Heart: An American Medical Odyssey (10 page)

September 11, the day the enzyme tests confirmed I’d had a heart attack, was also the day of the 1984 Republican primary in Wyoming. I was unopposed. President Reagan called me on September 13 to wish me a speedy recovery, and we laughed together as he told me about the dinner he attended the evening before roasting our mutual friend, the retiring senator from Tennessee, Howard Baker.

I was in the hospital for a week and then went home for rest and recuperation. I had a good deal of time during those weeks to think about my heart and my health. It was then that I made one of the most important decisions of my life.

The second heart attack was a true wake-up call. For the previous six years, I had believed my heart attack had been a onetime event that I had taken the necessary steps to fix. I played tennis, took annual pack trips
into the Wyoming wilderness, skied in the Rockies, and worked overtime as Wyoming’s congressman and as part of the House GOP leadership. In no way was I limited physically by my heart.

In retrospect, my refusal to accept the notion that I had a chronic disease may have been helpful from the standpoint of my being able to aggressively pursue my political career and enjoy the active pursuits I loved. I didn’t think of myself as a patient, and I didn’t act like one. If I had, I might not have run for Congress, put in the long hours required, or sought a House Republican leadership position. My view of my health also affected the way others perceived me. My colleagues in Congress, for example, a group of highly motivated, ambitious political figures, might have been unlikely to select me as one of their leaders if they had thought of me as “the guy with the bad heart.”

The reality, however, was that I was a patient with coronary artery disease. This second heart attack forced me to acknowledge that I had a significant chronic heart problem that would likely worsen over time.

When I’d had false alarms in the years preceding my second heart attack, I was treated by whichever physician was on call at that moment. Most of them had never seen me before. Though I’d had excellent care, the realization that this was going to be a lifelong challenge convinced me I needed to find a single physician to follow my case and know my heart and my disease better than anyone else.

Lynne was working then at
Washingtonian
magazine where one of her colleagues was John Pekkanen, a renowned journalist who specialized in health care. She sought John’s advice about the best cardiologists in the DC area, and he recommended several good physicians, including Dr. Allan Ross at George Washington University Hospital. Dr. Ross was focused primarily on research at that point, but he agreed to take me on as a patient. I remained in his care until he retired and passed me on to Dr. Jonathan Reiner, who has handled my care for the past fifteen years.

The decision to develop a long-term relationship with a top-flight physician was one of the most important I ever made. I am convinced that I would not be writing this history if it hadn’t been for the
outstanding work, knowledge, and commitment I’ve benefitted from as a result of that choice. When we were discussing the possibility of doing this book together, Dr. Reiner told me he does not know any other patient who suffered a heart attack in the 1970s and is still alive today. My longevity is directly due to the expertise of the doctors who have treated me, and primarily to my cardiologists, Dr. Ross and Dr. Reiner.

Though it coincided with my reelection campaign for my fourth term in the House of Representatives, the 1984 heart attack did not lead me to question my choice to serve in elective office or my commitment to a long-term career in politics. I spent the next several weeks recuperating at home in McLean, Virginia.

On October 2, 1984, I went to the Capitol when the Wyoming Wilderness Act was up for a vote in the House of Representatives. Along with my Senate colleagues Al Simpson and Malcolm Wallop, I had worked very hard on this legislation, which set aside nearly a million acres in wilderness area in my home state. I wanted to be sure it passed, and I wanted to be there to cast my vote for it.

I spent the last two weeks in October campaigning in Wyoming and was reelected to my fourth term with 74 percent of the vote that November. I felt no aftereffects from my second heart attack and had been able to resume a full and active schedule.

In February 1985, I took on additional responsibilities in the House when I was named to the Permanent Select Committee on Intelligence, which has responsibility for congressional oversight of all matters relating to the nation’s intelligence agencies, including the CIA, the Defense Intelligence Agency, and the National Security Agency. It is the kind of assignment some members don’t relish. The work is mostly highly classified, and you can’t explain to your constituents how you are spending your time. Studying the materials and intelligence reports is a significant commitment of many hours and must be done only in the secure committee facilities in the Capitol. But it is an assignment of real significance in terms of the security of the nation, and I found the work fascinating.

In 1986, I was reelected as the House Republican Policy chairman for the
Ninety-Ninth Congress. That November, Al Simpson and I had been planning to go elk hunting. The day before we were scheduled to leave, House Republican leader Bob Michel called and asked me to attend a meeting the White House had just called. It seemed I was the only member of the House Republican leadership in town that day.

As it turned out, the meeting, on November 12, 1986, was a briefing delivered by national security adviser John Poindexter in the White House situation room. I sat around a table with the Senate majority leader, Bob Dole, the Senate minority leader, Robert Byrd, House Speaker Jim Wright, and a number of members of President Reagan’s cabinet. Poindexter explained to us that in an attempt to secure the release of American hostages being held by Iran’s ally, Hezbollah, the United States had been selling arms to what they believed were moderate factions in Iran. Some of the hostages had been freed, but the policy was badly misguided. It violated an existing arms embargo and put the United States in the position essentially of negotiating with terrorists.

A few weeks later, we learned the picture was even more complicated when it was revealed that proceeds from the arms sales were being sent to the Contras, a rebel group in Nicaragua. Congress had prohibited the president from providing any assistance to the Contras when it passed a series of amendments, collectively known as the Boland amendment, in the early and mid-eighties. In the aftermath of the revelation about the diversion of funds, a joint select committee was formed in Congress to investigate what had happened. I was the ranking House Republican on the committee and presided, along with chairman Lee Hamilton, over committee hearings on the arms sales and fund diversion throughout the first half of 1987.

The issues raised by Iran-Contra were significant and concerning. Clearly the administration made mistakes in carrying out a policy of essentially negotiating with terrorists. But there were also legitimate questions to be asked about the proper role of Congress in the conduct of US foreign and national security policy. And the political atmosphere in Washington meant that, in my view, many of the Democrats
on the select committee were more interested in scoring partisan points against President Reagan than they were in understanding what truly went wrong and finding ways to prevent it from happening again.

Against the backdrop of my involvement in the significant, highly scrutinized, and time-consuming Iran-Contra committee, I was still dealing with matters of my heart. On January 27, 1987, President Reagan was scheduled to deliver his annual State of the Union address to a joint session of Congress. This would be the One Hundredth Congress and the beginning of the year marking the bicentennial of our Constitution. I was booked to appear on several news programs that night after the speech. I was at work in my office and began to feel some chest discomfort. I took two nitroglycerin pills and called Pete Williams, my press secretary, and Patty Howe, my legislative director, into my office. I asked them to cancel my interviews for the evening and then asked Pete to walk with me over to the Capitol physician’s office. We walked the length of the hallway to the elevator. I was feeling worse by the minute and didn’t think I could make it over to the Capitol. Pete and I turned around and headed back to my office to call an ambulance.

I took a few steps, and there, in front of the Capitol policeman’s desk, fainted. Pete, pretty scared by this point, asked the policeman to call for a doctor. Instead, he called his superior and shouted, “Member down.” Pete ran down the hall to our office and had Patty call the House physician. The Cannon House Office Building nurse was on duty. She came out with a pillow and checked my blood pressure. Apparently, as I lay there sprawled out and unconscious on the marble floor with my shirt open, several of my colleagues walked by. As Pete tells it, they didn’t quite step over my body, but it was close.

Eventually an ambulance came, and Pete rode with me to the George Washington University Hospital emergency room. Pete was understandably pretty worried and didn’t think I was getting medical attention quickly enough. At one point, he started yelling to no one in particular, “This is a United States congressman!” Either in light of that information or, more likely, because they wanted to get Pete to quit yelling, I was taken back for evaluation. After a few hours and tests,
the doctors determined I had not had a heart attack but probably had an adverse reaction to the nitroglycerin. They released me to go home.

I was somewhat surprised, given the dramatic nature of the event and the fact that several of my colleagues had strolled past me while I was unconscious on the floor, that the story never made the media. Pete Williams, a dear friend to this day, felt guilty that he’d been standing there when I passed out and hadn’t caught me. I couldn’t resist giving him a hard time about it when I got back to the office the next day. “Thanks, Williams,” I told him. “You dropped me!”

A few months later, in May 1987, after I’d had an abnormal stress test, Dr. Ross performed another catheterization. In 1987, the standard procedure was to access the femoral artery through the groin. The area was shaved and prepped with antiseptic and a local anesthetic was administered. I was given mild sedation but was sufficiently awake to be aware of what was going on around me. On occasion, I remember being asked to cough during the procedure. I was sometimes able to see the screen the doctor used to steer the catheter into the arteries of my heart. When the dye was injected, I felt a warm flush. The only uncomfortable part of the procedure occurred after the catheter was withdrawn and the entry wound closed. The final step, to ensure there was no subsequent bleeding from the entry point, was to apply heavy pressure to the wound for approximately half an hour. This task was usually assigned to the largest member of the surgical team. The procedure has since been significantly improved.

It wasn’t until I was reviewing my own medical records in preparation for writing this book that I realized this particular catheterization included some worrying moments. In the words of Dr. Ross:

Unfortunately, during one injection he developed ventricular fibrillation requiring cardioversion x3 with 300 joules

As happens sometimes, but not often, the dye had prompted my heart to fibrillate in a potentially deadly rhythm. It took three electric shocks to set things right.

This catheterization showed that my right coronary artery had begun to narrow, but there had been no further progression of the plaque in other vessels in the heart. At my follow-up appointment a few weeks later, Dr. Ross advised that I should restrict my most strenuous activities, particularly at high altitudes, in the hope that I would be able to continue to participate in less strenuous recreational pursuits without risking damage to muscle deprived of oxygen. We also agreed that given the results showing narrowing of an artery that had previously been plaque free, I would now have more regular stress tests.

As I was receiving news of a worsening heart condition, my responsibilities on the Hill continued to increase. On June 4, 1987, I moved up in the House leadership when I was elected chairman of the House Republican Conference, the number-three elected position in Republican leadership. Meanwhile I was still engaged in the high-stakes hearings about the Iran-Contra affair. At first glance, it might seem that my professional activities would have added to the stress of the somewhat negative health report. I think it was actually just the opposite. The job of ranking member on the Iran-Contra committee involved me in critically important matters—issues relating to the constitutional roles of the president and Congress, questions about how far the United States should go to secure the release of our hostages, and inquiries about how best we could prevent the Soviets from gaining a foothold in Latin America. I think it was the import of these issues and the sense that I was an important participant in a set of historic events that enabled me not to dwell on the negative developments with respect to my heart. I didn’t have time and was not inclined to sit around and feel sorry for myself. I believed Dr. Ross had laid out a reasonable course of action that involved some curtailing of my activity. He had also scheduled me to begin the new cholesterol-lowering drug, lovastatin, as soon as it received approval from the Food and Drug Administration (FDA). The combination of comfort with my physician and his judgments, a sense that we were doing all we could do to deal with the disease, and a knowledge that I had important work to do for the nation allowed me to continue to participate fully in all I was called on to do.

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 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.