A change of heart
FDR's death shows how much we've learned about the heart
Dueling memories. Historians speculate that as Roosevelt's cardiac problems became more apparent, McIntire grew more determined to hide the reality that he had overlooked or concealed for so long. Years later, in a 1970 journal article called "Clinical Notes on the Illness and Death of President Franklin D. Roosevelt," Bruenn wrote about the frustration of treating FDR. His account of the examinations and treatments of the president was the first medical data made available apart from McIntire's memoirs. Bruenn's account contrasted sharply with the self-serving recollections of McIntire, and Bruenn concluded by saying, "I have often wondered what turn the subsequent course of history might have taken if the modern methods for the control of hypertension had been available." The president's original medical chart vanished immediately after his death, and the most reliable enduring record of his health during his presidency is the notebook that Bruenn kept.
Bruenn persisted in speaking his mind, calling in other experts, and eventually he prevailed over McIntire. But even with focused concern, Bruenn was virtually powerless to control FDR's severe hypertension. Roosevelt began taking digitalis, the only drug available for treatment of heart failure. At the very end of his life, he was prescribed phenobarbital, a sedative, which doctors at the time hoped would lower blood pressure. It proved ineffective. Lifestyle alterations for Roosevelt included a recommendation that he cut back on cigarettes from 20 a day to 10, but Bruenn was frustrated in his attempts to convince the president of the importance of it. Few doctors at the time considered tobacco a risk factor for cardiovascular disease, and Bruenn's concern about FDR's smoking was probably aimed at providing relief from a chronic cough and respiratory problems.
For the next few months, the president rallied publicly. With his country and millions of its troops depending on his strength of command, he felt he could not quit in the middle of war, and he decided to run once again for re-election. In 1944, the year before his death, Roosevelt's blood pressure numbers read like a recipe for disaster: March 27, 186/108; April 1, 200/108; November 18, 210/112; November 27, 260/150. And yet, during those months, he traveled to Hawaii to confer with top brass. He went to the Democratic National Convention in Chicago. He traveled to Alaska and to Washington State. He met with Winston Churchill in Canada.
He may have suffered an attack of angina as he delivered his final inaugural speech on Jan. 20, 1945. He conveyed a message of hope, but the world was at the height of war, and the ceremony was solemn. The expense of a show of festivity would have been inappropriate, and the oath of office was taken quietly on the South Portico of the White House.
The impropriety of public celebration, ironically, served Roosevelt's failing health. The address--about 500 words--was by far his shortest inaugural speech. It was to be the last time the public would see him standing.
As he departed for the Black Sea port of Yalta in early February to determine the destiny of Europe, Roosevelt looked gravely ill. While there, his blood pressure was 260/150, a level we now call malignant hypertension.