December 1999 | Volume 50, Issue 8
I first met Douglas MacArthur in November 1921. I was only six months old at the time, but family lore has impressed it firmly in my memory. My father was a major in the Army Medical Corps; General MacArthur was the superintendent at West Point. Dad operated on Mrs. Arthur MacArthur, the general’s mother. I do not know what her medical problem was, but there were serious postoperative complications, and my father stayed at the hospital, never venturing far from her bedside, for at least ten days, until she was out of danger. Every day that my mother was alone at home with my parents’ firstborn—me—General MacArthur sent her a dozen long-stemmed American Beauty roses, with a note expressing his appreciation and understanding. I recall as a youngster seeing those notes, but they have long since disappeared from the family archives. I would give almost anything to have one now.
On March 2, 1964, the eighty-four-year-old general was admitted to Walter Reed General Hospital in Washington, D.C. The MacArthurs had lived in the Waldorf Towers in New York since their return from Japan in 1951; he was chairman of the board of the Remington Rand Corporation. In late February his physician, Dr. Morris Schleifer, had called Lt. Gen. Leonard Heaton, the surgeon general of the Army, to say that General MacArthur was ill but was reluctant to have the surgery that Dr. Schleifer believed was urgently needed. General Heaton visited the MacArthurs in New York, agreed with Dr. Schleifer, and was able to persuade the general to come to Walter Reed for treatment. President Lyndon Johnson sent Air Force One to bring General MacArthur, Mrs. MacArthur, and their son, Arthur, to Washington.
General Heaton had selected six of us at Walter Reed to take care of the general. We all gathered at the nurses’ station on Ward Eight, the VIP ward on the fourth floor. As General MacArthur went into the bedroom to change into hospital garb (he occupied the Presidential Suite), General Heaton turned and, catching me completely by surprise, said, “Okay, Scott, you’re in charge. Go in, get a history, do a physical examination, and then tell us what we’re dealing with.” So I had one and a half hours alone with Gen. Douglas MacArthur.
During the few days before his arrival the rumors had flown thick and fast: “He hates doctors, he won’t even talk to you.” “He won’t let you take his blood pressure.” “He’ll refuse to have blood taken from his arm for tests.”
Instead he was relaxed, friendly, candid, and answered my questions simply and clearly. I am certain he sensed that I was tense (because I was), but he quickly put me at ease, and it was a very pleasant and useful session.
The first question of any medical history is always: “What is your chief complaint; what bothers you the most?” To which he answered, “Doc, it’s this damned itching.”
It turned out that General MacArthur had had gallstones for several years and had experienced a number of episodes of pain and jaundice, caused by the gallstones obstructing the flow of bile. These symptoms had always cleared up spontaneously, and he had therefore refused to have his gallbladder removed, though the indications for surgery were clear. This time there had been steadily deepening jaundice for at least five months, suggesting the possibility of a malignancy (a possibility later disproved). Obstructive jaundice is associated with generalized itching, itching so severe that there are reports of its driving patients to suicide. I was therefore surprised, as I carried out the physical examination, to find no evidence of scratching; there was not a mark on his skin. When I asked General MacArthur about this, he replied, “Yes, it gets pretty bad. Why, sometimes I almost have to scratch.”
The examination also showed enlargement of his liver and spleen and dilation of the veins over the abdominal wall, evidence of biliary cirrhosis, with a potentially serious complication: portal hypertension, which causes dilation of the veins inside the esophagus, which may bleed severely.
At this point let me make something plain. There are two types of cirrhosis of the liver: One is portal (or Laennec’s) cirrhosis, which is associated with alcohol abuse; the other is biliary cirrhosis, which is caused by prolonged obstruction to the flow of bile from the liver to the gallbladder and thence to the small intestine, where it plays an important role in digestion. General MacArthur had biliary cirrhosis.
The general was otherwise in good overall condition—no significant heart or lung problems—and there were no contraindications to the proposed surgery, cholecystectomy (removal of the gallbladder) and relief of the obstruction to the flow of bile through the bile ducts.
During the few days of preoperative studies and consultations and for almost two weeks after the operation, there was ample opportunity to sit and talk. He held all of us spellbound with tales of his boyhood on isolated Army posts with his father during the closing years of the Indian Wars and with stories about Gen. John J. (“Black Jack”) Pershing during World War I. Many were hilariously funny, and he told them all enthusiastically and well.
Throughout his stay with us he never lost his interest in world affairs. The Vietnam War was just beginning to heat up, and he had firm opinions about it, declaring in no uncertain terms that we must not send any more American troops to fight on the mainland of Asia. Mail for him arrived every day, in increasing volume. Soon there were two or more full sacks every morning. Most letters bore the expected address, but several were delivered with only “The Old Soldier” on the envelope, and one, from Australia, with only five stars in a circle.
General Heaton and the other surgeons performed the operation on March 6, 1964. The gallbladder was successfully removed, and the obstructing gallstones were cleared out of the bile ducts. General MacArthur withstood the procedure well, recovering quickly from the anesthesia; his jaundice began to fade, and within fortyeight hours the itching had subsided completely.
Then disaster. At four o’clock on the morning of March 23, bleeding suddenly began from those esophageal veins. Nothing would stop it, and a second operation was necessary. This was successful—the hemorrhage was arrested—but the general’s recovery from the anesthesia was very slow. He seemed to be gaining ground when, six days later, suddenly another crisis developed, a totally unrelated surgical emergency. A third major operation in less than three weeks was more than any eighty-four-year-old patient could tolerate. General MacArthur never fully regained consciousness. He slipped gradually into a coma and died on April 5. Mrs. MacArthur, their son, Arthur, and the general’s friend and World War II aide Maj. Gen. Courtney Whitney were at his side.
An autopsy was carried out immediately. It brought no surprises; we had missed nothing. I am convinced that everything we did was right, but unavoidable complications defeated us. I have heard rumblings of criticism: that it was unnecessary and cruel to have operated on a man of his age three times in such a short period. But what else could we have done? The indications for removal of his gallbladder were very clear. We could not stand by and allow him to bleed to death just to avoid the second operation. Failure to carry out that third procedure would have resulted in certain, agonizing death. It was a terrible disappointment not to have been able to save that gallant man.
Why had he refused for so long surgery to correct what was a rather common condition—gallstones? Certainly he did not lack physical courage, nor did he have an unrealistic fear of pain. Was it because he refused to surrender to the mundane? MacArthur does not scratch.