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Office of the Press Secretary

For Immediate Release March 14, 1997
                           PRESS BRIEFING BY
                     National Naval Medical Center
                           Bethesda, Maryland                    

5:50 P.M. EST

MR. MCCURRY: Good evening, everyone. I want to start by paying a special White House tribute of thanks to Admiral Dick Ridenour, the Commander of the National Naval Medical Center here at Bethesda. He and his team have done a very good job serving all of us and all of you today, and we appreciate their help, and certainly the President appreciates all the support and help he's gotten here today.

The President's medical team here with you right now successfully concluded their treatment of the President today at 4:43 p.m. -- or excuse me -- successfully concluded the surgical procedure at 4:43 p.m. And, of course, they're attending to him in post-operative procedures now, so the President was in surgery for roughly two hours and four minutes.

They're here, they can tell you more about it. The President, after the surgery, was taken back up to the Medical Evaluation and Treatment Unit, the METU unit here at Bethesda, and came into the room to find Mrs. Clinton and Chelsea watching a Cary Grant movie. And, of course, his first words were, "Where is the basketball?" So I expect he'll be watching a little bit of the tournament now.

I'd like to start by introducing Dr. Connie Mariano, the President's personal physician, and she in turn will introduce the team that worked on the President today. And they can tell you, in as much explicit detail as you think you need, what they did to the President today and why the President is happy about it.

Dr. Mariano.

DR. MARIANO: Thank you, Mike.

We're fortunate today to have a team of excellent physicians who have treated the President and a surgeon who will be involved in his post-operative care. First of all, I'd like to introduce to you Dr. Dave Adkison. Dr. Adkison -- he is the Chairman of Orthopedics and he is a specialist in sports medicine. His assistant in the surgery was Dr. Marlene De Maio (phonetic), and she's the assistant department head, also specialist in the field of sports medicine. The President's anesthesiologists were Dr. Robert Petty and Dr. Alvin Manalaysay, who is the Chairman of Anesthesia.

I know you're very interested in learning about a little bit more details of the surgery, so without further ado I'll introduce you to Dr. Dave Adkison. He can give you the details about that.

DR. ADKISON: Thanks, Connie.

Last night while the President was descending some stairs at Mr. Norman's house in Florida, slipped on a stair and sustained a twisting injury to his knee, where his knee actually thrust to the side. He said he heard a loud snap in his leg, and Mr. Norman, fortunately, caught him. He was seen at a local hospital in Florida, where he was evaluated by an orthopedist -- Joel Cohen, I believe was his name -- who evaluated him and referred him back up here to us.

So what happened with the President last night, if I can walk over to these, I can illustrate -- or how would you want to do that? We'll have Marlene point. How's that?

The quadriceps tendon is actually a group of four muscles that go through one tendon that extend the leg, the thigh muscle. It's in three layers. And the President had a very unusual form of tear. Instead of tearing transversely, which it usually does, this one actually had torn fairly high in his thigh, headed down towards his kneecap and then split and sort of delaminated the tendon and then came around to the inside of his knee. A little more of a complex tear than, again, is usually seen.

So we repaired it in layers, as -- essentially got an anatomic repair on the tendon. As the repair was done, one of the things that we do is bring sutures through bone, through the kneecap, to bring the tendon back into place and then suture the remainder of the tendon together. And after we had done that we were very pleased that he was able to achieve nearly a full range of motion of his knee. We didn't stress it beyond a certain point, but we're very happy with our repair.

He tolerated the procedure very well, very comfortable. And I'll be glad to answer any questions.

Q Dr. Adkison, if this were not the President of the United States, would you want this patient to go to Helsinki, leave on an overseas trip in the next few days?

DR. ADKISON: But he is the President of the United States. (Laughter.) I think that he can travel. He should be out of the hospital reasonably soon. It will depend on his pain control. It will depend on how comfortable he is with his post-operative regiment and how he feels. Flying on Air Force One, I understand, is not like flying on a commercial airline. So I don't know that you could take those rules and apply them. I don't think you could.

Q Will he be taking any painkiller medicine afterwards to control the pain?

DR. ADKISON: There will be some -- not narcotics, but some analgesic that we use. It will depend. I'll actually leave the issues about pain control to the anesthesiologists who have done some fairly special things for him so that he can be fully alert and fairly comfortable, as well. And that's their purvey and I'll let them talk about that.

Q -- complicated nature of the tear affect rehabilitation?

DR. ADKISON: Anytime you tear the tendon, you have to go slowly to start with. The fact is that it was not an unfavorable tear, it was rather unusual. But, in fact, we don't anticipate that it will slow him down over the average recovery.

Q And will he have full recovery of the knee, do you believe, sir? Do you believe that he will eventually have -- regain full use of his knee?

DR. ADKISON: Most people will lose a little bit of motion, a little bit of flexion in the knee. That varies. And again, that's all comers -- that isn't healthy 50-year-olds who do this. And I suspect that given the repair that we got, he has an excellent chance to regain full motion in his knee.

Q We were told that he began to doze off a few times during the surgery. Was he ever really unconscious?

DR. ADKISON: No. We were playing some very nice music for him -- but, no.

Q Could you tell us a little bit what he was doing in those two hours?

DR. ADKISON: Talking for the most part. We chatted a bit. He and I share a common interest in music and we listened to some, so I think he layed back and enjoyed it.

Q What music?

DR. ADKISON: Lyle Lovett.

Q How long will you keep the President here?

DR. ADKISON: How long will we keep it here? I can distill it down very quickly, as I've told the family. When you don't hurt, when you don't have a fever, when you're able to get around and eat okay, then it's okay to go.

Q Tonight at least?

DR. ADKISON: He'll be -- oh, at least tonight, oh, yes. He'll be here tonight, yes. We would anticipate on average about a 48-hour stay for this -- on average, again, but it varies.

Q He'll probably go home on Sunday? He'll be able to go home Sunday?

DR. ADKISON: I would think that that was not an unreasonable estimate.

MR. MCCURRY: Since we're talking about him, I thought maybe you'd like to hear from the President. So he just wanted to say hello. So we connected him in here.

THE PRESIDENT: Mike, can you hear me?

MR. MCCURRY: Yes, sir, we can hear you fine. Go ahead.

THE PRESIDENT: Well, I'm enjoying this press conference. (Laughter.)

MR. MCCURRY: First one in a long time you probably enjoyed.

THE PRESIDENT: It's wonderful not to be answering the questions. But I want you guys to quit giving my doctor a hard time about letting me go to Helsinki. We're all going to Helsinki; we have to go to Helsinki. (Laughter.)

MR. MCCURRY: Thank you, sir.

THE PRESIDENT: I feel great. They did a terrific job. And let me say, I just had an unlucky break. But I've had almost no injuries in my life. In 25 years of running and a lot of other athletic activity, I've been remarkably free of injuries. I had one skiing accident once, and this was just an accident. Accidents happen to people. But I was very fortunate that Greg Norman, being a better athlete than I am, immediately heard my knee pop and turned around and caught me before I fell on the ground. And then the hospital down in Florida did a wonderful job -- Dr. Cohen and the other people. And my team did a good job here. I feel great.

And don't worry about it, I'll just spend a little time here and get home and go back to work.

Thank you.

MR. MCCURRY: We are trying to get -- work out a way he could do some questions, but we were unable to do that.

Dr. Adkison, let me turn it back over to you.

DR. ADKISON: Thank you.

Q Doctor, did you ever ask the President to not go? Did you bring up the topic of Helsinki?

DR. ADKISON: No, no, I didn't bring the topic up.

Q Did he ever ask you, should I go, should I not go? Was it ever on the table?

DR. ADKISON: On the table, you mean, with whether we would do the surgery or not?

Q No, did he ask your medical advice as to whether or not he should go?

DR. ADKISON: No, not really.

Q Doctor, can you detail his rehabilitation process, how long it will take and exactly what he will be doing to get the knee better?

DR. ADKISON: It depends on what you mean by rehabilitation. We'll start range of motion of the knee within pain tolerance fairly quickly -- tomorrow. He'll be on crutches for some period of time, anywhere -- eight weeks plus or minus a little bit of time. We won't let him start strengthening the muscle for about three months. Again, it depends on how well he's doing. He wants to know when he can swing a golf club, and we'll see.

Q What about a brace for his leg? You're not going to put him in a cast?

DR. ADKISON: Absolutely no cast, no. We're not going to do that.

Q What device will you use to stabilize --

DR. ADKISON: Well, we've put him in a brace. We can put him in a lockable brace, one that's adjustable to allow the knee to go into full extension and to a few degrees of flexion. Again, his knee in surgery tolerated flexion very nicely, and we'll progress him as tolerated. We'll use the brace to control his motion. The main thing we don't want to have happen to him is for him to fall without some kind of protection, which then, again, he might reinjure this.

Q -- did you get a -- of what happened immediately following the twist? Did he try to walk on it, did he hobble, was he writhing in pain? What was happening?

DR. ADKISON: I think he was pretty much in pain. I think his staff and Mr. Norman helped him into a vehicle and he took off.

Q -- wait there in any way?

DR. ADKISON: Let me defer to Connie. I wasn't there.

DR. MARIANO: That was in West Palm Beach after we were at Greg Norman's house. And he was in pain at the time. They immobilized him -- Dr. Lang -- William Lang was the White House physician with him at the house -- hold on to the leg, immobilize him, got him in an ambulance with Secret Service and proceeded to St. Mary's Hospital, where this all began.

I'm sure some of you have some questions for the anesthesiologist. Dr. Petty, do you want to entertain any questions they might have?

DR. PETTY: My specialty is regional anesthesia and I primarily do anesthesia for orthopedic procedures, so that's why I was selected to take care of the President today.

Our primary concern with the anesthetic was, number one, that we gave him an anesthetic that the surgeon can do the procedure with; but we also tried to give him an anesthetic that wouldn't alter his mental status in any way, so that he could stay alert at all times and -- according to the 25th Amendment I guess we were trying to uphold.

He had an epidural anesthetic, which is still running. We will basically run that anesthetic continuously, with low dose, low strength local anesthetic while he's in the hospital. And he should really have no pain postoperatively while that epidural is running.

Q What's it like working on the President of the United States?

DR. PETTY: It's fairly intimidating, but you have to treat him like every other patient and do your job.

Q Were you nervous?

DR. PETTY: Yes, sir.

Q Doctor, how will you control pain once he leaves here?

DR. PETTY: We will primarily control it with PO medicine -- medicine by mouth.

Q And what will that be?

DR. PETTY: We will try to stay away from narcotics or opioids as much as we can. Nonsteroidals, Extra Strength Tylenol. The most pain will be in the first 24 hours. If we can continue the epidural and relieve his pain for the first 24 hours, he shouldn't require a lot of pain medicines after that time period.

Q Dr. Adkison, -- question the President -- do you think it's more like he will leave on Sunday than Saturday?

DR. ADKISON: Again, a lot of this depends on what I said. It depends on how comfortable he is, and we would anticipate for most people -- if you did this, about a two-day stay.

Q Doctor, how was he during the operation? What did he say to you, what kind of questions did he ask?

DR. ADKISON: I think we mostly enjoyed talking about music. I mean, he told me about some great CDs I should buy and -- not the monetary kind, but the music kind -- (laughter) -- you know, it was just chit-chat. He's very pleasant to deal with.

Q Doctor, how long did you say the President would be on crutches?

DR. ADKISON: On crutches?

Q Yes. Can he walk without them? Would you recommend that he walk without them?

DR. ADKISON: We wouldn't recommend it. And again, we would estimate about eight weeks, plus or minus a couple. And a lot of this varies on how well you regain your motion, what the signs are of healing, how the swelling goes away, how the soft tissues around the kneecap move, and a lot of things that play into that.

Q -- without crutches would you be concerned?

DR. ADKISON: I'd call Connie.

Q Doctor, is there anything you did differently than you would do for a regular patient, due to the fact that he is the President?

DR. MARIANO: The press conference, that's different.

DR. ADKISON: Yes, that's the big difference.

DR. MARIANO: And the Secret Service.

DR. ADKISON: We gave him a standard operation.

Q How does this compare to other similar tears, other than a certain degree of difficulty? This is kind of the same --

DR. ADKISON: They each have their own personality that the injuries do. I would say the most important thing is to clearly identify the extent of the tear and the character of the tear. And his was rather unusual. I mean, it tore in a way where there actually still was some of the tendon attached to the bone, which is uncommon, and where there was a fairly large amount still attached to bone.

Q Is that good or bad?

DR. ADKISON: Well, we'll see where it goes. It actually -- it made the reapproximation technically easier, which is nice, and helped put it back together a little bit easier.

Q -- rehab -- will that make --

DR. ADKISON: I don't think it will change his rehab that much. Again, we'll see. The rehab, interestingly enough, it was more a factor of how you individually heal. Some people lay down scar if you scratch them with razor blade, and some people you couldn't get them to scar no matter what you did to them.

Q Are there risks of giving him the epidural that long, with blood pressure, for example?

DR. MANALAYSAY: No, ma'am, the local anesthesia that we use is so dilute that it just barely makes his leg numb and doesn't really have any effect on his blood pressure.

Q What are the potential post-operative complications for this kind of surgery?

DR. ADKISON: Anytime you open the skin there are certain risks, whether you're taking care of a quadriceps rupture or you're doing a simple hand incision or something. Infection, very low rate. The biggest concern of this operation, of course, would be stiffness, as I mentioned earlier. Particular complications otherwise are generally more related to your health. Blood clots, anytime you operate on a leg, are a concern, and we've taken precautions about that.

Q Is he on antibiotics?

DR. ADKISON: No, no he's not.

Q Doctor, we were told there would be an augmented medical team going with the President to Helsinki. Could you describe how that augmentation will play out?

DR. ADKISON: Connie can.

DR. MARIANO: Wherever the President goes, he's within a few heartbeats away from a physician and a nurse and a medic. And I will be that physician on the trip to Helsinki. In addition, I have a critical care nurse on board that airplane. I will bring Dr. De Maio* with me to assist me should there be any problems. In addition, we'll have a physical therapist to help augment our team. Also, wherever he goes overseas, we send an advance team out to survey that hospital or a hospital we may use should problems rise, routinely on trips such as these.

So we will have a medical advance in place in Helsinki, like we do for all of our overseas trips. So we have people prepared, should any problems arise.

Q How many physicians were involved in this procedure?

DR. MARIANO: It took a village to put the President together. (Laughter.) It was quite a group. We didn't count how many.

Q Can you approximate?

DR. ADKISON: Six to eight.

DR. MARIANO: Six, eight.

DR. ADKISON: Dr. De Maio and I were the operating surgeons.

Q How long before the President can jog again under normal conditions?

DR. ADKISON: Under normal conditions? We would anticipate somewhere in the six-month range. We'll be working with him to do some other things otherwise to stay aerobically fit.

Q Like what?

DR. ADKISON: Upper body work. When he can get in the pool, we can work with that. Stairmasters, those kinds of things. There are other ways to stay aerobically fit without running.

Q And what about golf, which may involve twisting?

DR. ADKISON: Again, it will depend on whether you're talking about and pitching and putting, or whether you're talking about taking a full turn. Full turn? About the same amount of time. There are some unusual sheer forces that occur when you swing a golf club, especially when you take a big turn, and we want to make sure that he's perfectly healthy before we let him do that. But his three-quarter game will be good.

Q Will the President be able to do his regular work okay?

DR. ADKISON: Thank you, sorry. We had the Lyle Lovett turned up real loud. Yes, yes, he should be fine to do his work. Thank you for asking that.

Q -- any reason for the nation to be concerned?

DR. ADKISON: I don't think so.

MR. MCCURRY: Thank you. I want to again thank the team here. They did a great job today and I want to thank them for coming and briefing you. If you don't have anything else for me, our intent is to declare a full lid at the conclusion of this briefing. We'll let you know what we plan tomorrow -- my guess is very low key tomorrow. At some point we'll give you some sense of who's going to visit the President, what the First Lady's plans are. We'll give you some kind of update on what he's up to and then call it -- try to shut things down here as early as we can tomorrow, too.

Q -- on Tuesday?

MR. MCCURRY: We are going ahead with the plans as scheduled for Tuesday, as you can tell. We will be adjusting what the President's mobile requirements are, to reflect the fact that he'll be a little less ambulatory than regular. But the intent is to go ahead with that schedule.

Q -- radio address, Mike?

The Vice President is going to chip in and -- let's see where my folks are -- I think that's right.

Q Is the family staying in the hospital tonight?

MR. MCCURRY: I think they're going to chip in and do -- the Vice President is going to chip in and do the radio address for him, I believe. Let me grab one of my folks and get the answer for you on that.

Q Is the family staying here tonight?

MR. MCCURRY: No, Chelsea left because she's going -- I think as maybe some of you read before -- she's going to the Viennese Waltz Ball tonight. So she was looking forward to that.

The Vice President, I believe, is going to do the address and the subject is education. We're going to try to sell that school construction funding story that we missed selling today.

Q -- picture, a photo op, Mike?

Q When will the Vice President return?

MR. MCCURRY: The Vice President was, I think, scheduled back later on this evening, right?

Q Mike, how about the First Lady? Will she stay?

MR. MCCURRY: I'll have to check on that. I believe she was going to go back down to the White House.

Q Can we get a picture, a photo op?

MR. MCCURRY: She's not going tonight.

McNeely, I think, shot a picture of the President as he was talking to us just now and he's trying to move that out to the wires digitally, so be on the look out for that.

Q Mike, I talked to a panicked member of the Gridiron Club earlier today.

MR. MCCURRY: Well, the Gridiron Club is an occasion that the President very much -- sort of -- was looking forward to. We are playing around with some ideas on a way that he might still make a contribution to the dinner. And I think the Vice President might be going, too. So he will certainly miss the opportunity to give back a little of what he was probably going to get.

Q Mike, kind of an insider question. Were you satisfied with the pool notification procedures last night, or are you --

MR. MCCURRY: I looked at them. I walked through them with Mary Ellen very closely. It took -- normally, when we're with the pool when they're at a remote location, it takes some time to assemble them. It took some time once the President -- once the doctors made the determination that he needed to go to St. Mary's and, once he got to St. Mary's, to know exactly what he would be doing there -- whether or not he'd be turning right around and coming back after an X ray, back to the cottage. And I have confidence that Mary Ellen and Kris served all you very well in getting you together as soon as they could. And she was alerted right away. Everyone in Washington that needed to be alerted was alerted. And we were able to assemble the pool, get them there, and you were able to cover the story, and America got to wake up to the news. That's the way it should be.

Q The First Lady is going to leave for Africa when?

MR. MCCURRY: We haven't -- I don't believe her staff has announced her schedule yet. They will review it, look at it. I think, obviously, they're going to want to see -- she's going to want to see the President tomorrow. And the President just feels it's very, very important for her to take this trip. This is a trip that those in the countries she will visit have been looking forward to, and it's something that she wants to do, and it's something the President very much wants her to do. So he was already, I think, even at 4:00 a.m. this morning was telling her that she should plan to continue on her journey.

Q -- said earlier that they were going to postpone it until Sunday at 7:00 p.m. Do you think that's changed?

MR. MCCURRY: Well, they're still looking -- they're looking at -- she was scheduled to arrive and have some down time when she arrived, so they're playing with their schedule. I know some of you are asking because you're scheduled to travel with her, and we'll do the best to get your her itinerary when we have it.

Q Do you plan to have any staff here?

MR. MCCURRY: We'll have kind of a regular, minimal pool staff here in the morning, and we'll give you some -- we don't plan to do any briefings or anything here early in the morning. Whatever we do, I think, we'll likely do more around midday, so that people don't have to worry about rushing in here Saturday morning. We'll give you an update. If the doctors have anything to report from overnight, we'll arrange for them to do that if they're willing.

And we will -- just remember, proportionally what we're talking about here. There's a lot of important news in the world today, and the President, in fact, was already planning tonight to see if he couldn't get an update on Albania and talk to Mr. Bowles further about some of the conversations we've had with the Hill today. I know you're very excited about this, but let's keep things in some perspective.

Q Did the President call the school today? Can you talk about it?

MR. MCCURRY: Yes, as the pool was briefed on the plane, he did call the school, promised that he would try to return and see them; did, in fact, announce his $5 billion school construction initiative and the Vice President talked about it at greater length out in California today. And I hope at some point, we can kind of bring that back into focus for all of you because it's an important element of the President's overall education challenge.

Q Trent Lott wasn't terribly sympathetic. He said that he heard they were -- he joked that he heard they were having a fundraiser, planning a fundraiser to sell opportunities to sign his cast. Any response?

MR. MCCURRY: Well, no. I mean, he must have been practicing his Gridiron material.

Can I excuse the docs? They've worked very, very hard today. And I thank all of you for your help today and for your treatment of the President. Admiral, thank you very much to your very talented staff and to the staff here.

Q Is the President aware that 40 hours is the normal stay for this procedure? Do you think he's willing to go along with that and do you assume he will?

MR. MCCURRY: For all his feistiness, he does rely very closely on the advice he gets from the team here at Bethesda, who he's come to know through his annual exams. He respects them a lot. He's got enormous faith and confidence in Dr. Mariano, as you all know. And they'll make a recommendation to him that I think that he will follow.

At the same time, he alerted them to the importance he attaches to Helsinki and I think they're certainly aware of that and they will understand that priority. But they will make a recommendation in the best interests of their patient. Is that fair to say, doctors? Okay. And then the President will do whatever he wants to. (Laughter.) No.

Look, you all understand that he attaches great importance to them and I think I can safely say there's been nothing about the treatment today or the analysis that doctors have made that would complicate him going on Tuesday, given the complication that already exists of dealing with a patient that's just gone through a procedure like this. But it's certainly not prohibited, and if it's not prohibited the President would very much want to go ahead with what is a very important summit between the two Presidents.

Anything else? Can we call it quits for the day? Thank you for your patience today. We will see you tomorrow. You can all go home and enjoy the weekend.

END 6:17 P.M. EST