Another four months, another Cheney heart problem. In November, the vice president had a heart attack; in March, he underwent surgery to expand a narrowed artery. And on Friday, the vice president told reporters that he would be heading into the hospital within the following 24 hours to have an electrophysiology study to determine whether he was developing what his cardiologist called "a persistent, abnormal heart rhythm."
If the test revealed that -- and Cheney said that it likely would -- he would be admitted to George Washington University hospital to have an implantable cardioverter defibrillator (ICD) inserted in his chest.
But Cheney is famous for understatement. His two previous episodes were marked by White House spin and subterfuge. So is Cheney being upfront about his treatment and prospects for recovery?
For the most part, yes. But he may have underplayed the seriousness of the surgery by saying, "It is basically an outpatient procedure."
When asked if the ICD implant was normally an outpatient procedure, Dr. J. Thomas Bigger, a Columbia University cardiologist, flatly replied no. "It's not the procedure that's big, it's the disease that's big," said Bigger, who served as a spokesman for Democratic presidential candidate Bill Bradley last year when it was revealed that the former New Jersey senator suffered from heart palpitations.
While Bigger acknowledged that "different [medical] centers have different ways of doing it," he said that he would never send a patient home the same day he performed an implant because he would want to make sure that the heart rhythm stayed stable after the procedure was completed. "It mainly has to do with being sure that everything is secure," he said. "There's no point in taking any chances with it."
Dr. Richard Stein, chief of cardiology at the Brooklyn Hospital Center and a spokesman for the American Heart Association, also claimed that an ICD implant would normally require a patient to stay in the hospital for the night. "Sure, you could go home if you had a doctor and nurse going with you, someone who could stay up and monitor whether anything went wrong," Stein said.
With White House physicians available around the clock, a doctor probably wouldn't demand that Cheney spend the night in a hospital. "It's kind of like the pope," Stein said. "If he says he wants to go home, you can't really stop him."
However, Douglas Zipes, president of the American College of Cardiology, allowed that the procedure "could be outpatient or inpatient," depending on a patient's health.
Otherwise, the information coming from the White House appears generally solid. Though he emphasized that he was not privy to details of Cheney's condition, Stein said that the chances of something going wrong with the procedure or of the vice president's being incapacitated were very, very small. "It's really a low-risk procedure," Stein said.
And Bigger couldn't stop praising the effectiveness of the ICD. "It's 99.9 percent perfect," he said. "It's good as gold."
At Friday's press conference, Cheney assured reporters that the problem was medically minor, but said that he wanted the press and public to be well informed, largely to guard against the confusion that has surrounded his previous cardiovascular issues. "We've had enough experience now that sometimes misinformation does arise, and there's intense speculation, and everybody sort of goes into a high hover," he said.
Cheney's concern about the speculation is well grounded, but he neatly stepped around the fact that much of the misinformation surrounding his past heart trouble has come from the Bush team itself. Starting with Cheney's selection as the vice presidential nominee, the Bush campaign gave only a well-edited version of his medical status, a considerable cause for concern given that Cheney had suffered three heart attacks before turning 50.
Then, amid November's Florida recount skirmishes, Cheney checked himself in to George Washington University Hospital complaining of chest pains. On the morning of Nov. 22, everyone from the GWU doctors to then-candidate Bush himself insisted that Cheney had not had a heart attack. "He was feeling chest pains, and turns out that subsequent tests, blood tests and the initial EKG showed that he had no heart attack," Bush said. By the end of the day, Cheney's doctor had revised his earlier statement, and acknowledged that Cheney had suffered a "very slight heart attack."
The cardiac spin team apparently stayed on the job, and in March, when the vice president underwent a heart catheterization as a "precautionary measure," Zipes told Salon that the White House's explanation didn't jibe with his experience. "No, you're not going to do [a heart catheterization] on a precautionary basis," he said, explaining that it would be incorrect to use that term to describe an invasive surgical procedure employed to help prevent a heart attack in a patient. At that time, Zipes also faulted the Bush team for failing to tell the whole story, and said, "I am concerned that they weren't forthright about what was going on."