What Dick Cheney can expect after his heart transplant
By David Hebestreit
David Hebestreit, a teacher at Livonia Churchill High School in Michigan, received a new heart in 2006. He is currently working toward an MFA in creative writing at the Rainier Writing Workshop at Pacific Lutheran University.
At 71, Dick Cheney, former vice president of the United States, lies in a hospital bed recovering from heart transplant surgery. Six years ago, when I received my transplant, I was a 35-year-old high school English teacher and soccer coach. Our lives are profoundly different, but he is about to experience the same things I did.
The reason that Cheney and I shared this predicament is that in 1996 I suffered a brain aneurysm. The emergency surgery to repair the ruptured blood vessel left me saddled with endocarditis, a viral infection of the lining and valves of the heart. This ruthless infection had its way with two valves, the mitral and aortic, and the lining of my heart.
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In 1997, I had open heart surgery to replace those valves with mechanical versions. For a number of years, they alleviated the symptoms, but over time the heart grew tired and weak, and worked inefficiently because the initial damage to the muscle could not be reversed. As a result, it became enlarged, as any muscle will when working harder.
It got so big, in fact, that I was diagnosed with full-blown congestive heart failure in 2001. This is when a white-coated doctor told me, without emotion, that I was going to need a new heart.
Cheney woke up a few mornings ago and was taken off the ventilator that had functioned as his lungs before and during surgery. He was prepped for the event, as I was. But coming off a ventilator is one of the least desirable tasks I have ever completed.
The drainage tubes will be plucked one by one from his body like green blades of grass from a spring lawn, thin but taut at the connection. The temporary pacemaker wires will likely be yanked in a day or two, dragging under the skin across the chest as they release from the tissue of the heart like a Band-Aid expertly ripped from the skin.
It will take several months for Cheney's sternum to fuse entirely, especially given his age. Simple tasks, such as turning in bed or getting up to walk, will require planning or he will meet with opposition in the form of pain.
Cheney has been receiving prednisone through an IV.
Prednisone, used to suppress the immune system in the initial year or so, is a steroid that will make his joints and muscles feel youthful for a while. But he will pack on the pounds due to ravenous eating and water retention. His face will become puffy, his body bloated.
He will need to adhere to a strict diet and monitor his weight daily, among a host of other daily protocols. All of this will become routine for him, or for the loved ones caring for him.
He will suffer from nausea and congestion that will cause his chest to rise and swell and will, in turn, cause him pain.
He will submit to a battery of tests. Blood draws will be routine, ensuring sufficient levels of immunosuppressant medicine in his blood. He will be prodded and poked by countless nurses, doctors and technicians.
Health care professionals will quiz Cheney about the arsenal of meds he must take on a rigid schedule, four times daily at first. He will learn which foods he cannot eat, those that interfere with the levels of the incredibly expensive meds in his blood. He won't be able to eat grapefruit. Raw foods are no-nos due to the possibility of food-borne illnesses that those with newly compromised immune systems simply cannot risk.
But Cheney will get better, day by day.
He will undoubtedly wonder about the donor and possibly even the donor's family. Admittedly, he will be given little information about the donor. It is simpler if no one knows much of anything about the donor organ that is sewn into Cheney. It makes for a totally clean slate, if you will.
My transplant experience included several organs from one donor coming to the same transplant center. As a result the small bits and pieces of information were pieced together by each recipient, thus yielding a fairly accurate picture of the donor. But each transplant center resists giving so much information that the recipients, flowing over with gratitude, can go in search of the donor family, who may just want to recede into the background and not be constantly reminded of their loss.
It won't take him long to realize that the heart he received was one that someone else also needed. This guilt may come and go quickly, or it may linger. It may never come at all. But other families will wish that their father, brother or son had received the new heart instead of Cheney.
When I was just a few days out of surgery, I ran into the mother of someone who was about my height and weight and had my exact blood type — a man who was essentially waiting for the same heart as me. She was having a bad day and told me that I had gotten her son's heart. Her son had come in before me and was still waiting. But his hadn't deteriorated like mine had.
Cheney may meet with scorn of this nature as a result of his age, or because of his social position. But it isn't likely. Cheney is tucked away in some cool, white pavilion as he recovers, away from the masses.
He will take meds the rest of his life, and will submit to a routine that, if he follows it, will permit him a chance at a better quality of life in the coming years.
If he decides against the routine prescribed for him, the odds of his finding success greatly diminish. The real kicker is that even though Cheney may do everything that the transplant center requires him to do, there may still be complications and organ rejection.
My transplant has been nothing but positive. But, across the board, I received a perfectly matched heart. Because of this, I take low doses of meds and have had almost no complications, excepting an infection here and there that comes as a result of a compromised immune system.
Even my ejection fraction, the measure of the heart's pumping efficiency, has returned to high-end normal levels, the same levels as when I was a collegiate soccer player.
The reality is that heart transplant surgery, while usually successful, is also fickle. Sometimes a well-matched donor heart is not accepted by the recipient's immune system. And the reason this happens is not always clear.
But, eventually, Cheney will walk out of the hospital and into the cold sunlight of a Virginia afternoon, thankful for so many things, I am sure. Perhaps he will be thankful for the advancements in medicine and technology. Perhaps he will be thankful that he has received, again, the gift of life. Perhaps he will even be thankful that he is not one of the 42 million Americans without health insurance. Because uninsured 71-year olds do not get heart transplants.
