updated 9/7/2004 10:51:44 AM ET 2004-09-07T14:51:44

Guest: Dr. Toby Cosgrove, Dr. Dean Ornish, Robert Sam Anson, Doris Kearns Goodwin, Douglas Brinkley

DEBORAH NORVILLE, HOST:  On the mend, President Bill Clinton recovering tonight from quadruple heart bypass.

(BEGIN VIDEO CLIP)

SEN. HILLARY RODHAM CLINTON (D), NEW YORK:  This is not how we expected to be spending our Labor Day weekend.

UNIDENTIFIED MALE:  This is not the average person in recovery.

(END VIDEO CLIP)

NORVILLE:  Was it all his fondness or fast food?

(BEGIN VIDEO CLIP)

BILL CLINTON, FORMER PRESIDENT OF THE UNITED STATES:  I just couldn‘t resist.  French fries and a chicken sandwich.

(END VIDEO CLIP)

NORVILLE:  Was it stress?

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE:  Being president of the United States is a high-stress occupation.

(END VIDEO CLIP)

NORVILLE:  Or genetics?  Tonight, Bill Clinton‘s close call.  He was in better shape than he had ever been.  He had great medical care.  So why didn‘t president Clinton know he was living with a time bomb?

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE:  This is a pretty common situation for a 58-year-old American male.

(END VIDEO CLIP)

NORVILLE:  Bill Clinton‘s wake-up call could be a wake-up call for you or someone you love.  Tonight, America‘s deadliest health crisis, as president Bill Clinton recovers from major heart surgery.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE:  He will have a normal longevity.

(END VIDEO CLIP)

ANNOUNCER:  From studio 3K in Rockefeller Center, Deborah Norville.

NORVILLE:  And good evening, everybody.  Former president Clinton is described as resting comfortably tonight at New York‘s Presbyterian Hospital.  He underwent four hours of successful quadruple heart bypass surgery.  And after the operation, his doctors said that Clinton was a heart attack waiting to happen.  Several key blood vessels were almost completely blocked, and there was, quote, “substantial likelihood” that he would have had a substantial heart attack in the near future.  But the problem‘s been fixed.  The former president is expected to make a full recovery.

(BEGIN VIDEO CLIP)

DR. CRAIG SMITH, LEAD SURGEON:  Starting this morning, around 8:00 o‘clock, he had a relatively routine quadruple bypass operation.  We left the operating room around noon, and he is recovering normally at this point.  So I think right now, everything looks straightforward.

UNIDENTIFIED MALE:  After the surgery, he‘s going to resume his very active exercise, and we will work with him to control other factors that can lead to the recurrence of this disease.  And with those things under control, with a normal heart muscle, he will have a normal longevity.

(END VIDEO CLIP)

NORVILLE:  And joining me to talk about the operation and the former president‘s condition is Dr. Toby Cosgrove.  He‘s the chief of thoracic and cardiovascular surgery for the Cleveland Clinic, a renowned cardiac institution in this country.

Dr. Cosgrove, the thing that hit me when I heard Bill Clinton had this problem, how is it that a guy who‘s had the best medical care anybody in the country can get had heart disease that had gone undetected until an emergency situation arose?

DR. TOBY COSGROVE, CHIEF OF CARDIAC SURGERY, CLEVELAND CLINIC: 

Deborah, good question.  As you know, coronary artery disease is the build-up of plaques in the coronary arteries, and it starts probably when you‘re 20 years old and gradually builds up and gradually builds up and gradually builds up.  And then the thing that frequently will tip people over into a sudden heart attack or sometimes sudden death or sudden appearance of symptoms...

NORVILLE:  Right.

COSGROVE:  ... is the rupture of one of those plaques, which then takes a narrowed artery and makes it even more narrowed or almost partially occluded.

NORVILLE:  And that was the chest pain that the president felt late last week.

COSGROVE:  That‘s when he started to get short of breath, and then it got worse and worse and worse, and then he got chest pain.

NORVILLE:  We all know that Bill Clinton lost a ton of weight.  He was on the South Beach died.  He‘s been working out.  He looks better than he‘s ever looked in the public eye.  Is it possible that that sudden weight loss triggered this plaque to break free?

COSGROVE:  No, I think that‘s completely unrelated.

NORVILLE:  All right.

COSGROVE:  He was headed in the right direction.  It was just too little, too late.

NORVILLE:  And you‘ve got—next to you here, you‘ve got a plastic model of a heart...

COSGROVE:  Right.

NORVILLE:  ... which is way bigger than a normal...

COSGROVE:  It is bigger.

NORVILLE:  ... person‘s heart would be.  But give us just a quick sense of what was wrong with Mr. Clinton and what they‘ve done to repair it.

COSGROVE:  OK.  There are three arteries that supply the heart muscle, one on the right, one that goes down the front of the heart, and another one that comes around back.

NORVILLE:  Right.

COSGROVE:  And what they did is they took the arteries that run along the inside of the chest wall and they used one of them to bypass these two arteries on the front of the heart, one of them to do the back of the heart.  And then they took a vein from his leg to jump over the blocks in the artery on the right side of his heart.

NORVILLE:  So that the blocked arteries are still there.

COSGROVE:  They stay.

NORVILLE:  They‘ve just done an end run, a bypass, around them.

COSGROVE:  Exactly.  It‘s like building a circle—a highway around a city.

NORVILLE:  Now, in reading about these, we hear that bypass surgeries last about 10 years.  But you actually believe that Bill Clinton‘s had the best kind of operation, and he‘s got veins that are going to maybe hold up a lot longer than that.

COSGROVE:  I think that Craig Smith and his associates did a great job.  They did—they followed the operation that would give him the best long-term results.  We know that the arteries on the inside of the chest wall are arteries.  And arteries are normally in arterial blood pressure.  A piece of vein, if you take it out of the venous system at low pressure and put it in the high-pressure system, get arteriosclerosis.  So they don‘t last as long.

NORVILLE:  Right.

COSGROVE:  Those artery grafts that he had should be -- 95 percent will be open 20 years from now.

NORVILLE:  But they did take one graft from the vein, but they used it

·         from the leg.  They used it in the back.

COSGROVE:  Right.  And they put it to the least important artery.

NORVILLE:  And what is his prognosis?  They‘ve said four to five days, he could get out of the hospital.  Could be a couple months before he‘s feeling close to 100 percent.  But there‘s also the mental aspect of recovery that we don‘t hear so much about.

COSGROVE:  Well, that‘s a good point.  A lot of times, men particularly, after heart surgery, feel very depressed.  They‘re suddenly not in control of their bodies anymore, and not in control of their lives.  And they‘ve been quite used to it, and that has been taken away from them.  They feel a little helpless, and they get depressed.  The good part is that that gradually wears off, and it‘s a situational depression.

NORVILLE:  The bad part is Bill Clinton has been a Type A man for such a long period of time, for him to no longer be the center of attention, to be out there on the book tour, to be out there doing campaigning for John Kerry, that‘s got to make the sudden stop seem even more intense than it would for a less rigorous individual.

COSGROVE:  Well, I don‘t think he‘s going to have any problem being the center of attention.  He‘s certainly been that today for the whole...

NORVILLE:  No kidding!

COSGROVE:  ... the whole nation.  But I think that he will have trouble adjusting to the fact that, you know, something very life-threatening happened to him and coming face to face with one‘s mortality.

NORVILLE:  A lot of people watching this show, watching a lot of the coverage, the person sitting here included, eat horribly, don‘t exercise enough.  I mean, I was doing my research today with a bag of Cheetos next to me, to be totally truthful about all this.  This is, we know, bad.  Bill Clinton knew visiting McDonald‘s all the time was bad.  And yet we do it anyway.  What does it take to get people to really make those diet and lifestyle changes that everybody like you says we need to be making?

COSGROVE:  Well, I think he‘s gotten religion today.  I suspect that he will understand that this is important.  And I hope that this is a lesson for the whole country.  We see someone who, as you say, has had great medical care but hasn‘t taken care of himself.  He‘s put himself in the world‘s most stressful situation.  He‘s eaten poorly.  He‘s been overweight.  He hasn‘t exercised the way he should.  And he has done most of the things that we advise not to do.

NORVILLE:  And yet, at the press conference about 4:00 o‘clock this afternoon, the head of surgery there at Columbia Presbyterian said this was a heart attack waiting to happen.  And here‘s how starkly he said that.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE:  There was a substantial likelihood that he would have had a substantial heart attack in the near future.  And that was the reason for the time urgency of what was done.

(END VIDEO CLIP)

NORVILLE:  A substantial likelihood of a substantial heart attack in the near future.

COSGROVE:  Right.

NORVILLE:  You talked with Dr. Smith after the surgery today...

COSGROVE:  I did.

NORVILLE:  ... the man who performed the procedure on Mr. Clinton.  What did he tell you about the extent of the blockage and how close he was to that heart attack Dr. Schwartz referred to?

COSGROVE:  We really didn‘t talk about that.  We talked about—because he‘d told me previously that he had very significant, very tight blocks in all three arteries...

NORVILLE:  Right.

COSGROVE:  ... when I talked with him on Friday.  He told—today we talked about the operation he did.  And he realized that this was going to be a little bit controversial, what he‘d done, but he thought that it was the best sort of an approach.  And I absolutely agree with him.  I thought that he did a terrific job.

NORVILLE:  Controversial in that they took other arteries from within the chest cavity...

COSGROVE:  Yes.  Right.

NORVILLE:  ... and used them, as opposed to go to the leg?

COSGROVE:  And they also—in order to do that, they put him on the heart-lung machine, which some people think is—increases the risk.  It‘s hard to prove that.

NORVILLE:  Increases the risk of some of cognitive impairment.

COSGROVE:  That‘s what you would believe.  Now, if you‘d looked at the studies that have been done on this very closely, there‘s not a lot of proof to suggest that that‘s true.

NORVILLE:  The other thing that a lot of people don‘t pay much attention to is that it‘s the No. 1 killer not only of men but of women in this country, heart disease.

COSGROVE:  Absolutely.  You know, this kills more women in the United States than does breast disease, going away.  It is a huge threat to women, and it‘s been very underrecognized and underdiagnosed in women.

NORVILLE:  Underrecognized, underdiagnosed and underaddressed by the American people.

We‘re going to take a short break.  When we come back, we‘ll have more with Dr. Toby Cosgrove.  And also: We‘ve heard it all before—eat right, exercise, keep the stress level down.  But heart disease still accounts for 40 percent of the deaths in this country.  Why aren‘t we getting the message?  In a moment, we‘ll also be joined by best-selling author Dr. Dean Ornish.  Stay tuned.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE:  He had been placed on a blood-thinning medication as part of his treatment, and it was our decision that it would be safest to wait until this medication had decreased to greatly cut down the chance of bleeding with surgery.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE:  ... he is generally extremely healthy, that it‘s possible to have an extraordinarily active schedule and remain healthy, and that we will work with him to fashion an exercise, diet and medication program that allows him to continue his active schedule.

(END VIDEO CLIP)

NORVILLE:  That was one of Bill Clinton‘s doctors talking about the former president today.  He was known to have a big appetite, often had to fight a weight problem.  But there were no signs of heart problems during all of those health exams that were made public during his presidency.  Is it possible that Mr. Clinton could have established a different lifestyle, diet and exercise regime during the White House years and avoided heart problems?

I‘m back with Dr. Cosgrove.  And also joining our discussion is Dr.  Dean Ornish.  He‘s the president of the Preventive Medicine Research Institute, also clinical professor of medicine at the University of California in San Francisco and author of a number of best-selling books, including “Dr. Dean Ornish‘s Program for Reversing Heart Disease.”

Dr. Ornish, welcome to our discussion.  And I know you have preached the mantra for a very long time that you can make those changes and avoid a trip to the cardiac wing, the way President Clinton has had to do.  At what point do you have to make the change in your lifestyle for it to forestall a trip to the surgeon?

DR. DEAN ORNISH, PRES., PREVENTIVE MEDICINE RESEARCH INSTITUTE:  Well, first of all, let me begin by thanking the surgeons and the doctors at Presbyterian Hospital for taking such good care of President Clinton.  I think the whole world is grateful for that.

And in response to your question, you know, we tend to think of advances in medicine as being a new drug or a new laser or something really high-tech and expensive.  And what we‘ve been able to show in our research over the last 27 years or so is that the choices that we make in our lives each day—what we eat, how we respond to stress, whether or not we exercise, the quality of our relationships, whether or not we smoke—these really play a much bigger determinant than anything that I or any other doctor can provide.  And at any age, when you begin making these changes, the benefits occur much more quickly than people had once thought possible.

NORVILLE:  Well, the healthy lifestyle plan, as outlined in your books

·         I‘ll just go through it quickly so we can get into it—is a low-fat, high-fiber diet, stress management—gosh, we all need to do that—moderate exercise, support groups and quitting smoking.

ORNISH:  Yes.

NORVILLE:  We know that Bill Clinton went on a diet.  We know that Bill Clinton was doing the South Beach, which is a pretty low-fat diet.  Was it not enough early enough, in your opinion, Dr. Ornish?

ORNISH:  Well, I‘d rather not talk about President Clinton himself, since I‘ve worked with him.

NORVILLE:  Oh, OK.

ORNISH:  But in general, if I can talk about—I think when people are trying to prevent heart disease, moderate changes may be enough.  But if you‘re trying reverse it, what we‘re able to show, and others have shown since then, is it requires bigger changes.  Some people need to make bigger changes than others.  In part, it‘s genetic.  In part, it‘s other factors.

But when people are willing—I mean, the South Beach diet is not a particularly low-fat diet.  And clearly, you know, it wasn‘t enough for him and for many other people.  But what we‘ve been able to show is that when people do make bigger changes at any age, that most people can stop or even reverse the progression of heart disease.  And if they use cholesterol-lowering drugs, it works even better.

NORVILLE:  And Dr. Cosgrove, in your experience, you can look at the figures and actually see that there‘s been a decrease in coronary disease in this country for a variety of reasons, one of which is what Dr. Ornish talks about.

COSGROVE:  Absolutely.  There‘s been a 40 percent decrease in deaths from heart disease in the last 20 years, while there‘s been almost no decrease from other causes of death in the United States.  And it‘s really due to three things.  It‘s due to what Dean talks about in terms of reduction of factors that cause this and lifestyle modification.   It‘s been related to medications, and it‘s been related to interventions, catheter-based and surgical-based.

NORVILLE:  And any one factor—is one factor more important than another?  In other words, is surgery responsible for half of that, or is it pretty much across the board?

COSGROVE:  Well, it‘s thought to be about equal, to be honest with you.  But we are dealing with a pandemic.  This is the largest cause of death in the world, and we‘re not going to wipe it out with surgery and we‘re not going to wipe it out with pills.  We have to get to a preventive sort of a therapy for it.  You ought to think of it like tuberculosis.  Initially, surgeons looked after it.

NORVILLE:  Right.

COSGROVE:  And after than, streptomycin came along, and now preventive medicine, and we really don‘t see much tuberculosis anymore, or polio.

NORVILLE:  Dr. Ornish, we know the president of the United States has probably got the most stressful job of any job out there.  And yet Bill Clinton‘s problems didn‘t manifest while he was in the White House.  It came during a stressful period with the release of his book.  How big a factor is stress management, in your opinion, in preventing heart disease?

ORNISH:  Well, stress plays a role in heart disease in two ways.  There‘s a direct effect of your brain on your heart, for better and for worse.  And under times of stress, your arteries may constrict.  Blood clots are more likely to form, and the blockages over time build up faster.

You know, heart disease is so much more dynamic than people had once thought.  It‘s not just the arteries slowly clogging up with rust in the pipe over a period of decades.  The arteries can change, and the blood flow to the heart can change minute to minute over time.  And so stress directly affects the heart in a negative way, but also it affects how you eat.  Many people eat when they‘re stressed.  They drink too much to cope with the stress.  They work too hard to distract themselves from their stress.  They smoke cigarettes as a way of dealing with their stress and loneliness.

I‘ve had a patient who said, I‘ve got 20 friends in this package of cigarettes, and they‘re always there for me, and nobody else is.  Are you going to take away my 20 friends?  What are you going to give me?

So it‘s important that we not only focus on the behaviors, but we deal with these deeper issues like stress and depression and loneliness that really play a role, as well.

NORVILLE:  And is there any one thing—and I‘ll ask both of our doctors here the same question—any one lifestyle change, any one change that an individual can make on their own, that you believe would forestall heart disease?  Dr. Cosgrove, you first.

COSGROVE:  Well, I think probably the most important thing I can see is weight management and diet.  That‘s something everybody can do.  And it‘s related to balancing exercise with a reasonable intake of food.

NORVILLE:  And when you say exercise—we saw Bill Clinton.  He jogged all the time.  There was even, you know, the joke on “Saturday Night Live,” where he jogged into the McDonald‘s, got the fast food and then jogged on out.

(LAUGHTER)

NORVILLE:  I guess we can laugh about it now because the surgery has had the successful outcome everyone was hopeful for.  But clearly, exercise, in and of itself, isn‘t enough.

COSGROVE:  No, clearly not enough.  You know, you can see great athletes who way overeat and over time, and even had great amounts of exercise.  That‘s not enough.

NORVILLE:  Dr. Ornish, Dr. Cosgrove says weight management and moderate exercise.  What‘s your prescription?

ORNISH:  Well, I agree with Dr. Cosgrove.  And I want to say also that I‘ve been consulting with McDonald‘s and some of the other food companies, like PepsiCo, because they realize they need to make healthier food, and they‘re finally beginning to do so.  And I think that‘s to their credit.

I think all of these things are important.  And different people are affected in different ways.  And the paradox is that sometimes it‘s easier to make big changes in all of these things at the same time, in diet, in quitting smoking, in exercising and managing stress better.  You know, so many people think, God, you‘re not going to be able get my patients to eat less red meat.  You expect them to do all these things at the same time?  There‘s no way.  But fear of dying is not a very good motivator.  I mean, when someone‘s had a bypass or an angioplasty or a heart attack, they‘ll do anything their doctor says for about a month or two.  And even then, they tend to get off of it.

But we‘ve been successful in motivating people to make changes in hospitals and places around the country, even in Columbia, South Carolina, where they told me gravy‘s a beverage.  This‘ll be a big change in our diet.

(LAUGHTER)

ORNISH:  And what we‘ve found is that while fear of dying doesn‘t work, because it‘s too scary, you know, and telling people that—you know, If you don‘t quit smoking, you‘re going to get lung cancer—I mean, everybody who smokes can just read the surgeon general‘s warning.

NORVILLE:  Right.

ORNISH:  It‘s not a lack of information.  What does work is joy of living.  And when you make big changes, most people find they feel so much better so quickly, it reframe the reason for making the changes from things like risk factor reduction and prevention, which are just boring to most people, to feeling better.  Your brain gets more blood.  You think more clearly.  You have more energy.  Your heart gets more blood.  Even your sexual organs get more blood, in the same way that Viagra works.  And for many people, those become choices worth making.

NORVILLE:  Well, I can certainly understand no being scared into something.  On the other hand, Dr. Cosgrove, if you go through surgery and you come out and you‘re awake at the end of it, you got to feel pretty grateful.  A you know, lot of people make a deal with God before they go under the knife.  Lord, just let me live, I‘ll do anything.  That‘s inspire a few lifestyle changes, won‘t it?

COSGROVE:  Yes, it will initially.  But I think it really has—it‘s very often not sustained.  And I think Dean Ornish is exactly correct.  It‘s hard to put people under those sort of circumstances and say, OK, they have to make a major change now.  There‘s got to be a better reason for doing it.

NORVILLE:  Bill Clinton had the best doctors in the world.  The outcome has been successful.  He‘s exactly where his surgical team wanted him to be this many hours after his operation.  But most folks don‘t live in New York, and they don‘t live in Cleveland, Ohio, either, Dr. Cosgrove, to come to your clinic.  How can they be sure, if they are one of these 300,000 people who are going to have a bypass this year, that their doctor knows what he‘s doing and their outcome will be as successful as it looks like President Clinton‘s will be?

COSGROVE:  Well, I think you have to ask the questions.  You have to say, How many of these operations have you don?  What have your results been?  Who can I talk with?  And you need to verify it talking with other people.  You know, any doctor who is reasonable doesn‘t mind getting—having you get a second opinion.  I do it all the time for people.  People do it all the time on me.

NORVILLE:  OK.  And Dr. Ornish, the change that you would have people make right now, so they don‘t have to go and consult with Dr. Cosgrove, is?

ORNISH:  Well, first of all, if you need surgery, Dr. Cosgrove would be a great person to do it.  But many people don‘t realize that bypass—angioplasty has never been proven to prolong life or prevent heart attacks.  And bypass surgery has been proven to do so only in a really small percentage of people who have the most sever disease.  Now, I can‘t tell somebody they shouldn‘t have these operations, but if you‘re told that you need one, you should look at all of the alternatives under your doctor‘s supervision.

NORVILLE:  Right.

ORNISH:  And what we‘ve been able to show in our studies is that most people who are eligible for a bypass or angioplasty were able to safely avoid it by making much bigger changes in diet and lifestyle than until then most doctors have been recommending.

NORVILLE:  But the emphasis is on the ward “big.”  Little changes won‘t make the difference.  It‘s got to be big.

ORNISH:  For preventing.  For preventing disease, it‘s the old saying about an ounce of prevention and an pound of cure.  Preventing disease, you have a spectrum of choices.  For reversing disease, it requires big changes.

NORVILLE:  All right.

ORNISH:  Or you should consider surgery.

NORVILLE:  All right.  Dr. Dean Ornish, thank you very much for being with us from San Francisco.

ORNISH:  Thank you.

NORVILLE:  Dr. Toby Cosgrove, good to have you here in New York with us.

COSGROVE:  It‘s been a pleasure.  Thank you.

NORVILLE:  We appreciate it.

You think your job is stressful?  What kind of pressure gets put on the president?  And what kind of toll does it take?  We‘ll get into that in just a moment.  Stay tuned.

(COMMERCIAL BREAK)

(NEWS BREAK)

NORVILLE:  Continuing our look at President Clinton‘s heart surgery and the toll that just being president takes on a person‘s health, I‘m joined now by two presidential historians, NBC News analyst Douglas Brinkley and Doris Kearns Goodwin.  Also joining us tonight is journalist Robert Sam Anson, who has covered a number of presidents during his career.  He now writes for “Vanity Fair” magazine.

Thanks, all of you, for being with us on a Labor Day night.  We appreciate it.  Robert, first off, give us a sense, if you could, please, of the kind of pace that Bill Clinton‘s been going since he left the White House.

ROBERT SAM ANSON, “VANITY FAIR”:  Well, he‘s a man who routinely sleeps three or four hours a night, max.  His lawyer tells a great story of getting called at his office in Washington when Clinton was in Hong Kong, and the lawyer saying to him, It‘s 4:00 o‘clock in the morning there.  And Clinton said, yes, I just finished shaking hands.  He operates like that 90 miles an hour all the time.  He did, in fact, the night before his surgery.  He spent 90 minutes talking to John Kerry before he went into surgery.

NORVILLE:  Yes.  We‘ll get into that in a few minutes.  But Doris Kearns Goodwin, I gather that that kind of pace, shaking hands until 4:00 in the morning, was just par for the course of a pattern that he established clearly when he was in the White House.

DORIS KEARNS GOODWIN, PRESIDENTIAL HISTORIAN:  Well, you know, the interesting thing is I think we sometimes stress too much that the White House job is one of such immense stress that it puts strain on a heart.  It‘s also an extraordinary fulfillment to be president.  You think of Teddy Roosevelt, you think of Franklin Roosevelt.  They loved being president.  And so, I think, did Bill Clinton.  The interesting thing is when Lyndon Johnson left the presidency, he came back home to the ranch, and that stress was even greater than being president.  He started smoking.  He started drinking.  He said, I can do whatever I want now.  But really, it was the sadness that led to his heart attack.  So I think sometimes we make too much of the stress because there is this extraordinary fulfillment, if you do love being president, as he did.

(LAUGHTER)

NORVILLE:  Douglas Brinkley, I wonder how much of the frenetic pace he‘s been keeping has to do with his own sense of protecting and shaping his place in history.  Gosh knows there was some damage control to be done when he left the White House. 

DOUGLAS BRINKLEY, NBC NEWS ANALYST:  Absolutely.

Well, all presidents in this modern era have two immediate goals.  One is to fund-raise money for their presidential library.  It takes a lot of work and effort.  After all, you‘re stepping off of the main stage and trying to get people to, in Clinton‘s case, give money to Little Rock, where his presidential library is opening. 

And, No. 2, you have to write a memoir.  You try to pull yourself into perspective.  Bill Clinton has never been known as a great writer, but he threw his entire self into this memoir “My Life.”  If you recall last May and June, he was working the midnight hours, apparently eating pizza until 1:00, 2:00 a.m., doing whatever he could just to get the last chapters of his book in. 

And then he went on a very grueling book tour across America.  His book is No. 1.  Then he went to Europe on that book tour.  And I think that kind of frenetic travel right you have crashed a book is real exhaustion.  I know Doris, who writes a lot, knows what it is like when you try to write and finish a book.  It really wipes you out.  And I think that may have been what happened here. 

NORVILLE:  And yet, Doris, you mentioned the sadness that LBJ experienced after he left the White House.  There is a bit of a letdown when you‘ve completed a big project, whether it‘s the writing of the book or going on the tour to promote the book, that sense of, I can rest.  I wonder if—I know you‘re obviously not a doctor—if that‘s a factor at play here. 

GOODWIN:  No, I think, clearly, there‘s a sense, when a big project is finished, that you let your system go down in a certain sense. 

And when you look at Bill Clinton, as we were saying earlier, he never did build those rest periods into his working life.  Like Franklin Roosevelt used to have a cocktail hour every night where the rule was, you cannot talk about the war or politics.  When he went to Hyde Park, when he did every other weekend during the war, he would sleep for 10, 12, 13 hours. 

The fact that Bill Clinton never built that into his life means that when it comes down to this, as you say, this rest period, his system is not used to it.  So hopefully, I think the doctors are going to say, build that rest and do fun things other than politics for a while. 

NORVILLE:  And yet, Robert Anson, this was fun for him.  He enjoyed kissing the babies and checking out the food at the state fair.  This wasn‘t drudgery for Bill Clinton when he had to do these things. 

ANSON:  Absolutely.  He loves it.  And without it, that‘s when he is bereft.  He hates going back to Chappaqua at night.

(LAUGHTER)

(CROSSTALK)

ANSON:  He is not somebody who sits in front of a TV.  He is always until the last dog is dead at a party.  And then he‘ll get on the phone or read. 

(CROSSTALK)

NORVILLE:  And yet you look at the toll that being president has taken.

And I want to just throw up a picture of Bill Clinton circa 1992 when he entered the White House, the former governor of Arkansas, looking young and virile.  Let‘s throw the picture up there, Lily (ph).  I know you‘ve got it in there somewhere.  There he is, dark hair.  The bags under the eyes did not exist.  And then fast-forward eight years and look at what eight years in the White House did to Bill Clinton.  It just took his toll.  He looks like Father Time, a nice-looking Father Time, but the hair is absolutely snow white. 

How much of that, Doris, has to do with just the stress that he in particular was under during those particular eight years? 

GOODWIN:  Oh, the amazing thing is now that we know that there was some underlying heart condition, it is extraordinary that the stress of the impeachment trial and Monica Lewinsky didn‘t do more damage when it did.  He must have just had an enormous willpower to get through that. 

It has to be for any president one of the greatest stresses they had to live through.  Surely having to put people in harm‘s way is an extraordinary thing they all share if they‘re in the middle of a war.  But thinking that your whole presidency might be collapsed because of something you did, I can‘t even imagine that for a personal strain how much worse than that could be. 

NORVILLE:  And yet let‘s do the same thing with George Bush.  In just four years, you look at George Bush going into office in the year 2000, the governor of Texas.  Again, the same thing, looked great, young, not a lot of gray in the hair.  Let‘s put the picture up, got the big smile on there.  Yes, I just won that presidency. 

And then four years from now, as you say, putting people in harm‘s way, it takes an enormous toll. 

Douglas Brinkley, is there any concern for our current president on the stress front? 

BRINKLEY:  Well, he does a good job at it, because he stays in shape.  He diets.  He exercises regularly.  Nobody has ever accused President Bush of not being fit. 

When you look back at some of our other presidents, they‘ve always had a very serious ailment they had to deal with, Woodrow Wilson and his stroke, Franklin Roosevelt with polio, John F. Kennedy, Addison‘s disease.  We don‘t have that with George W. Bush.  He is in very good shape.  And he is able to do what I call the Ronald Reagan hours, essentially, an 8:00 a.m. until 6:00 p.m. kind of schedule.  He knows when to be on and when to be off. 

People like Bill Clinton are always on.  George W. Bush knows how to have his downtime.  And, in fact, right before the 9/11 attacks, he was being criticized for vacationing a month of August at his Texas ranch.  So he knows how to go down when he needs to. 

NORVILLE:  Yes, it‘s interesting.  He had a Texas ranch to go down to. 

Robert Anson, Bill Clinton didn‘t have a Crawford, Texas, or a Key Biscayne that Nixon had or any of those other presidential retreats, beyond Camp David. 

ANSON:  That‘s true. 

And the piece of land—Whitewater didn‘t work out. 

(LAUGHTER)

ANSON:  He‘s never really had a place to go.  He‘s found other people‘s places.  He stayed—he‘s a house guest in California.  He‘s a house guest on Martha‘s Vineyard.  He is really unsettled.  It‘s really emblematic of him, that he keeps moving from place to place without much respite. 

NORVILLE:  Yes. 

Well, moving from place to place and from issue to issue.  And I guess it is absolutely typical for Bill Clinton that just hours before he went under the knife and had his heart operation, he was on the phone rendering campaign advice to John Kerry. 

When we come back, more on the president‘s heart bypass surgery and its effect on the Democrat who is not in the hospital, John Kerry. 

Stay with us.

(BEGIN VIDEO CLIP)

SEN. HILLARY CLINTON (D), NEW YORK:  I‘m just here to express his gratitude and real appreciation for all of the incredible expressions of positive feelings and concern that we‘ve already received. 

(END VIDEO CLIP)

(COMMERCIAL BREAK)

NORVILLE:  Former President Clinton is recovering from quadruple heart bypass surgery, which means a key player for the Kerry campaign is on the sidelines.  How could that affect the race? 

Stay with us.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

GEORGE W. BUSH, PRESIDENT OF THE UNITED STATES:  He is in our thoughts and prayers.  We send him our best wishes for a swift and speedy recovery. 

SEN. JOHN KERRY (D-MA), PRESIDENTIAL CANDIDATE:                And I want you all to let a cheer out and clap that he can hear all the way to New York, all the way to New York. 

(CHEERING AND APPLAUSE) 

(END VIDEO CLIP)

NORVILLE:  President Bush and John Kerry out on the campaign trail today, talking about former President Clinton, who underwent bypass surgery today.  Doctors say Mr. Clinton is expected to make a full recovery and that he could actually leave the hospital in four or five days. 

(BEGIN VIDEO CLIP)

DR. ALLAN SCHWARTZ, NEW YORK PRESBYTERIAN HOSPITAL:  At home, he‘ll have a schedule of exercises that will gradually increase and he will gradually resume an entirely normal physical exercise and work schedule. 

(END VIDEO CLIP)

NORVILLE:  Yes, but will that schedule resume in time for John Kerry‘s presidential campaign?  They were planning on making big use of Mr. Clinton in these remaining two months before the election.  Obviously, all that is on hold.  But will Mr. Clinton be back on the stump later? 

Back now with presidential historians Douglas Brinkley and Doris Kearns Goodwin and journalist Robert Sam Anson.

You know, it‘s interesting, guys.  just before the president had his surgery, he was on the phone with John Kerry.  He spent about an hour and a half with him giving him all sorts of campaign advice, which the polls say he definitely needs. 

Doug, what do you think the best advice is the president passed on to Mr. Kerry? 

BRINKLEY:  Well, to focus on domestic issues.  That‘s where John Kerry seems to be doing the best in the polls.  In many ways, Clinton is saying to continue my legacy, the fact of balancing the budget, the fact of pushing issues of more inexpensive prescription drugs, deal with issues of health concerns, Medicaid, Medicare.  That‘s what Bill Clinton did in the ‘90s.  And it gave America a very blossoming economy. 

And I think he thinks that John Kerry has been focusing a little too much on his retorts to Vietnam and doesn‘t want him to get into that trap, but to forge forward on the domestic issues. 

NORVILLE:  And, Doris, I wonder how much of this is kind of a replay of the Al Gore thing.  Remember, Gore sort of ran not attached to Bill Clinton, and, at the end of the day, that seemed not to be the best idea he had in the campaign?  Is Bill Clinton out there saying, embrace me, embrace me?  I had 64 percent approval ratings when I left the White House.  I‘m not such a bad guy.  Give me a hug. 

GOODWIN:  Well, I think what happened in 2000 is that the polls seemed to suggest that while Clinton would be terrific getting out the base of the Democratic Party, that the swing voters might be turned away, just as the others were turned on.  So they made the decision not to get him involved. 

And from everything we heard, he was furious at that decision.  So, now it is true he is wanted.  And the interesting thing is, perhaps if he is able to come back, even in the last couple weeks, that would be time enough.  Eisenhower came back two weeks before the 1960 election and almost swung it to Nixon away from Kennedy.  And just think, he‘ll come back.  He‘ll look like the good old fellow instead of the lusty young fellow he once was.  And so we‘ll have all these extra feelings for him at the same time.

NORVILLE:  Robert, do you think that‘s likely to happen?  There are others who say that it would not be such a bad thing for Senator Clinton if President Clinton weren‘t out on the campaign trail and Senator Kerry didn‘t get elected this time around. 

ANSON:  Well, that‘s certainly true. 

And I think it also ought to be noted that Bill Clinton was not a great fan of John Kerry during the primaries.  That‘s for sure.  First of all, he wanted John Edwards.  And when that didn‘t work out, he wanted Hillary.  And when she wouldn‘t run, he wanted Wes Clark. 

NORVILLE:  Right. 

ANSON:  And, until the very end, he was trying the get John Edwards to stay in the race because he didn‘t want Kerry. 

Now they‘ve developed a good rapport and have been talking roughly about once a week.  The concern in the Kerry camp, frankly, until a few months ago, was that Clinton would be too much around.  Now, he brings two things to the party.  One is the ability to raise a lot of money.  Well, the Kerry campaign has got many problems, but money isn‘t one of them.

NORVILLE:  Money is not one of them, yes.

ANSON:  Money is not one of them.

The other is that he energizes the base.  Well, the base has been energized by George W. Bush.  Bill Clinton is not necessary for that.  The one thing he could do, possibly, is help turn out the black vote on Election Day, though I think that‘s still very problematic. 

This may be against conventional wisdom, but I think, frankly, that his absence from the campaign will have a marginal effect. 

NORVILLE:  Really?

Well, let‘s look at the latest “Newsweek” poll.  The poll that has just come out this week shows that there‘s now a double-digit gap between the two candidates.  It shows Bush polling at 52 percent approval and Kerry at 41 percent, with a 4 percent margin of error on this thing. 

You say, Doris, that‘s not so far that the Kerry folks can‘t pull it through.  But yet, when you look at the Kerry campaign, they‘ve been rearranging the chairs on the deck.  They had a lot of the Clinton folks come in over the weekend to lend their expertise. 

GOODWIN:  Well, there‘s no question that they‘re feeling something.  And they should be feeling something right now.  They should be energized to try and figure out what hasn‘t worked in this last month. 

I think, beyond having the focus on domestic things, which is what evidently was said to him by President Clinton, that what he has got to do, John Kerry, is to disconnect Iraq from the war on terror.  What the Republican Convention did was to make it seem as if they were one and the same thing.  And before that convention, the polls showed that the American people didn‘t think the war was worth the loss of lives and treasure and that it wasn‘t necessarily connected to the war on terror. 

They have to disconnect that.  And he has to be able to say, this was not a necessary war for the war on terror.  And it sounded today like he was beginning to talk in that direction. 

NORVILLE:  And, Doug Brinkley, what about that need for John Kerry to get out there and say, you have got a choice on November 2 and there‘s a clear distinction between me and my opponent in the White House?

BRINKLEY:  Well, that‘s, of course, what he needs to do now.  Everybody is noticing the polls, although Gallup poll today made it a little closer than that “Newsweek” poll. 

And John Kerry, as Doris said, I think has to make Iraq an issue.  He hasn‘t done that so far.  He seems to have circled the Iraq issue.  He‘s been accused of flip-flopping on it.  And it is sort of sticking in our popular culture.  If he can separate them, and we hit that 1,000-death mark in Iraq, and people start wondering, which many polls show many Americans aren‘t quite convinced that Iraq was the right war...

NORVILLE:  Right. 

BRINKLEY:  Then Kerry will be able to use that as an issue.  But he is going to have to reassure people that he‘s the right national security president.  He is going to surround himself in the coming days with people like John Glenn or John Breaux, ex-generals and admirals, to try to keep bringing home that message that he is fit to be a wartime commander in chief. 

NORVILLE:  Yes, well, as Doris points out, the news moves in a nanosecond these days.  And one little change can really impact a campaign. 

We‘ll take a short break.  More with our panel in just a sec.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

H. CLINTON:  I wanted to report to you that my husband is doing very well.  He is in great humor.  He is beating all of us at cards and the rest of the games we are playing. 

(END VIDEO CLIP)

NORVILLE:  Back with our discussion about President Clinton‘s heart surgery with Douglas Brinkley, Doris Kearns Goodwin and Robert Sam Anson.

Folks, as you know, the e-mail site for President Clinton‘s foundation has been flooded with well-wishes.  Something like over 37,000 e-mails have been sent wishing the president a speedy recovery. 

Anybody surprised by the outpouring Bill Clinton has generated with his procedure? 

BRINKLEY:  No, I haven‘t been particularly.  I think he is a beloved president by a large segment of the population.

And, in fact, the irony is the things that a lot of people were endeared to President Clinton was his fast-food eating, the fact that he liked Big Macs and Whoppers and Wendy‘s and the like.  And, hence, he had a common touch, that he was comfortable in the malls or Wal-Marts of America, and that‘s something that John Kerry hasn‘t been able to connect to.  And so a lot of people, particularly middle-class Americans, relate to Bill Clinton. 

NORVILLE:  I guess, Doris, if John Kerry went in and ordered a Big Mac, people would think he was trying to pull a Clinton on them. 

GOODWIN:  Yes, I wouldn‘t think that would be a good idea. 

But we are so much more intimately connected to our president‘s private lives today than we used to be.  As Doug Brinkley knows so well, when President Cleveland had a malignant tumor removed from his jaw in the middle of his presidency, nobody even knew it happened.  It happened in the middle of the East River on a yacht.  When President Wilson had an incapacitating stroke, it was kept from the public. 

Now we have nightly bulletins, hourly bulletins about Clinton‘s health.  And it does make us feel more connected.  And television, obviously—you keep seeing those pictures of Clinton as a young man and you feel that sense of something happening to his body. 

NORVILLE:  Yes. 

And, yet, Robert Sam Anson, I wonder if it can work in the same way for the people who want to either stay in the White House or get into the White House.  John Kerry has had his public health problems.  George Bush is in good shape, but everybody knows that Dick Cheney has got a ticker that‘s not so good.  Does that make them more relatable to the electorate as well? 

ANSON:  I don‘t think so, particularly. 

I think the Clintons will certainly garner considerable sympathy.  I think that could be for Kerry the best electoral effect is that it blurs his image and makes people feel warm and fuzzy about him.

NORVILLE:  Right. 

ANSON:  And, at the same time, I think it will help distance Kerry from Clinton, because that‘s been one of the complaints, is that the essence of Clintonism is to blur distinctions.  And that‘s been one of the big raps on Kerry, is that he is too indistinct from Bush, especially on Iraq. 

NORVILLE:  Yes. 

You know, the same time Mrs. Clinton made that statement on Saturday, the Clintons also released this written statement.  They said: “We are grateful for the excellent care provided by the doctors, nurses, and staff of the hospital.  And we are fortunate to have great health care coverage and continue to hope for the day when every American will enjoy this basic right.”

(LAUGHTER)

NORVILLE:  Even from the hospital, they are able to do a little bit of campaigning. 

What, Robert, can Bill Clinton do from his hospital bed and his recuperating wing that would be helpful for John Kerry? 

ANSON:  Well, his first speech, he could say, I have risen from my death bed to tell you to vote for John Kerry. 

(LAUGHTER)

GOODWIN:  Win one for the Gipper. 

ANSON:  It‘s so important. 

NORVILLE:  Doris, what could he do?  Seriously, because he can‘t be out there on the stump, but, clearly, they need his help.  He is a popular man. 

GOODWIN:  If he can‘t be out there on the stump, they will bring the stump to him. 

(LAUGHTER)

GOODWIN:  Can‘t you just see him sitting on a stool in the middle of the hospital bed with the television cameras all around?  In the modern day, you don‘t have to be out there.

He can have a backdrop behind him, as if it were different cities, and it‘s still the hospital room. 

(LAUGHTER)

NORVILLE:  This rally, and change the pillowcase behind him. 

(CROSSTALK)

NORVILLE:  Doug?

BRINKLEY:  Yes, Bill Clinton is an optimistic.  And I think he is going to take the fact that he has had a heart problem here, heart disease, which 40 percent of Americans, as you mentioned, are inflicted with, and become a spokesperson in many ways for the heart, for heart disease.

In the same way that Ronald Reagan has become synonymous with Alzheimer‘s and stem cell research, I think, in the coming decade or decades, you will see Bill Clinton dealing with issues of heart disease, talking about it and trying to bring an awareness, just like your program has done tonight, Deborah.  It‘s teaching people about how to diet, how to take care of one‘s body, so you don‘t have heart problems as you start hitting middle age and older. 

NORVILLE:  Yes.  Of course, talking about it and hearing people yack about it on television and putting the Big Macs away and not supersizing it, that‘s a lot harder to do. 

Is there any way that the Bush campaign can make political hay of this, Doris, in your opinion? 

GOODWIN:  No way.  They would be crazy if they try to do anything. 

I think Bush did the right thing in just dignifiedly sending his good wishes to President Clinton.  And they would advised not to let anything bad be said at this moment, just as the Democrats had to be sure when Ronald Reagan died that anything bad wasn‘t said at that time.  These are not moments when partisanship is very high. 

NORVILLE:  Yes.  Well, it‘s nice to hear that people do believe that, and that‘s a refreshing thought on which to end this conversation. 

Doris Kearns Goodwin, Doug Brinkley, Robert Sam Anson, thanks, all, for being with us tonight.  We appreciate it. 

GOODWIN:  You‘re welcome. 

NORVILLE:  When we come back, as kids get ready to go back to school across the country, some sobering thoughts to keep in mind. 

First, a break.

(COMMERCIAL BREAK)

NORVILLE:  You can send us your ideas and comments to us at NORVILLE@MSNBC.com.  Some of your e-mails are posted on our Web page.  That‘s NORVILLE.MSNBC.com, which is where you can also sign up for our newsletter. 

That‘s our program for tonight.  Thanks for watching.  I‘m Deborah Norville. 

As you know, children in this country are getting set to go back to school.  Tomorrow, a back-to-school story of unbelievable horror and mourning in Russia.  Terrorists stormed a school and took the lives of hundreds of children and their teachers, and some parents.  Now even more proof, not that anyone needed it, that terrorism can strike at any time any place.  Tomorrow night, we will take you to Beslan, Russia, where people are still reeling with anger and sadness.  We‘ll also look at the bigger picture of terrorism worldwide. 

That‘s our program for tonight.  Coming up next, an MSNBC special. 

Brian Williams hosts “GEORGE BUSH: THE FATHER‘S FOOTSTEPS.” 

Thanks for watching.  Have a great night, and enjoy what‘s left of Labor Day.  We‘ll see you tomorrow. 

END   

Copy: Content and programming copyright 2004 MSNBC.  ALL RIGHTS RESERVED.  Transcription Copyright 2004 FDCH e-Media, Inc. (f/k/a/ Federal Document Clearing House Inc., eMediaMillWorks, Inc.), ALL RIGHTS  RESERVED. No license is granted to the user of this material other than for research. User may not reproduce or redistribute the material except for user‘s personal or internal use and, in such case, only one copy may be printed, nor shall user use any material for commercial purposes or in any fashion that may infringe upon MSNBC and FDCH e-Media, Inc.‘s copyright or other proprietary rights or interests in the material. This is not a legal transcript for purposes of litigation.

Discuss:

Discussion comments

,