Heart: An American Medical Odyssey

by Cheney, Dick

  Cheney returned to the ICU on four intravenous drips to sustain his blood pressure and cardiac function. Although the vice president’s left ventricle was fully supported by the VAD, the right ventricle was not, and it was struggling. Dr. Jason Vourlekis, the director of the cardiac surgical ICU, was waiting for Cheney when he returned from the operating room and would oversee the care of the vice president until he was stable for transfer to the step-down unit.

  By Friday, only forty-eight hours post-op, Vice President Cheney had improved to the point where he could be taken off the ventilator. Over the next few days, he remained relatively stable, making slow but steady progress, but four days later, on Tuesday, July 13, the vice president became short of breath and a chest X-ray revealed a new abnormality in the right lung consistent with pneumonia. Antibiotics were prescribed, but over the next few days, Cheney’s respiratory status declined.

  On Sunday, July 18, eleven days following surgery, Shashank Desai, Jason Vourlekis, Gigi El-Bayoumi, Nelson Burton, and I met at Fairfax to discuss Cheney’s status. Over the prior few days, the vice president’s chest X-ray had worsened. It was becoming increasingly hard for him to breathe. After a long discussion with Mrs. Cheney, Liz, and Mary, we made the decision to place the vice president back on the respirator.

  Recovery from a critical illness is often not complication free, and although it was disappointing to lose ground, I remained optimistic.

  “This is a setback, not a catastrophe,” I explained.

  The vice president was kept sedated, his antibiotic regimen was broadened, and he remained on the respirator for the next five days. During these difficult first few weeks, not a moment went by that a member of the vice president’s family wasn’t with him. Mrs. Cheney, Liz, and Mary took turns sleeping in the room adjacent to his.

  On July 23, two and a half weeks after his VAD surgery, Cheney was once again extubated.

  Relieved that he was off the respirator, and no doubt anxious to hear how his patient was feeling, Dr. Vourlekis said, “I think you look good, Mr. Vice President. What do you think?”

  The room was silent while we awaited Cheney’s response. The vice president looked up at Vourlekis and, mist bellowing from the humidified oxygen mask on his face, said, “I think you’re full of s—t.”

  CHAPTER 14

  Transplant

  VICE PRESIDENT CHENEY

  Of all the procedures I have undergone since that first heart attack in 1978, the LVAD surgery was by far the toughest. The actual operation was complicated by the fact that I was very weak with a failing heart and rapidly declining liver and kidney functions at the time of the surgery. It was especially difficult because it required going in through the scar tissue left from my bypass surgery in 1988. The network of blood vessels that had developed on the site created serious bleeding problems for the surgical team. I needed twenty units of blood during the surgery, and I was on the operating table for more than nine hours the night of July 6 and the morning of July 7, 2010.

  My hospital stay lasted five weeks. Some of that time I spent on a respirator, heavily sedated. At one point, the respirator was removed, but when I contracted pneumonia, I had to go back on it. I was fed intravenously and lost more than forty pounds. When I saw myself in the mirror for the first time some weeks after the surgery, I saw my dad, shortly before he died of heart failure just before his eighty-fourth birthday.

  When I came out from under the sedation, I was asked what, if anything, I remembered from that period. I said I had very vivid memories of living in a villa in a small village north of Rome. I recalled the streets of the village and small, attractive cafés where I ate great Italian food and drank good Italian wine. I had walked through the same street every morning to get coffee and a roll for breakfast and to pick up my morning newspaper. There was an American couple there that I talked to on occasion. The man was there for some kind of medical procedure. I had the feeling I was also there for a medical procedure, but it was never clear what kind and I never saw any evidence of any medical facilities or personnel. I also had a vivid recollection of sitting out on a patio overlooking a long dirt road with a car on it climbing up a hill to get to the village, but it never got there. Sometime later, while watching one of my favorite movies, Saving Private Ryan, I recognized that scene. In the movie, Private Ryan’s mother watches the car from the window of her kitchen. When it arrives in the yard outside her door, two passengers emerge, an army officer and a priest. They are there to notify her that three of her four sons had been killed in action in World War II.

  At other times I believed the hospital was located at LAX in Los Angeles or on the Sioux Indian Reservation in South Dakota. I remembered a visit from Dr. El-Bayoumi, our family physician. I had tried to persuade her to help me escape from the hospital because, I told her, “I don’t belong here; there has been some kind of mistake.” But the overwhelming memory was of my Italian interlude. My family wanted to know if they were with me, and unfortunately I had to tell them they were not—which wasn’t the right answer. Their experience had been the direct opposite of mine. They had been extremely worried about my condition and my prospects, especially when I contracted pneumonia and had to go back on the respirator. At the least, they said, I could have taken them to Italy.

  When I discussed my long dream with my doctors, they said they had no idea what goes on in the heads of patients when they spend a long time heavily sedated, as I had. My family and I speculated the fact that one of my principal surgeons was named Rongione might have been responsible. I also had been reading a novel by Dan Silva, a friend and one of my favorite authors, set in Italy. Lynne and I and our family have had many occasions over the years to travel to Italy. It is a place we love. It was not at all surprising that if I was going to take a vacation someplace while I underwent everything that was being done to me, I had chosen Italy.

  • • •

  After regaining consciousness and getting off the respirator, I was still very sick and weak. I developed a craving for crushed ice. The doctors didn’t want me to drink large quantities of liquids, but they would let me eat ice. I remember lying in bed while Lynne, Liz, and Mary took turns feeding me small spoonfuls. My doctors were most concerned that I had completely lost my appetite. I was wasting away because I didn’t want to eat. It wasn’t just hospital food. Things had a different taste than they ever had before, and nothing seemed appetizing. Until I resumed eating normally, there was no prospect that I could recover from the surgery or begin the long, demanding process of rehabilitation.

  Eventually I regained my appetite when the doctors agreed I could have some of my favorite foods. I developed an immense craving for milk, which I hadn’t drunk on a regular basis since I was a youngster. Häagen-Dazs vanilla ice cream was a hit. My daughter Mary brought me homemade chocolate chip cookies baked according to my mother’s recipe. I finally convinced my doctors that what I really needed was a Big Mac and a large order of fries. I got them, although they were not part of the normal menu for patients in the ICU.

  My biggest problem aside from my loss of appetite was that my weakened state before the surgery, plus the surgery, combined with all those weeks flat on my back, part of it sedated and on a respirator, had destroyed my ability to do anything for myself. For the first time in my life, I was completely and totally disabled. With the exception of breathing, there was no bodily function I could perform without assistance. And to keep breathing, I had to exercise my lungs several times a day with a device designed to expand my lung capacity. The degree of helplessness was extreme. I remember thinking that for the first time, I really understood the enormous challenges facing those who are permanently disabled. I came to understand the courage and determination it takes them to perform functions I had always taken for granted. I was told I could plan on at least one full week of rehab for every day I spent in the hospital. In my case, that meant thirty-five weeks just to recover my normal capabilities.

  • • •

 
Once I was off the respirator, the rehabilitation process began. The therapists were dedicated professionals who were very good at their jobs. They saw me every day, often two or three times a day, and never let me duck a session. No excuses were accepted. We started small with simple exercises to begin regaining my strength. At first it took two of them to sit me up in bed or get me to a wheelchair. I was just dead weight because all of my muscles had atrophied. Simple tasks such as taking the cap off a tube of toothpaste were impossible. From my bed, I could see the bathroom, and I longed for the day when I would be able to get out of bed, walk to the facility, and use it on my own.

  In the early days of recovery, I had numerous tubes in my chest. The most important was the LVAD driveline, but there were also other tubes draining my chest, which would come out as I healed. I had an IV and a device in an artery in my arm to precisely measure the amount of oxygen in my blood.

  One particular memory of Lynne stands out in my mind. The night they wheeled me into the operating room for the emergency surgery, they were concerned that my fingers had swollen so much they might have to cut off my wedding ring. Fortunately they were able to get it off, and Lynne wore it on a gold chain around her neck until she could return it to me some weeks later. It was the first time I had been without my ring in the forty-six years we had been married.

  Inova Fairfax Hospital had an innovative program we participated in during my stay. They allowed visits by family dogs, a great morale builder. Of course, there were certain standards that had to be met, but our two labs, Jackson and Nelson, were perfectly well behaved the day they came to see me. They seemed to understand this was a special event and acted accordingly. It was great to see them. My family had also decorated my room with photographs that had been taken by David Bohrer, my official photographer in the White House. As my overall condition improved, I was taken outside to a garden at the hospital for some fresh air.

  As I got ready to check out of the hospital, I thought of all the tremendously dedicated and talented people who had performed the surgery and looked after me for the initial five weeks of my recovery. One of the most impressive was Pat Rakers, the nurse in charge of my stay in ICU. She was tough but compassionate and ran her unit with an iron fist. Pat didn’t take any lip from anybody, including senior physicians and former vice presidents. She was a veteran of fourteen years” service in the US Army. While I was secretary of defense, Pat had been a member of the crew of a Patriot missile battery. After her time in the army, she went to nursing school and has followed my case in the years since I was her patient.

  • • •

  Being deemed fit to go home didn’t mean I could get along without assistance. We made arrangements with a firm to provide health care at home during the early weeks of my recovery, including having someone in the house twenty-four hours a day to help with essential functions. They also made arrangements to transport me home from the hospital. When I was taken to the parking lot on a gurney, I saw a vehicle that didn’t look like an ambulance, which is what I had been expecting. It looked exactly like a hearse. It was a long, black limo with room in the back for the gurney and barely enough for the patient. Lying flat on my back, I had only a few inches of space between my nose and the roof of the “hearse.” It immediately occurred to me that I was being taken out of the hospital in exactly the kind of vehicle they would have used if my surgery had not been successful. I thought it was pretty funny, but I never shared that with my family. I wasn’t certain they would see the humor in it.

  When we arrived home, I was moved from the “hearse” to a wheelchair and taken into the master bedroom. Significant changes had been made to accommodate my needs as a patient. Lynne had rented a hospital bed, which could be raised, lowered, or adjusted at the touch of a button. There was also a specially designed chair suitable for use in the shower and the bathroom, but it still required professional help to make use of it. The home health care people were set up in the basement, and I could summon them with a two-way radio from my hospital bed anytime I needed help. Most of them were nurses or EMTs working a second job. They were very good and proved invaluable in the early weeks of my recovery at home.

  The LVAD is a tremendous piece of lifesaving equipment, in my case providing the time needed to become eligible for a heart transplant. Initially it takes a lot of getting used to and a good deal of discipline on the part of the patient and the family. Even after you have left the hospital, it is crucial to have someone to help on a continuous basis and, if at all possible, to have a devoted family member who can be your advocate and ask all the tough questions, taking responsibility for your care. In my case, Lynne devoted virtually all her time for many months to focusing on my well-being. She learned everything there was to know about the LVAD and the technology it represents. Liz and Mary, as well as Gus Anies, who works for us, took training on the operation of the equipment so they could help me deal with a crisis should one arise.

  My family got deeply involved in other ways with my care while I was still in the hospital. During the most difficult days of my recovery, one of them was present twenty-four hours a day. There was a window in my room that opened out onto the hallway. Each morning I could look out and see doctors making their rounds followed by the usual collection of residents, students, and nurses. One day as I looked out, I saw a familiar face: Liz was in the gaggle following the doctors.

  While the up-to-date LVAD I used is a significant improvement over the older machines that required patients to be tethered to a large machine and therefore unable to move about independently, it still requires a lot of effort to adjust to always having to be plugged into a power source. When I came to after the surgery, one of the first things I was aware of was the driveline coming out of my chest into a control element, through the base power unit, and into a wall socket. It was mandatory that I never be without power for the LVAD. When we moved out of the vice president’s residence in 2009, we had moved into a new home we had built in McLean, where there are a lot of old trees, and much of the power distribution system is aboveground. It is not at all unusual in a thunderstorm or a heavy snowstorm to have major power outages. Without knowing that someday I would be living on an LVAD, we had fortuitously installed at our new house a large generator powered by natural gas that automatically turns on any time there is a power outage.

  On one occasion, a TV camera crew came to the house to shoot an interview with me for a documentary. They were determined to set up a lot of lights to supplement the natural light that was available. In doing so, they had knocked out the circuit breaker, shutting off power to that part of the house. I told the producer, tongue in cheek, that I was living on a heart pump that required power twenty-four hours a day. I said I didn’t want them to be alarmed, but it made me very nervous every time they shut down the power. (I didn’t tell them I was operating on batteries at the time.) They became exceedingly apologetic and cooperative once they believed their zealotry about lighting might be a threat to the continued functioning of my heart.

  In my initial period at home, I was in bed most of the time and therefore on the tether connecting my LVAD to the base power unit, which was plugged into an electrical outlet in the wall. As I made progress and became more active, I began to operate off the batteries that came with the LVAD. We had ten or twelve of them that when fully charged were good for up to twelve hours of operation. I wore two at a time. One was supposedly sufficient to run the LVAD, but I never gave one-battery support more than a brief test. Redundancy is a very good thing when your life is at stake. I charged the batteries I wasn’t wearing with a machine that fit inside a Rollaboard. When I traveled I carried it that way. The base power unit also fit into a Rollaboard for easy transport. At night in bed, I would switch over to the tether connecting me to the unit, which was much more comfortable for sleeping.

  There are numerous alarm systems on the LVAD that signal when the batteries are low or if there is a malfunction in the equipment. I carried a black “go bag
,” which contained a spare control element as well as extra batteries, so that I could replace all of the external equipment if necessary. On one occasion when Lynne and I were at a cocktail party, there was suddenly a noise that sounded a lot like a cell phone going off. My immediate reaction was to wonder what fool had failed to turn off his phone at the party. Then Lynne came over to me and said, “Dick, I think you are beeping.” She was right: an alarm was indicating my batteries were low. We stepped into a nearby room and put in new batteries, trying to draw as little attention as possible.

  On more than one occasion, in the middle of press interviews, I deliberately disconnected one of my batteries, which always triggered the alarm. It was disconcerting to those around me, most of whom didn’t realize I had a backup and everything was still operating normally. I did it once to Jamie Gangel of NBC, who immediately pleaded, “Please reconnect that!” and forgot the line of questioning she’d been pursuing. Once flying across the country, I had my noise-canceling headphones on, listening to music. I was reading a newspaper when my assistant, riding several rows in back of me, came up and tapped me on the shoulder. When I took my earphones off, she told me I was beeping. Because of my headphones, I hadn’t heard it, but everyone else on the plane had.

  Once when I left my house in Wilson, Wyoming, to run some errands in downtown Jackson, I forgot the go bag, which presented quite a dilemma when my batteries started beeping. All the instructions say that they are good for only ten minutes after the beeping starts—and replacements were twenty minutes away. I called my daughter Mary, who was visiting, and she grabbed the go bag and headed in her car to the Snake River bridge, the halfway point between our house and Jackson. I set out for there myself and got new batteries from Mary before the old ones ran down.