Heart: An American Medical Odyssey (7 page)

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 nonexistent. 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.

An eclectic playlist streams softly in the background as I back through the doorway, warm water dripping from my arms. The staff, wearing masks, scrubs, and several pounds of protective lead, go about their jobs with an efficient, good-humored professionalism. The patient, covered neck to toe by a blue surgical drape, lies cruciform on a narrow gantry, eyes closed in a fentanyl-induced fugue, his right arm strapped to a board, palm up and perpendicular to the table, an oval opening in the drape exposing his wrist painted orange with antiseptic scrub. Two palm-sized patches on his chest are attached to the defibrillator perched on a rolling cart near the wall, its reassuring beeps quickly fading into familiar white noise. I dry my hands with a towel and slip into the sleeves of a sterile gown that unfolds with a quick downward flip. I pull on a pair of gloves, the latex issuing its characteristic
thwack
as I release each cuff. A nurse ties the back of my gown, and I step toward the patient preparing for a routine procedure that not long ago was impossible.

•  •  •

For millennia, the human heart remained mysterious and inviolable, the center of the physical body and the immortal soul, the sacred wellspring of character, intelligence, and valor.

In ancient Egypt, the heart was the only internal organ left in place during mummification, believed indispensable in Duat, the underworld, where it would be weighed against a feather, the symbol of Maat, goddess of truth and justice. Should the scales balance, the deceased would be deemed worthy of admission to the afterlife. If, however, the heart was heavy, Ammit, the devourer of the dead, a fearsome creature with the head of a crocodile, body of a lion, and hindquarter of a hippopotamus, would consume the heart, leaving the soul without rest.

Although the Greeks of the fourth century B.C. knew that the heart had four chambers and understood its anatomical relationship to the large blood vessels arising from it, knowledge they derived principally from the dissection of animals, luminaries like Aristotle and Hippocrates did not understand the organ’s role in the circulation of blood. Aristotle believed that the heart was the center of human consciousness, and in many of the languages that evolved over the millennia, the word
heart
represents more than just the cardiac structure. Mandarin uses the same character (xīn) for both “heart” and “mind.” The English word
courage
is derived from the Latin
cor
(heart), as are its Italian, French, and Portuguese counterparts, and the word
core
literally means heart.

At the beginning of the third century B.C., human dissection was permitted in Alexandria, and it was there that important advances were made in understanding the structure of the vascular system. The Greek physician Herophilus correctly considered the atria part of the heart (as opposed to part of the vessels leading into the heart) and was the first to describe the differences between the thick-walled arteries and the thin-walled veins, noting correctly that the vessel exiting the right ventricle was an artery, not a vein, and the vessels leading into the left atrium were veins, not arteries. Herophilus is also credited as being the first physician to count the pulse, though he incorrectly believed that the pulsations were caused by the contraction of the arteries.

Galen, a second-century Greek physician who lived in the Roman Empire and whose writings would dominate medicine for fifteen hundred years, believed that the heart was the source of the body’s heat and moved pneuma (air, vital spirits) around the body. Although Galen did not believe that the heart was a muscle, he clearly understood its unique attributes:

Its flesh is hard and not easily injured, being composed of fibres of many different kinds, and because of this, even if it would appear to be like muscles it is clearly different from them. . . . And in its hardness, tone, or tension and general strength and resistance to injury, the fibres of the heart much surpass all other fibres. For no organ functions so continuously, or moves with such force as the heart.

The classic view of circulation, which would perpetuate into the seventeenth century, can be summarized. The veins, it was thought, were the principal blood vessels and arose from the liver; the arteries contained only a small amount of blood mixed with pneuma; the heart provided the body’s heat and vital spirits; blood was propelled by inspiration; and the pulse was caused by contraction of the arteries.

Even Leonardo da Vinci, whose detailed dissections and subsequent drawings so elegantly depicted the anatomy of the heart, could not break with the Aristotelian and Galenic view of the purpose of the heart, though he came close to articulating its role in circulation when he wrote, “The heart is the seed which engenders the tree of the veins.”