Treatment of President Kennedy
The first physician to see the President at Parkland Hospital was Dr. Charles J. Carrico, a resident in general surgery.[C2-192] Dr. Carrico was in the emergency area, examining another patient, when he was notified that President Kennedy was en route to the hospital.[C2-193] Approximately 2 minutes later, Dr. Carrico saw the President on his back, being wheeled into the emergency area.[C2-194] He noted that the President was blue-white or ashen in color; had slow, spasmodic, agonal respiration without any coordination; made no voluntary movements; had his eyes open with the pupils dilated without any reaction to light; evidenced no palpable pulse; and had a few chest sounds which were thought to be heart beats.[C2-195] On the basis of these findings, Dr. Carrico concluded that President Kennedy was still alive.[C2-196]
Dr. Carrico noted two wounds: a small bullet wound in the front lower neck, and an extensive wound in the President’s head where a sizable portion of the skull was missing.[C2-197] He observed shredded brain tissue and “considerable slow oozing” from the latter wound, followed by “more profuse bleeding” after some circulation was established.[C2-198] Dr. Carrico felt the President’s back and determined that there was no large wound there which would be an immediate threat to life.[C2-199] Observing the serious problems presented by the head wound and inadequate respiration, Dr. Carrico directed his attention to improving the President’s breathing.[C2-200] He noted contusions, hematoma to the right of the larynx, which was deviated slightly to the left, and also ragged tissue which indicated a tracheal injury.[C2-201] Dr. Carrico inserted a cuffed endotracheal tube past the injury, inflated the cuff, and connected it to a Bennett machine to assist in respiration.[C2-202]
At that point, direction of the President’s treatment was undertaken by Dr. Malcolm O. Perry, who arrived at trauma room 1 a few moments after the President.[C2-203] Dr. Perry noted the President’s back brace as he felt for a femoral pulse, which he did not find.[C2-204] Observing that an effective airway had to be established if treatment was to be effective, Dr. Perry performed a tracheotomy, which required 3 to 5 minutes.[C2-205] While Dr. Perry was performing the tracheotomy, Drs. Carrico and Ronald Jones made cutdowns on the President’s right leg and left arm, respectively, to infuse blood and fluids into the circulatory system.[C2-206] Dr. Carrico treated the President’s known adrenal insufficiency by administering hydrocortisone.[C2-207] Dr. Robert N. McClelland entered at that point and assisted Dr. Perry with the tracheotomy.[C2-208]
Dr. Fouad Bashour, chief of cardiology, Dr. M. T. Jenkins, chief of anesthesiology, and Dr. A. H. Giesecke, Jr., then joined in the effort to revive the President.[C2-209] When Dr. Perry noted free air and blood in the President’s chest cavity, he asked that chest tubes be inserted to allow for drainage of blood and air. Drs. Paul C. Peters and Charles R. Baxter initiated these procedures.[C2-210] As a result of the infusion of liquids through the cutdowns, the cardiac massage, and the airway, the doctors were able to maintain peripheral circulation as monitored at the neck (carotid) artery and at the wrist (radial) pulse. A femoral pulse was also detected in the President’s leg.[C2-211] While these medical efforts were in progress, Dr. Clark noted some electrical activity on the cardiotachyscope attached to monitor the President’s heart responses.[C2-212] Dr. Clark, who most closely observed the head wound, described a large, gaping wound in the right rear part of the head, with substantial damage and exposure of brain tissue, and a considerable loss of blood.[C2-213] Dr. Clark did not see any other hole or wound on the President’s head. According to Dr. Clark, the small bullet hole on the right rear of the President’s head discovered during the subsequent autopsy “could have easily been hidden in the blood and hair.”[C2-214]
In the absence of any neurological, muscular, or heart response, the doctors concluded that efforts to revive the President were hopeless.[C2-215] This was verified by Admiral Burkley, the President’s physician, who arrived at the hospital after emergency treatment was underway and concluded that “my direct services to him at that moment would have interfered with the action of the team which was in progress.”[C2-216] At approximately 1 p.m., after last rites were administered to the President by Father Oscar L. Huber, Dr. Clark pronounced the President dead. He made the official determination because the ultimate cause of death, the severe head injury, was within his sphere of specialization.[C2-217] The time was fixed at 1 p.m., as an approximation, since it was impossible to determine the precise moment when life left the President.[C2-218] President Kennedy could have survived the neck injury, but the head wound was fatal.[C2-219] From a medical viewpoint, President Kennedy was alive when he arrived at Parkland Hospital; the doctors observed that he had a heart beat and was making some respiratory efforts.[C2-220] But his condition was hopeless, and the extraordinary efforts of the doctors to save him could not help but to have been unavailing.
Since the Dallas doctors directed all their efforts to controlling the massive bleeding caused by the head wound, and to reconstructing an airway to his lungs, the President remained on his back throughout his medical treatment at Parkland.[C2-221] When asked why he did not turn the President over, Dr. Carrico testified as follows:
A. This man was in obvious extreme distress and any more thorough inspection would have involved several minutes—well, several—considerable time which at this juncture was not available. A thorough inspection would have involved washing and cleansing the back, and this is not practical in treating an acutely injured patient. You have to determine which things, which are immediately life threatening and cope with them, before attempting to evaluate the full extent of the injuries.
Q. Did you ever have occasion to look at the President’s back?
A. No, sir. Before—well, in trying to treat an acutely injured patient, you have to establish an airway, adequate ventilation and you have to establish adequate circulation. Before this was accomplished the President’s cardiac activity had ceased and closed cardiac massage was instituted, which made it impossible to inspect his back.
Q. Was any effort made to inspect the President’s back after he had expired?
A. No, sir.
Q. And why was no effort made at that time to inspect his back?
A. I suppose nobody really had the heart to do it.[C2-222]
Moreover, the Parkland doctors took no further action after the President had expired because they concluded that it was beyond the scope of their permissible duties.[C2-223]