A Heart to Serve

by Bill Frist

Josh helped formulate the ideology expressed in the document, and Larry Lindsey and Condi Rice had great influence, as well. Karl crafted the political strategy. When there was a debate that we could not settle, we took it to Josh, who in his evenhanded, steady, smart way brought closure. What could have been a divisive process began to flow seamlessly. The usual high-priority conservative issues drove the platform: prolife measures, tax cuts, and national security. Thanks to much work with committed platform delegates representing all points of view on the life issue, there wasn’t much controversy there. The party stood strong for life while encouraging Republicans who might not share that view to be part of our governing majority, too.

  For me, the biggest challenge set out by Governor Bush and Josh was to take the issue of K–12 education, one that had traditionally been way down on the Republican priority list, and elevate it to the very top of the platform, making it the number-one issue on the Republican agenda. Governor Bush had extensive experience with education in Texas, where his reforms were working well in reducing the so-called achievement gap between students from rich and poor communities. It was an issue he was passionate about, and very comfortable with. My initial reaction was that it couldn’t be done. Republicans don’t believe education is a federal issue, considering it a matter for local control. But through his emissary Bolten, candidate Bush sent the message, “Just get it done.” And we did.

  We finished our work on the platform two days before the convention. I made sure we dedicated the Republican platform document that year to recently deceased Paul Coverdell—an unprecedented move that met with unanimous support.

  The August convention came off without a hitch, and of course, George W. Bush was elected president in November. At the same time, I had been running for re-election back home and won decisively. Democratic nominee Al Gore had lost his home state of Tennessee; if he had won at home, he would have been president of the United States. And in a small way, the Frist campaign played a role. The Bush and Gore teams had monitored how much each was spending on airtime in the media in Tennessee. Both reasoned that staying about even would allow their candidate to win. It was Gore’s home state—surely he would win. But the Gore campaign overlooked the fact that the concurrent Frist Senate campaign, even without a viable opponent, had raised several million dollars to spend on TV with a message exactly paralleling the one that Bush was using. Thus, though monitors were reporting equal media spending by the Bush and Gore campaigns, the Bush message was being heavily and daily reinforced in the minds of Tennesseans to the tune of an extra $3 million of impact. Of course, our campaign is not why Bush won Tennessee (and thus the presidency), but the massive message support our under-the-radar Senate campaign purposely and strategically provided didn’t hurt either.

  So now I had stepped into raw politics at the national level. I’d come to Washington solely to be a policy maker, but now through a series of events beginning with the untimely death of a colleague, I began to see how political elections—not just my own—could affect the direction of the country.

  Before the November elections, I’d begun to consider running for the chairmanship of the National Republican Senatorial Committee (NRSC), the campaign arm of the party whose responsibility is to recruit top-quality Senate candidates, convince them to run, and help raise funds to finance their successful campaigns. Of all the positions in Senate leadership, the chair of the NRSC is the one most like an executive position. You have a clearly defined job to do—to win elections. You have total control over the money you raised for all of the candidates, deciding who gets it and who doesn’t. You develop the overall strategy and you hire the best campaign people to fulfill your vision and plan. And, more so than in any other Senate leadership position, you are measured in wins and losses. That’s accountability.

  My chief rival for the post was Senator Spence Abraham, the former head of the Michigan Republican Party and a keen political operative who knew well how to run campaigns. He was also a great colleague, and a close friend, a fellow member of the Senate class of 1994. My work with the platform committee and my own re-election effort had highlighted some issues I thought could be good for Senate Republican candidates around the country. For example, I saw what we’d been able to accomplish in elevating a nontraditional Republican issue like education to the forefront of the Republican national agenda. We needed that sort of change and fresh approach. What about another nontraditional issue—health care?

  I went by to talk to our majority leader at the time, Trent Lott, as did Spence, and he encouraged us both to run.

  I met with Mitch Bainwol, with whom I had developed a close working relationship on the platform committee. Mitch loved politics and had demonstrated over the years, initially working with Florida senator Connie Mack, strong political and management acumen. I called Mitch and asked if we could discuss the NRSC. To get away from the phone and other distractions, we left my office, walked across Constitution Avenue, and began strolling the large circular driveway on the east side of the Capitol, lined with dark green park benches and a variety of trees planted by members of Congress in honor of their states. (Karyn, the boys, and I had ceremoniously planted a Tennessee tulip poplar there in 1996.) It was a glorious, sunny fall day.

  Lap one. Mitch laid out the strategy. “It can’t be done in two years. It will take four years to win back the Senate, so just accept the fact that this cycle we will not win but we will smartly build for the next. Thus, you will have to serve as NRSC chair for two two-year cycles.”

  Mitch explained to me his reasoning. This was all before the election, and we had the majority going in. Winning seats two years later would be virtually impossible if we kept the majority in November, and thus we should frame the assignment as a four-year project to condition public expectations. He explained that if for some reason Republicans were no longer in control after the elections, we would have a much better shot in picking up seats.

  Lap two. “You can do this. People will doubt it initially—you are not seen as a political animal—but they doubted you in your first Senate race. I saw how you worked the platform committee. It is a winning style…I know.” As we were walking, Pennsylvania senator Rick Santorum, our Republican Conference chairman, was passing in the other direction. He glanced at the Congressional Directory in Mitch’s hand, a good hint at what we were discussing. He walked by us, smiled, and simply said, “I know what you guys are doing.” He did. He understood the game.

  Lap three—and by this time I was no longer noticing the people eating their late, brown-bagged lunches on the benches, or kids stopping to be photographed with the majestic Capitol in the background. “I will leave my job and support you if you do it,” Mitch said.

  That evening I went home and discussed with Karyn whether to run for NRSC chair. I told her it would be the only job in leadership that I would want—it would be like setting up a transplant center from scratch. All would be under my control, so I couldn’t be whipsawed by having to please my colleagues or be tempted to bend to the whims of the media. Karyn saw my enthusiasm, but she tempered her encouragement with the thought that I would have to be gone on most weekends recruiting candidates, raising money, and then campaigning state by state. But, knowing that in the long run the real appeal to me was bringing future outstanding leaders into the fold, she said, “You should do it.”

  While I was honing my ideas and my plans to present to my colleagues in anticipation of what was likely to be an interesting leadership contest between Spence and me, circumstances changed. That November, Spence lost his bid to return to the Senate, and I would become chairman of the Senatorial Committee almost by default, another unexpected turn in my career. No one else was about to run and lead the NRSC when, as Mitch had spelled out so clearly as we walked the circle, Republicans by all accounts were going to get killed in the next cycle—the first midterm election of a Republican president.

  Once again, I was reaching out of my comfort zone, a doctor running the major cam
paign committee for the highest legislative body in the land. It was exhilarating to be entering the national political stage on behalf of my party. But politics-as-usual was about to be interrupted by history in a more shocking fashion than anyone could have anticipated. The world was forever transformed.

  10

  A Frightening New World

  For me, as for most Americans, September 11, 2001, began as a beautiful early fall morning. My staff and I had just completed our ritual “Tennessee Tuesday,” a weekly breakfast meeting held on the top floor of the Hart Senate Office Building looking out over the dome of the Capitol for me to personally welcome and interact with all the many constituents from Tennessee who visited Washington each week. I’d left the meeting a bit early to go to Senator Kay Bailey Hutchison’s office to lead a 9:00 A.M. discussion on tax policy with a small roundtable group of twelve or so businesspeople she had pulled together.

  Shortly after nine o’clock, one of Kay’s staff pulled her aside and said a small plane had gotten off course and crashed into the World Trade Center. A few minutes later, word came it was an airliner. As a pilot I knew that airliners didn’t get off track. And a minute later, as a TV was being hauled into the room so we could keep up with what was happening, another airliner penetrated the other tower. It was clear we were under attack.

  I left and rushed back to my office to talk to our staff and make contingency plans for the day. I tried to call Karyn but there was no answer either at home or on her cell phone. All this was shocking enough, but then before long, we could see ominous, long thick plumes of black smoke rising in the west from the Pentagon just across the Potomac River. This was a large-scale, multiple-target attack. And one of the targets clearly was right where we were sitting. What would be next? Were Karyn and the boys safe? How would we respond? That was up to our federal government…but I was the federal government, and at that moment I knew my colleagues and I didn’t have a clue what was going on.

  Nine days later, with our country still reeling in shock and disbelief, I felt it important to approach President Bush about another area of our national vulnerability and to recommend steps to help prepare for an ominous potential threat—the use of biological weapons by terrorists to harm us. Bioterrorism was not a new issue for me; indeed, because of my scientific background and my transplant experience with infectious diseases, I well understood the horrendous potential of an attack in which lethal bacteria, viruses, or toxins could be released into the air, food, or water supply we all use daily. As far back as 1997, as chairman of the Subcommittee on Public Health, I had called for and then chaired a series of formal hearings and briefings on bioterrorism, including our committee’s public health preparedness in the face of an attack or a natural outbreak of an infectious disease.

  In a hearing in March 1999, I again expressed my concern, stating bluntly my belief that “as a nation, we are currently more vulnerable to bioweapons than any other traditional means of warfare.” And then again in July 2000, in a speech before the Centers for Disease Control and Prevention’s International Conference on Emerging Infectious Diseases, I asked, “Is the threat of bioterrorism real? Most experts agree that it is no longer a question of ‘if’ but ‘when.’ Today most Americans are aware of the threat of natural infection, especially from new strains of influenza (avian and swine), but remain skeptical of biowarfare. And therein lies the danger. This trusting facet of our nature opens us up to terrorist attack.” Little did I know then how prescient these words would be, especially to my audience in Washington.

  In biowarfare or bioterrorism, the enemy and its weapons remain invisible, while evidence of their attack may not surface for days after they have left the scene. The effects, however, can be devastating. Ounce for ounce, biological agents such as anthrax or smallpox are among the most lethal weapons of mass destruction known. Inhalation of a millionth of a gram of anthrax may be deadly. Scientists have estimated that as little as 220 pounds of anthrax spores released over Washington, D.C., under the right atmospheric conditions could cause three million deaths—and nobody would know we had been attacked until people started getting sick. For the terrorist, whose goal is to terrify and paralyze, anthrax would be an ideal agent.

  Well before the September 11 attacks, Senator Ted Kennedy and I had spearheaded a bipartisan bill providing for emergency preparedness in the face of a bioattack. Kennedy’s longstanding commitment on health issues had introduced him to the dangers of emerging resistance of microorganisms to antibiotics and the potential use of infectious organisms as weapons of terrorism and mass destruction. The bill called for preventive measures, as well as upgraded early warning systems at the Centers for Disease Control and Prevention (CDC), improved hospital response capabilities, training, staffing, vaccines, antibiotics, and care for victims of bioterrorism. While that was a good start, in many ways we were still doing too little, too late—a fact that began to become clear in October 2001, when the first reports surfaced of unexplained cases of anthrax appearing in the United States.

  Amidst a growing climate of national fear post-9/11, on October 15 I called together a statewide roundtable discussion on bioterrorism at the Tennessee Emergency Management Agency (TEMA) headquarters in Nashville. By then, a Florida man named Robert Stevens had already died of inhalational anthrax, although authorities had initially blamed his illness on natural causes.

  Seated at a conference table in Nashville, I listened to one person after another confess how woefully unprepared the various responders might be in the face of a bioterrorism attack. Worse yet, I knew Tennessee was not alone in this regard. Few states, if any, were prepared for bioterrorism threats; most knew the threat existed, but had done little to nothing to prevent it, or to prepare for a worst-case scenario.

  Immediately following my meeting at TEMA, I walked into the hallway to respond to reporters’ questions on the meeting and what we discussed.

  “Dr. Frist,” said the first reporter, “what can you tell us about the news this morning that a letter containing anthrax has been delivered to the office of Majority Leader Tom Daschle, an attack aimed specifically at the highest-ranking member of the Senate?” My staff had not had time to brief me on the headline news breaking while we had been in our meeting.

  As a doctor I have learned to control my emotions, but the news that a potential act of bioterrorism could hit so close to home—some of my own Public Health Subcommittee staff members were right down the hall from Daschle’s suite—stunned me. I replied to the reporter that I had not been briefed on the events, and I tried to minimize the concern. I recalled receiving an anthrax hoax letter three years earlier in my Nashville office. Fortunately, it was much ado about nothing, but we had put in place at our office safer protocols for handling the mail as a result. I hoped this was just a hoax as well.

  I went on to my next stop in Nashville, a speech about bioterrorism, this time to the Nashville Rotary Club meeting at a downtown hotel. By the time I arrived, I had been notified that a large amount of a powdery white substance had been found in a letter received and opened by a member of Daschle’s staff. The hand-printed envelope, made to look as though sent by a child, had a return address reading, “Fourth Grade, Greendale School, Franklin Park, NJ.” Already, health officials in Washington were urging people who might have been exposed to undergo nasal swab testing. A three-day supply of antibiotics had been distributed by the Capitol physician’s office to people in the Daschle suite known to have been exposed to the substance in the envelope.

  Anthrax is an infectious disease caused by a spore-forming bacterium called Bacillus anthracis. It cannot be passed from one person to another, but individuals can come in contact with it in three ways: through the skin, by breathing it into the body, or by eating tainted food. Anthrax can switch back and forth between two states: the active “vegetative” form and a dormant “spore” form. When the bacterium senses a lack of nutrients or water, it has the strange ability to encase itself in a thick, hard shell—a spor
e—that protects it. These spores can survive in the soil for decades, which explains why anthrax often strikes grass-eating animals such as cattle, sheep, goats, and horses.

  The form of anthrax that concerns us most is called inhalation anthrax, in which the spores are actually inhaled into the lungs. This is the form that is most likely to be used in biological warfare, and it is by far the most deadly. Inhaling a quantity of spores the size of a tiny speck of dust (possibly less than ten thousand spores) can be fatal.

  The initial stage of inhalation anthrax makes a person feel as though he or she has the flu. Indeed, that is one reason the disease can be so deadly; it seems relatively innocuous at first. Within a few days, the anthrax releases a deadly toxin that enters the bloodstream, causing severe shock and often death if left untreated.

  If given early after exposure to inhalation anthrax, antibiotics such as ciprofloxacin (Cipro) and doxycycline are usually quite successful in combating the disease. Nasal swab tests can be done relatively quickly and easily to determine whether a person has been exposed to inhalation anthrax. But to do all this, our public health agencies needed to be educated, trained, and prepared. In 2001, our nation’s ability to deal with a large-scale bioterrorism attack was woefully inadequate, as we were about to find out.

  That afternoon, my communications director, Nick Smith, and I headed straight back to Washington, wondering what we might find upon our return. I knew that we needed to act quickly before panic gripped the nation; the priority had to be disseminating accurate, understandable information, as well as treating those who had been exposed to the anthrax. Much to my surprise, I found the Hart Building—the site of the attack—had remained wide open, with people still working at their desks, even in areas that might have been affected by the anthrax. Fortunately, the ventilation system had been shut down within an hour of the incident to help prevent the tiny particles of anthrax from spreading still further.