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State of the Art

by Michael Walsh

Heart: An American Medical Odyssey, by Dick Cheney and Jonathan Reiner, M.D., with Liz Cheney (Scribner, 352 pp, $28)

‘You’re not sure what is happening, but somehow, in a visceral way you can’t articulate, you know that it is not good. At first, the symptoms were subtle. Maybe you awoke not feeling right; you might have had some of these symptoms yesterday, but you’re not really sure when it began. You thought it might be indigestion because you’re a bit nauseated, and you took some antacid a little while ago, but the discomfort hasn’t eased. Now you’re feeling something in your shoulder and chest, and your left arm is tingling. Someone tells you that you look pale, and you realize that your shirt is drenched even though it is not warm in the room. You’re asked if you are having chest pain, and you say no, it’s not a pain, it’s more like a pressure or maybe a tightness. When you try to describe what you’re feeling, you subconsciously place a clenched fist over your chest. You have the sense that if you could manage to burp, you would feel better, but you can’t, and to make matters worse, you’re a little short of breath.

“You don’t know it yet, but a blood clot, smaller than a pencil’s eraser, is forming inside one of your coronary arteries, and if it is not dealt with quickly, it can kill you.”

This is about as good a description of a heart attack as can be imagined by anyone who has not, in fact, had one, the confusing, conflicting symptoms perfectly set forth. And no wonder: It’s written by Dr. Jonathan Reiner, director of the cardiac-catheterization laboratory at George Washington University Hospital in Washington, D.C., and one of the nation’s top cardiologists. He is the co-author of this riveting true-life medical thriller, in collaboration with the country’s most famous heart patient, former vice president Dick Cheney, and with Liz Cheney, the ex-veep’s daughter.

They say that if you survive your first heart attack, your long-term survival chances are good. Dick Cheney’s heart history proves that maxim five times over. Cheney will go into the books as either a political hero or a villain, depending on who’s writing the history; scholars and partisans can and will argue about that for decades. But it’s his history as a heart patient — he suffered his first heart attack in 1978, and had four more after that before his heart completely gave out — that deserves prolonged, nonpartisan scrutiny. For Cheney’s lethal coronary-artery disease and his perils-of-Pauline heart, perhaps uniquely in modern medical history, have been consistently outpaced by discoveries and improvements in medical technology, each one appearing just when he needed it most, right up to his successful and so far complication-free heart transplant in 2012.

Heart is written in alternating sections, taking us through Cheney’s entire cardio history, as seen through the eyes of both the patient and the doctor. Much of Cheney’s personal story will be familiar to those who read his 2011 memoir, In My Time, a well-written, dispassionate, and fluent account of his many years in public service as a congressman from Wyoming, White House chief of staff under Gerald Ford, secretary of defense under George H. W. Bush, and vice president in the George W. Bush administration; were the man a Democrat, he’d be celebrated by the media as a selfless patriot with a “compelling personal narrative” of overcoming the worst kind of physical adversity. As Reiner notes of his controversial patient, “My father used to say that it’s one thing to have a disease, but quite another to let the disease have you. . . . [Cheney] managed to live an extraordinarily full life despite having had to live with an extraordinarily aggressive disease for a very long time.” Aside from one delightful shot at John McCain, however, this book is as apolitical as possible.

The real interest here is Reiner’s contribution, a lucid and jargon-free recounting of the history of heart surgery, from something once deemed impossible to a commonplace procedure today. The advances made in the treatment of cardiovascular disease, including bypass surgery, drugs, angioplasty, medicated stents, defibrillators, VADs (ventricular assist devices), and transplantation: Cheney’s had them all. It is astounding to think that, as recently as President Eisenhower’s 1955 heart attack at the age of 65, the standard course of treatment — assuming one survived the initial infarction — was essentially bed rest and prayer. Writes Reiner: “Eisenhower’s case illuminates the standard of care for a heart attack at midcentury. For the first eight decades of the 20th century, the standard therapy for a heart attack mostly involved bed rest and pain control, usually with morphine, palliative treatments intended to keep the patient quiet and comfortable in the hope that no further catastrophe would befall the damaged heart.”

Now, just over half a century later, hope is no longer the principal option, and a heart attack is not a sentence to prolonged invalidity and death. True, heart disease — an unsexy killer — is still the leading cause of death in the U.S. for both men and women, killing about 600,000 people annually; according to the Centers for Disease Control, one in every four deaths is attributable to coronary causes. And yet, as Cheney’s epic medical saga proves, one can live a long and productive life in spite of it all.

I know. Four years ago, while I was on business in Washington, D.C., a heart attack hit me at 3 a.m. in my hotel room near Dupont Circle. At first, I had no idea what was happening: Pressure in the chest, check; tingling in the left arm, check; nausea, check. Heart attack? Impossible. It had to be indigestion, or an old ulcer acting up. I suffered with it for six hours before finally calling a doctor, who advised me to get to the hospital as fast as possible. A short time later, I was on the gurney, being rushed into the catheterization lab at G. W. University Hospital. As I was being prepped, one of the medical staff told me I was a lucky man, that the doctor on call was Dick Cheney’s personal heart doctor. Five minutes later, Dr. Jon Reiner introduced himself to me and went to work.

Take it from one who knows: If you have a heart, then Heart is for you.

– Mr. Walsh is a journalist, novelist, and screenwriter, and a regular contributor to National Review Online. Writing as “David Kahane,” he is the author of Rules for Radical Conservatives: Beating the Left at Its Own Game to Take Back America.

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