Heart: An American Medical Odyssey

by Cheney, Dick

  Vice President Cheney never asked for, and never received, any special accommodation while he was on the transplant list, as some television pundits later insinuated. Cheney waited twenty months for the call that finally announced his new heart, almost double the usual wait.

  When I arrived at Fairfax, the vice president had already changed into a hospital gown and was sitting with Mrs. Cheney and Liz in the same corner ICU suite in which he nearly died following surgery to implant the VAD two summers before. I had an uncomfortable moment of déjà vu when I entered the unit, but I reminded myself that this wasn’t the same patient we admitted in July 2010. This patient was well nourished, with great kidney function, excellent physical strength, and no evidence of clinical heart failure. That other patient had been dying.

  The nurses were busy with their long preoperative checklist, and it would be several hours before the surgery began. A team would be going out to harvest the heart early in the morning, and Cheney wouldn’t be brought to the operating room for several hours. Hopefully he would be able to get a little sleep before then.

  Shashank had some lingering questions about the donor and the heart. The only way to answer those questions was to physically evaluate the ultrasound and the donor ourselves. Without telling the Cheneys where we were headed, Shashank and I excused ourselves and left Fairfax.

  • • •

  At 3:00 a.m., we drove through mostly deserted streets to the hospital where the donor was being sustained on a ventilator and IV drips. When we entered the ICU, we found the transplant coordinator busily working the phones. Shashank and I introduced ourselves, and she pulled up the echocardiogram on a computer for us to review.

  It’s often difficult to get good-quality echo images in a ventilated patient, but what we could see suggested that the heart was normal in size, with normal valves, and good function. It looked like a fine heart.

  We asked the coordinator if we could see the donor, and she took us to the room. I entered filled with a mixture of sadness, respect, and gratitude, consciously reminding myself that I wasn’t looking at a patient who was dying but someone who had already died. The monitors in the room displayed blood pressure, pulse rate, and blood oxygenation, and they all looked fine, but in this terrible setting, they told me nothing about the patient; they were just individual gauges of organ function. This patient was dead.

  I found it impossible to look at this person, a few days ago full of life, and now lifeless, without the humbling reminder of how temporary everything in this world is.

  • • •

  I arrived home as the sun inched over the horizon and caught a couple of hours of sleep before returning again to Fairfax midmorning. The vice president had been brought to the OR early, and his operation began around ten o’clock. Simultaneously, surgery was under way at the other hospital to harvest the donated organs.

  Because the success of the transplant is inversely related to how long the donor heart is without blood, surgery to remove the old heart cannot wait for the arrival of the new organ. Conversely, the actual surgery to remove the recipient’s damaged heart cannot begin until the team harvesting the donor heart is certain that the donor organ will be suitable, and that happens only when the harvesting surgeon physically examines the heart. Word came that it was a go, and the two surgeons, Dr. Anthony Rongione (who saved Cheney’s life twenty months earlier with his brilliant implantation of the VAD) and Dr. Alan Speir, the hospital’s director of cardiac surgery, who had trained in cardiothoracic surgery in Texas under Dr. Denton Cooley, got to work.

  As was the case during the VAD insertion, the cannulas for the heart-lung machine were placed first, via the large femoral artery and vein at the top of the leg, so that if the surgeons encountered severe bleeding when they opened Cheney’s chest, they would be able to support his blood pressure with cardiopulmonary bypass.

  Once Cheney was on bypass, Rongione and Speir opened the chest and went about the process of meticulously dissecting scar tissue so that the entire heart and its vascular connections were visible.

  Late in the morning, before the new heart arrived, Alan called me over to the table.

  “Hey, Jon, take a look.”

  In Alan’s raised right hand, festooned with surgical clamps and now separated from the body that it sustained for seventy-one years, rested the vice president’s heart. It was huge, more than twice the size of a normal organ, and it bore the scars of its four-decade battle with the relentless disease that eventually killed it.

  I turned from the heart to look down into the chest. Although we had passed the surgical point of no return at least an hour before, the surreal void was a vivid reminder that there was no turning back.

  It was surprisingly quiet in the operating room as we awaited the new heart. During the brief interlude, I checked my phone and found a text message from my wife, who was on her way to Colorado with our children. The message read: “Praying for RBC. Thought of him while flying over this vast beautiful country.”

  Right on cue, the electric doors to the OR slid open and a burly surgeon carrying a small Igloo cooler hustled into the space. The cooler contained the donor heart, which was immersed in a cold electrolyte solution inside a double layer of transparent plastic bags. The surgeon who harvested the heart was Dr. Lucas Collazo, and after handing off the priceless gift to the surgical team, he shook my hand and reminded me that our training had overlapped at North Shore University Hospital twenty-two years earlier.

  The new heart was gently handed to Rongione and Speir and placed in the chest of the vice president. First, the back of its left atrium was sewn to a small residual cuff of Cheney’s original left atrium. Next to be connected was the inferior vena cava, the large vein that returns venous blood from the lower half of the body. Then one after the other, the superior vena cava, the pulmonary artery, and finally the aorta were joined to the new heart.

  When Rongione and Speir were satisfied that all of the anastomoses were secure, the aortic clamp was removed. Now, for the first time in its new home, the heart received warm blood, and after a single shock from defibrillator paddles, it started to beat on its own.

  I know that heart transplantation is fundamentally an elegant surgical procedure forged from a century of relentless work by courageous people who refused to believe that it couldn’t be done, but for me, like the birth of a child, the awakening of a heart in its new host is a moment filled with divine grace.

  • • •

  As the surgical team started to close the vice president’s chest, I stepped out of the operating room to update Mrs. Cheney and Liz, waiting in the same ICU space where they had sat vigil twenty months earlier. I described how different things were this time: how well Cheney had done, the magnificent new heart, and, with a quivering voice, the moment it started to beat. Soon we were joined by Drs. Speir and Rongione, whose beaming smiles telegraphed their news.

  EPILOGUE

  Days of Grace

  VICE PRESIDENT CHENEY

  When I awoke after surgery, Dr. Reiner and Dr. Speir were standing by my bed telling me the operation had gone very well. They said that as soon as the new heart had been connected to my blood supply and given a shock, it had started beating, which if you think about it is pretty amazing—an organ from one person happily taking up residence in another—and all because thousands of people have worked in research laboratories and operating rooms over the years perfecting the medicines, the techniques, and the technology that make transplant surgery possible. Getting a new heart is miraculous, but so is the way that researchers and doctors have worked for decades to advance the knowledge and skill that came together for me in a hospital in Northern Virginia.

  Of the three open heart surgeries I’ve had, transplant was by far the easiest. After the operation, I was on a respirator just a few hours, and I experienced only the mildest discomfort, even on the incision. Tylenol 3 was the strongest painkiller I needed. Three days after the surgery, I was out of bed walking the halls
of the coronary care unit. I had been told that if everything went perfectly, I might get discharged after two weeks in the hospital. I was out in nine days. Three weeks after the surgery, I was in Wyoming, speaking to the Republican state convention in Cheyenne.

  My recovery continues to be trouble free. I take antirejection medications to suppress my immune system so that it does not reject my new heart. With my immune system suppressed, I am more vulnerable to infections, and I have thus become a great consumer of antibacterial hand wipes. I use them on armrests and tray tables when I’m on a plane and keep them handy whenever I’m going to be shaking a lot of hands. Having my immune system suppressed also makes me more vulnerable to skin cancer, so I’ve learned to apply sunblock first thing every morning and to never go outside without a hat—preferably my Stetson. I also have regular tests—heart biopsies and gene profiling—to look for the signs of rejection, but so far none have appeared.

  When I woke up in the hospital, all the paraphernalia connected with the LVAD was gone. I was no longer connected to an electrical source. There was no base power unit. There were no batteries. And other things were gone as well, including my old heart, which after thirty-five years of coronary artery disease, five heart attacks, and episodes of A Fib and V Fib had grown to twice the normal size in an effort to pump blood through my body. Missing was the stent that had been inserted in a coronary artery and the ICD that had saved my life. The only evidence I have been a heart patient—to a layman like me, at least—is the scar on my chest.

  Writing this book with Jonathan Reiner has been a great experience. Jon is not only a world-class cardiologist, he is a thoughtful, well-read person who brings a long perspective to his work. He is also a man of unfailing good humor, which is pretty important in someone with whom you spend long hours in the cath lab or going over book revisions. I thought I knew a lot about coronary artery disease when we began this project because I had lived with it for thirty-five years, but now I feel as though I have been through a yearlong advanced seminar on the history of medical cardiology. Studying my medical records has also given me a whole new perspective on what I have been through. As I was living it, I dealt with one crisis at a time, but now I see the long arc of my disease and understand the relationships between what previously had looked like discrete events.

  I particularly realize how fortunate I have been that new medications, procedures, and devices in coronary medicine have stayed ahead of my disease. Jon observed one day that it was as though I were traveling down a street, late for work, and all the lights ahead of me were red, but they turned green just before I got there. Most of the innovations that have saved and extended my life weren’t available when I had my first heart attack in 1978. The health care system that produced such rapid development and has driven the dramatic reduction in the incidence of death from heart disease over the past forty years is a national treasure and deserves to be preserved and protected.

  I find myself thinking a lot about the past these days, about ancestors like Samuel Fletcher Cheney, my great-grandfather, whose Civil War sword hangs on the wall of my office alongside ceremonial swords presented to me by the Corps of Cadets at West Point and by the commandant of the US Marine Corps. I think about my parents and questions I should have asked them while they were here. How I wish they had lived long enough to have been at the inaugural when I was sworn in as vice president on January 20, 2001. What a pleasure it would have been for them to know their great-grandchildren.

  I think about the future, too, and how grateful I am to be able to leave a record of my life for my grandchildren and their grandchildren. I spend a lot of time with my four granddaughters and three grandsons, doing things I never thought I would be able to. The other day, before I realized what I had done, I had picked up a forty-pound sack of horse feed and thrown it into my pickup truck with nary a twinge—except maybe in my bad knee. Three years ago, I was in end-stage heart failure and could hardly get out of my chair.

  Fifteen months after receiving my new heart, I look on every day as a magnificent gift. I had reconciled myself to dying. I was grateful for having been able to share my life with Lynne and Liz and Mary and the rest of our wonderful family. I considered myself fortunate for all that I had been part of as a result of my career. I had indeed lived in interesting times. I felt I had left nothing undone and was at peace with the idea that I had reached the end of my days.

  And now suddenly I have new days ahead—incredible and amazing days that I never expected to see. I owe these days of grace to the donor of my heart and the donor’s family, to my medical team, and to family and friends all across America who have sent their prayers my way. They have given me the gift of life, and I thank them. I cannot imagine anything more precious that one human being could bestow on another.

  Meeting with presidential counselor Jack Marsh in my West Wing office in 1976. The White House used to give out free packs of cigarettes emblazoned with the presidential seal. Official White House Photo by David Hume Kennerly

  On the floor of my West Wing office with a calculator and election returns from the 1976 New Hampshire primary. Official White House Photo by David Hume Kennerly

  Late on election night 1976, when Bob Teeter and I met with President Ford and Senator Jacob Javits, one of Ford’s closest friends, and delivered the news to the president that it looked like we had lost the 1976 election. All the votes weren’t in yet, and we decided to wait until the next morning to concede the election. Official White House Photo by David Hume Kennerly

  On the road during the 1976 campaign with President Ford and press secretary Ron Nessen. Official White House Photo by David Hume Kennerly

  Dr. Reiner, circa 1964.

  With Dr. Jonathan Reiner and Dr. Alan Wasserman, leaving GW Hospital, March 6, 2001. Official White House Photo by David Bohrer; Presidential Materials Division, National Archives and Records Administration

  Drs. Jonathan Reiner, Alan Wasserman, and Sung Lee at the press conference after the ICD implant, June 30, 2001. Getty Images/Greg Whitesell

  Internal components of an ICD. Reproduced with permission of Medtronic, Inc.

  Popliteal aneurysm repair team, September 24, 2005. From left to right: Dr. Ryan Bosch, Dr. Anthony Venbrux, Dr. Jonathan Reiner, Dr. Barry Katzen, and Dr. Peter Gloviczki.

  In my West Wing office, April 2008. Official White House Photo by David Bohrer; Presidential Materials Division, National Archives and Records Administration

  In the West Wing, April 2008. From left to right: Dr. Cindy Tracy, Dr. Ryan Bosch, Dr. Jonathan Reiner, and Col. (Dr.) Lewis Hofmann. Official White House Photo by David Bohrer; Presidential Materials Division, National Archives and Records Administration

  Cover of The New Yorker from August 30, 2004. Copyright © 2004. Originally published in The New Yorker. Reprinted by permission.

  One tabloid’s take on the cardiac technologies from which I benefitted. Photo by David Bohrer/ The White House

  Schematic diagram of HeartMate II LVAD system. Photograph courtesy of Thoratec Corporation

  With my surgeon Dr. Alan Speir at Inova Fairfax Hospital four days after the heart transplant. Photograph courtesy of Liz Cheney

  Components of the explanted VAD. Photograph courtesy of Thoratec Corporation

  With Liz at Inova Fairfax Hospital four days after the heart transplant. Photograph courtesy of Alan Speir, MD

  With Dr. Shashank Desai and Pat Rakers, my ICU nurse, one year after the transplant. Photograph courtesy of Jonathan Reiner, MD

  With Lynne at our home in McLean a few hours after I was released from the hospital following my transplant operation. Photograph courtesy of Kara Ahern

  In the spring of 2013, my grandson Richard asked me to be his kindergarten show-and-tell. I was happy to oblige. The teacher said I was the most exciting show-and-tell since the morning a little girl brought her cow to class. Photograph courtesy of Liz Cheney

  At the ceremony for the Bush Library groundbreaking on November 16, 201
0, my first public appearance after the LVAD surgery. There were audible gasps when I walked onstage. AP Photo/LM Otero

  This picture of me with my youngest grandchild, Sarah Lynne Cheney, was taken in May 2010, shortly before I went into end-stage heart failure. I was much more sick than I knew or looked at the time. How lucky I am that now I have the chance to watch her grow up. Photograph courtesy of Heather Poe

  At the dedication of the George W. Bush Presidential Library and Museum in April 2013, a little more than a year after my transplant. Getty Images/Alex Wong

  Acknowledgments

  VICE PRESIDENT CHENEY AND DR. REINER

  This story would not have been possible without the tireless, world-class efforts of the physicians, nurses, and staff of the George Washington University Medical Faculty Associates, the George Washington University Hospital, Inova Fairfax Hospital, the White House Medical Unit, and several other institutions. Special recognition goes to Dr. Benjamin Aaron, Dr. Ryan Bosch, Dr. Nelson Burton, Dr. Brian Choi, Dr. Lucas Collazo, Dr. Anthony Caputy, Dr. Paul Dangerfield, Dr. Rick Davis, Dr. Shashank Desai, Lori Edwards, Dr. Gigi El-Bayoumi, Dr. Joseph Giordano, Dr. Peter Gloviczki, Dr. Wes Hiser, Dr. Lew Hofmann, Dr. Andrew Holmes, Dr. Dick Katz, Dr. Barry Katzen, Dr. Sung Lee, Dr. Janet Lewis, Dr. Conor Lundergan, Dr. Gary Malakoff, Julia Mason, Dr. Paul Massimiano, Mary Beth Maydosz, Dr. Ramesh Mazhari, Sarah Murphy, Dr. Wayne Olan, Pat Rakers, Dr. Anthony Rongione, Carolyn Rosner, Dr. Allan Ross, Dr. Nader Sadeghi, Dr. Alan Speir, Dr. Cindy Tracy, Dr. Dick Tubb, Dr. Jacob Varghese, Dr. Anthony Venbrux, Dr. Jason Vourlekis, and Dr. Alan Wasserman.