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WHEN JEFF JACOBSON, a neurosurgical resident, heard the trauma team being paged, he rushed to the ER. There was a slight chance that the bullet had hit Reagan’s spinal cord; Jacobson’s task was to determine whether he had suffered any nerve damage. Jacobson worked his way through the throng of doctors and nurses and began to assess the president. He asked him to move his left hand, left arm, right hand, and right arm, and then his legs. The surgeon tapped the president’s knees and ankles with a rubber mallet, then ran a pinwheel over his extremities. Reagan reacted perfectly to all the tests.

As Jacobson stepped away from the president’s gurney, he noticed a second patient in the trauma bay: this was Jim Brady, the president’s press secretary. As nurses and technicians cut off Brady’s clothes, inserted IV lines, and put an oxygen mask on his face, Jacobson performed a cursory inspection of Brady’s head, which was swaddled in bloody bandages. The press secretary’s left eye was swollen to the size of an egg, and blood and brain matter oozed from the wound just above the eye. Clearly, the injury was devastating, but Brady was breathing on his own and moaning, two good signs.

Also attending Brady was Paul Colombani, who had rushed down the stairs with David Gens. Colombani quickly checked the press secretary’s chest, lungs, abdomen, and extremities but found no other wounds. He stepped back to allow Judith Johnson, an anesthesiologist, to go to work. To ensure that his brain was getting enough oxygen, Brady needed to be put on a respirator as soon as possible. Johnson asked Brady whether he was getting enough air.

Yes, he said, trying to remove the mask.

“No, you’ve got to leave it there,” Johnson said.

Brady’s blood pressure was high and his pulse was racing. Johnson ordered a nurse to administer the drugs that would put the press secretary to sleep and paralyze his body. It would then be easier for Johnson to get a tube down Brady’s throat and take over his breathing with a machine or a respiration bag.

Brady was large and had a short neck, both factors that made it more difficult to “tube” him. Johnson had to get it right the first time: failure would waste precious seconds or minutes, allowing carbon dioxide to build up in Brady’s blood and brain. Repeated attempts to insert the breathing tube might also make Brady vomit, sending debris into his lungs that could obstruct his air supply and later lead to infections.

With Jeff Jacobson and Paul Colombani standing by, Johnson stood over the front of the gurney; then she gripped Brady’s jaw, swiveled his head, and aimed the breathing tube at the back of his tongue. The tube went in on the first try. Doctors immediately increased his air supply to 100 percent oxygen and raised the head of Brady’s gurney to a 45-degree angle, hoping to reduce pressure on the press secretary’s brain.

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ARTHUR KOBRINE, ONE of GW’s top neurosurgeons, was reviewing X-rays in a room near the ER when his beeper went off. Walking down the hall, Kobrine spotted Dan Ruge, an old friend who had been his teacher years ago at Northwestern University’s prestigious medical school.

“Art, I’m glad you’re here,” the president’s doctor said. “There’s someone in the back you have to see.”

“Is it the president?”

“It’s not the president, but it is somebody who I think is going to need your services.”

Kobrine moved toward the trauma bay and spotted Reagan lying on a gurney in Bay 5A. Turning right and stepping into Bay 5B, Kobrine immediately saw that Brady was in very bad shape. His first cursory examination confirmed his sense that the press secretary’s chances of survival were slim.

A fellow surgeon who’d been observing the initial treatment of Brady pulled Kobrine aside. “I hope you are not going to operate on this guy,” the doctor said. “It wouldn’t be good for your career.”

Kobrine shrugged off his colleague; of course he would operate. If he didn’t, Brady would die.

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SHORTLY AFTER BRADY arrived in the