Quotes of the Day
It was the size of a dime and as thick as a nickel—a discolored blotch on John McCain's left temple. He didn't pay it much mind during the heat of the 2000 Republican primary campaign. But after losing the nomination to George W. Bush, the Arizona Senator found himself with time to spare. So as Bush celebrated victory, McCain headed to the National Naval Medical Center in Bethesda, Md., to have the spot checked out.
Less than three weeks later, McCain endured 5½ hours of surgery to remove a patch of skin including the blemish, roughly 5 cm (2 in.) wide. The diagnosis: Stage 2A melanoma, an invasive form of skin cancer that claims the lives of up to 34% of those diagnosed within 10 years. Doctors also made an incision down his left cheek to remove lymph nodes in his neck in case the cancer had spread; they found it had not. The surgery left a large scar, and for weeks McCain retreated from public view to recover.
Losing the G.O.P. nomination in 2000 gave McCain time to catch and treat the cancer at an early stage, which possibly saved his life. "If it was left alone, the risk was high that that melanoma would not just have become thicker but would also almost certainly have spread to the lymph nodes," says Dr. Jeffrey Lee, a cancer physician at the M.D. Anderson Cancer Center, who did not participate in McCain's care. "And the assumption would be that could occur within a period of a few months, if it hadn't happened already."
Eight years later, McCain at 71 finds himself on his way to another Republican Convention, and the questions about his health are no longer secondary to his political fortunes. If he were to win in November, he would become the oldest first-term President in U.S. history. To make the issue more pronounced, his likely opponent is young enough to be his son; at 46, Barack Obama hopes to become the fifth youngest President ever.
McCain's handlers know his age is both a strength and a weakness, one that his campaign is acutely sensitive about. Early this month, aides pounced on Obama's suggestion in a television interview that McCain was "losing his bearings as he pursues the nomination" by making negative attacks. Within hours, adviser Mark Salter had released a blistering memo saying the comment was a "not particularly clever" knock on McCain's age. "We have all become familiar with Senator Obama's new brand of politics," Salter concluded.
But if McCain intends to make his experience a plus with voters, he must also make sure that his health is at the very least not a negative. And so, after weeks of delay, the McCain campaign plans to deal with the issue later this month, with a release of his medical records and a briefing by his various doctors in Arizona, where he underwent the surgery. Though details are still being firmed up, the campaign says it expects to offer enough documents and medical opinions to lay to rest any concerns about the candidate's condition. "What you are going to find is that he is in good health," says Charlie Black, a senior adviser to the campaign.
On the trail, McCain likes to deflect questions about his age and health with jokes. "I'm older than dirt—more scars than Frankenstein," he says, often before telling a story about the spry antics of his still vibrant 96-year-old mother Roberta. At a recent meeting with newspaper editors in Washington, McCain pretended to fall asleep when asked about his age. Humor aside, the campaign has clearly decided that the candidate is his own best defense. "Obviously, I think there will be a greater observance of me," he said about his age while on a bus tour through Iowa last year. "Whether it has an impact or not will be directly related to my performance."
He is religious about taking precautions. When outdoors, he usually dons a baseball cap, even in the dim light of winter. His chalk-pale skin is a testament to the care he now takes in the sun. "I hope everyone has some sunscreen," he told the traveling press at a recent campaign stop in the coal hills of Kentucky. His doctor checks for new blemishes every few months, with his last announced checkup taking place in March. "Everything's fine," McCain said the following day.
The campaign schedule, meanwhile, has provided McCain with perhaps the best opportunity to try to prove that his age is not an issue. With alacrity, he has routinely worked 16-hour days and six- or seven-day weeks for more than a year. While other candidates recline in privacy in the bus or on the plane between events, he grabs a candy bar or a bag of potato chips and engages reporters for hour-long interviews. Asked during one bus-ride gabfest if the issue of age had been raised by anyone during the campaign, McCain deadpanned, "Yeah, especially by my wife."
In fact, McCain has spent the majority of his life living with the physical disabilities and the mental trauma he suffered as a young Navy pilot. When his plane was shot down over Hanoi in 1967, McCain broke both his arms and his right leg at the knee. He was stabbed twice by a bayonet, had his shoulder smashed by a rifle butt and endured the angry kicks and punches of the mob that discovered him. Those injuries, along with the more calculated torture that followed during 5½ years of captivity, left him unable to raise either arm more than 80 degrees. Depending on the weather, his right knee aches, causing a visible limp.
After his release from Vietnam, McCain was evaluated for years by Navy psychiatrists and deemed on the whole to be coping well with the horrors of his captivity, which included malnourishment, regular beatings and two suicide attempts. Doctors determined that he had an "overdeveloped superego" and an "unrealistically high" need for achievement, two characteristics that have put him in the mainstream of presidential candidates. In 1999, before his first White House bid, McCain released 1,500 pages of medical records dating back to his days in the Navy, as well as the psychiatric evaluations he received after his return from Vietnam. He has long maintained that he never suffered flashbacks or posttraumatic stress disorder, though he admitted in his memoir that "for a long time after coming home, I would tense up whenever I heard keys rattle," a sound made by his prison guards.
The sunburns that blistered McCain's skin as a child may prove far more of a threat to his longevity than his time as a prisoner. McCain's 2000 brush with melanoma wasn't his first and, experts say, may not be his last. He had a melanoma removed from his left shoulder in 1993 and had other noninvasive skin cancers removed from his upper left arm in 2000 and his nose in 2002. All were picked up and treated in the earliest stages of the disease, but because melanoma is one of the more unpredictable types of cancer, doctors say he remains at risk for not only spread from the excised cancers but new growths as well. "We know that there is a 40% risk of melanoma coming back with metastases even though the primary lesion is taken out," says Dr. Antoni Ribas, a cancer surgeon at UCLA Medical Center, who has not treated the Senator.
If either happens, McCain has several options. New lesions could be removed by surgery, as his previous ones were. Recurrent growths are trickier, since they are more likely to originate not on the skin but deeper in the body. Once melanoma spreads, it generally cannot be effectively treated with surgery or radiation, which are designed to target contained growths. Chemotherapy drugs and medications that stimulate the immune system are options, but some may not be suitable for McCain, doctors say, because of his age and the toxicity of the treatments.
As for his general health, McCain says he tries to get exercise when he can, like hiking with his wife and children in Arizona, including an August 2006 trek with his son 30 miles (48 km) through the Grand Canyon over three days. "In the Senate, I try to walk up the stairs most of the time," McCain says. "I don't take the subway." On occasion, he swims, and the old Navy captain still endeavors to do his sit-ups and push-ups, though the exact number is a matter of some discussion. "I can do at least 30 or 40," he said last spring of the push-ups, as his campaign bus crossed the countryside. "But it's pretty easy to cheat on a push-up." He paused, aware that he had grabbed the attention of his traveling press. "I would never do such a thing, of course," he added, smiling.
- Michael Scherer and Alice Park
- His bout with melanoma after the 2000 campaign makes his health and his age election issues today. Why he's still at risk