Illustration by Tina Berning
Dick Cheney’s first heart attack occurred when he was 37, a young man running for the U.S. House of Representatives in Wyoming. His most recent — a fifth — happened in 2010.
By then, the former vice president had taken advantage of everything technology and medicine had to offer a man with chronic heart problems: stents, defibrillators, an extended-battery-powered heart pump and quadruple coronary bypass. He was at what he believed was the end of the road.
Facing end-stage heart failure, he received a left ventricular assist device, or LVAD, in the summer of 2010 that saved his life. But for Cheney, the device wasn’t enough. He realized that a transplant was the only option that would set aside decades of heart ailments and give him a gift by then he thought was impossible: longevity. Twenty months later, when he was 71, a late-night phone call informed him a donor had been found. Life for Cheney would begin anew.
Nearly two years after his transplant, Cheney and his cardiologist, Jonathan Reiner, MD, have written a book about his history of heart ailments, Heart: An American Medical Odyssey. Paul Costello, executive editor of Stanford Medicine, spoke to Cheney about life after near death.
Costello: You’ve written a book that serves up intimate details about your health over 35 years of heart disease. Why did you decide to tell your story?
Cheney:While I was living on a heart pump, the left ventricular assist device, awaiting transplant, I got a call one day from someone at the Cleveland Clinic who said they were getting ready to have a conference on innovation in cardiology. They had suppliers and doctors coming in to speak but they needed a patient. I had virtually everything done to me that you could do to a heart patient since my first heart attack in 1978, so I agreed. That started the wheels rolling.
I also get questions all the time and letters from people about various aspects of my case. Some have a loved one awaiting a transplant or getting ready to undergo the LVAD procedure. Nearly one in four Americans has some kind of heart problem. This told us there’s a story to be told that was useful and that would also tell the success that we’ve experienced in medical innovations under our existing health-care system.
Costello: What did you hope to accomplish?
Cheney: We didn’t write it for political reasons. It was a combination of being able to tell a story and the fact that during 35 years of heart ailments, I’ve held some pretty important jobs. I’ve been able to live a full and active life while dealing with heart disease as we went through it.
‘It offered the hope of a return to a normal life and the prospect of taking 35 years of coronary heart disease and putting them behind me. In my mind, it wasn’t a close call.’
Costello:When you made the decision to proceed with surgery if a heart became available, what factors carried the day?
Cheney:The main consideration was longevity. We got into the LVAD because I was at the end of my line. I’d had five heart attacks and an incident of sudden cardiac arrest, and by early July of 2010, I was near death. My ejection fraction was down somewhere around 10 percent. My heart was no longer able to provide an adequate supply of blood to my liver and my kidneys. We reached the point where the only way to deal with that crisis was an all-night surgery to install the LVAD. I had a very tough recovery coming out of that. Five weeks in the ICU. I contracted pneumonia. I was heavily sedated on a respirator for part of that time. I was one sick puppy.I was confident early on that I wanted to go for a transplant if I could get one. It offered the hope of a return to a normal life and the prospect of taking 35 years of coronary heart disease and putting them behind me. In my mind, it wasn’t a close call.
Costello:You were at death’s door in 2010. But you write that you were at peace facing death. Why weren’t you more fearful?
Cheney:The fifth heart attack was in February, and by June I reached the point where I was obviously in end-stage heart failure. All I wanted to do was to get out of bed in the morning, sit down in my chair and sleep some more. I’d lost most of my physical abilities to do anything.
I had my first heart attack at 37 years old, when you think you’re going to live forever. Over time, with chronic heart issues, I concluded that sooner or later, I was going to run out of technology and new innovations in the area of heart medicine.
That’s how my dad had died. That’s how my maternal grandfather had died. I fully expected there would come a time when, indeed, that would be representing the end of my days. I thought about it. I was at peace. It wasn’t painful. It wasn’t surprising or frightening. I had lived a wonderful and remarkable life. I had a tremendous family. Everything a man could ask for. Now my time had come. I wanted to talk with my family about final arrangements. It was a very hard conversation for them, much more so than it was for me, but I felt I needed to express my views. I was at peace. That was the only way I could think of to describe it. It was not frightening, unpleasant or disturbing. It was my time.
Costello: Now you’re living without a threat of imminent death. Can you even describe how that feels?
Cheney: A day doesn’t go by that you don’t think about the fact that you’ve been a beneficiary of a miracle that’s a result, I always remember, of a donor. I wake up every morning with a smile on my face, grateful for another day that I never expected to see.
Costello: When you consider the conversations you had with your physicians over the years about your heart issues, is there any one conversation that stands out?
Cheney: It was 1978. I was 37 years old and running for Congress, my first campaign for elective office. I had a heart attack. It was a mild one. As I was recovering in Cheyenne, Wyo., I asked my doctor, Rick Davis, if this meant I would have to give up my campaign. He replied, “Aw heck Dick, hard work never killed anybody.” That’s what I wanted to hear. I can tell now, by going back and looking at medical records from that period of time, that Rick and another doctor who also treated me had reservations about my going forward with a campaign. Neither of them believed that telling me to get out was the right thing to do because I was so committed to the campaign and because it meant so much to me. So, while privately they clearly had some reservations, what I took away from those conversations was Rick’s advice: “Hard work never killed anybody.” I sort of lived that way through my career. There was never a moment when I wasn’t eager to get back to work. A crisis would arise. We’d deal with it and then I’d move on. The mindset I came away with was that I wasn’t a patient or a victim.
Costello: You wrote that the dramatic reduction of the incidence of heart disease over the past 40 years is a national treasure and deserves to be protected. Can you expand on that? What needs to be done to protect it and what might stand in the way?
Cheney: The first thing that comes to mind is that, as efforts are made to try to reform our health-care system, you don’t want to do something stupid or that has unanticipated consequences. For example, the idea of a device tax, which is part of Obamacare. Putting a tax on the first dollar of revenue on the folks who come up with those innovations and implementing them is a really bad idea. Why would you want to slap a medical device tax on those devices that not only in heart care, but in other areas, save lives?
Costello: Is the protection of NIH funding critical too?
Cheney: Well, I think that ought to be a priority. If you want to have the best health-care system that’s effective, you’ve got to have the necessary investment in research. NIH is part of that process.
Costello: What are you doing to take care of your new heart?
Cheney: One, I don’t eat raw seafood. When you suppress your immune system, one of the big no-no’s is oysters on the half shell or sushi. I used to enjoy all those foods but that’s not a hard sacrifice.
I ride a recumbent bike about 30 minutes a day. I live a normal, active life. I love to fish and hunt. I am getting plenty of exercise and doing those things I’ve always loved doing. I have to wear a hat every time I go outside because you’re more vulnerable to skin cancer when your immune system has been suppressed.
Costello: Aren’t you amazed that four years ago you were at death’s door and now you’re able to live life?
Cheney: Exactly. It’s the gift of life itself.
Costello: You dedicate your book to your family and your donor. I wonder, have you ever considered, what if you have the heart of a liberal Democrat?
Cheney: [laughs] Well, I don’t worry about it. People speculate, “Did it change you? Do you have different values and attitudes?” Not that I’m aware of. I operate on the basis that it’s my new heart. I don’t spend a lot of time thinking about where the heart came from. What kind of life did they live? Who were they? From my own standpoint, it’s a great gift from a donor and the donor’s family but now it’s my heart. It’s that mindset that I think works best for me. SM
This interview was condensed and edited by Paul Costello.