Heart: An American Medical Odyssey (26 page)

“Say that again, Lew.”

He did, and I told him that it must be an error. He said that’s what
he thought, but the lab had verified the result.

A high blood concentration of potassium is called hyperkalemia, and a
level that high is a medical emergency because it can lead to cardiac arrest. Lew asked
if the vice president’s defibrillator would protect him, and I told him if the
vice president really was hyperkalemic, it would not.

I asked Lew if there was any way to repeat the
potassium test that night, and he told me that it was possible, but it would take a
couple of hours to get the blood to a lab. I did not ask Lew where they were going; it
wasn’t something I needed or wanted to know. Many years later, I learned that to
ensure the continuity of government, the vice president was taken to Camp David, the
presidential retreat in the Catoctin Mountains of Maryland. On the helicopter ride from
the White House, Lew passed a note to the vice president informing him that we needed
another sample of blood.

“Not tonight, Lew. You can have it in the morning,” the vice
president responded.

•  •  •

The back cover of Vice President Cheney’s memoir,
In My Time,
features a solemn photograph taken aboard Marine
Two, the vice-presidential helicopter, as it left the South Lawn of the White House on
September 11. The image, taken by White House photographer David Bohrer, depicts the
vice president and Mrs. Cheney in an intensely personal moment. Just visible in the vice
president’s hand is the note from Lew Hofmann alerting Mr. Cheney to our concern
about his blood.

On the morning of September 11, 2001, I was at work in my West Wing
office with John McConnell, my speechwriter, when my assistant, Debbie Heiden, called in
to report that an airplane had struck the World Trade Center in New York. I turned on
the TV and a few minutes later saw the second hijacked aircraft strike. I placed a phone
call to the president, who was in Florida, and we agreed this was clearly a terrorist
attack and discussed what he was preparing to say to the press.

As colleagues on the White House staff gathered in my
office, the door suddenly burst open, and Jimmy Scott, one of my Secret Service agents,
came rushing in and told me we had to leave immediately. He placed one hand on my left
shoulder, and with the other hand he grabbed the back of my belt and propelled me out
the door. When we reached a tunnel underneath the White House, we stopped as more agents
joined us and additional weapons were taken out of a locker. At that point, Scott told
me they had evacuated me from my office because of a report from the control tower at
Washington Dulles International Airport that an aircraft, believed to have been
hijacked, was headed for the prohibited air space over Crown (the code word for the
White House). This plane was American flight 77, which had struck the Pentagon. There
was a small black-and-white TV set in the tunnel as well as a secure phone, which I used
to call the president. I told him that Washington was under attack as well as New York
and recommended that he not return to the White House until we could ascertain the
extent of the attack. The Secret Service made the same recommendation.

After the call we proceeded down the tunnel to the Presidential Emergency
Operations Center (PEOC), where I would spend most of the rest of the day. Norm Mineta,
secretary of transportation, joined me there and was instrumental in working with the
Federal Aviation Administration in getting all of the aircraft down out of the sky that
day. Initially we had reports of six hijacked aircraft and many inaccurate reports of
car bombs, explosions, and other incidents.

One of my major concerns was to “preserve the continuity of
government.” In the event that an attack should take out both the president and
vice president, it’s crucial to make certain that potential successors are safe
and secure. On 9/11, I worked to arrange for the movement of Speaker Hastert to a secure
location, since he was next to me in the line of succession.

At one point shortly after I arrived in the PEOC, an Air Force officer
came into the room and said that a plane believed to have been hijacked
was headed for Washington and was just eighty miles out. He wanted to know if they
were authorized to shoot it down. Based on a conversation I’d had previously with
the president, I gave the order to take it out. A short time later, we received a report
that a plane had gone down in Pennsylvania. Initially we believed one of our aircraft
had shot it down. It was sometime later that we learned that the courageous passengers
on United flight 93 had taken it down. If it hadn’t been for their bravery, flight
93 would most likely have been flown into the Capitol or the White House.

Later that day after the president returned to the White House, he
convened a meeting of the National Security Council and addressed the nation. That
evening, Lynne and I flew by helicopter to Camp David, where we spent the night. I sat
up until the early morning hours watching television coverage of the events of 9/11 and
thinking about the policies we would need to pursue to make certain we didn’t get
hit again.

The events of 9/11 marked a sea change in terms of our priorities and
policies and fundamentally changed the focus of our administration. Before 9/11,
terrorist attacks such as the assault on the World Trade Center in 1993 and the attack
on our embassies in East Africa in 1998 were treated as law enforcement problems. The
FBI would investigate, capture the suspects, bring them to trial, and if convicted they
would serve their terms in US prisons. But 9/11 changed the paradigm. The destruction of
the World Trade Center, the attack on the Pentagon, and the murder of nearly three
thousand Americans was an act of war, worse than the Japanese attack on Pearl
Harbor.

Our main priority for the remaining seven and a half years we were in
office was to make certain the terrorists were never able to launch another
mass-casualty attack against the United States. We were especially concerned about an
attack using weapons far deadlier than airline tickets and box cutters, such as
biological or chemical weapons or even a nuclear device. Using the president’s
constitutional authority as commander in chief and the congressional authorization to
use military force
to capture al Qaeda, we implemented a number of
programs designed to provide the intelligence we needed to prevent further attacks.

The two most important programs were the Terrorist Surveillance Program
(TSP) and enhanced interrogation techniques. TSP permitted us to intercept contacts
between al Qaeda terrorists overseas and their associates inside the United States.
According to General Keith Alexander, director of the National Security Agency, this
program has allowed us to intercept some fifty attacks targeting the United States and
friends overseas. The enhanced interrogation program was instrumental in our ability to
develop vital intelligence about al Qaeda. In 2004 the CIA produced a report concluding
that Khalid Sheikh Mohammed, the mastermind of 9/11, had been the “pre-eminent
source on Al Qaeda.” KSM was subjected to these techniques more than any other
high-value detainee. Both programs have generated considerable controversy, but they
both produced valuable intelligence we needed to keep the country safe. The record
speaks for itself.

•  •  •

For the twelve years prior to my election as vice president, I had no
significant incidents involving my health. I experienced the one heart attack during the
Florida recount, but it was a minor event, barely qualifying to be called a heart
attack. For the eight years I was vice president, however, there were events that
indicated my coronary artery disease was progressing. I never believed that the disease
inhibited my capacity to do my job. I basically dealt with each problem as it came up,
relying on my doctors to keep track of how I was doing physically and to let me know
when I needed to make changes in my regimen or my medications. I did not sit in my
office wringing my hands, worried about when the next heart attack would occur.

After my first heart attack in 1978, I felt a strong sense of fragility in
the period immediately after I was released from the hospital. I worried that if I moved
too suddenly, I might trigger another event. As I reengaged in that first political
campaign, I frequently recalled Dr. Rick Davis’s advice that “hard work
never killed anybody.” As I
grew stronger and was able to
take on more and more responsibility in the campaign, I no longer worried about that
next attack. I assumed my lifestyle changes had solved my problem.

By the time I began my service as vice president I could look back on
twenty-two years of living with heart disease. I had accomplished a lot in spite of my
condition and was confident going forward that I could continue to do the same. The key
was to deal with my health separately from my job and never to let one interfere with
the other. I didn’t want worries about my heart disease to keep me from focusing
on the requirements of my job. And I didn’t want the job to be an excuse for not
doing something that needed to be done to deal with a health problem.

As we approached the 2004 reelection campaign, I raised with President
Bush the possibility of my stepping aside so he could appoint someone else to serve as
vice president in his second term. This wasn’t related to my health, but rather
because I felt strongly that the president should have the opportunity to make a change
if he thought it would strengthen the ticket. I believed, as the incumbent vice
president, that it was my responsibility to make it easy for President Bush to select
someone else if he wanted to do so. The first two times I brought the subject up, I felt
President Bush had not really focused on it. So I went back a third time and he agreed
to think about it. A few days later, he came back to me and said that he wanted me to
continue on the ticket, which I was honored to do.

When Lew Hofmann redrew the vice president’s blood early in the
morning on Wednesday, September 12, he had more on his mind than just potassium. The
repeat labs were normal, and ultimately we deduced that the high potassium was simply
the result of the prolonged delay
in processing the sample, which
ensued following the evacuation of the White House. This is the note that he sent to the
vice president:

September 12, 2001

Mr. Vice President

I am very pleased to report that your repeat potassium
was NORMAL! Both Dr. Reiner and Dr. Malakoff share my
joy. . . .

Find enclosed your dose of Cozaar and K-Dur for today.
Additionally, there is a packet of doxycycline antibiotic for protection from
anthrax infection as we discussed this morning. Dr. Malakoff is fairly certain that
he has given you this medication in the past without adverse effect. You should take
one tablet twice per day for three days. Should the threat persist beyond then, I
will provide another packet of medication. . . .

Lewis A. Hofmann, MD

White House Physician

In the days and weeks following September 11, people in Washington, New
York, and other cities around the country wondered whether, and when and how, the next
attack would come. National Guard Humvees were posted around DC, including on the
sidewalk in front of our clinic, antiaircraft batteries were positioned on the National
Mall, and police stationed at strategic locations brandished automatic weapons. Within
this new reality, the White House Medical Unit took steps to protect the president and
vice president from potentially weaponized biological agents.

In a note to the vice president on September 15, Lew wrote:

We began the prophylaxis in an uncertain threat environment in order to
provide protection, flexibility, and reassurance to you. . . .

Monitoring has been in place for several days, and no evidence of
chemical or biological attack has been identified. . . . The risk of
taking the medication is very small compared to the severity of illness
that would be caused by exposure to anthrax. Therefore until the threat landscape
becomes more clear, I recommend continuing the doxycycline.

A few days later, letters containing anthrax spores were mailed to two US
senators and several media outlets, resulting in the deaths of five people, prompting
Lew to change his advice for the vice president:

Dr. Tubb has recommended anthrax vaccination for the President, and I
recommend the same for you. . . . I am writing to you as your White House
Physician rather than as a biological warfare expert. . . . My
recommendations are specific to your situation only, and cannot be generalized to large
groups, forces or populations. They should also be placed in the context of intelligence
reports you may have received to which I am not privy.

In his book
The White House Physician,
Dr.
Ludwig M. Deppisch calls the WHMU “an
apolitical,
professionally focused, tightly structured, military-staffed health maintenance
organization,” but in post-9/11 America, the fuller scope of the medical
unit’s mission became apparent.

In October, Lew Hofmann again updated the vice president:

I would like to close by sharing with you that the White House Medical
Unit took the lead several years ago in preparing for bio/chemical terrorism. On
September 11th, in an uncertain environment, we took broad measures to defend against
attack. . . . As we have discussed, you are now effectively immunized
against anthrax and the antibiotics you are taking should protect you from plague and
tularemia. We have an effective plan in place to treat an attack with botulism, and we
stand prepared with vaccination to prevent you from smallpox infection if you are
exposed. Please advise me if you require additional information, and I truly appreciate
the opportunity to serve.