The Medical Ordeals of JFK

Recent assessments of Kennedy's presidency have tended to raise "questions of character"—to view his Administration in the context of his sometimes wayward personal behavior. Such assessments are incomplete. Newly uncovered medical records reveal that the scope and intensity of his physical suffering were beyond what we had previously imagined. What Kennedy endured—and what he hid from the public—both complicates and enlarges our understanding of his character
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"Yellow as Saffron"

Serious back problems added to Kennedy's miseries from 1940 on. In 1938 he had begun having "an occasional pain in his right sacro-iliac joint," according to a Navy medical history recorded in December of 1944.

It apparently grew worse but at times he was completely free from symptoms. In the latter part of 1940 while playing tennis he experienced a sudden pain in his lower right back—it seemed to him that "something had slipped." He was hospitalized at the Lahey Clinic ... for ten days. A low back support was applied and he was comfortable. Since that time he has had periodic attacks of a similar nature.

Kennedy's service in the southwest Pacific on PT boats —which he managed to arrange by calling on his father's connections to hide his various illnesses from military physicians—added to his pain, especially after a Japanese destroyer sank his boat, leading to a week-long physical ordeal. (For all the accuracy of the popular accounts praising Kennedy's valor on PT-109, the larger story of his endurance has not been told. Lennie Thom, his executive officer, wrote letters home discussing JFK's back problem and his refusal to report to sick bay: "Jack feigned being well." Kennedy acknowledged to his parents that life on the boats was "not exactly what the Dr ... ordered." But he did not let on to his crew or his commanding officer that he was ill or in pain. And except for his chronic back ailment, which he simply could not hide, and which he seemed to take care of by wearing a "corset-type thing" and sleeping with a plywood board under his mattress, the men on PT-109 saw no poor health. Before the war was over, however, Kennedy found himself once again in the hospital for both back and stomach problems.)

Although college football injuries and his Navy mishaps may have contributed to the back pain, the steroids he was most likely taking to control his colitis may have caused the underlying problem. Navy medical records indicate that back surgery Kennedy underwent in 1944 had revealed clear evidence of osteoporosis. The surgeons removed "some abnormally soft disc interspace material" and anticipated additional problems if he continued to suffer bone loss. It was, as it had long been with Kennedy, one thing after another.

At the beginning of 1945 Kennedy went to Castle Hot Springs, Arizona, in an attempt to recover his health. It was an elusive quest. Although he refused to complain to his father about his continuing maladies, his doctor reported to Joe that Jack was "not getting along well at all." He remained in almost constant back pain, and he had trouble digesting his food. A companion in Arizona remembered that "he looked jaundiced—yellow as saffron and as thin as a rake." He returned to the Mayo Clinic for a while, but the doctors had nothing new to recommend, so he didn't stay; he traveled to San Francisco and Europe as a correspondent for the Hearst newspapers. Friends in San Francisco told him he looked "sickly"; in Europe he became terribly ill with a high fever, nausea, and vomiting. Back in Boston, in June of 1946, he collapsed at a parade, where a witness remembered his turning "very yellow and blue" and looking like he was having a heart attack.

Despite his medical difficulties, Kennedy ran successfully for a House seat in 1946. A returning war veteran who knew him then says, "I was as thin as I could be at that time, but Jack was even thinner. He was actually like a skeleton, thin and drawn." Despite the medications he was taking for the colitis, he continued to have abdominal pain and problems gaining weight. Because hot baths gave him temporary relief, he spent some time every day soaking in a tub. He also had experienced a burning sensation when urinating, the result of a "non-specific urethritis" dating from 1940 (possibly an infection contracted from a sexual encounter in college), which later became chronic prostatitis, or inflammation of the prostate, which sulfa drugs temporarily suppressed.

A strenuous daily routine during the campaign intensified Kennedy's fatigue, nausea, and vomiting—symptoms of the as yet undiagnosed Addison's disease. People around him noticed his bulging eyes and jaundiced complexion, and the limp caused by unremitting pain. They marveled at his stamina and refusal to complain; it was "a tremendous effort of will," one of them says.

The following year, while in England, Kennedy became ill again. He ended up in a hospital in London, where a doctor for the first time diagnosed the Addison's disease. (Because Kennedy had served in the South Pacific and malaria has similar symptoms, and because Kennedy's long history of stomach and colon problems suggested that his difficulties were related to an ulcer or colitis, his previous doctors had not diagnosed the Addison's.) The doctor told Pamela Churchill, Winston Churchill's daughter-in-law and a friend of Kennedy's, "That young American friend of yours, he hasn't got a year to live." On his way home to the United States, on the Queen Mary, Kennedy became so sick that upon arrival a priest was brought aboard to give him last rites before he was carried off the ship on a stretcher. In 1948, when bad weather made a plane trip "iffy," he told his friend Ted Reardon, "It's okay for someone with my life expectancy," but suggested that his sister Kathleen and Reardon take the train.

By 1950 Kennedy was suffering almost constant lower-back aches and spasms. X-rays in the Travell records, which I examined with the help of a physician, show that the fourth lumbar vertebra had narrowed from 1.5 cm to 1.1 cm, indicating collapse in the bones supporting his spinal column. By March of 1951 there were clear compression fractures in his lower spine. He needed crutches to get up a flight of stairs. Later that year, during a trip to Japan, he had a severe crisis related to Addison's when he apparently neglected to take his steroid medications. He ran a temperature of 106, and his doctors feared for his life. The episode convinced him to be more rigorous about taking his medicine, and over the next two years back problems became his principal complaint.

In 1952, during a successful campaign to replace Henry Cabot Lodge as senator from Massachusetts, Kennedy suffered headaches, upper respiratory infections, stomachaches, urinary-tract discomfort, and nearly unceasing back pain. He consulted an ear, nose, and throat specialist about his headaches; took anti-spasmodics and applied heat fifteen minutes a day to ease his stomach troubles; consulted urologists about his bladder and prostate discomfort; had DOCA pellets implanted and took daily oral doses of cortisone to control his Addison's disease; and struggled unsuccessfully to find relief from his back miseries.

Dave Powers, one of Kennedy's principal aides, remembers that at the end of each day on the road during the campaign, Kennedy would climb into the back seat of the car, where "he would lean back ... and close his eyes in pain." At the hotel he would use crutches to get himself up stairs and then soak in a hot bath for an hour before going to bed. "The pain," Powers adds, "often made him tense and irritable with his fellow travelers." (Much later, in February of 1960, during the presidential campaign, as Kennedy stood for hours in the freezing cold shaking hands with workers arriving at a meatpacking plant in Wisconsin, Powers whispered to Kenneth O'Donnell, another Kennedy aide, "God, if I had his money, I'd be down there on the patio at Palm Beach.")

By the spring of 1954 Kennedy's back pain had become almost unbearable. X-rays show that the fifth lumbar vertebra had collapsed. Kennedy could not bend to pull a sock onto his left foot, and he had to ascend and descend stairs moving sideways. Beginning in May he had to rely on crutches more than ever, and walks from his office to the Senate for quorum and roll calls, on hard marble floors, became a daily ordeal. In August a team of physicians from the Lahey Clinic, in Boston, visited him on Cape Cod, where they described yet another surgery, a complicated procedure to achieve spinal and sacroiliac fusions that, they hoped, would strengthen his lower spine. They explained that without the operation he might lose his ability to walk, but that so difficult a surgery on someone with Addison's disease posed risks of a fatal infection, because the steroids were suppressing his immune system.

Rose Kennedy said later, "Jack was determined to have the operation. He told his father that even if the risks were fifty-fifty, he would rather be dead than spend the rest of his life hobbling on crutches and paralyzed by pain." Joe tried to dissuade his son from the surgery, reminding him of FDR's extraordinary achievements despite confinement to a wheelchair. After he entered the New York Hospital for Special Surgery, on October 10, the team of endocrinologists and surgeons postponed the operation three times in order to assure an "extended metabolic work-up prior to, during, and after surgery."

The operation, which finally took place on October 21 and lasted more than three hours, was at best a limited success. A metal plate was inserted to stabilize Kennedy's lower spine. Afterward a urinary-tract infection put his life in jeopardy. He went into a coma, and once again a priest was called to administer last rites. By December Kennedy had shaken the infection and was sufficiently recovered to be moved to the family's Palm Beach home. Nevertheless, he remained far from well; his doctors could not promise that he would ever walk again. Moreover, there was reason to believe that the site of the plate was infected. Consequently, in February another operation was performed at New York Hospital, to remove the plate. The Travell records show that extracting it meant removing three screws that had been drilled into bone and replacing damaged cartilage with a bone graft. After another three months recuperating in Florida, Kennedy returned to Washington in May.

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