
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Drs. Young and Scott subsequently retired to the secrecy of Coolidge’s private White House study, where they were joined by Boone and Coupal. Young informed the president that Mrs. Coolidge had a kidney infection. He also advised Boone to sleep at the White House in order to monitor Mrs. Coolidge’ condition. The patient’s symptoms worsened over the next two days as she suffered severe pain spasms from her diseased kidney. The frightened president became so distraught that he confided to a long-time friend, “Hillsey, I’m afraid Mammy will die.”
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Dr. Coupal was worried about Mrs. Coolidge’s heart and urged the administration of digitalis, a heart stimulant. His colleague Boone disagreed and was supported by Walter Bloedorn (“No! Don’t let them stampede you. Use your own judgment.”) and by the president (“You know best”). An electrocardiogram performed two days later confirmed Boone’s opinion.
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As a result, President Coolidge increasingly relied upon Boone to manage his wife’s care. He judged that the navy physician’s abilities were superior to that of his titular superior, Charles Coupal, a conclusion shared by Boone, who disparaged Coupal’s ability, considering it to be that of a family physician of the sort that one might have discovered at that time in towns and small cities in the United States.
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Almost two weeks after the disease’s onset, the patient continued to battle terrible pain. Coupal urged the administration of benzyl benzoate as a pain killer, then in use as an antispasmodic to halt intestinal, biliary and ureteral colic. Boone, continuing his intellectual feud with his colleague, administered it “ against my better judgment.” When there was no improvement, Boone decided that codeine was the appropriate remedy. In a peculiar display of professional one-upmanship, the doctor complained to Coolidge about Coupal’s therapy and phoned Dr. Young, who agreed “with my deductions and treatment of Mrs. C, congratulates me on my conduct of the case.”
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Due to insufficient rest, and despite her adherence to Boone’s admonition to avoid walks, Grace Coolidge remained both weak and tired through the early part of the Coolidges’ 1928 summer vacation at Brule, Wisconsin. The kidney attacks finally subsided during the summer, and there was no recurrence thereafter. In this pre-antibiotic era, rest and supportive care were sufficient to overcome the infection.
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Several comparisons are appropriate with Mrs. Harding’s illness in the White House six years previously. The disease was the same, but Mrs. Coolidge’s recovery was permanent, while Mrs. Harding’s outcome was eventually fatal. Both received VIP medical care from many physicians, both military and civilian, who were among the most illustrious in their field. In both situations, Boone was involved, and in both professional disagreements arose. However, the complete secrecy in the Coolidge White House was in stark contrast with the transparency in the Harding’s executive mansion.

Four years after the comprehensive media coverage of her son’s fatal illness (see below) all news of Grace Coolidge’s condition was suppressed. This may have been at the first lady’s request. Grace had complained earlier about her lack of privacy, especially after having endured the death of her younge
r
son in the public eye.
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The society sections of contemporary newspapers noted Mrs. Coolidge’s absence at events where her presence was anticipated, but there was no significant clarifying comment.
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Dr. Hugh Young abetted in placing a shroud over publicity by his semi-clandestine appearances at the Washington Naval Hospital and in Calvin Coolidge’s study. His respect for his patient’s confidentiality was reflected in his 1940 autobiography. Grace Coolidge was not listed in its subject index. (The urologist had previously treated the disabled Woodrow Wilson in the White House. Young wrote about this episode at length in the same volume.)
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The Coolidges were not the only presidential couple whose child died immediately before, during, or shortly after their term in the White House. The tragic deaths of young Benjamin Pierce and Willie Lincoln were discussed in a previous chapter and a more recent example, the demise of newborn Patrick Kennedy, is considered later.
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During the first half of the twentieth century, White House physicians, with a very short list of patients to follow and only an occasional acute illness to treat, often interacted socially with members of the first family. Both Drs. Coupal and Boone connected with the Coolidge sons, John and his younger brother, sixteen-year-old Calvin Jr. They rode horseback, played tennis, shot pool, went sightseeing and had lunches aboard the
Mayflower
together. Boone acted almost as an older brother.
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A tennis foursome between the two Coolidge sons and the two physicians was the setting for the subsequent Coolidge family tragedy. Cal Jr., late and in a rush to join his companions already on the court, donned his tennis shoes without wearing protective socks. A blister appeared on his toe afterwards. The boy was reticent about the lesion, took a bath and applied iodine. Symptoms arose over the next few days; he became tired and listless; pains shot up his leg, which became stiff.

On July 2, 1924, Cal was absent from a scheduled tennis foursome. Boone quickly sought out the president’s son to determine whether he was ill and located the boy in the Lincoln bedroom, lying down while the first lady played the piano. Boone’s examination noted a fever and swollen lymph glands in his groin. In addition, red streaks ascended his leg and a blister, darker and larger than usual, was located “on the third toe just behind the second joint on the anterior surface.”
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Boone, alarmed by signs of a significant systemic infection, called Coupal to the bedside. The two physicians operated in tandem during the entire tragic episode, in sharp contrast with their disagreements four years later during the illness of Grace Coolidge. Antiseptic dressings were applied and a blood culture was obtained. Boone personally took the specimen to a military laboratory for analysis. The physicians disclosed their apprehension to Grace Coolidge and the president. Mrs. Coolidge was calm, resourceful and an efficient asset throughout her son’s illness.

The president’s son was sicker the following day, more febrile and very restless. Colonel William Keller, the chief of surgery at Walter Reed Army Hospital, and Charles W. Richardson, a noted Washington physician, came to the White House to consult.
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The military physicians thought it wise to enlarge the medical team with more civilian consultation. John B. Deaver, professor of surgery at Philadelphia’s German Hospital, arrived on the next train. He joined Keller in suspecting appendicitis as the cause of the illness but was insufficiently certain to operate immediately. However, Calvin’s condition continued to deteriorate and the blood culture from two days earlier disclosed a systemic infection due to staphylococcal aureus bacteria.

Drs. Boone and Coupal were aware that the situation was grave and that some sort of notification to the public was necessary. “President’s Son Is Seriously Ill; Foot Is Poisoned” was the headline in the July 5 edition of the
Atlanta Constitution
. The bulletin was informal in nature and not signed by the doctors. It was explained that no formal bulletins would be issued, the White House taking the position that the patient was “not a public character, and should be treated with no more dignity than any other upstanding American boy.”
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A far lesser degree of transparency was practiced by these same doctors four years later.

On July 5, Deaver returned, accompanied by a pathologist, Dr. Kolmar from the University of Pennsylvania School of Medicine. Deaver decided hospitalization was necessary; an operation was performed at Walter Reed Hospital. Assisted by Keller, Deaver made an incision over the left tibia and chiseled some of the bone for culture to determine whether the infection had traveled. It had. “It was their belief … that the poison in the system had centralized sufficiently to warrant an effort at draining it from the body before the youth’s strength was further wasted in fighting the infection.”
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This was a peculiar notion since a prior culture of the blood had already disclosed a generalized infection.

The patient’s decline was precipitous. Calvin Coolidge, Jr. died on July 7, 1924, from staphylococcal septicemia, only four days after the severity of his illness was recognized.
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Many prominent American newspapers remarked on Mrs. Coolidge’s courage and endurance during this ordeal.
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In
The Tormented President
Gilbert analyzed Calvin Coolidge’s depression after his son’s death: “not believing that death had occurred, of missing his young son, of not being happy without him, of seeing him playing tennis on the WH courts every time he glanced out the window, and of soon joining his son in death.” The president’s behavior in office underwent a remarkable change: he became indifferent instead of engaged, listless instead of alert and in control, passive instead of actively engaging with his cabinet and Congress.
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Coolidge’s major depression resulted in a pronounced propensity to sleep. He slept eleven hours a night. His accustomed post-lunch naps lengthened to between two and four hours. His presidential work schedule was reduced to four and a half hours a day.
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In sharp contrast, his first lady reacted with hope and acceptance. She spoke of her son’s smile, of his happiness in heaven, of her sense of nearness to him, and of allowing her to glimpse God’s faith and the glory of his grace. She handled the loss of a son far better than her predecessors, Jane Pierce and Mary Lincoln. Grace wore all white at that August’s Republican National Convention and throughout the summer. She immediately returned to entertaining and presented a cheerful demeanor in the White House.
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And she discovered that the “Summer Game” was a source of fun and enjoyment. Mrs. Coolidge regularly attended the Washington Senators’ baseball games. She became a rabid fan, sat by the Senators dugout, was known by all the players, and refused to leave the ballpark even when her dour husband left during the early innings. In later years, when she retired to Massachusetts, she became a loyal supporter of the Boston Red Sox.
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Grace discovered Dr. Joel Boone to be an intelligent, attentive and available listener, and she came to rely upon the physician as a counselor and friend. She requested his advice on the selection of a boarding school for her sons. He recommended his alma mater, Mercersburg Academy in Pennsylvania, which the boys subsequently attended.
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Grace befriended not only Boone, but also Boone’s wife and daughter Suzanne. Suzanne was often asked to spend nights at the White House and the Coolidges took her to the circus. The first lady, becoming estranged from her husband, enjoyed her discreet talks with Boone as a way to unwind. The Coolidges’ proximity during their long 1925–7 summer vacations led to increased marital unhappiness. No word of these problems got out, only in Grace’s conversations with Boone.

During an Adirondack summer vacation, Grace and Boone had a long conversation about John, her remaining son. She confided to the doctor that she and Coolidge were not “at all in accord on John.”
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If she challenged the president on John’s upbringing, he would retaliate and not speak to her for three days.
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Calvin Coolidge’s concept of the relative positions of a husband and wife may be a reason for any marital discord: “Marriage is the most intricate institution set up by the human race. If it is to be a growing concern it must have a head. That head should be the member of the firm who assumes the greater responsibility for its continuance. In general this is the husband…. In my humble opinion the woman is by nature the more adaptable of the two and she should rejoice in this and realize that in the exercise of this ability she will obtain not only spiritual blessing but her own family will rise up and call her blessed.”
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