by Joe Biden
Beau held steady for ten or twelve days, and there was some evidence on the scans that the tumor might be shrinking. His appetite was still bad, so the doctors inserted a feeding tube. But in the first few days of May, he started showing a little improvement. He was more responsive, and the nurses even got him out of bed and helped him take his first steps in almost two weeks. Late one afternoon when I was with him and he was awake, we were talking to one of the nurses. “Where do you live?” I asked her. She pointed out the window, across the Delaware River; the sky was the beautiful after-light that follows a warm spring rain. “I live right over there,” she said, pointing. “Oh, look at the rainbow! Look at the rainbow. Where it landed. My house is right there.” Then she turned to Beau. “It’s good luck, Beau,” she said. “That’s good luck.” I took that rainbow as a sign. If Beau was on the upswing, we decided he should go to Walter Reed, the military facility just outside Washington, where he would be able to restart his physical, speech, and occupational therapy once he rebounded from this temporary, virus-induced illness.
* * *
When “George Lincoln” arrived at Walter Reed on May 5, 2015, a team was already in place for his rehab. He got visits that first day from a nutrition counselor, a speech therapist, and an endocrinologist who was going to watch his salt level over the next few days. And they helped him dodge a potentially deadly bullet. A very observant resident who stopped in to see him noticed that Beau seemed to be suffering real discomfort; it turned out to be peritonitis, an infection in his abdomen where his feeding tube had accidently pulled loose. He was rushed into emergency surgery to replace the feeding tube and clean out the infection. Complications piled up for the next two weeks and brought him more suffering and more pain. He was courageous and stoic, and just kept fighting, but every time Beau looked to be gaining ground, something would knock him back. The oxygen tube that fed through his mouth was agonizing for him, so a surgeon performed a tracheostomy and inserted a breathing tube at the base of his neck. He was just barely responsive for long stretches, and his entire right side was nearly paralyzed. There was fluid buildup in the left ventricle of his brain, and every time the doctors drained it the fluid just came back, which meant he was in pain or disoriented when he was conscious. One night, at two o’clock in the morning, his breathing suddenly became labored, which turned out to be a sign of pneumonia, requiring a jolt of powerful antibiotics. When a Catholic priest swung by Beau’s room to check in, Jill thanked him for stopping by but asked him to please leave. And not to come back. She didn’t want Beau to get the idea he was there to perform last rites. In fact, there would be no discussion about last rites.
Jill and I kept reminding each other the doctors had warned us that Beau would get much worse before he got better. We kept telling ourselves that these hard times were to be expected, and he would turn the corner. Could be any day now. There was still hope.
What I felt, most of all, was helpless. I did what I could, which was to just be there whenever I could. I visited early in the morning most days, before I started my official schedule, and again every night when I was done. The ride to the hospital was less than half an hour from the White House, and even faster from our residence at the Naval Observatory. Once the motorcade hit the hospital grounds and made the left into the back alley, I would always look up at Beau’s room on the second floor to see if the light was on. Maybe he’s up tonight, I’d think. Maybe he’s looking out the window at me. The agents would let me out of the car at a side door, where I would be met by an army nurse, who would lead me in. Not that I needed guidance after a while. Thinking my way through the maze to get to Beau had become part of the ritual I used to calm myself. Even now, I remember every step and every turn: the straight walk back through a quiet marble corridor, the right turn and transit across an intersection of two hallways, then the left into the elevator, and the ride to the second floor. I’d exit the elevator and make a hard left, then stop at the nurses’ station to greet the team on duty and thank them for all they were doing. I tried not to dwell on the sights to the left of the station, where the rooms were full of patients who were not going to make it. That was not going to be my son, I’d tell myself as I headed to the right, toward Beau’s room at the corner. And just before I got to his room I would begin to psych myself up. Smile, I’d say to myself. Smile. Smile. Smile. How many times Beau had said to me, “Don’t look sad, Dad. You can’t let anybody see you sad because it will make them feel bad. And I don’t want anybody feeling sorry for me.” You gotta make the final turn with a smile on your face, I’d think. And then I’d make that turn and see either Hallie or Hunter or Jill or Ashley there, at the bedside, holding Beau’s hand. “Hi, honey,” I would say with all the cheer I could muster. “I’m here.”
I came in one night anxious to tell Beau about the scene at the White House earlier in the day. “Honey,” I said as I sat down by his bed, “guess who was at the office today?” Beau’s eyes were closed, but I could tell he heard me. “Elton John was there,” I said. “You remember when I used to drive you and Hunt to school? That song we would all sing together, the three of us, as loud as we could? ‘Crocodile Rock.’” The boys were four and five when that song was big, when it was just the three of us. After Neilia died, but before I met Jill. I started singing the lyrics to Beau, quietly, so just the two of us could hear it. The words came back like it was yesterday, but after the first few lines I started to get emotional and wasn’t sure if I could go on. Beau didn’t open his eyes, but I could see through my own tears that he was smiling. So I gathered myself and kept at it, for as much of the song as I could remember.
* * *
The doctors were mulling the latest scan on the morning of May 15 and trying to find a way to relieve the constant pressure on Beau’s brain, while I was trapped in the patient waiting room, which the White House communications team had converted into a private space where I could make secure calls. There was a new crisis in Iraq that day, and it needed my attention. Although I knew it was my responsibility, I felt for the first time a sense of resentment that I had to divert focus to anything other than Beau, even for just half an hour. My son was in one room in extremis and I was sitting in another, forced to deal with a problem sixty-two hundred miles away. The previous night, ISIL had blown into the city of Ramadi, west of Baghdad, under the cover of a blinding sandstorm. The first ISIL wave to hit the capital of Anbar Province was a convoy of armored vehicles. Many looked like something out of a Mad Max movie, appearing like a demonic vision through the wall of sand, led by giant steel plows welded onto the front. They were rolling bombs, loaded with explosives, with suicide drivers at the steering wheels. ISIL had reportedly massacred at least a dozen families and fifty policemen and tribal fighters in the early assault. The jihadists had already taken control of the main government buildings in Ramadi. The chairman of the provincial council was accusing Abadi of taking his eye off Ramadi and failing to live up to his promise to fund, train, and equip local Sunni tribal fighters.
When Abadi got on the phone with me that morning, ISIL was still on the attack—and gaining ground. The progovernment forces in the city did not have the wherewithal to hold their defensive positions. Abadi said his soldiers simply lacked the firepower to push back the enormous armored truck bombs. He asked for antitank rockets so his men could knock the things out before they were on top of them, and he asked for more air strikes. I told him the antitank rockets were already in the pipeline, but we would send more and expedite delivery. I reassured him that the president and I were still behind him, but he needed to do a better job of getting money out of the banks and U.S. weapons out of the warehouses in Baghdad and into the hands of desperate Sunni tribal fighters near Ramadi. His security forces, all over the country, had to prove they could reclaim territory and then hold it. Taking back Ramadi, which was in the Sunni heartland of Iraq, would be an even bigger test than Tikrit. But we would help.
Abadi went on live television a few hours later
and told the Iraqi people that their military forces would stand and defend Ramadi from ISIL. He was sending reinforcements. “The next hours,” he said, “will unfold with victory in Anbar.” Less than forty-eight hours later, ISIL had taken over the entire city. They surrounded the Iraqi command center and pummeled it with waves of suicide bombers, slaughtering people trapped inside. At least five hundred Iraqi soldiers and local policemen fled Ramadi toward the safety of Baghdad, just sixty miles away. They left behind another enormous supply of valuable equipment and weapons for ISIL to take.
“All security forces and tribal leaders have either retreated or been killed in battle,” lamented one Sunni tribal leader in Ramadi. “It is a big loss.” The fall of Ramadi “represented the biggest victory so far this year for the Islamic State,” the New York Times opined in its news coverage. “The defeat also laid bare the failed strategy of the Iraqi government.”
The president convened a meeting of the National Security Council on May 19, and the focus was Ramadi. The debate among the principals was pretty hot. The most pessimistic view was that our strategy was in serious jeopardy because the Iraqi troops lacked real backbone. We could provide the Iraqis with military training, equipment, and weapons, and we could carry out air strikes, but we could not give Iraqi soldiers the courage to go out, take territory from ISIL, and hold it. This had been an ongoing concern of the president’s from the beginning of the campaign against ISIL in Iraq. The project had been full of risk from the jump, and the president never received enough solid information to be sure-footed in his decision-making. A year earlier he had been wary of becoming too involved. He felt like we had our fingers in a dam, with no adequate measure of the power of the force on the other side. Could we contain ISIL? Could we control the war? Could we control the aftermath? The president was willing to put together a coalition to assist, but it was unlikely to succeed, he believed, without a legitimate Iraqi fighting force as a real partner. And, while Kurdish Peshmerga and Iranian-backed militias had reclaimed some terrain in the areas they coveted, there was very little evidence before May 2015 that Iraq’s security forces were willing and able to reclaim and hold core Sunni territory.
But there was one big difference now; the president did have a little bit of hope to hold on to. Abadi had defeated ISIL in Tikrit just six weeks earlier, and he had done it with a nonsectarian force. When the prime minister had come to Washington two weeks after the victory in Tikrit, at my urging, for a long sit-down with the president, I think Barack saw in Abadi what I had seen. He was a partner worth backing.
The plan presented to President Obama by his key advisers on May 19, two days after the fall of Ramadi, made for a tough decision. We needed to get the Sunni tribal forces into the fight, our State and Defense Department colleagues emphasized. That required sending a few hundred special operations forces and advisers to Taqaddum air base, within fifteen miles of Ramadi, to help mobilize, train, and arm nearby Sunni tribes, and work with the Iraqi Army and Abadi’s elite troops to coordinate the counteroffensive on Ramadi. My counsel was to give Abadi the help needed to reclaim the momentum from ISIL.
I got the sense that the president saw the logic of the strategy and was already inclined to pursue it, but he was worried about our ability to protect a few hundred Americans on the ground, operating out of an isolated air base in close proximity to Iranian-backed groups, at the edge of ISIL-controlled Anbar. “Joe,” the president would say to me in private, “what happens if they go in and capture twenty of our guys and behead them? What the hell are we gonna do then?” He did not want our military dragged back into Iraq in a big way. And even if the counteroffensive on Ramadi did succeed, then what? Was there any guarantee the Iraqis could hold and govern the city once it was liberated? This was no easy call. But President Obama agreed to take it under advisement.
* * *
Something good was finally happening with Beau. The day Ramadi fell, he got out of bed for something approaching physical therapy. He was able to stand upright, with some help from the nurses, for five minutes. “Good day,” Doc O’Connor recorded. Natalie and Hunter came by the day after to see their dad. Two days later a surgeon did a procedure that finally appeared to relieve the worst of the pressure in Beau’s skull. He was becoming increasingly alert all the time. Doc told me he noticed Beau moving his upper arm on his long-paralyzed right side, and then his right thigh. The next day he was strong enough to sit up in a motorized wheelchair for a spin around the nurses’ station. He was clearly aware again of what was happening, nodding his head in response to questions and giving fist bumps. Hallie got permission to take him for a ride outside, where he could feel the sun on his face for the first time in two and a half weeks. Seven weeks after the live virus injection, it looked like Beau had finally started to climb out of the dark hole.
Barack invited me to play golf that Saturday. He was worried about me, he explained, and hoped to distract me for a few hours. Jill encouraged me to go; it seemed, after all, like things were going to get better for Beau. The worst part is, I can’t even remember whether or not I went.
* * *
A week after the fall of Ramadi, Secretary of Defense Ash Carter went on CNN and called out the men in the Iraqi military. “What apparently happened was that the Iraqi forces just showed no will to fight,” Carter said in an interview that aired Sunday, May 24, on State of the Union. “They were not outnumbered. In fact, they vastly outnumbered the opposing force. And yet they failed to fight.” This reflected the understandable skepticism some in our administration had about Iraq’s willingness to take on ISIL. But I wish he hadn’t said it.
When my team briefed me for my scheduled call with Prime Minister Abadi the next morning, Memorial Day, there was no surprise. Ambassador Jones and Deputy Special Envoy McGurk had been in touch with Iraqi officials, who all told them that Abadi was stung by Carter’s statement and worried that Iraq was about to be abandoned. It wasn’t hard to imagine what Abadi was feeling just then. When he told reporters, “It makes my heart bleed because we lost Ramadi,” I knew his words were sincere. The briefers were all in agreement with me that my main task on the call that morning was to reinforce my belief in Abadi. He was under enormous pressure, and I wanted to make sure he heard me when I said we were still with him. I knew how tough Ramadi was, having been in the area in 2006 when the forerunner of ISIL, al-Qaeda in Iraq, controlled the city. Thousands of U.S. soldiers and marines, the most capable warriors in the world, fought like hell for four months to win back the city. Seventy-five U.S. service members and uncounted numbers of Iraqis were killed in that fight. I also knew, having watched Beau, the kind of sheer guts required to wage an uphill and scary battle against a vicious and remorseless foe. Knew how important it was to have real support.
Abadi was gracious on the call that morning. I didn’t spend any time reminding him what we needed from him. He knew all that. I simply told him I recognized and appreciated the incredible sacrifices of Iraqi soldiers. I assured him the weapons and equipment we had promised were still in the pipeline. More important, I assured him that, despite Secretary Carter’s statement, our administration had not lost faith in him. We remained committed to helping him turn the tide, because we still believed he could. I told him, as I had before, that he was a real leader, a man of both political and physical courage.
* * *
There was only one other small public event on my Memorial Day schedule before I could head over to Walter Reed to spend the holiday with Beau. I was anxious to see him, in part to see if there was more improvement and in part because I could not get out of my head the image of the dream I had the night before. Beau had appeared to me, completely cured, his old self again. The image was so vivid and felt so real. Beau was off in the distance, finishing one of his regular runs through the grounds of the Tatnall School, skirting the lake behind our house. I was trying desperately to find Jill or someone in the family, to share the amazing news. “I saw Beau running!” I wanted to shout. “
I saw Beau running!”
CHAPTER NINE
You Have to Tell Them the Truth
When I got to Walter Reed on Memorial Day afternoon, Beau looked better to me than I’d seen him in weeks. He seemed to be more aware and responsive by the hour. The doctors thought maybe they finally had a handle on the chief problem: the pressure caused by the buildup of the cerebral spinal fluid in the left lateral ventricle of his brain. The ventricles of the brain produce, reabsorb, and drain cerebral spinal fluid in order to keep it in proper balance, but Beau’s system wasn’t draining properly. Doc O’Connor suggested to me that it might be a buildup of dead cancer cells that had sloughed and clogged the draining channel, like leaves in a gutter. The neurosurgeons at Reed had done a procedure a few days earlier that finally seemed to open up the pathway. Beau’s left ventricle appeared to be clearing and shrinking. And there had been no evidence of cancer cells in the drained fluid. Medical researchers on the floor were really paying attention to Beau’s progress now and were genuinely excited that they might be seeing the first success of its kind in the treatment of glioblastoma—this new combination of the live virus and anti-PD-1 antibody.