Heart: An American Medical Odyssey

by Cheney, Dick

  We would also like to thank those who made the book possible, beginning with attorney Bob Barnett, whose excitement for the project was immediately apparent. Bob’s wise counsel and his unique insight every step of the way have been irreplaceable.

  We are both grateful to Carolyn Reidy, the CEO of Simon and Schuster, and Susan Moldow, the publisher of Scribner, for their enthusiasm and support for this project. Our editor Shannon Welch provided seemingly endless encouragement and gently guided us through the amazing and sometimes arduous process of writing this book. We also offer our thanks to the assistance of Simon and Schuster’s John Glynn and Brian Belfiglio.

  DR. REINER

  Two days after Dick Cheney’s heart transplant in March 2012, I sat with Liz and Lynne Cheney in Inova Fairfax Hospital. As it was already quite apparent that the vice president was going to do well, spirits were very high. I told Mrs. Cheney and Liz that the entire history of cardiovascular medicine could be told through the remarkable thirty-five year medical odyssey of Dick Cheney.

  Mrs. Cheney said, “That would be a great book!”

  “That’s my book,” I said half jokingly.

  “Let me tell Dick,” she said as she left the room. In a few minutes Mrs. Cheney returned and said, “Dick loves the idea.”

  Two weeks later Liz called and asked if I was serious about the book. I said I was. “Good,” she said. “Dad’s already told Don Rumsfeld he’s writing a book with you.” Such was the beginning of this project, and it would not have been possible without the warm support of Lynne and Liz Cheney.

  Liz was an invaluable collaborator from the very beginning of this project, and I will always be grateful for her assistance, friendship, and constant encouragement.

  I had the great good fortune to have an “in-house” medical editor (who also happens to be my wife). Charisse is a pulmonary/critical care–medicine physician, and her input was irreplaceable. The writing of this book consumed the little free time my usual occupation affords me, and without the love, patience, and help of Charisse and my daughters, Molly and Jamie, it simply would not have been possible.

  Over the past fifteen years almost every member of the division of cardiology at George Washington University Hospital has had a role in the care of Dick Cheney, and I will forever admire their dedication to the treatment of people with heart disease. The group includes Dick Cheney’s former cardiologist, Dr. Allan Ross, who was a mentor to me when I came to GW twenty-three years ago and who gave me my start in academic medicine. Dr. Alan Wasserman, Dr. Dick Katz, and Dr. P. Jacob Varghese were, and continue to be, my teachers, and to them I offer my deepest respect and gratitude. My colleagues Dr. Cindy Tracy and Dr. Sung Lee were important members of the team caring for Vice President Cheney, and their skill and professionalism have always been remarkable. Dr. Gary Malakoff cared for Mr. Cheney for many years, and after his departure his very large shoes were not easy to fill. Dr. Gigi El-Bayoumi, who became the vice president’s internist five years ago, is one of the most remarkable physicians I have had the honor of working with, and she continues to teach me much about the art of medicine and the healing power of compassion.

  Dr. Lew Hofmann will have my eternal respect and admiration. Lew has the rare combination of competence, professionalism, and humility. Lew spent more than twenty years in service to the Air Force and this country, including eight years caring for Vice President Cheney and his family. If we had a most valuable player award it would go to Lew.

  Over the last few years I have had the great pleasure of working with the heart failure team at Inova Fairfax Hospital. Dr. Shashank Desai and his colleagues have built a superb program, and their care for a critically ill Dick Cheney was remarkable. Special thanks go to Dr. Nelson Burton, Dr. Anthony Rongione, Dr. Alan Speir, Dr. Jason Vourelkis, and nurse practitioners Carolyn Rosner, Lori Edwards, and Mary Beth Maydosz.

  As the deadline for this manuscript sped closer, my colleague Dr. Ramesh Mazhari very generously assumed some of my clinical duties and shooed me off to the library, enabling me to complete the book. Dr. Miriam Fishman and Gwen Grossman reviewed portions of the manuscript, and their thoughtful input was helpful and always appreciated.

  Finally, I would like to thank Vice President Dick Cheney for his wholehearted commitment to this project. It’s not easy to sift through decades of your own medical records, documenting the relentless progression of a lethal illness, but the vice president did just that, always with great curiosity and enthusiasm.

  As we were completing the book I asked Vice President Cheney if he was at all apprehensive when he received the call alerting him that a heart had been found and within a few hours he would be undergoing a transplant.

  “No,” he said.

  “The last operation to place the VAD almost killed you. Why weren’t you afraid?” I persisted.

  “Because you told me the transplant would be easier.”

  There is no greater honor for a physician than to have a patient place his or her trust in you, and I will forever be humbled by the confidence placed in me by this singular patient and by every patient for whom I am privileged to provide care.

  © DAVID HUME KENNERLY/GETTY

  DICK CHENEY served at the highest levels of government and the private sector for more than forty years. He was White House chief of staff under President Gerald Ford and was elected six times to the US House of Representatives from Wyoming, eventually becoming the minority whip. He served as secretary of defense under President George H. W. Bush, overseeing America’s military during Operation Desert Storm in 1991. He served as chairman and CEO of a Fortune 500 company, and as the forty-sixth vice president of the United States, he served two terms under President George W. Bush during the dawn of the Global War on Terror, playing a key role in events that have shaped history.

  © MATT MENDELSOHN

  JONATHAN REINER, MD, is the director of the cardiac catheterization laboratory at the George Washington University Hospital and professor of medicine at George Washington University in Washington, DC. A graduate of the University of Pennsylvania and Georgetown University, Dr. Reiner completed a residency in medicine at North Shore University Hospital and Memorial Sloan-Kettering Cancer Center in New York and fellowships in cardiology and interventional cardiology at the George Washington University Medical Center. The management of patients with complex coronary artery disease remains his focus today. Dr. Reiner lives in Maryland with his wife, Charisse, and daughters, Molly and Jamie.

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  In My Time

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  Notes

  CHAPTER 1: A PRIME CANDIDATE

  In 1502, Leonardo da Vinci: Charles D. O’Malley and J. B. de C. M. Saunders, Leonardo da Vinci on the Human Body (New York: Greenwich House, 1982), 22, 300.

  The term atherosclerosis: James L. Young and Peter Libby, “Atherosclerosis,” in Leonard S. Lilly, Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty (Philadelphia: Lippincott Williams & Wilkins, 2007), 118.

  the Spanish influenza pandemic infected: US Department of Health and Human Services, The Great Pandemic: The United States in 1918–1919, http://www.flu.gov/pandemic/history/1918/the_pandemic/index.html.

  Atherosclerotic disease developed in the United States: J. Michael Gaziano, “Global Burden of Cardiovascular Disease,” in Peter Libby et al., Braunwald’s Heart Disease: A Textbook of Cardiovas
cular Medicine, 8th ed. (Philadelphia: Saunders, 2008), 1–14.

  In 1971, Abdel Omran: Abdel R. Omran, “The Epidemiologic Transition: A Theory of the Epidemiology of Population Change,” Milbank Memorial Fund Quarterly 2005, 84:737–741. (Reprinted from Milbank Memorial Fund Quarterly, 1971;49:509–538.)

  there were steep reductions in deaths: Gregory L. Armstrong, Laura A. Conn, and Robert W. Pinner, “Trends in Infectious Disease Mortality in the United States during the 20th Century,” Journal of the American Medical Association 1999;281:63.

  On the eve of World War II: Hardy Green, “How K-Rations Fed Soldiers and Saved American Businesses,” Bloomberg.com, February 20, 2013, http://www.bloomberg.com/news/2013-02-20/how-k-rations-fed-soldiers-and-saved-american-businesses.

  Following the war, Keys returned: Patricia Sullivan, “Ancel Keys, K Ration Creator, Dies,” Washington Post, November 24, 2004.

  Beginning in the late 1940s: Ancel Keys et al., “Coronary Heart Disease among Minnesota Business and Professional Men Followed Fifteen Years,” Circulation 1963;28:381.

  1957 American Heart Association report: I. H. Page, F. J. Stare, A. C. Corcoran, H. Pollack, and C. F. Wilkinson, “Atherosclerosis and the Fat Content of the Diet,” Journal of the American Medical Association 1957;164:2051.

  Ancel Keys continued to investigate: Ancel Keys (ed.), “Coronary Heart Disease in Seven Countries,” Circulation 1970 (suppl. to vol. 41): 1–211.

  In 1961, the American Heart Association appeared: Irving H. Page, Edgar V. Allen, Francis L. Chamberlain, Ancel Keys, et al., “Dietary Fat and Its Relation to Heart Attacks and Strokes,” Circulation, 1961;23:134–135.

  Later that same year: “The Fat of the Land,” Time, January 13, 1961.

  According to the American Lung Association: “Trends in Tobacco Use,” American Lung Association Research and Program Services, Epidemiology and Statistics Unit, July 2011, http://www.lung.org/finding-cures/our-research/trend-reports/Tobacco-Trend-Report.pdf.

  Despite a greater than 50 percent decline: http://www.lung.org/stop-smoking/about-smoking/facts-figures/smoking-and-older-adults.html.

  There are more than seven thousand chemical substances: http://www.cdc.gov/tobacco/data_statistics/sgr/2010/consumer_booklet/chemicals_smoke/.

  Framingham investigators had developed: “History of the Framingham Heart Study,” http://www.framinghamheartstudy.org/about/history.html.

  In the 1970s, doctors: J. Judson McNamara, “Coronary Artery Disease in Combat Casualties in Vietnam,” Journal of the American Medical Association, 1971;216(7):1185–1187.

  CHAPTER 2: ECHOES OF IKE

  indigestion while playing golf: Frank H. Messerli, Adrian W. Messerli, and Thomas Lüscher, “Eisenhower’s Billion-Dollar Heart Attack—50 Years Later,” New England Journal of Medicine 2005; 353;12:1205.

  In his exhaustive book: Clarence G. Lasby, Eisenhower’s Heart Attack: How Ike Beat Heart Disease and Held On to the Presidency (Lawrence: University Press of Kansas, 1997), 97–98.

  In 1880, Karl Weigert, a German pathologist: Nikhil Sikri and Amit Bardia, “A History of Streptokinase Use in Acute Myocardial Infarction,” Texas Heart Institute Journal 2007;34:318.

  the legendary Sir William Osler: William Osler, The Principles and Practice of Medicine (Birmingham: The Classics of Medicine Library 1978), page 641.

  “Obstruction of a coronary artery’: James Herrick, “Clinical Features of Sudden Obstruction of the Coronary Arteries,” Journal of the American Medical Association 1912;59:2015–2020.

  “Which comes first’: William Roberts, “Coronary Thrombosis and Fatal Myocardial Ischemia,” Circulation 1974;49:1.

  “I am happy the doctors’: Dwight D. Eisenhower: “Remarks upon Arrival at the Washington National Airport,” November 11, 1955, http://www.presidency.ucsb.edu/ws/?pid=10384.

  In 1933, William Kouwenhoven: Jonas A. Cooper, Joel D. Cooper, and Joshua M. Cooper, “Cardiopulmonary Resuscitation: History, Current Practice, and Future Direction,” Circulation 2006;114:2841.

  The first successful defibrillation: Ibid.

  In 1956, one year after President Eisenhower’s: Paul M. Zoll, Arthur J. Linenthal, William Gibson, Milton H. Paul, et al., New England Journal of Medicine 1956;254:727–732.

  “Cardiac resuscitation after cardiac arrest’: W. B. Kouwenhoven, Dr. Ing, James R. Jude, and G. Guy Knickerbocker, “Closed-Chest Cardiac Massage,” Journal of the American Medical Association 1960;173:1064.

  The stage was set: D. G. Julian, “The History of Coronary Care Units: Ischemia and Infarction,” Lancet 1961;21:840–844.

  Years later, Julian noted: Ibid., 498.

  CHAPTER 3: INTO THE HEART

  In ancient Egypt: James Peto, The Heart (New Haven, CT: Yale University Press, 2007), 1012.

  Although the Greeks: C. R. S. Harris, The Heart and Vascular System in Ancient Greek Medicine, From Alcmaeon to Galen (Sandpiper Books, Ltd., 2001), 160, 179, 271, 272.

  Even Leonardo da Vinci: Charles D. O’Malley and J. B. de C. M. Saunders, Leonardo da Vinci on the Human Body (New York: Greenwich House, 1982), 282.

  “That there is one blood stream’: William Harvey, On the Motion of the Heart and Blood Vessels in Animals, Alexander Bowie ed. (London: George Bell and Sons, 1889), xviii.

  “The heart of animals’: Ibid., 4.

  “An organ . . . particularly vulnerable’: Harry M. Sherman, “Suture of Heart Wounds,” Boston Medical and Surgical Journal 1902;146:653.

  In 1929, Werner Forssmann: David Monagan, Journey into the Heart (New York: Gotham Books, 2007), 18–27.

  “I checked the catheter position’: Werner Forssmann, “Catheterization of the Right Heart,” Kleinische Wochenschrift 1929;8:2085–2089.

  For the next quarter-century: “The Nobel Prize in Physiology or Medicine 1956,” http://www.nobelprize.org/nobel_prizes/medicine/laureates/1956/.

  CHAPTER 5: A TALE OF TWO DRUGS

  In the late 1970s: Marcus A. DeWood, Julie Spores, Robert Notske, et al., “Prevalence of Total Coronary Occlusion during the Early Hours of Transmural Myocardial Infarction,” New England Journal of Medicine 1980;303:897–902.

  Using a laboratory model: Keith A. Reimer, James E. Lowe, Margaret M. Rasmussen, and Robert B. Jennings, “The Wavefront Phenomenon of Ischemic Cell Death. I. Myocardial Infarct Size vs Duration of Coronary Occlusion in Dogs,” Circulation 1977;56:786–794.

  Progressively longer occlusions: Keith A. Reimer and Robert B. Jennings, “The Wavefront Phenomenon of Ischemic Cell Death. II. Transmural Progression of Necrosis within the Framework of Ischemic Bed Size (Myocardium at Risk) and Collateral Flow,” Laboratory Investigation 1979;40:633–644.

  In 1933, William Tillett: William S. Tillett and R. L. Garner, “The Fibrinolytic Activity of Hemolytic Streptococci,” Journal of Experimental Medicine 1933;58:485–502.

  Evgenii Chazov in the Soviet Union: E. I. Chazov, L. S. Matveeva, A. V. Mazaev, K. E. Sargin, et al., “[Intracoronary Application of Fibrinolysis in Acute Myocardial Infarction],” Terapevticheskii Arkhiv 1976;48:8–19.

  Peter Rentrop in West Germany: K. P. Rentrop, H. Blanke, K. R. Karsch, V. Weigand, et al., “Acute Myocardial Infarction: Intracoronary Application of Nitroglycerin and Streptokinase,” Clinical Cardiology 1979;2:354–363.

  In the years that followed: Nikhil Sikri and Amit Barda, “A History of Streptokinase Use in Acute Myocardial Infarction,” Texas Heart Institute Journal 2007;34:323–324.

  In 1956, researchers: P. Roy Vagelos, “Are Prescription Drug Prices High?” Science 1991252:1082.

  In September 1980, Sankyo: Jonathan A. Tolbert, “Lovastatin and Beyond: The History of the HMG-CoA Reductase Inhibitors,” Nature Reviews 2003;2:517–526.

  Questions concerning the clinical impact: “Scandinavian Simvastatin Survival Study Group: Randomised Trial of Cholesterol Lowering in 4444 Patients with Coronary Heart Disease: The Scandinavian Simvastatin Survival Study (4S),” Lancet 1994;344:1383–1389.

  CHAPTER 6: BYPASS

  “
Surgery of the Heart’: Stephen Paget, “Wounds of the Heart,” in Surgery of the Chest (Bristol, CT: John Wright & Co., 1896), 121.

  “The sight of the heart beating’: James W. Blatchford III, “Ludwig Rehn: The First Successful Cardiorrhaphy,” Annals of Thoracic Surgery 1985;39:494.

  “The road to the heart’: Harry M. Sherman, “Suture of Heart Wounds,” Boston Medical and Surgical Journal 1902;146:654.

  During that long night: John H. Gibbon Jr., “Development of the Artificial Heart and Lung Extracorporeal Blood Circuit,” Journal of the American Medical Association 1968;206;1983.

  Determined to solve the problem: Larry W. Stephenson, “History of Cardiac Surgery,” in Cardiac Surgery in the Adult, Third Edition, ed. Lawrence H. Cohn (New York: McGraw-Hill Medical, 2008), 8.

  The idea for this approach: William S. Stoney, “Evolution of Cardiopulmonary Bypass,” Circulation 2009;119:2849.

  “a potential mortality of 200 percent’: Ibid., 2849.

  In Detroit, Dr. Forest Dodrill: Manon Caouette, “Research on Cardiopulmonary Bypass in North America,” in Dawn and Evolution of Cardiac Procedures, ed. Marco Picichè (Milan: Springer-Verlag Italia, 2013), 118.