A Heart to Serve

by Bill Frist

  Trent Lott and Tom Daschle, the Senate leaders, contacted me and asked me to be the liaison for the senators, who were already being deluged with questions from their staff regarding anthrax, and the medical, law enforcement, and bioterrorism investigation just underway at the Hart Building. I told them that I would help any way I could. The questions from the Senate offices ran the gamut:

  “How do I know if I have been exposed?”

  “Are my children at risk?”

  “Am I going to die?”

  “Am I contagious?”

  We did our best to answer the questions, advising those who thought they might have been exposed to the anthrax to take the Cipro the Capitol physician’s office was offering.

  It was late Monday afternoon when investigators finally closed off a section of the Hart Building where the anthrax had been found. By that time, nasal swab testing confirmed that at least twenty-eight people had been directly exposed to the anthrax in or near the Daschle suite. Suddenly, the anxiety level on Capitol Hill soared. People were afraid; they wanted answers from their leaders, and they weren’t getting them.

  My first move was to get trustworthy information out quickly. That afternoon I posted scientifically accurate anthrax information on my personal official Senate website to educate people on the Hill, including the senators’ office staff members, many of whom by then feared for their lives, not knowing whether they had been exposed to the anthrax, or whether the spores in Hart would infect their spouses and children when they went home that night.

  On Tuesday morning, Senate staff members who worked on the fifth and sixth floors of Hart were surprised to discover a police barricade barring entrance to their workplaces. Instead, they were instructed to obtain a nasal swab. Hundreds of people lined up in the Hart Building to be tested. Others came from all over Capitol Hill to be tested as well, some out of confusion, many out of fear, including many who had been nowhere near the Hart Building on Monday. The lack of information about anthrax, coupled with rumors running rampant, fed the aura of fear and caused many people to be on the verge of panic—exactly what a terrorist would want to happen.

  As the only scientist and doctor in the Senate, I knew the most important thing I personally could do was communicate calmly and accurately to the American people, since the most powerful antidote to panic is reliable, honest, straightforward information. Nick had arranged interviews with major media outlets in Washington, so we started early on Tuesday morning with the Today Show. I then conducted a press conference and from there, we went floor-hopping at 400 North Capitol, where many of the networks have facilities to do interviews. I did eight back-to-back television interviews in the same building. Later, I appeared on CNN’s Larry King Live. At 9:30 P.M., we were still doing radio interviews. I shared with the American people the facts; what I could not do was predict the future.

  A command center had been set up in the Secretary of the Senate’s office on the third floor of the Capitol. My staff and I worked closely with the new command center as well as the Capitol Physician John Eisold, who demonstrated steady, capable leadership throughout, and other agencies, continually posting updated information on my Senate website. Because of my work on the Public Health Threats legislation in 2000, we already had a section on our website devoted to bioterrorism, biological agents, and public safety. It was a good thing, since the CDC website soon crashed due to the enormous number of requests from all around the country. Our site became a reliable source of information for the country.

  On Wednesday, the Hart Building was closed completely, and the testing site was moved to the Russell Senate Office Building. The Senate and House leadership met that morning, and when word was received that even more locations had tested positive for anthrax, the government leaders decided to close their respective office buildings. But when the leaders presented the decision to the full Senate, many senators balked, suggesting that closure of the buildings could be interpreted as a sign that we were giving in to terrorists if we disrupted the country’s business because of the attack. Many, if not most, on Capitol Hill, believed the anthrax was the second round of terrorist attacks coming on the heels of 9/11.

  The Senate opened for business as usual again on Thursday, and following the official presentations of the facts, I briefly addressed those senators gathered in the Senate dining room on the first floor of the Capitol, offering information and my views on the best way to proceed from a medical standpoint. My comments seemed to reassure many of my colleagues, and I stuck around afterward to more fully answer the questions of particularly anxious or inquisitive members. We decided to close the three Senate office buildings but to continue the normal course of Senate business in the Capitol. The nation’s business would continue. The House closed its offices and formally adjourned, creating a bit of an awkward situation in terms of public perception, since the Senate remained in session. (House leadership publicly blamed the Senate leadership for misrepresenting their intentions to stay open.)

  When test results confirmed that anthrax contamination had then been detected in the Dirksen Senate Office Building’s mailroom, as well as other places in Hart, the decision was made to close all congressional buildings until further tests could be run. This created even more fear and anxiety among the thousands of Capitol Hill workers. Had hundreds of people been infected with the deadly agent?

  Along with other members of the command center response team, I participated in two press conferences, six hours apart, in an attempt to answer the many questions in the public’s mind, as well as to provide updates. By Friday, it seemed that the anthrax outbreak had been contained. Thousands of people had now been tested. Although several people were extremely sick, as yet nobody had died as a result of the attack. They were being treated, and everything finally seemed under control.

  But that was about to change. On Saturday morning, I attended a meeting in the Secretary’s office in the Capitol, at which it was reported that an individual who worked and lived several miles away from Capitol Hill had been admitted to a community hospital with acute shortness of breath and flu-like symptoms similar to what one would see with anthrax. But his test results would not be back for another twenty-four hours. Our military labs were shouldering the bulk of the highly specialized anthrax testing being requested. But what caught my ear was the fact that the patient was a postal worker.

  I was alarmed.

  The importance of this seemingly innocuous bit of information could not be overstated: A person who had not been anywhere near the Hart Building on Monday now had signs of anthrax! It would have been impossible for someone miles away from the location where the letter was actually opened to have inhaled spores from the anthrax-laced envelope. I feared that the news could portend a much larger scenario. Was this an expansion of terrorist activity? Were there other deadly letters going around the country? Would we now start seeing cases around elsewhere? Were postal workers safe, or would we now have to shut down the mail system in Washington, perhaps even nationally?

  While the questions continued to fly, I got up and went across the room to a telephone and called the White House. I asked to speak to President Bush’s recently appointed Homeland Security advisor, former governor Tom Ridge of Pennsylvania. Ridge called back immediately.

  “Tom, I’ve just learned something that you need to know,” I said directly. “We may have a potentially national public health emergency on our hands. Something we’ve never seen. The anthrax we are dealing with here on Capitol Hill may be tied to people all around the country. I am worried we are not prepared. We need a lot more resources on this.”

  Ridge, sensing my alarm, asked for my suggestions. I asked for a little time to get more information. We agreed to have a conference call in one hour, with the nation’s top officials in charge of emergency preparedness and key members of our team at the command center in the Capitol. By the end of our call, the leaders understood the seriousness of the situation. The unspoken question in all of our minds
was, How much of this stuff is out there?

  On Sunday morning, we received word that the patient’s test results were in—he had inhalational anthrax. My worst fears had been realized. Immediately the public health command began testing postal employees. But even as the testing began, the first postal worker, fifty-five-year-old Thomas Morris Jr., had died. A short while later, a second postal worker, forty-seven-year-old Joseph Curseen Jr., passed away as a result of anthrax inhalation. We were in big trouble.

  We realized then that our understanding of how anthrax could be spread was antiquated. All our assumptions were based on how the anthrax acted in rural, pre-modern settings before centralized air-conditioning and before massive air blowers were used to sort mail. Most of our information on anthrax pertained to how it behaved naturally in rural settings, not how it could be “weaponized” through special engineering to remain in the air for prolonged periods of time, and used by terrorists or others intending to kill people with it. We were working with an inadequate body of knowledge.

  Homeland Security took over the dispensing of information to the American public regarding the anthrax alarm, although I continued to answer questions in interviews on national television newscasts. Repeatedly, I emphasized that anthrax was infectious but not contagious (that is, transmissive from person to person), but fear could be paralyzing, debilitating, and dangerous. I did my best to discuss the situation just as I would any medical crisis, as a physician, a counselor, and a reassuring voice to those in need, even though this health issue involved the entire nation. My website received more than forty thousand hits per day during the crisis, as people sought out accurate, reliable information. Over the next three months, I wrote an entire book (When Every Moment Counts: What You Need to Know about Bioterrorism from the Senate’s Only Doctor) to educate our citizenry regarding the dangers, prevention, and response to biological attacks. Knowledge is power when it comes to fighting terrorism.

  I had run for the Senate to help affect a larger group of people than I could in a single hospital, and now here I was dispensing medical information to the nation. In this one event was the convergence of science, security, medicine, policy, diagnosis and treatment, psychological reassurance, and communication. I would never have dreamed that my medical training would be put to use in such a way.

  As we dealt with the ramifications of the anthrax-laced letter, those of us interacting with the command center became increasingly concerned about how vulnerable our nation was to such attacks. Think of it: One letter had essentially shut down the legislative branch of our U.S. government and threatened to shut down Washington. Indeed, the Hart Building would remain closed for three months, ousting from their offices for the duration over half the U.S. senators. During that time, another anthrax-laced letter, addressed to Senator Patrick Leahy, chairman of the Judiciary Committee, was intercepted and opened safely by well-protected hazardous-materials personnel inside a laboratory. The handwritten letter matched the one sent to Daschle’s office. Was this a terrorist, or a disgruntled former employee, or someone related to the perpetrators of 9/11? Would we ever find out?

  Postal facilities began passing all mail through radiation machines, since the gamma rays could kill the anthrax. Nearly ten thousand people in the Washington area received Cipro during those first days following the receipt of the anthrax letters. The federal government negotiated with Bayer, the company that produces Cipro, to purchase the antibiotic for less than a dollar per dose, a quarter of the usual price. But the fact that we did not have a ready supply pointed up another area of concern.

  As the nation moved into the Thanksgiving and Christmas seasons, fortunately, there were no further confirmed incidents of anthrax or any other biological agents launched against us. Tragically, five people died up and down the East Coast as a result of the 2001 anthrax attack; seventeen others were sickened. It appeared that postal workers were now on the front line of the first “new” war of the twenty-first century.

  When the government went back to work, Senator Kennedy and I redoubled our commitment to pass preparedness legislation to better thwart bioterrorism. This time around it no longer took a lot of effort to convince Congress of the need. Meanwhile, the FBI interviewed more than five thousand people in an effort to track down the perpetrators of the attack, but nobody was ever brought to trial. The case has never been solved. In mid-2008, the Justice Department paid Steven Hatfill, a scientist at the Army’s biological warfare labs at Fort Detrick, Maryland, $5.8 million in damages for having wrongly accused him of wrongdoing. And in August 2008, Bruce E. Ivins, a brilliant but troubled Army biodefense researcher, who was being aggressively pursued by the FBI as the primary suspect, committed suicide.

  It took nearly three years, but in 2004, when I was majority leader, we finally enacted the most comprehensive reform of our intelligence community since 1947. This legislation broke down the barriers to information sharing between the U.S. intelligence agencies and created a National Counter Terrorism Center to coordinate our efforts. We also established a provision for a National Counter Proliferation Center to stop weapons of mass destruction from being made and delivered.

  The anthrax scare on the heels of 9/11 was a wake-up call for many in the medical community, as well as Congress. We realized how grossly unprepared our nation’s hospitals, clinics, and producers of vaccines and antibiotics were for a major threat of deadly anthrax or other chemical and biological agents. Since then, our government has moved from a precarious position to being more appropriately prepared. But we have a long way to go, and we dare not let down our guard for a moment. We as a nation respond to crisis with determination and courage, but we must also be smart and plan so as to prevent and preempt.

  MEANWHILE, DESPITE THE MOOD OF NATIONAL CRISIS CREATED by the 9/11 attacks and anthrax, politics never completely disappeared. And as the 2002 elections neared, my role in running the NRSC campaign committee of the Senate loomed as a major challenge.

  The hand we were dealt put us at a huge disadvantage. Twenty Republican Senate seats were up for grabs, but only fourteen Democratic seats. Moreover, as 2001 had unfolded, the mood of the country had turned disconsolate. Our economy had spiraled downward after the 9/11 attacks. Corporate scandals riddled the news, producing even more suspicion on the part of the public. While the awful terrorist attacks provided a brief burst of genuine congressional unity, soon Congress was back to its bickering ways, the Democrats quarreling with the Republican president on seemingly petty issues rather than addressing the economic unease people felt, as war in Afghanistan unfolded and America struggled to recover. Many of my colleagues were concerned that these congressional fissures would reflect badly on Republicans.

  Given that the first midterm elections are notoriously bad for the party of a sitting president, no one gave us much chance to gain ground. The American people historically seemed to like balancing the power equation by electing a majority of Congress from the party opposite that of the president. Consequently, as we approached the midterm election, the sense of unease among Republicans was palpable.

  Nevertheless, the NRSC executive team we put together over the month after my election operated seamlessly. There was the former Marine, no-holds-barred campaign operative Chris LaCivita; my long-term close friend and finance director from Nashville Linus Catignani; the sophisticated and gracious fundraiser and friend to senators, Ed Rahal; the experienced media director Ginny Wolfe; and the disciplined and detailed legal counselor Alex Vogel. And there was the mastermind of it all, Mitch Bainwol. Mitch had run several statewide campaigns, run the Republican National Committee, managed the platform committee, and been in two different leadership staff director roles. His political experience balanced my policy experience.

  We had our humorous moments as well. Alex recalls his first meeting with Linus, our lead fundraiser, who had come with me from Nashville. Alex cautioned him about receiving shady money. “For any new donors over twenty-five thousand dollars, we need to vet
them in advance. We just can’t have Russian mobsters giving us fifty-thousand-dollar checks,” Linus nodded.

  Two days later, Alex received an e-mail from Linus: “Exactly what does vet in Washington entail?”

  Alex, realizing we had a long way to go, recalls thinking, We’re in serious trouble! Two years later, Linus had raised more money for the NRSC than anyone in its history.

  Service in the Senate is serving your constituents. Service as chairman of the NRSC is serving your team of Senate colleagues. The distinction is subtle but important. Effective leaders must clearly identify who they are leading and serving.

  Our team faced three main challenges: finding the right candidates to run, formulating a unified message, and then, of course, finding the money. What appealed to me about the NRSC was that it had to be run with an executive style. In many ways running the NRSC was a lot like starting up a business, managing it aggressively for a year or two, and then closing it down. With the NRSC, however, you only find out whether your product is a success in stark win-loss columns after all the work is over—on election day.

  My number-one priority was not fundraising—that would come. It was recruiting top candidates to run. It takes a great horse to win a competitive race. So that’s where I put in my time and focus. I thought a lot about Dad’s old saying, “Good people beget good people.” We were recruiting people to serve their country, and I began with the same values Dad wrote about in his letter to future generations: “integrity and high moral standards.”

  As an unlikely candidate not so long before, I could use my own campaign story to refute just about every preconceived notion I would hear from a potential candidate about the difficulties of a political novice’s taking on an incumbent. “If I could do it,” I’d say, “so can you.” We actively sought candidates to run in Missouri, Tennessee, North Carolina, Georgia, and Minnesota, mostly through face-to-face meetings. Mitch systematically planned out the recruitment process and we began very early, in January and February, almost two years in advance of the election, conducting polls and testing people’s names long before they were aware of our interest. Week after week I’d take off to encourage, cajole, and confide. I flew up to Nantucket to meet with Congressman Saxby Chambliss of Georgia and his wife, Julianne, while they vacationed. I did a poll showing Lamar Alexander that Tennessee wanted him to return to public service, that the Senate needed his experience and statesmanship. I met with St. Paul (Minn.) mayor Norm Coleman late one night under a lamppost in D.C. to persuade him that living in Washington could be positive for a family. And I shared with John Cornyn on a drop-in visit to his attorney general office in Austin that the Senate campaign committee would give him full financial support if he ran.