Dr. Jenkins. Margaret—certainly. Those three—there were probably some student nurses too, whom I didn't recognize. Shall I continue?
Mr. Specter. Yes, please. Have you now covered all the people you recollect as being in the room?
Dr. Jenkins. Well, as I came into the room, I saw only the—actually—you know, in the haste of the coming of the President, two doctors whom I recognized, and there were other people and I have identified all I remember.
Mr. Specter. What did you observe as to the President's condition when you arrived in the emergency room?
Dr. Jenkins. Well, I was aware of what he was in an agonal state. This is not a too unfamiliar state that we see in the Service, as much trauma as we see, that is, he had the agonal respiratory gasp made up of jerking movements of the mylohyoid group of muscles. These are referred to sometimes as chin jerk, tracheal tug or agonal muscles of respiration. He had this characteristic of respiration. His eyes were opened and somewhat exophthalmic and color was greatly suffused, cyanotic—a purplish cyanosis.
Still, we have patients in the state, as far as cyanosis and agonal type respiration, who are resuscitatable. Of course, you don't stop at this time and think, "Well, this is a hopeless circumstance,"—because one in this state can often be resusciated—this represents the activities prior to one's demise sometimes, and if it can be stopped, such as the patient is oxygenated again and circulation reinstituted, he can be saved.
Dr. Carrico had just introduced an endotracheal tube, I'm very proud of him for this because it's not as easy as it sounds. At times and under the circumstances—it was harder—he had just completed a 3-month rotation on the anesthesiology service, and I thought this represented good background training for a smart individual, and he told me he had a cuff on the endotracheal tube and he introduced it below the wound.
The reason I said this, of course, this is a reflex—there is a tube, the endotracheal tube, if it is pushed down a little too far it can go into the right main stem of the bronchus impairing respiration from both lungs, or both chests.
There was in the room an intermittent positive pressure breathing apparatus, which can be used to respire for a patient. As I connected this up, however, Dr. Carrico and I connected it up to give oxygen by artificial respiration, Dr. Giesecke and Dr. Hunt arrived on the scene with the anesthesia machine and I connected it up instead with something I am more familiar with—not for anesthesia, I must insist on that—it was for the oxygenation, the ability to control ventilation with 100 percent oxygen.
As I came in there, other people came in also. This is my recollection. Now, by this time I was in familiar surroundings, despite the anguish of the circumstance.