Heart: An American Medical Odyssey (21 page)

At about 2:30 p.m., Alan addressed the media.

As I think everyone is aware, Secretary Richard Cheney came to the George Washington University Hospital emergency room with chest pain . . . early this morning.

Neither his initial EKG nor his blood work indicated that he had a heart attack. After consultation with his internist, Dr. Gary Malakoff, director of the division of internal medicine, Dr. Jonathan Reiner, cardiologist and director of the cardiac catheterization laboratory and Dr. Richard Katz, chief of cardiology, and when a second EKG showed minor changes, a decision was made to perform a cardiac catheterization. The results of the catheterization showed an increased narrowing in a side branch of artery, specifically
the diagonal branch of the left anterior descending artery. The rest of his coronary anatomy is completely unchanged from a previous study performed in 1996.

A decision was made to place a coronary stent in that area that showed some additional narrowing. After placement of the stent, the artery now appears normal. Mr. Cheney has returned to his hospital room and is doing well.

While there is no evidence of any new heart muscle damage on either the heart catheterization or the follow-up electrocardiograms, a second set of cardiac enzymes tests was minimally elevated. He is in good condition and will be at bed rest for the remainder of the day as a standard protocol in procedures such as this. We expect a short hospital stay and expect that Mr. Cheney will be back to normal functions without limitations in a brief period of time.

Alan took a lot of heat for his statement. While he clearly stated that the second set of cardiac enzymes was elevated, he hadn’t used the lay term
heart attack.
I was present throughout the hospitalization, and no one in Mr. Cheney’s family or the Bush campaign at any time tried to edit our disclosure or obscure the fact that there had been a small heart attack. In fact, to ensure that we were being fully transparent, we held a second press conference two hours later in which I participated. Before Alan introduced me, he passed out copies of Mr. Cheney’s cardiac enzymes and explained them more fully:

The first value was obtained at approximately 8 a.m., and the values are completely normal. The second set of values were obtained, were available to Dr. Reiner sometime after noon today, while he was in the catheterization laboratory. The second set of values show an elevated level, a minimally elevated level that shows that there was a very slight heart attack. The third set of values shows that the levels have basically tapered off and have not continued to increase.

It is generally accepted that plaque rupture is the typical trigger for an event such as Mr. Cheney’s. Inside the vessel, a cholesterol plaque becomes abraded, or “ruptures,”
allowing a clot to develop and changing a lesion that the day before may have been only moderately narrowed into a much more significant blockage. Sometimes very minute pieces of clot can break off, lodge downstream, and cause the small enzyme elevations (small heart attacks) like Mr. Cheney’s. Angioplasty and stent placement can seal these roughened areas inside the artery and prevent these events from becoming much larger, clinically more significant heart attacks. I don’t think any heart attack is insignificant, but Mr. Cheney’s heart attack was small, and I described it at the press conference in the following way:

We have biochemical markers that enable us to determine whether or not there has been any damage at all to the heart muscle. And over the last several years . . . we’ve had some new tools, much more sensitive markers which weren’t available several years ago which enable us to detect extremely small levels of heart muscle damage. . . . Two or three years ago we would simply—based on the biochemical data available then, we would simply have classified the event as just angina. But because we have more sensitive markers, we can detect extraordinarily minute elevations in these markers of heart muscle damage. So, you know, we’ve really had to rethink what a heart attack is.

Mr. Cheney’s hospitalization was brief and his recovery uncomplicated, but
in an editorial a few days after Mr. Cheney was discharged, the
New York Times
said Americans “have reason to be concerned by the failure of Mr. Cheney’s aides and doctors to inform the public fully and promptly about his true condition,” an insulting allegation that was simply wrong. The
Times
went on to say, “Wednesday’s bumbling performance may not fall into the category of deliberate misinformation, but it did not cover anyone with glory.”

Despite the tumult in the press, I was proud of the care provided to Mr. Cheney at GW, what the
Wall Street Journal
called, “aggressive, invasive treatment with cardiology’s state-of-the-art technology.”

When I took the oath of office as vice president of the United States on January 20, 2001, I had been living with coronary artery disease for twenty-two years. I had survived four heart attacks, the last occurring just months before, and quadruple bypass surgery. Medical advances such as cholesterol-lowering drugs and stents had improved my life expectancy and justified my doctors” view that I was capable of serving as vice president. Without those advances, I would have long since been forced to retire and may not have survived at all. While I had not sought the second-highest office in the land, I had been chosen by the president, nominated by my party, and elected to serve. I was honored to do so.

One of my first acts after being sworn in as vice president was to sign a letter resigning the vice presidency. I had asked David Addington, my longtime assistant and legal counsel, to review all of the procedures and authorities having to do with the continuity of government. What were the procedures, for example, if the president became ill or incapacitated? What about the vice president? How would we make sure the government could continue to function if we were attacked and either the president or vice president was unable to carry out his responsibilities? My most important responsibility as vice president was to be prepared to take over in the event something happened to the president. I wanted to be fully briefed on everything that would be involved in such a transition.

After David completed his review, he came to see me. Looking over the Constitution and relevant statutes, he had discovered a potential problem that could be significant especially in my case.

The Twenty-Fifth Amendment to the Constitution specifies a procedure for temporarily removing a sitting president if he is unable to perform the duties of the office. The vice president convenes the cabinet and puts the question of the removal of the president to a vote. If a majority of the cabinet concurs, the vice president becomes acting president, and the Speaker of the House and the president pro tem of the Senate are notified.

The Twenty-Fifth Amendment also made provision for the president to appoint a vice president if there was a vacancy in that office. Nixon used it to appoint Gerald Ford when Spiro Agnew resigned. Ford used it to appoint Nelson Rockefeller when he became president upon Nixon’s resignation. There is no provision for replacing a vice president who becomes incapacitated, however. This is especially problematic since only the vice president can convene the cabinet to initiate the procedure for replacing a president. There is also the possibility that in the case of a president’s death, a nonfunctioning vice president would replace him. As a constitutional officer, the vice president cannot be fired. He can resign or be removed only through the impeachment process.

At least once in our history, we have seen a president disabled: Woodrow Wilson suffered a stroke in October 1919 with seventeen months left in his second term of office. Given my medical history, I thought it was important to make a provision for the possibility that my abilities might be impaired by a stroke or a serious heart attack that would leave me still in office but unable to carry out the duties of vice president.

The solution we came up with was for me to sign a letter of resignation dated March 28, 2001, just sixty-seven days after we were inaugurated. I addressed it to the secretary of state, the standard form for such a letter from a president or vice president, and printed it on my official stationery. I gave the signed letter to David Addington with very
clear instructions that he was to hold on to the letter and if the need ever arose, he was to present it to the president. It would then be up to the president to decide if and when to forward it to the secretary of state. Once it was submitted to the secretary, the office of vice president would be vacant, and the president could appoint a successor using the provisions of the Twenty-Fifth Amendment. The only other person I told about this arrangement was President Bush. I thought it was important that he know about it.

•  •  •

When Governor Bush asked me to be his running mate, he made it clear that it would be a consequential post. I would be a full member of his team and help govern the nation. From our first week in office, he was a man of his word. California had been experiencing rolling brownouts, and Alan Greenspan, chairman of the Federal Reserve and an old friend of mine from the Ford administration, was greatly concerned that the power shortages could spread to other parts of the country and cause significant problems in the economy. After we talked about the matter in my West Wing office, we went together to see the president, and our meeting led to the creation of an energy task force to develop a new national energy policy, which the president asked me to chair.

He also asked me to take on the task of conducting a review of a number of studies that dealt with the problem of “homeland security.” My national security background had been an important reason for his selecting me, and with his approval, I embarked on a series of visits to the Central Intelligence Agency, the National Security Agency, the Defense Intelligence Agency, and other parts of the intelligence community. I’d had a special interest in intelligence matters since my days on the House Intelligence Committee and as secretary of defense, but after eight years in the private sector, I needed to catch up.

As vice president, I also served as the president of the Senate, which after the 2000 elections was evenly divided, with Republicans and Democrats each holding fifty seats. My tie-breaking vote placed the
Republicans in the majority and allowed them to select the chairs of each committee. My Senate colleagues invited me to attend the weekly GOP policy lunch, which I did whenever I was in Washington.

House Speaker Denny Hastert and Ways and Means Committee chairman Bill Thomas approached me with a unique suggestion. They were old friends from our days together in the House and said they looked on me as a “Man of the House.” For that reason, they wanted me to have an office on the House side of the Capitol as well as the Senate side. Given the opportunity to choose one of two offices that were traditionally occupied by the chairman of Ways and Means, I chose one right off the House floor near the Democratic cloakroom. For the first and only time, the vice president had been given offices on both the Senate and House sides of the Capitol, and they turned out to be great locations for me to work with senators and representatives on important issues before the Congress.

In 2001 and again in 2003, President Bush called for major tax legislation, and I worked with the congressional leadership to get it passed. In 2003 both the House and the Senate passed major tax bills but were deadlocked when it came to convening a conference to rewrite the two versions. Emotions were running high among Republicans in both chambers, especially between the chairmen of the House Ways and Means Committee and the Senate Finance Committees. Senate Majority Leader Bill Frist and House Speaker Denny Hastert asked me to intervene and broker a deal. I worked with Congressman Bill Thomas and Senator Chuck Grassley and we crafted an agreement acceptable to both. I then cast the tie-breaking vote to get the bill passed by the Senate.

•  •  •

While I was vice president, my daily health care was primarily the responsibility of the White House Medical Unit (WHMU). Some view the WHMU and the idea of around-the-clock medical care for the president and vice president as unjustified perquisites of office. In fact, they are an integral and vital part of the White House operations, just as are
the Secret Service and the White House Communications Agency. The nation has a significant stake in the health and well-being of the president and vice president once they are elected and sworn in, and helping to ensure that well-being is the job of the medical unit.

Traditionally the director of the WHMU, always a physician, has the president as his patient. The vice president’s physician is the deputy director. In my case, that was Lewis Hofmann, an Air Force lieutenant colonel, later promoted to full colonel. Lew oversaw a team of nurses, physician’s assistants, and other doctors who played an important role in my care. I was extraordinarily fortunate to draw Lew for that assignment. He is a top-notch physician. He was always discreet, worked endless hours, and traveled over a million miles with me on Air Force Two during my time in office. He played a vital role in dealing with all my health issues during that time. He remains a good friend today, and I consult him from time to time even though we are both now civilians. Perhaps Lew’s greatest contribution was his ability to adapt to my special requirements.

I had made the decision after my 1984 heart attack to pick a doctor and a hospital where I would go for all matters related to my coronary artery disease. I had also developed the habit over the years that I wouldn’t sign up for any procedure or prescription for any kind of medical problem without first checking with my cardiologist. My heart always came first, and I wanted Dr. Reiner and George Washington University Hospital to continue the role they had played before I was elected. As a former member of the Board of Trustees of the Mayo Clinic, I was also eligible for ongoing care at the clinic, and from time to time, I sought medical advice from experts there. Instead of relying solely on White House doctors and Bethesda Naval Hospital for my care, which is the conventional arrangement, I wanted to make certain that I continued my previous relationships.