A Heart to Serve

by Bill Frist

  Mitch had four pockets of potential staff to draw from—the NRSC campaign committee staff, my existing Senate office staff, a loyal and experienced group from Senator Pete Domenici’s office, and the new recruits. Emily Reynolds joined me again, this time to serve as secretary of the Senate. Ramona Lessen, who served as my first-class assistant through all twelve years in Washington and remains a dear friend, summed up the attitude of many on our staff; when she looked around our conference room, and she said, “All right, this is really scary. Who’s supposed to be the adult here?” Most of the staff entrusted that responsibility to Ramona!

  As had been the case when I first set up my D.C. office in 1994, our goal was to get the best available people on board quickly. Bob Stevenson, a gifted communications director and an icon on Capitol Hill, moved from the Senate Budget Committee to take the reins of our press operation. Bill Hoagland, a Senate veteran and one of the sharpest budget experts ever to walk the halls of the Capitol, had worked with Pete Domenici and the Senate Budget Committee since its inception. Bill worked with us the entire time I served as majority leader. Similarly, Dave Schiappa had served as secretary for the minority, then secretary for the majority, during the tenure of Senators Dole and Lott. Dave knew more about how the Senate business actually got done than most senators, and I was thrilled when he agreed to stay on with us. Having Dave in place allowed us to breathe a lot easier, just knowing that we had somebody experienced on the Senate floor every day to guide the processes.

  Marty Gold was one of the most brilliant and highly respected experts on congressional procedures. He loves and respects the institution and knows Senate parliamentary procedure inside out, which would prove invaluable during my tenure as leader. Marty had worked through the 1970s with Senator Mark Hatfield and then he joined the staff of Republican Leader Howard Baker, where he served as the procedural specialist from 1979 to 1982. For years Marty had been offered the position of Senate parliamentarian but had declined. But just maybe he would respond to my invitation—to return to the majority leader’s office now that it was again occupied by a Tennessean. I called him on Christmas Eve and asked him to help, and he willingly put his career as a partner in Covington & Burling law firm on hold to help serve the country. Steve Biegun, whom I’d known when he was chief of staff of the Foreign Relations Committee and who had enormously impressed me with his work on the platform committee, came to work with us as our foreign policy advisor and proved to be another extraordinarily skilled team member.

  Dean Rosen came on board as my chief advisor on health-care issues. Dean was so knowledgeable about health care that many people actually thought he was a doctor. He had the useful experience of having served in and out of government—as counsel for the Health Insurance Association of America and before that as counsel to both the House Ways and Means Committee and the Senate Labor and Human Resources Committee. Mitch Bainwol agreed to serve as chief of staff during the transition period but was anxious to return to the private sector. Lee Rawls came over from the FBI to serve as our chief of staff. Lee had been with me previously in my Senate office after Mark Tipps had returned to Nashville. Lee, who had formerly been chief of staff with Pete Domenici and had worked closely with Howard Baker at Howard’s law firm, provided maturity and keen insights into almost every issue we faced. I relied heavily on his wisdom. Everyone who came to work for us from the private sector took a big cut in pay to do so, but signed on nonetheless, a demonstration of their commitment to public service.

  The intensity of those days reminded me of setting up the Transplant Center at Vanderbilt. Then, I had more than six months to put together a smooth working operation to give people hope through transplantation, but after becoming majority leader on December 23, we had only fifteen days before the Senate reconvened to address the nation’s business. I will always be appreciative of those who sacrificed what they were doing to come on board, on the spur of the moment.

  The Republican leader’s office, S-230, was a majestic suite of high-ceilinged rooms in the Capitol building, facing west toward the Washington Monument and the Lincoln Memorial—the view that Bob Dole often quipped was the “second-best view in Washington.” Even the physical aspect of moving into the suite was made more difficult because most people had left D.C. for the holidays.

  With such a transition, there is a complete turnover of staff. The Lott staff, many still reeling from shock at the events that had transpired after the Thurmond incident, were unable to vacate the offices until the night before the new session of Congress began. Alex described a poignant moment when he first walked through the empty, vacated offices. There in the middle of the floor was a large trash can, full of discarded paper and personal effects. Sitting atop the bin was a huge framed painting of the White House, the glass shattered in dozens of pieces.

  Under the awkward circumstances, we didn’t want to seem overly aggressive or obnoxiously forward. Even changing the nameplate outside the office door was a sensitive issue. So Ramona asked the Capitol maintenance staff to wait until the building was closed to the public, and all the reporters had cleared out, before taking Trent’s name down and putting mine up. We did not have so much as a single desk in place or a telephone assigned the evening before the opening gavel of the first session of the 108th Congress. We had to start from scratch, and we had to do it fast. Fortunately, we discovered that the competent Capitol maintenance staff can, amazingly, empty, paint, and refurnish a suite of offices overnight.

  Exacerbating matters still further, all of the major television networks were vying for early-morning interviews featuring our first day on the job. We agreed to an exclusive interview with Diane Sawyer of ABC’s Good Morning America. The interview was to be done at 7:00 A.M. from my new office. We moved what little furniture we had in front of a large fireplace in the office, making it appear on television that we were comfortably moved in and operating.

  Later that morning, Mitch McConnell introduced me as the new leader, saying, “In a remarkably short period of time, Bill Frist has reached the pinnacle of two very demanding professions, one, heart surgery, the other in politics. He has become the majority leader in less time than any other leader in either the House of Representatives or the U.S. Senate.”

  I opened the Senate floor as I would almost every day for the next four years, following the Pledge of Allegiance and prayer by Lloyd Ogilvie, the Chaplain of the Senate. We began as usual, negotiating all the organizing resolutions and delineating how things would run in the new session. The rules defining how the Senate will operate have to be passed anew at the beginning of each two-year Congress. All of the negotiations had been done ahead of time, so the first day of the new session was typically more formality than action. But in the early hours of the new session, as we were still going through the rules pro forma, Senator Hillary Clinton came to the floor, offering a partisan, Democratic-sponsored new bill on workman’s compensation. We interpreted this as a provocative shot being fired by the minority party on a day customarily reserved for the swearing-in of the new senators. Was the minority party simply attempting to throw a wrench into my first day as majority leader? It was a bit of political gamesmanship—and a statement of what was to come.

  At the January 7, 2003, swearing-in of the ten new senators, nine of whom were Republicans, CNN congressional reporter Jonathan Karl related what he thought an interesting observation to his audience. Apparently, I had been standing in the center aisle of the Senate floor, along with the now minority leader, Tom Daschle. Trent had joined his fellow Mississippian, Thad Cochran, as Thad took the oath of office in the Senate well, at the front of the chamber. Jonathan Karl reported Trent’s actions after Thad was sworn in by Vice President Dick Cheney:

  As he [Lott] walked back, Daschle was standing next to Frist, to shake everybody’s hands. Senator Lott went over to Tom Daschle. They shook hands, they embraced, they shared a laugh, and then Senator Lott walked right by Bill Frist without giving him so much as a handshake. It was
a very chilly moment. You could actually feel the chill up in the spectators’ galleries in the Senate. 1

  Ironically, if that happened, I never noticed. Trent and I were on the same team, and I was glad he was there. He may have experienced some awkwardness coming back to work, but I would routinely call on him for advice and opinions. Rick Santorum had been supportive of Trent all the way to the end. In the post-Lott shuffle, Rick was in line to be the chairman of the powerful Senate Rules Committee. But Rick felt so bad about the way events had devolved that he graciously gave up his committee chairmanship to Trent.

  Trent Lott was not a visionary sort of leader who comes up with innovative transforming ideas, but he relished the political maneuvering required of an effective leader and was outstanding at it. He was by nature not a risk taker; he hesitated taking legislation to the Senate floor unless he had the support to pass it. He knew how to count votes. Trent playfully continued to command attention, a trait that may trace back to his cheerleading days at Ole Miss. For instance, for the first several months of my tenure, Trent consistently showed up about fifteen minutes late at our weekly caucus policy lunches in the dark-paneled Mansfield Room of the Capitol. The lunches took place immediately following a small prayer group that he, Rick, and several other senators held every Tuesday. Trent had a way of making a dramatic entrance, talking as he entered the back door, flicking various senators’ ears as he passed behind his seated colleagues, and finally sitting at the far side of the room. This was all in good fun but sometimes a little distracting to his Senate colleagues when they were in the middle of a presentation.

  From our majority leader’s office budget, we quietly extended courtesies that reflected the body’s appreciation for Trent’s service, including extension of his official car and driver for a couple of years and provision of an additional staff person. Trent was a very good leader. I had admired him for coming back after his resignation amidst all the controversy. He worked hard and eventually re-entered leadership when he defeated Lamar Alexander for Senate minority whip. He served until December 2007, when he resigned from the Senate to become a lobbyist.

  DURING THE DECEMBER 22 CONFERENCE CALL WITH CORETTA Scott King, Andrew Young, and Julian Bond, the group invited me to speak at the Congress of Racial Equality (CORE) dinner in New York City on January 20, less than two weeks into my new role as majority leader. Of course, I accepted the invitation.

  The attendees at the CORE dinner that evening received me warmly, and perhaps it was fitting that one of my first speeches as Senate majority leader should be before that particular group.

  I opened my message with Martin Luther King Jr.’s Letter from a Birmingham Jail. In it, King wrote, “Like a boil that can never be cured so long as it is covered up, but must be opened with all its ugliness to the natural medicines of air and light, injustice must be exposed, with all the tension its exposure creates to the light of human conscience and the air of national opinion.”

  I then told the crowd about a man who had come for treatment to a hospital in Sudan during one of my medical mission visits:

  Several villagers were carrying a man who was deathly sick—pained, feverish, and stick thin. Except his leg. It was huge—inflamed and swollen enormously with what to my eye was a deep-seated abscess. A boil buried deep and covered up by muscle and skin. The infection would bring certain death if not opened and drained. The tribal medicine man did not have the experience to cure such an ugly wound.

  So I took a scalpel and folded it in the man’s hand. I then held his hand and together we incised the skin, pushed deep into the wound—through the swollen underlying tissue, then through the muscle. Sensing his hesitancy, I assured him it was okay. We were doing it together—hand grasped over hand.

  Carefully, respectfully, steadily, we pushed deeper. The patient’s pain was intense. But suddenly we struck the pocket of infection. All its ugliness gushed forth and was exposed to the air and light. At that instant the hurt flowed out and the healing began. And I saw, in the eyes of a patient facing death, the hope that shines with new life.

  I paused long enough for the audience to fully grasp the picture I had described—a true story—and then I continued:

  Like the boil deep in that man’s leg, America’s wounds of division run deep. They have festered long. Too long. And we as a people have paid a terrible price throughout our history. Nearly thirty-five years ago, Martin Luther King paid with his life. Tonight we honor his sacrifice. And celebrate his bold commitment to lifting up the less fortunate among us. But we also have a duty—a duty to act.

  My title is majority leader of the United States Senate. It is not a position I sought. It is not a position for which I ran. And of course no one wished for the event that led to my ascension. But I do feel deep inside—just like in Africa—that my hand can now be grasped by others to seize an unprecedented opportunity. To dig deep into America’s soul and lift up our dialogue to a higher and more robust level. This may cause tension. But by letting air and light into our dialogue, I believe we will find a new optimism to help heal our wounds of division.

  As I finished my talk to the members of CORE that evening, the crowd rose to their feet in appreciation and agreement. The nation had been through a difficult two months, reminding us of our ugly past. But as I headed back to Washington that night, I felt as though we had started anew, and we had a great future ahead.

  LEARNING THE MYRIAD PROCEDURAL INTRICACIES OF RUNNING THE U.S. Senate was a daunting task, and one that had to be done virtually overnight. I couldn’t have done it without the expert group of people around me, especially Marty Gold and Dave Schiappa. We really were baptized under fire—especially from the Democratic opposition—but we surged forward, achieving some major victories in a relatively short time.

  Adding a significant moral impetus was President Bush’s stunning announcement during the January 2003 State of the Union message that he would seek an astounding $15 billion over five years to combat HIV/AIDS in the world’s poorest and most heavily AIDS-burdened countries. This sum was more than any other country in history had committed to fight a single disease outside its borders. While liberal voices loved to talk about the problem of HIV and AIDS in the developing world, it took the conservative President Bush to actually move the country from rhetoric to action. The President’s Emergency Plan for AIDS Relief (PEPFAR) is, I believe, among the president’s top two or three defining legacies of his tenure in office. And no other initiative better illustrates how one man’s passions to bring health, hope, and healing to the world can alter the course of history.

  Amazingly, when the president made his announcement, only a handful of people were in the loop. Particularly surprising were the people not in the loop, including Health and Human Services Secretary Tommy Thompson, the senior budget watchers at the Office of Management and Budget, and the many global health experts at the government’s beck and call. The idea for PEPFAR seems to have originated with Condoleezza Rice, deputy chief of staff Josh Bolten, and Mike Gerson, the president’s brilliant head speech writer and conservative social voice. Bolten instructed a very small group of people in the White House, which included Gary Edson, a deputy national security advisor, to develop a major global AIDS initiative that would be built around providing life-saving antiretroviral drugs as well as prevention measures. Bolten encouraged his small group to “think big.” Tony Fauci, the longstanding director of National Institutes of Allergy and Infectious Disease at the National Institutes of Health, was the chief scientist charged with developing the policy: he was dispatched to Africa by the president specifically to determine if a truly bold initiative could have an impact in saving lives. His conclusion: it could!

  The president was personally involved. In private meetings, he asked pointed questions about what specific outcomes could be achieved, how the program could work, and what risks might be involved. He was most interested in tangible results. His view seemed to echo the sentiments of Gerson, “If we can do this and
don’t, it will be a source of shame.”

  The decision had been a long time in coming. Many people think that AIDS developed in the early 1980s, when the syndrome was first observed in the United States, but actually the disease had been around for a long time—we just didn’t know it. Perhaps as early as the 1940s, a condition that later came to be called Slim Disease had been decimating populations in West and Central Africa, causing drastic weight loss, diarrhea, and overall physical decline leading to early death. No one knew what caused it or how to treat it, and most of its victims died horrible deaths. We may never know for sure, but it was most likely AIDS.

  A number of researchers have concluded from DNA evidence that HIV—the Human Immunodeficiency Virus—may have arrived on American shores as early as 1969, coming in first from Haiti.

  I was a third-year surgical resident in Boston when the first reports appeared in the medical literature. On June 5, 1981, the Morbidity and Mortality Weekly Report, a widely read publication of the Centers for Disease Control and Prevention, published the first report of five mysterious cases of Pneumocystis carinii pneumonia among previously healthy young men in Los Angeles, two of whom had already died. Within just eighteen months, epidemiologists identified the major risk factors, and in March 1983 the CDC issued recommendations for prevention of sexual, drug-related, and occupational transmission of AIDS even before the cause of the new, unexplained illness was known.

  It was natural that I, as majority leader, take on this issue in the legislative branch. What other senator had researched and published scientific papers on immune suppressed patients, and held the hands of patients dying of HIV? During the mid-1980s, in response to the sudden emergence of the mysterious and deadly HIV virus, we in surgery radically altered how we carried out our daily procedures. Before, blood was always considered relatively sterile, but now it could contain a deadly, toxic agent. We began to double-glove while performing surgery and wear eye protection. In the early days when I operated on a patient with HIV, I would not require my assistants to scrub in—if they accidentally got stuck with a needle and got infected, we had no treatment to cure them. Early on, some surgeons even refused to do heart surgery on HIV patients because life expectancy from the disease was so poor.