Free Heart: An American Medical Odyssey by Dick Cheney, Jonathan Reiner Page B

wrist crease. After allowing the anesthetic to take effect, I pinch an IV catheter between my right thumb and forefinger and, with my other hand, get a fix on the location of the pulsating vessel lying a millimeter or two below. Very deliberately, as if demonstrating the procedure in slow motion, I pierce the skin aiming for the target under my left hand, and a few seconds later a crimson flash appears in the IV announcing the needle’s arrival in the slim radial artery. I step on a foot pedal to turn on the X-ray tube mounted in the large C-shaped arm encircling the patient and watch on the monitor as the curved tip of a thin wire slides through the radial artery sheath and up the arm toward the shoulder. A one-meter-long catheter is threaded onto the wire, and together they are navigated through the radial and brachial arteries of the arm to the axillary and subclavian arteries of the shoulder and finally down into the aorta to the level of the aortic valve, from where the coronary arteries arise.
    Through my latex gloves, I can feel the familiar supple smoothness of the catheter. With a subtle clockwise torque I engage the originof the coronary, the two-millimeter polyethylene catheter now swinging in synchrony with the moving muscle. I glance quickly at the patient and then at the EKG and blood pressure waveforms while I work the controls to position the digital detector above the patient’s head for the first set of images. A programmable power injector delivers six milliliters of iodinated X-ray contrast into the coronary artery; on the monitor, a gray-scale road map of the vessel plays back in a continuous loop, the angular borders of the vessel flexing in concert with the underlying myocardium. I repeat the imaging in multiple projections before switching catheters to assess the other coronaries. Finally, I pass a rounded catheter, shaped like a pig’s tail, across the aortic valve and inject dye into the heart, inside the left ventricle, creating a vivid image of the contracting heart. The images acquired during the cardiac catheterization are stored in an array of servers, immediately reviewable on workstations around the hospital, and over the Internet, on my iPad, smart phone, or computer anywhere in the world.
    The patient occasionally stirs but will not remember the half-hour procedure, accomplished through a 2-millimeter puncture in his wrist.
    •  •  •
    Two weeks after the November 1978 election, and five months after his heart attack, Dick Cheney underwent a follow-up stress test at Natrona County Memorial Hospital in Casper. Now back at unrestricted activity, walking every day for exercise, weighing a slimmer 179 pounds, and no longer smoking, the newly elected congressman achieved a peak heart rate of 200 beats per minute without chest pain or EKG abnormalities.
    Although he was demonstrating reassuring cardiac fitness at the outset of his congressional career, the stress test could not delineate the amount of Cheney’s underlying coronary disease or whether another heart attack was imminent. In a February 1979 letter to Dr. Freeman Cary, the attending physician of the US Capitol, Dr. Hiser had raised the possibility of coronary arteriography (that is, cardiac catheterization) to further define Cheney’s coronary anatomy:
    Dick Cheney suffered an inferior myocardial infarction in 1978. He has had several treadmills performed since then and has done quite well on them. . . . He had been recommended to have coronary arteriography performed because of his young age and the brilliant career he should have before him. He has not made a final decision as to whether he would desire to have this done.
    The day before Thanksgiving in 1979, almost a year and a half after his heart attack, Cheney finally underwent cardiac catheterization to define the extent of his coronary artery disease. Dr. Al Del Negro performed the procedure at Georgetown University Hospital in Washington, DC, employing a now