snapshots of the VA

For two weeks, I'm on nightfloat at a Veteran's Administration hospital, a dark quiet place at night.

***

There's a big photo of the president at the entrance. Each night as I walk in, I think, I hope that photo looks a lot different next year.

***

There's no cafeteria at night. There is a room full of vending machines. I had a 20 dollar bill and I wanted a Coke Zero. In a quiet hour, I walked down to the emergency department and asked the clerk if there was a cashier anywhere who took payments at night, so I could get change. He sent me to the security desk, staffed by a VA police officer who told me that there was no cashier anywhere, and no change machine he could think of. I thanked him, and started to turn to walk away.

"But there's a stamp machine," he said; "You could buy a stamp and it'll give you change. It'll be all coins though."

"That's brilliant!" I said. A minute later I was the proud owner of a few US flag stamps, and seventeen one-dollar coins, sixteen of which had the picture of Sacajawea and her baby, and one of which had Susan B. Anthony. I filled my scrubs shirt pocket with them.

***

Near the physical therapy section, across from an office of the Disabled Veterans of America, there is a xerox copy of an article on a bulletin board commemorating the passage of the Americans With Disabilities Act. In a nearby hallway, there is a sentimental print of a painting of a man in a wheelchair, seen from the back, with each of his strong arms extending out to the hands of his children, his son on one side and daughter on the other. I say sentimental because of the style, a style of illustration that is seen on sentimental family portraits of all kinds; on the other hand, among the kitsch and sentiment of all the other hospital art I have seen, I have never seen this picture before.

***

At night, there are tasks that the nightfloat intern does that are done for us at the larger hospitals. For instance, I draw blood overnight, and take it down to the lab for processing.

Recently I went down to the lab in the middle of the night, around the corner from the darkened entrance to the building. In the waiting room just inside the entrance, a TV was playing Law and Order reruns to a dark lobby full of empty chairs. The lab itself, hidden behind a couple of turned corners, is a big brightly-lit room full of equpiment, which would be loud and busy by day, but is all quiet in the middle of the night. One technician was on duty, a friendly man who looked not too far from being eligible for his federal pension, and when I walked into the room, he was looking at a computer screen showing an internet page that said in big letters, "When You Will Die": an internet death clock.

***

In a back control room in the radiology department, there's a picture posted up, with a headline above it: "The terrorists have won the toss, and they have chosen to receive." The picture (of course) is of a huge bomber photographed from above with its potential payload of bombs and missiles lined up impressively on the tarmac in front of it.

***

We have a patient getting a scan, for which the nurse and I need to roll him down to radiology because it's the middle of the night. As we are in the control room, the tech says one or two things about the patient that are not too terrible, but not entirely kind. But after the study is done, as we transfer the patient back onto his bed, and start wheeling it out of the room, the tech looks down at the patient and says with evident sincerity, "I hope you feel better soon. Thank you for your service."

***

There is a whole sub-genre of New England VA patients, large men with large unruly beards. They live in Maine or New Hampshire in the woods or some back corner of a town, maybe in some shack or trailer, maybe just in their cars.

Without betraying the confidence of any one of these patients, let me just say that as I leave hospital rooms at night after being called to evaluate another such man, it is not infrequently that I recall the state slogan of New Hampshire, emblazoned proudly on every license plate, including cars used as homes by large veterans with unruly beards and worsening medical problems:

"Live Free or Die."

"Far horizons": no AIDS vaccine today

Top: Bill Clinton and Bill Gates, both of whom head foundations which make AIDS a high priority, and also tend to favor technological solutions; since leaving office, Clinton's own choices have suggested more strongly than ever that political expediency drove his AIDS decisions in office. Bottom: George Bush plugs a cord into a prototype hybrid electric-hydrogen car.


Ten years ago today, on May 18th, 1997, President Clinton called on scientists to develop a vaccine to prevent HIV infection, and to do it within ten years:

“My fellow Americans, if the 21st century is to be the century of biology, let us make an AIDS vaccine its first great triumph.”

Clinton compared this presidential goal to President Kennedy’s “moon shot.” But this year, we mark the date knowing that Clinton’s goal was not reached, and won’t be any time soon.

When Clinton made his speech I’d just started working as a community educator for an HIV vaccine research group. The next year, some of my fellow community educators and I started marking the date with media briefings, community forums, and other outreach events. When we started the idea of marking the date each year, public relations people from the National Institute of Allergy and Infectious Diseases resisted it. “We don’t like timelines,” I remember one saying.* No wonder. Vaccine scientists have been saying that an HIV vaccine might be about ten years away for about twenty years now.

I was deeply committed to the cause of HIV vaccine research. (I still am.) At the time, I thought holding the government to a timeline was just fine. What I also knew then, and understand even more clearly now, is that although Clinton’s pledge was inspiring and important, it was also a political dodge.

During the same time that President Clinton was calling for an AIDS vaccine, he was refusing to take leadership to support needle exchange, which he and his scientific advisors knew would prevent HIV infections immediately, and not just ten years from then. And until the end of his administration, he supported international trade rules that made it impossible for poor people living with HIV and AIDS to get generic versions of life-saving medicines.

We can keep supporting the HIV vaccine effort even as we understand that there are more immediate things we can do about AIDS today. But today, let’s mark the anniversary of Clinton’s speech by looking back to another recent presidential call for a new technology:

“I ask you to take a crucial step and protect our environment in ways that generations before us could not have imagined. In this century, the greatest environmental progress will come about not through endless lawsuits or command-and-control regulations, but through technology and innovation. Tonight I'm proposing $1.2 billion in research funding so that America can lead the world in developing clean, hydrogen-powered automobiles.”

That’s George Bush, in his 2003 State of the Union address. He’s making the same gesture that Clinton made in 1997, although with a much less eloquent speech and an even more egregious policy context. In both cases, these presidents made bold calls for new technology that didn’t (and doesn’t) yet exist, as a way of avoiding political choices they didn’t want to make. AIDS means talking about sex and drugs; AIDS means realizing that “free trade” isn’t free. And global warming means making tough changes today, rather than waiting for a hydrogen car to let us keep living the exact same lives we have today but with water vapor coming out the exhaust pipe.

This similarity between the two presidential speeches suggests that this is not a problem of Democrat or Republican tactics: it’s a common mistake in American politics generally.

Bill Clinton’s AIDS vaccine speech was really a more broad-ranging speech about science and technology, made at a black university in the same week that he apologized on behalf of the US government for the Tuskegee Experiment. In his broader discussion of science, two of Clinton's sentences that sound like political throw-away lines turn out to be the key to understanding the whole speech. These two sentences illustrate how Americans get ourselves in trouble when we look to technology to save us from politics:

“We have always believed, with President Thomas Jefferson, that freedom is the first-born daughter of science. With that belief and with willpower, resources, and great national effort, we have always reached our far horizons and set out for new ones.”

Thomas Jefferson or not, nothing about this is true. Freedom is not the daughter of science: science is the daughter of freedom. And as this anniversary reminds us, we actually quite often fail to reach “our far horizons”; and having failed, we sometimes never get around to setting out for new ones. Asking engineers and scientists to solve a political problem with new technology does not require willpower, significant resources, or great national effort; it is an act of avoiding all of the above.

Most of all, when we look to science to bring us freedom from responsibility to make difficult social and political changes, we tarnish the value of science, and the importance of freedom.


______________________

* NIAID now coordinates observances for the day and puts on its own PR effort. The anniversary created its own momentum that was hard for any PR person to resist. And in the absence of startling scientific progress, there was no other regularly predictable news angle for the vaccine development effort.

Testimony: Alberto Gonzales should be kicked out... of the ICU

Apropos of I'm not sure what, except to illustrate the general theme that Alberto Gonzales is an ethics-less toady, Senator Chuck Shumer (D-NY) drew the following story out of former deputy Attorney General James Comey, told below in an excerpt of the transcript from Wednesday May 16 2007.

Let the other blogs chatter about how this hurts or doesn't hurt Gonzales' chance at keeping his job. Here are the questions from the Hemodynamics.blogspot point of view:

Where was hospital security?

And where were the doctors? and John Ashcroft's nurse?

And if you were a resident that month in the ICU, and John Ashcroft were your guy, and you'd been having family meetings with Mrs. Ashcroft, and you knew that Mr. Ashcroft was not the acting attorney general at that moment, what would you do?

Finally, if the president calls the hospital and tells the nurse that Alberto Gonzales is coming and needs to talk to John Ashcroft, but Mrs. Ashcroft is forbidding all calls and does not want Alberto Gonzales to come, what is the legal right and what is the legal obligation of medical staff to stop Gonzales and Card?

Read, and discuss amongst yourselves.

_______________________________

SCHUMER: Before we get to the other issues, I want to go back to an incident from the time that Mr. Gonzales served as White House counsel. There have been media reports describing a dramatic visit by Alberto Gonzales and Chief of Staff Andrew Card to the hospital bed of John Ashcroft in March 2004, after you, as acting attorney general, decided not to authorize a classified program. First, can you confirm that a night-time hospital visit took place?

COMEY: Yes, I can.

SCHUMER: OK. Can you remember the date and the day?

COMEY: Yes, sir, very well. It was Wednesday, March the 10th, 2004.

SCHUMER: And how do you remember that date so well?

COMEY: This was a very memorable period in my life; probably the most difficult time in my entire professional life. And that night was probably the most difficult night of my professional life. So it's not something I'd forget.

SCHUMER: Were you present when Alberto Gonzales visited Attorney General Ashcroft's bedside?

COMEY: Yes.

SCHUMER: And am I correct that the conduct of Mr. Gonzales and Mr. Card on that evening troubled you greatly?

COMEY: Yes.

SCHUMER: OK. Let me go back and take it from the top. You rushed to the hospital that evening. Why?

COMEY: I'm only hesitating because I need to explain why.

SCHUMER: Please. I'll give you all the time you need, sir.

COMEY: I've actually thought quite a bit over the last three years about how I would answer that question if it was ever asked, because I assumed that at some point I would have to testify about it. The one thing I'm not going to do and be very, very careful about is, because this involved a classified program, I'm not going to get anywhere near classified information. I also am very leery of, and will not, reveal the content of advice I gave as a lawyer, the deliberations I engaged in. I think it's very important for the Department of Justice that someone who held my position not do that.

SCHUMER: In terms of privilege.

COMEY: Yes, sir.

SCHUMER: Understood.

COMEY: Subject to that, I -- and I'm uncomfortable talking about this...

SCHUMER: I understand.

COMEY: ... but I'll answer the question. I -- to understand what happened that night, I, kind of, got to back up about a week.

SCHUMER: Please.

COMEY: In the early part of 2004, the Department of Justice was engaged -- the Office of Legal Counsel, under my supervision -- in a reevaluation both factually and legally of a particular classified program. And it was a program that was renewed on a regular basis, and required signature by the attorney general certifying to its legality. [An NSA surveillance program.] And the -- and I remember the precise date. The program had to be renewed by March the 11th, which was a Thursday, of 2004. And we were engaged in a very intensive reevaluation of the matter. And a week before that March 11th deadline, I had a private meeting with the attorney general for an hour, just the two of us, and I laid out for him what we had learned and what our analysis was in this particular matter. And at the end of that hour-long private session, he and I agreed on a course of action. And within hours he was stricken and taken very, very ill...

SCHUMER: (inaudible) You thought something was wrong with how it was being operated or administered or overseen.

COMEY: We had -- yes. We had concerns as to our ability to certify its legality, which was our obligation for the program to be renewed. The attorney general was taken that very afternoon to George Washington Hospital, where he went into intensive care and remained there for over a week. And I became the acting attorney general. And over the next week -- particularly the following week, on Tuesday -- we communicated to the relevant parties at the White House and elsewhere our decision that as acting attorney general I would not certify the program as to its legality and explained our reasoning in detail, which I will not go into here. Nor am I confirming it's any particular program. That was Tuesday that we communicated that.

COMEY: The next day was Wednesday, March the 10th, the night of the hospital incident. And I was headed home at about 8 o'clock that evening, my security detail was driving me. And I remember exactly where I was -- on Constitution Avenue -- and got a call from Attorney General Ashcroft's chief of staff telling me that he had gotten a call...

SCHUMER: What's his name?

COMEY: David Ayers. That he had gotten a call from Mrs. Ashcroft from the hospital. She had banned all visitors and all phone calls. So I hadn't seen him or talked to him because he was very ill. And Mrs. Ashcroft reported that a call had come through, and that as a result of that call Mr. Card and Mr. Gonzales were on their way to the hospital to see Mr. Ashcroft.

SCHUMER: Do you have any idea who that call was from?

COMEY: I have some recollection that the call was from the president himself, but I don't know that for sure. It came from the White House. And it came through and the call was taken in the hospital. So I hung up the phone, immediately called my chief of staff, told him to get as many of my people as possible to the hospital immediately. I hung up, called Director Mueller and -- with whom I'd been discussing this particular matter and had been a great help to me over that week -- and told him what was happening. He said, "I'll meet you at the hospital right now." Told my security detail that I needed to get to George Washington Hospital immediately. They turned on the emergency equipment and drove very quickly to the hospital. I got out of the car and ran up -- literally ran up the stairs with my security detail.

SCHUMER: What was your concern? You were in obviously a huge hurry.

COMEY: I was concerned that, given how ill I knew the attorney general was, that there might be an effort to ask him to overrule me when he was in no condition to do that.

SCHUMER: Right, OK.

COMEY: I was worried about him, frankly. And so I raced to the hospital room, entered. And Mrs. Ashcroft was standing by the hospital bed, Mr. Ashcroft was lying down in the bed, the room was darkened. And I immediately began speaking to him, trying to orient him as to time and place, and try to see if he could focus on what was happening, and it wasn't clear to me that he could. He seemed pretty bad off.

SCHUMER: At that point it was you, Mrs. Ashcroft and the attorney general and maybe medical personnel in the room. No other Justice Department or government officials.

COMEY: Just the three of us at that point. I tried to see if I could help him get oriented. As I said, it wasn't clear that I had succeeded. I went out in the hallway. Spoke to Director Mueller by phone. He was on his way. I handed the phone to the head of the security detail and Director Mueller instructed the FBI agents present not to allow me to be removed from the room under any circumstances. And I went back in the room. I was shortly joined by the head of the Office of Legal Counsel assistant attorney general, Jack Goldsmith, and a senior staffer of mine who had worked on this matter, an associate deputy attorney general. So the three of us Justice Department people went in the room. I sat down...

SCHUMER: Just give us the names of the two other people.

COMEY: Jack Goldsmith, who was the assistant attorney general, and Patrick Philbin, who was associate deputy attorney general. I sat down in an armchair by the head of the attorney general's bed. The two other Justice Department people stood behind me. And Mrs. Ashcroft stood by the bed holding her husband's arm. And we waited. And it was only a matter of minutes that the door opened and in walked Mr. Gonzales, carrying an envelope, and Mr. Card. They came over and stood by the bed. They greeted the attorney general very briefly. And then Mr. Gonzales began to discuss why they were there -- to seek his approval for a matter, and explained what the matter was -- which I will not do. And Attorney General Ashcroft then stunned me. He lifted his head off the pillow and in very strong terms expressed his view of the matter, rich in both substance and fact, which stunned me -- drawn from the hour-long meeting we'd had a week earlier -- and in very strong terms expressed himself, and then laid his head back down on the pillow, seemed spent, and said to them, "But that doesn't matter, because I'm not the attorney general."

SCHUMER: But he expressed his reluctance or he would not sign the statement that they -- give the authorization that they had asked, is that right?

COMEY: Yes.

And as he laid back down, he said, "But that doesn't matter, because I'm not the attorney general. There is the attorney general," and he pointed to me, and I was just to his left. The two men did not acknowledge me. They turned and walked from the room. And within just a few moments after that, Director Mueller arrived. I told him quickly what had happened. He had a brief -- a memorable brief exchange with the attorney general and then we went outside in the hallway.

SCHUMER: OK. Now, just a few more points on that meeting. First, am I correct that it was Mr. Gonzales who did just about all of the talking, Mr. Card said very little?

COMEY: Yes, sir.

SCHUMER: OK. And they made it clear that there was in this envelope an authorization that they hoped Mr. Ashcroft -- Attorney General Ashcroft would sign.

COMEY: In substance. I don't know exactly the words, but it was clear that's what the envelope was.

SCHUMER: And the attorney general was -- what was his condition? I mean, he had -- as I understand it, he had pancreatitis. He was very, very ill; in critical condition, in fact.

COMEY: He was very ill. I don't know how the doctors graded his condition. This was -- this would have been his sixth day in intensive care. And as I said, I was shocked when I walked in the room and very concerned as I tried to get him to focus.

SCHUMER: Right. OK. Let's continue. What happened after Mr. Gonzales and Card left? Did you have any contact with them in the next little while?

COMEY: While I was talking to Director Mueller, an agent came up to us and said that I had an urgent call in the command center, which was right next door. They had Attorney General Ashcroft in a hallway by himself and there was an empty room next door that was the command center. And he said it was Mr. Card wanting to speak to me.

COMEY: I took the call. And Mr. Card was very upset and demanded that I come to the White House immediately. I responded that, after the conduct I had just witnessed, I would not meet with him without a witness present. He replied, "What conduct? We were just there to wish him well." And I said again, "After what I just witnessed, I will not meet with you without a witness. And I intend that witness to be the solicitor general of the United States."

SCHUMER: That would be Mr. Olson.

COMEY: Yes, sir. Ted Olson. "Until I can connect with Mr. Olson, I'm not going to meet with you." He asked whether I was refusing to come to the White House. I said, "No, sir, I'm not. I'll be there. I need to go back to the Department of Justice first." And then I reached out through the command center for Mr. Olson, who was at a dinner party. And Mr. Olson and the other leadership of the Department of Justice immediately went to the department, where we sat down together in a conference room and talked about what we were going to do. And about 11 o'clock that night -- this evening had started at about 8 o'clock, when I was on my way home. At 11 o'clock that night, Mr. Olson and I went to the White House together.

SCHUMER: Just before you get there, you told Mr. Card that you were very troubled by the conduct from the White House room (ph), and that's why you wanted Mr. Olson to accompany you. Without giving any of the details -- which we totally respect in terms of substance -- just tell me why. What did you tell him that so upset you? Or if you didn't tell him just tell us.

COMEY: I was very upset. I was angry. I thought I just witnessed an effort to take advantage of a very sick man, who did not have the powers of the attorney general because they had been transferred to me. I thought he had conducted himself, and I said to the attorney general, in a way that demonstrated a strength I had never seen before. But still I thought it was improper. And it was for that reason that I thought there ought to be somebody with me if I'm going to meet with Mr. Card.

SCHUMER: Can you tell us a little bit about the discussion at the Justice Department when all of you convened? I guess it was that night.

COMEY: I don't think it's appropriate for me to go into the substance of it. We discussed what to do. I recall the associate attorney general being there, the solicitor general, the assistant attorney general in charge of the Office of Legal Counsel, senior staff from the attorney general, senior staff of mine. And we just -- I don't want to reveal the substances of those...

SCHUMER: I don't want you to reveal the substance. They all thought what you did -- what you were doing was the right thing, I presume.

COMEY: I presume. I didn't ask people. But I felt like we were a team, we all understood what was going on, and we were trying to do what was best for the country and the Department of Justice. But it was a very hard night.

SCHUMER: OK. And then did you meet with Mr. Card?

COMEY: I did. I went with Mr. Olson driving -- my security detail drove us to the White House. We went into the West Wing. Mr. Card would not allow Mr. Olson to enter his office. He asked Mr. Olson to please sit outside in his sitting area. I relented and went in to meet with Mr. Card alone. We met, had a discussion, which was much more -- much calmer than the discussion on the telephone. After -- I don't remember how long, 10 or 15 minutes -- Mr. Gonzales arrived and brought Mr. Olson into the room. And the four of us had a discussion.



...

SCHUMER: Let me ask you this: So in sum, it was your belief that Mr. Gonzales and Mr. Card were trying to take advantage of an ill and maybe disoriented man to try and get him to do something that many, at least in the Justice Department, thought was against the law? Was that a correct summation?

COMEY: I was concerned that this was an effort to do an end-run around the acting attorney general and to get a very sick man to approve something that the Department of Justice had already concluded -- the department as a whole -- was unable to be certified as to its legality. And that was my concern.

SCHUMER: OK. And you also believe -- and you had later conversations with Attorney General Ashcroft when he recuperated, and he backed your view?

COMEY: Yes, sir.

SCHUMER: Did you ever ask him explicitly if he would have resigned had it come to that?

COMEY: No.

SCHUMER: OK. But he backed your view over that what was being done, or what was attempting to being done, going around what you had recommended, was wrong, against the law?

COMEY: Yes. And I already knew his view from the hour we had spent together going over it in great detail a week before the hospital incident.


...

SCHUMER: OK. Well, let me just say this, and then I'll call on Senator Specter who can have as much time as he thinks is appropriate. The story is a shocking one. It makes you almost gulp. And I just want to say, speaking for myself, I appreciate your integrity and fidelity to rule of law. And I also appreciate Attorney General Ashcroft's fidelity to the rule of law as well, as well as the men and women who worked with you and stuck by you in this. When we have a situation where the laws of this country -- the rules of law of this country are not respected because somebody thinks there's a higher goal, we run askew of the very purpose of what democracy and rule of law are about. And this -- again, this story makes me gulp.