by Joe Biden
The president and I talked briefly about Tikrit at our lunch, and about what might come next in Iraq, but I think he could tell I was distracted and down. He knew I was just back from M. D. Anderson, and he knew I was headed back there soon. The president had kept up with the general outlines of what had been happening in Houston.
“How did it go, Joe?” he asked. “How is Beau?”
The talk at lunch ended up being almost entirely about Beau. I could tell looking at him across the table that the president was genuinely concerned. He liked Beau and respected him and thought, like me, that my son had a big future ahead of him. I found myself explaining to him what Beau had just been through the previous week and what was coming up, attempting to keep it on a fairly straightforward, clinical footing. Part of that was for my own protection. I did not want to break down in front of anybody, least of all the president of the United States. The one time I had cried in front of other people, in the hours after Beau had that first strokelike episode three years before the cancer diagnosis, I remember feeling ashamed afterward. I determined then to never, ever let that happen again other than with family. And I had lived up to that. But as I talked to Barack across the table that day I must have started to confide things I hadn’t intended to. I was hurting, and the president could see it. As I explained to him that the next procedures were uncharted territory, but they were our only hope to save Beau, I looked up and found Barack in tears. He is not a demonstrative man, in public or in private, and I felt bad. I found myself trying to console him. “Life is so difficult to discern,” he said.
I told him I was debating whether to fly down to Houston later that night, to be with Beau for the injection in the morning, or to fly tomorrow and be there when he woke up. Barack didn’t hesitate. He said I should be with my son before he went in, not after. Whatever was on my schedule could not be more important.
“Joe,” he said, “you’ve got to go down tonight.”
I knew he was right. That’s what I had planned on doing, but it meant something to me to hear it from Barack. I was in the air, heading to Houston, a few hours later.
CHAPTER EIGHT
Home Base
Sunday, April 12, was the sort of day when all good things seem possible. Jill and I woke up at our home in Wilmington and the sun was already starting to burn away the last wisps of fog on the lake behind our house. Early lilacs were blooming, and even the tallest trees around the lake were leafing out. It felt like the dark gloom of a very difficult winter was finally lifting. Jill and I were looking forward to spending most of the day with our youngest grandchildren, Natalie and Hunter. Beau and Hallie were bringing them over later that morning to tape a segment for Reading Rainbow’s “Story Time.” Natalie, Hunter, Jill, and I were all going to be reading from Jill’s children’s book, written for the families of U.S. military personnel who had been deployed overseas. At heart, it was the story of how Natalie and Hunter coped with the difficulty of having their dad far away, in a dangerous spot, for more than a year.
Everyone arrived, and while the crew spent the morning setting the lights in our library, we reviewed the parts each of us was to read: “Daddy is a soldier,” Natalie’s mom answers in a quiet voice.… “Soldiers have to do hard things sometimes.” Her father takes Natalie in his arms. “Home is wherever I’m with you,” he sings softly. Natalie smiles. “I like that song, Daddy.” The sun was up high by the time Natalie, Hunter, Jill, and I sat down in our library to tape the segment, and it was warm enough to throw open the doors that led out onto the back porch.
Beau kept to himself that day, out of sight of the visiting television crew, but I only had to walk twenty feet, through a couple of doors, to check in on him. He was settled into our sunroom, windows pushed open, where he could look down on the lake and feel the gentle, warm breeze on his face. This was his favorite spot in our house, where I sometimes found him sitting quietly on nice days like today, watching the play of light and shadow on the water as a single cloud or two scudded by overhead. Below was the dock where he had spent hours with his son, their fishing lines dangling in the water. Overhead in the distance, he would spy an egret or two making long, lazy arcs before turning and gliding down to skim the still surface of the lake. Jill always said we were going to will our property to Beau, he loved it so much. We could find ways to even things out for Hunt and Ashley, she said, but Beau should have the house.
Our eldest son was holding his own against the cancer. Was better than holding his own. He had come through the injection of the live virus ten days earlier without a single complication. He was moving well. His appetite was still good. And he was mentally sharp. But the two fresh, angry scars on his scalp put us all on edge; the entire family was dreading the coming effects of the untested experimental treatment. Dr. Yung and Dr. Lang had warned us that Beau would get worse before he got better. Maybe much worse. They said he would likely be at his most vulnerable point in the third or fourth week, when the virus and Beau’s own immune system were at war with the tumor. The inflammation could be painful and debilitating. There was no predicting how low he would get, or if he would survive the onslaught. The climb up from the physical nadir could take a long time, too, and we wouldn’t know for sure until then if the treatment had been successful and Beau’s tumor was gone. The next six or eight weeks would tell all.
Beau was still determined, but I could tell he was tired. And he needed to gather some strength for his trip back down to M. D. Anderson in two days. He was going to have another set of scans, and if all looked good, he would get the second injection of pembro, the anti-PD-1 antibody. Howard had been on the phone with Dr. Yung about the wisdom of the second shot. Beau’s immune system could potentially jump the tracks and start eating away healthy brain tissue. The doctors were still debating among themselves. Beau was ready to take the risk. He knew just how bad this could get, but he was willing to face it, and I think in large part, he was willing to face it for the rest of us. He had texted a friend two days earlier with an assessment of how things were going. “All good!”
I was the last of the four to read from Jill’s book at the taping: “Natalie and Hunter are playing soldier with their Daddy dolls. Hunter starts to cry.” I suddenly realized this was not going to be easy to get through. The absence of the father felt too close to home, too close to this home.
“‘I want Daddy.’ Natalie holds her doll up in front of her face. She pretends the doll is a puppet. ‘Don’t cry, Hunter. Be a big and strong boy,’ she says in her Daddy voice.
“‘That’s not Daddy talking,’ says Hunter.
“‘Yes, it is. That’s what Daddy would say.’”
* * *
When we finished the taping, I went back to the sunroom and found Beau sitting with my sister, Val. They were flipping through news channels and looking over the newspapers. The big story that Sunday was Hillary Clinton, who had officially announced her candidacy for the Democratic presidential nomination. The chatter on cable news among pundits and professional prognosticators was that her announcement all but sealed the deal. She was a lock for the nomination. They pointed to her fifty-point lead in the early polls over her strongest challenger, me. Lesser-known candidates like Vermont senator Bernie Sanders were polling below 3 percent. President Obama had offered what seemed like a coordinated, nonendorsement endorsement the day before. “She was a formidable candidate in 2008,” the president told reporters while on a trip to Panama. “She was a great supporter of mine in the general election. She was an outstanding secretary of state. She is my friend. I think she would be an excellent president.” This was on the heels of a meeting I’d had with the president’s trusted pollster earlier that week, a meeting I had taken at the president’s urging. The message I took from that meeting was that Hillary’s poll numbers, her money, and her campaign organization were just too formidable. I had no real path to the nomination, so why rock the boat and complicate things for the party?
None of that mattered to Bea
u. He was reading all he could about the Clinton campaign—its message, its candidate’s travel schedule, its early field operation. He wanted to be up on everything, so he would be ready to pitch in the minute I announced my own candidacy. Beau believed, as I did, that I was prepared to take on the presidency. That there was nobody better prepared. No matter what people in the outside world said or thought, Beau and Hunter believed we could win. In my own head, the race was more than anything a matter of daring. And if I had my two sons behind me, anything was possible. Beau had a way of instilling courage and calming me. He was the last person in the room with me before the presidential primary debates in 2007, the vice presidential debate in 2008, and the vice presidential debate in 2012, when it was up to me to put wind back in the Democrats’ sails after Barack’s demoralizing performance in his first debate against Mitt Romney. Beau would always grab my arm just before I walked onstage and pull me back toward him until I was looking into his eyes. “Dad. Look at me. Look at me, Dad. Remember, Dad. Home base, Dad. Home base.” What he was saying was: Remember who you are. Remember what matters. Stay true to your ideals. Be courageous. Then he would kiss me and shove me forward. So the 2016 Biden campaign would have a late start. So what? If Beau made it through the next few months and came out alive, I knew we could do this.
* * *
I was in the office three days later, that Wednesday, when the call came from Houston. My brother Jimmy had made the trip with Beau down to M. D. Anderson so Dr. Yung and Dr. Lang could assess the early results of the live virus injection, and Dr. Yung could administer the second injection of pembro. The news as it was reported to me was very good. In fact, the news was potentially incredible. The scans showed inflammation, but it looked like the tumor growth had really slowed. There was clear evidence of necrosis on the edge of the tumor, which meant the virus was probably already exploding cancer cells. Beau was in good shape, not yet showing ill effects from the virus, and there was already evidence of tumor destruction. This was something they hadn’t seen in nearly three dozen tries with the live virus injection. I asked if it was because of the earlier pembro treatment. “That’s what we’re hoping,” Dr. Yung said.
I got on the phone with Howard and with my brother Jimmy. Howard said Dr. Lang and Dr. Yung were excited by the possibilities. Jimmy was even more bullish. The doctors had never done this before, but they were very encouraged. We really may have something was the way Jimmy heard it. We may have cracked the atom. “Lang and Yung are almost giddy,” my brother told me. I hung up the phone and felt like I could take a real, long, deep breath for the first time in months. Don’t get your hopes too high, I reminded myself. Don’t tempt the Fates.
Dr. Yung was concerned about being overly aggressive. The tumor had been growing fast just two weeks earlier, and Yung and Beau had agreed to fight it with like aggression. But now that the tumor seemed to be slowing in its growth, or maybe even shrinking, and Beau was in pretty good shape, Dr. Yung was leaning toward caution. He told Beau they could wait another couple of weeks, take another set of scans, and see if he needed another injection of pembro then. Both Yung and Lang were a bit surprised at Beau’s reaction to pumping the brakes. He seemed to shrink into himself a little bit when he got the news. By the time he got home to Wilmington late that night, he was downhearted, though he never showed it. When Jimmy dropped him home, Beau gave him the thumbs-up. “All good, Uncle Jim. Hundred percent. All good.”
Beau didn’t get out of bed the next day, Thursday, and everybody in the family figured it was just exhaustion from the trip. But he didn’t get out of bed on Friday, either. He was overwhelmed by fatigue and wouldn’t eat. Howard stopped by Beau’s house on Saturday and found him lethargic and unresponsive. He was certain Beau was badly dehydrated. Beau didn’t want to go to the hospital, so Howard gave him three liters of fluids to boost his electrolytes. When Howard came back the next day and found him worse, he packed Beau off to Thomas Jefferson University Hospital in Philadelphia. This was likely the start of the first serious symptoms of the virus. Beau was still badly dehydrated when they admitted him, and his sodium levels were dangerously low. He couldn’t keep his eyes open. He was barely responsive. The best he could do in response to a question was a thumbs-up, or a barely audible “Yes.”
This was it now. We were in the worst of it, and unsure how long the worst would last. The effects of the virus were beginning to punish Beau. The swelling in his brain was intensifying and the pain would have been excruciating, so the doctors kept him heavily sedated most of the time. There was a lot of talk in Wilmington about why Beau, who had announced his intention to run for governor, had skipped every crucial political event in the first four months of the year. Beau still wanted to keep his illness out of the public eye. He was admitted to Jefferson under the same alias he had gone by at Anderson, “George Lincoln.” The Secret Service agents kept going out of their way to ensure Beau’s privacy and to protect his dignity. I would visit when I could sneak in and out without detection, but I made sure to keep up my schedule so I didn’t call attention to his hospitalization.
So I wasn’t around as much as I wanted to be, which was every moment, but Howard and Doc O’Connor agreed to be my eyes and ears at the hospital. Howard ran over to the ICU whenever he had a spare moment. Doc sat in the room during visiting hours when Hallie or other members of the family were there, and played the M.D. card to gain entrance to Beau’s room in the off-hours to sit with him. Howard and Doc phoned me with reports as often as they could. Beau was under heavy sedation around the clock and rarely conscious. Occasionally nurses would give him something to wake him up, and he would give a thumbs-up—his nonverbal All good!—when they asked him how he felt.
Whenever I mused out loud to Doc that maybe I should dump my schedule and just move in to Jefferson, he would caution that we were in for a long haul. The prime minister of Japan was coming to town, and I had to deliver an important speech at the NAACP meeting in Detroit, and Natalie was bringing her entire class on a field trip to the White House and then for pizza back at the Naval Observatory. Doc reminded me that we weren’t sure how long it was going to take for Beau to climb out of this, so I had to be patient and keep hitting my marks. “Nothing is happening right now, but I’ll let you know the minute it does,” he kept saying, “and we can get you up here in no time if we need to.”
Somebody from the family was at Beau’s bedside constantly, and other good friends stopped by to lend support. One of the visitors was Michael Hochman, a college friend of Beau’s who had a present for him. Right after Beau’s diagnosis in August 2013, the two of them decided to run a marathon, something neither had ever done. They trained on the hilly trails in Brandywine State Park together, all through the fall and winter. Beau was still as competitive as ever, even sick, pushing Michael. But over time Beau was only capable of a slow jog, and then a walk. He encouraged his friend to keep going without him, though, and he did. Michael showed up at Beau’s bedside the last week in April, having just completed the Kentucky Derby Festival Marathon. Beau was not really able to talk and just barely awake during the visit. But Michael told him about the race. “We did it, Beau,” he said, and put the finisher’s medal on his chest. Beau squeezed his arm. “The medal is more his than mine,” Michael said to Val, who was staying with Beau that day. “He was the wind at my back.”
I don’t remember telling Barack about Beau’s hospitalization, but he must have sensed something was afoot. He let me know he was thinking of me in the way it was most comfortable for him. He seemed to be going out of his way to say nice things about me in public, especially in my absence. When he hosted the winners of the 2014 NASCAR Sprint Cup Series at the White House two days after Beau’s hospitalization, he spoke about the teamwork required to win championships, and how their success reminded him of his relationship with me. “Instant chemistry,” he called it. “When you have a trusted partner shouting world-class advice into your ear at every turn, you can’t lose.” The president
made an unusually fond statement about me at the White House Correspondents’ Dinner later that week, though he wrapped it in a joke about the then-current controversy involving businesses that had refused to cater to gay weddings. “I tease Joe sometimes,” Barack said, “but he has been at my side for seven years. I love that man. He’s not just a great vice president, he’s a great friend. We’ve gotten so close, there’s places in Indiana that won’t serve us pizza anymore.”
* * *
Beau’s illness made me increasingly aware of the incredible advances and the new possibilities in cancer treatment, but I had also become painfully aware of the unnecessary snags and obstacles in our health-care system. We had an extraordinary team of doctors at Anderson and at Jefferson who were absolutely dedicated to saving Beau, but we still had frustrations—right from the beginning. The doctors who administered Beau’s radiation treatments at Jefferson, for instance, did not readily accede to the idea of taking orders from a doctor at another hospital, even though we had made it plain that we had chosen Al Yung, at M. D. Anderson, to quarterback Beau’s treatment. It was only after Howard explained to the radiologists at Jefferson that they would listen to Dr. Yung, or Beau would go elsewhere for his treatment, that they agreed.
Howard was an incredible secret weapon for Beau, and something all families should have: a devoted patient advocate. He acted as a translator between the doctors, who tend to speak in almost incomprehensible professional jargon, and Beau, Hallie, Hunter, and the rest of our family. Howard also did what he could to cut through the knotty administrative issues all families must face. One of the biggest problems was simple communication and information sharing between hospitals. The economic recovery package our administration pushed through in 2009 included nearly twenty billion dollars to aid hospitals and doctors’ offices across the country to implement and update their electronic medical records system. The problem was, the system upgrades lacked uniform software. There were a handful of very capable and ingenious vendors servicing major health-care providers, and they each had proprietary technology. Which meant the various systems were unable to talk to one another. (Read: their creators were unwilling to make them talk to one another.) One of our biggest frustrations during Beau’s time in the Philadelphia hospital was the inability of the doctors and technicians at M. D. Anderson to interface with the doctors and technicians at Jefferson. Dr. Yung and Dr. Lang needed to see the scans in real time, but the two hospitals were on two different systems, so Anderson was unable to receive electronic files of the scans of Beau’s brain they were doing at Jefferson. Nobody wanted to lose the valuable time waiting for the arrival in the mail of a physical CD, so Howard and Hunter were forced to get on FaceTime with Dr. Yung and use the cameras on their iPads to stream images from Philadelphia to Houston. This, I determined at the time, was something that needed fixing.