The Heart Of The Matter

Posted: Jul 08, 2001 12:00 AM
Question: (BEG ITAL)``Mr. Vice President, can you continue in your current job ...?'' Question: (BEG ITAL)``Have you talked at all with the president about the possibility of resignation and how that would be handled?'' --Reporters, Cheney press conference, June 29 WASHINGTON--The silliness has gone on long enough. It is time for a little clarity about Vice President Cheney's health. It begins with the distinction between having an underlying disease and what we colloquially think of as being ``sick.'' For example, you can have progressive underlying kidney disease for years without even knowing it, let alone feeling it. You can have kidney disease that destroys 50 percent of normal function, and you will still feel perfectly normal. (Which is why a healthy person can donate a kidney with impunity.) Indeed, you generally don't experience any symptoms whatsoever until your kidneys are about 80 percent gone. Vice President Cheney has coronary artery disease. But he is not ``sick.'' Cheney has physiological changes in his heart, but (BEG ITAL)day-to-day he has no clinical symptoms: no anginal pain, no shortness of breath, no weakness, nothing. The Holter monitor he wore for 34 hours picked up four very short episodes of arrhythmia; he felt none of them. His heart is damaged, of course, but it functions perfectly adequately to sustain a normal life. Yes, Cheney is not going to run the Boston Marathon. Not many 60-year-olds do. To carry on anything but extreme activity, he is in as good shape as any other 60-year-old. Contrast this with American leaders who were indeed sick. President Kennedy because of his Addison's disease, Eisenhower after his major heart attack, and Roosevelt as a result of his coronary disease, often felt sick--suffering pain, exhaustion, weakness or other symptoms that directly affected not only their lives but often their ability to perform in office. This is not the case with Cheney. We know that from his self-report, and from the report of all of his associates. For those inclined to see conspiracies of silence of the kind that covered up disease and debility in past presidents, I can report one experience that offers firsthand corroboration of Cheney's health. I happened to have been with the vice president on March 5, shortly before he entered George Washington Hospital for that emergency procedure to clear the blockage in his coronary artery stent. I was at a lunch with him that concluded no more than two hours before his symptoms struck and he went to the hospital. What did I see from a distance of two feet? A man who showed not the slightest evidence of any pain, weakness, pallor or any other sign of physical discomfort. It is possible that he was being supremely stoic. But why? The fact that he canceled other appointments later in the day when he experienced pain shows that he is not wont to permit deference to guests to jeopardize his life. I have not practiced medicine for a long time, but I still know the signs of cardiac distress. This man was not suffering them. Outside of his well-publicized episodes, Cheney doesn't. Which is why the question of resignation is so out of place. Yes, his cardiac disease may someday affect his day-to-day life. At that point the question will be relevant. Today it is not. What then (BEG ITAL)does Cheney's heart disease do to him? For now, it has one effect: It puts him at higher risk for some (BEG ITAL)future catastrophic event. You and I and have a finite risk of suffering a fatal heart attack or arrhythmia in the next 24 hours. It is very small but it is real. Cheney's is higher. Big deal. It is not as if he is uniquely at risk. One percent of Americans who turn 60, as Cheney recently did, will not live to see 61. By late middle age, most people have some medical problem--kidney, liver, lungs, breasts, etc.--that may kill them. Cheney's happens to be cardiac. After FDR and Kennedy, and more recently, Tom Eagleton (depression) and Paul Tsongas (a fatal cancer), the press has grown rightly suspicious of politicians hiding or underplaying illness. But Cheney has been straight. Rather than being hectored about his health, perhaps he deserves a little credit for the grace and good humor with which he faces a problem that seems to scare others a lot more than it scares him.