Heart: An American Medical Odyssey

by Cheney, Dick

  Many cases of cardiac arrest associated with acute myocardial ischaemia could be treated successfully if all medical, nursing, and auxiliary staff were trained in closed-chest cardiac massage and if the cardiac rhythm of patients with acute myocardial infarction were monitored by an electrocardiogram linked to an alarm system.

  Years later, Julian noted that it was essentially the success of closed chest cardiac resuscitation that triggered the creation of the coronary care unit (CCU). Julian opened the first CCU in Sydney, Australia, in November 1962 and was soon followed by colleagues in Kansas City, Toronto, New York, and Miami.

  Concentrated monitoring in a coronary care unit enabled physicians to rapidly recognize and reverse a variety of complications after a heart attack. Crucially, nurses were given the responsibility for the detection of ventricular fibrillation and its treatment with defibrillation. The nursing staff could quickly attend to ventricular fibrillation, often before the arrival of a physician. Continuous EKG monitoring could detect heart blockage or other slow heart rhythms, allowing treatment with a pacemaker prior to a cardiac arrest. Patients with low blood pressure or other symptoms of shock could receive medication such as norepinephrine from a staff specially trained to administer and adjust these drugs.

  The net result of this new model of acute cardiac care was a substantial drop in in-hospital deaths. During the 1950s, when President Eisenhower experienced his myocardial infarction, 30 percent of patients died during their hospitalization. In the era of the coronary care unit, the in-hospital death rate declined to 15 percent.

  Eleven days after Dick Cheney was admitted to the CCU in Cheyenne Regional Hospital with an acute inferior wall myocardial infarction, he went home. The sole medication prescribed to him on discharge was Anturane (sulfinpyrazone), a drug typically used to lower uric acid levels in patients with gout, but used in his case to prevent a recurrent heart attack because of its aspirin-like inhibitory effect on platelets, the blood cells that are essential to clot formation.

  Today, a patient discharged following a heart attack will be treated with a host of medications, including antiplatelet drugs like aspirin and clopidogrel (Plavix), statin medications like atorvastatin (Lipitor) or rosuvastatin (Crestor) to reduce cholesterol, beta blockers to slow the heart rate, and ACE inhibitors to prevent congestive heart failure.

  Following an exercise stress test three weeks after the heart attack, during which Cheney had no chest pain or concerning EKG changes, Dr. Hiser prescribed an exercise program consisting of thirty minutes per day of walking at a target heart rate of 120 beats per minute. Even with the reassuring stress test, Hiser remained cautious and somewhat ambivalent about Cheney’s return to the campaign. In a July 10, 1978, letter to Dr. Davis, he wrote:

  His plans for the campaign are now familiar to you . . . he will resume the campaign, but not actively until late July or early August. Jumping fully into the campaign will be delayed until mid-August. Even at that time he has been admonished to not excessively fatigue himself and to maintain his exercise program and to get a full eight hours sleep every night. . . . The campaign is so important to him that I am reluctant to tell him that he should drop out of it.

  At the end of July, Cheney was allowed to resume limited campaigning but only after Dr. Hiser issued strict conditions, underscoring the fragility of a post-MI patient. In September 1978, with the campaign for Congress in full swing, Dr. Hiser ordered blood tests that documented an elevated total cholesterol of 271 mg percent (the normal range 110 to 253) and a triglyceride (a type of lipid) of 334 mg percent (normal range 29 to 201). In view of these abnormal results he reminded Cheney of the importance of adhering to the restricted diet and advocated weight reduction and continued exercise. Dick Cheney didn’t need to be reminded about tobacco; he smoked his last cigarette the day he had his first myocardial infarction.

  CHAPTER 3

  Into the Heart

  VICE PRESIDENT CHENEY

  On election night, November 7, 1978, we watched the returns with friends and campaign aides at our home in Casper. We set up extra TVs in the dining room and study so we could watch all three networks and the local Casper station, KTWO. I had won the three-way primary that August with 42 percent of the vote, the smallest total I would ever receive during my congressional career. I suspected that the primary fight would be tougher, and the outcome closer, than the general election, but no successful politician takes anything for granted. Watching the returns come in and seeing that I’d been elected to the US House of Representatives with 59 percent of the vote that November night was a life-changing experience. I felt privileged to be selected by the people of Wyoming to represent them in Congress. Thirty-five years later, after holding other positions of high office, no title ever made me prouder than being known as the Gentleman from Wyoming.

  The morning after the election, I called Congressman John Rhodes of Arizona, the Republican leader in the House of Representatives. Rhodes had succeeded Jerry Ford as the minority leader in the House in December 1973 when Nixon selected Ford to be his vice president, and I got to know Rhodes when I served as White House chief of staff. As the minority leader in the House, Rhodes would have a major voice in committee assignments for the newly elected Republican members of the Ninety-Sixth Congress. I asked him to consider me for a seat on the Committee on Interior and Insular Affairs. As a public lands state where the federal government owns 50 percent of the surface and 65 percent of the mineral rights, Wyoming is affected greatly by decisions that come within the jurisdiction of the Interior Committee.

  Rhodes said he thought there wouldn’t be any problem with fulfilling my request. Then he added that he wanted me to take a seat on the Committee on Standards of Official Conduct, better known as the Ethics Committee. The committee’s jurisdiction includes conducting investigations of alleged wrongdoing by members accused of violating House rules. If members are found guilty, the committee is charged with recommending appropriate sanctions to the full House up to and including expulsion.

  The power invested in the Ethics Committee to sit in judgment and sanction members has led to a set of rules that are unique. The committee always has an equal number of members of both parties (six Republicans and six Democrats in 1978). Although the chair was of the party that controlled the majority in the House, no significant action could be recommended to the House without at least seven votes. The leaders are careful to appoint only members they believe will understand the significance of the responsibility and will conduct themselves in a manner that puts the interest of the House of Representatives ahead of personal or partisan interests. Freshmen are rarely selected to serve on the committee. Rhodes’s decision to appoint me indicated he had confidence in my experience and judgment to handle the assignment. I readily accepted.

  A week after the election, Lynne and I took the girls to Hawaii. We spent some time on the big island of Hawaii at the home of our friend Jack Ellbogen. We also spent a few days in Honolulu with Congressman Bill Steiger and his wife, Janet. Bill, who’d been my first boss in Washington, was a rising star in the Republican Party. We enjoyed a wonderful few days of rest and relaxation before we all went to Washington to take up our places in the Ninety-Sixth Congress.

  A few weeks later, I was in Washington for the orientation sessions for new members. Many of our meetings were held at the Dulles Marriott Hotel, but we also gathered for introductory meetings at the Capitol. On December 4, 1978, I stepped out of the organization meeting of the Republican conference for a photo shoot with U.S. News & World Report. As I emerged onto the steps of the Cannon House Office Building, I noticed the flag over the Capitol was being lowered to half-staff. I asked one of the Capitol police officers standing nearby why they were lowering the flag, and he explained it was because a member of Congress had just died. “Who?” I asked. “Bill Steiger of Wisconsin,” came the answer. I was stunned to learn that Bill had died of a heart attack in his sleep. He had just turned forty, only two years older than I was. When I�
��d had a heart attack in the middle of my first campaign six months earlier, Bill had urged his donors to write a check to me in Wyoming.

  Bill’s funeral was held in Oshkosh, Wisconsin, a few days later. Though I hadn’t yet been sworn in, I was granted permission to fly with the official delegation of Bill’s colleagues from the House. The service was especially poignant because Bill had been so young and because we all knew he’d had such a bright future ahead of him. His death was a tragedy for his family, for those of us who knew him, and for the nation.

  • • •

  Even the death of such a close friend and mentor from a heart attack did not cause me to think much about my own mortality. I considered my heart attack as a one-off event, and I basically thought of myself as healed.

  I was leading an active life physically, playing tennis and planning a ski trip for the upcoming holidays. I’d quit smoking, was watching my diet, and trying to exercise regularly. I was doing what a prudent man would, but I also was in denial to some extent. I told myself I had dealt with my heart problem by quitting smoking. I certainly didn’t think of myself as sick or even as someone suffering from coronary artery disease.

  I maintained a busy and demanding schedule in Washington and back home in Wyoming. I was especially focused in my first term on solidifying my electoral base in the state. I wanted to lay the political groundwork at home so I would have the freedom to get involved in difficult and often controversial issues at the national level.

  During the week in Washington, I was busy with committee hearings and meetings, as well as regular sessions of the House. On weekends, I flew home to spend time with my constituents. Because Wyoming has only one congressional district, I was responsible for covering the entire state. As one of my friends remarked when he first traveled across my district, “In Wyoming, it’s a long way between voters.”

  Traveling home was made difficult by the fact that there were no direct flights between Washington, DC, and Wyoming. I usually left late in the day and arrived in Denver after the last connecting flight to Wyoming had departed. I’d spend the night at an airport hotel, and the next morning I’d fly or drive to whatever part of the state I was scheduled to visit. Sometimes we would charter a plane to get to as many communities as possible because much of Wyoming had no commercial air service. During congressional recesses, I visited communities throughout the state, attending and speaking at events or holding office hours. I would announce that I was planning on being in a town on a certain date and time and invite anyone who wanted to see their congressman about an issue or a particular problem to stop by. During my first term, I spent roughly 170 days in or traveling to Wyoming. The schedule was tough and demanding seven days a week, but I loved being Wyoming’s congressman.

  In that first term, my committee assignments generated a fair amount of activity. The Interior Committee had some jurisdiction over nuclear power. When there was an accident at the Three Mile Island nuclear facility in Pennsylvania, we were involved in visiting the plant, holding hearings, and trying to understand what had happened. The accident eventually had a huge impact on the future of nuclear power in the country. For many years afterward, lingering questions in the public mind about safety discouraged the construction of any new nuclear power plants, which also had consequences for Wyoming, the largest uranium-producing state in the nation.

  The Ethics Committee had one of the most active agendas in its history in the Ninety-Sixth Congress. I gave my first speech on the floor of the House as a member of the committee. Congressman Charles Diggs of Michigan had been convicted of accepting kickbacks from members of his congressional staff; however, after his conviction, the voters of the Thirteenth District had reelected him. The case forced the Ethics Committee to make a decision about Article I of the Constitution. Article I grants the House the power to expel a member for misconduct if approved by two-thirds of his colleagues. It also specifies that members will be elected by popular vote. Which was to take precedence: the power of Congress to expel a member for misconduct or the right of the voters to pick their representative?

  I agreed with the committee that we had to accept the judgment of the voters of the Thirteenth District and supported the committee’s recommendation for censure. A number of members disagreed, however, and argued for expulsion. The motion to censure nevertheless prevailed, and we accepted the voters” decision about whom they wanted to represent them. The following year when Diggs’s conviction was upheld on appeal, he resigned.

  The biggest scandal the committee had to handle while I was a member was ABSCAM. A number of House members, as well as one senator, were caught up in an FBI sting operation. Undercover agents posing as representatives of a wealthy Middle Eastern sheikh offered cash payments to members as bribes. All of the transactions were captured on videotape, so there wasn’t a shred of doubt about the guilt of those who had been caught. All of them were either defeated or resigned except Congressman Ozzie Myers of Philadelphia, who refused to resign and was not subject to an intervening election. Myers insisted on taking the matter to a vote of the whole House and became the first congressman since the Civil War to be expelled.

  At the end of my first term in December 1980, I was elected by my colleagues to be chairman of the House Republican Policy Committee, the fourth-ranking leadership post. It was unusual for someone to be elected to the leadership after only one term in office, and it was only the second time that Wyoming’s congressman was part of the elected leadership. The first time had been from 1919 to 1923, when Congressman Frank Mondell had served as the majority leader. My selection as part of the House Republican leadership had an enormous impact on my career. By 1988 I rose to the number two position as the House Republican whip and was in line to become the GOP leader when Bob Michel retired or Speaker of the House if we won the majority.

  As policy chairman, I was a regular participant in meetings to determine our legislative strategy and our positions on key issues that came before the House. During the Reagan years, we met regularly with the president. Being policy chairman led to my appointment as a member of the Intelligence Committee and as the ranking Republican member on the committee to investigate the Iran-contra affair. Working with my Senate colleague, Al Simpson, part of the Republican leadership in the other body, we were often able to push policies important to the people of Wyoming. In later years when I became secretary of defense, the relationships that I developed during my years as part of the House leadership were instrumental in my work on Capitol Hill.

  I maintained a significant international travel schedule during the early 1980s as well. A partial list of delegations in which I participated includes visits to the Soviet Union, Egypt, Grenada, Singapore, Japan, England, El Salvador, Israel, and France.

  I never felt during these years that my health interfered with my ability to do my job, but I did experience a number of false alarms, instances when I felt something wasn’t quite right, when I thought I might be having a heart attack but it turned out I wasn’t.

  One of the most important lessons I had taken from that first heart attack was “When in doubt, check it out.” Some people are hesitant to go to a hospital and embarrassed if they do rush to the ER only to find out they aren’t having a heart attack. I have never understood this. I knew that getting to the hospital could mean the difference between life and death if I were having an attack, so for me there was never any question of getting it checked out. There were some memorable false alarms, though.

  One I will never forget occurred during a delegation visit to Tokyo in September 1981. Lynne and I were in Japan with a small group of congressmen and senators under the auspices of the Center for Strategic and International Studies. One evening in our hotel, I felt some chest discomfort and consulted the hotel physician, who recommended I go to the local hospital. The doctor summoned the ambulance, which arrived carrying an emergency team of six paramedics, all of whom wore yellow hard hats and none of whom spoke English. My Japanese was nonexisten
t. The language barrier didn’t prevent me from noticing the paramedics” intense interest in the cowboy boots I was wearing, and with all the pointing and gesturing that went on, I got the idea that they thought my footwear was pretty exotic. The blaring sirens of the ambulance that rushed me to the hospital sounded exactly like the ones in the movie Godzilla. I couldn’t get the images of a giant monster rampaging through the streets of Tokyo from my mind.

  While I was in the emergency room, I was pleasantly surprised when the US ambassador to Japan, former senator Mike Mansfield, walked in. Mike was a longtime senator from my neighboring state of Montana and had been the majority leader of the Senate for many years. I deeply appreciated his gracious act of coming to the hospital to check on me.

  Another rush to the hospital occurred while I was hosting a staff retreat at Flat Creek Ranch near Jackson Hole. I began to have some chest discomfort and told Lynne we needed to get to the hospital in Jackson to have it checked out. Lynne got my state representative, Merritt Benson, to drive both of us into town. The road in and out of the ranch was actually a National Forest Service jeep track for about two-thirds of the way, and it was like driving on a dry, rocky riverbed. Though the ranch is only fifteen miles from the town of Jackson, the road conditions can make the trip as long as two hours. It turned out I wasn’t having a heart attack, but bouncing along the dirt road as Lynne urged Merritt to go faster was in itself a somewhat stressful experience.

  So I was careful about heeding alarm bells, but I didn’t spend a whole lot of time thinking about my heart condition. Of course, in hindsight, that first heart attack in 1978 was the initial manifestation of what would become a lifelong battle with coronary artery disease. At the time I didn’t think of it in those terms. I thought of my heart attack as something behind me, something I could avoid a repetition of by taking care of myself. The heart attack and the surrounding publicity had in no way impaired my election campaign or my career in Congress. Indeed it was possible to believe it had had a positive effect to the extent it raised my name recognition across Wyoming. And perhaps most important of all, it had made me quit my smoking habit cold turkey. I had not had a cigarette since the night I passed out in the emergency room at Cheyenne Memorial Hospital. If I hadn’t been inspired to do that, my life would have undoubtedly ended long ago.