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Hernandez, the paramedic, was convinced the president wasn’t going to make it. He looked like a heart attack victim in the final moments of life. My God, he’s Code City, Hernandez thought—paramedic jargon for someone about to die.

Paul, still struggling to keep calm, leaned over and spoke into Reagan’s ear. “We’re going to cut your clothes off and stick some needles into your arms to pump in fluid and draw blood.”

“I feel so bad,” Reagan said. “I really feel awful. I can’t breathe.”

Paul loosened the president’s tie, ripped apart his white shirt, and began slicing at his suit with scissors so nurses and technicians could insert intravenous lines and take Reagan’s blood pressure. Paul noticed blood on the president’s left hand. She still couldn’t stop her own hands from trembling, and she felt her skin getting hot and splotchy.

Another ER nurse elevated the foot of the bed to force more blood toward the president’s heart and head. A technician who had just arrived in the trauma bay helped Kathy Paul cut off his suit jacket. The technician then jabbed a three-foot-long IV line into a vein in Reagan’s right arm and snaked it to his heart so that it could supply fluids and measure how the heart was functioning. A smaller line was inserted into a vein in his left arm. The nurses and the technician were following standard ER procedures: strip, insert IVs, start fluids.

“I’ve got a line!” the technician shouted.

At first the technician was so busy that she didn’t look at her patient’s face. As usual, she had responded to the emergency call by getting to the trauma bay as fast as she could and then going right to work. But now she noticed that several men in suits surrounded the patient, and that some of them had radio plugs jammed in their ears. She also thought one or two of them were holding guns. Finally she looked closely at the patient’s face and realized that it was President Reagan. Dizzy and disoriented, she swiveled, grabbed a pack of smelling salts from a box on a shelf, and inhaled. A moment later, she returned to the president’s side.

Herndanez pulled off Reagan’s shoes and socks and began yanking at his pants, hoping to pop the button. But his trousers wouldn’t budge. What are these, made of steel? he wondered as he kept tugging. When they finally came off, Hernandez’s partner cut away the president’s boxer shorts with a pair of bandage scissors. He left the shredded undershorts on the table; the rest of the president’s clothes had already fallen into a pile on the floor.

Wendy Koenig had helped cut away the president’s shirt, and while doing so she noticed that it was stitched with the monogram “RR.” When she looked into Reagan’s ashen face, she saw that he was laboring to breathe and seemed about to go into shock. He’s barely hanging on, she thought. He’s going to die. Her hands started shaking. She fought back tears. Suddenly her mind flashed on two images. In the first, it was 1963 and she had just come home to find her dad sobbing in front of the television. The second was a vivid and recent nightmare in which Reagan had been wheeled into the ER and then died from a heart attack.

Now, trying to refocus, Koenig wrapped a blood pressure cuff around the president’s left arm, put her stethoscope under the device, and began to inflate the sleeve to constrict blood flow. She released the pressure and listened for the telltale thump of Reagan’s systolic blood pressure. But she couldn’t hear anything above the din in the trauma bay.

“I can’t get a systolic pressure,” Koenig told the nurses and doctors around the gurney.

Koenig repeated the procedure. Again, she heard nothing.

“Oh, shit, try it again!” Mitchell shouted. “Try again!”

* * *

SINCE ENTERING THE ER, Jerry Parr had stayed as close as possible to the president. As the nurses and technicians cut away Reagan’s clothes, he’d turned to Ray Shaddick and said, “Set up a perimeter.” He also told a nurse to prevent any unnecessary hospital personnel from coming into the ER.

But now there was nothing left for Parr