by Joe Biden
CHAPTER TWO
Have a Purpose
When Beau first saw the scans that showed a lesion on his brain, in the summer of 2013, part of his reaction was relief: he finally had an explanation for what had been happening to him. Beau had awakened one morning three years earlier unable to speak and paralyzed on the right side of his body. He was rushed to the hospital, where the initial scan showed a clot in his brain. But the classic stroke symptoms lifted just a few hours after he got to the emergency room, while the doctors were still deciding how best to treat him. “Dad, look,” he called to me from a gurney in an examining room, and moved his right arm and leg up and down. It seemed to me like a miracle. My White House physician, Kevin O’Connor, thought Beau had probably suffered something called Todd’s paralysis, which is a common aftereffect of brain seizures. Nobody had a definite explanation, but any sign of a clot had disappeared and Beau had no lasting deficits.
Beau was fine for a few years after that, but then he started to get strange feelings and dizziness on some of his longer runs. He thought it might be dehydration, until it got worse. His balance wasn’t always steady and he had auditory hallucinations. On some runs the sound of a jet engine bearing down on him was so real and so present, I found out later, that he would sometimes find himself ducking down by the side of the road. He had started to wonder if these were panic attacks or PTSD from his tour in Iraq, or if he was just losing his marbles. So, disconcerting as it was, the outline of a large mass on the left side of his brain did at least reassure him that he was not going crazy.
They saw the tumor on a scan in Chicago, after Beau had another strokelike episode while on vacation with Hunt and their families. We got Beau back to Thomas Jefferson University Hospital in Philadelphia, where the doctors already knew him and where Ashley’s husband, Howard, was affiliated as a head and neck surgeon. The neurologists at Jefferson did a battery of tests and scans before presenting us a range of possible diagnoses: from a benign growth; to lymphoma, which was likely curable; to glioblastoma, which was likely not. When the doctors at Jefferson suggested that we should prepare for the worst, just in case, Beau’s first reaction was anger. Goddammit! Then we all got to work.
Howard and Kevin O’Connor, whom we all called Doc, got on the phone with experts to get advice about where the best place for treatment was, whatever the diagnosis. Doc was army like Beau, a Delta Force doctor who had been in serious combat. He was almost always calm under pressure, but even he was a bit shaken by the possibility of glioblastoma. When Jill asked him about the best place to go for a glioblastoma, he blurted out, without thinking—because he would not allow himself to believe it could be the worst—“If it’s The Monster, it doesn’t matter where we go.” Jill burst into tears.
Doc was good with Beau, who was still trying to get his bearings in those first few days. Real fear was starting to creep in. Sometimes Beau would grab him when everybody else was out of earshot to get his honest assessment. “Whatever it is, this is bad,” he told Beau, “but we’re gonna find out what it is. And once we find out what it is, we will have a plan.”
“Promise?” Beau asked.
“Promise. You’re good. People do survive this, and all the people who do survive this look like you. They’re young. They’re fit. They’re healthy. We will have a plan.”
“Thanks, Doc,” Beau said. “You know I love the army.”
* * *
By the time we got Beau down to M. D. Anderson Cancer Center in Houston just a few days later, all the diagnosticians were leaning toward glioblastoma, but they couldn’t be sure. It was hard to fathom, looking at Beau—tan and handsome and fit, with an uncharacteristic week’s growth of beard—that there could be anything seriously wrong with him. He looked to me to be as healthy and vibrant as he always had, from the time he was a little boy. He could have gone out and run ten miles that day, and he seemed to be firing on all cylinders. The anesthesiologist at Anderson set aside an hour to explain the very complicated and risky surgery he was going to have the next day to remove the tumor and determine if it truly was glioblastoma. Beau waved him off after twenty minutes. “I got it,” he said. Let’s get going on this thing! We found a big neighborhood Italian restaurant in Houston that night, and nobody there would have guessed we were facing a crisis. We ate, and had some laughs, and projected hope. We were all together: Beau and Hallie, Jill and I, Hunt and Kathleen, Ashley and Howard.
Beau was not kidding himself about the enormity of his situation. The newest scan at M. D. Anderson showed a big gray mass in his left temporal lobe, which meant it was likely threaded through areas in the brain that controlled his speech, cognition, and movement. And yet Beau seemed concerned less about himself and his prognosis than about everybody else in the family. He was worried about his wife and his children, his brother and his sister, his mom, and even about me. When they wheeled him into the Brainsuite for the long and arduous surgery, Howard and Doc were with him. Beau grabbed Doc’s hand on the way in. “Doc,” he said, “promise you’re going to take care of Pop.”
“You’re going to be around to take care of your dad, Beau.”
“Seriously, Doc. No matter what happens. Take care of Pop. For real. Promise me. For real.”
* * *
While Beau was getting settled into the operating room, the rest of us were escorted to the conference room the hospital’s patient affairs staff had kindly set aside for us. There was enough room for the Secret Service detail, and I had a secure telephone line. The Anderson team was working hard to preserve our privacy, which we greatly desired, but the passage to our waiting room added a touch of the surreal. We walked through a maze of hallways, every one muted, beige, and seemingly endless. The panels of lights overhead were a sharp fluorescent white. I think the entire family was feeling like we were in a place we had never been, either physically or intellectually. There was a lot of information coming at us, and fast. I kept thinking there was so much I had to learn about this disease. Would I have the time to learn all I had to know? I could feel control slipping away as we followed our guides down the long hallways. There were no windows, no way to sight a horizon, no way to orient to any foreseeable future. Nobody said a word.
We finally got to the conference room and sat down for the long wait ahead of us.
We had been drawn to M. D. Anderson by the reputation of Dr. Raymond Sawaya, a neurosurgeon who was regarded as among the best in the world at a procedure called awake craniotomy. The operation allowed the surgeon to remove the greatest part of a brain tumor without doing damage to speech, cognition, or motor skills. The patient was actually conscious through most of the surgery, naming simple objects drawn on flash cards or in casual conversation with the anesthesiologist, while Dr. Sawaya probed the outlines of the tumor with tiny electrodes. If Beau suddenly couldn’t identify a picture of an elephant or a car, felt a loss of strength, or couldn’t talk at all, Sawaya knew he could not cut in that spot without doing serious damage. Beau had to be strong enough to endure hours of this very disconcerting procedure. Dr. Sawaya and his anesthesiologist had allowed Howard and Doc O’Connor into the operating room, so they could help to calm Beau. And they apparently kept things light and easy and humorous. “Remember,” one of the medical professionals said, “what happens in the Brainsuite stays in the Brainsuite.”
While Dr. Sawaya scouted the area around Beau’s tumor for places to cut, he also sent a small biopsy to the lab. He needed to wait for lab results before he started excising the tumor. If the cancer turned out to be lymphoma, Sawaya could be more conservative. Lymphoma would melt away under radiation and chemotherapy, whereas a glioblastoma would be almost entirely unaffected by even high doses. So if the lab results confirmed glioblastoma, he would work hard to remove as much as he possibly could. Sawaya had more than seventy long-term survivors among the patients he had treated in the previous thirty years, and what separated these survivors from the rest was the amount of tumor removed in the initial surgery. When Dr
. Sawaya got 98 percent or more of the tumor, there was a much better chance for the patient to beat the odds. Anything less made a difficult battle that much harder.
* * *
We were all drained and mostly silent when Dr. Sawaya came into our private waiting room sometime after one o’clock that afternoon, more than seven hours after Beau reported to the OR. The surgeon was a tall and elegant man, with a slight soft accent from his early life in Syria and Lebanon. His presence and his demeanor were always confident and comforting, and he was obviously pleased with how the surgery had gone. Dr. Sawaya had removed a tumor slightly larger than a golf ball, he explained, and Beau had come through it without a single complication; except for the scar on the left side of his head, he would be as he was before. His speech, his cognition, and his motor skills were unharmed. But the news was not all good. The tumor was slightly diffuse, and Sawaya had not been able to get all of it. He had detected some microscopic cancer cells right against the wall of an artery, and he knew if he tried to cut them out Beau would have been left with serious and irreversible damage. Then the news got worse. Much worse. The lab results, Dr. Sawaya explained, confirmed the medical team’s expectations: Beau’s tumor was definitely a glioblastoma. Stage IV. I was at the back of the room, toward the corner, when Sawaya delivered the news—and I was glad no one in the family was looking at me. I put my head down and stared at the floor. I felt like I had been knocked down. I reached for my rosary and asked God to give me the strength to handle this.
* * *
Beau was awake and alert later that afternoon, and eating solid food that night. The next morning he was out of bed, walking around, and already anxious to get home. But there was a lot to absorb and a lot of decisions still to make. We were now in the hands of M. D. Anderson’s preeminent neuro-oncologist, Dr. W. K. Alfred Yung, who would be overseeing Beau’s treatment. Dr. Yung had grown up in Hong Kong but had come to study medicine in the U.S. He had lost his mother and two siblings to cancer and he was himself a cancer survivor, which meant he was a true and committed warrior against this disease and somebody who understood what it was like to be in our shoes.
Dr. Yung had all the new pathology reports in hand. Genetic tests on the mass showed that Beau had the worst of the worst; he lacked a key mutation that slowed the growth of the tumor but had two separate mutations that accelerated it. Yung was gentle, but he was honest and straightforward with Beau. “We’re going to be laying out an aggressive treatment plan, and I think you can handle it,” he said. “You’re young and you’re healthy. We know those are good prognostic factors. But you’re going to be in for a tough fight, Beau. You have a long battle in front of you.”
Beau did not ask Dr. Yung for a judgment as to how much time he might have. Nobody in the family asked, either. We had all looked up the standard prognosis for glioblastoma by then. The tumor usually recurred within six or seven months of surgery, and the median life span after the initial diagnosis was twelve to fourteen months. Maybe two in a hundred get to long-term tumor-free remission. But that means some people do beat it, we told ourselves. So why not Beau?
We also knew there were extraordinary advances being made in treating glioblastomas, and we knew that Dr. Yung and the team at M. D. Anderson were on the cutting edge of experimental treatments. I was sure I would have access to the other best minds in the field. Experience had taught me that a vice president was likely to be able to convince almost any doctor or medical researcher in the country to take his call. And I was not going to be shy about asking for help and advice. Beau also had a stalwart support system. Hallie was a rock. She would keep their life on track, make sure their children were well and safe. I knew she would have her hand on Beau’s back and put high hopes in his ear. Jill would keep a mother’s vigilant eye trained on Beau. If something made him uncomfortable or caused him pain, she would know before he said a word and do whatever she had to do to make it better. Ashley would be there at his side during his treatments in Philadelphia, and offered the unconditional love and adoration of a little sister. Hunt was Beau’s secret weapon. His mission his whole life had been to protect his brother; and that’s what he’d do. Whatever it took. And Beau knew Hunt would be there whenever he needed him. That didn’t even need to be said. They’d always been there for each other, from the time they were little boys, and nothing had changed. It just was more intense now. “You know I’d trade places with you if I could, Beau,” Hunt had told his brother the day of the surgery. And we all knew he meant that, literally. Hunt would be the last person in the room to help Beau make the hard decisions about which promising but unproven new treatment might be worth the risk. And he would be the one person in whom Beau could confide anything. While Beau was telling me and everybody else in the world he was fine—“All good. I’m all good”—he could tell Hunt the absolute truth about his very real fears.
More important than that, we were all following Beau’s lead, taking our cues from him. And Beau was determined to make the fight—odds be damned. “Don’t let anybody tell me what the percentages are,” he told Hunt and me. “Okay? I’m going to beat this, goddammit. We’re going to beat this. I don’t want to hear anything about percentages.”
* * *
As we were preparing to leave the hospital, just two days after the surgery, Dr. Sawaya swung by Beau’s room to wish him luck. Beau gave him a hug, and Dr. Sawaya returned the embrace. The two men had clearly been through something like battle. When Dr. Yung checked in on us a little later, I pulled him aside and asked him a question all fathers must: “What should my son do now? How should he live?”
He said Beau should be positive and hopeful. He should go home and do whatever he was going to do before the diagnosis. I told him Beau had been planning to run for governor of Delaware. “Then tell him to go home and run for governor,” he said. “He should live like he’s going to live.”
I wanted the entire family to hear that, so I gathered everybody in the little hallway outside Beau’s room and Dr. Yung explained again that while this would be a difficult fight, there was hope. I think he was looking at Beau when he said it, but the message was intended for all of us. We should not let this disease take over our entire existence. He told Beau to go home and live like he had a future: “Run for governor. Have a purpose.”
Almost every day after that, I found myself acting on that advice—have a purpose. No matter what came at me, I held fast to my own sense of purpose. I held on for dear life. If I lost hold of that and let Beau’s battle consume me, I feared, my whole world would collapse. I did not want to let down the country, the Obama administration, my family, myself, or most important, my Beau.
CHAPTER THREE
Solace
The White House thought it best that I represent the president at the memorial service in New York for one of the two police officers murdered the Saturday before Christmas 2014. The president was with Michelle and his daughters on their annual holiday trip to Hawaii, where he had grown up, and the staff deemed it unwise for him to take an eleven-hour flight straight into a major controversy. I agreed to do the event. I knew I should do it, even though performing these eulogies had always stirred painful memories of my own losses and had taken on a sense of foreboding as well since Beau’s diagnosis. So I spent the last few days before Christmas preparing remarks. I knew I had to strike the perfect balance to help start the healing in New York City. The killings of uniformed New York City policemen Rafael Ramos and Wenjian Liu was another in a series of sudden, violent tears in the tattered relationship between cops and the black community. The two men were executed by a lone gunman while sitting quietly in their patrol car in Brooklyn, just doing their job. “They were, quite simply, assassinated—targeted for their uniform,” New York City police commissioner Bill Bratton had said in announcing the deaths of the two cops. “They were ambushed and murdered.”
News of the senseless act hit in the middle of more than two weeks of growing demonstrations against police brutali
ty in the city. Those protests had been sparked by a grand jury’s decision not to indict a policeman who had choked to death a forty-three-year-old African American man named Eric Garner—in spite of the fact that the entire incident was preserved on cell phone video. New York mayor Bill de Blasio had been careful not to criticize the grand jury, but he did make a point of expressing sympathy for the Garner family and for every parent who had to worry about his or her nonwhite son in any encounter with the cops. The mayor detailed the special precautions he and his wife insisted their mixed-race son observe in his dealings with police: do everything they tell you to do, don’t move suddenly, don’t reach for your cell phone. “I’ve had to worry over the years,” the mayor explained. “Is Dante safe each night?… And not just from some of the painful realities of crime and violence in some of our neighborhoods but safe from the very people [we] want to have faith in as their protectors.” The head of the city’s largest police union, Patrick Lynch, immediately accused the mayor of throwing police “under the bus.”
When de Blasio got word of the ambush of Ramos and Liu in Brooklyn he rushed to the hospital to comfort their families and friends. The mayor forcefully condemned the killings, and did so without pause, as did President Obama. “Officers who serve and protect our communities risk their own safety for ours every single day and they deserve our respect and gratitude every single day,” the president said. “I ask people to reject violence and words that harm, and turn to words that heal—prayer, patient dialogue, and sympathy for the friends and family of the fallen.” But things were already getting out of hand.
New York congressman Peter King was visibly distraught when he went on TV just hours after the shooting. Representative King is a reasonable and dedicated public servant, but his anger at the awful murder seemed to have got the better of him. The statements by the president and the mayor were perfunctory and disingenuous, King told one interviewer. It was “time for elected officials to stand by the men and women of law enforcement and end the demeaning of police officers and grand juries,” King said, implying that the president and the mayor were part of the problem. Former New York mayor Rudy Giuliani was already, in the first hours after the shooting, being outrageous. And he knew from long experience that a number of press outlets would allow him to speak unchallenged. He asserted that the president had given license to the gunman, who was found to have announced on social media his intention to hunt and kill police officers to avenge Garner and others who had been killed during recent interactions with law enforcement. “We’ve had four months of propaganda, starting with the president, that everybody should hate the police,” Giuliani said, a statement both mean-spirited and demonstrably false. Patrick Lynch was even more dramatic. “There’s blood on many hands tonight,” he said. He blamed all “those that incited violence on the streets under the guise of protest that tried to tear down what NYPD officers did every day.… That blood on the hands starts at the steps of city hall, in the office of the mayor.”