Dick Cheney's heart

The following script is from "Dick Cheney's Heart" which aired on Oct. 20, 2013. The correspondent is Dr. Sanjay Gupta. Michael Radutzky and Denise Schrier Cetta, producers.

Dick Cheney is one of the most polarizing figures in America. But whatever your opinion of him, you'll be surprised to learn that during his years in government, his biggest fight was for his own survival.

He has been the beneficiary of nearly every medical breakthrough to combat heart disease over the last 35 years, including a heart transplant at the age of 71. And as you'll hear tonight, many of those innovations came just in time to save his life.

It's all revealed in a new book called "Heart," that he's written with his cardiologist Jonathan Reiner. It's a medical story, but also a story about how his disease intersected with pivotal moments in modern history. Cheney's health was so tied to his political career, just 67 days after taking the oath as vice president, he took a historic and unprecedented action.

Dick Cheney: Basically, what I did was I resigned the vice presidency effective March 28, 2001.

Sanjay Gupta: So nearly, for your entire time as vice president, there was a letter of resignation sitting there.

Dick Cheney: Pending.

Sanjay Gupta: Pending.

Cheney discovered there was no provision in the constitution to replace a vice president who is alive, but incapacitated. So he drew up a letter of resignation to give to the president.

Dick Cheney: It says, "In accordance with Section 20 of Title Three of the United States code, I, Richard B. Cheney, hereby resign the office of Vice President of the United States...

Sanjay Gupta: How did President Bush react when you told him about this?

Dick Cheney: A little surprised. But he thought it was a good idea.

It was just three years ago Cheney says that people gasped, when they saw how frail he had become. Today, just 20 months after his heart transplant, Cheney's weight is back to normal, the color has returned to his skin - he has no shortness of breath.

Sanjay Gupta: How are you feeling?

Dick Cheney: Fantastic. Now I'm to the point where-- I literally, you know, feel like I have a new heart. A lot more energy-- than I had previously. There aren't any real physical limits on what I do. I fish, I hunt. And-- I don't ski, but that's because of my knees, not my heart. So it's been a miracle.

Dick Cheney is a product of modern medicine at its best. He has suffered five heart attacks, undergone open heart surgery, multiple catheterizations and angioplasties, had a defibrillator implanted, and a pump attached directly to his heart -- all of that before his transplant at age 71. Each time Cheney reached the precipice of death a breakthrough in medical technology extended his life.

Bad hearts run in Dick Cheney's family, and early on he did little to take care of himself. He had his first cigarette at age 12, and by the time he was President Ford's chief of staff at age 34, his daily staples included fatty food, beer and up to three packs a day.

Dick Cheney: All the cigarette companies donated cigarettes in a white box with gold trim around it embossed with the presidential seal. That was kind of, if you were in a cocktail party, or maybe even Washington, and whipped out your presidential cigarettes and lit it up with a park of matches from Air Force One, that was sort of a status symbol.

After his first White House stint, Cheney returned to Wyoming to run for Congress. At just 37, his genetics and his lifestyle caught up with him. He suffered his first heart attack, and doctors thought he should quit the race, but he didn't want to hear it.

Sanjay Gupta: You were pretty persuasive because, I mean, they said, "it would be wise to drop out of this at the present time."

Dick Cheney: They said that in the medical records.

Sanjay Gupta: They didn't tell you that?

Dick Cheney: Well, I don't recall. What I took away from the conversations was that key phrase is "hard work never killed anyone."

Sanjay Gupta: Patients like to hear what they want to hear.

Dick Cheney: And that may well have been the case here, as well, too. But they also emphasized that stress comes from doing something you don't want to be doing.

He won that election and five more after that, but his heart disease was steadily progressing. By the time Cheney took over as the first President Bush's secretary of Defense in 1989, he'd suffered three heart attacks and undergone quadruple bypass surgery. It was a time of global upheaval. And Dick Cheney was in the center of it all - the collapse of communism, the uprising in China's Tiananmen Square and the first Gulf War.

Dick Cheney: Our Army, Navy, Air Force and Marines prepare for one of the largest land assaults of modern times.

Sanjay Gupta: Looking back, do you think the stress affected your heart disease and your overall health?

Dick Cheney: I simply don't buy the notion that it contributed to my heart disease. It was in fact that getting back to work, getting back to that job, whatever that job might be, was important enough that I, in fact, kept 'em separate, I guess would be the way to think about it.

Sanjay Gupta: But I do wonder, as a doctor, is that really plausible? Can you really keep such a significant medical history and such a significant job separate?

Dick Cheney: I did.

But when George W. Bush asked Cheney to be his running mate in 2000, there was enough concern that the Bush campaign sought out the opinion of world renowned Texas heart surgeon Denton Cooley. After speaking with Cheney's cardiologist, Dr. Jonathan Reiner, Dr. Cooley told the Bush campaign that Cheney was in good health with normal cardiac function.

Sanjay Gupta: The normal cardiac function wasn't true.

Dick Cheney: I'm not responsible for that. I didn't know what took place between the doctors.

Sanjay Gupta: This idea that you have this respected heart surgeon from Texas who didn't see you, didn't examine you, and then writes something saying that you have normal cardiac function. That just wasn't true, Mr. Vice President.

Dick Cheney: Go ask Denton Cooley about that.

Sanjay Gupta: But sir, you saw it.

Dick Cheney: Listen to me, I think the bottom line is: was I up to the task of being vice president? And there's no question. I think based upon the fact that I did it for eight years that they were right.

Sanjay Gupta: How were they able to say that you were able to do the job?

Dick Cheney: The way I look at it Sanjay is that first of all, I didn't seek the job. The president came to me and asked me to be his vice president. The party nominated me. The doctors that consulted on it reached a common conclusion and the people elected me. Now what basis do I override the decision making process? Do you want to have an offshoot where we come check with Sanjay Gupta and say, "Gee, is he up to the task?" That's not the way it works.

Despite Cheney's insistence that he was fit for office, and just four months after being cleared by his doctors, Cheney suffered another heart attack, his fourth.

[Dick Cheney: It was there and it was chest discomfort. Sufficient so I thought I ought to check it out.]

This time it came while the country was embroiled in the 2000 presidential recount. Cheney needed a stent to prop open a clogged artery.

[Swearing in:

Rehnquist: Are you read to take the oath of office?

Dick Cheney: I am.

Rehnquist: Please raise your hand and repeat after me.]

Yet again modern medicine had helped Dick Cheney dodge a bullet. But it was just nine months later when Cheney confronted, what he considers, one of the biggest challenges of his life: 9 / 11.

With President Bush in Florida, Cheney was in a bunker under the White House helping make decisions, even given authority by the president to shoot down passenger airliners.

Sanjay Gupta: I mean as far as stress goes, and again, as a doctor - with your heart history, how worried were you about just your health in the midst of all this?

Dick Cheney: Didn't occur to me.

Sanjay Gupta: Not at all?

Dick Cheney: No. I didn't think about my health. I was thinking about the problem we were dealing with.

But what Cheney didn't know was that his cardiologist Jonathan Reiner had received the results of a blood test that morning showing his potassium levels were dangerously high, a condition called hyperkalemia.

Sanjay Gupta: Big concern, I mean, how big are we talking about?

Jonathan Reiner: Potassium of 6.9 can kill you.

Sanjay Gupta: This is a huge problem.

Jonathan Reiner: Yeah. I laid awake that night, you know, watching the replays of the towers come down and now thinking that, "Oh great, the vice president's gonna die tonight from hyperkalemia."

Another blood test the next day showed Cheney's potassium levels were normal. But this level of scrutiny over Dick Cheney's health is a reminder he is not an ordinary patient. And caring for him often required extraordinary precautions.

In 2007, when Cheney needed his implanted defibrillator replaced, Dr. Reiner ordered the manufacturer to disable the wireless feature - fearing a terrorist could assassinate the vice president by sending a signal to the device, telling it to shock his heart into cardiac arrest.

Jonathan Reiner: And it seemed to me to be a bad idea for the vice president to have a device that maybe somebody on a rope line or in the next hotel room or downstairs might be able to get into-- hack into. And I worried that someone could kill you.

It might sound farfetched, but years later this scene from the SHOWTIME drama "Homeland" showed just how it could be done to the fictional vice president.

Sanjay Gupta: What did you think when you watched that?

Dick Cheney: Well, I was aware of the danger, if you will, that existed but I found it credible. Because I know from the experience we had and the necessity for adjusting my own device that it was an accurate portrayal of what was possible.

The precariousness of Cheney's physical health raises questions about his state of mind when he was helping make decisions, including those about war and peace.

Sanjay Gupta: You were instrumental in many big decisions for the country, including going into Afghanistan and Iraq.

Dick Cheney: And terrorist surveillance programs and enhanced interrogation programs--

Sanjay Gupta: Terrorist surveillance programs, wiretapping, enhanced interrogation. You'd had had four heart attacks, three catheterizations at this point, a defibrillator, bypass surgery.

Dick Cheney: Right.

Sanjay Gupta: Did you worry about your physical health impacting your judgment and your cognition?

Dick Cheney: No.

Sanjay Gupta: Not at all?

Dick Cheney: No.

Sanjay Gupta: Were you the best you could be?

Dick Cheney: You know, I was as good as I could be, you know, given the fact I was 60-some years old at that point and a heart patient.

Cheney didn't want to acknowledge numerous studies that show a significant connection between severe heart disease and memory loss, depression, a decline in decision-making abilities and impaired cognition. Or that he could be one of the many patients vulnerable to these side effects.

Sanjay Gupta: Did they talk at all about potential side effects because of limited blood flow to the brain, on cognition, on judgment? Was that something that you had heard about in any way?

Dick Cheney: Yeah.

Sanjay Gupta: Both, you didn't know about it? You weren't worried about it?

Dick Cheney: No.

Sanjay Gupta: Did anyone counsel you at all on that?

Dick Cheney: Not that I recall.

Sanjay Gupta: What about even things like depression?

Dick Cheney: No. No.

And that's all he wanted to say about that. But what Dick Cheney was eager to talk about was his transplant, detailed in his book, "Heart."

Dick Cheney: When you emerge from that gift of life itself, there's a tremendous feeling of emotion, but it's very positive. I think my first words when I came out from under the anesthetic when they said it had worked great was, "Hot damn." Literally.

Cheney and Dr. Reiner wanted to show us just how dramatic his transformation has been.

This is an image of Cheney's ravaged and diseased heart just moments after it was removed.

Jonathan Reiner: This is a rather large basin. And here is your heart.

Dick Cheney: It's the one I lived with for 70 years.

Jonathan Reiner: A normal heart would basically be about the size of two fists clamped together like this, maybe even a little bit smaller. And you see this is about half a foot wide.

Sanjay Gupta: Old heart, new heart.

Dick Cheney: Old heart, new heart. Its one of those situation where bigger isn't necessarily better.

That's because a bigger heart can't effectively pump blood through the body.

The X-ray on the left shows Cheney's enlarged heart - twice the normal size and pushing on his other organs. On the right, his new heart.

And then there's this comparison... again on the left, Cheney's diseased heart - weakened, with narrowed arteries. And his new heart - with healthy vessels and no blockages.

Dick Cheney: Dramatically displays how sick I was.

Today Cheney says he's taking good care of his new heart. He spends much of his time back in Wyoming with his family - and playing rodeo hand to granddaughter Gracie.

Dick Cheney: You wake up every morning with a smile on your face because you've got a new day you never expected to have. And there's a sense of wonderment. Nothing short of magical.

Sanjay Gupta: You know, magical, wonderment, you're words. Those aren't words you typically hear, or expect to hear from you...

Dick Cheney: Like Darth Vader. Well, those are the words I choose to describe it.