Bird Shot Lodged in Heart of Cheney Shooting Victim
NGUYEN: Want to take you now live to Corpus Christi, Texas, to get an update on Harry Whittington, the man who was shot in the hunting accident involved Vice President Dick Cheney. Let's take a listen.</s>PETER BANKO, CHRISTUS SPOHN MEMORIAL HOSPITAL: ... today. He's the emergency department medical director for Christus Spohn Memorial. Just as a brief statement, even though Dr. Blanchard and I are kind of the faces out here in front, we've got 6,000 associates, 1,000 physicians and over 500 volunteers that are behind us doing the hard work each and every day. And I want to recognize them for the hard work they do. Have kind of an interesting update today. This morning, at 6:30 a.m., our trauma team evaluated Mr. Mr. Whittington, and there were some changes in his status and symptoms. We noticed an heart irregularity at that time. We quickly moved Mr. Whittington to our ICU, where he was evaluated by our cardiac team and cardiologists. They decided, based on his condition, which is called atrial fib -- Dr. Blanchard will talk about that -- that we needed to take him for a procedure called a cardiac catheterization. He had that performed around 9 a.m. this morning. Our cardiologist and cardiac surgeons evaluated the results of that exam, as well as talked to the White House medical team about the results of that exam. The good news is Mr. Whittington has a very healthy heart. As I said yesterday, probably healthier than mine. However, some of the bird shot appears to have moved and lodged into a part of his heart, causing the atrial fib and what we would say is a minor heart attack. At this point in time, there's no plans to do surgery to remove that bird shot. It's fixed in the heart at this point in time. However, it will require that we monitor Mr. Whittington for up to another seven days in the hospital to make sure no more bird shot moves into vital organs, as well as that piece of bird shot doesn't move anywhere else in the heart.</s>BANKO: Which part do you want me to repeat?</s>UNIDENTIFIED MALE: What moved?</s>BANKO: Some of the bird shot appears to have moved and lodged into his heart, causing what we call atrial fib. Dr. Blanchard will get into some of the medical pieces of that. And it's basically caused him to have a minor heart attack. So we're going to need to monitor him for another week in the hospital, just to make sure that particular bird shot hasn't moved. We talked before about how there are -- bird shot was left inside him. Some of that has moved. We want to make sure others have not move, as well as that particular one is stable, before we release him from the hospital. But yes, he's actually in stable condition, talking to the doctors. He is what we call asymptomatic. He had no chest pain. Dr. Blanchard could talk, probably, in better detail about that. He's not having any chest pain, alert. He wanted -- he talked to the doctors about wanting to go home. Doing very well. But we just want to make sure that there are no future issues with that.</s>UNIDENTIFIED MALE: What time did he actually have that heart attack?</s>BANKO: I...</s>DR. DAVID BLANCHARD, EMERGENCY ROOM CHIEF: We don't know exactly the time that it happened. We do know that when our trauma team and other interdisciplinary physicians were making rounds this morning we picked up an irregular heartbeat. Bear in mind that at no time did he ever have any chest pain or the classic signs of a heart attack, anything like that. And we all know well that there are tens of thousands of people every year that have silent heart attacks that never even go into the doctor to be taken care of. But we figure probably sometime around 6:30ish this morning. We can't put a real timetable on exactly when it did occur, though.</s>UNIDENTIFIED MALE: ...</s>BLANCHARD: Well...</s>UNIDENTIFIED FEMALE: Can you explain how it moves to the heart?</s>BLANCHARD: Right. What happens is, when bird shot is in your body, until the inflammatory changes set in and there are fibrosis (ph) scar tissue down, there's always the risk that they can move. And one of the things I did say yesterday, of course, is that we'll watch very closely for any migratory changes of this bird shot in the system. We knew that he had some bird shot very close to the heart from the get-go. But in point of fact, it has now got to the point where it has caused some inflammatory changes and has moved into a position where it has caused some irritability of the muscle of the heart. And when the muscle of the heart is irritated, it does some quivering or some irritability, and he displayed those signs today in terms of listening to the heart and on the EKG, called atrial fibrillation. So at that point, we immediately moved him back into intensive care services, to the trauma section, and called the cardiologist, which came in immediately and evaluated him and subsequently led to his cardiac cath.</s>UNIDENTIFIED MALE: How much bird shot migrated? A couple of pieces?</s>BANKO: From what we understand, it was only one bird shot.</s>UNIDENTIFIED MALE: Which chamber of the heart is the bird shot in and why can't you remove it?</s>BLANCHARD: OK. That's a very good question. We're not 100 percent certain exactly the location of where it is in the 3-D dimension. We have discussed with the White House staff, we have discussed with our cardiothoracic vascular surgeons, in conjunction with our cardiologists, what would be the best approach. We have talked to the family directly regarding that. And when all else is equal, if you can take a conservative approach and a get good outcome in a stable, asymptomatic patient, versus a 78-year-old, and take him to surgery with all the attendant risks of anesthesia, the possibility of all other things that could happen, we feel at this point it is in his best interest to treat him in a conservative standpoint with medical therapy. And we've had the concurrence of the White House staff and all of the various specialists that we have been involved with.</s>UNIDENTIFIED MALE: I know a little bit about cardiac catheterization. So when you went in there, you were able to examine the blood flow in both the right and left chamber. You must be content that the blood flow is acceptable in both?</s>BLANCHARD: I can tell you from the report back from the cardiologists that his coronary arteries are clear. And there was even a comment made that he has the heart of a much, much younger looking individual.</s>BANKO: Just one point of clarification. The bird shot was not ever in the chamber of the heart, any of the chambers of the heart.</s>UNIDENTIFIED FEMALE: Why is the White House</s>BANKO: To have bird shot lodged in the heart is an extremely rare occurrence. It does not occur every day. It probably only occurs a handful of times during the -- in any given year around the country. So therefore, cardiologists and cardiac surgeons don't run into this every day of the course of their career. They may see it once or twice in their lifetime. So our cardiac surgeons and cardiologists wanted to consult with other cardiologists and cardiac surgeons that have expertise. Part of it, too, is one of our former cardiologists that is a partner of one of our cardiologists here is now in Washington and partners with some of the White House team in electrophysiology. So there are natural connections there. Physicians always want to get outside expertise. So in this case, they did literature review, as well as talked to other physician colleagues around the country to make sure they were doing the right thing.</s>UNIDENTIFIED MALE: What was the response of the White House?</s>BLANCHARD: When you get a regular x-ray of an individual, you'll see the peppering. The bird shot metallic density show up like a sore thumb, and yes, they'll show up very well on X-ray. But they don't give you the position in a 3-D fashion that a CAT scan or other modalities would.</s>UNIDENTIFIED MALE: Why is the White House physician in any way involved in this? Isn't this a private matter? Why is the White House involved?</s>BANKO: The White House physicians treated Mr. Whittington on the ranch and have been involved in some way in his care. Our cardiologists know the physicians that are part of the White House team and feel comfortable talking to them about the case as colleagues.</s>UNIDENTIFIED MALE: Does he want to remain here, or does he want to go back to Austin?</s>BANKO: We've not had those discussions. But it's my understanding as of now he will remain here for the weeklong observation.</s>UNIDENTIFIED FEMALE: To get very basic...</s>UNIDENTIFIED MALE: Would it be possible for him to be moved to Austin?</s>BANKO: It's always the patient's choice whether -- where they're located. We've not had those discussions with the family. And they've not brought those to our attention.</s>UNIDENTIFIED MALE: What time will he be moved to Austin...</s>UNIDENTIFIED MALE: What time did you actually notify the White House this morning? And did you tell them when you notified them that he had had a minor heart attack?</s>BANKO: Our cardiologists probably talked to him shortly after the cardiac cath was done between 9:30 and 10 a.m. this morning.</s>UNIDENTIFIED MALE: And you did tell them he had had a minor heart attack?</s>BANKO: I did not hear the conversation the cardiologists had amongst themselves, so I can't tell you what -- and heart attack is a layman -- a layman's term so they wanted a little bit more clinical detail.</s>UNIDENTIFIED FEMALE: Can you explain in very basic terms how he was sprayed with the bird shot? Did it penetrate through his skin and it's been a slow process of entering into the body and then migrating towards the heart? Can you explain how this happened 72 hours after he was actually sprayed with the bird shot?</s>BLANCHARD: Well, what happens is when you take the initial injury from bird shot, it does break the skin and to enter. The first 48 to 72 hours are usually the most critical, because until the inflammatory response occurs and the pellets become seated -- not pellets, but bird shot, become seated, we don't know exactly what will happen down the line, if they will shift position. Ninety-nine point 99 percent are not problematic at all. But it's one problematic bird shot, in this particular case, that we feel has caused the entire problem. And that's what we're monitoring very carefully.</s>UNIDENTIFIED MALE: Are there other bird shot -- is there other bird shot that could migrate?</s>BLANCHARD: We feel at this point very strongly that all of the other bird shot that is within him are not problematic, and it's only this one that we are concerned about.</s>UNIDENTIFIED MALE: Can you -- how many pieces of bird shot are in him?</s>BLANCHARD: Well, as I said yesterday, it's more than the fingers of one hand but probably less than 150 to 200. Can't say for sure.</s>UNIDENTIFIED MALE: You know the size of the bird shot?</s>BANKO: I think they said five millimeters.</s>BLANCHARD: They're about five millimeters, just like a</s>BB. UNIDENTIFIED MALE: Can you go over one more time what the catheterization process is? Like what does that entail?</s>BLANCHARD: The cardiac catheterization is when they go in through the groin. They thread up a catheter. They insert a dye into the system under special fluoroscopy (ph) equipment. And you can map and outline the coronary blood supply through all the heart chambers and see if there is any blockage or occlusion and if you have to act appropriately. And he did very well throughout that.</s>UNIDENTIFIED MALE: So there was no blockage then? It was just that his muscles were...</s>BANKO: As I said yesterday, his heart looked healthier than mine does.</s>BLANCHARD: Yes. The BB -- the BB basically has set up irritability and inflammatory changes in an area of the heart which has led to the ischemia or the relative lack of blood flow to that area, hence the silent or minor heart attack.</s>UNIDENTIFIED MALE: Can you say that again, slowly?</s>UNIDENTIFIED FEMALE: Yes, say that slowly.</s>UNIDENTIFIED MALE: ... stable enough condition to make that trip back to Austin?</s>BANKO: We've not had those discussions amongst the medical team or families, so I can't comment.</s>UNIDENTIFIED MALE: Say that again, Doctor Blanchard. The BB has -- would you please, a little slower? What you just said? The BB has...</s>UNIDENTIFIED FEMALE: For us nonmedical people here.</s>BLANCHARD: The BB basically has lodged in a certain area causing inflammatory changes. When that occurs, there's irritability to the heart muscle, because the heart is a muscle and it recognizes that there's a foreign body there. And as a result, the chambers of the heart, the two top chambers, not the bottom, were beating irregularly. It's basically like an electrical short circuit, called atrial fibrillation. It is easily treated with medication. It is a nonsurgical type of a condition.</s>UNIDENTIFIED MALE: But you -- there's no way that you know the precise location? In other words, during the cardiac catheterization, you were unable to locate the BB? If using x-rays you're unable -- or MRIs, you can't find precisely where it is?</s>BLANCHARD: Well...</s>BANKO: We've done ultrasound, CAT scan, and then the cardiac cath. They're all 2-D exams. There's ability to do a 3-D exam. We've got a 64-slice CAT scan. The issue is the bb, because of the radiograph, creates a starring effect. So it's not like you can just see the BB there. You're going to see the BB there. You're going to see the BB and a star, which then creates issues for the cardiologists and radiologist to be able to determine exactly where it is, because it creates a little area around it, so then you can't even -- there's no exam at this point in time that we have available to us that can pinpoint exactly where it is.</s>QUESTION: Can he live with that in his heart?</s>UNIDENTIFIED MALE: Yes. There are tens of thousands of people that go around with shrapnel in their bodies. Bear in mind, the heart is as big as a fist. The pellet -- the BB -- I keep saying pellet. The BB is in that area of this area that's really small. We know the general area that it's in. We know what it's doing. The answer to the question is, yes. People do very well with shrapnel in their body. Some people can have some problems and difficulty, but certainly that's why we are watching him in a close- observation situation.</s>QUESTION: Could it be fatal? Could that situation ultimately be fatal if that goes through his body and ends up somewhere you don't want it to end up?</s>UNIDENTIFIED MALE: As far as I know, the BB is in a fixed position. It is not mobile to the point where it could travel.</s>QUESTION: Couldn't it travel, doctor?</s>UNIDENTIFIED MALE: Hypothetical question to which I can't give an answer.</s>QUESTION: Fair to say this is a serious injury? If the BB went that far in, seems like it would be more of a serious-type wound...</s>UNIDENTIFIED MALE: We're dealing with an individual that has good coronary arteries. He's 78 years of age. There's always the potential for all kinds of problems. We know that when people are put into the hospital. We have every specialist available to take care and to deal with problems, should they occur. We are very, very optimistic that with Mr. Whittington's strong heart, his personality, his stamina, the will, that he will do very well, and we're prepared to do anything that may develop.</s>QUESTION: Just in terms of the depth of which these BBs went in. Maybe I misinterpreted you, but it sounded as if it was a lot more superficial. I never really got the sense it was that far...</s>UNIDENTIFIED MALE: When you look at the human body, not mine, because I'm not a good representation of it, the BB would have to go very far in to get to my heart. Mr. Whittington is in much better shape than I am. The chest cage is a very shallow cavity. It doesn't take much depth to go into a vital area.</s>QUESTION: Doctor, in the past 48 hours, we've been listening to, you know, he's in great shape, he's healthier than I am, and now, today, we're hearing he's had a heart attack essentially. Can you put that into context as far as this injury?</s>UNIDENTIFIED MALE: He's not had a heart attack in the traditional sense. As we've said before, he was asymptomatic. So when someone -- normally think of a heart attack as crushing chest pain, shoulder pain, not able to bear. He had none of those symptoms. Dr. Blanchard could talk a little bit more about -- heart attack is a layman's term.</s>UNIDENTIFIED MALE: What we're talking about here basically is a silent heart attack or asymptomatic heart attack. Had we not had the cardiologists and the cardiovascular team actually probing, looking into this particular issue it probably would have never been picked up in the long run. So this is not the heart attack that we think that is due to a blockage that the person is going to collapse and have an arrest, not that type at all. What we're talking about is relative ischemia to a certain area of the heart due to an inflammatory to response to a metallic foreign BB. And that's the type. Bear in mind, Mr. Whittington was asymptomatic at all times, even this morning, when this irregular heart rhythm was picked up. So we felt clearly in his best interest to pursue it much more aggressively by taking him to the cardiac cath lab.</s>QUESTION: Is the BB actually lodged in the heart muscle, or is it just</s>UNIDENTIFIED MALE: We feel that there's a whole side of inflammation either touching or embedded in an area of the muscle of the heart.</s>QUESTION: What kind of life of this man going to have after this? I mean, he's 78. He's had, quote/unquote, some kind of heart attack. He's got all these things in them that we don't know how many they are. Will he have to be monitored every week, every month? He's 78. What kind of life is he going to have once he leaves the hospital?</s>UNIDENTIFIED MALE: He will have the full life that the Lord intended him to have, and this shouldn't affect that one way or the other.</s>QUESTION: Couldn't this come up at any time, go through his body and kill him in essence?</s>UNIDENTIFIED MALE: It's not -- as we said before, it's not moving, and it's not in a position right now that we feel -- the cardiologists do not feel it's going to move. Otherwise, if one of our cardiac surgeons has had experience with this before, and has written a paper on it. He did not feel that it was in a position where it was going to move. If it were in a position where it was going to move, they would have gone in and done surgery immediately. It is not in a position where they think it's going to move any further to endanger his health.</s>QUESTION: But doesn't he have to be closely monitored.</s>UNIDENTIFIED MALE: Bear this in mind, we're dealing with a rounded, smooth object. If you're dealing with a piece of glass or an object that has a specular sharpness to it, years down the line, they can burrow through and fistulize and travel. The fact that this is a rounded, solidified BB is an excellent thing in and of itself, and that's why we feel that it should not be a problem in the future barring other complications.</s>QUESTION: What about a chance of infection from this BB?</s>UNIDENTIFIED MALE: Well what about it? There's always a chance of infection! But the problem is, we've got him covered from that standpoint. If an infection occur, guess what, we will treat it appropriately! But right now, there's no evidence of that.</s>UNIDENTIFIED MALE: One more question. One more question -- one more question, right here.</s>QUESTION: What if you hadn't found this, this morning? What if you hadn't done that procedure, which you said...</s>UNIDENTIFIED MALE: One last -- this is the last question.</s>UNIDENTIFIED MALE: Well, WE would have found it, because we fortunately do daily rounding and more on patients in the hospital, so THAT it would have been picked up. It's not even a plausible scenario that it would not have been picked up --</s>UNIDENTIFIED MALE: That's it, thank you. Thank you.</s>NGUYEN: All right. You've been listening to Peter Banko, hospital administrator, and David Blanchard, the emergency room chief. They talk about the developments with Harry Whittington, the 78-year- old hunting partner that was accidentally shot by Vice President Dick Cheney. There's been some significant developments today in regards to Mr. Whittington's health. We learned he had a heart irregularity, which when they checked on that, they discovered that birdshot move and became lodged in part of his heart, causing a minor heart attack. Now, because of that, they had to do a cardiac catherization around 9:00 Eastern -- I should say Central Time this morning, and they're going to continue to monitor Mr. Whittington for another week or so. And we also learned that there's still birdshot that will remain inside him, which will cause him to continue monitoring him for sometime. And the hospital has been, indeed, in contact with the White House and White House physicians about the whole scenario of what's happening and the condition of Harry Whittington. And as you know, we're going to continue following this as well. You want to stay tuned to CNN. There's more LIVE FROM coming up right after this.