by Bill Frist
“Tommy,” I said, “why don’t you bring the professor on out to the airport? I’ll take him along on the transplant run.”
I could tell by the hollow tunnel sound of Tommy’s voice that he had the car phone on the speaker, and I knew Uwe could hear me.
“No, no,” came Uwe’s disembodied voice. “Billy, I can’t stand to see blood. I’m sure I’ll faint or throw up.”
“C’mon,” I said. “I’ll teach you some real health-care economics tonight. You’ll get a real-life perspective that no other ivory-towered academic in the world has.”
Uwe finally acquiesced. “Great!” I declared. “See you at the airport in a few minutes.”
These transplant runs are precise and finely tuned, but appear a lot more casual than one might think. We didn’t look like a highly trained transplant team that night as we walked out on the tarmac to board the plane. I was wearing khakis and a parka, the nurses were in casual dress, and so was the procurement specialist. I saw Uwe eyeing the Igloo ice chest I carried.
“That’s not my dessert I left on the table, Uwe. That’s where the heart goes,” I told him.
He smiled, as though he didn’t believe me. I shrugged and motioned the group toward the King Air. We climbed aboard the six-passenger prop plane, and I grabbed the right rear seat, which I superstitiously claimed on every donor run. “Better buckle up tight,” the pilot said. “The skies aren’t too friendly tonight. Looks like we might hit some turbulence.”
Turbulence doesn’t bother me. But thunderstorms mean delay on the return home and that is something we could not afford. Once the heart is cut out and in the cooler, every second counts. The pilot’s warning soon proved correct. Nasty storm clouds covered most of the sector east of Nashville and before long we had to skirt to the south of a full-fledged thunderstorm. The small plane frequently shuddered as we bounced along through the rough weather. Uwe looked as though he were riding a roller coaster, holding on white-knuckled tight.
It was difficult to talk over the din, so I punched on a reading light above me, and pulled out of my briefcase reading materials to fill the time. Wondering how I could possibly read with the constant lurching up and down, Uwe asked, “Are you looking up where the heart is?” he quipped, as though trying to deflect some of his nervousness with humor. “No need, I can tell you that much. It’s right here,” he said, pointing to his own chest.
I looked up at him and said as casually as I could over the noise of the props, “No, it’s a survey. Sort of a rundown of the top current political issues important to Tennesseans. I need to know what they are thinking. You see,” I said slowly, watching Uwe’s face for a reaction, “tonight is my last transplant. I’m going to run for the U.S. Senate.”
Uwe responded with a quick smile, but when he saw I was dead serious, he asked with a disbelieving expression, “What’d you say? Leave surgery for politics? You’ve got to be kidding.”
OF COURSE, I WASN’T KIDDING. THE SURVEY I WAS READING HAD been conducted by professional pollster Whit Ayres. I had hired him, along with a seasoned and aggressive campaign manager, Tom Perdue, both out of Atlanta, to help design and execute my first campaign for public office. Whit, who specialized in southern races, had comprehensively surveyed the attitudes and views of Tennesseans. Jim Sasser, the current senator from Tennessee, a three-term incumbent Democrat in line for Senate majority leader, was well known, enjoyed broad support from Tennessee voters, and was—according to conventional political wisdom and all the pundits—certain to be re-elected. I was an unknown Republican in a traditionally Democratic state who had never run for office. But Ayres had concluded that when our positions, records, and political beliefs were described without benefit of “name recognition,” the polls indicated that I, or someone like me, had a real chance of winning the election. The pilot in me said trust what the instruments tell you. The scientist in me said trust the data.
Some of this I explained to Uwe as we tossed and turned in the December skies over East Tennessee. Uwe knew and respected Jim Sasser, the sitting senator I would challenge. Moreover, Uwe, like most people, assumed that Sasser was unbeatable, that I—a political unknown, a campaign naïf—was a little crazy to take him on. Uwe told me so. As did almost everyone in the weeks to come.
I told Uwe he was probably right. The political consultants and campaign experts I had talked to in the last few months had warned me that before I could face Sasser in the general election, I would have to distinguish myself somehow from a crowded field of Republican candidates if I hoped to win the party’s primary. They cautioned that I couldn’t count on much support from the Tennessee Republican Party, since there were others with more experience than I had, and the party leaders (understandably enough) would want to put up a candidate they thought had the best chance against Sasser, probably someone from East Tennessee where the bulk of Republican votes lie. Besides, even if I managed to win the primary, Senator Sasser—in line for the most-powerful leadership jobs in the country—would put up a terrific fight.
“Maybe I am crazy,” I told Uwe, “but it’s taken me nearly twenty years to get where I am in medicine, and I’m willing to give myself another twenty to do what I want to do in politics.”
These were just the kinds of things I had hoped to talk to Uwe about. Of all those I knew well, Uwe was the one who most clearly loved public policy for its own sake. But he was a friend as well, and I could tell that he was worried—and not just about whether I had bitten off more than I could chew. (In fact, he would have understood that was part of the fun.) He was also worried that political life might not live up to my expectations. As he later said, he was sure I was capable, but he wondered whether I would be fulfilled in the cat-and-dog fights of the political arena.
“It’s really your fault,” I said to Uwe. “At Princeton, you were always harping on one’s marginal work product, the need to improve it. At this point in life, I think mine would actually be better in the political world; I can affect a lot more people. As you say, I’ve reached the top of my profession, and in the course of my career, I’ve probably changed a few thousand lives, and these people have gone on to live good, productive lives. And their families are happy. But more people than that were shot and killed in America last month by gang members in our major cities.”
Perhaps I was naïve, but I was still a true believer. I sincerely thought that a good legislator, a good governor, a good president, or a good senator could make a difference in the lives of millions of Americans. I thought good people should run for office, smart people, honest people, people with common sense and with vision, the kind of citizen legislators our founding fathers had always imagined would serve in the Congress. And now I wanted to be among that number.
“OKAY, ONLY FOUR THOUSAND MORE ENVELOPES TO STUFF,” TRACY Frazier said to the group of us sitting around her kitchen table, inserting copies of my first political letter into envelopes. Tracy had been the administrator who helped me set up the transplant center. Now we were on a new mission. No mailing machines for us, no headquarters office, in fact. We were starting the campaign from scratch, working at Tracy’s home because we didn’t even own a campaign desk yet.
The odds against me winning a seat in the U.S. Senate were staggering. I had no prior experience in government; I was virtually unknown outside Nashville, even though I had spoken to countless groups across the state about organ donation. Moreover, it was one thing to talk about the need for organ donors, but I was not in the habit of talking about myself or what I thought about the controversial current issues of the day. My mind was more engaged with using Positron Emission Tomography with the glucose analog Fluorodeoxyglucose to detect cardiac rejection than with the policy intricacies of welfare reform. Nor was I a favorite of the Republican Party, since I was not a traditional party product. Large financial backers for my campaign were nonexistent when I started out; they preferred to invest where they could win.
As friends and family members gathered around my paren
ts’ kitchen table on Bowling with increasing frequency on Saturday mornings to have breakfast and to discuss the possibility of my candidacy, it slowly dawned on my parents that I was serious about entering public service. Thinking perhaps that Senator Howard Baker had unduly influenced my decision, Dad called the senator and said, “Howard, please don’t try to talk my son into running for the United States Senate. He’s spent nearly twenty years becoming a great heart transplant surgeon, and is doing a great service here.”
Senator Baker respected Dad immensely, but he didn’t back off a bit. “Dr. Frist, I’m not about to tell your son not to run,” he said. “I won’t encourage him too much, but I’m not going to discourage him, either.” I think that was enough to signal to Dad that my candidacy was not a mere pipedream.
In any case, few political observers gave me a chance—not the head of the party, not the forefathers of the party in Tennessee, no one. Instead, nearly everyone said, “Don’t be foolish. You have a good job; you’re making a difference in people’s lives, doing something worthwhile, people respect you. Let well enough alone.” The most highly regarded fundraiser in the state said don’t run. No one said, “Do it; go for it. We believe that you can win.”
No one, that is, but my family members (though some of them were understandably skeptical at first) and closest friends. Gathered at the Bowling home, my brother Tommy, my sister Mary and her husband Lee Barfield, and boyhood friends such as Barry Banker and others talked about the possibilities. Amazingly, starting at the very bottom, we put together a first-rate political campaign team—albeit quite unconventional.
For instance, we initially did not use any Washington consultants, pollsters, campaign managers, or media people. We built our team from local Tennesseans, for the most part, most of whom had never before worked on a political campaign. I now know that such an organization is unheard of in the world of major political campaigns, but at the time, we were just a bunch of friends out to do the impossible. We didn’t know enough to know what we didn’t know. We set out with a simple campaign slogan: “Frist First!”
Eventually, I realized that just as Howard Baker had advised, I needed a few experts from outside Tennessee to help run our campaign. But where does a novice politician find such help? I talked to a number of potential campaign managers, but was unimpressed. Then, along with Karyn, Lee, Barry, and Tracy, we attended a large National Republican Senatorial Committee (NRSC) conference in Washington, where a number of people had gathered who planned to run for office, as well as individuals whom the Campaign Committee were hoping to convince to run. Oliver North’s group was there, as was Senator Phil Gramm, then head of the NRSC, who had his sights on an eventual run for the presidency. For me, it was an inspiring conference. One of the speakers was a seasoned campaign manager, Tom Perdue.
If I had been trying to find someone whose personality was almost totally opposite from mine, Tom Perdue would have been the perfect choice. Blunt, rough around the edges, tough as nails, with a perpetually wide-eyed, intense look about him, Tom had run Paul Coverdell’s successful 1992 Senate campaign in Georgia, upsetting Democrat Wyche Fowler. For all his gruffness, Tom had a southern good-old-boy appeal, although he often sounded more like a Marine Corps drill sergeant than a politician. Even Tom’s humor was brutally honest and brusque. But in listening to him, it was obvious that he knew the nuts and bolts of how to put together a campaign. And his focus was totally on winning. I loved his focus.
I invited Tom to Nashville to meet with me and our small nucleus of supporters and assess my chances. Our first organizational meeting actually took place in our garage. Tom came in loaded with ideas; he had read and heavily underlined my book Transplant and had absorbed its message. Tom brought with him Whit Ayres, the Atlanta-based pollster with whom he had previously worked, and Whit had prepared some preliminary information on the feelings of people across the state on issues such as abortion, the death penalty, and other hot-button issues. Tom and Whit quizzed me about my positions or opinions on those issues, and all my answers were quite conservative, but not satisfactory to Tom.
Tom rubbed his chin and spoke directly. “Well, you’re not going to win.”
“Why? What do you mean?”
“If you are the least bit wishy-washy on these issues, the conservative base will kill you. Do you want to win, or not?” Tom urged me to spend some time to clarify my positions in my own heart and mind.
Despite Tom’s bluntness, I recognized that he possessed an adroit understanding of what issues truly mattered to the public and how I could best express my heart and mind on those issues. Eventually, we brought Tom and Whit on board, and together they mapped out what they saw as a potentially winning campaign strategy. Basically that strategy was to be everywhere in Tennessee, talking to voters. Knowing my work ethic in transplantation and the not-uncommon thirty-six-hour days, they said you must outwork them all. “You need to be willing to stand out in front of Wal-Mart, hand out flyers, and ask people for their votes one by one, day after day,” Tom told me.
So that’s what I did. In seven years of hierarchical surgical training that began at 5:30 A.M. every morning and continued through most nights, I had learned it pays to follow orders.
Another person I began talking with early on about joining our team was Emily Reynolds. A Nashville native, Emily had risen to a prominent fundraising position within GOP circles, playing critical roles in several Senate and presidential campaigns. She had recently helped engineer the fundraising for Senator Kay Bailey Hutchison’s winning campaign in Texas. Emily was (and still is) one of the most capable women in American politics. (Emily served as secretary of the Senate during my tenure as majority leader.) Wooing Emily back to Nashville, and asking her to lead the difficult task of raising funds for an unknown candidate, a doctor no less, was asking her to take an enormous risk. But she did it. For some reason, Emily believed in me and caught the vision of what we might be able to do. And, luckily for me, Nashville was her home.
On March 1, 1994, at Kitty Moon’s video production studio in Nashville, with my family at my side, as well as a number of my former patients, I announced my candidacy for the United States Senate. (It’s a small world—Kitty was the daughter of Dr. Moon, the pharmacist who answered Mother’s calls for Dad’s patients when I was a little boy.) Somewhere, Senator Sasser’s campaign consultants must have been chuckling at the thought of a politically naïve forty-two-year-old doctor with no experience running against an eighteen-year veteran senator and future leader of the Senate. The day before my announcement, the local newspaper ran a derogatory article talking about the audacity of my running for senator. As a result, I spent most of the following day in Knoxville answering questions. At a press gaggle in the Knoxville airport as I left to return home, the chief question posed was, “You are a wealthy doctor. How in the world do you know anything about helping people who live in the real world?”
I looked over to my side and there were four people there, all of whom had received transplanted hearts by my hands. As I acknowledged their presence, they stood up, and I reminded my audience, “Individuals can make a difference in this world. Through excellence and a commitment to hard work and serving others, individuals can make a profound difference.” That became a theme of our entire campaign, that it is not the political professionals who have changed society, but rather individuals with a heart to serve, acting with whatever their God-given talents might be, who have truly transformed the world. And every one of us has a role to play.
Most of my campaign was spent crisscrossing the state of Tennessee. I mostly avoided Washington. But I did go to Washington on a single trip for an early campaign event, a fundraiser. I walked into the NRSC Building, where the event was to be held a couple of blocks from the Capitol, and noticed a large group of people gathered in the inner meeting area. I thought, Wow, all this crowd just to meet me. I must be doing a lot better than I thought. But I was quickly ushered into a side room off the atrium by a junior st
affer who politely told me, “Dr. Frist, your event is in here.” The tiny room was empty. A small TV was playing my campaign bio on a continuous loop over in the corner. The boisterous, packed house fundraiser in the adjacent room was for an incumbent senator. No one came into my event (except for Senator John Warner, who kindly stuck his head in as he was leaving his colleague’s event to give me a word of encouragement—something I will never forget). That settled it. I said, “Washington…never again. We are running a Tennessee campaign.”
I returned to Tennessee even more obsessed with proving that the impossible could be achieved. I traveled the state from 6:00 A.M. until midnight, day after day, just listening to people’s thoughts, ideas, and opinions. We had ninety-five counties to cover, and I set out to spend time with the people in every one of them. I heard a lot of “You can’t do it” in my meetings every day. Many refused to take the time to see me. Again and again, I heard, “You won’t win; don’t even bother.” Interestingly, the more I heard such pessimistic voices, the more convinced I became that I could do it by working harder. Surgical residency had been good practice for all this.
I faced five opponents in the Republican primary, the most popular being a successful self-made businessman from Chattanooga, Bob Corker, who now serves in the Senate. I ran on a conservative platform, which was relatively easy for me, because I truly believed in the need for better fiscal responsibility in government and in keeping taxes low. Welfare reform, term limits, and allowing prayers in school were other causes in which I strongly believed. Most of all, I emphasized my belief in an individual’s responsibility and dignity, rather than government providing everything for people, at the taxpayer’s expense, of course.
And, naturally, I spoke often about health-care reform. The bloom was already off the 1993 Clinton universal health-care plan, which was plagued by a overly bureaucratic morass—the proposed bill was more than one thousand pages long—and, even more important to the American public, the restriction of patients’ choices. I had lived socialized medicine in England, so it was easy for me to discuss the shortcomings of so-called Hillary-Care. None of the other candidates in Tennessee (or elsewhere) could speak from the direct experience of having actually worked for and operated within a socialized health-care system.