Heart: An American Medical Odyssey

by Cheney, Dick

  Clinically, Mr. Cheney continues to lead an asymptomatic and extraordinarily vigorous lifestyle. He travels extensively for work, exercises 30 minutes per day several days per week on a treadmill, and engages in vigorous recreational activities such as hunting.

  I knew that my statement would be carefully scrutinized, and for that reason, the 173 words took me most of an afternoon to write. Cheney had a complicated medical history, and the task of distilling twenty-two years of cardiac events into a few paragraphs of text intended for the general public was challenging. Ultimately I decided to simply summarize Cheney’s salient history and his current status.

  CHAPTER 9

  Recount

  VICE PRESIDENT CHENEY

  Presidential campaigns are about electing presidents. Rarely does a vice-presidential candidate matter to the outcome. There are two times, however, when he or she can make a real difference—for better or worse. The first is the acceptance speech at the party’s national convention. The second is the nationally televised debate.

  From the time my selection was announced, we had only eight days to prepare my convention speech. I had the help of three first-rate speechwriters: John McConnell, Matthew Scully, and Lynne. Lynne knows me better than anyone else, is a supremely skilled writer, and my toughest critic. I have always felt blessed to have her in my corner. We worked around the clock those first days, as we were also making our initial campaign stops, to prepare for a speech we knew the world, or at least the country, would be watching. I have made other important speeches since then, including my acceptance speech at the 2004 convention, but nothing will match the feeling of walking onto that stage in Philadelphia the night I was nominated for the first time. I had a great time delivering the speech to an applauding, cheering, chanting, foot-stomping crowd.

  The rest of the launch of the vice-presidential campaign wasn’t as smooth. When George Bush selected me to be his running mate in 2000, I’d already had more than twenty-five years of national political experience. As we say in Wyoming, this wasn’t my first rodeo. I had run successfully six times statewide in Wyoming and had overseen Gerald Ford’s 1976 presidential campaign. Nevertheless, joining a national ticket as the vice-presidential nominee was a life-changing experience for my family and me. Among other things, it meant that I had to make the transition from being CEO of a major corporation with 100,000 people in 130 countries working for me to being a candidate for vice president where I wasn’t in charge of anything except my personal performance on the stump making political speeches.

  I hadn’t been active in a campaign since 1994, and I hadn’t been a candidate since 1988, so when we split off from the presidential campaign after a train ride through the Midwest with the Bushes, things got a little rocky. My first solo outing was to Florida, where I was to deliver a speech on education, specifically focused on our policy of using tax-exempt bonds to finance new school construction. Someone at campaign headquarters in Austin had produced the speech and scheduled the event at an elementary school.

  I realized I was in trouble when I walked into a room full of third graders sitting cross-legged on the floor. There was a good deal of technical financial complexity in the speech. Wanting to do well and not wanting to cross headquarters in Austin on my first solo event on the trail, I decided to deliver it as written. Periodically I looked up from the text into the faces of the gathered eight-year-olds who were looking up at me completely perplexed. It was clear they were all thinking, Who is this guy, and when is recess?

  Eventually we got the kinks worked out thanks to some wonderful campaign staff who became like family and to my actual family. Mary joined me on the road as my personal assistant, Lynne was my top adviser on everything from education policy to speech editing to what tie I should wear, and Liz oversaw my debate preparation. She was especially helpful during one of the high points of the campaign for me, my debate with Senator Joe Lieberman from Connecticut, the Democratic vice-presidential candidate. Joe and I had a good deal of respect for one another, and it showed in the debate, which was well received in most quarters.

  Our grandkids accompanied us on the campaign planes, trains, and buses for most trips. They always helped us keep our perspective, and they made us laugh, which is important on a campaign. The conventional wisdom is that a career in politics and political campaigns can put strains on a family, but that was never the case for us. Campaigns have always been family affairs that have pulled us closer together, perhaps because we never lost when I was on the ballot. The 2000 campaign was the closest we ever came to ending our winning streak.

  On Election Day, Lynne and I voted in our home polling place at the Wilson fire station in Jackson Hole. Then we took the campaign plane, loaded with staff, family, and a few friends, and flew to Austin to await the returns. En route we received the results of some early exit polls, which were not encouraging, but exit polls are notoriously inaccurate.

  On arrival in Austin, I stopped by campaign headquarters to talk to our chief strategist, Karl Rove. Karl was optimistic and remained confident we would win. He was ultimately right, but it was one of the closest races in history. I’d been through a close election before. The day before the balloting in 1976, the Gallup organization had President Ford ahead by 1 percent. That evening the returns showed Governor Carter with a clear lead, but it was close enough that President Ford decided to wait until the next morning when all the returns would be in before making a concession statement. In 2000, Vice President Gore called Governor Bush to concede late in the evening and then changed his mind and withdrew his concession statement.

  When we checked into the Four Seasons Hotel in Austin, we had planned to stay for one night and then fly to Washington. Instead, we ended up staying for ten days, and when we finally left for Washington, we still didn’t know the outcome. As we went through the recounts and endless press analyses of “hanging chads,” all we could do was wait. Most days we had conference calls with our man in Florida, Jim Baker, who kept the governor and me informed of the state of play. He sometimes asked for guidance on various legal issues. It was reassuring that every time the Florida votes were counted and recounted, we were ahead.

  During the recount, Lynne and I accepted an invitation from the governor and Laura to join them for a night on their ranch near Crawford. We enjoyed the quiet time together with the Bushes, even though it was impossible to talk about much of anything other than the ongoing Florida contest.

  Although there had been no official outcome to the election, I knew we needed to begin the transition. Under normal circumstances, a president-elect has the time from the election in early November until the January 20 inauguration to find and recruit a cabinet, fill thousands of jobs, and put together a legislative program. Many of the jobs require Senate confirmation, security clearances, full field FBI background investigations, financial reviews, and the resolution of potential conflicts of interest. Under normal circumstances, the task is challenging, and most presidents spend a good part of their first year in office operating with holdovers and acting personnel in many of the most important positions. In the situation we faced in 2000, it would be virtually impossible to run an effective transition if we waited for the final resolution of the Florida recount.

  Governor Bush asked me to return to Washington and get things started. Fortunately I had the work of Clay Johnson, a longtime friend of the president, to build on. He had begun planning for the transition months before the election.

  As long as the outcome of the election remained in dispute, the federal assets of office space and money set aside to support the transition weren’t available to us. So we started our transition planning around the kitchen table in our townhouse in McLean, Virginia, just across the Potomac from Washington, DC. We raised money from private contributions and quickly found a supporter willing to provide space in an empty office building near Tysons Corner, Virginia. Our staff consisted mostly of unpaid volunteers.

  I was in our townhouse in McLean on
November 22 when I awoke in the middle of the night with chest discomfort. I had experienced similar instances over the years that proved to be false alarms, but if I had learned anything over the twenty-two years since my first heart attack in 1978, it was “When in doubt, check it out.”

  I woke Lynne and told her I was having chest discomfort and wanted to go to the hospital to have it checked. Then I alerted the Secret Service detail that had been set up in my garage since I’d joined the ticket. We climbed into their black Suburban for the drive to George Washington University Hospital in downtown Washington. We made good time, being about the only car on the road at 4:30 a.m.

  Preliminary tests showed no increase in my blood enzyme levels, indicating there had been no damage to my heart and therefore no heart attack. Nonetheless, Dr. Reiner recommended that given my history and my chest discomfort, we should do a cardiac catheterization. That procedure showed that one of my coronary arteries had a 90 to 95 percent blockage. A stent was inserted to open up the artery, and I returned to my hospital room. Subsequent blood tests showed there had been a slight increase in my enzyme levels and that I had indeed suffered a very mild heart attack.

  The fact that I was in the hospital in the middle of the presidential election recount generated considerable interest among the press. Journalists along with their cameras, lights, microphones, and satellite trucks gathered outside the hospital. Governor Bush was also getting questions down in Texas. Acting on the first set of test results, which had shown no rise in my enzyme levels, we had told the governor’s staff that I had not had a heart attack, and this was the information he repeated to the press.

  A short while later my doctors held a press briefing in Washington. In front of a packed room, they explained that my enzyme levels had been elevated, a clear message from their perspective that I’d had a heart attack. Unfortunately, the press pool missed the subtlety. Austin was concerned that we would be accused of a cover-up since the physicians had not actually said the words heart attack. At my family’s request, the doctors convened a second press conference in which they said the key words, emphasizing, “This would be the smallest possible heart attack a person can have and still have it classified as a heart attack.”

  We had a unique Thanksgiving dinner in the hospital that year, with food brought in by friends and family and Secret Service agents gathered around. Shortly after that, I was released, and on December 12, 2000, the Supreme Court handed down its decision in Bush v. Gore. George Bush and I became the president-elect and vice president–elect of the United States.

  DR. REINER

  November 22, 2000

  A ringing phone in the middle of the night rarely brings good news. For me, the call usually comes from a wide-awake ER doc telling me that someone I am about to meet is having a heart attack.

  I glanced at the clock as I reached for the phone: 5:00 a.m.

  I don’t even think I’m on call tonight.

  “Jon, it’s Alan.”

  It was Alan Wasserman, the chairman of the Department of Medicine at George Washington University. I could hear the urgency in his voice.

  “Cheney is having chest pain. The Secret Service is bringing him in.”

  That was about all Alan knew.

  “Okay, I’ll meet you there,” I said, and hung up the phone.

  I hurtled out of bed, took a thirty-second shower, shaved, and jumped into a business suit like a firefighter rushing to catch the truck.

  As I hustled out of the house, my wife, Charisse, gave me a kiss, told me to be careful driving, and said, “Do a good job. I know you will.”

  So early in the day before Thanksgiving, the roads were free of the usual choking morning traffic. I raced into Washington ignoring the speed limit; the Potomac River on my right not yet visible in the chilly predawn gloom.

  Two weeks had passed since one of the closest presidential elections in US history, and the outcome was still uncertain. The previous night, the Florida Supreme Court had ruled in favor of Vice President Gore, allowing the swing state’s recount to continue. The whole process had devolved into a bitter court battle involving scores of lawyers, with the presidency of the United States at stake. This was going to be a circus.

  As I pulled off the Whitehurst Freeway and swung my car onto Washington Circle, I found network satellite trucks, black Secret Service Suburbans, and DC police cars everywhere. It was still dark, but the sidewalk across from George Washington University Hospital on Twenty-Third Street was starting to fill with camera crews, cables, and correspondents.

  I parked, grabbed my white coat from my office across the street, and headed into the hospital, flashing my ID at the lobby checkpoint where the security had been beefed up. Cheney had initially been taken to the emergency room where a chest X-ray, EKG, and blood tests were obtained, but for security reasons he was quickly moved out of the busy and relatively open ER and brought to the more secure third-floor coronary care unit (CCU).

  When I arrived in the CCU, Secret Service agents were posted outside Cheney’s room and at other points in the corridor. I met Alan Wasserman, Gary Malakoff, and Dick Katz, GW’s chief of cardiology, in the hallway, and they briefed me on what they knew.

  Cheney had woken up around 3:30 a.m. with chest and left shoulder pain. He didn’t have some of the other typical cardiac symptoms, such as nausea, sweatiness, or shortness of breath, but when his chest pain persisted, he wisely decided to come to the emergency room. Upon arrival, he was given a nitroglycerin tablet under his tongue, and it promptly relieved his pain. A nurse handed me Cheney’s EKGs.

  Think of an electrocardiogram as essentially a map of cardiac electrical activity. Contraction and relaxation of the heart are governed by a wave of electricity that takes about half a second to spread through the muscle. Injury to the heart causes characteristic EKG abnormalities.

  When compared to prior tracings, Cheney’s initial EKG showed subtle changes, particularly in the leads recording activity from the left side of the heart. A subsequent EKG had more pronounced abnormalities, quite characteristic of muscle injury.

  “He needs to be cathed,” I said.

  • • •

  The first casualty of a hospitalization is privacy, which is why I always knock before entering a patient’s room. When I did, a familiar voice told us to come in.

  When we entered the room, we found Cheney awake, pain free, and in good spirits. Lynne Cheney, whom I had not met before, stood on the right side of the bed, a monitor on the wall behind her displaying her husband’s vital signs and EKG waveform.

  I introduced myself to Mrs. Cheney and then asked the patient to describe, one more time, what happened during the night. Cheney said that he had been well the day before and had gone to sleep at his usual time. Sometime after midnight, he went down to the kitchen and made himself a snack. Eventually he went back to bed but was awakened a few hours later by chest and shoulder pain that persisted until he was given the nitroglycerin in the ER. I asked if he had noticed any similar discomfort in recent days, and he said no. Finally, I did a brief physical exam, listening with my stethoscope for any signs of congestive heart failure or new murmurs, which, reassuringly, I did not find.

  I told Cheney that his symptoms concerned me, and I knew that to make a decision to come to the hospital on this particular night, he must have felt quite unwell. Furthermore, I noted that there were new abnormalities in the electrocardiogram, and coupled with the fact that his pain resolved promptly with the nitro, there likely was a new coronary lesion, but the only way to know for sure was to do a cath. At the time, Cheney’s cardiac enzymes were not yet available.

  I outlined what we might find during the procedure. I told Cheney that his pain was likely coming from a narrowing in one of his “native” (original) coronary arteries. I knew this because a prior catheterization in 1995 had shown that two of his bypass grafts were closed, and the EKG changes pointed toward involvement of a region of the heart no longer supplied by a graft. I said that if
we found a blockage and if the vessel could be treated, we would repair it during the same procedure. I also told Cheney that it was possible, but not likely, that this was a false alarm. Finally, I stated that I thought it was important that we treat him the same way we treat every other patient who is admitted with a similar clinical presentation and not try to take any shortcuts.

  It is commonly believed that VIPs receive better medical care than the general public. While it is true that connected people are often immunized from some of the annoying facets of modern American health care (waiting interminably for a call to be returned, being told that the next available appointment is six months away, or getting stuck in an ER for hours), there is a potential downside to being a celebrity.

  In 1964, Walter Weintraub published an article, “The VIP Syndrome,” in which he described the hospital turmoil that frequently follows the admission of prominent or powerful patients and the poor outcomes that sometimes ensue. Weintraub and others have noted that when a well-known person is admitted to a hospital, there is a tendency to consciously or unconsciously alter the care that is typically provided, and it often has negative consequences. For example, in an attempt to spare a VIP inconvenience or discomfort, fewer tests may be performed, or conversely, in a desire to leave no stone unturned, every conceivable test will be ordered. The department chief may be called, when in reality the better choice is a different, sometimes younger, physician who has more experience treating the problem at hand. Numerous specialists may be consulted, each told only what they need to know, creating silos of care. There is a tendency to place a VIP in a more luxurious or more discrete hospital location, apart from where treatment is usually rendered, and the treating physicians may avoid using the intensive care unit because of the perceived undesirable atmospherics, even when that setting might be preferable.