by Joe Biden
“This trip is important, Doc.”
“I know this is important, sir, but you have pneumonia. And right now, you look like shit. I can’t make you not look like shit.” He just kept talking, and I didn’t have the strength to stop him. “I’ve never recommended canceling a trip, you know that. But you’ve got to pay the piper now or you’re not going to get well. This is bad.” I did not sign off on the plan. Doc went away and came back with Steve, who agreed I should cancel the trip. I did not agree. Doc went away and he came back with Steve and Jill. And I finally agreed—in part. I would not fly to Uruguay the next day, but I would fly to Guatemala City for the second part of the trip, which was the crucial part, after I took a couple of days to rest and heal.
* * *
I stayed put at the Naval Observatory that weekend, doing what business I could, but not feeling a whole lot better. I had a call with President-elect Tabaré Vázquez to apologize to him for missing his inauguration in Montevideo, and I had a call with President Poroshenko, who wanted me to know that, two weeks into the new cease-fire, the Russians had not yet stopped shelling across the border into Ukraine. Ukrainian soldiers and civilians were still being killed. And the international monitors could find no evidence that Russia was removing its heavy artillery from the front lines, as Putin had agreed to do. I told Poroshenko to stay strong and I would continue to do what I could to help. I also congratulated him on the anticorruption legislation his new government was going to pass next week, which would bring money from the IMF that was critical to stabilizing Ukraine’s economy and protecting it from Putin’s ongoing treachery.
Jill and I were upstairs in the private quarters for the first phone call from Houston with an update on Beau. The new scans looked bad, but the way I heard it, the doctors could not be sure if they were seeing new tumor growth or more necrosis, which is evidence of the destruction of the cancer cells. They said they would call as soon as they had more detailed information. I hung up and took a deep breath. Let it be necrosis, I said to myself. Please, God, let it be necrosis. They called us with the report later that night. The news could not have been worse. This was all new tumor growth. The cancer cells in Beau’s brain were multiplying fast, and in new places. My heart sank. This was the moment we had been dreading from the day Dr. Sawaya removed the original tumor.
Hunt got me patched into a separate conference call that weekend so the three of us—Beau, Hunt, and I—could all talk with Dr. Yung and Dr. Sawaya. The doctors explained the disconcerting architecture of the new growth. There was a large mass in front of the space where Dr. Sawaya had removed the original tumor. Sawaya was prepared to go in and remove it as soon as possible. But there was also growth well behind the original tumor, which Dr. Sawaya could not safely remove.
Dr. Yung told us there were other options for treatment and still reason for hope. Hunter thought maybe they could try the promising new experimental immunotherapy we had talked about a few months earlier. The medical team at M. D. Anderson had prepared Beau for the therapy a month earlier by drawing his blood and collecting some of his T cells—the white blood cells that identify and destroy malicious foreign agents in the body. The idea of this new immunotherapy was to identify the specific protein in the tumor cells that was triggering the growth and to engineer the patient’s natural T cells to attack that specific protein only. The T cells would, in theory, gobble up the cancer cells and leave all the nearby healthy brain cells untouched. But it turned out they couldn’t make that work. Beau’s cancer cells had proven too diabolical; the doctors had been unable to identify and isolate the unique protein in Beau that was triggering the growth.
There was another possible treatment, Dr. Yung assured us, though it was further outside the box than anything they had tried to date. Dr. Sawaya would surgically remove the cancerous nodule in front and then, a few days later, another specialist at Anderson would inject a specially engineered live virus into the new tumor growth in the back. The purpose of the injection was to activate Beau’s own immune system and let it attack the cancer cells. They had already had extraordinary success in a few of the twenty-five patients who had received the live virus injection. Dr. Yung explained that they also wanted to try something else in combination—a separate immunotherapy treatment designed to hypercharge the organic attack on the tumor. Beau would be the first person ever to have this combination, and the risk was enormous. There was the possibility that Beau’s immune system would overreact and start eating healthy brain cells, too. Hunter asked most of the questions that day, because he knew what he was talking about and he could talk for Beau. I was a little lost sitting there listening to the medical jargon as the sleet pinged against the Observatory windows. I still felt lousy, and my head was swimming in all this talk of proteins and antibodies and antigens and reengineered viruses. I wasn’t sure what the right course was, but Beau settled it. All good. Let’s do it. All good. All good.
The surgery would have to wait three or four weeks, the doctors explained, to allow time for the chemotherapy drugs Beau was now taking to clear his system, so he would be able to heal after another major brain surgery. The doctors decided to do the first injection of the immunotherapy—called anti-PD-1 antibody—as soon as possible. Dr. Yung wanted to do the procedure in the middle of the next week, on Wednesday, March 4.
When I got off the phone, Jill and I just stared at each other, and embraced. At that moment, even in her embrace, I think I had lost hope. I was determined not to break down in front of Jill, since I knew it would really scare her. So I walked into the bedroom, grabbed my rosary, and started praying. I didn’t know what to ask for, but the simple act of prayer calmed me. I had to be strong. I had to maintain my sense of hope. The real fight was on now. Beau had survived the early and middle rounds, but the decisive round was approaching fast, and we all had to gird up. This was life and death.
* * *
I knew Hunt would be going down to Houston to be with his brother for the first injection of the anti-PD-1 antibody, but I spent that Sunday night debating with myself what I should do next. The official plan at that moment was for me to get on a plane and make the trip to Guatemala the next morning, Monday, March 2. But I wanted desperately to stay home and be with Beau. What I really wanted to do was just go hold him. And I knew if I called Barack at the White House that night and told him why I was canceling my trip, he’d say, “Go, Joe. Take as much time as you need.” But I also knew that nothing was going to happen with Beau while I was out of the country, and my canceling the trip would have only invited more attention to his circumstances. And besides, I’d be back on Wednesday morning before the first anti-PD-1 injection.
I also knew Beau would be disappointed in me if I canceled, especially on his account. I had an obligation—a duty, Beau would call it—to the country. I have to admit, though, if it had been a different man in the White House that night—somebody whose policies and character I doubted—I might have made that call. I might have stepped away from my job for a time. But I felt an obligation to Barack, who was my friend. The president had put his trust and faith in me. He was counting on me. He had enough to worry about already without adding me to his list.
Jill and I got on the marine helicopter at 9:40 the next morning, flew to Andrews Air Force Base, and boarded Air Force Two for the flight to Guatemala City. I hadn’t slept well and was still popping Mucinex and antibiotics. I couldn’t take a deep breath without feeling a sharp stab in my left lung. But I was confident I was doing the right thing. I settled into my cabin and started reading through the briefing books.
I might have been in the minority even around the White House, but I really believed at that time that in terms of game changers for our long-term national security, Central America held the greatest potential for our administration. As so often happens, the opportunity grew out of a crisis, when thousands of children from the Northern Triangle—Guatemala, Honduras, and El Salvador—began showing up at our southern border in the summer of 20
14. The influx of unaccompanied children captured the headlines as well as the imagination of the American people. What would cause that many parents to put their children on a bus and send them to America alone? What parent could imagine that was their best possible alternative? How bad did things have to be for those parents to put their children’s lives at risk?
When Barack turned to me and said, Joe, you’ve got to do something about this, I was glad he had chosen me. It didn’t take long for me to realize that we had a real chance to bend the arc of history a bit. In fact, of all the crisis spots around the world, I had come to believe that Central America held the best opportunity. With only two years left in office, we didn’t have the time to get it right in most places. The best we were going to do in the Middle East was to maintain the line and start building the mechanisms among our allies to begin the long campaign of disabling and destroying ISIL and the other terrorist groups. Real stability in countries like Iraq, Libya, and Syria was a long way away. In eastern Europe, all we could do was to keep building consensus to shame and isolate Putin and Russia. Maybe we could begin to lay down a foundation to make real progress with China. But I had come to believe we had a really good chance, if we were smart, and had lots of courage and a little bit of luck, to put our relationships in Latin America on an entirely hopeful new trajectory—one that turned the region from its inhabitants’ widely held belief that the United States was the continental bully dictating policy to smaller countries, to the realization that we could be a true partner in improving those countries.
I had been saying it even before the unaccompanied-children crisis of 2014. I had first laid out some guiding principles for U.S. engagement in Latin America back in May 2013, at a speech at the State Department before a standing-room-only crowd, including dozens of diplomats and other government officials from across Latin America. “In the region, we’re still viewed by many as disengaged, domineering, or both,” I said, “but I would argue that’s not us anymore. Too many in my country still look south to the region of 600 million people and see mostly pockets of poverty and strife. But that’s not you anymore. Neither stereotype is accurate. And they haven’t been, I would argue, for some time.
“The changes under way give all of us an opportunity to look at the hemisphere in a very different way.… I think we should be talking about the hemisphere as middle class, secure, and democratic. From Canada to Chile and everywhere in between.”
Central America was a critical link in ensuring that that became a reality. And my instinct was, after working closely with the presidents of Guatemala, Honduras, and El Salvador for the last nine months, that they believed I really meant it. That it was possible.
My old friend Tip O’Neill, the twentieth century’s most colorful and successful Speaker of the House, famously said, “All politics is local.” I’ve been around long enough to presume to improve on that statement. I believe all politics is personal, because at bottom, politics depends on trust, and unless you can establish a personal relationship, it’s awfully hard to build trust. That is especially true in foreign policy, because people from different countries often know little about one another, and have little shared history and experience. I have spent countless hours trying to build trust across those divides, and I have always followed my father’s advice: Never tell a man what his interests are. Be straight and open with him about your own interests. And try to put yourself in his shoes. Try to understand his hopes and his limitations, and never insist that he do something you know he cannot. It’s really just about making the effort to make a personal connection.
Presidents Otto Pérez Molina of Guatemala, Juan Orlando Hernández of Honduras, and Salvador Sánchez Céren of El Salvador had become my friends in the last nine months. I believed they trusted me. I told the old communist guerilla from El Salvador, President Sánchez Céren, “If I end up being in the jungle, I want to be with you.” And I was their contact. They knew I spoke for the president. I was their confidant. And I knew that if a new replacement suddenly showed up for the March 2015 summit, there was a chance the whole enterprise would suffer a serious setback. That was a chance I was unwilling to take.
* * *
I arrived in Guatemala City with a real tribute in hand—the possibility of a big new aid package for the Northern Triangle. I had put together a package that would take care of not only the security concerns of the three countries, but governance issues as well. I had worked with the State Department and my own staff, and with support from Republicans and Democrats in the House and the Senate we were able to develop an aid package similar to Plan Colombia, which had helped get Colombia on its feet. The billion-dollar package for the Northern Triangle was beyond anything they had ever seen or expected from the United States. The region could always count on the Republican-controlled Congress to put up a quarter of a billion dollars for drug interdiction, but the size and scope of this aid package was something entirely new. The budget request included money for police and security, sure, because these countries led the world in murder rates, but our administration’s request balanced security and development assistance based on the key lesson from Plan Colombia: high-intensity law enforcement operations are not a long-term solution without a robust judiciary and strong government institutions.
The budget request, which had been presented to Congress in January, also included funding for boys’ and girls’ clubs to help keep at-risk youth from joining gangs; support to aid government agencies in collecting taxes more effectively and ensuring that those tax proceeds were managed fairly and transparently; and investment in regional energy integration to lower the incredibly high energy costs. The energy part was key, I believed. Lowering energy costs for the average citizen in the Northern Triangle could reduce inequality, promote economic growth, and even help cut down the levels of violence.
We were signaling fundamental changes in our relationship with the entire hemisphere. This was my fifth major trip in less than two years. President Obama was meanwhile about to normalize diplomatic relations with Cuba, which made it harder to demagogue about Yanqui imperialists. And when somebody in the administration stood up and said, “It’s not what we can do for you, it’s what we can do together,” Latin America was starting to buy in. I had already been talking to my friends in the Senate, on both sides of the aisle, and I knew what was possible. So I could look each of the three Northern Triangle presidents in the eye and tell them that passage looked like a good bet. We might not get the entire billion, but we would get close.
By the time I went into the critical meeting of the trip—just the three Northern Triangle leaders and me—I think they understood I was serious about helping them. But I told them they had to be serious about helping me help them. I would lobby the Hill to get the budget request passed, but there were things they had to do to reassure appropriators in the United States Congress. “First,” I told them, “everybody up my way thinks you are all corrupt. Second, they think you don’t deliver very well on your word. Third, your tax system and your regulatory schemes are corrupt. You collect almost no taxes from the wealthy, while soaking the poor and the meager middle class. So you’ve got to commit to making some changes.”
They each knew from previous talks with me that I expected them to make some politically difficult promises. They each had to tackle the smuggling networks and correct the misinformation about the U.S. immigration system to stop the flow of immigrants across our southern border. They each had to be seriously committed to achieving the sort of governance that served all of their citizens. And they each had to match our aid package, and much more than dollar-for-dollar. I really challenged them to develop a serious plan and to start delivering results. If they did, I assured them, President Obama and I would meet their political will step by step. But if they couldn’t step up, we wouldn’t step up. I told them that if what I was asking was too difficult for them, I understood. No problem. I got it. But if they said yes, then I was going to go up to the Hill and mak
e personal commitments, staking my credibility on their willingness to tackle internal reforms. I would be offering my assurance to Congress that things were going to be different down here. “If you don’t live up to your promises,” I said, “I’m going to be the guy who comes after you.”
The private meeting with the three presidents was scheduled for fifteen or twenty minutes, but it lasted well over an hour. And we emerged with real purpose. The four of us spent the next several hours hammering out the inelegantly titled “Joint Statement by the Presidents of El Salvador, Guatemala, and Honduras, and the Vice President of the United States of America Regarding the Plan for the Alliance for Prosperity of the Northern Triangle.” Molina, Hernández, Sánchez Céren, and I did not want to waste our time together. We took the unconventional tack of negotiating in real time, while our respective staffs scrambled back and forth behind us to agree on specific language.
The process was exhausting, but we came out with a document to reckon with. It had more than three dozen serious and specific commitments from the Northern Triangle presidents pledging to use the money and expertise we were offering to make sure their governments would actually be responsive to the needs of their citizens. There were specific commitments to provide access to quality education for the underserved; to empower women; to improve health care, nutrition programs, and public safety; and to reform the justice system top to bottom—from the police departments, to the courts, to the prison system. There were pledges to promote fairness in the tax system as well as efficiency and effectiveness in tax collections, and detailed plans to provide economic opportunity and affordable energy. The United States government would provide experts from our departments of Justice, the Treasury, Customs, and Energy to help the leaders of Guatemala, Honduras, and El Salvador set up mechanisms of governance that did not yet exist. I really believed these efforts could put the three countries on the road to political stability and the sort of broad economic expansion that benefited everyone.