The Implications, Medical and Political, of Cheney's Heart Troubles

Dick Cheney talked Friday like he was off to get his teeth cleaned. "I look on this as an insurance policy," he said, in announcing he would visit George Washington Hospital Saturday for more tests on his crotchety heart — and the likely subsequent implantation of a pacemaker. It is, he said, a "routine but precautionary step that my record calls for."

Though Cheney is trying to be reassuring, for him it probably is almost routine by now. Once more through the chart: This is the vice president's third hospitalization since the election. He had his first heart attack in 1978, quadruple bypass surgery in 1988, and his latest, fourth heart attack in November (complete with wire stent to open a 90-percent-blocked artery).

Now he's going in for the same procedure he had in March — a cardiac catheterization, for which doctors insert wires into a vein in his groin and thread them up into his heart. The wires are tipped with electrical sensors that give precise readings on the rhythm of the heart muscles "for the purpose of determining the vice president's risk of developing a persistent, abnormal heart rhythm," said Dr. Jonathan Samuel Reiner in a statement released by the White House.

Cheney said the trouble turned up when he wore a halter cardiac monitor that detected "some minor periods, very short periods, one to two seconds each, of rapid heart rate," he said. "I can't feel anything when it happens, I am asymptotic, nothing shows externally with respect to that."

"But it does raise the possibility that I may need to have implanted, sort of — I think of a pacemaker plus. It is something called an ICD, an implantable cardioverter defibrillator," the vice president said. The device in question is a battery-driven device, about the size of a silver dollar, that senses the beating rhythm of the heart and sends an electrical jolt to heart muscles to correct any abnormal rhythm. It's generally implanted under the collarbone, with wires threaded to the heart muscles, and lasts about 8 years before needing replacement.

It's not a particularly risky procedure; most implantations are done under local anesthesia and take 1-1 1/2 hours, according to WebMD. Afterwards, Cheney should keep his cell phone at least six inches away from his heart to avoid interference, and stay away from MRIs and certain types of welding equipment. But the new ones aren't bothered by microwave ovens, and for the most part pacemakers are safe and reliable.

But it's still a surgical procedure, which raises the possibility that something will go wrong, and George W. Bush will have to find himself a new chief adviser/energy czar/congressional arm-twister/Senate tiebreaker/rock on which his White House is built/most invaluable vice president in history. Cheney works longer hours than his boss, he sits in when Bush meets world leaders, and his appearance last week at an Orlando fund-raiser June 23 brought in $2.5 million for the GOP. And there's only one of him.

Is Bush ready to do without him?

Probably more now than ever. Although pundits who were worrying about this sort of thing during the campaign tended to think a year was a safe minimum learning-to-fly-solo period — for what that's worth — but Bush has been in office five months now, and his feet are pretty wet. And it's not as if Cheney is the only wise old government hand left in this Administration.

White House watchers insist that Cheney and his workload are still critically important to Bush, and the man is certainly uniquely useful as a man of infinite qualifications and zero ambition for higher office. He's also a living reassurance to the right wing that Bush won't let his professed love for reaching across the aisle get out of hand.

Yet the Bush Administration's prime agenda-setting days were already waning when Jim Jeffords turned the Senate upside down. Politically, the ball has long since left Bush's court, and while Cheney keeps the White House's trains running on time, they depart on Tom Daschle's schedule now.

In public-opinion polls, Cheney's unusually high profile is fading — in a New York Times/CBS poll conducted last week, 59 percent had no opinion of him whatsoever, compared to 49 percent two month ago. Of those who think about him, 27 percent view him favorably, and 14 percent view him unfavorably. There are even some indications — especially in the energy arena, where two-thirds think Bush and Cheney are too beholden to oil companies — that Bush might be more popular with the American center if Cheney weren't around. (Cheney, after all, is the one who actually got rich in the oil business.)

Every day Bush is in office, he gets more comfortable with the job, and the bodily presence of Cheney gets less critical. Cheney, of course, doesn't dispute that publicly. If his latest visit to the hospital turns up further information suggesting "I would not able to perform, I'd be the first to step down," he said Friday.

As it is, he expects to be home Saturday night after the procedure — and back at work Monday.