07.15.10

The Miracle of Dick Cheney

He’s had five heart attacks, and could soon seek a transplant. Dr. Kent Sepkowitz on the extraordinary history of Dick’s ticker—and how government health care keeps him alive.

Thursday’s news that former Vice President Dick Cheney had received a left ventricular assist device, or LVAD, is the latest installment in America’s longest-running medical drama, a story extending back to 1978, when Cheney had his first of five heart attacks. With the insertion of the LVAD, Cheney has completed a rare quadrifecta of heart procedures, costing about a half of million dollars in all—and led left-wingers, cardiologists, and left-wing cardiologists to wonder how a man with such a bad metaphoric and anatomic heart can keep on kicking. Or as Firesign Theater once famously asked of George Tirebiter, "How does an old man like you stay alive?"

But before going to the actuarial tables, we need to review his truly remarkable medical history—keeping in mind all the while that what we know about Dick and his heart is of uncertain accuracy. After all, Cheney is a maniacally secretive man famous for such tours de force as stonewalling attempts to discover what his National Energy Policy Development Group, aka the energy task force, was up to in the early months of his vice presidency. So it does seem rather odd that the one set of facts he actually is entitled by law to keep his trap shut about—his medical history—is the only area for which he readily has given up total unfiltered information.

Cheney’s miraculous longevity is… exhibit A in the argument for intrusive and overarching government programs to ensure the public’s health.

The heart has four main parts, each relatively independent of the other, each with its unique roster of ailments and remedies. Cheney has had serious problems with three of them. First there are the valves, those mechanical open-close governors of forward blood flow. People with valve problems develop heart murmurs and may eventually need valve replacement. To date, this is the only part of Cheney’s heart still in tip-top shape.

Next is the wiring, the nerves that control rate and rhythm, referred to as the conducting system. Dick, alas, has had some difficulties here. There are two basic flavors of heart rhythm problems—“atrial,” including the common condition atrial fibrillation; or ventricular, which may manifest as the often-fatal ventricular tachycardia, or, worse yet, ventricular fibrillation. Cheney has required electrical shocks twice for the atrial problem (not cheap) and in 2001 implantation of an automatic implantable cardioverter defibrillator (AICD) (call it $25,000-$30,000) to respond to any ventricular turbulence.

The third component of the average heart is the set of coronary arteries, the blood vessels that feed blood to the heart itself. Trouble here can require coronary artery bypass graft (CABG) surgery, which Cheney underwent in 1988; he received a quadruple bypass, probably reflecting the widespread nature of his arterial narrowing ($100,000 to $200,000). In 2000, at the height of the Florida non-recount, one of these arteries clotted off, resulting in his fourth heart attack and the need for a stent—a stiff pipe placed to pry the artery open and maintain its capacity (also not cheap).

Finally, this month, he needed help to treat the fourth component of the heart: the muscle. The heart muscle does what the heart does—it pumps blood forward. When the heart can no longer do this adequately, the condition is called heart failure. And in the last few months, Cheney has developed intractable heart failure. The best remedy for severe heart failure is a heart transplant, which, according to the Los Angeles Times, Cheney is considering. But for those who need help before a heart is available, or for whom a transplant is too risky, we have a gizmo called the left ventricular assist device, a $200,000 item. The LVAD is a cumbersome almost-artificial heart that requires the recipient to wear heavy batteries, a shoulder sling with various parts, tubes going through the chest and into the heart and abdomen, and other substantial inconveniences. It helps push a portion of the heart’s blood forward, doing the work the failing ventricle no longer can accomplish. Once used only to stabilize people awaiting heart transplant, it now is referred to, not ironically, as a “destination therapy”—the exact intervention that you want, not the half-assed loaner you are stuck with till the real McCoy arrives.

So there you have it: the curious case of Cheney and his Wondrous Heart. But what about the basic question from above: Why on earth is anyone with this cardiac history still alive? Could it be some odd demonic possession or other explanation better suited for True Blood than for the medical textbooks?

Six years ago, the doctor and medical historian Howard Markel, writing in The Atlantic, assembled seven fancy cardiologists and discussed Anonymous Patient C’s medical history with them; all were surprised that he was still puttering along, and even more surprised to then be informed that he was at the time their vice president. Stated most simply, he should have died long, long ago. Most people with his heart, his weight and sedentary habits, his history of cigarette smoking and who knows what else already have heard the bell toll. But not Cheney—pointing out that, though useful to define national trends, population-based statistics are completely useless for predicting the fate of an individual. The extremely unlikely happens every day, all of the time: Just as it’s the rare person who wins the lottery, or is struck by lightning, or rolls snake eyes 50 times in a row, so too does a bad guy with a worse heart beat all the odds to stay alive.

Oil baron, draft dodger, professional paranoid, and all-around Blue Meanie, Cheney’s miraculous longevity is nothing so much as the happy product of the heavily tax-subsidized and regulated American health-care system, exhibit A in the argument for intrusive and overarching government programs to ensure the public’s health. Though the free-marketeers would argue the exact opposite—that the invention of such sci-fi devices as the LVAD are the product of unfettered capitalism—this completely ignores the reality of how such inventions are tested, monitored, and reviewed. Devices are studied in hospitals propped up by Medicaid and Medicare dollars organized by doctors funded by federal grants. Patient safety is assured by government bean-counters spread throughout windowless Washington offices via a process that is noticeable only when it fails—when, for example, a pacemaker is found to be defective, or a medication proves toxic.

Cheney is alive today despite a lifetime spent trying to deprive the needy of basic human rights such as health care. Yet his continued survival shows both the impotency of his attempts and the potency of the American health-care system, a lumbering bureaucracy no doubt, but one that blindly cares for big-hearted Joes as well as heartless Dicks.

Kent Sepkowitz is an infectious disease specialist in New York City. He has contributed to The New York Times, Slate, and, oh-so-briefly, O Magazine. He also writes academic medical articles that are at times pretty tough sledding.