In fall 1999, Lynne and I hosted a fund-raiser at our home in Dallas for the literacy program sponsored by Barbara Bush. George W. Bush, governor of Texas, attended and during the evening asked if there were some place where we could talk privately. I took him into the library and closed the door. He asked me if I would be willing to take on a major role in his campaign for the presidency. I supported Bush and was prepared to do what I could to help him get elected, but I also had a full-time commitment to Halliburton and a significant position in the campaign simply wasn’t possible.
A few months later, once the primary campaign had gotten underway, Joe Allbaugh, one of the governor’s top aides, came to see me in my office in Dallas and asked if I would be willing to be considered as a candidate for vice president. I said no; I was not interested. I told Joe that I thought I was a bad choice from the campaign’s standpoint. My home state of Wyoming is one of the most Republican in the country and has only three electoral votes. I told Joe that if Governor Bush couldn’t carry Wyoming without me on the ticket, they had bigger problems. I made the point that because I was in the oil business and Governor Bush had previously been in the oil business, a Bush-Cheney ticket would be a ripe target for the Democrats. I also pointed out that I had a history of coronary artery disease—three heart attacks and quadruple bypass surgery. Joe didn’t argue with me. He took my answers on board and reported back to the governor.
What I didn’t tell Joe, because I wanted to be polite, was that I had absolutely no interest in being vice president; I thought it was a terrible job. President Ford had told me on more than one occasion that the eight months he spent as vice president were the worst months of his life. I knew from personal experience that Nelson Rockefeller hated the job. The city of Washington is full of people telling stories about the irrelevance of the post. The only reason to take the job is to run for president, and I had decided not to do that several years before. Finally, I was very happy as chairman and CEO of Halliburton, and it paid a lot better than government work.
A few days after Joe’s visit, Governor Bush called me directly and asked if I would help him find a vice-presidential candidate. I readily agreed. It was an important assignment, and it was something I had done before for President Ford in 1976. It was also a short-term commitment that would not last beyond the national convention. I would not have to leave Halliburton to do it.
I pulled together a small team of key people to help review and screen the potential candidates. I had learned over the years that while there are a great many who want to be vice president, only a few meet the very high standards to qualify. First and foremost, the individual has to be capable of serving as president if something happens to the incumbent. Second, the candidate has to add to the overall political attractiveness of the ticket. Third, you want to avoid the train wreck of picking someone whose background or personal life contains embarrassing episodes or information.
The first list we put together numbered twenty-five or thirty prospects. We prepared and sent out a detailed form asking for a wide range of information from those still on the list after I had personally contacted each one. Not everyone wanted to be considered. One potential candidate threatened never to speak to me again if I put his name on the list. There were a couple of people not on the list who contacted me seeking to be included. They explained that they had tough reelection campaigns and it would help them back home in their districts if word got around that they were under consideration. I promptly put them on the list.
We put together a file on each candidate who was seriously under consideration. We promised to maintain the confidentiality of their submissions, and when the process was complete, we returned all the materials they had submitted. As we went through this process, the list grew shorter. I personally interviewed a number of candidates. Throughout the process, I kept in regular contact with the governor. For each of our sessions, we prepared two notebooks, one for each of us—and he returned his to me when we finished.
On July 2, 2000, I went to the Bush ranch in Crawford, Texas, for a final meeting. We spent the morning reviewing the remaining candidates, a much shorter list than we had started with. Then Laura joined us for lunch. Afterward, the governor took me out on the back porch for some further conversation. It was a typical Texas July day, with the temperature well over 100 degrees. He looked me in the eye and said, “You know, you’re the solution to my problem.”
At that moment, it occurred to me that he had never accepted my “no” when Joe Allbaugh had asked if I was willing to be considered for vice president some months before. And I must admit that going through the search with him had a significant impact on me. I had seen up close how much time he had devoted to selecting a running mate. He had given a great deal of thought to what he wanted in a vice president. He wasn’t making a conventional choice in terms of the Electoral College, or the GOP, or the expected impact on the popular vote. He had emphasized repeatedly to me that he wanted his vice president to be an important part of his team, someone who could help govern.
He had worked my “no” around to a tentative “yes.” I told him I would consider it. I said I would see what I would have to do if he were to select me. I had obligations to Halliburton and would have to have a conversation with my directors.
I would also have to switch my voter registration from Texas to Wyoming. Under the Twelfth Amendment to the Constitution, the electoral votes of a state cannot be cast for a president and vice president from the same state.
There was also the matter of my medical history. We would need to satisfy ourselves that there was no health problem that would prevent me from running or serving.
Finally, I emphasized that I had not been vetted in the conventional sense and that I needed a day when I could meet with him and lay out all the reasons I wasn’t the right choice.
A few days later, I flew down to Austin and met with Governor Bush and campaign strategist Karl Rove at the mansion. We discussed the vice presidency, and Karl and I made essentially the same arguments against my candidacy, pointing out that I was not a good choice from a political standpoint. I underscored my misspent youth just as I had done with his father ten years before when I was under consideration for secretary of defense. I repeated that I had twice been kicked out of Yale and twice arrested for driving under the influence in my early twenties.
Finally, I focused on my history of coronary artery disease. I told him that I had to be aware at all times of my heart condition and that if I ever felt so much as a twinge, I would have to have it checked out immediately to determine whether I was having another heart attack. I said if it happened in the middle of the vice-presidential debate, I wouldn’t delay until the debate was over. I would, without hesitation, seek the nearest emergency room for the appropriate tests. The governor took all this in, and we arranged to have his physician, Dr. Denton Cooley, talk to my cardiologist, Jonathan Reiner, about my fitness to run and serve as vice president.
It soon became clear that Rove and I hadn’t been very persuasive. I received a call from the governor telling me that Dr. Cooley had reviewed my medical situation with Dr. Reiner and concluded that there was no health reason that I couldn’t run for and serve as vice president. A few days later the governor posed the question formally, asking me in an early-morning call to be his running mate as the GOP candidate for vice president of the United States. That afternoon, Lynne, Liz, and I flew to Austin, and George Bush announced me as his choice for vice president on the GOP ticket.
I have never regretted my decision to accept his offer. I had been able to think of many reasons that it wasn’t a good idea, but in the end, there were two basic considerations that I found persuasive. First, I fit the profile of what he was looking for in a running mate because of my previous experience, especially in national security matters. Second, I was persuaded it would be a consequential vice presidency. He made it clear I would be an important part of his team, not just a typical vice president relegated to attending funerals and fund-raisers. President Bush kept his word throughout our eight years in the White House. He did not always follow my advice, but he always gave me an opportunity to tell him what I thought on important issues. I was able to play a significant role because that is what he wanted.
Some of my critics have suggested that I “manipulated the process” to get selected as vice president. That proposition is simply not supported by the facts. If I had wanted to be vice president, all I had to do was say “yes” the first time it came up with Joe Allbaugh.
In the end, I agreed to become vice president because George Bush persuaded me I was what he was looking for and that my experience would be a valued addition to this ticket. When you are asked to do something on behalf of the country, you have an obligation to try to do it. Looking back now some thirteen years after I made that decision, I am deeply grateful for the opportunity I had to serve during those difficult and challenging years. And I owe President George W. Bush a deep debt of gratitude for having made that possible.
The pink “While You Were Away” note said simply, “Dick Cheney called.”
A little annoyed to discover the message so late in the day, I asked my assistant, Yaa Oforiwaa, why she didn’t page me when Cheney called hours earlier.
“He didn’t want to bother you,” she said.
For many years, Cheney’s cardiologist had been Dr. Allan Ross, an internationally renowned clinician and researcher. Allan was chief of cardiology at GW when I began my fellowship in 1990, and he quickly became a mentor. Allan brought me into his research group when I was a first-year fellow and later, when I completed my training, he gave me a job. After Allan’s retirement in 1998, Cheney’s internist, Gary Malakoff, asked if I would assume Cheney’s care. Gary told me that Secretary Cheney was now CEO of Halliburton, a Dallas-based company, but he still came to Washington periodically for checkups. I had met Cheney a few years earlier when he came in for a catheterization, and I told Gary I would be happy to see him.
Mr. Cheney’s most recent clinic visit was in November 1999, at which time he seemed to be doing pretty well. In spring 2000, Cheney had been in the news a lot. He was vetting potential vice-presidential running mates for Governor Bush, and the press was speculating that an announcement was going to be made soon. The Veep sweepstakes is a quadrennial DC obsession, and the spotlight at the time seemed to be focusing on Pennsylvania governor Tom Ridge.
Yaa told me that Mr. Cheney needed to schedule a clinic appointment in the next week or so, but he wanted to have a stress test first.
Why does Cheney need a stress test now? I wondered.
I walked over to the clinic and tracked down Gary and asked him if Cheney was feeling all right. Gary told me that as far as he knew, everything was okay.
“Gary,” I said, “I think Cheney is going to run for vice president!”
• • •
Stress testing has been used for decades as a noninvasive way to assess the adequacy of the heart’s blood supply and is based on a fairly simple principle. Progressively vigorous exercise, usually walking on a treadmill with increasing pace and incline, results in a rise in blood pressure and pulse, and consequently increases the work required of the heart. If the blood supply to the myocardium is intact and unimpeded, the continuously monitored EKG reveals only a faster heart rate. If a coronary artery contains a narrowing restricting blood flow, characteristic changes are often evident in the EKG tracing and patients may also develop chest pain. Ironically, this abnormal result is called a “positive” test (positive for whom?) whereas a normal result is referred to as “negative.”
If a patient has had a prior heart attack or has an otherwise abnormal baseline EKG, a standard stress test can be difficult to interpret, and myocardial perfusion imaging is often performed instead. At the outset of this procedure, commonly called a nuclear stress test, patients are injected intravenously with either the radioactive isotope thallium-201 or technetium-99m, agents that are avidly absorbed by the heart as long as the muscle is alive and the blood supply to it is unobstructed. Images of the heart are acquired while the patient lies under a gamma camera, essentially a digital detector of radioactive particles, a technology that was invented in the 1940s during work on the Manhattan Project. The patient then exercises, is injected with a second dose of radioisotope, and again is imaged under the camera. The entire process takes about two hours.
Normal heart muscle absorbs the tracer homogeneously, which the computer displays as color-enhanced, cross-sectional silhouettes, and the pictures at peak exercise should be similar to those obtained at baseline. If there is a blockage in one or more of the coronary arteries or the patient has had a prior heart attack, a defect is apparent in the digital images. A nuclear stress test is more sensitive and specific for detecting the presence of coronary disease than is a regular stress test, raising the precision of the exam. It does, however, expose the patient to a significant amount of radiation, about the same as a CT scan, equivalent to about 850 chest X-rays, enough to set off the radiation detectors at federal buildings like the White House. Still, for patients with a prior heart attack, known complex coronary disease, or women in whom the false-positive rate for a regular stress test is quite high, nuclear imaging, can be quite useful.
• • •
Dick Cheney arrived unaccompanied for his stress test at George Washington University Hospital on July 11, 2000. He was able to exercise for nine minutes on the treadmill (about average for a fifty-nine-year-old man) and had no chest pain. Not bad. The nuclear images, however, were a mixed bag. While the test was unchanged compared to the prior year’s exam, with no signs of new ischemia, there was clearly evidence of significant damage from the old heart attacks involving both the lateral and inferior walls of the heart. Overall it was a stable but definitely abnormal test.
The next day, I stopped by Cheney’s internist’s office, and together Gary Malakoff and I walked over to the clinic to see Cheney. After brief pleasantries, Cheney almost matter-of-factly said, “It looks like I may be asked to run for vice president.”
I think Gary might have actually said, “Oh my God!” but I forced myself to channel some of Cheney’s preternatural calmness and tried to act as if patients tell me that all the time.
“What will you be able to say about my health?” Cheney asked.
I began by reviewing the results from the stress test and echocardiogram. I told Cheney that although the two studies clearly showed impairment of his cardiac function, a consequence of his three heart attacks, the results appeared to be stable when compared to tests performed a year earlier. It was a good sign that Cheney continued to lead an energetic life, with a very demanding job, and was able to ski at high altitudes and hunt, reassuringly without signs of clinical heart failure. I told Mr. Cheney that I felt his cardiovascular status was sufficient for what I could only imagine would be a remarkably fatiguing and stressful job, but although I thought he would do well, there was obviously no way I could predict the future. Cheney never really asked whether we thought he was physically fit to be vice president. I don’t think he intended the meeting to be the political version of preoperative clearance. He simply wanted to know what we would be able to say. Before leaving, Cheney asked us to keep the news confidential until an announcement was made and told us that at some point, Gary and I would need to put together something in writing. At no time did he try to suggest what we would or wouldn’t be able to talk about.
• • •
Five days later, on Monday, July 17, my assistant Yaa called the cath lab to tell me there was a Dr. Cooley on the phone from Texas.
“Dr. Denton Cooley?” I asked.
“Yes, Denton Cooley.”
I didn’t know Dr. Cooley personally, but I certainly knew who he was. Dr. Cooley was one of the pioneers of cardiovascular surgery, and at eighty years old, he was still one of the world’s preeminent heart surgeons. Cooley’s career had been filled with legendary accomplishments. He was the founder of the Texas Heart Institute and its chief surgeon, and in 1968, he performed the first successful heart transplant in the United States. The following year, he implanted the world’s first total artificial heart, a gutsy attempt to save the life of a dying forty-seven-year-old man using an untested and unapproved device. In 1984, President Ronald Reagan presented Dr. Cooley with the Medal of Freedom, the nation’s highest civilian award.
“Do you know what he wants to talk about?” I asked.
“He didn’t say, but Dick Cheney called earlier and said it was okay for you to speak to him.”
I moved to a phone where I could talk in private and called Dr. Cooley in Houston. He was cordial but got right to the point. He told me that Governor Bush had asked him to review Dick Cheney’s medical history, and Cooley asked me to summarize it for him. After a quick, slightly uncomfortable flashback to medical school and my first day on cardiac surgery, I launched into a long, detailed, and comprehensive review of Cheney’s history.
I told Dr. Cooley about Cheney’s three prior heart attacks, the first at age thirty-seven and the most recent twelve years before, in 1988. I discussed Allan Ross’s decision to send then Congressman Cheney for coronary artery bypass surgery and the details of the operation performed by Dr. Aaron. Following surgery, Cheney had undergone cardiac catheterization twice in the 1990s, both of which I had participated in, revealing that two of his bypass grafts had closed. One of these grafts, the left internal mammary, was not functioning, likely because all of the blood flow to the front of the heart was going through the relatively little diseased, “native” left anterior descending coronary artery that the graft was intended to bypass. The second graft undoubtedly had failed because Aaron had attempted to bypass the artery that caused the 1984 heart attack, which he described in his op-note as an “unfilled, unused, and atrophied vessel.” I went on to review the results of Cheney’s recent stress test and echocardiograms and his lack of symptoms or congestive heart failure. After I had spoken uninterrupted for several minutes, Dr. Cooley asked me if Cheney was ever in cardiogenic shock.
Cardiogenic shock is a critical condition defined as the inability of the heart to provide the bare minimum amount of blood necessary for organ function. If it is not quickly rectified, death usually follows.
“No, sir,” I replied.
“Well, then, I will call and reassure the governor,” Cooley said, thanking me for my time before ending the call.
Governor Bush later said, “Dick had talked to his doctor and then I got Denton Cooley to call Dick’s doctor to discuss the record, and I talked to Dick extensively about his health.” Mr. Bush went on to say that when Dr. Denton Cooley told him Mr. Cheney “was suited to be the vice president, I felt that was good enough for me.”
Later that day, I wrote a letter to Gary Malakoff that reviewed the events of the prior week and summarized what I thought about Dick Cheney’s cardiovascular fitness to serve as vice president of the United States. I concluded the letter in this way:
Today I spoke with Dr. Denton Cooley after this was requested by Mr. Cheney. I reviewed Mr. Cheney’s medical history essentially as I outlined it to you above. Later I spoke with Mr. Cheney. During that conversation I clearly reviewed what I consider to be key elements of his cardiovascular status; that his heart shows the effects of at least 2 prior MI’s, that his left ventricular performance is impaired but he has no symptoms c/w CHF [congestive heart failure] and has no angina. I stated that his risk of an adverse event is higher than a person of similar age without heart disease but that his short-term and long-term risk is not quantifiable. I also mentioned that his current vigorous lifestyle is in many ways very reassuring.
On July 25, 2000, the day that the Bush campaign announced that Dick Cheney was the governor’s pick for vice president, Dr. Cooley released a statement from Houston in which he said, “In a recent checkup by Dr. Jonathan Reiner, he declared that Mr. Cheney is in good health with normal cardiac function.”
While I did believe that overall Dick Cheney was in good health and I thought his cardiac history would not interfere with the duties of vice president, I knew that his heart function hadn’t been normal in twenty-two years, and I had explained that to Dr. Cooley.
The newspapers and cable news outlets soon filled with uninvolved and uninformed medical pundits opining about Dick Cheney’s chances of surviving his time in office. Without either a physical exam or record review, the New York Times’s Lawrence K. Altman actually calculated the candidate’s odds:
Mr. Cheney’s statistical chances of survival for the next five years are 94 percent, slightly lower than for Americans without heart disease, according to figures that a Duke University cardiologist, Dr. Eric Peterson, calculated by comparing Mr. Cheney’s medical profile with those of other patients in a national registry of bypass operations kept at Duke.
USA Today quoted Dr. Lawrence Cohn, of Brigham and Women’s Hospital in Boston, as saying that “if Cheney has scrupulously taken his medicine, watched his diet and exercised, ‘he’s golden.’ ” Other experts offered less rosy pronouncements. In the New York Daily News, Dr. Stephen Siegel, a cardiologist at NYU Medical Center, said, “Atherosclerosis is like incurable cancer—it’s a disease you control, not cure.” Craig Smith, chief of cardiothoracic surgery at New York-Presbyterian Medical Center in New York City, said, “The negatives are that he had early onset of coronary disease, which makes him more prone to have a recurrence.”
• • •
Sometimes the determination of whether a patient is medically fit for a job is easy. Consider the case of a commercial pilot who came to see me several years ago after he began to have chest pain. The patient was an experienced 747 captain who flew long-haul, trans-Pacific routes for a major airline and had flown as recently as a few days before his clinic appointment. Because pilots fear being grounded, they tend to be notorious doctor-phobes, a fact that made this patient’s visit all the more concerning. I ordered a stress test, which was grossly abnormal, and the cardiac catheterization that followed a few days later identified severe coronary disease. When we finished the procedure, I put a hand on the pilot’s shoulder and told him I thought he was a very lucky guy, having dodged a huge bullet. Imagine developing a heart attack while strapped into the cockpit of a jumbo jet traveling at 550 miles per hour 38,000 feet over the Pacific Ocean or, worse, losing consciousness on final approach with 450 souls in the seats behind you. The good news was that his heart could be fixed, and I was confident he would do very well. The bad news was that because he was going to need bypass surgery, his days as an airline pilot were over. Federal aviation regulations disqualify pilots with angina, significant coronary disease, or a history of myocardial infarction and it would be difficult for him to regain his flight certificate. I told him that I was very sorry that he wasn’t going to be able to fly, projecting how I would feel if I could no longer practice medicine. He told me not to worry; he was close to retirement and he would be fine.
I’ve been asked to clear Secret Service and FBI agents before they return to duty, foreign service officers prior to their overseas postings, as well as tour bus drivers, US marshals, and police officers; each of these occupations has well-codified health requirements. You can’t get a driver’s license if your vision is poor, enter the military if you fail the physical, or get security clearance without a background check. There are, however, no established medical fitness criteria for candidates for president or vice president of the United States.
• • •
On March 4, 1841, William Henry Harrison became the nation’s ninth president, but his time in office would be very brief, ending only thirty-two days after his inauguration when he died after developing pneumonia. Following Harrison’s death, Vice President John Tyler assumed the presidency, invoking for the first time in American history Article II, section 1 of the US Constitution, which states:
In Case of the Removal of the President from Office, or of his Death, Resignation, or Inability to discharge the Powers and Duties of the said Office, the same shall devolve on the vice president . . .
Because eight of the thirty-seven vice presidents who followed Tyler were eventually elevated to the presidency, the essential medical qualification of a vice president is undoubtedly fitness to be president. How medical fitness is defined, who gets to define it, and how much the public has a right to know are more difficult questions.
• • •
During the 1960 presidential primaries, rumors began to circulate that Senator John F. Kennedy had Addison’s disease, a serious and potentially life-threatening illness involving the adrenal glands, prompting the candidate’s brother Robert F. Kennedy to declare:
The Senator does not now nor has he ever had an ailment described classically as Addison’s Disease, which is a tubercular destruction of the adrenal gland. Any statement to the contrary is malicious and false.
While tuberculosis was not the cause of Senator Kennedy’s adrenal insufficiency, he clearly did have Addison’s disease, which was diagnosed in England in 1947 after Kennedy, then a Massachusetts congressman, collapsed during a visit to London. Senator Kennedy told the historian Arthur Schlesinger, “No one who has the real Addison’s disease should run for the presidency, but I do not have it.” Kennedy adviser Theodore Sorensen said, “He is not on cortisone. . . . I don’t know that he is on anything—anymore than you and I are on.” The candidate was, in fact, taking cortisone daily and had a steroid pellet surgically inserted under his skin every few months to replace hormones his adrenal glands could no longer sufficiently produce.
In 1992, the Journal of the American Medical Association published an interview with two of the pathologists who performed President Kennedy’s autopsy after his assassination on November 22, 1963. While the Warren Commission report of the autopsy findings did not describe the adrenal glands, in the journal interview, Dr. J. T. Boswell, one of the principal Kennedy pathologists, stated that they could find no gross evidence of adrenal tissue and only scant cells on microscopic examination, consistent with the diagnosis of severe Addison’s disease. In a follow-up editorial, the journal’s editor in chief, Dr. George Lundberg, noted that in the 1960 general election, only 114,673 (0.17 percent) votes separated Kennedy from Nixon. Lundberg writes:
The mental and physical health of a presidential candidate . . . is of great political concern to the electorate. But had the American people been told that one candidate had suffered for more than 13 years from an incurable, potentially fatal, although fully treatable disease and that there were potential serious adverse effects of treatment, would the election results have been different?
Herbert Abrams, professor emeritus of radiology at Stanford University and a member of Stanford’s Center for International Security and Cooperation, has written extensively about presidential health and public disclosure. He notes that when the public votes, “it expresses its consent and endorsement at the ballot box. Such consent can only be informed if it is based on full disclosure.” How much does the public have a right to know? Abrams likens the threshold for candidate disclosure to the informed consent process prior to medical procedures:
When the public chooses a president, the risk that must be disclosed is any illness that may impede the candidate’s capacity for decision-making for the nation, or render him disabled during the course of his tenure as president and thereby unable to serve.
Lawrence Altman, now a senior scholar at the Woodrow Wilson International Center in Washington, DC, who has spent much of his career relentlessly advocating for greater access to the medical records of political candidates, states:
In my view, the public uses elections to hire its officials, expecting these employees to be able to serve their full terms without being inconvenienced except for minor ailments. Nevertheless, no ailment should disqualify anyone, even if ill or dying, from holding office. The choice is the electorate’s.
Although in recent elections it has become increasingly common for the candidates” physicians to release statements outlining their patient’s pertinent medical issues, cooperation, transparency, and veracity have varied over the years.
• • •
In spring 1944, as US and Allied forces were readying for the invasion of Europe, President Franklin Delano Roosevelt’s health was declining. The president had developed influenza in December 1943 and had not rallied after that illness. On March 27, 1944, Dr. Howard Bruenn, a cardiologist from the National Naval Medical Center, examined the president. He found that the president appeared tired and gray, coughed frequently, and was significantly short of breath when he moved. The president’s blood pressure was 186/108, and examination of the chest revealed rales (derived from the French râle, meaning “rattle,” indicating the presence of fluid in the lungs). Dr. Bruenn diagnosed congestive heart failure and recommended one to two weeks of bed rest, codeine to suppress the cough, digitalis to strengthen the heart, and sedation. Admiral Ross McIntire, the president’s physician, rejected the recommendations, citing in Bruenn’s words the “exigencies and demands on the President.” The president’s condition remained unchanged over the next few days, and civilian consultants were brought in, one of whom was the prominent surgeon Frank Lahey, founder of Boston’s Lahey Clinic. On April 4, the president felt better, but his blood pressure was now 226/118. In response to growing rumors about the health of the president, Admiral McIntire held a press conference and declared:
When we got through, we decided that for a man of 62-plus we had very little to argue about, with the exception that we have had to combat the influenza plus the respiratory complications that came along after.
The public was never told that the president was struggling with congestive heart failure.
In a letter dated July 10, 1944, ten days before FDR accepted the nomination of the Democratic Party for a fourth term, Dr. Lahey wrote:
On Saturday, July 8, I talked with Admiral McIntire in my capacity as one of the group of three, Admiral McIntire, Dr. James Paullin of Atlanta, Georgia, and myself, who saw President Roosevelt in consultation and who have been over his physical examination, x-rays, and laboratory findings concerning his physical condition. . . . I am recording these opinions in the light of having informed Admiral McIntire Saturday afternoon July 8, 1944 that I did not believe that, if Mr. Roosevelt was elected President again, he had the physical capacity to complete a term. I told him that, as a result of activities in his trip to Russia he had been in a state which was, if not in heart failure, at least on the verge of it, that this was the result of high blood pressure he has had now for a long time, plus a question of a coronary damage. With this in mind it was my opinion that over the four years of another term with its burdens, he would again have heart failure and be unable to complete it. Admiral McIntire was in agreement with this.
In November, President Roosevelt defeated New York’s governor, Thomas E. Dewey, in an Electoral College landslide. Only a few months into his fourth term, on April 12, 1945, President Roosevelt died from an apparent cerebral hemorrhage, likely precipitated by his uncontrolled hypertension.
• • •
Mr. Cheney asked Gary Malakoff and me to provide our own reports, which the campaign released the same day as Dr. Cooley’s. I intended the statement to be a succinct and accurate description of Mr. Cheney’s medical history and his current status, not an exhaustive case presentation. No one from the Bush-Cheney campaign proffered any guidance or guidelines for the documents, which were released to the public unedited. I wrote:
Mr. Cheney has a remote history of an inferior wall myocardial infarction that occurred in the late 1970’s. Cardiac catheterization following that episode revealed moderate coronary artery disease and he was managed medically for the next several years. A small, second, myocardial infarction occurred in 1984 and again in June 1988. Cardiac catheterization during that hospitalization demonstrated an increase in the extent of his coronary disease and he subsequently underwent successful coronary artery bypass graft surgery at George Washington University by Dr. Benjamin Aaron. Following surgery, Mr. Cheney returned to his vigorous lifestyle and has been essentially asymptomatic for more than a decade. Recent nuclear stress tests have been stable, and unchanged, for the past several years. Recent echocardiography shows some left ventricular dysfunction consistent with the history and distribution of his remote myocardial infarctions.
Clinically, Mr. Cheney continues to lead an asymptomatic and extraordinarily vigorous lifestyle. He travels extensively for work, exercises 30 minutes per day several days per week on a treadmill, and engages in vigorous recreational activities such as hunting.
I knew that my statement would be carefully scrutinized, and for that reason, the 173 words took me most of an afternoon to write. Cheney had a complicated medical history, and the task of distilling twenty-two years of cardiac events into a few paragraphs of text intended for the general public was challenging. Ultimately I decided to simply summarize Cheney’s salient history and his current status.