36 Minutes at Dawn

What the doctors did for Lyndon Baines Johnson in Bethesda Naval Hospital last week was essentially what they would have done for any patient who happened to have the same complaints. But because Johnson is President of the U.S., there was a sort of fail-safe setup --twice the average number of physicians and surgeons.

The night before his surgery, the President was given a routine physical examination. Then the otolaryngologists (ear-nose-throat specialists), headed by Dr. Wilbur J. Gould of Manhattan's Lenox Hill Hospital, reconnoitered the presidential larynx, the territory in which they would be operating at dawn. The polyp, about the shape and consistency of a tiny button mushroom, was growing from the right vocal cord. Surgeon George A. Hallenbeck of the Mayo Clinic and Dr. David P. Osborne, a Navy surgeon, examined the presidential abdomen, where a lump the size of a golf ball protruded near the scar left by his gallbladder operation. Then the two groups of surgeons got together in a skull session with the anesthesiologists and the President's two personal physicians to settle details of what everyone would do in the morning.

Calming & Relaxing. Awakened just after 5 a.m., the President was soon stretched out on a mobile bed. Into an arm vein, the Mayo Clinic's Dr. Edward P. Didier and an assistant injected a muscle relaxant and a pre-anesthesia dose of a barbiturate to serve both as a mild analgesic and a calming agent.

In the operating room, nurses pasted electrodes to the President's chest, so that a continuous electrocardiogram could be taken and shown on a TV-type screen. Dr. Didier worked a thin plastic tube through the President's throat and down his windpipe to deliver the anesthetic. Anesthetics must be chosen with special care for a patient with Johnson's heart-attack history; nitrous oxide offered the advantage of inducing only light anesthesia, so that the patient wakes up with a minimum of hangover. Dr. Didier had to use an especially thin tube to leave room for what else had to go down the presidential throat: a laryngoscope (see diagram), 2.5 centimeters in diameter. Peering through the laryngoscope with the six-power operating-room microscope, Dr. Gould saw the polyp. It was a bit bigger (4 mm. by 5 mm.) than he had expected, and a bit lower down. Still, it was a simple though delicate procedure to work his cupped forceps around so that he got almost all of the polyp at one snip. Two more snips removed tiny bits from its edges, where it had been attached to the vocal cord.

Plopped into a stainless-steel bowl, the polyp was rushed to the pathology laboratory only a couple of doors away. There, Dr. Lewis B. Woolner (Mayo) and Dr. James Humes (Navy) swiftly cut the main part in two and sprayed one half with a substance to deep-freeze it instantly. Then, with a microtome, they cut off slices only hundredths of a millimeter thick. Examined under the microscope, all the cells appeared to be normal; the polyp was noncancerous. All this took only 17 minutes.

Steel Stitches. Now it was time for Drs. Hallenbeck and Osborne to work on the hernia in the abdominal wall. The surgeons made an incision two inches long. They could see that the lining of the abdominal cavity was itself intact; this meant that the tissue now protruding was not part of the bowel. Instead, it was fatty tissue. The surgeons pushed this back. Then they used thin, stainless-steel sutures to close the inner muscular layer, along with the fascia (a parch-mentlike layer between muscle and skin) and the skin itself. Time: 19 minutes. The patient was out of anesthesia soon after 7:30.

If he indulges in no unusual physical activity, the President should have nothing more than the usual discomfort of tightness around the abdominal scar for a short time after the steel sutures are removed. His throat, Dr. Gould estimated, is likely to be sore for about five weeks.

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