by Bill Frist
“Where did you do your training?” he asked as we entered the OR, still bleeding at a good clip from the chest tube.
“Princeton and Harvard,” I replied.
“Now I can relax; I know I am in good hands,” he said. “I can entrust my life to a Princeton man.”
Minutes later he was asleep and I made a large incision through his right chest. Once inside, I discovered about two centimeters of shattered rib embedded deeply in the colonel’s lung, making the operation even more tricky and tedious. He had an eight-centimeter hole in his back, where the bullet had exited after blasting completely through his body. Once I was able to control the hemorrhage, I moved next to repair the wound near the heart. Finally, I reapproximated his ribs, sewed him up, and took him to the recovery room.
I estimated that Petraeus’s recovery would be about a week, but within twenty-four hours, the colonel was already badgering me to get back to Fort Campbell. “I feel fine, really, Doc,” he said. “I’m ready to go home.”
David Petraeus was as much a scholar as he was a soldier. He had done graduate work and earned a Ph.D. in 1987 at Princeton’s Woodrow Wilson School of Public and International Affairs, which explained the Princeton comment on the way to the OR. Petraeus had done his doctoral dissertation on some of the military lessons learned from the Vietnam War.
With Petraeus lobbying hard to get out of the hospital early to get back with his soldiers, I finally acquiesced and allowed him to return to Fort Campbell after only two days of recovery time. He still had a tube in his chest when he left the hospital, but he didn’t seem to mind. His men mattered more to him than his own comfort.
The next time I heard anything about him was when another trauma surgeon called me a few years later, wanting to know exactly what surgical procedure I’d done on David Petraeus. Now a brigadier general, Petraeus was back in a trauma unit after having suffered a badly fractured pelvis when his skydiving canopy collapsed about a hundred feet off the ground due to a wind shear, at a parachuting drop zone near Fort Bragg, North Carolina. Tough as nails, Petraeus survived the parachute’s collapse and recovered with as much aplomb as he had the gunshot wound. I remember thinking this guy really got himself into some tough situations—shot with an M-16 and falling from the sky without a parachute. No telling what would happen to him in the future.
Our serendipitous 1991 meeting would lead to our paths crossing many times in the future, as I transitioned to the Senate and Petraeus continued to climb the military command structure. We stayed in touch over the years, and I visited the general and his soldiers at Fort Campbell several times, once spending a night in the barracks with my son Jonathan to experience a bit of the soldiers’ life from their perspective. At the time, we were working on appropriations in the Senate to improve the living conditions for soldiers at U.S. bases. In October 2002, General Petraeus and I ran the army ten-miler together in Washington, D.C., along with a contingent of his soldiers. Perhaps I should say we started running the ten-miler together, since after the first one hundred yards, the intensely competitive general whose goal was clearly to beat every one of his soldiers left me in the dust!
A few months later, David Petraeus was leading his men in Iraq. Karyn and I visited with Petraeus’s wife, Holly, at Fort Campbell, while her husband was launching the assault on Baghdad.Karyn would be donating the proceeds from her book Love You, Daddy Boy to the nonprofit foundation Operation Eagles’ Nest to support the families at Fort Campbell. And I spoke with him in Iraq by phone from my Senate office on the very day he began the assault.
In mid-2004 I took a Senate delegation to Iraq and visited with General Petraeus. While I was there, Petraeus asked me to speak to a group of fifty young Iraqi soldiers in the middle of their military exercises. Standing in the hot, dusty training compound, Petraeus gathered the soldiers around us and he told them the story of how we had met on that fateful day back in September 1991. The moral of the story was to always be prepared and to always expect the unexpected. He was a soldier’s soldier; you could tell the Iraqi recruits respected him tremendously.
An intense competitor who used to challenge his men to push-up contests and almost always won, General David Petraeus is also one of the U.S. Army’s brightest minds and best analytical thinkers. He combines a keen understanding of history with a willingness to try some off-the-wall, out-of-the-box approaches. One of his slogans displayed in the 101st’s barracks in Iraq was: “What have you done to win Iraqi hearts and minds today?”
Interestingly, my friendship with General Petraeus is colored with many intersections and many parallels. From emergency surgery, to our common interests at the Wilson School at Princeton, to our time in Iraq together, to our mutual commitment to winning the war on terror—the fibers of our lives have been woven into a marvelous tapestry with a similar commitment to serve.
When the true and accurate history of America’s wars in Iraq and Afghanistan is written, General David Petraeus will join the ranks of Dwight Eisenhower and Douglas MacArthur.
OUR EFFORTS AT VANDERBILT ACCELERATED PROGRESS IN THE transplant field through our unique multiorgan, multidisciplinary approach, sharing information across subspecialties, allowing more efficient and better use of resources, incorporating an infectious disease expert who did nothing but transplantations, and bringing a hospital ethicist onto the team—an innovative, forward-looking step at the time. As a result, the entire field of transplantation benefited. And we developed a model of integrated health-care delivery, called today value chain care delivery, which I believe addresses most of the major problems of cost, access, and quality we experience today.
Walter and I coordinated all of our initial transplant runs. We went wherever a viable donor could be found, if—and it was a big if—we could get there, excise the heart, and bring it back to Nashville and transplant it into another human being, all within the strict limit of four hours. Through years of experimentation, Shumway had discovered that the human heart could survive outside the body for up to four hours if kept sufficiently chilled. It would restart if transplanted within that extremely narrow window of time. The key, of course, was that there could be no wasted time and absolutely no mistakes—a challenging standard to meet, but one that transplantation made essential.
The tension of a transplant run—racing against the clock to retrieve a still-beating heart from the body of a person who has already died, and then returning to the hospital to insert that heart into the body of another person being kept alive by a machine—is matched only by the sense of fulfillment you feel in saving a life through means that were impossible only a decade before. Nevertheless, the math of heart transplants tended to be depressing. Somebody had to die so another person could live. That was the constant dilemma we faced. We always had more patients needing transplants than we had available organs to transplant. So each week I would helplessly watch some of my patients waiting for transplants die.
Hoping to educate the public on the need for donors, I began traveling around Tennessee talking about the moral/ethical issues of transplantation, dealing head-on with questions such as, “Who should decide who gets to live and who dies?” I encountered substantial resistance to the concept of transplantation from certain elements of the public. Insurance companies remained reluctant to fund the procedure, declaring it experimental long after the procedures were proven effective. Medicare moved even more slowly, taking eight years before finally agreeing to pay for the procedure.
Some people opposed transplantation on religious or philosophical grounds; others simply felt it was too morbid to take an organ from a dead person and place it in a living body. Many potential donors wondered whether a physician—despite the Hippocratic Oath—might work less strenuously to save their lives if the doctor knew the patient had signed a donor card. Still others were concerned about the possibility of doctors compromising care to provide a donor, or worse yet, the possibility of organized crime or other unscrupulous parties bidding high for body parts.
I did my best to assuage everyone’s concerns, while throwing myself into making more people aware of the need for organ donors.
Nowadays, the profiles of recipients and donors are matched on a national computer base, but in the 1980s, I carried an index card in my white physician’s coat front pocket every day. On the card would be written the names of approximately twenty patients, all who would be dead in a few months if I didn’t find them a heart. I knew personally every one of the patients listed on that card, along with their spouses and families. It depressed me but at the same time it inspired me to act. Somehow, I had to find a way to make the unrealized potential supply out there meet the growing demand for this new, poorly understood, life-saving procedure.
I’d been hired to be a surgeon, not a spokesperson. But I had to get the word out. My goal became to reach as many people as possible, especially community leaders who in turn could educate others, through whatever means possible. So at nights and on weekends, I left the hospital to travel far and wide speaking about the dire need for organ donations. I spoke to Rotary Clubs and other civic groups; I visited with hospital staffs all over Tennessee. I wrote articles for newspapers, magazines, and newsletters. My efforts were having an impact, but not nearly enough. Too many of my waiting patients were still dying.
Up until this point in my life, I’d always felt that if you just worked hard enough you could always accomplish your goal. But now, just working hard was not enough. I needed a louder, more far-reaching megaphone. I began to wonder what role my interest in public policy might play in making the miracle of transplantation more widely available. Were my parallel interests of science and policy back at Princeton beginning to intersect?
Kidney transplantation, unlike heart, had been performed fairly routinely around the country for about twenty years. The director of kidney transplantation at Vanderbilt, Keith Johnson, had presciently realized the huge potential of pubic policy in transplantation years before. He spearheaded the initiative in the late 1970s that led to Tennessee’s being the first state in the country to put an organ donor form on the back of the driver’s license. But by the mid-1980s the form had been taken off, allegedly for financial reasons.
Now, with Keith’s support, I initiated a statewide grassroots campaign to return the donor form to every new driver’s license. With no political or grassroots organizing experience, I jumped into this new arena of public policy headfirst. With the help of Tracy Frazier, my energetic administrative assistant at the transplant center, I organized committees in the seven major cities across the state and set up community generated letter-writing campaigns. We planned and implemented a lobbying effort in Nashville, another first for me. I’ll never forget the thrill when I went to see the distinguished and long-serving lieutenant governor John Wilder. After what I remember as my nervous and poorly organized presentation, he stood up and shook my hand firmly and said in his rural southern drawl, “Boy, I don’t really understand the transplanting body parts, but I love y’ur passion, and if it’ll he’p others like you say, I’m your man in the Senate.”
Our grassroots effort paid off. Three months later, legislation was passed, and the organ donor card was back on the Tennessee driver’s licenses—for good. Wow! Even a doctor can get involved and influence public policy to change the course of peoples’ lives. We now could reach millions of people in a new way and so thereby save hundreds of lives.
Could the healing of an individual be expanded to the healing of a community through public policy and public service? Suddenly, public policy began to seem like a powerful way of expanding what I was already trying to do as a physician.
7
The Unlikely Candidate
I can’t really explain it, John; I just feel it is something that I want to do. It’s something somebody should do,” I said as I lifted my cup and took a sip of hot, freshly brewed coffee at Shoney’s over on Murphy Road in Nashville.
“Yes,” said John Van Mol, “but why does it have to be you?”
I had come to know John when his public relations firm Dye, Van Mol & Lawrence volunteered to help me with spreading the word across the state on organ donation. On a pro bono basis, he had personally put together a bicycle tour for my heart transplant patients, lead by inspirational patient Jimmy Moore, who traveled over five hundred miles, from Mountain City near the Virginia border to Memphis. What better way to tell the world that transplants work than the visual of a bevy of patients cycling across the state? Then, when I wrote the book Transplant, John helped with the Tennessee book tour. John and I got together periodically for breakfast meetings throughout the late 1980s, and I found myself talking about my future possibly leading in a different direction—toward politics.
John, whose business in life required him to get down to the core of a matter before deciding how to sell it, would listen to me, sip his coffee, and then ask, “Now, really, why do you want to do this?” Over and over again he would press me on that point. “You have it all right now. A great reputation, the satisfaction of knowing you are saving lives every day. You give up a lot of things to enter politics, and in exchange for what?” he wanted to know. “Will you really have more of an impact in politics than you can have in medicine?”
I knew I finally got through to John one morning, when I said, “John, this heart transplant business is a good thing. It’s fun, it’s important, and I think I’ve made a contribution. But when you get right down to it, I’ve now trained many others to do the surgery—now maybe I should try to expand service to a larger community.”
Bing! I could see the light come on in John’s eyes. Thinking, no doubt, that I was talking about job burnout rather than putting my skills to work in politics, John at last began to talk to me about public service. In fact, he got excited about the possibilities. “What about governor?” he asked. “Just from the little I know about the job, and the governors I’ve worked with, it looks to me to be among the best jobs. You get to be the CEO of the state, you’re at the top, setting the agenda, as opposed to Congress, where you are one of 435 people, or the Senate, one out of a hundred.”
John was on a roll, so I didn’t even try to interrupt him. “You know what we need to do?” John gushed. “We need to come up with a list of people you should talk to to see if it is really right for you. You can see Governor Ned McWherter, and you should probably talk to former governor Winfield Dunn, and former governor Lamar Alexander. And you know Al Gore, don’t you?”
“Yes,” I said. “I’ve talked to him a few times since I moved back to Tennessee and I’ve worked with his staff on transplant issues, but not about this. Dad even told me that one day he would be president.”
John was exuberant now. “I can go to my friend Don Stansberry, who is best friends with Howard Baker, and then we can see Howard himself. We’ll come up with a list of all the people you know and all the people I know . . .”
I liked the idea of talking to Howard Baker, a former U.S. Senate majority leader, White House chief of staff to President Ronald Reagan, and 1980 presidential candidate, but one who never forgot his deep roots in rural Tennessee. Not only because he was the most respected statesman in Tennessee, but also because throughout his career, Howard Baker had emphasized the notion of the citizen legislator—the ordinary citizen who steps up to serve the community, state, and nation. That was a civic ideal that appealed to me.
And that’s how we wound up in East Tennessee on March 6, 1990, visiting with Howard Baker. I finished an all-night case, repair of a torn thoracic aorta, at about 8:00 A.M. and rushed out to the airport to fly over to Knoxville for the meeting. I grabbed a couple of my Transplant books on the way out the door as gifts for my hosts.
Senator Baker had lunch with John and me at a restaurant in his hometown of Huntsville, about an hour from Knoxville. Also joining us was Donald Stansberry, an experienced Tennessee political insider and a partner in Senator Baker’s law firm.
“Well, what are you?” Howard Baker asked me between mouthful
s of delicious country cooking. I must have looked puzzled, because he clarified his question. “Are you a Republican or a Democrat—or does it matter?”
Up till then, I simply hadn’t thought about the implications of party affiliation that much. I swallowed hard, and replied, “I’m a doctor.”
The three men around the table laughed. “I mean,” I went on to explain, “you know my father, Senator. Our family is traditionally quite conservative, which means I guess I’d say Republican, but I haven’t been all that active in politics since I was in college. I didn’t vote until I was thirty-two…I was working all the time to be a great surgeon…but when I voted, I voted Republican.”
Howard Baker smiled his best Andy-Griffith-Matlock-country-lawyer smile, the one he used to veil his wise insight into matters. I could tell he was a little taken aback by my statement of not voting while I was in surgical training. He tilted the conversation toward his own voting record. Most of the time, Howard Baker had hewed to the conservative line, supporting the Vietnam War, championing nuclear power, favoring increased defense spending, and arguing for a balanced budget. But he always followed his conscience, which led him to support Lyndon Johnson’s landmark Great Society programs on civil rights and open housing. Similarly, much to the chagrin of folks from the coal-bearing hills of East Tennessee, including his own family members who made their living by mining, he helped write the tough 1970s environmental legislation on clean air, clean water, and strip-mining. A man of legendary integrity, he was, according to Tennessee senator Jim Sasser, “too well adjusted” to become president, and I found his pragmatic approach to politics very congenial.