Nixon in a Deep Coma; Prognosis Is Seen as Bleak

Richard Nixon’s condition worsened dramatically Thursday and the 81-year-old former President fell into a deep coma, his physicians said. His daughters were at his bedside and his prognosis was bleak.

A massive stroke on Monday left Nixon paralyzed on the right side, unable to speak and partially blind. The stroke was followed by very serious brain swelling, which specialists fought to control in an intensive care unit of the New York Hospital-Cornell Medical Center.

But medical experts said the usefulness of treatments, while often having short-term benefits, was limited in a stroke the size Nixon suffered. Swelling, which can compress the brain stem where breathing and heart rhythm are controlled, often is a major cause of death in strokes.

“President Richard M. Nixon’s condition has deteriorated and he is now in a deep coma. He is resting comfortably. His family is at his bedside,” the hospital announced.

Stroke patients have made remarkable recoveries when expecatations were minimal. But language such as that used in the hospital statement generally signals that the chances of such a recovery are rapidly diminishing--a fact confirmed by doctors at the medical center.

Nixon was rushed to New York Hospital on Monday after suffering the stroke just before dinner time at his home in Park Ridge, N.J. For a time, medical personnel were guardedly optimistic, but as brain swelling set in, his prognosis steadily worsened. It was understood Nixon did not wish heroic life-support measures taken.

Doctors familiar with the case said the stroke probably resulted from chronic heart disease, which caused the heart to beat irregularly.

Often patients with heart rhythm disturbances are prone to blood clots which can form when one of the heart’s chambers is unable to pump blood forcefully, these physicians said. Nixon for many years had atrial fibrillation, a heart rhythm problem, and in an effort to avert a stroke he took the anticoagulant Coumadin.

The presence of chronic heart disease both complicated and limited the options available to physicians once Nixon reached the hospital.

In an effort to treat the clot that formed in his heart and lodged in the brain’s middle cerebral artery, his doctors prescribed injections of Heparin, a second anticoagulant. At one point, it appeared the strategy was working. Nixon was taken from the intensive care unit to a private room. But about two hours later, his condition worsened and a CT scan revealed brain swelling.

World leaders from President Clinton to Russian President Boris N. Yeltsin sent well wishes and prayed for his recovery. The former President’s office near his home in New Jersey was flooded by hundreds of phone calls and at the Richard Nixon Presidential Library and Birthplace in Yorba Linda, Calif., hundreds of visitors expressed hope that he would regain his strength.

Nixon’s illness turned national attention to strokes, the nation’s third-leading cause of death.

“All illnesses are terrible, but out of attention to this problem, the public must learn that stroke can be devastating, can sometimes be fatal,” said Dr. Fred Plum, the chief neurologist treating Nixon. “But there is considerable promise stroke may be reducible if the patient gets to the hospital in time.”

“Hospitals have to learn acute stroke takes a priority with acute chest pain,” said Plum, the chief neurologist at New York Hospital-Cornell Medical Center.

The neurologist urged people to become as familiar with the signs of a stroke as they are with the signs of a heart attack and to regard such symptoms as a suddenly weak side or arm or paralysis or accompanying language difficulties or confusion “in the same terms they look at severe chest pain.”

Nixon, the 37th President of the United States and the only one to resign from office, had returned from Russia only six weeks ago. He was in good spirits and had spent part of Monday working on a Republican fund-raising speech. Nixon was on the front porch of his house when he suddenly became ill, press aides said. He dropped a glass and went into the kitchen where Heidi Retter, a maid and cook was preparing dinner. She helped him sit down. Local police and an ambulance were summoned.

Respecting Nixon’s longtime preference to be treated by his personal internist, he was taken to the medical center alongside the East River in Manhattan. Physicians familiar with his illness said the time between his stroke and his arriving at the hospital did not make a difference in his treatment.

Several relatively short-term measures were available in an effort to reduce swelling in the brain, including the administration of the diuretic Manitol, which removes fluid from the body. Physicians also may place a patient on a respirator causing faster breathing, which can change blood chemistry, resulting in a reduction of brain volume. But it was understood that Nixon in the past had expressed unwillingness to be placed on a respirator in the event he became severely ill.

Swelling commonly can progress from the start of a stroke to up to 96 hours afterward, when it usually starts to subside.

“We see a lot of people with strokes and a lot of brain swelling who recover perfectly well,” said Dr. Denise Barbut, director of the stroke center at New York Hospital.

Physicians monitoring Nixon’s condition paid particular attention to his level of consciousness. When he was taken from his private room back to intensive care, doctors said the former President was drowsy, but could be roused. But as his condition worsened, the coma deepened and he could not respond to verbal commands or painful stimulation.

Both of Nixon’s daughters, Julie Nixon Eisenhower and Tricia Nixon Cox, rushed to the hospital soon after the stroke and remained at his bedside on Thursday.