Heart Murmurs

Dick Cheney's brief but sudden hospitalization questions about fitness and truthfulness

As Defense Secretary for the father of George W. Bush, Dick Cheney has already spent a lot more time in the Oval Office than the man he would like to serve as Vice President. If the younger Bush eventually enters the White House, Cheney promises to be an even more influential Vice President than, well, Al Gore. As head of the informal transition team, Cheney has been making regular trips to Bush's ranch outside Austin, Texas, to start shaping a potential Cabinet. In the excitement about the vote in Florida, he and James Baker are George W.'s chief strategists. It was Cheney who brought in Baker in the first place, and the two men hold a daily conference call with Bush that is George W.'s first order of business each morning.

Bush aides say Cheney is far more involved than Bush with both the transition and the postelection recount struggles. All the more reason for George W. to look so relieved when he appeared before reporters on Wednesday, a few hours after Cheney had been admitted to George Washington University hospital in Washington. He "sounded very strong," said Bush, who had talked to Cheney earlier by phone from the ranch. "Dick Cheney is healthy."

It was a reassuring performance, but it wasn't exactly the straight story. In fact, Cheney had suffered what his doctors belatedly described as a mild heart attack, though Bush almost certainly didn't know that when he appeared before the cameras. Cheney had just undergone a surgical procedure to insert a stent, a steel mesh cylinder that expands to pry open a clogged artery. A Bush aide, Dan Bartlett, said later that Bush knew the procedure had taken place but did not tell the public because he did not feel equipped to discuss it. And anyway, he wanted to focus on the good news about Cheney's condition. But Bush communications director Karen Hughes says that at the moment he spoke to the press, Bush was not aware of the stent insertion.

Whichever is true, Wednesday's display of conflicting information did nothing to relieve the longstanding questions about just how serious Cheney's coronary problems are and why he won't say more about them. Cheney had three heart attacks between 1978 and 1988, the year he underwent quadruple-bypass surgery. In July, after Bush picked Cheney as his running mate, two of his doctors issued letters giving him a clean bill of health. But it was a bill without particulars. Cheney has repeatedly refused to allow reporters to interview him or his doctors about his health, to name the numerous medications he admits to taking or even to say where on his heart his bypasses are located.

All of that would put Cheney firmly in the long line of public figures who were less than candid about their medical history, especially when they have something to hide. In 1919 Woodrow Wilson suffered the massive stroke that left him partly paralyzed. But Wilson's doctors and his wife Edith hid the seriousness of his condition so well that even Congress was in the dark. The Senate was reduced to dispatching a "smelling committee" to the White House in a failed attempt to sniff out his real condition. John Kennedy flatly denied that he had Addison's disease, an often fatal immune-system disorder that he struggled with all his life. After he was shot by John Hinckley Jr. in 1981, Ronald Reagan was closer to death, and slower to recover, than anyone admitted at the time. And in 1992, when Paul Tsongas was a Democratic presidential candidate, he and his doctors said he was free of the lymphoma that led to his 1986 bone-marrow transplant. He died of the disease in 1997.

But Cheney's closemouthed approach to his medical history has only encouraged more questions about it. His latest coronary episode, and the bumptious way the news went public, is likely to stir them up further. After Bush spoke, there was more confusion at a news conference held by the doctors who attended Cheney at the hospital. Alan Wasserman, president of the hospital's medical faculty associates, mentioned that Cheney's second blood test for the cardiac enzymes given off by a damaged heart muscle showed that Cheney's "enzyme levels were slightly elevated." Anyone who is not a cardiologist might suppose he was just passing on an innocuous test result. What he was actually offering was medical jargon that signifies a mild heart attack. Emphasis on mild--Cheney's episode qualified as a heart attack only under a stringent new definition adopted by the American Heart Association about a year ago. All the same, 2 1/2 hours later Wasserman had to reappear to speak the plain English words: "a very slight heart attack."

The hospital says the Bush campaign had nothing to do with preparing Wasserman's first dissembling statement. And though Cheney's wife Lynne and daughter Liz were involved, Cheney's press secretary, Juleanna Glover Weiss, insists they did not at first understand that what he had suffered qualified as a heart attack. Communications director Hughes says she also did not understand until she asked the hospital's p.r. director to explain the meaning of the elevated enzyme levels. Once she realized that this signaled a mild heart attack, she says, she immediately told the hospital that the doctors should go before the press again to say so. "One of the networks was still reporting that he had not had a heart attack," says Hughes. "I was adamant that it needed to be corrected."

It was only after last week's emergency that Cheney's doctors finally made public a crucial measure of his coronary performance, the "ejection fraction," which indicates the heart's pumping power. A healthy heart registers within the 50% to 70% range. Cheney's is a serviceable 40%. His cardiologist, Dr. Jonathan Reiner, called that a sign of moderate impairment. Cheney's doctors also announced that for 30 days Cheney will take a blood thinner, Plavix, to prevent blood clots from forming around the stent before it can be covered by the growth of new tissue.

As he left the hospital Friday, Cheney told reporters he would return this week to "a fairly normal schedule." He was going home with an upbeat prognosis from his doctors, so there's little reason to suppose that poor health would cause him to step aside before Dec. 18, when the Electoral College will formally choose the President and Vice President. If that were to happen, however, and if Bush turns out to be the winner of the presidential race, he could simply name Cheney's replacement, a choice that would have to be approved in a vote by the 165-member Republican National Committee. But after the Electoral College votes, or at any time during a Bush Administration, Bush's choice to succeed Cheney would have to be approved by both houses of Congress, a process set out in the 25th Amendment to the Constitution. In 1973, when Vice President Spiro Agnew was forced to step down in a kickback scandal, Richard Nixon named Gerald Ford to replace him, in part because Ford was House minority leader, which made quick approval in Congress more likely. By contrast, Ford's selection of Nelson Rockefeller, a congressional outsider, was held up for months by hearings into Rockefeller's finances.

As Cheney was leaving the hospital last week, reporters inquired if he had plans to ask Bush to replace him as his running mate. He laughed and said, "No, not yet." He and his doctors insist that the stress of his latest campaign, to say nothing of the chaos that followed Election Day, did not have much to do with his problems last week. Nothing he went through as a candidate for Vice President, Cheney said, compared to the stress he faced as Defense Secretary during the Persian Gulf War.

But Cheney's first heart attack also happened during a political campaign, his first run for the House. And if George W. Bush actually makes it to the White House, the pressure on Cheney will be something else again. In a Senate likely to be split 50-50, the Vice President presides as the tie-breaking vote. Compared with the Democrats, the Iraqis were a piece of cake.

--Reported by Jay Carney/Austin and John Dickerson/Washington