Instrumental and often overshadowed

April 2011 -- Some recent press items about the 30th anniversary of the 1981 assassination attempt on President Ronald Reagan have, surprisingly, highlighted the key role nurses played in the care Reagan received in the days following the Washington, DC shooting. On March 28, the Washington Post ran a substantial article with the excellent headline, "30 years later, nurses recall their role in saving Reagan's life." The piece, written by Del Quentin Wilbur based on his recent book about the shooting, starts off by emphasizing the hand-holding and "hovering" aspects of the care by the nurses who treated Reagan at George Washington University Hospital. But perhaps because the writer took such a close look at the shooting for his book, the piece goes on to reveal some of the specific, substantive things the nurses did to help save Reagan's life, like skilled monitoring, placing IVs, and education and psychosocial care of the gravely wounded president. And on April 8, the Saratogian (Saratoga Springs, NY) ran an article by Glenn Griffith about local bookstore owner and former GW nurse Robyn Ringler, who also cared for Reagan. That piece is more about Ringler's work since the 1999 Columbine shootings to support gun control efforts, including a recent press DC conference at which she appeared alongside James Brady and other prominent advocates. The report does not convey much nursing skill beyond the fact that Ringler understood that Reagan almost died, nor does the piece link Ringler's advocacy directly to her nursing. But it does at least present a nurse who is a strong advocate; indeed, the best element here is probably the headline: "Nurse to a president fights gun violence." We thank those responsible for both pieces, but particularly the Post's Wilbur, who clearly set out to draw attention to the pivotal role nurses played in Reagan's care.

The Washington Post on nurse Joanne Bell: "Shut up and go to sleep"

The Saratogian: "Nurse to a president fights gun violence"

"Shut up and go to sleep"

The Washington Post piece has that great headline about nurses' "role in saving Reagan's life," a focus on the profession's life-saving that is rare in major U.S. newspapers. Unfortunately, other prominent elements early in the item are likely to reinforce the unskilled angel stereotype. The caption for a photo accompanying the piece shows nurse Marisa Mize outside the GW ER, noting that she "remembers holding the hand of President Ronald Reagan after he was shot in 1981." And Wilbur, who adapted the piece from his new book Rawhide Down: The Near Assassination of Ronald Reagan, leads off with this paragraph:

Nearly a decade to the day after Denise Sullivan tended to Ronald Reagan during the darkest night of his life, the nurse received a handwritten letter from the former president. "Your hand clasp was one of the most comforting things done for me during my stay," Reagan wrote, describing his gratitude toward a nurse who hovered by his bedside in the hours after surgeons removed a would-be assassin's bullet lodged just an inch from his heart.

What a mess that is for nursing: Sullivan "tended" to Reagan, she "hovered by his bedside" after surgeons did what sounds like the real work, and what Reagan remembered was her "hand clasp" and her "comforting." Naturally patients will remember nurses' emotional support in awful times, and that is important, but this busload of angel imagery will reinforce the public's view that nurses are all about unskilled "tending." The piece's overall focus on how much the Reagans appreciated this kind of support also tends to support this view of the profession.

Fortunately, the piece does not stop there. The article notes that Reagan wrote the letter soon after meeting Sullivan again at a ceremony renaming the GW ER for him, and that the letter "highlighted the instrumental and often overshadowed role that nurses and technicians played in saving the president's life after he was shot on March 30, 1981. It was during those tense hours -- while inserting IV lines, checking his vital signs and monitoring his breathing -- that a small cadre of nurses got an unvarnished glimpse of a president."

The piece briefly describes the March 1981 shooting that brought Reagan to the ED in a presidential limousine. Kathy Paul Stevens was one of the first nurses to see Reagan as he hobbled in. He reportedly "collapsed into the arms of nurses and [Secret Service] agents," and "to Stevens and other medical personnel, Reagan looked like he might die." The piece says that Stevens' hands shook while "tending to the president," and she prayed for him not to die there. Nurse Wendy Koenig "battled back tears as she strapped an inflatable cuff on the president's arm to ascertain his blood pressure. But she couldn't hear anything through her stethoscope."

"I can't get a systolic pressure," Koenig said in near panic while other nurses and technicians sliced off Reagan's new blue suit and hooked up IV lines that would provide critical fluids to help prevent the president from slipping into shock. Finally, Koenig got a reading: around 60 -- very low for a man whose normal blood pressure was 140.

The piece says surgeons discovered a bullet wound in Reagan's chest, a physician "inserted a tube to drain blood," and Reagan began to feel better and start bantering with technician
Cyndi Hines, who "worked alongside the ER nurses" and "had inserted an IV line into Reagan's right arm when he arrived." Reagan asked Hines what she thought, and she told him he was doing all right and was going to the OR. Hines says that he was probably wondering if he was going to die; "patients, afraid to pester the doctors, asked her that question all the time." That's a nice touch, underlining both the key roles non-physicians play and how little respect they get relative to physicians.

Reagan spent three hours in surgery to stop the bleeding and get the bullet out of his lung. Anomalously, the piece spends no time at all on the bold heroism of the surgeons, but moves immediately to the recovery room nurses!

In the recovery room that night, two other nurses -- Denise Sullivan and Cathy Edmondson -- took over [Reagan's] care. When he struggled with the breathing tube snaking down his throat, they gently admonished him not to touch it; holding his hand, they told him everything would be okay. Eventually, someone gave Reagan a pen and pencil and a clipboard, and the president began jotting notes. "I keep on breathing?" he wrote at one point. Yes, the nurses said.

The piece describes more interactions between Reagan and these two nurses. Reagan told jokes and the nurses chuckled, thinking the jokes meant he was going to make it. Reagan reportedly wrote an "innocently flirtatious" final note to Sullivan ("Does Nancy know about us?"). In Reagan's thank-you note ten years later, he worried that that note might have offended Sullivan.

The Washington Post article moves on:

Over the next few hours, two other nurses would take over the president's care -- Joanne Bell and Marisa Mize. While Bell monitored his machines and blood pressure, Mize held Reagan's hand. At one point, she noticed that he was clutching at his breathing tube. While patting the president's head and reassuring him it was all right to be scared, she persuaded him to relax and to let the machine breathe for him.

Reagan wrote notes to Mize, asking if he would be able to resume activities like ranch work. She reassured him that he would in a few months. After Reagan's breathing tube was removed, a little more than 12 hours after the shooting, the president began "bantering and cracking jokes with a small crowd of doctors and nurses."

An hour later, Bell grew worried that the president wasn't getting his rest. Deciding it was time to intervene, the no-nonsense nurse placed a wet washcloth over his eyes. "In the most polite way I know how," she told Reagan, "I'm putting this cover over your eyes, and I want you to shut up and go to sleep."

The article closes with a couple anecdotes about the Reagans' enduring appreciation for Mize's work. Not long after the shooting, Reagan had begun tracking down the nurses who had "comforted him through the difficult night" to thank them. He called Mize and told her she was "the one who told me it was okay to be scared and that you wouldn't leave me." And years later, when Nancy Reagan was "touring a different hospital where Mize happened to be working," Mize could "barely get out an introduction before she was enveloped in a tight hug," as the former First Lady told her, "'I know who you are, Marisa Mize.'"

The piece includes many helpful elements. Of course, there is some "tending" and "comforting" throughout, but the report also describes things the nurses did that require considerable skill and toughness. Perhaps most striking is Bell's admonition that Reagan "shut up and go to sleep" so that he could get the rest he needed to recover--obviously not an easy thing for someone to tell the president. The article also describes specific care tasks that show nursing expertise, from physical tasks like checking vital signs and monitoring care technology to psychosocial care like keeping Reagan informed, reassuring him about the future, persuading him to relax so as to enable him to benefit from the care provided, and telling him it was okay to be scared.

And the Reagans' own reported attitude toward the GW nurses provides a fairly good model for the public. It's not clear if the first couple understood that the nurses played a key role in saving Reagan's life, but it is clear that the couple noticed the nurses and greatly appreciated their psychosocial care. Many celebrities would have focused solely on physicians, and never made such efforts, for years afterwards, to thank and recognize their nurses. This at least suggests to readers that they too should consider the nursing role when they or loved ones are in the hospital.

"Nurse to a president fights gun violence"

The Saratogian item, "Nurse to a president fights gun violence," is more about the interesting life of a local gun control advocate than it is a conscious effort to recognize nursing or what nurses did for Reagan. Still, it does show the public a nurse who is a strong public health advocate, a message captured in the headline.

The piece says that in addition to running her local bookstore, nurse Robyn Ringler "has another passion: lobbying for legislation to limit gun violence." Ringler was reportedly a guest at a late March event in DC to recognize the 30th anniversary of the assassination attempt, because "before her career in books, Ringler was a nurse [who] nursed Reagan and his press secretary James Brady as they recovered from gunshot wounds." The "was a nurse" phrasing implies that nursing is not a real profession that practitioners remain a part of even after clinical practice ends. By contrast, it's unlikely that we would read that anyone "was a physician."

The piece also says that it was not Ringler's experience nursing Reagan that led her "become a gun safety advocate" and join gun control groups like the Brady Campaign, but instead the 1999 shooting at Columbine High School, which affected Ringler deeply because she had a high school age daughter at the time.

Even so, there is some description of Ringler's experience after the assassination attempt:

"It was surreal," she said. "The first time I saw (Reagan) his face was gray. He had the pallor of death and he was wheezing. It was not good. His kids were all there in tears and his wife was very emotional. I left work that night thinking there was a 50-50 chance he wouldn't pull through." She was the assistant head nurse at George Washington University Hospital . . . She worked the 3 to 11 p.m. evening shift as one of two nurses assigned to him. She was surprised to read in the newspapers the next morning that the president was doing fine and was recovering. "It was the first time I realized that newspapers could be wrong," she said. "They hadn't been told the truth about his condition. He was not fine and was not recovering and until the third day his situation was still very much in doubt. But then on day three he started telling us stories of his days working in Hollywood and I knew he was going to be all right."

This really says little about what nurses did for Reagan, though it does at least suggest that Ringler had a good sense of Reagan's poor condition (a sense that seems to be somewhat at odds, by the way, with the account in the Post piece, which at least implies that Reagan basically turned the corner less than 24 hours after the shooting).

The rest of the article describes Ringler's work as a gun control advocate and her life in general. Ringler talks about her involvement with the Brady Campaign, and the piece says that she "was singled out at the start of the March 30 [gun control] event for her nursing work 30 years ago and her more recent work supporting legislation to limit high-capacity gun clips," specifically a bill sponsored by U.S. Rep. Carolyn McCarthy's (D-NY), who "lost her husband during a shooting rampage in 1993 on a Long Island Railroad car." Ringler says that in advocacy events like these, she tells her story about caring for Reagan, just as McCarthy, Brady, and others tell their stories.

The piece gives a little more information about Ringler's life since 1981, noting that she "went to law school, moved to Ballston Lake with her husband, worked for two local legal firms and then decided to become a stay-at-home mom," finally opening her current bookstore when her daughters had left for college. The report does not say why she stopped practicing nursing. It does say that Ringler is a blogger. Her blog, "Read this, it will make you feel better," is part of the Saratogian's Community Media Lab, and it is about Ringler's "favorite reading material and about being a bookseller." The blog seems to be primarily related to her bookselling and it has no evident health care focus despite the "feel better" part of the title, with the exception of a piece that Ringler posted the day after the Saratogian story about her role in Reagan's care and the development of her gun control views. That post does contain some helpful material about the work she and the other GW nurses did for Reagan. We thank Ringler for being a strong public health advocate who at least makes clear that she has a nursing background, and we thank the Saratogian for running this story about her.

You can reach Del Quentin Wilbur, the author of the March 28, 2011 Washington Post article "30 years later, nurses recall their role in saving Reagan's life," at wilberd@washpost.com.

Glenn Griffith, author of the April 8, 2011 piece in the Saratogian "Nurse to a president fights gun violence," can be reached at ggriffith@saratogian.com.

You can see more about Del Quentin Wilbur's book Rawhide Down: The Near Assassination of Ronald Reagan and hear interviews with two of the nurses who took care of Reagan.