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- October 03, 1988
- Vol. 30
- No. 14
Shadow of Death
No Stranger to Cruel Fortune, the Senator from Delaware Escapes a Silent Killer—an Aneurysm Ready to Burst
None of Biden's political struggles could have prepared him for the life-or-death battle he was called upon to wage last year. At 45, he suffered an aneurysm—bleeding from a weak spot in an arterial wall near his brain, an affliction that is often lethal and nearly always neurologically damaging. In his first in-depth interview on the subject since his recovery, Biden spoke recently with reporter Linda Kramer about his experience on the threshold of death.
I never get headaches. But I suddenly started getting them while campaigning for the Presidency in the spring of 1987. I found myself taking Tylenol more frequently than I ever had in my life, to the point where the woman who arranged my schedule started carrying a family-size bottle in her purse.
People were saying, "Well, he's overtired. He's working 18 hours and going to three states in a day; maybe the stress or pressure of running is getting to him." I rejected that out of hand. But it perplexed me that I found myself in such discomfort.
After I ended my campaign, I still had occasional headaches. Then one day toward the end of January, I was working out in the Senate gym, and I felt a very warm sensation, resulting in pain going up the back of my neck to the top of my head. I thought I had just strained something, so I stopped, went in and took a shower and got dressed to catch the train home to Delaware. I found the pain getting progressively worse and spreading to my lower back and legs. I made it with some degree of difficulty to the train, and I found myself wondering if this is what happens when you have a heart attack.
When I got home, my son Hunter helped me up the stairs. I asked him to take my shoes off for me, and I lay on the bed for some time. Jill, my wife, insisted on calling the doctor. The doctor came and ran through a series of alternatives. What seemed to make sense was that I'd pinched a nerve in my neck lifting weights. Then I went to an orthopedic surgeon who x-rayed me and found I had a degenerative disc in my neck. He said it was consistent with the pinched-nerve diagnosis, so I was put in a soft cervical collar and stayed home for several days.
By early February, I was feeling much better and went up to speak at the University of Rochester in New York State. After my talk I went back to my hotel and turned on the television, and then I felt a severe pain in the top of my head. The pain came on like a flash, and I fell down on the bed. I don't know whether it knocked me out for a second or a minute or what. But I remember my vision sort of clearing, and I remember being afraid to move, lest the pain return. I figured if I could just hold out until morning I could make my 7 o'clock flight home.
When I arrived, Jill immediately called the doctor, who rushed me to St. Francis Hospital in Wilmington, where they performed a spinal tap. They found blood mixed in my spinal fluid. Then they did a CAT scan and at first were very relieved not to find what they were looking for. I was unaware of it, but they were looking for bleeding from a blood vessel in the head.
Then the neurologist said they should do an angiogram, which involves inserting what looks like a fishing line into an artery in the groin area. Then they run a catheter all the way up through the chambers of your heart. They go into the arteries that lead to your brain; they shoot a dye in, and at the same time they take pictures. You feel some heat in your eye region, and you see a miniature lightning storm in your eye. I was awake while they worked in order to follow their instructions. (I don't want to scare anyone reading this—it sounds worse than it is.) So I was there on the table, lying very still for quite a while. Finally, the radiologist, who is a friend, said, "Joe, we've got a problem. You have an aneurysm—a weakness in the wall of the artery. It has bled and will have to be corrected."
He explained that the aneurysm was in the cranial cavity. I'm not a doctor, but as I understand it you have to picture the portion of the carotid artery that branches into three parts inside the skull at the base of the brain. There are several inches of artery there, and that's where the aneurysm was. With new microsurgical techniques, you don't have to touch inside the brain at all to deal with any of this, but if the doctor slips, if an instrument just grazes the brain...it doesn't take much to do damage. Medical people believe this kind of aneurysm is congenital, that it isn't produced as a consequence of tension or some kind of serious blow. The doctors doing the angiogram told me they thought there might be two aneurysms, because one out of five people with this type of aneurysm has a second. So they had to go back and take more pictures, and they found it. This weakness in the wall was smaller, and there had been no indication of bleeding from it.
The family chose Dr. Eugene George at Walter Reed Army Medical Center in Washington to do the surgery. I was not quite aware of how urgent it was. I was taken straight from the room on a stretcher and out in the snow to an ambulance. We got down to Walter Reed very late that night. They did a series of tests confirming that action had to be taken. Dr. George looked at the angiograms and told my family, "I think it's too risky to wait. We should go in right now." He explained to me what he was going to do in some detail. Essentially, he was going to open the skull and go down around the brain and find this little bubble in the artery. He was going to put a clip on it, and that clip would make the artery whole. Over time the artery reconstitutes itself, and you have extra protection because the clip stays on forever. Dr. George told me I had a 60 percent chance of pulling through whole, and I thought that sounded pretty good. He said I'd either die or have serious damage or I'd be able to get off the table as good as new.
I've been in difficult situations before. They all related to people I loved and cared about, but they did not relate to my personal physical vulnerability. And here I was for the first time: Something very serious had happened to me, and maybe I would die.
The whole clan was gathered there at the hospital with me. I made sure I had a chance to be alone for a minute with my two boys, Beau and Hunter. I spoke about my hopes and expectations for them, and how I wanted them to view this. I didn't want them thinking, "Why my dad?" and "Why did this happen to him?" I tried to point out to them how lucky we were even if it ended there. We've had a love that I believe most people don't even get to experience, and I wanted to make sure they understood that.
My wife was with me as they wheeled the stretcher to the operating room. I remember seeing everybody as I was wheeled by and waving to my mother and father. We got down to the door of the operating room, and Jill kissed me goodbye.
It was about a nine-hour operation. They tell me they ran into a little problem once they got inside—the aneurysm burst and there was a lot of bleeding. I don't know if that meant it would have burst had we waited, and I'd be long gone, or that it burst because of the trauma of getting in. But the next thing I knew, I was awake and in the intensive-care unit. My wife and two boys were there, and we established that I wasn't dreaming.
The first thing you do is confirm that you're really alive. It sounds silly, but just as a pilot checks out his instruments before he takes off, I sort of checked out mine. I realized I could speak—that was the first big hurdle. Then my sight started to come back as I came out of the anesthesia, and I could see the clock— that was a great relief. I could read the time and calculate the square footage of the ceiling based on the ceiling tiles. Neurologically at least, I realized I still had it. Then I started to feel a little pain in my head, and it was the most welcome pain I'd ever felt. You know it was like, "Thank God, I can feel pain!"
Just 13 days later I went home. But I wasn't out of the woods, not yet.
I was home three weeks, resting up for the surgery for the second aneurysm and doing really well, when I felt discomfort in my back that, by midnight, turned into a horrible pain. It was an embolism—a blood clot that breaks off and, in this case, lodged in my lung. Blood clots are a danger when you're lying on your back for a long time and receiving transfusions, especially if you've been bleeding.
An ambulance came and took me to St. Francis and then down again to Walter Reed. By that time, things had stabilized, but they kept me in intensive care for about a week. I didn't think much about the embolism, except about the pain, until I later learned that about 600,000 people a year have pulmonary embolisms and 10 percent die from them.
Because of the experience with the embolism, the doctors decided to delay operating on the second aneurysm for about a month. That was the worst part—having to put off the other operation. I went home again March 24 and returned for the second operation on May 2. This was one of those aneurysms where there was only a 1 percent chance of dying, because it wasn't bleeding and was smaller in size. Plus I was in good health—all of which added up to an easier job, although the doctor kept teasing me after I called it a piece of cake.
From my perspective, it was a piece of cake because I was in the hands of a team of brilliant surgeons and I had the support of my family. God, I was so proud of my wife. She just took charge. She's as tough as nails, and I think I always kind of knew that. But to see the way my boys took care of me—they're men, not boys—and the way my 7-year-old daughter dealt with it all, it made me so proud of my family. I don't think I could have done as well as they did.
I left Walter Reed May 21. Dr. George assured me that there was no danger of a relapse or having another aneurysm. By July I was up and around, but I decided not to return to the Senate until September, when I could come back full-time. August was one of the happiest months of my life, with no worry, just euphoria that God was so good to me. My doctors told me that the prospects of my still being alive if I had stayed in the presidential race were very remote.
My instructions were to build up my stamina. I ate well, lifted weights, rode my stationary bike and spent time at the beach with my kids and lying around the swimming pool getting the best tan I've had since I stopped life-guarding in 1966. I also had ample time for reflection.
It's funny. I'd never been sick in my life. I'd had bronchial asthma, but I had known how to deal with that, and I'd never been hospitalized except when I had my tonsils out. I think I took my health for granted in a way, but I'd always been conscious of taking care of myself. Dr. George said one of the reasons he thinks I came through all this so well is because I was in good shape ahead of time, and I never smoked or drank.
The aneurysm made me realize how vulnerable I am, and it did an interesting thing to me. Instead of making me feel that now there's a great urgency about what I must do with my life, it had the exact opposite effect. I feel serene. I've gained great strength from the fact that I know death came close and I handled it. It gave me some perspective and confidence.
A lot of people ask me, "Why did this happen to you?" They go back and refer to 1972 [when Biden's first wife and daughter were killed]. They point to other things in my life and say, "My God, you've had it tough and been unlucky." But I think God balances it out. I've had a great life. I don't think, "Why me?" I never have. The only flicker of that occurred in 1972, and it just quickly hit me: There's no answer to that. I came out whole. I live.
My consulting neurologist, Dr. Fred Plum, who last examined me in August, said, "Joe, you're lucky. You came out of this totally unscathed."
I am lucky. Hell, I have my whole life back.
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