The Unfortunate Case of President James Garfield

(Based on true events.)

Attorney General:  “Now, let us review this one more time.  Dr. Willard Bliss, you are aware that the Washington Post has accused the physicians involved in this case of malpractice.  Our President is dead and we must take a serious look at what transpired.  My role here is to review the conduct of those involved to insure no litigation is forthcoming.

Dr. Bliss:  Certainly, sir.  I am eager to cooperate.

Attorney General:  Alright then.  As we all know, President Garfield was shot on July 2, 1881 while waiting to embark on a train at the Washington depot.  

Dr. Bliss:  Yes, sir.  Two shots were fired.  The assassin, Leon F. Guiteau, has been apprehended and is awaiting trial.

Attorney General:  I understand that you were the first physician on the scene, correct?

Dr. Bliss:  Indeed.  I found the President to be in shock.  His breathing was erratic and shallow and his pulse was thready.  We immediately hastened him to the White House where he was examined and found to have two bullet wounds.  The first simply grazed his arm.  The second was lodged internally deep within the abdominal cavity and, it was thought, most likely within the substance of the liver.  

Attorney General:  Was the President aware of what was happening?  

Dr. Bliss:  He was fully conscious and complaining of numbness in his legs.

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Attorney General:  And what diagnosis does “numbness in the legs” usually imply?

Dr. Bliss:  Sir?

Attorney General:  Has “numbness” got anything to do with the liver?

Dr. Bliss:  (With a wry smile.)  Only if an overly taxed liver fails to metabolize an excessive supply of port, I suppose.

Attorney General:  Let us be strictly serious, sir.  The Washington Post quotes an unnamed source as saying that YOU placed an “unwashed finger” into the wound.

Dr. Bliss:  Yes, I was attempting to determine the depth and breadth of the wound.  

Attorney General:  With an “unwashed finger”?

Dr. Bliss:  An oversight, sir.  In my haste to retrieve the projectile I acted without regard for minutia.

Attorney General:  (reading) Then a “non-sterile metal instrument” was used to probe the President’s wound, is this correct?

Dr. Bliss:  Again sir, it was imperative that the bullet be located and removed promptly before causing further damage.  

Attorney General:  So, sterility is not an issue here?

Dr. Bliss:  It is less important, I believe, when death is imminent.

Attorney General:  And what were your conclusions from examining the President?

Dr. Bliss:  At that time, it was thought that the bullet had most certainly lodged within the liver and the President would expire with alacrity from internal hemorrhage.

Attorney General:  Now, in fact, Dr. Bliss, the President did NOT die from hemorrhage within hours as predicted, is that correct?

Dr. Bliss:  Yes sir.  The President was, no doubt, a most vigorous specimen who fought a courageous battle.  Regrettably, he expired 80 days later in spite of the superior care rendered by no less than 16 of our most respected physicians and surgeons.

Attorney General:  Sixteen?

Dr. Bliss:  Indeed.  

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Attorney General:  My good doctor, I have a statement from the medical examiner who preformed the autopsy.  It is his opinion that the initial wound probing created a “false passage” in the tissue that later confused subsequent examiners with regard to the actual trajectory of the bullet.  The bullet was not found anywhere near the liver.  In fact, it entered the right posterior thorax, fractured rib 11, traveled leftward and anteriorly into the L1 vertebral body, then lodged about 2.5 inches to the right of the spine and below the inferior border of the pancreas where it rested harmlessly in a bed of tissue.  I am perplexed.  It seems that by the time the President met his demise, the original three-inch deep channel became “a wound in excess of twenty inches long extending from ribs to groin and was oozing purulent drainage”. Does this agree with your recollection of the events?

Dr. Bliss:  Allow me to explain, sir.  I did consult the Army Surgeon General who assessed the wound as well.

Attorney General:  By sticking another unwashed finger into it?  This was the “charlatan” whom the Post claims extended the original wound up to the ribs?

Dr. Bliss:  Where DO they get their information, I’d like to know?

Attorney General:  This damning account by the Post goes on to state that the Navy Surgeon also probed the wound and must have punctured the liver for he concurred that the President would die within hours from bleeding – since, following his examination he now washemorrhaging.

Dr. Bliss:  It does seem that the good surgeon my have inadvertently penetrated the capsule of the liver – an unfortunate occurrence that could have happened to anyone.  

Attorney General:  “Anyone”, that is, possessing the good sense to blindly probe a wound with a contaminated finger.  Shouldn’t the “surgeon” have then performed “surgery”?

Dr. Bliss:  It was agreed that surgery would be ineffective because the wound was too great and significant blood loss would preclude a successful outcome.  We did, however, utilize the latest invention of Mr. Alexander Graham Bell who brought with him a most curious instrument called an “induction balance” to locate the bullet.

Attorney General:  A metal detector?

Dr. Bliss:  Yes.  Mr. Bell felt that the bullet was lodged very deeply in the back.

Attorney General:  . . .causing more probing, of course.

Dr. Bliss:  Yes, sir, although I regret that we were again unsuccessful at locating the bullet.

Attorney General:  Really?  (Under his breath) There seems to be a pattern here. (Aloud) In fact, doctor, it’s been suggested that the only metal this new device detected were the springs in the mattress!

Dr. Bliss: Perhaps the device will find some useful purpose in future.

Attorney General:  I see.  Accordingly, over many days, the President then went on to develop fever and multiple infections and became increasingly weak, yes?

Dr. Bliss:  The President was put on a diet of brandy-flavored milk. In spite of this he grew weaker and weaker.

Attorney General:  You mean he FAILED to gain strength on this restricted and unorthodox diet?

Dr. Bliss:  We had to be cautious with oral intake lest a perforation in the bowel become manifest.   The President was fed through the rectum.

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Attorney General:  The rectum?  You put brandy-flavored milk into his colon?

Dr. Bliss:  It is a perfectly acceptable route for hydration when the integrity of the proximal gut is in question.  Our intention was to strengthen him slowly.

Attorney General:  Ever so slowly, I suppose.  Prior to the unfortunate events of July 2nd, I understand President Garfield was a robust 210 pounds.  The medical examiner records his weight at less than 130 pounds.  What say you?

Dr. Bliss:  I surmise that the horrid infections from the toxins released by the bullet into the blood caused the wasting process.

Attorney General:  An 80 lb weight loss!  

Dr. Bliss:  Over a period of several months, sir.  More like a pound a day.

Attorney General:  I am puzzled as to this accusation of “torture” by the Post regarding a “cooling system” supposedly implemented to keep the President comfortable.  Can you enlighten me?

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Dr. Bliss:  Indeed, sir.  As you are aware, the summer heat in the State of Washington can soar to 100 degrees. We were able to keep the President relatively comfortable by placing cotton towels dampened in ice water on his body for the fans to blow over causing evaporation.  

Attorney General:  This kept him comfortable?

Dr. Bliss:  He spoke nary a word of complaint.

Attorney General:  Was he speaking AT ALL by this point?

Dr. Bliss:  There were moments of lucidity, to be sure.

Attorney General:  The medical examiner’s report states that the President had a ruptured bladder. How did this happen when the original wound was no where near the bladder?

Dr. Bliss:  Iatrogenic, I expect.

Attorney General:  English, please, sir.

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Dr. Bliss:  It would seem that this injury, too, was caused by additional probing into the wound to locate the sinister bullet.

Attorney General:  (under his breath) was it the bullet that was sinister?

Dr. Bliss:  Sir?

Attorney General:  Sir, the medical examiner concludes that the President finally succumbed to a “massive myocardial infarction which was the culminating insult to a vessel that suffered sepsis, massive blood loss, malnutrition, disturbances of electrolytes, gangrenous bowel and encephalopathy”.  I see no documentation by any of the attending physicians regarding a “heart attack”.  The Washington Post quotes the President’s final words while clutching at his chest and moaning “This pain, this pain.”  What were you thinking?

Dr. Bliss:  At the time, sir it was assumed that a blood vessel had ruptured in the President’s stomach resulting in the typical, excruciating pain that causes one to clutch one’s chest.

Attorney General:  Forgive my ignorance but what kind of expression of pain is associated with a “massive” heart attack, pray tell?

Dr. Bliss:  I suppose a heart attack could present in such a manner as well.

Attorney General:  You “suppose”.  

Dr. Bliss:  Your tone is accusatory.  (A pause)  In retrospect, I believe there were one or two events during this traumatic and difficult case that could have been handled differently.

Attorney General:  One or two. . .?

Dr. Bliss:  Perhaps.

Attorney General:  Sixteen different physicians?  All probing and prodding the poor man until a simple wound causing a benign insult was turned into a weeping, festering, smoldering septic ulcer that spewed it’s toxins into his bloodstream resulting in encephalopathy, shock and ultimately, an agonizing death.  This was tantamount to torture!

Dr. Bliss:  Sir, you make it sound as though we were the assassins!

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Attorney General:  I am not a physician.  But the evidence here is pretty damning.

Dr. Bliss:  Sir, my colleagues and I are confident that although there may have been a few minor irregularities in the manner in which this case was handled, we will ultimately be vindicated as a group of physicians who wanted nothing better than to make our country’s leader well again.  We understand, too, that due to the celebrity of the deceased, it is necessary to scrutinize our interventions under a microscope, but I must say that this interrogation is becoming quite tedious and tiring.

Attorney General:  I beg your pardon.  That will be all.

Dr. Bliss:  Thank you sir. (hands him an envelope).

Attorney General:  What’s this then?

Dr. Bliss:  An invoice.  Our professional fee.  Please present it to the Senate.

Attorney General:  For how much?

Dr. Bliss:  $85,000.  Good day, sir.

Attorney General:  (to himself) it would have been more economical to have hired a competent assassin in the first place.

 

Author’s note: President James Garfield died on September 19, 1881 at age 49. This “play” was first Published in Stitches the Journal of Medical Humour in 1989 (written by Shannon Lee)

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