A Heart to Serve

by Bill Frist

  I took a stab at explaining my attraction to public policy and politics, talking about my years at the Woodrow Wilson School, my family’s strong commitment to serving others, how I had always lived with a thought in the back of my mind that I wanted to spend some part of my life doing some kind of public service. Baker was affable enough. “You know,” he said, “I think public service is the most important second undertaking that a public-spirited citizen can engage in, and I wish more bright men and women would do it. But the political process and what you have to go through and the effect it can have on your life—one word sums it up: demeaning. You must be secure in your own skin and know who you are. And if you do something like this, be prepared to quit. At any point. The true citizen legislator should look on public office as if it’s an out-of-town visit, not a move. And not only that, you’ve got to be prepared to lose.”

  “Well,” I said as the waitress refilled my glass of iced tea, “in my case, it’s pretty clear what I would do if I lost. I’d go back to transplanting lungs and hearts.” Then I moved on to what truly bothered me about what Senator Baker had said—the demeaning part. I was worried about Karyn and the boys. I had already put them through more than they deserved with my time away from home during my surgical training and now my time at Vanderbilt. “What about your family?” I asked. “How does a campaign affect one’s family, one’s wife and children?”

  “Campaigning can be infectious,” he said. “You and Karyn might find yourself together day and night, on this effort. The major danger comes later, after the election. You can get captured by the city, by Washington, and by the system. Even though you go home every weekend—and most members do—in effect, you are going home as a tourist. You don’t really live there. And that can be terribly hard on a family.

  “But if you decide to run for office,” he told me, “you’ve got to make a clean break. You can’t be a candidate and do your surgery at the same time. A clean break will reflect a real commitment on your part, and will let people know you’re serious. And you will be able to figure out how much you really like being a candidate. Two years before the primary, certainly not later than Christmas, two years in advance, you’ve got to make that commitment. Take a year and travel the state. You have no political background, so you’re going to have to cover every town, every spot, by car, by airplane—you love to fly, use a plane. But talk to people, get ideas. You don’t have to have an agenda. Listen to them, let them tell you what they want in a senator. Everyone will just assume you agree with them. They’ll argue with you, and maybe even dislike you if you disagree with them, but if you look them in the eye, and listen to them, they’ll give you a chance. Doing this, you’ll figure out for yourself how much you really like the people of Tennessee, and how much they like you. And you will discover whether a life of politics is for you.”

  Senator Baker cleared his throat and spoke sonorously, “Now, about this party thing. You need to talk to people, listen to them, but you have to make up your own mind. You’ve been rather apolitical up till now—that’s the nature of being a doctor. But there is a grand opportunity in the Republican Party right now. I assume that’s your inclination, or you wouldn’t be talking with me. But talk with Lamar Alexander. Go by and see Winfield Dunn, and others. And I’d ask Lewis Lavine, Lamar’s former chief of staff when he was governor, to help you understand the politics of Tennessee. Talk to Congressman Quillen in East Tennessee. Whatever you do, you’re going to need East Tennesseans’ votes.” (East Tennessee has historically been the state’s Republican stronghold. As a Republican, you can’t traditionally win Tennessee without winning by a large margin in East Tennessee.)

  “I strongly urge you to consider serving in the Senate,” he said. “Go to Washington rather than stay in the state. Washington is where the action is. You can influence the whole country. You can deal with world issues. And for all I said about getting enamored by the city, it’s a great place to live. Beautiful, good schools, inspiring culture, a great place to raise a family.”

  We continued talking about the nuts and bolts of politics—finding a staff, opinion polling, and the like. All too soon, it was time for John and me to head back to the Knoxville airport.

  Just before we left, Senator Baker touched my arm. “Let me ask you, son,” he said in a fatherly tone. “What do your dad and Tommy think about all this?”

  No doubt the senator noticed my countenance drop. “I haven’t talked to Tommy about this,” I said. “Nor to Dad, either, really. I’ve dropped a few hints, that’s all.”

  “At the end of the day,” he said with the bottom-line advice, “don’t overanalyze all this. Your gut will tell you if it’s the right thing to do.”

  And his final words: “You know,” he said, shaking his head as he looked from man to man in turn. “I think this is doable.”

  The seed had been planted.

  I WASN’T OVERLY WORRIED ABOUT A POLITICAL RACE. IT COULDN’T be more grueling than seven years of surgical residency. I was a risk taker by nature; I relished a tough challenge, gravitating toward goals that seemed out of reach. A much greater concern was Karyn and my sons. I didn’t know how Karyn would react when she fully realized the seriousness of my thoughts about entering the political arena, but my guess was that after all the family sacrifices that accompany a life with a heart surgeon, her response would not be positive. Karyn cherished our family and our privacy. Harrison, Jonathan, and Bryan were the most precious things in her life, and she would never jeopardize their happiness or their opportunity to grow up with normal childhood experiences. She knew politics would throw up challenges that we would simply not have to face if I stayed a surgeon. Both family and privacy would in some way be sacrificed on the altar of politics if I were to run. You don’t run and serve as an individual; you run and serve as a family.

  And then there was Dad. I recalled how he had reacted to Tommy’s bold decision to focus on the business side of health care, in Dad’s mind “deserting the noble practice of medicine” for business. And that was entrepreneurship, something Dad instinctively admired. Dad had never been one to look up to the values of typical politicians. He’d have trouble understanding why anyone would abandon medicine for politics—least of all his son.

  But my real worry was that I could well be handing them—Karyn and the boys, my brothers and sisters, and especially Mother and Dad—public humiliation and defeat. If I ran for the governor’s seat or for the Senate and I lost, they all would have to suffer through the loss with me. And why put them through that? And if I won, their lives would be subjected to more public media attention; the media tends to disparage successful people.

  All these concerns gave me pause. But the thought of the good I might be able to do in public life kept me interested. As a heart surgeon I had the good name, the income, and the ability to heal individuals—but I didn’t have the reach of public policy to improve the lives of others. And I had a passion to do so.

  Over 1991 and 1992, while growing the transplant center and operating daily at Vanderbilt and the Veterans’ Hospitals, I slowly and deliberately engaged myself in political life. I talked to people and wrote letters—to Howard Baker and Winfield Dunn, to Al Gore and Lamar Alexander, to former U.S. ambassador Joe Rogers and Nashville-based Republican fundraiser Ted Welch, to former Senator Bill Brock and Republican National Committee Chairman Richard Bond. I attended a Bush-Quayle fundraiser in Nashville and had my brother-in-law, Lee Barfield, write to his friend Al Hubbard, Dan Quayle’s chief of staff, for advice. I talked with political professionals, election strategists, and campaign managers like Bill Roesing, Jim Cannon, and Emily Reynolds. At Princeton board meetings, I bent the ear of Missouri senator Jack Danforth, an Episcopal minister, hoping to get a better feel for his world. (If an Episcopal minister could jump into politics, I thought, surely a heart surgeon could.)

  I let some of these people know I was generally interested in public service and asked them to keep me in mind if they heard of a good
appointive position, which would avoid all the potential negatives of a campaign. To others, I talked candidly about positioning myself for a possible electoral bid in 1994. Doggedly, systematically, carefully, I approached those identified as the authorities in the field. I literally went down my long list, checking each name off as I talked to them. Gradually I learned the right questions to ask, and then I listened with the same intensity with which I listened to a patient who had come to see me with chest pain and three-vessel coronary artery disease.

  I had worked closely with the staff of fellow Tennessean Al Gore on some of the public issues dealing with transplantation in the 1980s, so I was interested in his take on my political considerations. Gore was still Tennessee’s senator at that point, although he was trying to secure his party’s nomination for the presidency. I had never met Gore, yet had deep-seated respect for his family tradition in service to Tennessee. Also it was he who helped author the landmark legislation that established the United Network for Organ Sharing, the successful public-private partnership that oversees the equitable distribution of organs across the country.

  Gore graciously spent an hour with me in his Washington Senate office, one whole wall lined from floor to ceiling with books, answering my questions about entering a life of public service. Years later, when I had young people request to see me in my Senate office, I frequently thought back to that meeting, remembering all the time Gore spent with me, just a constituent who had a vague interest in serving others.

  Gore pointed out that there was a real opportunity in those days for thoughtful, intelligent, substantive people within the Democratic Party. It was advantageous, he felt, to be a Democrat in Tennessee, as demonstrated by the long, rich history of Democrats who had dominated Tennessee politics for generations.

  On the other hand, Lewis Lavine, Lamar’s former chief of staff, who had grown up a Democrat but had become a Republican, told me he just felt more comfortable around Republicans. Although he thought that in Tennessee a mediocre Democratic candidate could still beat an excellent Republican, he emphasized that ultimately you had to feel comfortable with your party, especially among those who would advise and support you. That gut feeling, Lavine said, was what really was most important.

  And just to confuse matters, there were the folks who suggested that political ideology and party affiliation were not nearly as closely related in Tennessee as they were at the national level. The conservative “blue dog” Democrats in the South, they’d argue, were no different in ideology from run-of-the-mill Republicans.

  Of all the new people I met during that period, Jim Cannon was to have perhaps the greatest influence on my ultimate decision. A tall, lean, distinguished-looking man, with a full head of sweeping hair and patrician manners, Cannon had a deep, philosophical reverence for public service and a pragmatic understanding of politics. A former editor of Newsweek, he’d served as Nelson Rockefeller’s chief of staff for fifteen years when Rockefeller was governor of New York; he held the same position with Howard Baker when he was majority leader in the U.S. Senate. Afterward, Jim worked with President Gerald Ford, and was actually writing a book about Ford and his family that day in June when Howard Baker called him to suggest a meeting with me.

  Sitting in Howard Baker’s law office on Constitution Avenue and listening to him and Jim Cannon discuss and expound upon the significance of politics, campaigns, and the workings of the American government, I got a good sense of just how noble public service could be when someone took the job seriously and did it right.

  In the months to come, Cannon and I spoke frequently by telephone, and whenever I was in Washington, I’d go by his wonderful Georgetown home or get together with him for lunch or coffee. When we both were on vacation in Nantucket in August, we met for breakfast at the local favorite, Downy Flake, just as all the neighborhood fishermen were returning from their daybreak ventures. He took me under his wing and educated me with his experiences.

  During one of our summer telephone conversations, we discussed party affiliation. Jim came up with the kind of pithy observation I learned to associate with him—and to value. Keep it simple, as Shumway had always said as we were sewing in a new heart. “The difference between Republicans and Democrats,” he said, “is that the Democrats think that government can solve problems, and the Republicans think that individuals can solve problems. That’s it, that’s the real difference.”

  That idea was not new to me, of course. Perhaps I was just ready to hear it at that point.

  In a sense, I realized, I had been a Republican all my life. My personal milieu—my family, my friends, my acquaintances—was generally Republican. More important, I believed in individual responsibility and accountability and a limited role for government; I was pro-business and valued hard work, freedom to choose, competition, and entrepreneurship as the wellsprings of happiness and prosperity. I valued the dignity of the individual.

  Simply put, I was a Republican. And, yes—it mattered.

  BY MIDSUMMER, I BEGAN PARTICIPATING IN REPUBLICAN PARTY activities: attending Statesmen and Lincoln Day dinners, sitting on committees, raising funds for the party, and contributing to Republican campaigns. I was still extremely self-conscious about these activities, however, and I remember being somewhat embarrassed by the fact that I was such a Johnny-come-lately to the grassroots efforts that were building a stronger GOP foundation across Tennessee. No one made me feel unwelcome, but I did not fool myself. Many in the Republican Party establishment were happy to see me merely because I came from a prominent family and might be a conduit for filling campaign coffers. Few, I’m sure, considered me a possible (much less plausible) candidate for public office.

  I was still trying to decide whether to campaign for an elected position or seek a political appointment within the government. From pundits, players, and party members far and wide, I received some encouragement and many suggestions. Some told me to make health care my issue, and to ride it to national prominence, while others warned me to be wary of health care as an issue, because consensus on the subject didn’t exist and probably wouldn’t exist for years. Republicans have never led on health care issues, many would advise. Others urged me to spend time on local issues, while others warned me not to get bogged down in local matters but rather to keep my eye on statewide and national concerns.

  After the Democrats nominated Al Gore to share the ticket with Arkansas governor Bill Clinton in the 1992 presidential race, there was a lot of speculation about the 1994 election in Tennessee. Who had a chance to win Gore’s old seat in 1994? Who might vie for the governor’s office, since the incumbent Democrat Ned McWherter, would be term-limited out of the running? And would anyone dare to take on Democrat senator Jim Sasser, the powerful Senate Budget chairman and three-term incumbent already touted as a front runner to become Senate majority leader?

  To say I was fascinated by all this would be an understatement. I remember especially the personalities. There was the ebullient Haley Barbour, with his good humor and his wild, colorful, Yazoo, Mississippi, language, charismatically leading the Republican Party. And the two low-key, down-home Tennessee boys, Howard Baker and Ned McWherter—both by then regarded as the statesmen of their respective parties—on opposite sides of the aisle politically, yet so much alike in their common sense ways. There were the serious and sophisticated politicos like Al Gore, although Gore’s style, especially his use of language filled with polished, prep-school periods, would be labeled “stiff” by a news media addicted to punched-up, often ungrammatical sound bites. There was the hard-nosed professionalism of Bill Roesing, and the intense political and fundraising savvy of Washington-based but Nashville-raised Emily Reynolds.

  To a lot of folks nowadays, the world of politics seems alien to their day-to-day reality. So I was surprised to hear so many of those already in the business tell me that you did not so much need a highly articulated and particular reason, a pet issue, or an explicit agenda to enter politics as you needed a deep passion
to serve and an unshakable faith in representative government. Looking back, those two distinct points of view had special relevance in my case.

  I had, of course, my own opinions on certain issues, like anybody else, and those opinions were often tied to my quotidian experiences. My years in medicine have given me a unique prism through which to view the realities of everyday living for all Americans, rich and poor. One could hardly work in a hospital and fail to see each day the effects drunk driving, or illegal drugs, or violent crime had on the fabric of American life. Behavior drives the health of an individual and behavior drives the health of society. Patients opened up and told you their life stories and the challenges they faced. They would vividly and emotionally describe the out-of-control welfare system that paid people not to work, stripping them of their individual dignity. Often, too, my particular brand of medical practice helped me to see better than many others the explicit link between broad public policies and specific, individual lives.

  For instance, a man had come to me the year before who was in need of a heart transplant, but he did not have the insurance to pay for it. A transplant in those early days of the new procedure cost about a hundred thousand dollars. He and his family might possibly come up with that amount if they pooled all their resources, but that’s all they had. If he spent the money, or could come up with about half of it for the hospital portion, the hospital would allow us to give him a new heart, and he would live, but his family would be impoverished. I can recall clearly sitting with him and painfully discussing the costs of the operation, what the hospital could cover, what he would have to contribute, and the long term impact spending that kind of money would have on his wife and two children. Such conversations are powerful and heart-wrenching. They hurt.