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CNN LARRY KING LIVE
Interview with Panel of Doctors Who Performed Surgery On Former President Clinton and Paul Begala
Aired September 6, 2004 - 21:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
LARRY KING, CNN ANCHOR: Tonight, exclusive: doctors in the operating room with former President Bill Clinton this morning. That successful quadruple bypass heart surgery may have prevented America's 42nd president from having a heart attack.
Here, and only here, for the hour: Dr. Craig Smith, the lead surgeon operating on President Clinton today. He's chief of cardiac surgery at New York Presbyterian Hospital, Columbia University Medical Center. Dr. Allan Schwartz, chief of the hospital's cardiology division, also in the operating room today.
Dr. Robert Kelly, senior vice president, chief operating officer at New York Presbyterian. He, too, was there for the president's surgery, and Dr. Herbert Pardes, the hospital's president and chief executive officer.
Also with us, Paul Begala, the co-host of CNN's "CROSSFIRE", a very close friend of the president's who served as a counselor in the Clinton administration. They're all next on LARRY KING LIVE.
A couple of quick things with Paul Begala first before we get into the doctors. Paul, have you spoken to any of the people in the intensive care unit with the president?
PAUL BEGALA, CO-HOST OF "CROSSFIRE": I have, and as you can imagine, it's a little bit like being hit by a freight train. You know, I think the enormity of it has hit all of his family and friends. He's doing well, as these doctors are the best in the world. And the phrase they keep using that Senator Clinton used in her statement was "Thank God and thank the medical team." And just in that order. There's a profound sense of gratitude.
The president is, you know, doing well, but he is in intensive care and they did stop his heart for 60 minutes. And for those of us who are layman, Larry, who have not gone through it the way you have, it's really actually quite a frightening thing today now that we've had to really confront it firsthand.
KING: It's very scary. I had it in 1987 at New York Hospital and you're scared the night before, but you recover very fast. Dr. Smith, when you opened the president up, was it -- did it look just what you expected it to be?
CRAIG SMITH, CARDIAC SURGEON, CHIEF, DIVISION OF CARDIOTHORACIC SURGERY: It was pretty much what we expected to find. There are always some subtle variations on what you already know from the angiogram, but nothing that really changed the course.
KING: Now, quadruple means there were four bypasses. Did you know you were going to do four?
SMITH: That was exactly what we expected.
KING: Did we do veins from both legs?
SMITH: Vein from one leg.
KING: What determines that, a vein from one leg and then where else do we get bypass operations -- where do we get the other bypasses?
SMITH: Well, in this case, I used the two arteries in the chest wall for the other bypasses for three of the four. And the selection depends on a variety of patient-related factors that are difficult to quickly summarize. But in President Clinton's case, it had to do with his age, lack of serious other medical problems that would make using the arteries in the chest wall more hazardous than usual. You know, without going into great deal of detail on the technical nuances of this, I think it was the best choice for a man of his age and circumstances.
KING: Dr. Schwartz, did you assist in the surgery?
DR. ALLAN SCHWARTZ, CARDIOLOGIST: Short answer, no. I was there in the operating room in case anything came up that required my input, but that really nothing did come up.
KING: Since it was a former president, were there extra staff on duty?
SCHWARTZ: No. The team in the operating room was pretty much the usual team, and the team in the intensive care unit is our usual team, and the people who took him preoperatively at the hospital was our usual doctors, nurses and professional staff.
KING: Dr. Smith, isn't there usually an assistant surgeon who say makes the initial cut of the chest?
SMITH: There usually is, yes. There was today.
KING: But it wasn't Dr. Schwartz?
SMITH: No, I had two assistants.
KING: Dr. Robert Kelly, what was your role today in the operating room?
ROBERT KELLY, CHIEF OPERATING OFFICER: I'm the chief operating officer of the hospital but I'm also a cardiac anesthesiologist. And I was there also just to help in case there were any difficulties in order -- also to make sure all of the logistics were worked out in the post-operative period.
KING: Are there special anesthesia problems with this surgery?
KELLY: Patients with this type of disease present unique problems for the anesthesiologist, primarily getting on to bypass, because their heart, a lot of patients, although President Clinton had not had a heart attack, a lot of patients having this type of surgery have had heart attacks and managing them during the early part of the operation can be a real challenge for the anesthesiologist, and in addition, getting off bypasses is also challenge for the anesthesiologist.
KING: Explain getting off bypass.
KELLY: Well, during the procedure, in order for the surgeon to be able to operate on the patient, the patient is put on a heart-lung machine and the heart is stopped, as you heard earlier in the show, that is called cardiopulmonary bypass.
At the end of the operation, after the surgeon has finished what he needs -- he or she needs to do, the patient needs to get off bypass, meaning we need to stop the machine, get the patient's heart beating again, get the heart pumping again, as well as get the lungs working again. And that's what the anesthesiologist is there to do.
KING: And I seem to remember this from my surgery. Do they get it pumping again by using like the battery booster shots that you would get in an automobile on a cold morning?
KELLY: On different patients it depends. There are some patients that that's called defibrillation and sometimes patients need to do that. Sometimes when you start profusing the heart again with blood, the heart spontaneously defibrillates on its own, meaning it comes back into rhythm on its own and starts beating on its own.
KING: What happened with the president?
UNIDENTIFIED MALE: He started beating on his own.
KING: He did?
And Dr. Pardes, what was your role today? I know you're president and CEO of the hospital. First, were you nerve us?
HERBERT PARDES, PRESIDENT AND CEO OF NEW YORK PRESBYTERIAN HOSPITAL: Oh, I think understandably a little nervous, but I'm very proud of the team that's here with me, and I felt very confident that the president was getting the very best medical care.
KING: What was your role in the room?
PARDES: I was in the room only briefly. My role really to run the hospital in general, and to coordinate many of the hospital's activities, both inside and outside.
KING: Dr. Smith, what happens in intensive care? After the heart is stopped and the bypasses are done and then the heart starts again, he goes into intensive care. How long and what happens there?
SMITH: Well, the normal course in intensive care is one or two days, and the first challenge is to let the patient wake up so that the breathing tube can be removed, get them off the mechanical ventilator. A number of issues are being watched at the same time to make sure other organs are still functioning well, kidneys, measured by urine output.
Another issue in many patients after heart surgery is bleeding from the chest tubes that drain blood from the space around the heart. And these are all issues that are sort of watched hour-by-hour, and as in this case, generally speaking, things settle down pretty quickly and become non-issues.
But once the patient is off the ventilator, he can sit up, and talk, and start moving around a bit, and head up to the step down unit or to a regular floor.
KING: Dr. Schwartz, could some side effects develop post- surgery?
SCHWARTZ: There are a number of things that can come up post- surgically many of which don't affect the ultimate good outcome of the surgery. Common things that occur after heart surgery are transient fevers, most of which turn out not to be of any significance but require an evaluation.
Another common side effect are transient irregularities of the heartbeat, in particular, an irregular beat called atrial fibrillation, again something that we can handle and has no long-term effects. So there are any number of things that can some up, but most of them are handled and do not alter the good outcome that's been achieved here.
KING: Dr. Pardes, were other bypass surgeries done today?
PARDES: I believe so. Maybe Dr. Kelly might know.
KING: No, today was a holiday, so there were no elective scheduled procedures today. We were prepared, if necessary, to do any emergency bypass surgeries, but there are no scheduled procedures today because of the holiday.
KING: What kind of pressure, Dr. Pardes, on the whole hospital when you have somebody this fame with satellite trucks out front and the like?
PARDES: I think that produces quite a bit of pressure. I'm pleased with the fact that our people focused primarily on trying to do the best for the patient, whoever the patient is, but this is obviously a leader of extraordinary significance to all of us throughout the country, and we wanted to make sure we do as well as we can for him and his family.
KING: Paul, did you keep in touch with the family or anybody during the surgery? BEGALA: Not during the surgery, Larry, but just after, when they moved him into the intensive care unit and he began to kind of come out of it, one of the folks there with him told him that -- one of the nurses taking care of him was, in fact, Irish, and you know President Clinton, who is Irish, and has the great love for the Irish, and he kind of smiled and he kind of gave a thumbs up and took it as a good omen. And, so, that's certainly a good sign.
KING: Yes, the best sign is waking up. Trust me. When you wake up, that's a good sign. We'll be right back. We'll be including your phone calls tonight as well on this edition of LARRY KING LIVE. Don't go away.
(BEGIN VIDEO CLIP)
BILL CLINTON, FORMER PRESIDENT OF THE UNITED STATES: Some of this is genetic, and I may have done some damage in those years when I was too careless about what I ate, so for whatever reason, I've got a problem and I've got a chance to deal with it. And I feel that I really got -- let me just say this. Republicans aren't the only people who want four more years here.
(END VIDEO CLIP)
KING: There is tonight a look at the Presbyterian hospital, Columbia University Medical Center. I had the honor back in 1995 of being commencement speaker at that great Columbia University medical school graduation. One of the most memorable events of my life, and today is a very memorable event in the life of former President Clinton.
Is it true, Paul Begala, that he would not take that bracelet off? What's the story?
BEGALA: Yes, it's true. He's got that woven cloth bracelet that Indian children in Colombia, in South America, gave him back in June of 2002 when he went down there for the transition of the two presidencies in Colombia. And they gave it to him as a sign of their support and their gratitude to him for his support and America's support in their war against drugs.
And legend has it that if you cut that, that it's bad karma, bad luck and he also felt like it would sort of be breaking faith. So what the gang told me there at the hospital was that doctors were nice enough to kind of bend the rules a little bit and I guess tape over that bracelet so that the children in Colombia who gave it to him will still know that their friend is still thinking about them and their war against drugs.
KING: Dr. Smith, you bent the rules.
SMITH: Well, yes, I guess we did in that case. I hope he doesn't develop any swelling in that hand.
KING: Any other special precautions, Dr. Pardes, like any special rooms for the family?
PARDES: Yes, we've tried to arrange both special rooms for the family so they can be nearby. They wanted to be as close as they can, and also provide some rooms for the additional staff and other people who attend to the president. So we tried to make it as congenial as possible for the whole family.
KING: The usually case, Dr. Smith, is the surgeon comes out to talk to the family at the end of the operation. Did you do that?
KING: And so you spoke to Chelsea and to Hillary?
SMITH: I did, to both.
KING: Did you come out smiling?
SMITH: I think so. We were very pleased with how it went.
KING: Did they seem very worried?
SMITH: I'd say they seemed appropriately worried. I don't think they were any more worried than average. It's a worrying situation for any family member. They've been very easy to work with throughout this whole business.
KING: There are a lot of surgery involvements here, Dr. Schwartz, correct, including diets, post-operative examinations? And he has to change his lifestyle, correct?
SCHWARTZ: Well, I think the target going forward is to prevent the recurrence of the problem. Now that Dr. Smith has taken care of the effects of the blockage that he has, we have to make sure that he doesn't develop new blockages in his own blood vessels or that he doesn't clog up the bypass grafts that were done. And that will involve some changes in his medical regimen, some changes in his diet, and a continuation of his very vigorous exercise program.
KING: Dr. Kelly, he told me the other night that, because his cholesterol got lower, he stopped taking his Statin, his anti- cholesterol drug. He thinks that was a mistake. Will he go right back on it?
KELLY: Yes, he will go back on Statin drugs, and Dr. Schwartz will be working with a nutritionist to make sure both of the medications are done appropriately, as well as the appropriate dietary changes they're taking in order to, as Dr. Schwartz said, prevent this from recurring as he gets older.
KING: And as I understand it, Dr. Kelly, the Statins should be a lifetime, right?
KELLY: Yes, it's a lifetime commitment to the medication, and there's a lot of beneficial effects to these drugs. There's a lot of new research on them indicating actually the doses are increasing to bring the cholesterol levels even lower than they have in the past. And I think they're going to become a widespread drug in the treatment of this disease.
KING: Dr. Smith, a very common post-operative concept is some sort of depression, mild depression, sometimes serious. Have you found that to be true, and do you tell the president about it, to expect it?
SMITH: I have found that to be true, and we did specifically discuss this with him, partly because we often do, but also because he actually raised the question. It is common. It is rarely anything that is not self-limited. I would have a hard time thinking of a patient who required real psychiatric treatment for typical post- operative depression. And we did talk about it a bit.
KING: But you do get -- I remember the weeps. You do get moments of really being down, maybe because, of course, it's your heart?
SMITH: I'm not sure entirely what's behind it, but that is definitely very common. I think we see this in 30 to 40 percent of the patients we operate on to some degree.
KING: Paul, how will he handle that?
BEGALA: Well, he's just going to have to work through it. You know, I do think those of us who love him and the Democrats who support him ought to give him a lot of time. You know, I think there's just too much talk about him getting out on the campaign trail.
I mean the docs, I think, generally say -- correct me if I'm wrong -- that it's two to three months before an average person is back to work. And I can tell you firsthand, having spent a lifetime on a campaign trail with Bill Clinton, is that when he goes to a rally or an event, he puts everything he has into it. It takes an extraordinary amount of energy. And so, while as his political adviser, I'd be real happy to see him campaigning, at his friend, I have to tell you, I don't expect to see it at all. I think we ought to give him several months to get back his health before we ask anything too much of him.
KING: Dr. Smith, does it depend on the job? I was back in four weeks.
SMITH: Well, it depends a lot on the job and it depends on the individual. It's one of these things that we really have to individualize. And it's very hard to know from where I sit or where Dr. Schwartz sits what are the stresses of anybody's job. They know the job better than we do.
I try to be relatively flexible with that. But how soon he can go back to work will have a lot to do with how well he can control the environment he's going into. If he's going to step into a campaign scene where he's got to be 110 percent, 48 hours running, he's not going to be able to do that for awhile. If it's a thing where he can kind of glide into it and take it sort of half way for a week or two, he might be able to do it sooner. But it's very hard to generalize.
KING: We're going to go to a break and then go to your phone calls. A great privilege to have with us these four outstanding doctors with us.
By the way, many people with heart problems don't have the resources Bill Clinton does, and helping them is one of the missions of the Larry King Cardiac Foundation. Our Web site, for your information is www.lkcf.org, and we have links to other sites with a lot of good information about heart disease and we also help people who can't afford it to get the kind of surgery we're discussing tonight. That's www.lkcf.org.
We'll be back with your phone calls for our panel next. Don't go away.
KING: Welcome back to LARRY KING LIVE.
By the way, anyone who wants to wish the president well can do so by e-mailing him at www.clintonfoundation -- that's one word -- clintonfoundation.org.
Let's go to your phone calls for Doctors Smith, Schwartz, Kelly and Pardes, and Paul Begala.
Cincinnati, Ohio, hello.
CALLER: Yes, hi, Larry, love the show.
KING: Thank you.
CALLER: First of all, I'd like to make a comment. Thank God that there are doctors like this in this world.
Second of all, I'd like to ask all of the doctors, as just an ordinary person, how in the world do you gentlemen cope with the nervousness of this? You know, how do you do it?
KING: A very good question.
Dr. Smith, you have to be thinking, this is not another patient, or maybe I'm wrong.
SMITH: Well, that's unavoidable, but the trick in a situation like this is to spend as little time dwelling on that as you possibly can and making it as much of a daily routine as you possibly can, because that's where the protection lies for the patient.
And you do get used to it to some extent. This is not the first somewhat high profile or high-stress patient we've taken care of at a place like this, but you're right. It's not a normal day.
KELLY: Larry, I want to emphasize how important it is for the care to be given as part of the routine that we do. We do a lot of these cases. And for us they are relatively routine. Obviously, for the families, it's a very big production for them.
But as much as possible, even when it's somebody like the president, we want to try and keep the routine intact, and that ensures the safety of the process, when people do the things that they normally do, that ensures a good outcome.
KING: So in other words...
PARDES: If I could answer that, Larry, I think one of the things that's helped us here is that Hillary and Chelsea are so easy to work with, and such warm and cooperative people, that it made it even easier for us.
KING: Dr. Schwartz, in other words, once -- let's say the chest is open, the surgery is under way, you're not thinking, "This is the president. This is the former president," et cetera, or are you?
SCHWARTZ: I think my answer to the previous question would have been that I'm nervous about everybody. So I think from the second, you know, we accept the responsibility of caring for someone in the hospital, until they are home and well, you know, I think they're on our mind, you know, all day long, every day, pretty much.
And I think that, although there was some extra stresses, obviously, associated with, dealing with President Clinton, that I think we approach each patient, you know, as a tremendous responsibility, and I think that a lot of concern and anxiety on our part goes into trying to see that they have a safe passage through our institution and come out better.
KING: Indeed, Dr. Schwartz, I've had many great doctors tell me every great doctor takes the patient home with them. That is the patient, whoever the patient is, is on the doctor's mind.
Let's go to Vancouver, British Columbia. Hello.
CALLER: Hello, Larry.
Dr. Smith, I was going to ask you whether or not President Clinton was going to require any blood thinners after this operation for a long time?
SMITH: It depends a little bit what you mean by blood thinners, but he will be on some kind of blood thinner indefinitely. Most people are on at least something like aspirin the rest of their lives when they have this kind of condition.
As to whether he would be on other blood thinners that are variations on the same theme is something I delegate to Dr. Schwartz and others who will base that on other developments that might occur as he recovers. But right now, the answer -- the simple answer is probably yes. He'll be on certain blood thinners.
KING: Aspirin definitely, right, Dr. Schwartz?
SCHWARTZ: Yes. I mean, I would be a little more specific and say that he'll be on aspirin unless something develops in addition that leads to us using something different or complementary to it.
KING: Las Vegas, hello. Las Vegas, hello. Are you there? You're not. To Atascadero, California. Hello?
KING: Atascadero, go ahead.
CALLER: Yes, I have a question. Is there any way that they can determine the strength of an artery that they're going -- or a vein they're going to use in the surgery? My husband had this done in '78 and died two months later a horrible death. They said the veins weren't healthy. Can't you tell, you know, when you select them?
KING: Dr. Smith?
SMITH: Well, yes, there are certainly things we do, the things we look at in every artery or vein we use as a conduit, as a bypass. And we certainly don't like to think we put in veins or arteries that won't last.
There are times, it's fair to say -- now, this, today was not one of those, but there are times when you might have to use an artery or vein as a conduit that you think is marginal because you have no option. I have no idea whether this applied to your husband in any way, but there are times we have to compromise in the quality of the bypass. That was not -- that is rarely the case, actually, and so it was certainly not the case today.
KING: From what you saw today, Dr. Smith, and this is always a guess, was President Clinton a high candidate for a heart attack?
SMITH: Well, actually, what we see today doesn't add too much information on that score, because we knew most of that from the angiogram. He had very critical, potentially life-threatening obstructions in his major branches supplying blood to the heart, and there was nothing in operation that changed our impression of that.
KING: We'll take a break and come back, reintroduce the panel and go to more of your phone calls on this edition of LARRY KING LIVE. Don't go away.
(BEGIN VIDEO CLIP)
CLINTON: I'm just going to have to be really careful. I've put about ten pounds of the weight I lost back on on my book tour, and I'm got to take it off and, you know, just do everything I can to try to keep my cholesterol down, keep my blood pressure down.
(END VIDEO CLIP)
KING: That's Columbia Presbyterian Hospital. Let's re-introduce our panel: Dr. Craig Smith, he performed the surgery today, chief of Cardiac Surgery at New York Presbyterian Hospital and the chief surgeon today; Dr. Allan Schwartz is chief of the Cardiology Division; Dr. Robert Kelly is senior vice president and chief operating officer, he was in the operating room today, especially in the area of anesthesia; Dr. Herbert Pardes, who was in and out, is president and CEO of New York Presbyterian Hospital and the New York Presbyterian Health Care System; and Washington is Paul Begala, good friend of President Clinton, he has been talking with people who were in the intensive unit today, he's co-host of CNN's "CROSSFIRE" and was counselor to President Clinton in the Clinton administration.
One quick question, Paul, before we get back to the calls, are you going to work on the Kerry campaign, that was in "The New York Times" yesterday?
BEGALA: Yes -- no, I work for CNN, Larry, I'm going to keep working for CNN if they'll have me. I absolutely...
KING: So you can't...
BEGALA: I support John Kerry. And I will advise him as I would advise any Democrat who wants advice, but I do it for free and I do it for love. So I'm going to continue to advise Kerry and support him but I'm not going to work for anybody but CNN.
KING: Carville, too?
BEGALA: Yes. That goes for James as well.
KING: OK. New London, Connecticut, hello.
CALLER: Yes, hi. I have a question for any of the doctors on the panel. I had a -- hi, can you hear me?
KING: Yes, go ahead.
CALLER: I had an angiogram done about a year-and-a-half ago when I was 48, because I was getting a lot of chest pains and you know, I was afraid something was wrong and they told me that that was the only definitive way to find out and it was perfectly clear.
And now I've had one doctor tell me that he doesn't worry about his patients for about two years after they have had a clear cardiac cath. And I had somebody else tell me that if you're my age, I just turned 50, and you're perfectly clear that generally, by my age, you would have developed something. So is there a medium to that, somewhere in the middle of the road?
KING: The question is, Dr. Smith, how often should you check your heart?
SMITH: This is really a better question for Dr. Schwartz.
KING: OK, Dr. Schwartz. Surgeons do surgery. The rest is up to the others. I found this out.
(LAUGHTER) SCHWARTZ: I think that it's very good that the arteries were very clear -- were clear, but it's not a guarantee against a future development of disease. The issue is, it sounds like a chest pain syndrome or a pain syndrome led to the investigation, and it becomes difficult unless they -- unless another cause is found for the pain or unless the pain goes away.
As time passes, it becomes difficult to eliminate the possibility that, even though the discomfort was not related to a blockage in the past it might currently be related.
There are other tests that I'm sure were -- or I would expect were discussed with you that can act as surrogates screaming to decide whether or not you should have another angiogram like stress tests.
KING: Yes, you get -- you don't just go in and have an angiogram once a year, do you? You have a stress test first, don't you?
SCHWARTZ: In general, stress tests are -- stress tests and a good medical history are the two screening tools that are used to decide who gets angiography.
KING: By the way, we have received some calls for the foundation number. If you want to contact Bill Clinton directly and wish him well, you just go www.clintonfoundation, that's one word, clintonfoundation.org.
And we go to Toronto, hello. Toronto, hello.
KING: Go ahead.
CALLER: I had a bypass a year ago July. I was supposed to -- I had four blocked arteries. They were only able to do two, because the veins in my body were too small.
KING: What's the question?
CALLER: I'm just wondering if -- what is the prognosis of having two done rather than four?
KING: OK, who wants to take it, Dr. Kelly?
KELLY: I think our surgeon would best answer that, Dr. Smith.
KING: OK. Dr. Smith, if you can't do it all, what happens?
SMITH: It depends a little bit on why all the bypasses couldn't be done, and if the reason was that the vessels were too small, sometimes that means that they were unimportant vessels serving a relatively small part of the heart, in other words, providing blood to a relatively small part of the heart, and maybe weren't contributing much and weren't worth bypassing, which is not something you can always tell with certainty from the angiogram. And it is common to go into an operation thinking you'll do three or four bypasses or two or three or four and end up doing one of those numbers. You don't always know which it will be. In fact, the president's case was one of the more straightforward, where we were really quite certain what it would be, but it's not always so clear. So it's not necessarily a bad thing.
KING: Dr. Kelly, when I woke up, I remember one thing vividly. I was freezing.
KELLY: You were freezing?
KELLY: Yes, it's not unusual, because of being in the operating room, where the temperature is quite low, and your body is cooled during the bypass period. There's a lot of work that needs to be done to rewarm the patient. We spend a lot of time making sure that the patient is under the appropriate blankets. We warm the fluids and try and make them much more comfortable but it can be very uncomfortable.
KING: Are they put in a bath of some kind?
KELLY: No, we don't put the patient in a bath during the procedure. We use the heart/lung machine to cool the blood, as well as cool the heart while it's on bypass and then we warm it using the same way, as well as using blankets, convection heaters that blow warm air on the patient.
KING: Dr. Smith, have you ever seen a heart not start up?
SMITH: I have to say that is one thing I have never seen. I have never seen a heart fail to start. You can run into other difficulties but that has not been one of them in my experience.
KING: Mitchellville, Maryland, hello.
KING: Go ahead.
CALLER: Hi, good night all of you and first of all I want to say thanks to surgical (UNINTELLIGIBLE), thanks to pre-op, thanks to surgery, and know the ICU. Anyone, can you please tell me how soon do you expect the president to resume his campaigning with John Kerry and John Edwards?
KING: That was asked a little earlier. It will be a while, right, Dr. Schwartz?
SCHWARTZ: Well, again, the type of very vigorous, very intense activity generally is a matter of months after surgery like this. This is -- although routine in the sense that we do many of these every day, this is a very major type of surgery, and even in a fit, healthy person like the president, full recuperation and full return to normal stamina takes a matter of months. KING: Dr. Kelly, when do they remove -- I'm remembering when it happened, when do they remove the clips from the chest that held the stitches together?
KELLY: They actually don't use the clips anymore. We actually sew underneath the skin so we don't do that anymore. We have chest tubes in place that will be coming out in the next 24 to 48 hours, as well as some of the other wires that get pulled out that are left in temporarily. But the clips that you had are no longer used.
KING: And is there still that kind of hoarse throat from that thing that's been down your throat? I had laryngitis like for a week.
KELLY: The endotracheal tube, the tube that goes into your lungs to help breathing during the operation and the immediate post- operative period can cause hoarseness, can cause a sore throat for sometimes days, sometimes weeks. It can be one of the more annoying things about any operative procedure.
KING: Dr. Pardes, who was with him when he woke up?
PARDES: When he woke up, I guess the staff, Dr. Schwartz visited with him. And ultimately, they had Chelsea and Hillary come down to see him after he had woken up. They also saw him before he woke up.
KING: Do they bring her -- Dr. Schwartz, do they bring the family in to recovery or do they wait until they get to intensive care?
SCHWARTZ: Well, actually the transition is from the operating room directly to our CT ICU, through the intensive care, and they -- Senator Clinton and Hillary -- and Chelsea did visit soon after the arrival of the president there.
KING: There's no recovery room anymore, Dr. Kelly?
KELLY: No, a lot of places take patients directly into the cardiothoracic intensive care treatment room after surgery. The number of transitions from the operating room to a recovery room and then to the intensive care unit. If you can bypass one of the transitions, it tends to be a little safer for patients. So we tend to take them directly into the intensive care unit now.
KING: Paul, how do you think he will handle inactivity.
BEGALA: That's going to be a great challenge for him. I'm encouraged that the doctors say he can do lower stress activities other than campaigning, which again, I don't have great hopes we'll see that before the November elections.
But he's got his foundation. They're doing wonderful work in trying to bring AIDS medicine to poor people in Africa. And the kind of office work, I think that he's got -- he won't be completely inert. There's no way to keep him still, short of stopping his heart for an hour, like these doctors did. But I think we won't see him campaigning. But I think he'll be back to work at the foundation just as soon as the doctors allow him.
KING: Cookville, Tennessee, hello.
CALLER: Can anyone on the panel comment on the President Clinton's triglicerides, LDL, HDL and risk ratio? And what is the most significant component for heart disease?
KING: Who wants to take it, Dr. Schwartz?
SCHWARTZ: Without getting into a lot of specifics about the president, in general the most significant component is what's called the LDL cholesterol. And the current guidelines for treatment target lowering the LDL cholesterol.
KING: That's the bad cholesterol, right?
SCHWARTZ: Excuse me?
KING: That's the bad cholesterol.
SCHWARTZ: That's the bad cholesterol, yes. And triglycerides, however, also play an important factor in the development of heart disease and often are a component of what's called a metabolic syndrome, which is linked to the development of type 2 diabetes. So, triglycerides are also an important component.
In the president's case, his LDL cholesterol was elevated, and he was started already on a statin drug even before transfer to our hospital.
KING: Cote St. Luc, Quebec, hello.
CALLER: Good evening, Larry. My question for the doctors is, if former President Clinton was a few years older, or if he was not in such good physical health, could there have been more complications with the surgery?
KING: Dr. Smith?
SMITH: Well, yes and no. If you're really asking about just a few years, it wouldn't make an awful lot of difference. And he is more fit than average, but fit enough to withstand the operation and people less fit would be expected to come through this without anticipating major problems.
And at the extremes, there are certainly correlations between advanced age and debility that increase the risk of complications.
But within reasonable parameters around someone like the president, we wouldn't expect increased complications.
KING: We'll be back with more right after these words. Don't go away.
KING: We're back. Anderson, Indiana, hello.
CALLER: Hi, Larry.
CALLER: Without proper insurance, how much would this operation cost the average person?
KING: Dr. Pardes, what does this operation cost now?
PARDES: I'm not sure.
UNIDENTIFIED MALE: About $25,000.
KING: Plus the hospital extras, right or total, $25,000?
PARDES: Dr. Kelly will tell you.
KELLY: There are hospital charges and physician charges. The hospital charges are in that ballpark. It can vary depending on what happens during the hospitalization. The physician charges are independent of that.
KING: By the way, our foundation, which I mentioned earlier, does take care of that for people who fall between the cracks. You can contact us at www.LKCF.org.
And by the way, if you do want to contact the president, I want to mention this one more time, it's www.Clintonfoundation.org. And I know he would love to hear from you.
CALLER: Hi. I wanted to know what determines how long you wait until they do the surgery.
KING: Great question. Dr. Smith, we know in the president's case, we the angiogram on Thursday or Friday, but they didn't do it until Monday. What is the determining factor?
SMITH: Well, the president's case is one example of a time we might choose to wait to reduce the risk of surgery. In this case, because of the presence of a drug that he had received on Friday that increases the risk of bleeding. And if we could wait, usually as little as 72 hours, sometimes longer, the risk of bleeding drops to a much lower or normal level.
So that was always a compelling reason to wait, if the clinical syndrome is stable enough to allow waiting. There can be other reasons to wait in other patients.
KING: It is elective surgery though, is it not?
SMITH: You mean this surgery in general, or president Clinton's surgery. KING: Bypass surgery, 90 percent of the time, the people choose to get it. They're not brought into the hospital and given it in an emergency situation?
SMITH: 80 percent to 90 percent of the time that's true, I'd say, yes.
KING: OK. To Scarborough, Ontario, hello.
CALLER: This is for Dr. Smith. Dr. Smith, I was just wondering how reliable the angiogram tests are? And if they are the only definitive medical resource that is available in medicine at this point that diagnoses whether or not surgery like Mr. Clinton had this morning is essential.
KING: Dr. Smith?
SMITH: I think it's fair to say that the angiogram is currently the most definitive test we have available to get the kind of anatomic detail that we need to make these decisions. There are other tests that you've already heard a little bit about, stress tests of one type or another that can help tell us when an angiogram is indicated. But I think the angiogram is still the gold standard, if you will.
There are some things on the horizon involving, you know, very accelerated CAT scan technology that may change that. But right now, the angiogram is the standard.
KING: Paul, do you think the president will handle well following doctor's instructions?
BEGALA: You know, I think so. I kind of hesitated, because he's not always been the best patient. But I remember when he was in the White House and he injured his knee at Greg Norman's house, terrible injury. I remember calling him -- and I had knee surgery years before, and said you know, it's tough and you got to really listen to your doctors. I was really impressed with what a good patient he was then.
He followed a very rigorous rehabilitation, that was actually pretty painful. He brought himself back. And by the time he was fully recovered, he had actually lost weight during the rehab, because he had been very careful to do exactly what the doctors say.
So, I tell you what, if having your heart stopped for 60 minutes doesn't king of ring your bell and make you listen to your docs, nothing will. So I think he has a ton of faith in his doctors. And I know he's grateful to them. And he's going to listen to them very carefully.
KING: The hardest thing to change is your personality.
We'll be back with our remaining moments. Don't go away.
(BEGIN AUDIO CLIP)
WILLIAM CLINTON, FRM. PRESIDENT OF THE UNITED STATES: I think if people have a family history there, and high cholesterol, and high blood pressure, they ought to consider the angiogram, even if they don't have the symptoms I had. That if there is some chance of damage there, but it's like 1 in 1,000. And I think it saved my life and I'm grateful to them.
(UNINTELLIGIBLE) Dr. Bardock (ph) and all the great people in Westchester County that did that, and then these people at Columbia Presbyterian. I feel just grateful.
I guess I'm a little scared, but not much. I'm looking forward to it. I want to get back -- I want to see what it's like to run 5 miles again.
(END AUDIO CLIP)
(BEGIN VIDEO CLIP)
BORIS YELTSIN, PRESIDENT OF RUSSIA (through translator): ... that today's meeting with President Bill Clinton was going to be a disaster. Well now for the first time, I can tell you, that you're a disaster.
(END VIDEO CLIP)
KING: We'll never forget that, will we, Paul?
BEGALA: No, you know, maybe a sense of humor is going to help a lot getting through this, Larry.
KING: It sure will. Bloomfield, Nebraska, hello.
CALLER: Yes, well I had four bypasses four years ago and...
KING: You've got a little thing on the line here. What's the question?
KING: Sorry, I can't hear you ma'am. I do apologize for that. But I think it's something in my ear. Vicksburg, Mississippi, hello.
CALLER: Yes, I've always been a big fan... KING: I'm sorry, there's something wrong with my ear switch. So I'm going to have -- can we fix it? I don't know what to do with this. OK. Let me ask a question of Dr. -- see those ear things? They're putting a new thing in my ear so I can hear. Now I can hear. That's modern television. They have these fantastic new little gimmicks, no big wires anymore, just a little thing that goes in your ear. But when it breaks, someone's got to hand it into your ear. Does that happen, Dr. Smith, in an operating room? Do you ever have -- oops!
SMITH: Never. There's always somebody to put the thing back in your ear. That's why it works.
KING: How big -- no, but you don't do it.
SMITH: No, there's always somebody.
KING: You're the surgeon man. How big a staff, Dr. Schwartz, was in that room?
SCHWARTZ: About 15 people.
KING: Is that about standard?
SCHWARTZ: Yes, that's about standard.
KING: Dr. Kelly, during any of the procedure, did you have any concerns?
KELLY: Well, we have concerns on every patient, but Senator -- or President Clinton's surgery went extremely well. It went exactly as Dr. Schwartz had interpreted from the angiogram. Dr. Smith had reviewed the angiogram and I think that it was going exactly as they thought it would go. So we were concerned about it, just to make sure that he did well, but there were no bumps in the road.
KING: Let's get another call in. Mound, Minnesota, hello.
CALLER: Yes, hello and to the proper doctor there, what value would have a heart scan been to determining the condition such as the president with his arteries, would it have been any value at all?
KING: Dr. Pardes, you remember them?
PARDES: Pardon me?
KING: The heart scan.
PARDES: I pass it to Dr. Schwartz.
KING: Dr. Schwartz, you recommend it?
SCHWARTZ: I think the heart scan is a screening test that can, in some patients, detect the presence of calcium in the arteries. Now with these multislide CTs, we can actually get pictures of the arteries that are not yet of the quality of angiograms, but are starting to approach it. So it's one more screening test.
Whether it would have been useful in detecting things earlier in the president, I can't answer. But again, this was detected at the right time. The president, the key thing here is that his heart had suffered no damage and has suffered no damage, so that really, nothing was lost and he was caught at a time when correction of his vascular problem, the hardening of the arteries that will be reversed by this combination of medical and surgical treatment, will restore him to a normal life and a normal longevity.
KING: And Paul Begala, just for information, Chelsea ought to have her cholesterol regularly checked, too, genes are a big part of this?
BEGALA: I'm sure all of us should. I do know that she sneaked out last night to her favorite Italian restaurant and brought back some takeout. She barely left her dad's bedside, but she had been on a business trip in Paris and flew home to be with him.
But you can't begrudge a woman in New York pasta when she's home on emergency, can you?
KING: No. Thank you all so much. Thank you so much, doctors, we can't tell you how much we appreciate you giving us the time.
Dr. Craig Smith, Dr. Allan Schwartz, Dr. Robert Kelly, Dr. Herbert Pardes and our old pal, Paul Begala.
And we salute the folks at Columbia Presbyterian, New York Presbyterian Hospital, Columbia University Medical Center. And I'll be back in a couple of minutes to tell you about tomorrow, don't go away.
KING: Tomorrow Ellen DeGeneres joins us, very, very hot. She has got a very successful daytime talk show now going into its second year. Ellen DeGeneres tomorrow night.
Saturday night, the third anniversary of 9/11. Mayor Rudy Giulani and a whole host of guests.
Right now, it's time to go to Atlanta, Aaron Brown is off for the Labor Day holiday but Miles O'Brien, always there, always ready, always steadfast. There he is.
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