Constant tension with the doctor caring for the US president.

Being the US President's physician is a very important position, one that not everyone can achieve. However, beyond the prestige, this job also brings tremendous stress.

Dr. Connie Mariano served as the presidential physician for nine years during the administrations of Bill Clinton and the Bush father and son.New York TimesConnie Mariano is the first Filipino-American to become a rear admiral, and also the first woman in the military to become a White House physician.

In the autobiographyThe White House Doctor: My Patients Were Presidents - a MemoirMariano revealed that the majority of White House medical staff come from the military. The doctors are from various specialties and are personally selected by the president.

Explaining this, Dr. Mariano said that few civilian doctors can suddenly quit their jobs after four years. Furthermore, medical teams are the first responders in emergencies, so it's "almost like military medical practice."

In addition to the head of state, the White House medical team, consisting of 24 staff members led by Dr. Mariano, is also responsible for the health care of the vice president and their family, and sometimes White House staff and guests. However, the president remains the top priority. If the president or a family member needs assistance, everyone else is disregarded, no matter how serious their condition.

Working with the president—the commander-in-chief of the U.S. military—White House doctors inevitably face pressure because their rank is lower than their patients, which can strain the doctor-patient relationship.

"Whenever the president acts excessively, the image of a military court pops into my head," Dr. Mariano admitted.

In 1997, Dr. Mariano yielded to President Bill Clinton when he insisted on going to Helsinki, Finland, to meet with Russian President Boris Yeltsin, just four days after surgery on his hamstring. When Clinton suffered from gastritis but continued working, Dr. Mariano "firmly decided" that she would inform First Lady Hillary Clinton. "Okay, I'll listen to you," Clinton eventually complied with the doctor's instructions.

In 1998, it was Hillary Clinton's turn to experience health problems. The then-First Lady suffered from phlebitis and developed a blood clot, but she refused hospitalization. Her medical team had to treat her as an outpatient and use a new blood-thinning medication.

Aside from these incidents, Dr. Mariano has not had any other conflicts with "high-profile patients." If she had, she stated she would resign. Other White House doctors have made similar commitments.

To ensure the health of the head of state, White House agents and medical staff must remain highly vigilant even when the president feels well. Rich Miller, a former senior agent to President Bush Sr., was so anxious that he told Dr. Mariano, "The question isn't whether the president will be assassinated, but when."

Before each trip by the U.S. president, like the Secret Service, the White House medical team must survey the destination, assess medical facilities, and consult with a select number of local doctors. "The Secret Service hunts for bombs and we hunt for pathogens," Mariano said.

Medical personnel are trained to stay away from the "assassination zone" surrounding the president to minimize the risk of being hit by stray bullets. They also wear civilian clothes because military uniforms make them easy targets.

"You can't treat the president if he's already dead," Dr. Mariano explained.

Illustrating the harsh realities of the job, Dr. Mariano stated that civilian doctors work a maximum of 80 hours a week, military doctors work a maximum of 18 hours at a time, but White House doctors must always be on standby. On one occasion, Dr. Mariano worked continuously for 50 hours.

The doctors at the White House always carry a heavy medical kit. They frequently suffer from jet lag due to time zone changes but must avoid using sleeping pills. To prevent staff burnout, Dr. Mariano implemented a rule of "no working more than 24 hours without a break." In addition, whenever traveling abroad, she arranged rotating schedules so that doctors on the flight could sleep in hotels while their colleagues on the ground took over.

Besides the persistent fatigue, the White House physician also faced numerous personal difficulties. Dr. Mariano delayed seeking treatment for her neck until the pain became so severe that it caused numbness in her arm. Her marriage also deteriorated because her husband felt she was away too much, as if she didn't exist.

Making a mistake can cost a White House doctor their entire career. In 1994, when President Clinton was planning a foreign trip, Colonel Bob Ramsey, a hematologist at the White House, was fired for sending the wrong blood type to the host country's hospital.

Conversely, the heroic actions of the White House medical team are rarely recognized. At President Bush Sr.'s final Christmas party before leaving office, Mariano witnessed a man standing nearby suddenly wheezing and then clutching his throat. She realized he was choking and immediately performed the Heimlich maneuver, helping the man cough up a piece of shrimp. Once he was stable, he left without a word of thanks.

In 2001, Dr. Mariano left the Navy and the White House. She continues to practice medicine at a private practice.

The current physician in charge of President Donald Trump's healthcare is Dr. Sean Conley.

Minh Nguyen