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By Root 1511 0

But once the two mustered sufficient support for their project, Giordano began to reconfigure the emergency room itself. The hospital, completed in 1948, was a massive six-floor bandbox-style concrete building that occupied an entire city block. Its layout was antiquated, and the emergency room, at just three thousand square feet, was tiny for a big-city hospital. With so little space, Giordano couldn’t create a Shock Trauma–style center; instead, he cordoned off a 150-square-foot area in one corner of the ER and dedicated it exclusively to trauma care. He bought high-tech medical equipment and suspended it from two large pods in the ceiling, saving space and making doctors and nurses less likely to trip over wires and tubes snaking through the trauma bay. He set up shelves in the bay and lined them with prepackaged kits for every imaginable procedure, just as at Shock Trauma. He shaved about three minutes off the time required to move a patient from the ER to the operating rooms by having maintenance workers knock out a wall and install a doorway to provide a more direct route.

Within two years of Giordano’s arrival at GW, the hospital’s emergency room was providing much better supervision, training, and treatment. In 1979 the District of Columbia’s government designated GW as an official trauma center, adding it to a growing list of such units across the country. GW had long been the Secret Service’s first-choice hospital if someone in or near the White House needed medical attention; now it actually could provide appropriate care in the event of an emergency.

* * *

THAT MONDAY, AS he stood in the vascular laboratory and watched the pressure cuff inflate, Joe Giordano was already many hours into another exhausting day. His days and nights at GW were often frantically busy: though he had handed off the responsibility of running the ER to another capable doctor, he was still in charge of the hospital’s trauma teams. Whenever a major trauma case arrived, whether at three p.m. or three a.m., he tried to get down to the ER. Between his vascular practice and his trauma duties, he was always on the run, which was probably why, with a receding hairline and a perpetual five o’clock shadow, he looked at least a half decade older than his thirty-nine years.

Just after 2:35 p.m., Giordano heard his name being called over the hospital intercom system. “Dr. Giordano, STAT to the ER. Dr. Giordano, STAT to the ER.” That was unusual. He couldn’t remember the last time he had been paged over the intercom—the ER usually called him on the phone. Something big must be happening.

Because of his long involvement in managing GW’s trauma teams, Giordano had been aware that a president might one day come through his doors, and in fact he had envisioned the moment a number of times. Even so, the scene he confronted when he reached the trauma bay was startling: a scrum of about fifteen doctors, nurses, and Secret Service agents stood in or near the bay, and the din of many voices reverberated off the ER’s tiled walls. But once Giordano slipped through the crowd and reached Reagan’s side, he felt strangely calm.

The first thing he noticed about the president was not the gunshot wound but his hair. It seemed too dark and thick to be natural. I wonder if he dyes it, Giordano thought. Then he focused his attention on his patient and the doctors treating him.

“How are you doing, Mr. President?” Giordano asked.

“I’m having trouble breathing,” Reagan replied through his oxygen mask.

Giordano felt Reagan’s femoral arteries on both sides of the groin. The pulse was strong. Bags of crystalloid fluid drained into the president’s arms, and his blood pressure was hovering around 100 or 110. After being introduced to Dan Ruge, Giordano asked for Reagan’s normal pressure.

“One forty over eighty,” Ruge said.

David Gens, who had been at the president’s side for about three minutes, gave Giordano a brief report on the situation. He explained that Reagan had been shot in the left lung, that they had not found an exit wound, and that the injured lung seemed