Editor’s note: This article is an edited version of a previously published work from the author.* Many of the details of this article were obtained via personal correspondence with Donald C. McIlrath, MD, FACS, in November 2008.
U.S. President Lyndon Baines Johnson was 57 years old when he developed right upper quadrant abdominal pain on September 7, 1965. The White House physician, George G. Burkley, MD, suspected gallbladder disease and confirmed his suspicion with an oral cholecystogram. X rays also showed a kidney stone in the right mid ureter. George Hallenbeck, MD, FACS, a noted gastrointestinal surgeon at the Mayo Clinic, Rochester, MN, was consulted and recommended surgery. Dr. Hallenbeck chose Donald C. McIlrath, MD, FACS, another Mayo surgeon, as his assistant.
The surgeons arrived in Washington, DC, two days before the operation and met with the president in the White House. The operative plan was to take out the gallbladder through a right subcostal incision. If the operation went well and the operative time was not excessive, the kidney stone would also be removed. For that reason, Ormand Culp, MD, FACS, a urologist at the Mayo Clinic, joined the surgical team.
Political implications
The president was only mildly interested in the details of the procedure but was very interested in its potential political implications. First, the president wanted to know how long he would be under anesthesia— unaware of his surroundings. Obviously, he wanted to be able to quickly return to running the country. He also wanted to know when he could inform the public about his recovery. The president had decided that he wanted to have his cholecystectomy on a Friday, so he would have the weekend to recover. President Johnson wanted to talk to the press the following Monday, and he wanted to look well and to be in firm control of his faculties. Friday also was selected because the president did not want his operation to have a negative effect on the stock market.
Dr. Hollenbeck and his team performed the operation Friday, November 8, at the Naval Hospital in Bethesda, MD. The gallbladder was inflamed, but the cystic artery and cystic duct were successfully exposed, ligated with catgut sutures, and divided. The gallbladder was resected from the bottom up with sharp dissection. Once the gallbladder was removed, Dr. Culp mobilized the right ureter, palpated the ureteral stone, and removed it through a transverse ureterotomy. Total operative time was approximately two hours.
Some scars take longer to heal
The president’s recovery was uneventful, and he was able to resume his duties the next day. He met the press on Monday without an intravenous line in his arm and reassured the nation that he was recovering well. The stock market responded favorably.
He advanced to an oral diet by day four, and on postoperative day 12, he was photographed showing his scar to reporters (see photo). He was discharged on postoperative day 17 without incident.
President Johnson showing his scar to reporters
Photo: Charles Tasnadi, Associated Press
Although President Johnson was incapacitated during the operation, there was no transfer of power to Vice-President Hubert Humphrey because the U.S. Constitution did not provide for this circumstance. In fact, the 25th Amendment, which created clear transfer of power in the case of presidential incapacity, was not ratified until 1967. Nonetheless, President Johnson made an informal arrangement with Mr. Humphrey that the Vice-President would be empowered if a vital decision was required in the perioperative period.
President Johnson had an eventful presidency that included the passage of the Social Security Amendments of 1965, which included Medicare and Medicaid, and the disastrous fallout from the Vietnam War. Although the president’s surgical scars healed quickly, the scars of the war were much slower to heal and were largely responsible for his decision not to seek re-election in 1968.†
*Pappas TN, Mulvihill MS. The President’s gallbladder: A historical account of the cholecystectomy of Lyndon Baines Johnson. Surgery. 2010;147(1):160-166.
†Jones JR. Behind L.B.J.’s decision not to run in ’68. New York Times. April 16, 1988. Available at: www.nytimes.com/1988/04/16/opinion/behind-lbj-s-decision-not-to-run-in-68.html. Accessed May 30, 2017.
