WASHINGTON
On Tuesday morning Kennedy complained to his chief White House physician, Rear Admiral George Burkley, about some discomfort in his right eye and a bout of abdominal cramps and loose stools. He blamed his distress on “an emotional factor,” admitting that drinking four Bloody Marys had probably “not helped.” Burkley found his eye normal. After he returned several hours later to say it felt “itchy,” Burkley referred him to an ophthalmologist, who also found nothing wrong. He reported the president’s abdominal problems to a gastroenterologist, writing in a note, “We should stress the fact that emotional tension rather than food could be the cause of the distress and that no actual organic change was taking place.”
None of Kennedy’s illnesses had proved more persistent and resistant to treatment, or led to as many lengthy hospitalizations, as those involving his digestive system. He had first experienced severe cramping at the age of thirteen, and between 1934 and 1940 had undergone months of invasive tests and hospitalizations. He complained to Lem Billings from one hospital that he was “suffering terribly,” had “a gut ache all the time,” and had endured eighteen enemas in three days. Few teenagers suffering his symptoms in Depression-era America would have been subjected to so much expensive and ultimately futile medical attention. His physicians diagnosed spastic colitis (now known as irritable bowel syndrome) and recommended stress reduction and antispasmodics. A gastroenterologist at the Leahy Clinic in Boston put him on a dietary regimen that he would follow for the rest of his life, calling for small meals and bland, milky foods. He devoured ice cream, sometimes drank glasses of heavy cream instead of milk, and loved fish chowder made with large quantities of butter and milk. It was a calamitous diet for anyone suffering from lactose intolerance, as he probably was, and raised his cholesterol to stratospheric levels.
The public saw a vigorous and youthful man who suffered recurrent backaches, an affliction bedeviling millions of middle-aged men, but his close friends and advisers knew a man who had seemingly suffered years of illness and pain without complaint. The diplomat George Ball praised him for bearing his ailments “with gallantry and with no perceptible loss of alertness,” Arthur Schlesinger was impressed that he never uttered “a word of self-pity or complaint,” and Ted Sorensen wrote, “In retrospect, it is amazing that, in all those years, he never complained about his ailments.” He certainly considered himself a stoic. When asked at a news conference to comment on the complaints of army reservists recalled to active duty, he said, “There is always inequity in life. Some men are killed in a war, and some men are wounded, and some men never leave the country. . . . It’s very hard in military or in personal life to assure complete equality. Life is unfair. Some people are sick and others are well.”
His physicians, however, knew a man who was preoccupied with his health and intent on micromanaging his treatment, who demanded remedies for every tickle in his throat, itch in his eye, grumble in his stomach, sleepless night, aching knee, and throbbing muscle—the kinds of complaints most people treat with aspirin, ice packs, and Pepto-Bismol. He was not a hypochondriac, merely someone who after a lifetime of illnesses and pains had become accustomed to seeking treatment for minor complaints. His principal health problems were real and painful. He frequently woke with cramping and diarrhea, and urinary tract infections had plagued him for decades, sometimes causing a burning sensation when he urinated or ejaculated. He was allergic to dust, animals, and certain foods, and afflicted by gum disease, deafness in one ear, and rapidly worsening vision. Athletic injuries, PT 109, and risky surgeries had aggravated a chronic back condition stemming from one leg being shorter than the other, and during much of his first years in office, he could not sit for any length of time, touch his toes, or put on his socks, and often used crutches in private. He also suffered from Addison’s disease, a debilitating and potentially life-threatening malfunctioning of the adrenal glands that had weakened his immune system to such an extent that a routine illness could turn serious, a factor undoubtedly contributing to his tendency to fuss over minor ailments.
He spent several hours every day attempting to alleviate his discomfort and pain. He wore hot mustard packs, soaked in hot baths, and swam twice daily in a White House pool that he kept heated to 90 degrees. Every morning he strapped himself into a canvas corset, anchoring it with Ace bandages looped around his chest and thighs; every afternoon he took a long nap, changing into pajamas, darkening the room, and lying under the covers on a heating pad. He spent a half hour daily in a small White House gym, following a regimen of back-strengthening exercises. He swallowed a pharmacopoeia of capsules and pills—steroids for his Addison’s, Lomotil and antispasmodics for his diarrhea and spastic colon, antibiotics for his urinary tract infections, vitamin B supplements, salt tablets, Choloxin for his high cholesterol, and antihistamines for his allergies. He cloaked his health under a carapace of secrecy. When he hired Dr. Travell he told her, “It’s best if you don’t go into any [of my] medical problems with Jackie. I don’t want her to think she’s married either an old man or a cripple,” adding, “Ted Sorensen is the only person here [in his Senate office] who is fully informed about my health. Discuss it with no one else.”
During a taped January 5, 1960, interview with Ben Bradlee and Jim Cannon for a book they were writing about contemporary politics, he essentially confirmed that he had Addison’s and was willing to lie to keep it secret. After Bradlee mentioned how green and sickly he had looked while running for Congress, he admitted suffering from “malaria and some adrenal deficiency.” When Bradlee asked if that meant Addison’s, he said, “Jack Anderson [who then worked for the influential political columnist Drew Pearson] asked me today if I had it. . . . I said, ‘No. God, a guy with Addison’s disease looks brown and everything. Christ, that’s the sun.” At this, everyone in the room had a good laugh.
When supporters of Senator Lyndon Johnson, Kennedy’s principal rival for the nomination in 1960, spread rumors about his health, he responded with a misleading letter drafted by Travell and signed by her and his endocrinologist, Eugene Cohen. It called his health “excellent” and said, “Your vitality, endurance and resistance to infection is [sic] above average. Your ability to handle an exhausting workload is unquestionably superior.” It skirted the Addison’s issue by stating that “your adrenal glands do function,” side-stepping the question of how well they functioned. He told reporters at his first postelection press conference that he had never had Addison’s disease, his back had been fine since his operation in 1955, and his health was “excellent.” None of these statements was even remotely true.
His robust physical appearance made it easier to dismiss the rumors about his poor health. When the journalist Hugh Sidey joined him for a swim in the White House pool, Sidey was impressed by his strong and handsome physique, calling his body “graceful and well-proportioned: broad shoulders, narrow hips and well-muscled legs,” yet scarred from his war injuries and back operation. Senator Fulbright, who saw him naked in a locker room after a round of golf, described him as “a very strongly built fellow” who had “tremendously strong arms and legs,” adding that, “surprisingly enough he looked much stronger and better built naked.”
Of the two secrets that could have ended his political career—his health and his womanizing—his health posed a greater threat because there were medical files that could confirm his illnesses. A month after Cohen and Travell released their letter, intruders broke into their offices on the same weekend. At Travell’s office they were thwarted by a steel door with hardened locks that protected the room containing her patients’ records. Cohen arrived Monday morning to find his cabinets open and the files of patients whose last names began with a “K” scattered across the floor. Luckily, he had given Kennedy a pseudonym beginning with another letter.*
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KENNEDY’S FABLED DETACHMENT failed him when it came to his health. Otherwise, he might have recognized the harmful effects of the rivalries between his physicians, and of his addiction to questionable treatments promising rapid but temporary relief. His search for a quick fix had led him to Dr. Max Jacobson, a New York physician who injected his wealthy and famous patients with “vitamin shots” laced with amphetamines. On multiple occasions between 1960 and 1962 Jacobson gave him a cocktail of vitamins and speed. Dr. Burkley became so alarmed that he wrote a stern letter cautioning, “You cannot be permitted to receive therapy from irresponsible doctors like M.J., who by form of stimulating injections offer some temporary help.” He added that Jacobson’s injections should not be taken by “responsible individuals who at any split second may have to decide the fate of the universe.”
Janet Travell’s expertise was in pharmacology and skeletal muscle pain. She had placed lifts in Kennedy’s shoes to equalize the disparity between his legs, recommended a hard mattress, tinkered with the height and pitch of his chairs, and suggested a rocking chair. She treated his back pain with anesthetics, temporarily alleviating his pain without addressing the underlying condition. Dr. Cohen had recommended her, but by November 1961 he had become so alarmed by her behavior that he told Kennedy he believed that she posed “a potential threat to your well-being” and urged him to dismiss her. In February 1964, Cohen unburdened himself to Dr. Burkley in a single-spaced four-page letter that could have been describing intrigues at the Russian imperial court. He said he was writing because he was horrified that Travell was being retained by the Johnson administration, and he wanted to record some facts about the White House tenure of a woman he called “a deceiving, incompetent, publicity-mad physician.”
He wrote that during the transition he had suggested another doctor for the post of White House physician. Travell, however, had accompanied Kennedy to Palm Beach, where she “wormed her way into having him agree that she be his physician,” despite being unqualified for the position because she was not an internist. Several days later, the president reversed himself and asked Cohen to choose a physician. He had arranged for a Dr. Donnally to attend to him during the inauguration, but Travell continued lobbying for the position, informing Cohen that Mrs. Kennedy disliked Donnally. Cohen succumbed and endorsed Travell because, given the secrecy surrounding the president’s medical background, there was no time to find another physician who could be trusted. He told himself that since Admiral Burkley, an internist who had treated Eisenhower, was on the White House medical staff, Kennedy would receive adequate care.
Within days he regretted his decision. Travell immediately called in reporters, providing them with material for several articles and leading Cohen to conclude that she was obsessed with publicity, a dangerous situation given the president’s medical history. After Kennedy injured his back during a tree-planting ceremony in Ottawa in May 1961 and Travell’s injections failed to alleviate his pain, Cohen recommended that he consult Dr. Hans Kraus, a renowned New York orthopedic surgeon and legendary mountaineer, medical contrarian, and fierce advocate for the medical benefits of physical fitness. (Kraus’s pioneering studies on the connection between exercise and muscular health had so impressed President Eisenhower that he had instituted the President’s Council on Youth Fitness and made Kraus a founding member.) Kraus had also developed a series of exercises to strengthen the back muscles that had proved effective in cases like Kennedy’s. Travell resisted summoning him to Washington and capitulated only in the fall of 1961 after Burkley and Cohen threatened to go to the president and charge her with incompetence.
When Kraus examined Kennedy in October 1961, he noted that his leg muscles were “as taut as piano wires,” he could not perform a single sit-up, and his fingertips dangled above his knees when he tried touching his toes. “You will be a cripple soon if you don’t start exercising,” he told him. “Five days a week. And you need to start now.”
Kraus flew to Washington three times a week to supervise his exercises and train White House therapists to handle additional daily sessions. He insisted on complete cooperation from the president and his medical staff as a condition of his employment. There were to be no second opinions, interference from other physicians, or interruptions during his exercise sessions. He prescribed a daily routine of breathing exercises, leg raises, stretches, knee bends, and toe touches, later adding weights, sit-ups, and leg spreads. After a month Kennedy was more mobile, his pain had diminished, and Kraus noticed, “a definite increase of strength and flexibility. . . . Patient is now able to do knee bends all the way down and get up without difficulty. He can walk well without shoes and without brace while he used to support his left hip and limp.” He reduced the frequency of his visits and told Kennedy his back brace was an unnecessary psychological crutch. He noted that he hoped to persuade him to discard it, “in a not too distant future,” writing in Kennedy’s file that when he did, “a very long step will have been taken toward the ultimate goal, namely, having a healthy person with occasional discomfort rather than an invalid.”
In November 1961, Kennedy asked Ken O’Donnell to fire Travell. O’Donnell delegated the task to Cohen, who wrote Kennedy on November 12 that he regretted he had been “burdened with initiating a housecleaning in your medical staff.” Speaking of Travell, he said, “In spite of repeated advice against her personal publicity . . . her own interests were placed above yours.” Cohen flew to Washington and was flabbergasted when Travell demanded several years’ worth of severance pay. On Christmas Day, a Washington newspaper reported that she was leaving and Salinger informed Cohen that he was about to issue a statement announcing her resignation. He called back an hour later to say that Travell had just met with the president and would not be resigning. Furthermore, the White House would be denying the newspaper story. “I hate to use the word blackmail,” Cohen wrote in his 1964 letter to Burkley, “but essentially this is how she has kept her tentacles stuck to the White House.”*
Just as Kennedy’s womanizing made it risky for him to fire J. Edgar Hoover, the perilous state of his health made it too dangerous to dismiss Travell. Unlike Hoover, she kept her title but not her power. Burkley became Kennedy’s White House physician in all but name, Kraus assumed sole responsibility for his back, and Travell was relegated to treating Jackie and the children.
Kennedy’s back improved throughout the winter of 1962, and he told Kraus, “I wish I could have known you ten years ago.” By April, Kraus had reduced his visits to several times a month and their relationship had ripened into a friendship. Kennedy admired mental and physical courage, and Kraus had demonstrated both, becoming the first climber to pioneer difficult climbing routes in the Shawangunks and Dolomites. (Kennedy was probably also impressed that James Joyce had taught Kraus English in Vienna, a fact Kraus was not shy about sharing.) Kraus was impressed that during the Cuban missile crisis Kennedy had come to the White House dispensary, where he was waiting for his scheduled exercise session, and had taken his hand and said, “I know, Doctor, you’ve come a long way to take care of me, but please forgive me. Tonight, I simply have no time.” He was floored that on the most important day of his presidency, he had taken the time to apologize to him personally. “You know I really liked Kennedy before that incident,” he said. “But after that, I liked him even more.”
Kraus returned to his office from a weekend in 1962 to find his cabinets open and his files scattered across the floor. Because he had labeled Kennedy’s file “K” and kept it in a separate drawer, the burglars had left empty-handed. Many in the White House suspected the FBI, the Soviets, or the GOP, in order of probability. Kennedy had scrambler phones installed in Kraus’s office, apartment, and country home, and whenever Kraus needed to consult Cohen and Burkley about the president’s condition he left his office and used a pay phone.
By the summer of 1963, Kraus considered Kennedy cured. He was playing golf, had not experienced any back pain during his strenuous European tour, and could toss his son in the air. Kraus remained on call for emergencies and saw Kennedy sporadically, but had he been a regular patient he would have discontinued their appointments. Kennedy had once told Jackie plaintively, “I wish I had more good times,” meaning more healthy times. By that standard, the summer of 1963 was a very good time. The gap between his robust physical appearance and the actual state of his health had narrowed to the point that he felt almost as well as he looked. Desensitization shots had reduced his allergies to animals and dust, making him less susceptible to sinusitis and other respiratory infections, his Addison’s was being managed with cortisone, and he boasted of feeling better than at any time in his adult life. All that remained was to discard his back brace, a device that made him sit bolt upright in chairs and in the backseats of limousines.