The Washington Post National Weekly - October 6, 2019

SUNDAY, OCTOBER 6, 2019

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‘OUT HERE, IT’S JUST ME’ 88 In the medical desert of rural America, one doctor for 11,000 square miles PAGE PAGE PAGE 12

Politics Trump’s GOP critics targeted 6

World For Brazil, green or growth? 10

5 Myths Ukraine 23

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THE FIX

Trump’s brazen China request BY

A ARON B LAKE

P

resident Trump on Thursday appealed to a foreign country to take action involving his electoral opponents. It was the third time we know of that he has done so.

The first time, when Trump asked Russia to find Hillary Clinton’s “missing emails,” his campaign insisted he was joking. The second time, when Trump asked Ukraine’s president to launch two other politically convenient investigations, we learned about it only after the administration tried to keep it under wraps.

Now, for his third act — this one involving China — Trump just came out and said it.

This might be Trump’s most problematic request of this sort, for a number of reasons.

Trump on Thursday publicly said China should launch an investigation into Hunter Biden’s work in the country. “And by the way, likewise, China should start an investigation into the Bidens because what happened in China is just about as bad as what happened with Ukraine,” Trump said.

He added later that he had not brought the matter up with Chinese President Xi Jinping, but that he might.

“I haven’t, but it’s certainly something we can start thinking about because I’m sure that President Xi does not like being under that kind of scrutiny where billions of dollars is taken out of his country by a guy that just got kicked out of the Navy,” Trump said. “He got kicked out of the Navy. All of a sudden he’s getting billions of dollars. You know what they call that? They call that a payoff.”

It’s not clear exactly what Trump is alleging here, nor has it been when Trump has previously invoked China while talking about the

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ANDY WONG/POOL/EPA-EFE/SHUTTERSTOCK

Then-Vice President Joe Biden and his son, Hunter Biden, in Beijing in 2013. Amid a trade war, President Trump publicly said Thursday that China should investigate the Bidens.

Bidens. But arguably, even more than his request to Ukraine, this one has the potential for a really corrupt appearance.

The chief reason for that: Trump is engaged in a trade war with China.

Trump certainly had — and has — leverage over Ukraine, both by virtue of hundreds of millions of dollars in U.S. aid to that country and because of Ukrainian President Volodymyr Zelensky’s quest for a personal meeting with Trump.

The U.S.-China relationship does not include such a power imbalance, in which it might look like Trump is picking on a small country to force it to bend to his will. But he does have significant leverage when it comes to China, notably because of the trade war he launched.

Most of the most provocative moves in the trade war have been made by Trump, who started this whole thing and has been more

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eager to ramp things up. China could very logically now believe that further escalations might be tied to whether it takes the actions Trump wants. Any future decisions could be colored accordingly.

And indeed, shortly before delivering the above quotes, Trump was explicitly talking about his leverage over China.

“I have a lot of options on China, but if they don’t do what we want, we have tremendous power,” Trump said. Thirty seconds later, he was talking about the investigations. If you’re China, you have to wonder if those things might be related in Trump’s mind.

Where this could lead to an even stickier situation, though, is if there is a trade war resolution before the 2020 election. Some Trump advisers have urged him to come to some kind of deal by then, for fear of the gambit backfiring in the November election.

Let’s consider for a moment that China investigates the Bidens (and we learn about it), and then Trump cuts some kind of deal with China.

How would we ever know that a very personal political favor wasn’t a factor in Trump giving China a deal with more favorable terms than he might have otherwise?

There’s a whole lot of ifs built into that. We don’t even know whether China would be willing to “play ball,” as the Ukraine whistleblower put it. But that’s the unholy setup.

And even if you set aside the trade war, this is still a U.S. president suggesting that a foreign country do something that is transparently geared toward his own reelection bid.

Trump has intermittently argued — however implausibly — that his effort to get Ukraine to launch investigations is about rooting out corruption in that country; his now-public request of another investigation involving the Bidens makes clear what this is really about. n

CONTENTS POLITICS THE NATION THE WORLD COVER STORY HEALTH BOOKS OPINION FIVE MYTHS

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ON THE COVER Ed Garner is the only working doctor for 11,000 square miles in West Texas. Photo

by MICHAEL S. WILLIAMSON of The Washington Post

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POLITICS

Fixations become agencies’ priorities

JABIN BOTSFORD/THE WASHINGTON POST

Key federal offices are increasingly compelled to fulfill Trump’s personal concerns

BY P HILIP R UCKER AND R OBERT C OSTA

A

s the impeachment drama has unfolded over recent weeks, a series of disclosures has illuminated President Trump’s command over key federal agencies, revealing how he has compelled them to pursue his personal and political goals, investigate his enemies and lend legitimacy to his theories about the 2016 election.

The Justice Department has

prioritized a probe that the president hopes will discredit a finding

by U.S. intelligence agencies that Russia interfered in the 2016 election to help him win. As part of that effort, Attorney General William P. Barr has met overseas with foreign intelligence officials to enlist their aid in “investigating the investigators,” as the right’s rallying cry goes, and dig into the president’s suspicions.

The State Department, meanwhile, has been investigating the email records of as many as 130

current and former department officials who sent messages to the private email account of Hillary Clinton, the former secretary of state and Trump’s 2016 opponent.

Secretary of State Mike Pompeo defied Congress on Tuesday by attempting to block the depositions of five department employees called to testify in the impeachment inquiry.

The inquiry itself was sparked by a July 25 phone call in which Trump asked his Ukrainian counterpart to investigate unsubstanti-

President Trump — who said last month after John Bolton’s exit as national security adviser, “It’s very easy actually to work with me. You know why it’s easy?

Because I make all the decisions.” — attends the swearing-in of his new secretary of labor, Eugene Scalia, on Monday.

ated corruption allegations against former vice president Joe Biden, a leading 2020 Democratic presidential candidate, and his son.

In each of these instances, the president or administration officials have strongly defended their conduct as proper and above board.

But taken together, they illustrate the sweeping reach of Trump’s power and the culture he has spawned inside the government. The president’s personal

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Campaign messages thrown off-kilter BY

S EAN S ULLIVAN

T

he eruption of impeachment proceedings against President Trump has thrown the Democratic presidential campaign abruptly off track, as the candidates scramble to respond forcefully on the scandal while simultaneously focusing on the bread-and-butter policies they have touted for months.

The unusual split messaging pushes the primary into complicated terrain just four months before the first nominating contest in Iowa. While the candidates are vying for the chance to unseat Trump in 2020, Democratic leaders in Congress have initiated an inquiry focusing on a different question entirely: whether to remove him from office before then.

The response has sometimes been awkward. Sen. Bernie Sanders (I-Vt.) recently delivered impassioned remarks on unions but tacked on a statement about impeachment beforehand after consulting with aides. Sen. Elizabeth Warren (D-Mass.) fielded questions about Medicare-for-all at a town hall, then faced inquiries from reporters on impeachment.

Former vice president Joe Biden spent a few minutes discussing impeachment at a recent stop before turning to an abbreviated version of his usual speech.

While leading Democrats increasingly demand forceful statements on Trump’s actions, many voters and activists are urging candidates not to stop talking about how they would provide health insurance to more Americans, shrink the gap between rich and poor, and combat climate change.

“Impeachment is an afterthought for a lot of people,” said Elesha Gayman, chair of the Scott County Democratic Party in Iowa.

“I appreciate them coming out with a statement, but that’s about where it needs to end. I think the most important thing to carry forward for the Democrats is going to be having a message and a vision for what they are going to bring to the table.”

CHERYL SENTER/ASSOCIATED PRESS

Democrats walk complicated line of talking about impeachment while still wooing voters on issues What’s clear is that the furor in Washington injects another huge dose of uncertainty, at a critical moment, into a contest that was already highly fluid.

House Speaker Nancy Pelosi (D-Calif.) took the rare step of beginning impeachment proceedings against Trump after he acknowledged urging the president of Ukraine to investigate Biden and his son Hunter Biden.

Many Democrats say dislodging Trump from office is unlikely, given the strong support for him in the Republican-controlled Senate.

Nevertheless, the Democratic presidential field has largely lined up behind Pelosi, endorsing her inquiry and vocally condemning Trump’s conduct. A whistleblower complaint at the center of the controversy alleges that Trump misused his office for personal gain. Trump has said he did nothing wrong.

Some voters expressed concerns about the Democrats forging ahead on impeachment. Di-

ana Kroeger, 52, an independent from Hollis, N.H., who stood in line for a photo with Warren after her Friday town hall event there, said “I’m worried” about the process, fearing it will further divide the country.

Will Norona, an autoworker from Flint, Mich., who walked a picket line in front of a GM plant in Detroit recently with Sanders, said he worried that focusing on impeachment could take attention away from other issues.

But other Democrats, believing Trump to be increasingly vulnerable, want to see the candidates call him out more aggressively than ever.

“They’ve got to keep the focus on Trump while hot lights are on him,” said Gilda Cobb-Hunter, president of the National Black Caucus of State Legislators.

Shawana Love, 42, an undecided voter who also joined the picket line in Detroit, said seeing the Democrats take steps toward impeaching Trump gets her more excited about the election.

Sen. Elizabeth Warren has used the inquiry to remind voters that she had long pushed for impeachment. “The way to hold this president of the United States accountable is to impeach him,” she said Sept. 27 in Hollis, N.H.

The fast-moving developments and clashing voter sentiments are prompting many of the candidates to dedicate valuable time at campaign events to responding to the latest Trump news with outrage.

But they are taking different tacks.

Warren has been pointing out that she advocated impeachment proceedings long before the recent revelations about Trump’s conversation with the Ukrainian president.

“The way to hold this president of the United States accountable is to impeach him,” Warren told reporters after Friday’s town hall.

“So I hope we go forward with care and deliberation, but that we do it quickly. I think it’s important. The American people are counting on us.”

Sanders has been more cautious about the prospect of impeachment. While he also supports an inquiry, a point he has emphasized repeatedly in recent days, he has long focused on policy, and he warned Democrats not to abandon work on other important issues.

“The Congress of the United States must show the American people that it can walk and chew gum at the same time,” Sanders said last week in Davenport, Iowa.

Sen. Kamala D. Harris (DCalif.) has sought to use the impeachment inquiry to remind voters of her experience as a prosecutor and a member of the Senate Judiciary Committee. Harris canceled a recent fundraiser in Los Angeles to fly back to Washington for a meeting of the Senate Intelligence Committee.

Biden is tethered to the situation more directly than any other candidate. Despite the centrality of his role, Biden has been more reticent than some of his rivals when it comes to impeachment.

At a recent fundraiser in Southern California, Biden said he and his family had done nothing wrong and accused Trump of trying to “hijack an election so we do not focus on the issues that matter in our lives.” He added, “This is not about me.” n

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NATION

Antiabortion law spreads in East Tex. BY

E MILY W AX- T HIBODEAUX

C

ity council meetings in East Texas address typical small-town issues, such as road contract approvals, tree removal and street closures for fall festivals and high school homecoming parades.

But a far more controversial agenda item has been appearing in this deeply conservative region of rural America: abortion.

Labeling it “murder with malice,” a growing number of town councils have been passing abortion bans and declaring themselves “sanctuary cities for the unborn.” Five towns have adopted the restrictive ordinance, which outlaws emergency contraception such as Plan B, criminalizes reproductive rights groups and fines doctors $2,000 for performing the procedure. A sixth East Texas town has adopted a more lenient version of the ordinance.

The activist behind the movement, Mark Lee Dickson, said he and antiabortion group Texas Right to Life plan to travel to more than 400 Texas municipalities to pitch the ban.

“This is a local issue because it impacts the most vulnerable — the unborn child,” Dickson said.

“If we could do this in Texas, we can do this in cities and towns in Arizona, in Florida, in Iowa.”

Texas has always been at the center of the abortion wars. Roe v. Wade, the Supreme Court ruling that legalized abortion nationwide, originated in the state. But this year, Texas didn’t follow other Republican-held state legislatures in passing a “heartbeat law” that outlaws abortion after about six weeks of pregnancy.

Dismayed by the lack of state action, Dickson and other antiabortion activists are bringing their cause “straight to the people” and lobbying town governments.

None of the new “sanctuary cities for the unborn” — most with a population under 3,000 — have abortion clinics, but Dick-

THE LILITH FUND

Towns become ‘sanctuary cities for the unborn’ after legislature fails to pass ‘heartbeat law’ son’s goal is to prevent health centers that perform the procedure from moving into Waskom, Joaquin and other towns that adopt the restriction.

Dickson also hopes to attract a legal challenge that forces the Supreme Court to reconsider Roe v. Wade.

But hundreds of miles west of these deep-red towns, another Texas city council is pushing the state’s abortion politics in the opposite direction.

The Austin City Council last month approved $150,000 for transportation, hotels and other costs for women seeking abortions, particularly those living in towns known as “abortion deserts,” places at least 100 miles away from an abortion facility.

“The right to an abortion is meaningless if it is not accessible,” said Aimee Arrambide, executive director of National Abortion Rights Action League (NARAL) Pro-Choice Texas.

On his website, Dickson labels Austin a “city of death.”

“Austin is going in the complete opposite direction of what we are doing,” said Dickson, 34.

“I think it’s amazing that little ol’ Waskom is on the lips of the people of Austin. It’s time for the smaller cities to start impacting the bigger.”

An all-male council voted in June to make Waskom the first city to adopt the ordinance, which forbids Planned Parenthood, NARAL Pro-Choice Texas and other “criminal organizations” that offer or assist in obtaining abortions from operating in the city. It declares that providing money, transportation or other aid to a person for an abortion is unlawful, and allows would-be relatives of the unborn to sue those who do.

The ordinance is only criminally enforceable if the Supreme Court overturns Roe v. Wade.

But, in civil cases, Dickson said, local courts could enforce the ordinance in a lawsuit against someone who provides emergency contraception or performs an

The Lilith Fund put up a billboard supporting abortion on the edge of Waskom, Texas. The city was the first to adopt the ordinance that forbids Planned Parenthood and other “criminal organizations” that offer or assist in obtaining abortions from operating there.

abortion in the town limits.

“This is a gray area,” said Greg Hutson, city manager of Gilmer, Tex., the most recent town to adopt the abortion ban. “This part could well be the vehicle that challenges Roe v. Wade.”

Some of the smaller towns that Dickson has approached passed the ordinance without controversy.

“The majority of us don’t want the blood of these babies on our hands,” said Deborah Ramsey, Republican chair for Morris County, where the Omaha City Council unanimously passed the ordinance on Sept. 9. The neighboring town of Naples did the same in a 5-to-1 vote.

The lone dissenting vote in Naples came from Councilman Danny Mills, who said he doesn’t support abortion personally but thinks it should remain a personal choice.

Mills, who served several terms as mayor, said he felt blindsided by the ordinance and didn’t like Dickson’s “theatrics” of the heartbeat bears.

“He came into our town out of the clear blue sky,” Mills said in a phone interview. “I just couldn’t see draining this tiny town’s mayor and police tending to somebody else’s private business to get an abortion.”

Most recently, the town of Gilmer — population 5,000 — voted 4 to 1 to adopt the ordinance, but only after removing several provisions, including the ban on emergency contraception and language that criminalized reproductive rights groups and classified abortion as murder.

Instead of using the phrase “sanctuary city for the unborn,” the council is calling its town “a safe haven for the unborn,” said Hutson, the Gilmer city manager.

“Portions of his ordinance are inflammatory, throwing gasoline on the fire,” said Hutson, who added that he’s been unsettled by residents’ bitter discord over the ordinance online. “We are a prolife town. But for the sake of the country, the two sides have to come together and learn to talk about this in a kind way.” n

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Harvard ruling is win for status quo

BY N ICK A NDERSON AND S USAN S VRLUGA

T

he first round in the lawsuit against Harvard University’s admissions program yielded a decisive victory for the status quo on affirmative action in higher education, with a federal judge ratifying how one of the world’s most prestigious schools uses race and ethnicity to choose a class and rejecting claims of discrimination against Asian Americans.

But the plaintiff, Students for Fair Admissions, which lost on all counts in the judge’s ruling this past week, pledged an appeal to the U.S. Court of Appeals for the 1st Circuit. Eventually, the case could reach the Supreme Court.

That would provide opponents of affirmative action another potential opening to overturn decades of precedent from the high court allowing race-conscious admissions, in a limited way, without racial quotas.

Most observers read Tuesday’s decision from U.S. District Judge Allison D. Burroughs in Boston as an endorsement of an admissions system used at many selective colleges. That system, known as “holistic review,” takes race into account as one among many factors in a prospective student’s background.

“It appears to be a slam dunk for Harvard,” Peter McDonough, vice president and general counsel for the American Council on Education, said after the ruling.

“It is close to a slam dunk for colleges and universities across the country.” The council, a prominent advocate for higher education, had joined with other groups in a friend-of-the-court brief supporting the Harvard model.

McDonough acknowledged that a potential Supreme Court showdown looms. “But for today the story line is the unambiguous nature of the judge’s ruling,” he said. “The judge has taken 130 pages to forcefully say ‘Harvard wins.’”

Critics of race-conscious admissions lamented the ruling.

They accused Burroughs of shrug-

CHARLES KRUPA/ASSOCIATED PRESS

Federal judge’s decision backs affirmative action, but potential Supreme Court showdown looms ging off questions the suit raised about why Asian American applicants tended to receive lower ratings from Harvard admission officers for their personal qualities.

“Today marks a dark day for millions of Asian American children nationwide,” Yukong Zhao, president of the Asian American Coalition for Education, said in a statement. “Our nation has witnessed another immoral attempt

by America’s ruling class to continue their institutionalized discrimination against Asian American children and treat them as second-class citizens with regard to educational opportunities.”

Another group applauded the decision as a “critical victory” for Asian American students. “While we must do more to ensure that Asian American students do not face unequal opportunities through harassment, stereotyping and language barriers,” said Aarti Kohli, executive director of Advancing Justice-Asian Law Caucus, “the use of race-conscious admissions policies —

which safeguard against discrimination — is an important step.”

Roger Clegg, general counsel of the Center for Equal Opportunity, which opposes what he described as racial preferences, said the ruling was not a surprise. “I don’t think it’s going to change the trajectory of what I think everybody expects to be a case that ends up before the Supreme Court,” he said. Clegg pointed to survey data from the Pew Research Center showing most Americans don’t support the use of race in admissions.

Affirmative action is not a universal practice in admissions.

Several states, including California, ban race-conscious admissions in public universities. But a substantial number of competitive private and public schools acknowledge taking race into account.

Students for Fair Admissions, which says it represents rejected Asian American applicants, filed its suit in November 2014, alleging violations of civil rights law

Harvard and other schools can continue to use race as one of many factors in their admissions, a U.S. district judge ruled Tuesday. One supporter of raceconscious admissions said the decision was a “slam dunk for colleges and universities across the country.”

and of Supreme Court mandates.

The group claimed that Harvard intentionally discriminated against Asian Americans, that it sought to “balance” its admitted class to meet preconceived targets for racial and ethnic groups, that it leaned too heavily on race as a factor in admission deliberations, and that it failed to give adequate consideration to raceneutral alternatives.

Burroughs rejected all the claims. The judge wrote that testimony from Harvard admission officers denying discrimination was “consistent, unambiguous and convincing.” She also noted that the plaintiff chose not to put an individual face onto its case.

There was no individual analogue to Bakke, Grutter, Gratz or Fisher — all surnames of plaintiffs who became part of the Supreme Court’s record on affirmative action.

Students for Fair Admissions, Burroughs wrote, “did not present a single Asian American applicant who was overtly discriminated against or who was better qualified than an admitted white applicant when considering the full range of factors that Harvard values in its admissions process.”

The judge wrote that Harvard’s record was not perfect. In a footnote, she wrote that “some slight implicit biases among some admission officers” may have affected the personal ratings of certain applicants. “While regrettable,” she wrote, such biases “cannot be completely eliminated in a process that must rely on judgments about individuals.”

She also admonished Harvard to follow the Supreme Court’s dictate from its most recent ruling on affirmative action, in 2016: that universities must continue to use data to scrutinize the fairness of their admissions programs and “assess whether changing demographics have undermined the need for a race-conscious policy.”

But Burroughs generally accepted the premise behind Harvard’s efforts: that consideration of race was necessary for the university to maintain a diverse campus. n

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In India, a battle of Gandhi’s legacy B Y J OANNA S LATER in New Delhi

I

ndia marked the 150th birthday of Mohandas Gandhi, the man known as the father of the nation, and across the country there were exhibits, commemorations, marches, prisoner releases and even a 1,000-footlong greeting card.

But the celebrations this past week masked a deeper unease. A century and a half after the birth of the revered leader of India’s independence struggle, Gandhi and his legacy are getting an update — and much of it is not positive.

Even as admiration for Gandhi remains widespread, aspects of his life and philosophy are increasingly a source of controversy.

Scholars have highlighted the racist language he used as a young man living in South Africa as well as his defense of India’s caste system.

Meanwhile, on the other side of the political spectrum, India’s right-leaning Hindu nationalist ideologues have long had an ambivalent relationship with Gandhi. Some view his dedication to nonviolence as a form of weakness, or think he betrayed the cause of Hindus with his support for religious pluralism. Earlier this year, one politician from the ruling party even described the man who assassinated Gandhi as a “patriot.”

In many parts of the world, “Gandhi is seen broadly as a nice, decent, open-minded, reasonable guy who advocated nonviolence, justice, peace and so on,” said Ramachandra Guha, a historian and author of a two-volume biography of Gandhi. But in India, “his ideas and legacy have been deeply contested.”

Gandhi is often given the title “Mahatma,” or “great soul,” and many in India refer to him simply as “Bapu,” a word for father. He inspired leaders such as Nelson Mandela and the Rev. Martin Luther King Jr., who wrote that Gandhi served as a “continual reminder” that “it is possible to resist evil and yet not resort to violence.” But

MONEY SHARMA/AGENCE FRANCE-PRESSE/GETTY IMAGES

On the leader’s 150th birthday, critics both on the left and right took aim at the ‘father of the nation’ in his long life in the public eye — his collected works comprise nearly 100 volumes — Gandhi delved not only into politics, but also economics, religion, sexuality, sanitation and even diet.

One recent critique centers on Gandhi’s two decades in South Africa as a younger man. During that time, he repeatedly referred to black South Africans using a racial slur and described them as inferior to Indians, views that prompted a university in Ghana to remove a statue of Gandhi late last year.

A growing number of writers and scholars have also criticized Gandhi for his views on India’s caste system, saying he was a conservative who believed in preserving hereditary roles for different caste groups in Indian society rather than eradicating them.

Gandhi denounced the practice of treating certain people as “untouchable” or somehow polluting.

Yet he also believed in having a

“harmonious social order,” said Anand Teltumbde, one of India’s preeminent scholars on caste and the author of a recent manuscript on Gandhi. “The caste system provided that order,” Teltumbde said.

Other scholars say that Gandhi advocated a gradual reform of the system because he did not want to alienate the upper castes, which were crucial to the independence struggle.

On Wednesday, Indian Prime Minister Narendra Modi paid tribute to Gandhi at an event in Gujarat, the home state of both men. Gandhi was an advocate for better sanitation, and Modi is using his 150th birthday to celebrate the government’s “Clean India” campaign, which has constructed millions of toilets nationwide. Because of the program, India’s rural areas have essentially eradicated the practice of defecating outside, Modi said, although experts cast doubt on that claim.

Modi also praised Gandhi in an

Indian Prime Minister Narendra Modi pays his respects to Mohandas Gandhi at Parliament House in New Delhi on Oct. 2 to mark the 150th anniversary of Gandhi’s birth.

opinion piece published in the New York Times, saluting him for giving “courage to millions globally” and for envisioning “a world where every citizen has dignity and prosperity.” Modi challenged “thinkers, entrepreneurs and tech leaders” to find innovative ways to spread Gandhi’s ideas.

Modi’s emphasis on honoring Gandhi in association with the cleanliness campaign strikes some of those who knew him as a strategic choice. Although Gandhi did advocate improved sanitation, they say, it was not his central message.

“Those connected to the current Indian regime are using a fragment of Gandhi to destroy the core of Gandhi,” said his grandson Rajmohan Gandhi, a professor at the University of Illinois at Urbana-Champaign. “The core of Gandhi is equality and especially minority rights.”

Modi “exalts Gandhi as a prophet of cleanliness and recycling,” added Guha, Gandhi’s biographer.

“He never talks about what Gandhi lived and died for, which was Hindu-Muslim harmony.”

Gandhi was assassinated in January 1948 by Nathuram Godse, a Hindu extremist. Godse was a former member of the Rashtriya Swayamsevak Sangh, a Hindu nationalist organization that is the ideological parent of the ruling Bharatiya Janata Party.

In May, Pragya Thakur, days before she was elected to India’s parliament for the BJP, hailed Gandhi’s assassin Godse as a “patriot.” Modi said Thakur’s remarks were “condemnable” and she apologized, but the party ultimately took no action against her.

Some rue the fact that Gandhi is becoming irrelevant in today’s India. He has been reduced “to a ritualistic presence in our collective life,” Apoorvanand, a professor at Delhi University who goes by only one name, wrote this month. “He has been made a lifestyle guru, a feel-good presence — something he never was.” To embrace Gandhi would mean reviving “a politics of dissent . . . which sometimes requires going against one’s own people.” n

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COVER STORY

A medical desert In rural West Texas, Ed Garner is the only working doctor

ELI SASLOW in Van Horn, Tex. BY

H

e woke up to the sound of an ambulance’s siren, knowing that the ambulance would soon be delivering another patient to him. Ed Garner, 68, changed into medical scrubs and walked out to his truck. He dialed the hospital as he started driving toward the emergency room.

“Any idea what might be coming?” he asked, but all anyone knew for certain

was that the ambulance was still on its way out to a patient. Sometimes the paramedics were back within minutes, and other trips took nearly two hours.

Sometimes they delivered Garner a patient in minor distress, and other times they brought him unresponsive victims of car crashes, heart attacks, drug overdoses or ranching accidents.

“Do we know anything yet?” Garner asked again, a few minutes later. A stethoscope dangled from his rearview mirror. He checked his police scanner, but it was quiet. He looked toward the

adjacent interstate but saw no obvious wrecks.

He lit a cigarette and rolled down the window as he drove by the dusty ranches and dry lakebeds of West Texas. He had started smoking to cope with the stress of medical school, but now he had been practicing rural family medicine for 41 years as the stresses continued to mount. He was the only working doctor left to care for three remote counties east of El Paso, an area similar in size to the entire state of Maryland, home to far-flung oil encampments, a desolate

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stretch of interstate, communities of drifters living off the electric grid, and highway towns made up of truck stops and budget motels. “A wild place of last resort,” was how Garner described parts of his territory, and for every person in every kind of medical trouble, the true last resort was him.

Now his phone rang and he answered.

“How bad is it?” he asked, and a nurse told him the ambulance was on its way back to the hospital with a truck driver who had collapsed at a gas station and couldn’t move his legs.

“Just give me a minute,” Garner said.

“I’ll be there as quick as I can.”

In the medical desert that has become rural America, nothing is more basic or more essential than access to doctors, but they are increasingly difficult to find. The federal government now designates nearly 80 percent of rural America as “medically underserved.” It is home to 20 percent of the U.S. population but fewer than 10 percent of its doctors, and that ratio is worsening each year because of what health experts refer to as “the gray wave.” Rural

Above: Vast stretches of West Texas country around the town of Van Horn offer few amenities, least of all emergency medical care.

Left: Ed Garner has been for years the only full-time physician at Culberson hospital in Van Horn.

doctors are three years older than urban doctors on average, with half over 50 and more than a quarter beyond 60.

Health officials predict the number of rural doctors will decline by 23 percent over the next decade as the number of urban doctors remains flat.

In Texas alone, 159 of the state’s 254 counties have no general surgeons, 121 counties have no medical specialists, and 35 counties have no doctors at all.

Thirty more counties are each forced to rely on just a single doctor, such as Garner, a family physician by training

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who by necessity has become so much else: medical director of Culberson County. Head physician for a nearby immigration detention center. Director of a rural health clinic. Chief of staff for Culberson Hospital. And medical director for the hospital’s emergency room, where the latest patient was being wheeled in as Garner introduced himself.

“We’ll get you something for pain,” he said, putting his hand on the truck driver’s shoulder. “Let’s figure out what’s going on and how we can help.”

“It feels like burning all the way up and down my legs,” the patient said. He’d been hauling a load from Florida to Central California in an 18-wheeler when he stopped in Van Horn, population 1,700, and collapsed with sudden numbness in his back and his legs.

“Here I am in the middle of nowhere, and I can’t even move,” he said.

“In a way, you got lucky it happened here,” Garner said, because there was no other hospital within at least 100 miles in any direction.

“Let’s get a CT scan and see what’s going on.”

A radiologist came to perform the CT scan, and Garner left to make his morning rounds in the hospital and the adjacent clinic. A 91-yearold was complaining of dizziness. A teenager needed a doctor’s signature on his mandatory high school sports physical. A U.S. Border Patrol agent arrived from the detention center with an undocumented immigrant complaining of dehydration and nausea. On most days, Garner saw about 20 patients with the help of a nursing staff and two physician assistants. The hospital had been trying to recruit a second doctor for almost five years. A new graduate from medical school had recently committed to work in Van Horn, but he was still awaiting his final licensing.

A nurse handed Garner a copy of the truck driver’s CT scan, which showed two bulging discs in his back, and Garner walked in to share the diagnosis.

“You’d learn a lot more with an MRI, but we don’t have an MRI machine here,” he said.

“So now what?” the trucker said.

“Could be back surgery, but you need to get some more information and talk to a neurosurgeon or an ortho.”

“All right. Let’s do it,” the truck driver said.

He leaned back against the bed and looked behind Garner, as if expecting a team of physicians to come in through the door. Garner followed his eyes out into the empty hallway.

“I’m sorry, but the best we can do is transport you to El Paso,” he said. “You need a specialist, and out here, it’s just me.”

H

is hospital shifts in Culberson County typically lasted 24 hours, and during the daytime he mostly did the work he’d imagined for himself when he chose to become a country doctor. He greeted patients by first name and handed out fruit cups to their children. They called him “Dr. G” and sometimes brought him homemade pies or Cheetos out of the hospital vending machine. He

treated their common colds, their sunburns, their diabetes, their insect bites, their addictions, their muscle aches, and sometimes also their loneliness. “My door’s always open for walk-ins,” he often told patients. “There’s no shame in coming just to talk.”

It was at night when he could feel his job turning into something more unpredictable and ominous — when he remained on call as much of the hospital’s support staff emptied out and the town’s population doubled because of travelers staying overnight in the roadside motels. The interstate became a sporadic trail of headlights across the desert, and Van Horn’s 24-hour truck stops turned into neon islands in the darkness. The only people who sought out medical care were those who urgently required it, and all Garner could do was go home with his emergency scanner and his hospital-issued cellphone to wait.

“Get some rest tonight,” an aide told him as he packed up to go home. “Hopefully it’ll be nice and qui—” “Please,” Garner said. “Not the Q-word. I know it’s silly, but I’m superstitious.”

He drove back to the small rental house where he’d lived for most of the past eight years. He’d left a busy clinic in Central Texas to take the job in Van Horn because it offered better pay, an adventure at the end of his career, and work that felt more essential, but his wife and four adult children still spent most of their time across the state, where Garner owned a small family ranch. Alone in Van Horn, he had little to do but eat a Subway sandwich, watch TV news and sit in a recliner

A migrant child is given a medical check, now required for children detained at the border, at Culberson Hospital.

The girl and her mother were brought there by U.S. Border Patrol agents.

with the cellphone on his lap. He checked the phone every few minutes to make sure he hadn’t missed a call from the hospital. He got up to play his guitar. He checked the phone’s ringer volume to make sure it was all the way up. He ate some more of his sandwich. He checked his phone again. He thought about all the medical emergencies that could happen in 11,000 square miles at night, which mostly meant remembering what he’d seen happen before.

There were elderly inpatients at the hospital with do-not-resuscitate orders who tended to die at 3 or 4 a.m., when the body was its weakest. There were babies who stopped breathing without warning in their sleep.

There were women who went into labor while passing through on the highway, and there was one woman who had arrived complaining of acute stomach pain and then needed to be told that she was several months pregnant, and then that her baby was dead.

His cellphone rang. He sat up and answered.

“Hello,” he said, and it was his wife. “Yep, just sitting at home, trying to close my eyes,” he told her. “Haven’t had anything yet.”

There were migrants who arrived at the hospital in the custody of Border Patrol after spending a week or more hiking across the desert, with cactus spines embedded in their feet and spider bites on their arms. There was a teenage boy from Honduras whose major organs had shut down from dehydration, and who died despite three hours of emergency intervention. There was a Border Patrol agent who died of blunt-force trauma. There was a

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COVER STORY woman who had been fatally stabbed by her husband at 5 in the morning, and then there was her husband, who had been shot by the Van Horn police. There was a sand truck that was struck by a train, and a fuel truck that caught fire on the interstate. There were tires that blew out in the heat and tires that skidded on black ice and an unending string of single-car rollovers at the posted speed limit of 85 mph. There was a highway pileup with so many victims it required a bus to transport them all to the hospital. There was an 11-year-old with two dislocated hips that needed to be forced back into place. There were patients in a single year from 36 states and 68 Texas counties.

His phone rang again, and this time it was the immigration detention center. A woman was having an asthma attack and couldn’t breathe.

“I’ll be over,” Garner said. He stood up, and a minute later the detention center called again.

The asthma attack had improved. The woman could wait until morning.

“Okay,” he said, and he sat back down and closed his eyes. A train blared its horn, and he checked the volume on his phone. A dog barked in the yard next door. Trucks rattled by on their way to the sand mine. His phone rang again, and this time when he answered, the sun had begun to rise, and it was a hospital administrator calling to remind him about a morning meeting to review emergency response protocols. Garner got dressed and drove back into the hospital.

“Did you get some sleep?” the administrator asked.

“I did,” Garner said.

D

uring the eight years he’d spent in Van Horn, hospital managers had done whatever they could to extend Garner’s career as one of the few country doctors left in West Texas. They’d increased his pay and recruited traveling physicians to take occasional shifts in the ER so he could go back to his ranch. They’d hired a full team of nurses and physician assistants to share his patient load and help in the ER. They’d even lobbied the state of Texas to change its laws regulating telemedicine and then installed video cameras and fiber optic cables in the ER so that, on some nights, the only doctor on call in Van Horn was actually a doctor from out of state who appeared on a video screen.

But what they wanted most of all was a second doctor, someone who could support Garner and one day succeed him, and after a nationwide search and five years of disappointments, that second doctor was finally pulling his car up to the hospital in Van Horn.

David Cummings, 43, grabbed a few boxes out of his trunk, carried them into his new office, and surveyed the empty walls.

“We’re so thrilled you’re actually here,” said Rick Gray, the hospital administrator. “You should start hanging up your things, put your mark on the place.”

“I’m still waiting on my certificates and stuff,” Cummings said. He had just finished his

Top: David Cummings, left, a doctor joining the Culberson Hospital staff, discusses a patient with Garner.

Above: Homecoming queen Jadyn Corrales and others show their school’s “eagle claw” gesture as the Van Horn High School band plays the school song.

medical school residency in Nevada, and he wasn’t scheduled to see patients for another few weeks. “What should I hang up, anyway?” he asked. “I don’t know this stuff. I’m a rookie.”

“You’re the doctor,” Gray said. “You hang whatever you want.”

Cummings had grown up in Central Texas as the son of an auto mechanic, and he’d worked in a factory for a few years before taking out nearly $500,000 in loans to scrap his way from community college all the way through medical school in El Paso. He was the first in his family with a college degree, and he’d never earned more than $50,000 a year, but in the past months he’d become the focus of a nonstop medical bidding war. Fewer than 2 percent of medical school students want to practice in towns smaller than 25,000 people, according to national studies, so when Cummings accepted a rural family medicine residency in tiny Winnemucca, Nev., recruitment emails began piling up in his email inbox, sometimes as many as 20 each day.

“Be the STAR of a Midwest waterfront community with 252K proven income!”

“Have a great job and a great life. Less than two hours from Tallahassee! 300K earning potential.”

KLMNO WEEKLY

“280K in small-town Minnesota with easy commute. Two songs on the radio and you’re at work!”

“Have you ever dreamed of immersing yourself in the stunning panoramic views of the Alaskan Ranges and Northern Lights? 50K signing bonus and 33 paid days off each year.”

“Ozark town with nearby symphony orchestra, wineries, and museums. Ask about our 3-day work week!”

What Van Horn offered was a three-year contract with $300,000 guaranteed for the first year, which was about 50 percent more than Cummings could have earned in a big city. He wanted to practice in a small town where he could get to know his patients. His wife liked the nearby mountains. They would be close enough to drive back to Central Texas to visit family. The federal government would forgive much of his student debt as a reward for his working in a medically underserved area. Van Horn had sealed the deal with a $5,000 signing bonus and a $3,000 monthly stipend during the final year of his residency.

One of the other reasons Cummings had chosen Van Horn was that there was another doctor in the office down the hall. He had never practiced without a supervising physician, and he didn’t want to start his career as the area’s only doctor.

“Got a minute, doc?” he asked, as he knocked on Garner’s open door and Garner motioned him in. They had met during Cummings’s interview, but they had spoken only a few times in the months since.

“They treating you okay?” Garner asked.

“You bet,” Cummings said. “But I’m tired of paperwork. I’m ready to get started.”

He said he needed to take an emergency medicine course later in the fall before he would be allowed to treat patients on his own in the ER, but in the meantime, he hoped to shadow Garner during a few overnight shifts.

“I’ll probably have questions,” Cummings said.

“Ask anything,” Gardner said. “Nobody wants this to work out more than me.”

So Cummings decided to ask a question that had been on his mind ever since he landed at the airport in El Paso and began driving into the empty desert and out toward Van Horn.

“I know you see it all out here,” Cummings said. “How do you deal with being on your own?”

“Reps, experience,” Garner said. He shrugged. “I’m not sure I’ve gotten totally comfortable with it yet.”

Cummings thought for a moment. Even during his residency in tiny Winnemucca, population 7,400, he had worked with a medical team of emergency physicians, hospitalists and general surgeons. Once he started in Van Horn, he would eventually become the only doctor on call.

“So what do you do?” Cummings asked.

“Mostly try not to think about it,” Garner said. “You operate in denial. You treat one patient and move on to the next.” n

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KLMNO WEEKLY

HEALTH

How to live to a ripe (and fit) age More sleep and exercise, a better diet, and less stress are keys to longevity

BY

C HRISTIE A SCHWANDEN

S

o you want to live to a healthy old age. But how?

You could start doing push-ups. A study published in February found that men who can hammer out 40 push-ups in one session had a lower risk of heart attacks and cardiovascular disease compared with guys who could do only 10 or fewer.

Or you could practice going from sitting on the floor to standing. Another study concluded that how easily people over 50 can do that is a good predictor of how long they might live.

Perhaps you want to work on your grip strength. That’s another measure that tracks longevity in middle-aged folks.

And if none of those appeal, you could always try improving your walking speed, which researchers have used to predict mortality rates in older adults.

The problem with any of these approaches is that you would just be training for a particular test, which misses the point. It’s not the push-up itself that makes you live longer; it’s that you are still strong and nimble enough to execute one.

What these tests have in common is they’re good shorthand of things that matter for longevity: overall health, fitness and muscle strength. A fit person walks faster than someone out of shape, and getting up off the floor is tricky for people with weak bones and muscles.

“Frailty is a really bad thing starting in middle age, and even worse as you get older,” says Michael Joyner, a physician and human physiology researcher at the Mayo Clinic.

One way to think of longevity is “not as some magic property of a body, but as the lucky state of not having a fatal disease,” says Steve Cole, professor of medicine and psychiatry and biobehavioral sciences at the UCLA School of Medicine. “By and large, people don’t die of being old; they die of disease.” Therefore, the study of

ILLUSTRATIONS BY MATTHEW RICHARDSON FOR THE WASHINGTON POST

longevity is a way of looking at disease risk or the rate of disease development, he says.

Over the years, various drugs and nutritional supplements have been studied for their potential to help us live longer, but nothing has been shown to work in humans to the extent that would be required for the Food and Drug Administration’s approval, says Gordon Lithgow, chief academic officer at the California-based Buck Institute for Research on Aging.

While researchers continue searching for a pill to extend life, you’ll have to try these verified methods.

Exercise is key The most powerful way to promote longevity and improve your long-term health is also simple and, depending on how you do it, free.

“There’s no question that exercise is the biggest anti-aging medicine there’s ever going to be — it’s really huge,” Lithgow says.

“Hands down, nothing com-

pares to exercise,” says Laura L. Carstensen, founding director of the Stanford Center on Longevity. “The great thing is that most people can do it, and you don’t need 10,000 steps per day to get the benefits.” It takes remarkably little exercise to get longevity benefits.

Even 10 to 15 minutes per day provides measurable rewards, says Michael Joyner, a physician and human physiology researcher at the Mayo Clinic.

Going from sedentary to even just a bit of exercise is where you get the biggest payoffs. The health benefits — such as reducing your risk of heart disease and diabetes — increase with greater amounts of exercise, until you get to about an hour of exercise per day. After that, the rewards start to level off.

“Almost anyone doing more than that is doing it for things other than health,” Joyner says.

Go ahead and train for that Ironman if that’s what you want, but if you’re exercising for health and longevity, you don’t need to run a marathon. Work by Iowa

State University epidemiologist Duck-Chul Lee suggests that even running a little less than 10 minutes per day could decrease your mortality risk by about 30 percent.

But you don’t have to run.

Walking or other moderate activities are just as good if you’re looking for a longevity boost.

Some of the early evidence for the heart benefits of moderate exercise came from studies in the 1950s by British epidemiologist Jeremy N. Morris showing that conductors on double-decker buses, who spent their shifts walking up and down, had lower rates of coronary heart disease and thus lived longer than bus drivers who spent their workday sitting. Since then, studies showing the cardiovascular benefits of exercise have been “incredibly consistent,” Joyner says.

But there’s more. Physical activity also reduces the risk of diabetes, which one study found cut six years off life expectancy.

Get enough sleep Extend your life span while you sleep. It sounds like a bad infomercial, but it turns out that sleeping well is a good way to keep your body healthy for the long haul. Sleep is a time when your brain gets caught up on maintenance. In 2013, a team led by Maiken Nedergaard at the University of Rochester Medical Center published a study in Science concluding that sleep helps the brain clear out metabolic waste that accumulated during waking hours, providing a kind of restorative maintenance.

Skimp on sleep, and you hinder this important work.

If you’ve ever missed a night of slumber, you know that sleep deprivation hampers your mood and makes it hard to think clearly, but it can have severe consequences for your metabolic health, as well. Take someone who needs seven hours of sleep per night and restrict them to only five hours of shut-eye for five nights and they experience

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HEALTH metabolic changes that look a lot like diabetes, says Satchidananda Panda, who studies circadian biology at the Salk Institute for Biological Studies.

Eat right Forget all those headlines you’ve seen about “anti-aging diets” and anti-aging “superfoods.”

“These notions are generally not supported by science,” Lithgow says. That’s not to say diet isn’t important, only that “nutrition is just a very difficult science,” he says.

Severely restricting calories in lab animals makes them live longer, but “it’s not clear that it works in humans,” Lithgow says.

Although there’s plenty of evidence that it’s not good to overeat, he says, whether drastically limiting food intake can extend life in people remains an open question.

What does seem clear, however, is that metabolic health is important for long-term health, because it keeps diabetes in check and that insulin sensitivity in particular appears crucial.

Given what we know right now, a Mediterranean diet — with its heart-healthy emphasis on fish, vegetables, fruits, nuts, healthy fats like olive oil, whole grains and limited consumption of red meat — “is probably the best approach for improving longevity,” Carstensen says.

But the benefits are pretty modest. If you hate eating that way, then the payoff probably won’t feel worth it to you, she says. At least try to eat a diet rich in fruits and vegetables.

Drink alcohol in moderation The idea of red wine as a health elixir became popular in the 1980s with the observation that

rates of coronary heart disease were low in France, despite the predominance of a diet relatively high in fat and cholesterol.

The French penchant for a glass of red wine with dinner was proposed as an explanation for this “French Paradox,” popularizing the notion of red wine as heart helper.

Subsequent studies have indeed found that moderate alcohol consumption may reduce the risk of coronary heart disease, and a two-year randomized clinical trial in Israel showed that people with Type 2 diabetes who were assigned to drink a glass of red wine with dinner every night experienced some improvements in blood markers associated with cardiovascular disease risk.

But other studies suggest that alcohol may raise the risk of many cancers, and a report published last year in the journal Lancet concluded that there’s no amount of alcohol that improves health. What gives?

“Alcohol studies are very much like nutrition studies — based almost exclusively on self-reports, and we know that people are really bad at self-reporting,” Carstensen says.

“Most people, when they say they’re drinking two drinks per day, are probably consuming more. We don’t know the amounts that people are consuming nor do we know what else they do.”

There’s some evidence that people who abstain from alcohol are sicker or less healthy than those who imbibe a little.

“That probably reflects not a lack of alcohol in their system, but something about their world — that they’re sick or isolated or don’t have friends to meet at the pub,” Carstensen says. “I’ve never seen a study that’s really controlled for all of those factors.” Which means that the studies calculating the health consequences of alcohol consumption depend on consumption figures that are inherently unreliable and may fail to account for other factors that could be at play.

Drinking to excess — more than one or two drinks a day — is unhealthy, and will take a toll on your longevity — no doubt about it. But taking the published studies together, “I don’t

think we have a lot of evidence that moderate alcohol is bad for you,” Carstensen says. At the same time, she’d “be very hesitant to recommend that people who don’t drink should start.”

Manage stress In today’s world, it’s easy to live in a state of chronic stress, and the problem isn’t just that stress feels lousy. It also makes you more susceptible to diseases that could shorten your life.

Researchers are now learning that many conditions associated with older age — such as cancer, heart attacks and Alzheimer’s disease — share a common ingredient: inflammation.

Under normal conditions, inflammation is simply the body’s response to injury — it’s how the body heals cuts and wounds and other insults, Cole says.

“Inflammation by itself is not inherently evil.” But when we’re feeling chronically threatened or under siege, our bodies amp up their inflammatory machinery to ready our biological response to injury, and that inadvertently fuels the development of an array of age-related diseases, where inflammation is a common fertilizer, Cole says.

Research has identified chronic stresses that can provoke harmful biological changes, including living in poverty, caregiving for a dying spouse, losing a loved one, suffering post-traumatic stress disorder, and experiencing prejudice.

Your chance of developing chronic inflammation also rises with the passing years. “Inflammation seems to be a general sign of aging, where our inflammatory processes are being turned on or accumulated,” Lithgow says.

What’s the antidote?

“Obviously we should all just be happy,” Cole says with a laugh, as if it were that easy. He knows that it’s not and says you probably can’t eliminate stress from your life, but you can find ways to manage it. Identify the recurring stressors in your life, and work on a plan to diffuse them.

Connect with people, have a purpose Forging connections with other people has been found to be a powerful way to manage stress and improve your overall wellbeing.

“People who report having stronger relationships live longer than people who are socially isolated,” Carstensen says. A me-

ta-analysis published in 2015 calculated that loneliness and social isolation were associated with 29 percent and 26 percent increases in mortality risk, respectively, and living alone was linked to a 32 percent increase risk of dying.

What’s clear is that people who have a strong sense of purpose and meaning in their lives have a markedly lower risk of death than those who don’t.

Centenarians tend to have a sense of purpose in their lives.

“It’s really important that people who are entering the later phases of life have a clear purpose, something to get up for everyday,” Lithgow says.

That thing can be anything from looking after a grandchild or working or tending a garden.

Many centenarians continued working into their 80s, 90s and beyond, Lithgow says, and usually these jobs are in environments where they interact with younger people. Interacting with other generations can keep older people engaged.n

KLMNO WEEKLY

“It’s really important that people who are entering the later phases of life have a clear purpose.”

Gordon Lithgow, chief academic officer at the Buck Institute for Research on Aging

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KLMNO WEEKLY

BOOKS

The grit and glam of a punk legend N ONFICTION

l

REVIEWED BY

S IBBIE O ’ S ULLIVAN

E FACE IT

By Debbie Harry Dey Street.

352 pp. $32.50

ven if Debbie Harry, of the band Blondie, isn’t to your taste — her voice too thin, her sexiness too blatant, her music too smooth — you can’t dismiss certain truths about her.

She paid her dues; her ambition never waned; and she was there, there being New York in the late ’60s and ’70s — a city full of garbage, rent-controlled apartments, and men and women discovering new ways of making art and music.

In her new memoir, “Face It,” Harry describes a life formed by the desire that, one way or another, she would leave suburbia and become a performer, a desire she shared with Patti Smith, Stevie Nicks and Chrissie Hynde, three other women who influenced post-’60s music. That Harry succeeded is a tribute to her ambition, perseverance, talent and good looks.

The book opens with her heartrending origin story. Harry’s mother gave her up for adoption, reluctantly, in 1945, when Harry — whose given name was Angela Tremble — was 3 months old.

Harry was raised in Hawthorne, N.J., by Richard and Cathy Harry in a migrant worker’s house near a park, where Harry spent most of her free time on her own, daydreaming — a tomboy who loved to play in the woods with her dog, Pal. Seeing a show at Radio City Music Hall piqued her interest in becoming a stage performer. By age 20 Harry was living in the East Village, on St. Marks Place, where, listening to the sounds of the city, she felt like she was “in the place where my next life would begin.” And so it did.

Harry quickly took to the artistically combustible downtown scene, watching acts like the Velvet Underground and Janis Joplin, and playing “anti-music music” with a fellow who called himself Charlie Nothing. She befriended street people and later the drag queen Divine. Ditching

DENNIS MCGUIRE

Debbie Harry found success with her band Blondie in New York’s music scene of the 1970s and 1980s.

her secretarial job at the BBC to work in a head shop, Harry navigated the edges of new sensibilities. She had a hookup with an Andy Warhol protege in a phone booth in Max’s Kansas City and began what she blithely calls “chipping and dipping” in heroin.

The chapters about the New York scene and Harry’s early adventures making music are the most compelling parts of the book. We’re in her environment — smelling the garbage piled up on the street, trolling the sidewalks for discarded clothing, stepping over drunks on the Bowery. Life was DIY. Nothing seemed to faze her.

There were loft fires and relocations, and she once was raped at knife point: “I can’t say that I felt a lot of fear,” she writes of the experience. “I’m very glad this happened before AIDS or I might have freaked.” In these chapters, Harry is introspective, as she writes about death, time and the serendipitous, sometimes hazardous life she was living.

In 1974, she and her lover, guitarist Chris Stein, founded Blondie. After playing in New York’s punk scene, the group gradually rose to stardom and soon toured with Iggy Pop, David Bowie and Television. By 1979, Blondie’s song “Heart of Glass” was No. 1 on the American charts, and the band’s popularity blossomed. Unfortunately, fame can make for a rather dull narrative. Once Harry digs into Blondie’s heyday, the book suffers in ways other rock memoirs often do — rehashing the next album, the next tour and so on.

More engaging is Harry’s effort to categorize her music, which she calls a “crossover between glitter-glam and punk.” She’s reluctant to name disco as an obvious influence, instead insistently aligning herself with punk. But she was familiar with disco — music favored by the drag queens she watched in underground clubs. She also loved drag’s performative qualities, especially its attention to fashion and gesture, two practices Harry perfected

while shaping her own image.

Her commentary on the sexual politics of the music scene of her time are insightful. Rock, she writes, “was a very masculine business in the mid-seventies.”

Patti Smith “dressed more masculine … my approach was different. . . . I was playing up the idea of being a very feminine woman while fronting a male rock band in a highly macho game. I was saying things in the songs that female singers didn’t really say back then.”

Readers, both familiar and unfamiliar with Harry’s career, will enjoy this memoir. Harry was a young woman who fell under the spell of New York and made herself into the performer she always knew she would become, one who went on to cast her own spell on millions of listeners. n O’Sullivan is a former teacher in the Honors College at the University of Maryland. Her book of essays about John Lennon is forthcoming from Mad Creek Books.

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SUNDAY, October, 6, 2019 20

KLMNO WEEKLY

OPINIONS

Jamal Khashoggi’s horrifying final moments DAVID IGNATIUS writes a twice-weekly foreign affairs column for The Washington Post.

At 1:14 on the afternoon of Oct. 2, 2018, a special­ operations team waiting for Jamal Khashoggi at the Saudi Consulate in Istanbul was told he had arrived. Just 25 minutes later, the Post contributing columnist was dead, and a noise that Turkish authorities later described as a bone saw could be heard. ¶ A year after Khashoggi’s killing, Saudi Arabia still hasn’t provided a clear explanation of what happened. But Saudi, U.S. and European sources, amplifying a June report by U.N. investigator Agnes Callamard, helped reconstruct the events leading to the shocking murder of Khashoggi, my colleague and friend.

The Saudi prosecution of this crime remains “episodic, haphazard and ad hoc,” a State Department official told me, but most of the facts are hiding in plain sight. This is a murder story that hasn’t died for a simple reason: It describes a macabre plot by Saudi Crown Prince Mohammed bin Salman and Saud al-Qahtani, his media and covert-operations adviser in the royal court, to silence a brave critic.

MBS, as the crown prince is known, has offered a general statement of responsibility. “It happened under my watch. I get all the responsibility, because it happened under my watch,” he told Martin Smith of PBS in a December interview that was released a few weeks ago. He gave a similar interview to CBS’s “60 Minutes” that was broadcast this past Sunday.

What happened on the way to Khashoggi’s horrifying final seconds? The journalist’s criticisms had angered MBS and Qahtani for more than a year, and U.S. and Saudi sources say the two began talking in 2017 about ways to muzzle him. But the operation that led to his murder in Istanbul began Sept.

28, 2018, when Khashoggi first visited the consulate there to inquire about legal arrangements for marrying his Turkish fiancee.

MBS’s team moved quickly.

The afternoon of Sept. 28, according to Callamard’s report, a Saudi security officer in Istanbul called Maher Mutreb, an intelligence officer who worked for the crown prince and Qahtani. The security officer explained that Khashoggi would return to Istanbul on Oct. 2 to complete his paperwork, providing a fortuitous opportunity to confront “one of the people sought” in Qahtani’s campaign against dissenters.

Later that evening, the consul general in Istanbul talked with a colleague in Riyadh who told him that a “top secret mission” was underway, Callamard reported, based on a recording of the call.

The formal order for the Istanbul operation came from Gen. Ahmed al-Assiri, deputy chief of Saudi intelligence. Assiri told the Saudi court on Jan. 31 that “he had ordered the team to convince Mr. Khashoggi to return to Saudi Arabia, but had never ordered the use of force,” Callamard wrote.

BRIAN STAUFFER FOR THE WASHINGTON POST

The authorization to kill Khashoggi, if that became necessary, came in a second order, from Qahtani, a Saudi source with contacts in MBS’s palace told me. The Saudi prosecutor himself has alleged that Qahtani “met with the ‘negotiation’ team in advance of the mission and sought Mr. Khashoggi’s return, saying that he was a ‘threat to national security,’” according to the U.N. report. But Qahtani has ignored the Saudi prosecutor’s request to testify, the Saudi source said.

Mutreb and his team arrived in Istanbul on a private jet from Riyadh at 3:30 a.m. on Oct. 2.

Drafted at the last minute was Dr. Salah Tubaigy, a forensic expert who had experience dissecting bodies. After checking into their hotel, the team went to the consulate to wait.

In the hour before Khashoggi’s arrival, Mutreb and Tubaigy talked about what they would do.

A book by Turkish journalists who have reviewed consulate surveillance tapes says Mutreb advised: “We will first tell him that we are taking him to Riyadh.

If he fails to comply, we will kill him here and get rid of the body,” according to an English translation.

A grisly discussion followed in which Tubaigy explained the dissection and disposal: “Joints will be separated … If we take plastic bags and cut it into pieces, it will be finished,” Callamard wrote, quoting the tape.

“We will have to take you back,” Mutreb told Khashoggi when he arrived, according to the tape. He ordered Khashoggi to text his son Salah in the kingdom to say that he would be away for a while. Khashoggi refused, and Mutreb warned him: “If you don’t help us you know what will happen in the end.”

Khashoggi refused to go quietly. “Are you going to give me drugs?” he protested. Then the tape records a conversation turning to struggle, perhaps as he’s being sedated. Someone asks, “Did he sleep?” and a voice urges, “Keep pushing.” There’s a gasping sound, probably after a bag is placed over Khashoggi’s head, then silence. And then the sound of bones being cut.

What does Qahtani say about whether the crown prince authorized these actions? We don’t know, because he has never been compelled to testify in the Saudi trial; Qahtani was fired from his job in the royal court, but a U.S. official says he lives comfortably and continues to advise some of his former colleagues. MBS, embraced by President Trump, travels the world as if the murder never happened.

But perhaps we can be guided by a Twitter message that Qahtani sent back in August 2017 when questioned about his activities: “I am a trustworthy employee who carries out the orders of my boss.” n

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SUNDAY, October, 6, 2019

THE 2019-20

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