If a narco-state or violent crackdown emerges in Venezuela, the White House will no longer be able to avert its attention from the mess or to ‘lead from behind.’

Contrary to statements by Venezuelan caudillo Hugo Chávez, a cancerous tumor discovered in his colon late last month has not been removed, according to my sources. Heeding the self-serving advice of Cuban doctors, Chávez has rejected surgery so that he can return to his public duties as soon as possible and bolster his regime’s ongoing succession strategy. The Castro brothers need him back on the political stage in Venezuela, not in a hospital bed. Meanwhile, back in Caracas, corrupt military leaders are consolidating their power and plotting their political survival as if Chávez were already dead.

Non-Cuban medical specialists insist that the larger-than-expected tumor must be removed before resuming last-ditch chemotherapy and radiation. They believe that Chávez’s decision to refuse surgery will hasten his death. Members of Chávez’s family and some close friends are furious that the Cubans are manipulating his megalomania to convince him that sustaining his “revolution” is more important than extending his life.

Havana’s ruthless leaders are obsessed with trying to manage the transition in Caracas in order to ensure continued oil and aid for Cuba’s comatose economy. There is bad blood between the Castro brothers and the military vanguard that has been taking charge since January. New National Assembly President Diosdado Cabello knows that Fidel Castro convinced Chávez to marginalize him years ago. And the new minister of defense, General Henry Rangel Silva, is convinced that Castro will betray him and other narco-military officers in order to inoculate the regime against U.S. scrutiny. Indeed, the Castro regime is appalled that these hyper-corrupt military leaders would emerge as the face of Chavismo, preferring a civilian formula that will placate the international community and answer to Havana.

According to sources in the Chavista inner circle, Cabello and Rangel Silva have grown accustomed to their preeminent positions. They have been empowered by the most corrupt elements of the armed forces to do anything to sustain the regime, so they no longer depend on Chávez and have no use for the regime’s civilian cadre. Although Cabello and his loyalists believe that they can engineer a victory for Chávez, they are worried that if their ailing boss appears weak and frail on the campaign trail, the viability of opposition candidate Henrique Capriles Radonski may grow.

If Chávez dies before the October 7 elections, the narco-generals believe that fielding a substitute candidate may be an unnecessary risk. This assessment puts them on a collision course with Chávez and his favored civilians. Brazilian leader Lula’s famed political advisor Joao Santana has begun grooming Nicolas Maduro to substitute for Chávez. However, after Chávez’s death, it will be extraordinarily difficult for Maduro to convince Cabello and the narco-generals to let him compete in the fall elections, take the reins of the movement, or manage a perilous transition.

For now, the Chavistas intend to emphasize their unity at all costs. However, the key players are plotting against one another to position themselves as Chávez’s heir. Because none of them believe that any potential successor can duplicate Chávez’s charisma, Cabello and his cadre will emphasize their ruthless efficiency in holding on to power over Maduro’s potential electoral appeal. The Cubans and Iranians, who depend on Venezuelan hospitality, will surely support Syria-style repression on the streets of Caracas if that is what is required to keep power. However, such violent tactics may split the military by alienating less radical officers and rank-and-file troops.

The narco-generals believe the Obama administration is too preoccupied with the Iranian crisis and rising gasoline prices to interfere with a Chavista succession. To make matters worse, because the Venezuelan opposition has consciously avoided any outreach to the United States, at least for now this democratic alternative is virtually invisible in Washington.

At this critical hour, Russian and Chinese policymakers are having second thoughts about pumping additional billions of dollars into the campaign coffers of a dying man. However, they are nervous about losing their sweetheart deals if Chávez’s regime were to perish along with him. Unless they believe that their investments will be safe under a democratic successor, they may double-down on the current team with the expectation that the Chavistas will retain power and honor their corrupt bargains.

A bipartisan cadre in the U.S. Congress is paying close attention to Iran’s beachhead in Venezuela, and may mobilize quickly to reject strong-arm tactics by the Chavistas. If a narco-state or violent crackdown emerges so near to U.S. borders, the White House will no longer be able to avert its attention from the mess in Venezuela or to “lead from behind.”

Roger F. Noriega was ambassador to the Organization of American States from 2001 to 2003 and assistant secretary of State from 2003 to 2005. He is a visiting fellow at the American Enterprise Institute and managing director of Vision Americas LLC, which represents U.S. and foreign clients.