Heart: An American Medical Odyssey (22 page)

Lew Hofmann worked effectively to put together a team approach that included everyone in my annual checkups, and he saw to it that the appropriate people were involved any time their area of expertise was needed. From my perspective as the patient, the process was flawless.

Whenever I traveled, even if it was just the short distance from the White House to the vice president’s residence, I was accompanied by an entourage that included not only the Secret Service but also one of my military aides with the “football,” which is actually a briefcase containing the codes necessary to execute our nuclear options, which I carried as a backup to the president. In addition, there would be my chief of staff or one of a handful of senior assistants trained in his responsibilities. And always Dr. Hofmann or one of his designated representatives from the WHMU would be in the motorcade. The traveling party expanded when I traveled outside Washington, DC, or overseas, but there was always twenty-four-hour coverage by the WHMU.

In 1993, when I left the Defense Department and joined the private sector, Lynne and I had purchased a home in Jackson Hole at the foot of the Tetons. This had always been our favorite part of the world, a place we had intended to honeymoon after our wedding in 1964. Unfortunately, I’d been hospitalized with food poisoning shortly before the wedding and had no health insurance. The money I’d saved for a honeymoon went to pay medical bills. But over the years, we’d been able to spend a good deal of time in Jackson with our family. It is home to one of the world’s greatest ski mountains and some of the best trout fishing anywhere. And, of course, it had been part of my congressional district for the ten years I served in the House of Representatives.

When I returned there as vice president, I skied at first, although not as hard as I once had because of a football injury to my right knee. Still, I loved to get out on the slopes, especially with the family’s newest skier, my granddaughter, Kate. A few years into my time as vice president, however, I gave it up. The knee problem and my history of heart disease led the doctors to recommend I stop taking the risk of flying downhill on a pair of skis.

Luckily, no one suggested I should give up fishing, which I usually do on rivers, using a drift boat. There is room for only three in a boat—two fishermen and a guide. Thus the Secret Service and my usual entourage had to get their own boats, and we always ended up with a flotilla. A
local police boat was normally in the lead, followed by vessels carrying two agents in wet suits who were rescue swimmers. They were on call in case I fell into the river. Next was my boat, followed by a boat carrying my lead Secret Service agent and another rescue swimmer.

Behind that, normally out of sight, were additional boats with my military aide, doctor, and a medical assistant; a representative from the White House Communications Agency; additional agents; and more law enforcement officials. Depending on the landscape, there were also sometimes Secret Service agents on horseback on the banks of the river. And there were usually helicopters stationed nearby, operated by a military unit that could respond in minutes if a crisis occurred. The WHMU and the Secret Service always made arrangements with the closest hospital in case I needed emergency care.

During my first fishing trips as vice president, the boat in front of mine was rowed by a Secret Service agent. That created problems because the agents didn’t know the river and would often row right through the best fishing holes, which would ruin it for the fishermen. Once we substituted guides for agents rowing in that lead boat, the fishing improved.

There were times when I had to place or receive secure calls from the river, and the WHCA personnel were there to set up the necessary satellite communications. Every year I took one trip that involved camping out overnight in a rugged remote canyon on the South Fork of the Snake River. Even there, my CIA briefer would arrive in the early morning with the president’s daily brief so I could stay abreast of events around the world.

In the eight years I was vice president, I never fell into the water, and I never had a medical crisis on the river. On one occasion, I witnessed the team in action when a friend fishing with me developed chest pains. I flagged down my lead agent and told him to contact the doctor. Within a matter of minutes, we were surrounded by most of my entourage, including a helicopter overhead. A medical technician administered an EKG to my friend while he was still in the drift boat.
Fortunately, he was not having a heart attack. But I was very impressed with the rapid, professional response. It was reassuring to see firsthand the capabilities of the team that was there should I ever need them.

Another occasion when the WHMU rendered great service was when I accidentally shot one of my companions on a South Texas quail hunt. Major Kenneth Baron, who had accompanied me on that trip to the Armstrong Ranch, immediately stepped up and took charge of providing first aid. The ambulance that was standing by in case I needed care was summoned to transport my friend, Harry Whittington, to the hospital. The major stayed with Harry and his wife, Mercedes, through the night at the hospital in Corpus Christi and did everything possible to make sure Harry got the care he required. Harry Whittington couldn’t have been kinder and more understanding about the accident. He was more worried about the flak I was going to receive in the press than he was about his own injuries. He was right about the flak. For years afterward, this incident was fodder for the late-night comedians. Years later, when I was going through my own medical crisis with end-stage heart failure, one of the kindest and most thoughtful letters I received came from Harry.

When I was a boy growing up in Brooklyn in the 1960s and 1970s, physicians made house calls. They didn’t call it “concierge” care and patients didn’t have to pay $2,000 for “special access’; it was simply the way medicine was practiced. Dr. Morris Steiner, our doctor, lived above his office in a beautiful turn-of-the-century Victorian house on East Nineteenth Street, a few blocks from our apartment. When my sisters or I got sick, he came to see us, bringing with him his seemingly bottomless leather doctor’s bag from which he would pull stethoscope and prescription pad, tongue depressors and otoscope, penlight, the occasional lollipop, and much wisdom.

Thirty-five years later and now with a stethoscope tucked in my own bag,
I walked the five blocks from my office on Pennsylvania Avenue to the northwest gate of the White House. Almost six weeks had passed since Chief Justice William Rehnquist swore in President Bush and Vice President Cheney on the west front of the Capitol, and Dr. Lew Hofmann, a physician from the WHMU, arranged for us to make a house call.

The WHMU is part of the White House Military Office, a group of US military agencies with about twenty-three hundred people who supply support services to the president; they include the White House Communications Agency, the Presidential Airlift Group, the White House Transportation Agency, and Marine Helicopter Squadron One.

I first met then Lieutenant Colonel Hofmann, an Air Force doctor specializing in family and aerospace medicine, shortly after the 2001 inauguration, when he became the vice president’s full-time White House physician. Lew was recruited to the WHMU in 2000 after spending three years with the Ninety-Sixth Medical Group at Eglin Air Force Base in Florida. When Dick Cheney took the oath of office and became the forty-sixth vice president of the United States, Lew became his doctor and, like me, he would spend the next 2,922 consecutive days and nights on call for his patient.

When Gary Malakoff and I arrived at the White House, Lew was waiting for us on the corner outside the security checkpoint, smiling warmly and dressed in civilian clothing. The military makes an effort to decrease their visibility while working at the White House, and most members of the WHMU wear their uniforms to work only one day per week.

I passed my driver’s license to a uniformed Secret Service officer inside a security booth and waited as he checked my name in his computer. He then handed me a plastic White House visitor pass suspended from a beaded chain, emblazoned with a large black “A [appointment].”

Gary and I placed our bags and phones in an X-ray scanner before walking through a magnetometer. After retrieving our belongings, we waved our visitor passes in front of a detector labeled with a small
White House icon, and an indicator light on a turnstile changed from red to green, the gate issuing a loud metallic
thwack
as it unlocked, granting us access to the White House grounds.

Our appointment with the vice president was scheduled for 6:00 p.m. (18:00 in the parlance of our new colleagues), but Lew asked us to arrive at 5:30 so that we could meet for a few minutes in the medical unit before going over to the West Wing. I think Lew, who had not worked with us before, wanted to be sure that we would not be late and would be ready when the vice president’s assistant, Debbie Heiden, called to tell us to come over.

On the way to his office, Lew gave us a brief tour of the Eisenhower Executive Office Building where the medical unit is based, his appreciation for its history very apparent. The building opened in 1888 to house the State, War, and Navy Departments, the original occupants immortalized in the scrollwork of hundreds of beautiful brass doorknobs. The essential role of the WHMU is to provide comprehensive health care to the president and vice president of the United States as well as their families wherever they go. It is staffed by six physicians, six nurses, and seven physician’s assistants, recruited equally from the Army, Navy, and Air Force (with an additional physician’s assistant from the Coast Guard).

Administrative offices for the WHMU and a sizable medical clinic that includes treatment rooms, X-ray, EKG, and emergency medical capabilities are located on the ground floor. In Lew’s words, “Pretty much we could do the first ten minutes of what could be done in an emergency room while waiting for the ambulance to come.”

Lew Hofmann later described the rationale for the WHMU clinic:

First, the purpose of the OEOB Clinic is to provide what we referred to as “Care by Proxy.” This means that if we are able to keep everyone in the staff running at best efficiency—from the Chief of Staff right down to the janitors—it enhances the ability of the President and Vice President to be efficient in their duties. When a staff member becomes ill, the advantages of our clinic are: (1) a
visit might only take the patient away from work for thirty minutes or so—including prescription—whereas leaving the complex for an appointment elsewhere could use up half the day or more; (2) we are uniquely qualified to advise the patient on whether to remain at work or go home; (3) with the availability of physical therapy in the clinic, patients are able to obtain these needed treatments with minimal interruption of their day—otherwise they likely would have chosen to forgo the treatments and experienced negative immediate and future quality-of-life consequences.

We exited the office building and walked across West Executive Avenue and into the West Wing through a white-canopied entrance bearing the presidential seal. With Lew Hofmann leading the way, we paused momentarily at the Secret Service desk just inside the doorway and entered a stairway on the left heading for the first-floor office of the vice president of the United States. When we entered the suite, Debbie Heiden, the vice president’s executive assistant, greeted us warmly. After just a few minutes, she told us we could go in and pressed a hidden button that unlocked a heavy mahogany door.

When we entered the office, Vice President Cheney was sitting at his desk, a large historical map decorating the wall behind him.

“Good afternoon, Mr. Vice President,” Gary and I said, almost in unison, as we shook Cheney’s hand.

The office was large, with a desk at the north end flanked on both sides by two flags and a fireplace on the opposite wall. A blue couch with adjacent armchairs and a Chippendale-style butler’s tray table sat in the middle of the room under a brass chandelier. Portraits of Thomas Jefferson and John Adams, both former vice presidents, hung on the walls separating the tall windows.

Although many of the checkups to follow would be conducted in this striking space, on this day I wanted to get an EKG, which would be easier to acquire in an exam room. Therefore, Lew had arranged for us to use the office of the physician to the president, Dr. Richard Tubb, located in the White House residence.

It’s a short but very interesting walk from the West Wing to the
executive mansion. We turned right as we left the suite into a corridor lined with photos of the new administration and formed an unlikely, rapidly moving procession of the vice president, his Secret Service detail, and his three doctors. As we turned a corner, I noticed an open door with only a velvet rope barring entry. I was pretending that this was just another day at work, but when we walked past the open Oval Office, my head spun around like the tourist I was trying so hard not to be. We continued down the hallway, past the cabinet room, and left the building into the West Colonnade, the open columned walkway bordered on one side by the Rose Garden that connects the West Wing with the residence.

The physician to the president, usually also the director of the WHMU, has a separate office on the ground floor of the White House adjacent to the Map Room, in what was originally servants” quarters, with two examination rooms and a beautiful view of the South Lawn. The vice president entered one of the exam rooms, and a WHMU nurse obtained an EKG that showed Cheney’s old inferior wall MI and other chronic changes. I noticed that the vice president had quite a few extra beats (premature ventricular contractions). I asked about any new symptoms, we reviewed his medications, and I did a focused cardiovascular examination. In my note summarizing the visit, I wrote:

Impression:

Symptomatically is doing very well. Has lost a significant amount of weight (was 220 lbs in 9/00). I discussed at length the importance of obtaining a Holter monitor to evaluate whether he has NSVT [Non-Sustained Ventricular Tachycardia] (defined as a triplet or more) which would place him at a higher risk of having sudden death. If the vice president does have NSVT this would then warrant an EP [electrophysiology] study. If inducible he would then require an ICD [implantable cardioverter defibrillator]. Mr. Cheney has agreed to schedule the placement of a Holter.