Grisham’s book states that Trump made the decision to keep his visit under wraps because, she suspects, he didn’t want to be the “butt of the joke” on late night television. The book also states her belief that he avoided anesthesia for the painful and invasive procedure because he didn’t want Vice President Mike Pence to take over temporarily as commander-in-chief and loathed showing any kind of weakness.

Former White House aides say they’re surprised the detail never got out while Trump was president. After all, just about everything else eventually made its way into TV chyrons and newspaper headlines.

Instead, the moment became emblematic of another prominent feature of the Trump years: the president taking an otherwise normal event — in 2018, more than 19 million colonoscopies were performed in the U.S. alone — and turning it into something far larger and more controversial by his cryptic handling of it. In the process, it fed a destructive feedback loop: in which the White House operates in secrecy, the press gets motivated by it and the resulting speculation and reporting feeds a narrative of media irresponsibility.