GOP elder statesmen George H.W. Bush and Bob Dole were hospitalized, but the extent of their illnesses purposefully kept vague. Dr. Kent Sepkowitz says this is typical with well-known people—and offers a guide to reading between the lines.
This week, we have been reminded once again how difficult it can be to obtain accurate details regarding the illness of a public figure. Tuesday, we read about the health problems of Sen. Bob Dole, who was hospitalized at Walter Reed because he was “infirm,” and yesterday morning, we learned President George H. W. Bush had entered a hospital in Houston because of bronchitis. A few facts (or perhaps “facts”) were given about each illness, but hardly enough to know if anything of concern was afoot.
Which means the fun now begins. For doctors and other amateur diagnosticians, the lack of specifics leaves the field wide open for speculation; an absence of facts allows substantial latitude. Like so many examples of inspired vagueness, evasion, and deliberate, hostile obfuscation, the art of both coding and decoding information owes a lot to the U.S.S.R. The discipline of Kremlinology was in its heyday a non-stop speculation about the possible rise and fall of various Communist Party apparatchiks based, for example, on how close or far one was standing to Khrushchev in the grainy black-and-white photo, or whether a person was allowed to speak (and for how long and in what place on the scorecard) at the meeting of the Congress of Soviets. A small amount of the speculation was based on likelihoods, past patterns, shrewd judgments. The rest, though, was derived from something approaching guessing the end of this season’s Homeland—a distracting parlor game that reveals more about the secret heart of the guesser than the situation being guessed about.
With those like me who pride themselves in being able to flick off one unsubstantiated possibility after another, there are a few helpful rules to guide our collective dumpster-dive toward the medical truth. First is this: the vaguer the dispatches, the sicker the patient. A celebrity said to have a stomachache or fever probably in fact has a stomachache or a fever. In contrast, a celebrity with a massive stroke may be described as checking into the hospital for routine tests, something the spokesman expects the doctors will soon complete.
A second important piece of information is timing: both the time of the hospital admission and when the announcement is made (and by whom). Calm, top-of-the-news-cycle info suggests the routine; however, a spokesperson with hair disheveled reading clumsily off lined paper may be telling us quite a bit more than the words he is reciting. For example, Bush 41’s illness came easily off the news conveyer belt, complete with a plausible diagnosis and a well-turned dispatch. On the other hand, we learned of Dole’s condition through Sen. Harry Reid, a member of the other political party, albeit a Dole admirer. His thin-lipped disclosure that Dole was “at Walter Reed not for a checkup … but he is sick” was just the sort of oddly timed, poorly controlled message that suggests a larger story; this is further suggested by a Dole spokesperson cheerfully suggesting all was well and that the senator would be released soon (though no diagnosis or symptom was listed).
There also, of course, is the age and overall condition of the person in question. When Pope John Paul II repeatedly was hospitalized, the well-tuned stonewallers of Vatican City chirpily proclaimed all was well—but a single glance at the poor old guy told the truth.
Though Dole has had the vampiric look of eternal life about him at least since his 1976 vice presidential debate against Walter Mondale, age seems to have crept up to the Jayhawk master at last. Ditto for the eternally bland and eternally middle-aged Bush 41, who once seemed to have stepped out of the not-quite-Brooks-Brothers catalogue showing off wing-tipped shoes, but now, alas, seems to be exactly who he is—a guy on his late eighties. A medical convention in describing a newly hospitalized patient is to state whether he looks older or younger or right at his stated age. Both of these octogenarians, after years of staying afloat on that adrenaline surge native to those in the Washington scramble to maintain a seat at the adult table, finally seem to be their stated ages.
The vaguer the dispatches, the sicker the patient.
That said, I will now try my luck at armchair diagnosis with apologies to Sen. Bill Frist, who codified the sport: Bush 41 has, as stated, bronchitis. Winter is a bitch, even in Houston; viruses like parainfluenza and respiratory syncytial virus (RSV) and a handful of others circulate even when there is no flu in town. These infections can cause a persistent cough, some fever, and generally knock an older person sideways, requiring hospitalization and a few weeks to recuperate. I suspect that barring a complication, Mr. Bush will be up and perhaps leaping, with help, from planes once again. In contrast, the no-information aura about Mr. Dole is disturbing. He was hospitalized for pneumonia two years ago and was treated for prostate cancer in the past as well. While neither of these previous diagnoses is likely to be relevant in whatever it is that ails him now, it suggests his remarkable reserve may finally be near exhaustion.
We may know the truth soon, but it may be a long, long while till something resembling reality floats our way. Once in a while, even at death, it is uncertain just what happened: just this week, Yasir Arafat joined Zachary Taylor, Beethoven, and many others as someone whose remains have been exhumed in order to probe more deeply into possible illnesses and causes of death. For those who hope that this second-look autopsy is guaranteed to settle the issue, please think again. In general the re-examination leads to nothing but more uncertainty and conspiratorial excitement. One way to avoid all of this, from amateur diagnosis to digging up the bodies of the deceased, is simple: a little bit of truth, aka transparency, in these matters would take away the fun of guessing but would give the public the facts they deserve.