The president’s office rang right on schedule, the first day of April 2015, and I grabbed my notes and headed down the corridor to the Oval Office for my weekly lunch with Barack. The president and I talked briefly about Tikrit and about what might come next in Iraq, but I think he could tell I was distracted and down. He knew I was just back from the hospital and he knew I was headed back there soon. “How did it go, Joe?” he asked. “How is Beau?”
The talk at lunch ended up being almost entirely about Beau. I could tell looking at him across the table that the president was genuinely concerned. He liked Beau and respected him and thought, like me, that my son had a big future ahead of him. I found myself explaining Beau’s treatment, attempting to keep it on a fairly straightforward, clinical footing. Part of that was for my own protection. I did not want to break down in front of anybody, least of all the president. The one time I had cried in front of other people, in the hours after Beau had a stroke-like episode three years before the cancer diagnosis, I remember feeling ashamed. I determined then never to let that happen again other than with family. And I had lived up to that. But as I talked to Barack that day I must have started to confide things I hadn’t intended to. I was hurting, and the president could see it. As I explained to him that the next procedure — the injection of a live virus — was uncharted territory, but our only hope, I looked up and found Barack in tears. He is not a demonstrative man, in public or in private, and I felt bad. I found myself trying to console him. “Life is so difficult to discern,” he said.
I told him I was debating whether to fly down to Houston later that night, to be with Beau for the injection in the morning, or to fly tomorrow and be there when he woke up. Barack didn’t hesitate. He said I should be with my son before he went in, not after. Whatever was on my schedule could not be more important. “Joe,” he said, “you’ve got to go down tonight.”
I knew he was right. That’s what I had planned on doing, but it meant something to me to hear it from Barack. I was in the air, heading to Houston, a few hours later.
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Sunday, April 12, was the sort of day when all good things seem possible. My wife Jill and I woke up at our home in Wilmington and the sun was already starting to burn away the last wisps of fog on the lake behind our house.
Our elder son was holding his own against the cancer. Was better than holding his own. He had come through the injection of the live virus ten days earlier without a single complication. He was moving well. His appetite was still good. And he was mentally sharp. But the two fresh, angry scars on his scalp put us all on edge; the entire family was dreading the coming effects of the untested experimental treatment. His physicians at MD Anderson hospital in Houston, Dr Yung and Dr Lang, had warned us that Beau would get worse before he got better. Maybe much worse. They said he would likely be at his most vulnerable point in the third or fourth week, when the virus and Beau’s own immune system were at war with the tumour. The inflammation could be painful and debilitating. There was no predicting how low he would get, or if he would survive the onslaught. The next six or eight weeks would tell all.
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The big story that Sunday was Hillary Clinton, who had officially announced her candidacy for the Democratic presidential nomination. None of that mattered to Beau, who was out of hospital and back home with us. He was reading all he could about the Clinton campaign — its message, its candidate’s travel schedule, its early field operation. He wanted to be up on everything, so he would be ready to pitch in the minute I announced my own candidacy. Beau believed, as I did, that I was prepared to take on the presidency. That there was nobody better prepared.
No matter what people in the outside world said or thought, Beau and Hunter believed we could win. In my own head, the race was more than anything a matter of daring. And if I had my two sons behind me, anything was possible. Beau had a way of instilling courage and calming me. He was the last person in the room with me before the presidential primary debates in 2007, the vice-presidential debate in 2008 and the vice-presidential debate in 2012, when it was up to me to put wind back in the Democrats’ sails after Barack’s demoralising performance in his first debate against Mitt Romney.
Beau would always grab my arm just before I walked on stage and pull me back towards him until I was looking into his eyes. “Dad. Look at me. Look at me, Dad. Remember, Dad. Home base, Dad. Home base.” What he was saying was: remember who you are. Remember what matters. Stay true to your ideals. Be courageous. Then he would kiss me and shove me forward. So the 2016 Biden campaign would have a late start. So what? If Beau made it through the next few months and came out alive, I knew we could do this.
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I was in the office three days later, that Wednesday, when a call came from Houston. My brother Jimmy had made the trip with Beau down to the hospital so Dr Yung and Dr Lang could assess the early results of the live virus injection, and Dr Yung could administer the second injection of [immunotherapy drug] pembro. The news was very good. In fact, the news was potentially incredible. The scans showed inflammation, but it looked like the tumour growth had really slowed.
The doctors had never done this before, but they were very encouraged. We really may have something was the way Jimmy heard it. We may have cracked the atom. “Lang and Yung are almost giddy,” my brother told me. I hung up the phone and felt like I could take a real, long, deep breath for the first time in months. Don’t get your hopes too high, I reminded myself. Don’t tempt the Fates.
But Beau didn’t get out of bed the next day, Thursday, and everybody in the family figured it was just exhaustion from the trip back home. But he didn’t get out of bed on Friday, either. He was overwhelmed by fatigue and wouldn’t eat. Our daughter Ashley’s husband, Howard, stopped by Beau’s house on Saturday and found him lethargic and unresponsive. He was certain Beau was badly dehydrated. Beau didn’t want to go to the hospital, so Howard gave him three litres of fluids to boost his electrolytes. When Howard came back the next day and found him worse, he packed Beau off to Thomas Jefferson University Hospital in Philadelphia.
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Beau was still badly dehydrated when they admitted him, and his sodium levels were dangerously low. He couldn’t keep his eyes open. He was barely responsive. The best he could do in response to a question was a thumbs-up or a barely audible, “Yes.”
This was it now. We were in the worst of it, and unsure how long the worst would last. The effects of the virus were beginning to punish Beau. The swelling in his brain was intensifying and the pain would have been excruciating, so the doctors kept him heavily sedated most of the time. There was a lot of talk in Wilmington about why Beau, who had announced his intention to run for governor, had skipped every crucial political event in the first four months of the year. Beau still wanted to keep his illness out of the public eye. He was admitted to Jefferson under the alias George Lincoln. The Secret Service agents kept going out of their way to ensure Beau’s privacy and to protect his dignity. I would visit when I could sneak in and out without detection, but I made sure to keep up my schedule so I didn’t call attention to his hospitalisation.
I don’t remember telling Barack about Beau’s hospitalisation, but he must have sensed something was afoot. He let me know he was thinking of me in the way it was most comfortable for him. He seemed to be going out of his way to say nice things about me in public. When he hosted the winners of the 2014 Nascar Sprint Cup Series at the White House two days after Beau’s hospitalisation, he spoke about the teamwork required to win championships, and how their success reminded him of his relationship with me. “Instant chemistry,” he called it. “When you have a trusted partner shouting world-class advice into your ear at every turn, you can’t lose.” The president made an unusually fond statement about me at the White House Correspondents’ Dinner later that week, though he wrapped it in a joke about the controversy at the time involving businesses that had refused to cater to gay weddings. “I tease Joe sometimes,” Barack said, “but he has been at my side for seven years. I love that man. He’s not just a great vice-president; he’s a great friend. We’ve gotten so close, there’s places in Indiana that won’t serve us pizza any more.”
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Beau was moved to the Walter Reed hospital, near the White House. Complications piled up for the next two weeks and brought him more suffering and more pain. He was courageous and stoic, and just kept fighting, but every time Beau looked to be gaining ground, something would knock him back. The oxygen tube that fed through his mouth was agonising for him, so a surgeon performed a tracheostomy and inserted a breathing tube at the base of his neck. He was just barely responsive for long stretches, and his entire right side was nearly paralysed. There was fluid build-up in the left ventricle of his brain, and every time the doctors drained it the fluid just came back, which meant he was in pain or disoriented when he was conscious.
One night, at two o’clock in the morning, his breathing suddenly became laboured, which turned out to be a sign of pneumonia, requiring a jolt of powerful antibiotics. When a Catholic priest swung by Beau’s room to check in, Jill thanked him for stopping by but asked him to please leave. And not to come back. She didn’t want Beau to get the idea he was there to perform last rites. In fact, there would be no discussion about last rites.
Jill and I kept reminding each other the doctors had warned us that Beau would get much worse before he got better. We kept telling ourselves that these hard times were to be expected, and he would turn the corner. Could be any day now. There was still hope.
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What I felt, most of all, was helpless. I did what I could, which was to just be there whenever I could. I visited early in the morning most days, before I started my official schedule, and again every night when I was done. The ride to the hospital was less than half an hour from the White House, and even faster from our residence at the Naval Observatory. Once the motorcade hit the hospital grounds and made the left into the back alley, I would always look up at Beau’s room on the second floor to see if the light was on. Maybe he’s up tonight, I’d think. Maybe he’s looking out the window at me.
The agents would let me out of the car at a side door, where I would be met by an army nurse, who would lead me in. Not that I needed guidance after a while. Thinking my way through the maze to get to Beau had become part of the ritual I used to calm myself. Even now, I remember every step and every turn: the straight walk back through a quiet marble corridor, the right turn and transit across an intersection of two hallways, then the left into the elevator and the ride to the second floor. I’d exit the elevator and make a hard left, then stop at the nurses’ station to greet the team on duty and thank them for all they were doing.
I tried not to dwell on the sights to the left of the station, where the rooms were full of patients who were not going to make it. That was not going to be my son, I’d tell myself as I headed to the right, toward Beau’s room at the corner. And just before I got to his room I would psych myself up. Smile, I’d say to myself. Smile. Smile. Smile. How many times Beau had said to me, “Don’t look sad, Dad. You can’t let anybody see you sad because it will make them feel bad. And I don’t want anybody feeling sorry for me.” You gotta make the final turn with a smile on your face, I’d think. And then I’d make that turn and see either [Beau’s wife] Hallie or Hunter or Jill or Ashley there, at the bedside, holding Beau’s hand. “Hi, honey,” I would say with all the cheer I could muster. “I’m here.”
I came in one night anxious to tell Beau about the scene at the White House earlier in the day. “Honey,” I said as I sat down by his bed, “guess who was at the office today.” Beau’s eyes were closed, but I could tell he heard me. “Elton John was there,” I said. “You remember when I used to drive you and Hunt to school? That song we would all sing together, the three of us, as loud as we could? Crocodile Rock.” The boys were four and five when that song was big, when it was just the three of us. After [first wife] Neilia died, but before I met Jill. I started singing the lyrics to Beau, quietly, so just the two of us could hear it. The words came back like it was yesterday, but after the first few lines I started to get emotional.
Beau didn’t open his eyes, but I could see through my own tears that he was smiling. So I gathered myself and kept at it, for as much of the song as I could remember.
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The doctors were mulling the latest scan on the morning of May 15 and trying to find a way to relieve the constant pressure on Beau’s brain, while I was trapped in the patient waiting room, which the White House communications team had converted into a private space where I could make secure calls. There was a new crisis in Iraq that day, and it needed my attention. Although I knew it was my responsibility, I felt for the first time a sense of resentment that I had to divert focus to anything other than Beau, even for just half an hour. My son was in one room in extremis and I was sitting in another, forced to deal with a problem 6,200 miles away.
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But the day Ramadi fell, Beau got out of bed for something approaching physical therapy. He was able to stand upright, with some help from the nurses, for five minutes. “Good day,” Doc O’Connor, my White House physician, recorded. My grandchildren, Natalie and Hunter, came by the day after to see their dad. Two days later a surgeon did a procedure that finally appeared to relieve the worst of the pressure in Beau’s skull.
He was becoming increasingly alert. Doc told me he noticed Beau moving his upper arm on his long-paralysed right side, and then his right thigh. The next day he was strong enough to sit up in a motorised wheelchair for a spin around the nurses’ station. He was clearly aware again of what was happening, nodding his head in response to questions and giving fist bumps. Hallie got permission to take him for a ride outside, where he could feel the sun on his face for the first time in two and a half weeks. Seven weeks after the live virus injection, it looked like Beau had finally started to climb out of the dark hole.
Barack invited me to play golf that Saturday. He was worried about me, he explained, and hoped to distract me for a few hours. Jill encouraged me to go; it seemed, after all, like things were going to get better for Beau. The worst part is, I can’t even remember whether or not I went.
There was only one other small public event on my Memorial Day [May 25] schedule before I could head over to Walter Reed to spend the holiday with Beau. I was anxious to see him, in part to see if there was more improvement and in part because I could not get out of my head the image of the dream I had the night before. Beau had appeared to me, completely cured, his old self again. The image felt so real. Beau was off in the distance, finishing one of his regular runs, skirting the lake behind our house. I was trying desperately to find Jill or someone in the family, to share the amazing news. “I saw Beau running!” I wanted to shout. “I saw Beau running!”
Beau looked better to me than I’d seen him in weeks. He seemed to be more aware and responsive by the hour. The doctors thought maybe they finally had a handle on the chief problem: the pressure caused by the build-up of the cerebral spinal fluid in the left lateral ventricle of his brain. The ventricles of the brain produce, re-absorb and drain cerebral spinal fluid in order to keep it in proper balance, but Beau’s system wasn’t draining properly. Doc O’Connor suggested to me that it might be a build-up of dead cancer cells that had sloughed and clogged the draining channel, like leaves in a gutter. The neurosurgeons at Reed had done a procedure a few days earlier that finally seemed to open up the pathway. Beau’s left ventricle appeared to be clearing and shrinking. And there had been no evidence of cancer cells in the drained fluid. Medical researchers on the floor were really paying attention to Beau’s progress now and were genuinely excited that they might be seeing the first success of its kind in the treatment of glioblastoma — this new combination of the live virus and anti-PD-1 antibody.
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Keeping the fluid levels in Beau’s ventricular system in balance and lowering the pressure on his brain was crucial to giving him relief from pain, and moments of clarity. And it was crucial to giving us hope. This was life or death now, and emotions were running high.
Jill and I were able to take Beau outside in his wheelchair that afternoon and the next evening too, for a full half-hour. I knew Beau had to be in pain; I could see it in his eyes. But he seemed better. He occasionally nodded or smiled, or gave a thumbs-up. The sunset was just starting to colour the clouds and I found myself remembering Beau as a little boy, sitting out on the balcony off my bedroom, looking out over the trees, watching the sunset. “Lookit, Daddy,” he would say as the sun dropped below the tree line. “It’s disappearing.”
He had a bad night on Wednesday, and by the next afternoon, Thursday, he was barely responsive. No nods. No fist bumps. No thumbs-ups. We all prayed it was just another temporary setback, and Beau would come out of it — with a little extra ground to gain back. Somebody came into Beau’s room to arrange a meeting for the next morning, when the doctors would give the family their assessment of Beau’s condition and his prognosis. There would be new scans to look at by then. I thought the images would probably show more build-up of the cerebral spinal fluid. Once they drained it, Beau would be back in the game.
The whole family gathered at ten o’clock Friday morning in a narrow conference room. The physicians did not like what they saw. The scans looked far worse than they had just two days earlier. But the doctors couldn’t be sure if it was the virus at work or the tumour.
I was still looking for a way through it, out to the other side, with Beau alive. And I think the rest of the family felt the same way. After about 45 minutes, one of the doctors finally said it might be worth waiting for another 24 or 48 hours, and see what happens. We all filed out of the conference room and walked back towards Beau’s room feeling hopeful, holding on to the idea that he might pull out of this again. But then we heard Howard’s voice behind us. “You’ve got to come back,” he said, as he steered us again to the conference room. “You have to tell them the truth,” Howard said to the doctors still assembled. What was happening in Beau’s brain was no longer reversible, the doctors said. There was no saving Beau. “He will not recover.”
These were the most devastating four words I have ever heard in my life. “He will not recover.” But goddammit, I still wanted to believe — maybe — maybe something will happen.
Hallie asked Howard if she should bring the kids down on Monday, and he told her, no, Hallie, you have to bring the kids here now. They came down the hallways of the hospital smiling, as if it were just another visit. The Secret Service agents, many of whom had been with our family for more than six years, bowed their heads and stared at the marble floor, or turned away, so nobody would see them weeping as Natalie and Hunter went by.
Nobody left the hospital that night. Hunter’s wife and daughters came to be with us. My sister Val, her husband, Jack, my brother Jim and his wife Sarah were there with us. My niece Missy, who had grown up with Beau, came to be with us, too And we waited, all of us, together. Hunter and Howard left the floor briefly, just after seven o’clock that night, to pick up food for the family. And not long after they walked out, Beau’s breathing became laboured, and then extremely shallow, and then appeared to stop. There was no heartbeat registering on the monitor. Hunt and Howard raced back, and when they arrived they found the rest of us gathered around Beau. Hunt walked over, bent down to kiss him and placed his hand over his brother’s heart. Howard looked at the monitor. “Look,” he said. Beau’s heart was beating again.
It didn’t last long.
May 30, 7.51 pm. It happened, I recorded in my diary. My God, my boy. My beautiful boy.
Extracted from Promise Me, Dad: A Year of Hope, Hardship and Purpose by Joe Biden, published by Pan (£8.99)
