Sundowning

Over the past week, the national media has aimed a laser pointer at two seemingly non-related issues concerning Donald Trump: first, the rather bizarre December 2015 letter written by his long-time gastroenterologist Dr. Harold Bornstein, attesting to his illustrious patient's "extraordinary health"; and second, the "nice and nasty" bipolarity of the Republican presidential nominee's long "immigration Wednesday," which began with a rather subdued, almost diplomatically correct afternoon meeting/joint press conference with Mexican President Enrique Peña Nieto in Mexico City, and ended with a fiery nighttime "10-point policy speech" before a frenzied, deliriously partisan throng in Phoenix, Arizona.

With regards to Dr. Bornstein's hastily drafted letter, medical professionals and media mavens parsed and vetted every word, every syllable of his four-paragraph epistle as if it were a long-lost Shakespearean sonnet. In the end, the letter raised far more questions than it answered; not so much about Mr. Trump's overall health - which by any professional measure the letter did not truly address - but rather about the circumstances under which it was composed. Historically, presidential candidates' medical records are longer, more detailed and clinical than a mere four chatty anecdotal paragraphs, and typically are released not by a specialist, but by one's PCP - their "primary care physician." The letter, which Dr. Bornstein admitted was written in less than five minutes while Mr. Trump's limo waited downstairs, used some distinctly non-standard language. As an example, he said there were no "significant medical problems" in Trump's history and that a recent examination "showed only positive results." Anyone with even a smattering of medical awareness knows that "testing positive" is, generally speaking, not a good thing - like testing positive for anemia, cancer or Psoriatic Arthritis. And while Dr. Bornstein's letter “state[s] unequivocally” that if elected, Donald Trump “will be the healthiest individual ever elected to the presidency,” it in no way offers a shred of diagnostic evidence for this assertion. I personally would love to see Mr. Trump engage in a one-on-one basketball game with Barack Obama, or challenge Theodore Roosevelt to a speed-climb up the Matterhorn. Then too, one wonders why this letter has suddenly become an issue, seeing that it was first released nearly nine months ago . . .

Then there was the matter of Trump's unprecedented "Immigration Wednesday," where he came in like a lamb down in Mexico City and went out like a lion in Phoenix, Arizona. No one is sure why President Nieto even invited Mr. Trump in the first place. It makes little sense for a man with a 23% approval rating - such as President Nieto has with his own people - that he should play host to a man whose public approval rating down south stands at a minuscule 2%. Sounds like a classic "lose-lose" proposition to me. After meeting together privately, the two held a press conference, where Mr. Trump was effusive in his praise of our neighbors to the south and quietly - almost humbly - averred that immigration is as much a humanitarian, as an economic or security issue for both countries. Not once did he bring up the issue of Mexico paying for the wall - a campaign bullet point he has loudly trumpeted over the past year. Later that day, President Nieto tweeted that under no circumstances would Mexico pay for Trump's wall.

That night, returning to Phoenix, Mr. Trump was back to being his aggressive, hostile, nativist self, blaming "illegal Mexican aliens" for everything from urban crime and low-paying jobs to a spike in drug addiction and the dangerous growth of inner-city gangs. Speaking from a teleprompter - which until recently he asserted should ". . . be outlawed for anyone running for president" - Trump swore to his cultists that he would deport "criminal illegal aliens" within the first hour of his presidency. (This, by the way, is already federal policy.) One can see the fingerprints - if indeed, not the hands and feet - of newly-minted campaign CEO Steve "the most dangerous political operative in America" Bannon in all this. For it has been Bannon and the folks at Breitbart who have been most responsible for the nativist "America First" ideology that pervades both the Trump campaign and much of under-educated white male America. In thinking back, this "nice-to-nasty" bipolarity is nothing new; Mr. Trump has been that way ever since he got into the presidential race more than a year ago.

In attempting to figure out what goes on in the mind of Donald Trump - of how he can be relatively lucid, engaging, even presidential in Mexico City during the day, and then so blusteringly bovine in Phoenix, Arizona at night, it dawned on me that perhaps that other laser-pointed issue - about his health - might provide aclue. And here, I know I am wading into a bacteria-infected cesspool. For while I am certainly not a medical doctor, I have nonetheless, over the past quarter century in my role as a medical ethicist, vetted more than a thousand medical research protocols and informed consent documents on everything from Acute Myeloid Leukemia and Ankylosing Spondylitis to Axillary Hyperhidrosis and Alzheimer's Brain Plaques. Again, I repeat: I am neither an MD nor a trained diagnostician. However, I have worked alongside some galaxy-class professionals over the years, and have learned much. All of which leads me to wonder if perhaps what is inexplicable about Donald Trump might not be caused by that which is referred to as either Sundowning or the Sundown Syndrome. This syndrome has long been noted in people in the early stages of pre-senile dementia. It is characterized by the emergence or increment of neuropsychiatric symptoms such as agitation, confusion, anxiety, and aggressiveness in the late afternoon, in the evening, or at night. In lay terms, the later it gets, the less lucid one becomes.

A bit of research into Donald Trump's year on the campaign trail reveals that many of his zaniest, darkest comments and accusations generally occur long after teatime . . . i.e. after sundown. Some of his most infamous post-sundown explosions include his repeating a long discredited rumor that Senator Ted Cruz's father, Pastor Rafael Cruz, was somehow involved in the assassination of JFK; tweeting that"Obama is, without question, the WORST EVER president. I predict he will now do something really bad and totally stupid to show manhood!" And then there is the ongoing puerile name-calling, which again, occurs in the evening. In perhaps his most notorious tweet, Trump reposted a photo meanly comparing his wife Melania with Senator Cruz's wife Heidi. The time? 11:35 p.m.

If indeed, Donald Trump is sundowning - is in the throes of early dementia - that would help explain his recent noticeable swings between daytime lucidity and control and his evening-time aggressiveness, bullishness and otherwise pathological behavior. In writing this, I am in no way seeking to be smug or snarky. Rather, I am concerned . . . terribly concerned. We've already had one president - Ronald Reagan - who may well have been in the early stages Alzheimer's Disease while serving as president. Luckily, Reagan was a professional actor who knew how to work with a cast; a leading man who had a long history of relying on others to make him look his best. To a great extent, this "cast" was able to cover for him even as he began moving from twilight to sundown. Donald Trump, on the other hand, far from being a member of a cast, considers himself to be the producer, director, star, hairstylist and lighting designer all rolled into one. Who will be there for him should sundown begin arriving earlier with each passing day?

Ironically, September is Alzheimer's Awareness Month. And just as ironically, this is the month in which Donald Trump and his crew are hinting that something is wrong - terribly wrong - with Secretary Clinton's health, stamina and judgment. Just as America has been demanding to see all of Secretary Clinton's emails and copies of the handful of speeches she gave before barons of Wall Street, so too should America demand to see Donald Trump's medical records and tax returns. At such a crucial time in American history, we simply cannot afford to have a president who becomes nastier, more aggressive, craven and combative as the day goes on.

Sundown should be a time of restful beauty . . . not fearful ugliness.