Press Briefing by Mike McCurry and Dr. David Wade

National Naval Medical Center

Bethesda, Maryland

1:44 P.M. EST

MR. MCCURRY: Good afternoon, everybody. I've 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 is the Chief of Clinical Services here at the National Medical Center -- National Naval Medical Center. He'll tell you a little bit about the procedure the President is just now going into. The President at 1:30 p.m. 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 has done since he arrived here at approximately 12:15 p.m. He went immediately to the Medical Evaluation Treatment Unit here, the METU 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 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 they went in to give the President a briefing, 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 from 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 a schedule after the procedure.

Dr. Wade can tell you more about what we expect. I think it will be a while before we can report back to you on the results or outcome of the surgery. That probably won't be until maybe dinner time tonight. So I would suspect maybe you'll have some time this afternoon.

Q: Can you tell us how the President is feeling? Is he in any pain? Is he taking any mediation?

MR. MCCURRY: He's -- Dr. Wade can tell you about any painkillers he's taking. He's 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, I 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 that, 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.

Q: Mike, did the doctor find any other injuries or illnesses as a result of the --

MR. MCCURRY: I'll let Dr. Wade brief on that. Not that I am aware of. But he seems to be fit. They were doing all the normal workup for the procedures he's about to --

Q: Did the President get his usual staff briefings?

MR. MCCURRY: The President had talked during the evening with the Chief of Staff, with the First Lady. We had several meetings this morning, directly with the Vice President's staff, and have been in close contact with them, although there has been nothing about our -- 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 coordination with the Vice President's staff.

The President has -- the only other phone call he's made that I'm aware of is 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 work that's underway to try to evacuate U.S. personnel and dependents and other American citizens.

Q: We were told earlier that the surgery might last one to two hours. When would you anticipate the surgery being over and you being able to come back to tell us more?

MR. MCCURRY: Well, as I say, my guess -- Dr. Wade knows this procedure, and he himself is a surgeon and has performed this surgery, this knee surgery himself, so he can tell you more and describe more of the procedure. But I suspect it will be 5:00 p.m. or so at the earliest before the President will be safely into 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 5:00 p.m.

Q: Mike, might the President's Helsinki schedule be altered in any way, depending on medical advice, assuming he goes ahead with the trip?

MR. MCCURRY: His schedule --

Q: Might his Helsinki schedule be altered in any way?

MR. MCCURRY: The morning jog out in the beautiful Helsinki morning is probably going to have to be canceled, obviously, and we'll have 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 will be affected at all.

Q: Could Dr. Wade describe the procedure?

MR. MCCURRY: If you'll let me get him up here, yes.

Q: If the President has to be on any kind of painkillers or any kind of drugs, might that change his mind about going forward with the summit?

MR. MCCURRY: I haven't heard anything from any of the doctors that have been describing procedures to me that would indicate that that would be a problem. I don't want to speculate on his medical workup post-surgery because that's better for the doctors to do later.

Q: Can you describe what happened, how he fell, how he hurt himself?

MR. 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 light, but in the shadows apparently the President thought he was on a walkway and, in fact, he had one more step to go. And so he lost his balance coming off that step and the leg decelerated.

Q: He was actually outside the house?

MR. MCCURRY: Yes, he was on the way out the door.

All right, let me thank Dr. Wade for being here. He can tell you more about the medical procedure itself and take any questions you have.

DR. WADE: Yes, ma'am.

Q: The procedure -- how long will it take, how complicated is it, and what will the President -- during the procedure?

DR. 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 are doing the actual incision and repair of the tendon.

Q: And how long -- when will the procedure actually start, do you know?

DR. WADE: Well, they were planning to start around 2:00 p.m. I'm not up there right now, so I can't comment if that will happen or not.

Q: Could you just describe the injury and what the procedure will be and just lay it all out for us?

DR. WADE: Yes, ma'am. What he had done was -- the insertion of the quadriceps tendon into the kneecap has been disrupted from the fall. And the operation will be intent on reattaching the tendon so that he can again extend his leg.

Q: How difficult a procedure is it? I understand in orthopedic terms it's not really a big deal. Is that true?

DR. 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.

Q: How do they actually perform it? How do they go about reattaching it? Do they drill a hole or something?

DR. 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.

Q: 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 that he may a need teflon graft, is it that serious?

DR. WADE: From the review that was going on upstairs prior to the President going to the operating room, they concurred with the findings of 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.

Q: What can you say about the recovery period? Might that have some -- on the surgery itself?

DR. WADE: We would hope that this will be a very short operation with a short recovery period in the hospital. Lord willing, all things going well, he would hopefully be home tomorrow or Sunday morning.

Q: But the long-term recovery once he leaves here.

DR. WADE: Long-term recovery, he should be able to be up and about 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 will 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.

Q: How about the cast? There will be a cast, sir, as I understand? How many weeks in a cast?

DR. WADE: There are actually, as I understand from Dr. Adkison, who is 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.

Q: What medications will he be on with the epidural? What other kinds of painkillers will he --

DR. WADE: I don't believe he plans to be under any other painkillers or sedatives, ma'am.

Q: How about crutches -- will the President require crutches?

DR. WADE: He may have them for some short while, but that somewhat depends on how he feels he's able to get around with the brace and the degree of mobility he needs to have.

Q: He'll be conscious during the whole procedure?

DR. WADE: That's anticipated; yes, sir.

Q: What are the chances that he won't be? What are the chances that you will have to render him unconscious --

DR. WADE: I would say they're very slim. As a matter of fact, the President asked us this 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 surety that this can be completed without the need for general anesthetic.

Q: -- what happens, or are we talking possibly 25th Amendment --

MR. MCCURRY: One reason that the Chief of Staff, Erskine Bowles accompanied the First Lady and 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've been in 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 -- deal with the situation, but that's not anticipated at this time.

Q: -- the President at 1:30 p.m. -- the overall procedure started now --

MR. MCCURRY: Well, Dr. Wade can answer, too, but they were taking him into surgery at 1:30 p.m. and planning to start the anesthesia with the intent of beginning the surgical procedure itself at roughly 2:00 p.m.

Is that correct, Doctor?

DR. WADE: Yes.

Q: Would there automatically be a transfer of power here if he did go --

MR. MCCURRY: There's a procedure in place, and if it becomes necessary to brief you on that, I will.

Q: Where is the Vice President?

MR. MCCURRY: The Vice President was in California and I think was planning to return -- scheduled to return to Washington. I'll double-check that, but we have not seen any need to adjust his schedule because of this. He would have the capacity to do anything he needed to do, irrespective of where he was.

Q: Would you be able to let us know when the surgery is over, even though you're not ready to come down and brief us about it?

MR. MCCURRY: We'll try to give you an update when we know it's been completed so you can at least report it's over with, given the breathlessness with which you're all reporting it.

Q: Could you let us know when it begins?

MR. MCCURRY: Yes, we can try to find out. It's supposed to begin minutes from now.

Q: Can you tell us about the doctors who are doing the surgery?

Q: Doctor, how long is the incision estimated -- will there be lots of --

DR. WADE: Hopefully not. The incision will probably be on the order of four to five inches in length and will run longitudinally along the leg.

Q: What about the rehab -- brace removed. That could be six weeks from now --

DR. 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. 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 one of our physical therapists who will be working with the President.

Q: -- the name and title of the lead surgeon, and how many people will he be assisted by?

DR. WADE: The primary surgeon is Commander David Adkison, who is the Chief of Orthopedics at this institution. He is a sports medicine-trained orthopedic surgeon.

MR. MCCURRY: We've got a copy of this that we'll make available to you.

DR. WADE: Yes. And the assistant surgeon is Lieutenant Commander Marlene De Maio (phonetic) and again, this is coming out, I believe, in print for your edification. She is also a sports medicine-trained orthopedic surgeon.

Q: Dr. Wade, normally would it be advisable for a patient who just had this kind of operation to take a transatlantic flight two or three days later?

DR. WADE: The President was very firm that he was going to Helsinki, and while we probably say -- 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 thing that we can do to minimize risk of complications, et cetera.

Q: Have you advised him -- has anybody here advised him that there could be complications and that it might not be a great idea?

DR. WADE: As part of informed consent that we always give the 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.

Q: But it's not so much being in Helsinki or being in Washington, but being on a long airplane flight which doesn't usually seem to be the kind of thing that's advised after surgery.

DR. 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 is part of what we do in military medicine.

Q: And will you be sending a team of doctors from here with the President?

DR. WADE: That was 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.

Q: How many patients undergoing this procedure have general anesthesia versus epidural? And to what extent was the epidural choice related to the question of the 25th amendment -- in other words, so he wouldn't have to go out completely?

DR. 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.

Q: Doctor, would you walk us through that demonstration one more time, please, and show us the area that you've -- and outlined --

MR. MCCURRY: I'll narrate. (Laughter.) The doctor is reaching down, touching his knee, pointing to the area of the kneecap, just above the kneecap -- four or five inches above. There, you've got your photo for the evening news. Just what you need.

All right. Thank you very much, everyone.

END 2:02 P.M. EST