The Washington Post National Weekly - September 24, 2017

SUNDAY, SEPTEMBER 24, 2017

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Children under ďŹ re Almost two dozen kids are shot every day in the U.S. This 4-year-old was one of them. PAGE 12

Politics Shift in clients at Trump clubs 4

World Stability is key for Merkel 11

5 Myths Hurricanes 23

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KLMNO WEEKLY

POWERPOST

Why the rush on health care?

BY

E LISE V IEBECK

S

enate Republicans’ latest effort to kill Obamacare has been nothing if not abrupt.

Think about it: Two weeks ago, Sens.

Bill Cassidy (R-La.) and Lindsey O. Graham (R-S.C.) hadn’t formally announced their bill devolving federal health-care spending to the states. Even when they did, congressional news led with President Trump’s talks with Democratic leaders on protecting undocumented immigrants. A sudden GOP gambit on health care seemed like a remote possibility, at best.

That all changed over last weekend when Republican leaders, pushed by conservatives to more seriously reckon with the possibility that they would not achieve their party’s central policy goal, began to take a closer look at the Cassidy-Graham bill. And now, they face the challenge of persuading 50 people in the Senate to support it before the end of the month, which would set the stage for Vice President Pence to cast the tiebreaking vote.

There are many questions surrounding this process. But the timing is perhaps the chief source of confusion among congressional observers. Why is it necessary to pass the healthcare bill by Oct. 1?

The answer lies in a combination of Republican legislative strategy, arcane Senate procedure and ordinary partisan divisions.

But it boils down to the fact that on Oct. 1, the number of votes needed to pass Cassidy-Graham will rise above the number of Republicans in the Senate, effectively blocking the bill’s path.

Here’s one way to think about it.

The Senate has until Sept. 30 to approve Cassidy-Graham with a simple majority of votes rather than the usual 60 needed for most

KLMNO WEEKLY

legislation. This creates a valuable opportunity for the GOP and its slim, 52-seat Senate majority. From now until the end of the month, Senate Republicans can approve legislation fulfilling one of their most controversial priorities without a single Democratic vote.

Of course, uniting 50 Republicans is hardly simple thanks to divisions within the party, and it’s still unclear whether GOP leaders can

MICHAEL REYNOLDS/EUROPEAN PRESSPHOTO AGENCY/EFE

“We would have to act before Sept. 30,” Senate Majority Leader Mitch McConnell (RKy.) has said of the Cassidy-Graham bill.

do it for Cassidy-Graham in time to meet the deadline. That, coupled with seven years of Republican commitments to repeal the health-care law, is why pressure on the leaders is so high.

“If we were going to go forward, we would have to act before Sept. 30,” Senate Majority Leader Mitch McConnell (R-Ky.) said Tuesday at a news conference. “We’re in the process of discussing all of this. Everybody knows that the opportunity expires at the end of the month.”

This publication was prepared by editors at The Washington Post for printing and distribution by our partner publications across the country. All articles and columns have previously appeared in The Post or on washingtonpost.com and have been edited to fit this format. For questions or comments regarding content, please e-mail weekly@washpost.com. If you have a question about printing quality, wish to subscribe, or would like to place a hold on delivery, please contact your local newspaper’s circulation department. © 2017 The Washington Post / Year 3, No. 50

McConnell and other Republicans can thank themselves for the deadline, which arose from their effort to pass health-care legislation without Democratic votes.

This is where the arcane Senate procedure comes in. The Sept. 30 deadline exists because of a process known as budget reconciliation, which allows some fiscal measures to pass without the usual 60 votes. Republicans set this process in motion at the beginning of the year, when they passed a budget bill that included instructions for two committees to begin work on health-care legislation with the goal of saving federal revenue. By giving the health-care effort a fiscal goal, GOP leaders qualified that legislation to be passed by a simple majority.

But those instructions expire at the end of the fiscal year that’s covered under the budget bill. Senators could always write new instructions into their next budget, but they were planning to use that opportunity to direct a different legislative priority — tax cuts. Conventional Senate wisdom dictates that the chamber may consider only one legislative priority at a time under reconciliation.

Republicans would prefer to face no deadline at all. But these hopes were dashed on Sept. 1, when the Senate parliamentarian, who helps interpret the chamber’s mind-bending rules, said the GOP’s “reconciliation instructions” would end Sept. 30, the last day of the fiscal year.

Graham urged Republicans to try again if his bill doesn’t pass.

“At the end of the day, will we try again? I would argue that yes, we should. I don’t want to go back to South Carolina and say I did everything I could do to repeal Obamacare and not believe it in my heart,” he said Tuesday. n © The Washington Post

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

4 8 10 12 16 18 20 23

ON THE COVER Carter Hill, 4, underwent surgery after being shot in an Aug. 6 road-rage incident. On average, 23 children were shot each day in the United States in 2015. Photograph by RICKY CARIOTI, The Washington Post

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POLITICS

Reshaping a key Trump business

BY D AVID A . F AHRENTHOLD, A MY B RITTAIN AND M ATEA G OLD

F

or two years, a shelter for victims of domestic violence called Safe+Sound Somerset held its fundraiser golf tournament at Trump National Golf Club in Bedminster, N.J. They loved it.

Then they quit it.

“Beautiful golf course. Beautiful facilities. We were treated well. But we couldn’t go back,” said Debbie Haroldsen, the charity’s acting executive director.

President Trump’s campaign-trail comments about women and Mexicans offended staff and clients. They found another course.

In Florida this year, the president’s politics attracted a new client for one of his businesses.

Steven M. Alembik, a conservative activist, is planning a $600per-seat gala at Mar-a-Lago Club.

His logic: Trump helped Israel.

So Alembik will help Trump.

“He’s got Israel’s back,” Alembik said. “We’ve got his back.’”

Trump’s divisive political career is reshaping a key — and previously apolitical — part of his business empire.

Trump-owned hotels and clubs have long made money by holding galas and other special events.

Now, their clientele is changing.

Trump’s properties are attracting customers who want something from him or his government.

But they’re losing the kind of customers the business was built on: nonpolitical groups who just wanted to rent a room.

This summer, 19 charities canceled upcoming events at Mar-aLago — a major blow to that club’s business — after the president said there were “fine people” among white supremacists, neoNazis and members of the altright protesting to preserve a Confederate statue in Charlottesville, Va. Dozens of other clients have left since Trump entered the 2016 presidential race.

A week ago came the latest cancellation: A triathlon for charity at Trump’s Charlotte golf

ALEX BRANDON/ASSOCIATED PRESS

Hotels and clubs lose nonpolitical clients, gain those with agendas course, called “Tri at the Trump,” was abruptly scrapped. Sign-ups were down, the organizer said, due to concerns over the name.

For the Trump Organization, a potentially troubling trend is emerging.

Before this year, many longtime Trump clients said they would return to use his clubs again — believing that quitting a Trump club would be a political act. Now, as Trump’s presidency has grown more polarizing, some customers say they see it as a political act to stay.

“We are not a political organization,” said Mike Levin, whose charity Harlem Lacrosse this year moved its golf tournament away from a Trump course in New York, after going there for two prior years. “Given the current political environment, we opted to reschedule for a different course.”

In all, Trump owns 12 golf courses in the United States — 11

on the East Coast, and one outside Los Angeles. He owns at least a partial stake in four hotels, in Washington, Chicago, Las Vegas and New York’s SoHo. And he owns Mar-a-Lago and a winery resort outside Charlottesville.

To assess the state of Trump’s hospitality business, The Washington Post reviewed public records, data released by the Trump Organization and social-media postings from Trump properties.

The Post identified a sample of more than 200 groups that had rented out rooms or golf courses at a Trump property since 2014.

Of those groups, 85 are no longer Trump customers. Many said they left for nonpolitical reasons. But 30 told The Post that they had left because of Trump’s political career.

The Post provided its findings to the Trump Organization, which declined to answer questions. A White House spokeswoman de-

This summer, 19 charities canceled events at Mar-a-Lago over controversial remarks the president made after the violent Charlottesville, Va., protests. Dozens of other clients have left Mar-a-Lago since Trump entered the 2016 presidential race.

clined to comment, referring questions to the Trump Organization.

The Post’s review could not determine if the Trump Organization’s special-event business is growing or shrinking overall.

But it did show, clearly, that one part of that business is thriving: political events.

For instance, in the 2014 election cycle, before Trump jumped into the presidential race, nine federal Republican candidates and committees reported patronizing Trump-owned properties.

Altogether, these groups spent $32,499 over two years, less than the clubs could take in from a run-of-the-mill golf tournament.

This year, figures are different.

At least 27 federal political committees — including Trump’s reelection campaign — have flocked to his properties. They’ve spent $363,701 in just seven months, according to campaign-

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POLITICS finance reports. In addition, the Republican Governors Association paid more than $408,000 to hold an event this spring at the Trump National Doral golf resort, according to tax filings, a gathering the group said was booked back in February 2015.

At Trump’s D.C. hotel, there have also been a slew of events for groups that have come to Washington to influence policy.

Just this month, the hotel hosted the prime minister of Malaysia, who is the subject of a Justice Department corruption probe, as well as the Louisiana Association of Business and Industry, which wants more offshore drilling. The hotel was also scheduled to host an association of candy-makers, who want federal help in a feud with the sugar industry.

In July, a trade group representing e-cigarette makers and vape shop owners brought about 150 people to the hotel. They paid $285 per guest room. They also paid to rent a ballroom, and reserve the hotel’s Lincoln Library, though the vapers wouldn’t say how much they cost.

Ten days after the group checked out, it scored a victory.

An Obama-era regulation requiring stricter government oversight of e-cigarette products was put on hold by the Food and Drug Administration.

Tony Abboud, the executive director of the Vapor Technology Association, said in a recent interview that the FDA decision was based on the merits and unrelated to the group’s choice of venue.

He said the Trump hotel was chosen for convenience.

“We put this together very quickly,” he said.

When asked whether the Trump hotel event had influenced the FDA’s decision, an agency spokesman said that the announcement was the “culmination of months-long internal discussions” about how to reduce tobacco-related deaths.

Rentals from groups such as these helped Trump’s D.C. hotel surpass its revenue expectations.

Through the first four months of the year, the hotel turned a profit of $1.97 million, according to documents reported by The Post last month. Before the election, the company had projected it would lose $2.1 million in the same period, the documents show. The revenue from food and

Charity events scheduled at Mar-a-Lago Before President Trump’s controversial remarks about violent protests in Charlottesville, 25 events were scheduled at the club for the upcoming event season. The club is now on pace for its slowest season in at least nine years.

52 50 40 30

28

20

6

10 0

2008-09

Source: Washington Post reporting

beverage sales — which includes special events — was part of that surprising performance. It came in 37 percent above expectations.

Trump’s politics was a draw for Alembik, the conservative Israel backer who decided recently to hold an event at Mar-a-Lago, the president’s club in Palm Beach.

Alembik said he will charge $600 per ticket. He expects 700 guests. That’s $420,000. In theory, Alembik said, any leftover proceeds will go to an Israeli charity called The Truth About Israel.

But, Alembik said, Trump’s club will probably keep most of the money. He said he’d seen an estimate of the costs. He declined to say what the number was, but said: “My God, they’re expensive.”

“With what Mar-a-Lago charges,” he said, “I don’t think there’s going to be much left over.” Alembik was fine with the idea that he was putting money into the president’s pocket: “Yeah, and the other ones are taking money out of his pocket,” he said, meaning the groups that canceled.

Alembik’s event is unusual, in that he is explicit about using a ballroom rental as part of a political message to the president.

More broadly, however, many Trump clubs seem to be losing the customers that had been commonplace before.

That trend began in California in 2015, just after Trump said in his campaign announcement that Mexico was sending “rapists” to the United States. The L.A. Unified School District canceled a golf tournament. So did ESPN, the

2014-15

2017-18 THE WASHINGTON POST

PGA, the L.A. Galaxy soccer team and the Union Rescue Mission.

The Post counted 11 special events at Trump’s California course in 2014. Now, 10 are gone.

Those departures made news.

But at other clubs, clients were also quietly deciding to leave.

“A lot of the children that are in our program are immigrant children, [and] we didn’t want them to feel offended” by Trump’s comments about Mexicans, said Debra Green, of a youth-sports charity called Jeremy’s Heroes. For four years, her charity, named for a passenger who fought back against hijackers on Sept. 11, 2001, had booked Trump’s golf course in Colts Neck, N.J., for its charity fundraiser. But in 2016, the group didn’t return.

That meant about $50,000 in lost business for Trump’s club.

At Trump’s course in the Bronx, the drop is spelled out in figures provided to New York City, which owns the land under the course.

The city data shows that the revenue from “outings” — events where the course is rented out by outside groups — declined 30 percent from 2015 to 2016 and is headed down again this year.

Other courses appear to be experiencing declines.

In Westchester County, N.Y., 14 of the 21 clients that The Post identified in 2014 are now gone.

In Colts Neck, 11 of 17 are gone.

The losses included the Golf Classic of the Sisters of Mercy, a tournament that benefits retired nuns. “The sisters cannot participate in a political campaign or

support a specific candidate,” a spokeswoman wrote.

Most of those departing cited nonpolitical reasons for their decisions — such as the end of a contract, the price of the rental or a need for more event space.

For the Trump Organization, some clubs are doing better than others. At Trump’s course outside Charlotte — one of just three courses in counties Trump won in 2016 — a number of events have sprung up since 2014.

But even there, the Trump name can be a drag for the club’s customers.

Like the organizer of “Tri at the Trump.”

“A lot of people wouldn’t participate because of that,” said Chuck McAllister, who runs the triathlon, referring to the Trump name.

The triathlon had used that name for three prior years. This year was different. Participant numbers were far below the high of 325-plus, set before Trump won the GOP nomination.

McAllister initially tried to resolve the controversy, first reported by the Charlotte Observer, by changing the race’s name to Tri for Good.

That wasn’t enough.

“I had some people sign up.

And I had some people want out,” he told The Washington Post.

“Probably a pretty even split.”

Finally, he canceled the event.

The situation “became way [too] politicized,” McAllister wrote in an email response to questions.

The other week, at Trump’s club in the New Jersey suburbs of Philadelphia, there was a tournament that epitomized the old business model for his events business. A charity tied to the Philadelphia Flyers hockey team held a celebrity golf tournament, with players teeing off and then gathering for fancy food.

It was the seventh year in a row the Flyers’ charity had come there.

It might be the last.

“We’ve made the decision that we will explore other options” for 2018, said Scott Tharp, the president of the Flyers’ charity, the Ed Snider Youth Hockey Foundation.

He was worried about the tournament being seen as a political statement.

Next year, Tharp said, “It’s going to be very hard to replace this venue.” n ©The Washington Post

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At least 27 federal political committees have flocked to his properties this year.

They’ve spent $363,701 in just seven months, according to campaignfinance reports.

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POLITICS

‘You’ve got to go’ to Ala., Trump told

BY R OBERT C OSTA AND P HILIP R UCKER

P

resident Trump had formally given Sen. Luther Strange his “complete and total endorsement.” But recently, his advisers were deeply divided on whether the president should risk jetting to Alabama to prop up the Republican, who was trailing in his primary race behind a challenger who had become a darling to Trump’s base.

That prompted GOP establishment forces to wage an intense behind-the-scenes campaign to convince Trump that he could carry Strange across the finish line with an appearance in Alabama.

Private polls were circulated in the West Wing showing a more favorable race for Strange than public surveys — including one the U.S. Chamber of Commerce commissioned from Trump campaign pollster Tony Fabrizio, whose imprimatur Republicans thought could sway the president. A close ally of Senate Majority Leader Mitch McConnell (R-Ky.) briefed Trump and Vice President Pence on the contest. Jeff Roe, Strange’s top consultant, fed regular updates to Jared Kushner, the president’s son-in-law and senior adviser.

And Sen. Bob Corker — whose own relationship with Trump was frayed by a summer of curt criticism — paid a visit earlier this month to the Oval Office, where he delivered a blunt request at the end of a broader conversation.

“You’ve got to go,” the Tennessee Republican told Trump, according to people briefed on the exchange.

“We need you there.”

The last-minute push, detailed by several White House officials and other Republicans, resulted in Trump deciding to stage a rally with Strange on Friday, followed by Pence heading down Monday on the eve of Alabama’s runoff election.

For Trump, the gamble tests whether his voters will heed his call — or instead will back Roy S. Moore, a Bible-quoting former state Supreme Court justice who enjoys the support of former White House chief strategist Stephen K. Bannon and other prominent

MELINA MARA/THE WASHINGTON POST

GOP made major push to persuade president to make appearance for Sen. Luther Strange members of the Trump coalition.

Senate Republicans also see the Alabama primary as a political squall that could shape the 2018 midterm elections and test the president’s willingness to bolster endangered GOP incumbents.

The winding process of securing Trump’s trip to Huntsville, Ala., reveals the fragility of the bonds between the president and other leaders of his party, who are searching for ways to steer him into becoming their reliable standard-bearer in next year’s elections.

“It’s important to have both [Trump and Pence] send a strong message,” said Sen. Cory Gardner (Colo.), chairman of the National Republican Senatorial Committee.

White House Chief of Staff John F. Kelly, who has tried to control what information Trump receives about the Alabama race, was initially wary of the president appearing with a senator who might lose. He preferred Trump spend

his time on such policy initiatives as tax reform rather than rousing crowds at political rallies.

Senate Republicans, however, were unwilling to let the president turn his attention elsewhere. A Strange defeat, they worried, could prompt some GOP senators to retire to avoid facing the wrath of anti-establishment voters and the likes of Bannon’s Breitbart News.

Kelly, who came around to backing the rally, was also told by several senators that Republicans might be hesitant to fully back Trump’s agenda if they were uncertain about his support for them.

As Trump mulled his options, McConnell spoke with Trump, and Gardner encouraged his Senate Republican colleagues to tap their own political networks on behalf of Strange, associates said.

“It was a reminder to the conference,” Gardner said of his remarks, which were recounted by several attendees. “The race is a snapshot in time, so you don’t want to put too much weight into

Sen. Luther Strange (R-Ala.), right, received an endorsement from President Trump, but GOP establishment forces wanted the president to stage an appearance in Alabama for the senator, who was trailing in his primary race. Trump decided to go there Friday.

it, but it’s important.”

After Corker’s meeting with Trump, strategist Ward Baker briefed Trump and Pence by phone on the Alabama landscape. Baker advises the Senate Leadership Fund, a McConnell-aligned super PAC that has poured more than $8 million into Alabama to support Strange. Kelly, as well as legislative affairs director Marc Short and Pence chief of staff Nick Ayers, also participated, people familiar with the discussion said.

Kellyanne Conway, counselor to the president, said she impressed upon Trump how much power his visit could have in Alabama and reminded him that all five of the candidates he backed in special elections this year won.

“There’s nothing like the hum of Air Force One touching down so that the president can lend direct and personal support to a candidate he’s endorsed,” Conway said.

“We’re already five for five in special elections this year, and those contests were in very disparate geographic and demographic districts where the common denominator ended up being the president and vice president getting involved.”

The sales job began early in the summer. On a Monday night in July at the White House, GOP senators pressed Trump and Pence on Alabama while they gathered over dinner of lemon agnolotti and grilled rib-eye.

Following downbeat talk about the prospect of the party’s healthcare legislation and hearing colorful stories from Trump about his time in Paris, Sen. Richard C. Shelby (R-Ala.) implored Trump to make Strange’s victory a priority.

“I told him, ‘Luther has voted with you on a lot of things, and that matters if you’re president — and I’ve seen quite a few presidents,’ ” Shelby recalled. “We got into that and how the primary was important — very, very important.”

Strange, a former corporate lobbyist and state attorney general, was appointed to the Senate in February by then-Gov. Robert Bentley (R), taking the seat held for two decades by Attorney General Jeff Sessions, who had been a firebrand on Capitol Hill.

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POLITICS ANALYSIS Strange has been dogged by his link to Bentley, who resigned in April amid a sprawling ethics and sex scandal that ended with him pleading guilty to two misdemeanor charges related to covering up an alleged affair with his former aide.

Experts on Alabama politics in Trump’s administration were mostly sidelined in the president’s discussions about how to handle the primary campaign there. Sessions, who as attorney general is not supposed to engage in political talks, was not consulted. Deputy White House Chief of Staff Rick Dearborn, who previously served as Sessions’s chief of staff in the Senate, supported Strange but was not central to Trump’s decisionmaking, according to Republicans involved in the talks.

For Trump, the decision to back Strange last month and to head there was as much about personal motivations as party pressure. He has a romantic view of Alabama — where he drew some of his biggest and most enthusiastic crowds of the campaign — and a rapport with Strange has been a constant since the two men began talking months ago.

Trump, who sometimes talks about staffing the government like running a television show, sees the hulking, 6-foot-9 senator as out of central casting. The president likes that Strange “can fill a room, literally and figuratively,” one White House official said, and admiringly calls him “Big Luther.”

Their phone calls sometimes stretch for more than an hour.

More significantly, Trump sees Strange as one of his most dependable votes on Capitol Hill. Strange has told the president that “the Trump agenda is Alabama’s agenda” and has pledged his unconditional support, White House officials said.

In early August, Strange said that the president told him: “Look, you and I have something in common. We’re both new to Washington. You have a background of getting things done, so I’m going to support you.”

Strange said he replied, “A tweet would be a good start.”

Trump did just that hours later, tweeting the night of Aug. 8.

It was an endorsement that caught McConnell and other senior Republicans unaware and, momentarily, left them satisfied. n © The Washington Post

KLMNO WEEKLY

THE FIX

The White House sounds ready for war with Manafort A ARON B LAKE

Special counsel Robert S. Mueller III is clearly building a case against Paul Manafort, President Trump’s former top campaign aide. The inescapable conclusion from that is that he is hoping Manafort will cut a deal — that he’ll “flip” on Trump and spill whatever beans he might have to spill.

With that possibility looking increasingly real, the White House must figure out what its Manafort strategy is. How the administration handles the former Trump aide who might wind up

Mueller’s investigators have obtained from Manafort. In those emails, Manafort talks about setting up a briefing with a Russian oligarch who is close to Russian President Vladimir Putin. He also discusses his newfound high profile as a Trump strategist and asks an employee, “How do we use [this] to get whole?” — apparently referring to debts he believed he was owed but had been unable to collect.

The White House is now seizing on that latter email. In comments to Bloomberg’s Margaret Talev late Wednesday, White House lawyer Ty Cobb said, “It

being its worst enemy is perhaps the most intriguing personal subplot of the Hollywood drama that is the Russia investigation.

And if the initial response to the latest Manafort news is any indication, they’re preparing to fight Manafort head-on.

The Washington Post broke a big story Wednesday, publishing some contents of the emails

would be truly shocking” if Manafort “tried to monetize his relationship with the president.”

Those are pretty harsh words, and they seem to echo other sentiments that have leaked out of the White House about Manafort. Here’s how The Post’s team described views of Manafort on Wednesday: “Former campaign officials

BY

said that Manafort frequently told his campaign colleagues that assertions made about him by the press were specious. They also privately shared concerns about whether Manafort was always putting the candidate’s interests first.”

It all sounds a lot like a White House that is preparing to disown Manafort and to say that he was out for himself from Day One. That could, of course, help them argue that he’s not credible; they could say that he’s basically about to do whatever it takes to save his own hide and will say anything — the usual strategy for witnesses who cut deals with prosecutors.

But if there is still a chance that Manafort wouldn’t flip, alienating him at this point would seem to be counterproductive. Why ruffle the feathers of a guy who could wind up doing you real damage? Why not keep your powder dry until you know where Manafort stands and whether Mueller actually has the goods to indict him, as investigators have reportedly told Manafort they intend to do.

The comments seems to be more a threat than anything else.

The White House hasn’t attacked Manafort directly — Cobb uses the important if-it’s-true modifier — but they seem to be signaling that they are ready and willing to go to war if that becomes necessary. Turning against Trump won’t be without consequences, they seem to be saying.

But if the White House keeps up this combative tone on Manafort, it could signal that they are resigned to the idea that he is no longer their friend.

They’ve sought to downplay his work for the campaign before, and now they seem to be coming right out and questioning his character. That seems a pretty significant moment in this whole matter — and perhaps a sign of a historic clash to come. n

© The Washington Post

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NATION

Vermont changes doctors’ incentives C AROLYN Y . J OHNSON Enosburg Falls, Vt. BY

D

oug Greenwood lifted his shirt to let his doctor probe his belly, scarred from past surgeries, for tender spots. Searing abdominal pain had landed Greenwood in the emergency room a few weeks earlier, and he’d come for a follow-up visit to Cold Hollow Family Practice, a big red barnlike building perched on the edge of town.

After the appointment was over and his blood was drawn, Greenwood stayed for an entirely different exam: of his life. AnneMarie Lajoie, a nurse care coordinator, began to map out Greenwood’s financial resources, responsibilities, transportation options, food resources and social supports on a sheet of paper. A different picture began to emerge of the 58-year-old male patient recovering from diverticulitis: Greenwood had moved back home, without a car or steady work, to care for his mother, who suffered from dementia. He slept in a fishing shanty in the yard, with a baby monitor to keep tabs on his mother.

This more expansive checkup is part of a pioneering effort in this New England state to keep people healthy while simplifying the typical jumble of private and public insurers that pays for health care.

The underlying premise is simple: Reward doctors and hospitals financially when patients are healthy, not just when they come in sick.

It’s an idea that has been percolating through the health-care system in recent years, supported by the Affordable Care Act and changes to how Medicare pays for certain kinds of care, such as hip and knee replacements.

But Vermont is setting an ambitious goal of taking its alternative payment model statewide and applying it to 70 percent of insured state residents by 2022, which — if it works — could eventually lead to fundamental changes in how Americans pay

JACOB HANNAH FOR THE WASHINGTON POST

The state is pioneering a health-care experiment to reward hospitals when patients stay healthy for health care.

“You make your margin off of keeping people healthier, instead of doing more operations. This drastically changes you, from wanting to do more of a certain kind of surgery to wanting to prevent them,” said Stephen Leffler, chief population health and quality officer of the University of Vermont Health Network.

Making lump sum payments, instead of paying for each X-ray or checkup, changes the financial incentives for doctors. For example, spurring the state’s largest hospital system to invest in housing. Or creating more roles like Lajoie’s, focused on diagnosing problems with housing, transportation, food and other services that affect people’s well-being.

Critics, however, worry that it will create a powerful tier of middlemen charged with administering health-care payments without sufficient oversight.

Those middlemen are accountable care organizations, networks of hospitals and doctors that

work to coordinate care and can share in the rewards if providers are able to save health-care costs, but remain on the hook if costs run too high. In Vermont, the goal is to limit the growth in overall annual health-care spending to 3.5 percent each year.

It will put a new burden on primary care doctors to keep people healthy — potentially punishing providers financially for patients’ deep-rooted habits and behaviors. And the core idea of increasing outreach to high-risk patients, though sensible on its surface, may not control health spending; one study found the approach was unlikely to yield net savings.

“I think this kind of model could be very good if it’s implemented the right way. There’s a big question on whether it will be implemented the right way,” said Amy Cooper, executive director of HealthFirst, an association of independent physicians in Vermont.

The current initiative is Ver-

John Graves lives in a South Burlington, Vt., apartment building that is part of a program that provides housing for formerly homeless people. It also helps them obtain medical care.

mont’s second attempt to revolutionize health care. It was the first state in the country to embrace a government-financed universal health-care system but abandoned the plan in late 2014 because of concerns over costs.

To hear Al Gobeille, a restaurateur who became Vermont human services secretary, tell it, paying for insurance coverage is just one of the big problems facing the American health-care system. The other, even more complicated one is reducing the underlying cost — and that is what Vermont is trying to tackle.

In 2015, a health insurance plan cost a family $24,000 in premiums, Gobeille said, and by 2025, that is projected to grow to $42,000.

“There’s going to be a calamity.

No family is going to be able to afford that,” Gobeille said. “So it’s important to move to a system that aligns more closely to the growth of our economy.”

This year, 30,000 Medicaid patients — like Greenwood — have transitioned into the experimental model through a pilot run by the accountable care organization OneCare Vermont. The system uses software to flag people with complex medical needs and chronic health conditions and to coordinate care and support for those deemed at high risk. Instead of billing for each overnight stay or medical scan, hospitals receive an upfront monthly payment to manage the care for every patient assigned to them, and primary care practices receive payments to help with the outreach work.

“It’s creating a situation where the physicians and hospital leaders and other clinicians in Vermont feel like they have enough support and structure around them that they can fundamentally pursue changes in their clinical models and their business models,” said Andrew Garland, vice president of external affairs and client relations at BlueCross BlueShield of Vermont. “It has us all rowing in the same direction.” n © The Washington Post

SUNDAY, SEPTEMBER 24, 2017

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Mountain of Confederate controversy The future is fraught for Stone Mountain and its giant relief sculpture

S TEVE H ENDRIX Stone Mountain, Ga. BY

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f all the Confederate monuments under fire, few are more figuratively weighted — and literally fixed — than the 1,700-foot-high outcropping of granite outside Atlanta with carvings of Robert E. Lee, Thomas “Stonewall” Jackson and Jefferson Davis.

Covering more than 17,000 square feet of mountain and 40 feet deep in the crannies, the carving is reportedly the largest flat relief sculpture in the world.

Looming over a popular public park like a stone-age billboard, it was conceived by Southern Confederate groups a century ago, was the birthplace of the modern Ku Klux Klan and remains an icon for white supremacists.

Now, calls to remove what may be the planet’s largest Confederate monument have roiled Georgia’s gubernatorial election and sparked what could be the most complex of the hot-button Rebel memorial fights erupting across the country.

Stacey Abrams, the African American minority leader of the Georgia House of Representatives who is seeking the Democratic nomination for governor, last month declared the carving “a blight on our state” and called for its removal. Several Atlanta Democrats and the local NAACP joined her. Many Republicans and Southern heritage groups condemned her position as divisive.

“Instead of dividing Georgians with inflammatory rhetoric for political gain, we should work together to add to our history, not take from it,” Republican Lt. Gov. Casey Cagle (R), who is also running for governor, said in response to Abrams’s call.

Not every black leader has embraced the move to scrub the three horsemen from Stone Mountain.

Former Atlanta mayor and civil rights standout Andrew Young said sandblasting the mountain could amount to a damaging “refight” of the Civil War. And political observers are not sure how hot the issue will burn in a state that is

ATLANTA JOURNAL-CONSTITUTION

Sculptor Henry Augustus Lukeman, with his hand on the sculpture, inspects the head of Robert E. Lee at Stone Mountain in 1928.

growing younger and, slowly, more Democratic in recent years.

“For old-line Georgians, I think this will be a big thing,” said University of Georgia political science professor Charles Bullock.

“For younger ones, not so big.”

Whatever the politics, Stone Mountain will be different than in cities such as Baltimore and New Orleans, where statues have recently been spirited from their pedestals at night.

“This one can’t be moved,” said Emory University historian Joe Crespino, who has written extensively about Confederate memorials. “It’s the side of a mountain.

You either destroy it or leave it in place.”

While activists just want these carved-in-stone elegies to the Confederacy gone, scholars typically call for the statues to be shifted from places of honor to educational settings, with placards and curators telling stories of when and why they were erected.

At Stone Mountain, Crespino said he would like to see officials add signage detailing the full history of the art while also scrubbing the park of some of the more changeable tributes, such as the names of Robert E. Lee Boulevard and Jef-

ferson Davis Drive.

Before the 1,700-foot-high stone dome was a monument, it was a granite quarry that sent building blocks to structures such as the U.S. Capitol Building and the Panama Canal. In 1915, Helen Plane, a member of the United Daughters of the Confederacy, pushed for the southern face of Stone Mountain to be sculpted as a monument to white Southern heroes.

It was the same year that the long-defunct Ku Klux Klan announced its modern rebirth by burning a cross on the mountaintop. (The ceremony borrowed the ritual from the recent blockbuster film “Birth of a Nation.”)

The time was right for an eyepopping project. It was the beginning of the roadside tourism economy and the revisionist “Lost Cause” narrative movement, which sought to minimize preserving slavery and maximize Southern honor and state sovereignty as the reasons for war.

Plane gained quick support from both business people and Dixie apologists.

The first artist hired was Gutzon Borglum, who would go on to carve four U.S. presidents into

Mount Rushmore. He was only able to whittle a gigantic silhouette of Lee’s head into Stone Mountain before a money dispute chased him from the project in 1925. Sculptor Henry Augustus Lukeman took over. He scraped away Borglum’s Lee and started fresh on the three-horsemen design before funds ran out in 1928.

The carving stood untouched for 40 years. A few years after the Supreme Court’s decision in Brown v. Board of Education, Marvin Griffin, Georgia’s newly elected segregationist governor, purchased the mountain for about $2 million in state funds, according to New Georgia Encyclopedia. Griffin formed the Stone Mountain Memorial Association to govern the public park with private investments.

Almost immediately, against the backdrop of the massive resistance movement toward dismantling segregation, monument boosters began fundraising.

Workers were back on the scaffolding by 1964, this time using blow torches to chip away at the stone.

The area remained synonymous with Klan gatherings and white-supremacist activity for several years. But it was the surrounding outdoor amenities and a privately managed amusement park that began to draw the major crowds. There are busy trails, a golf course and a lakeside Marriott resort. A popular laser show plays to pop music each night across the face of the mountain.

Demographic changes in DeKalb County mean that a majority of visitors on any given day are African Americans or immigrants.

“Most people who come don’t seem to think about it at all,” said John Bankhead, spokesman for the Stone Mountain Memorial Association.

It’s not just the granite that guards the figures on Stone Mountain. A portion of a 2001 state law explicitly protects the carving from being “altered, removed, concealed, or obscured in any fashion . . . for all time.” n ©The Washington Post

SUNDAY, SEPTEMBER 24, 2017

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WORLD

Mexicans unite after deadly quake P AUL I MISON Mexico City BY

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n one of Mexico City’s trendiest streets, lined with art galleries, cafes and gourmet restaurants, taco vendor Luis Miguel Osorio and his wife and daughter worked rapidly Wednesday to serve food to the victims, volunteers and emergency workers crowded around a nearby apartment building that collapsed during Mexico’s deadliest earthquake in 32 years.

The site remained one of several crisis points around the capital as authorities and volunteers worked to locate the missing and rescue those still trapped beneath rubble a day after the temblor.

Authorities have reported a death toll in the hundreds in central and southern Mexico, with the largest number of fatalities in Mexico City.

Yet, in the space of 24 hours, a sense of terror shifted to a spirit of solidarity as friends, neighbors, relatives and often complete strangers came to one another’s aid, transcending Mexico’s usually rigid class divisions.

With many businesses closed, Osorio and his family, who have run a taco stand on Álvaro Óbregon street in the Roma neighborhood for 17 years, came out to support the rescue efforts with food, water and other supplies.

“The whole city was affected, and we’re part of the city, so we’re here to help,” he said. “What else were we going to do?”

Tuesday’s 7.1-magnitude earthquake, with an epicenter southeast of Mexico City in Puebla state, occurred 32 years to the day after the country’s worst temblor, which killed thousands in 1985, and 12 days after an 8.1-magnitude quake that rattled the capital and killed 98 people in southern Mexico.

Just days earlier, the wellheeled residents of Roma, located close to the city’s downtown, were depositing canned food, blankets and water at drop-off points for their compatriots affected by the earlier quake in some of Mexico’s

ALEJANDRO CEGARRA FOR THE WASHINGTON POST

Despite strict class divisions, citizens banded together to help find victims and offer aid poorest, most rural areas. Yet as Álvaro Obregón street filled with dust and debris, with one building toppled and many others damaged, these residents, too, became victims.

“It felt like the world was ending,” said Amanda Ramírez, 22, who lives close to a collapsed apartment building where people were still trapped beneath rubble.

Following emergency protocols, she abandoned her third-floor apartment when the quake hit, leaving behind everything except her keys, and descended a staircase that veered and contorted beneath her feet.

“There were moments as I went down the stairs in which I thought, ‘Will I make it out?’ ” she said.

Elsewhere in the neighborhood, windows were shattered and buildings rendered uninhabitable, forcing many to seek shel-

ter elsewhere.

Ramírez, a pharmacist, was able to escape her building unscathed and returned only to pack an overnight bag before traveling to her mother’s house across the city. With scores of people still trapped and rescue operations underway in various parts of the capital, many others were not so lucky.

Rescue efforts have been led by joint teams of federal, state and local officials, along with the military. But ordinary citizens have also come forward to help, sometimes producing unlikely friendships.

University student Amelia Lara, 21, comes from Gustavo A. Madero, one of Mexico City’s poorest districts, yet on Wednesday she found herself bandaging the wounds of lawyers and workers from Mexico’s financial district as she volunteered to provide

Volunteers pass buckets filled with water bottles Wednesday in Mexico City.

Tuesday’s 7.1magnitude earthquake was the nation’s deadliest in 32 years. “It felt like the world was ending,” one survivor said.

first aid.

“The conversations were interesting,” she said. “People were in shock, many were shaking and crying, so you just tried to take their minds off things, ask them about silly things.”

Mexico’s capital is one of the world’s largest cities and reflects the country’s huge gulf between rich and poor. While residents of Roma enjoy leafy green parks, European-style cafes and wellkept streets, many of the city’s less-fortunate citizens live in dusty slums on the edge of the metropolis, commuting to informal jobs in the wealthier neighborhoods.

As authorities barred many residents from returning to their homes because of structural damage, nearby Parque Mexico became a makeshift campsite where people grouped together, alert to the possibility of aftershocks that might cause further destruction.

On Wednesday morning, the park was also a drop-off point for people wishing to donate blankets, water and other supplies.

The strong sense of solidarity in a city known for its obnoxious drivers and rough edges — not to mention its social snobbiness — reflects Mexicans’ typically resilient sense of humor.

“These kinds of events bring the best out of Mexicans,” said Álvaro Jiménez, a middle-aged engineer who was volunteering in the rescue efforts. “We can fight each other like dogs when things are going well, but when somebody needs help, we band together.”

With cruel irony, the city had undergone a drill to commemorate the capital’s far more destructive 1985 earthquake just hours before the latest disaster occurred. And by Wednesday afternoon, there were fears that another building, six stories high, could topple in the Roma neighborhood.

“It’s mysterious and it’s tragic,” Jiménez said. “But you can’t do anything to stop it. You just do everything you can to help the people affected.” n ©The Washington Post

SUNDAY, SEPTEMBER 24, 2017

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Germany expected to reelect Merkel G RIFF W ITTE Wismar, Germany BY

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he skinheads were outside blowing their whistles, and President Trump was an ocean away threatening to “totally destroy” another country, when Angela Merkel stepped to the podium in this quietly prosperous seaside city to make her pitch to voters for another four years as Germany’s chancellor.

She would modestly increase tax cuts for working families. She would widen access to high-speed Internet in rural areas. She would keep talking to her fellow European leaders, even when it gets frustrating.

And oh by the way, she casually mentioned before shuffling off, she’d really appreciate your vote.

The speech, devoid of all rhetorical flourishes, lofty promises or cutting attacks, never elicited much applause from the hundreds of languid supporters arrayed before her. But by all measures, it was exactly what Germany wants to hear.

With the country casting ballots Sunday, and with the wider world convulsed by change, Merkel is on the cusp of something extraordinary: winning a fourth term in office with a campaign built on a promise to keep things more or less the same.

So how did she do it?

“Stability, stability, stability,” said Stefan Kornelius, a Merkel biographer. “She’s led Germany through 12 rather calm and prosperous years. The country, despite challenges from abroad, managed to escape all of these. People feel protected by her.”

But whether the low-key, incremental and reactive style of leadership that has served the 63-yearold so well in the past continues to work in her favor will be the question that defines her legacy — and helps to shape the West’s future.

Merkel shows no sign of changing, Kornelius said, with few hints of the sort of grand vision for Germany, Europe or the West that she has famously, and perhaps intentionally, eschewed.

AXEL SCHMIDT/REUTERS

In a turbulent world, the 63-year-old chancellor is likely to be rewarded for the country’s stability But the environment around her has been profoundly altered, with Trump’s election and the growing threat of despotism worldwide creating pressure on Merkel, and on Germany, to fill the void in defense of democracy.

“She’s one of the few out there with the guts to serve as a role model for Western ideals,” said Kornelius, a journalist with Munich’s Süddeutsche Zeitung. “The time is over when Germany can only react.”

Merkel, who decided to run for another term after Trump’s victory last November, was once expected to face a strong challenge from both left and right in this year’s vote. But her center-right Christian Democrats have led the polls by double digits for months, and victory is now considered all but assured.

The win would put her in rarefied company: Another term would allow her to equal the longest tenure for a post-war German chancellor, and defy the political gravity of a world in which leaders

who linger for a decade or more must choose between accepting inevitable defeat or employing authoritarian tactics to remain in power.

The mood in Wismar, a handsome, Gothic-brick port city of 13th century lineage that is tucked just inside the borders of the old East Germany, reflects how she’s managed to pull it off.

The city, with its industrial base of factories and shipbuilding, should be a heartland for the center-left Social Democrats (SPD). And on a local level, it is, with an SPD mayor.

But, the mayor said in an interview at city hall, there’s no denying that the politically ambidextrous and East German-raised Merkel is popular here — even if he’s a bit reluctant to admit it.

“She’s the mother of the nation,” said the mayor, Thomas Beyer.

When Merkel came to office, he said, the city was struggling with high unemployment and a declining population. A dozen years later, Wismar is thriving, with a de-

German Chancellor Angela Merkel has led the country for 12 years and is virtually ensured another victory.

mand for new schools, tourists thronging the cobblestone market square and hundreds of new jobs expected next year when a cruiseship builder moves into town.

Although Merkel alone doesn’t deserve credit for the renaissance, he said there’s no doubt her government has contributed.

“People want this to continue,” Beyer said, “There’s a great need for continuity. There’s a great need for security. And people feel now is not the time for experiments.”

That point was driven home for Wismar resident Petra Lemsky, 56, during a recent vacation to the United States.

“The atmosphere was really bad. The wages were really low,” said Lemsky, whose blond hair is cut in a Merkel-esque bowl and who subconsciously arranged her hands in the signature Merkel diamond as she spoke. “Germany is doing really well compared to America. I want it to stay that way.”

Once taken for granted, European tranquility has been rocked in recent years by a series of crises that have consumed much of Merkel’s attention — war in Ukraine, Greek debt, terrorist attacks and Brexit, to name but a few.

“One by one, she’s managed these crises quite well,” said Thomas Kleine-Brockhoff, director of the Berlin office of the German Marshall Fund. “But her legacy is that of a crisis manager.”

In her fourth and final term, he said, Merkel will be trying to fix what has made Europe so prone to crisis to begin with, including the “fair-weather construction” of the euro currency, the absence of a common European security strategy and the growing chasm between European Union members over the bloc’s basic mission.

“What is her vision? There’s a vision of an institutionally sound and stable Europe,” said KleineBrockhoff, who until recently was a top adviser to the German president. “If, through her incrementalism, she can be seen as someone who made sturdy and stable the European ship, that would certainly be a worthy legacy.” n © The Washington Post

COVER STORY

PHOTOS BY RICKY CARIOTI/THE WASHINGTON POST

‘DON’T LET MY SON DIE’ A bullet pierced 4-year-old Carter Hill’s skull just above his right temple and emerged from a hole in the center of his forehead. The shooting occurred Aug. 6 in what police would later call an incident of road rage.

BY JOHN WOODROW COX in Cleveland

T

he bullet exploded from the gun’s barrel, spiraling through cool night air toward a gray SUV’s back passenger-side window. Carter “Quis” Hill was perched in his car seat on the other side of the glass, and as it shattered all around him, the round burrowed into his head, an inch above the right temple.

From the boy’s hand slipped a bright-red plastic Spider-Man mask he’d gotten for his 4th birthday, nine days earlier.

A white Pontiac blew past, disappearing into the distance. Carter’s mother, Cecelia Hill, knew it was the same car that had been chasing them for three miles before someone inside fired eight shots at her 2004 Volkswagen in what police would call an extraordinary act of road rage.

Now she shoved her foot against the brake, squealing to a stop in the middle of Interstate 90. In the back seat, her son and daughter snapped forward against their taut seat belts. Carter’s 7-year-old sister, Dahalia

Bohles, looked over at him. Shards of glass speckled her dark hair, but she didn’t notice them at first.

“Mommy, Quis got blood on his head,” the second-grader said, then she reached over and began to wipe it away.

“Stop!” Hill screamed, turning to check on her son, who, just before midnight on Aug. 6, had become one of the nearly two dozen children shot — intentionally, accidentally or randomly — every day in the United States. What follows almost all of those incidents are frantic efforts to save the lives of kids wounded in homes and schools, on street corners and playgrounds, at movie theaters and shopping centers.

For Carter, his mother feared it might already be too late.

The bullet had driven through her boy’s skull and emerged from a hole in the center of his forehead. Blood trickled down over his eyes, along his nose, into his mouth.

“Mommy, Mommy,” he’d been shouting minutes earlier, as Hill had fled from the shooter, but now her irrepressible 36-pound

preschooler, with his plum cheeks, button nose and deeply curious brown eyes, was silent. He stared at her.

She faced forward and punched the gas, pushing the speedometer past 100 mph. Hill veered off an exit, stopped and leapt out of the car. She rushed to the other side and unbuckled her son, then wrapped him in both arms and collapsed to her knees.

“Help,” he heard her yell into the night, over and over, until a passing driver pulled up and called 911.

“Please don’t let my son die,” prayed Hill, a 27-year-old housekeeper at a medical clinic who had raised her kids mostly alone. She squeezed Carter against her chest.

Hill wished he would cry or scream or speak, even one word, because when Carter was happy, he chattered without pause about the most important things in his life: bananas, or “nanas,” which he could eat for any meal of the day; growing up to be the Hulk, because smashing things sounded like the best job; his sister, who was Carter’s favorite friend, even though she wouldn’t let him play with her Barbies; fidget spinners, mostly because when his mom called them “finny” spinners, it made

him laugh so hard that he would hold his stomach and fall to the floor.

But there, bleeding into Hill’s blue work shirt while sirens drew closer, he still hadn’t said anything.

“Is my baby going to be all right?” she asked the paramedics in the ambulance as it sped to the hospital, but they didn’t answer.

C

arter was among the last children shot that day, a 24-hour stretch of gun violence that, according to police reports, left girls and boys from one coast to the other maimed or dead.

About 1:10 a.m., in Kansas City, Mo., 803 miles from Cleveland, Jedon Edmond found a gun in his parents’ apartment and pulled the trigger, accidentally firing a round into his face. Jedon, who died at a hospital, was 2.

Eighty minutes later, Damien Santoyo was standing on a porch in Chicago as a car drove by, and someone inside opened fire, striking the 14-year-old in the head. He died at the scene.

Less than two hours after that, at almost the exact same moment, a 15-year-old boy in Louisville was blasted in both legs outside a club, and a 16-year-old girl in Danville, Va., was continues on next page

UNIVERSITY HOSPITALS

Top, Efrem Cox, left, and Nicholas Bambakidis performed the surgery that saved Carter Hall’s life. Above, scans show the skull fractures caused by the bullet that struck Carter in Cleveland. He was riding in the back of his mother's car when he was shot.

SUNDAY, SEPTEMBER 24, 2017

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COVER STORY patients: lost fingers, toes, eyes and limbs, and mangled spleens, livers, kidneys, lungs and hearts.

What she has seldom seen, though, are children who live through rounds to the head.

from previous page

fatally wounded on a street corner by a round meant for someone else.

Then, on a Metro car just outside the nation’s capital, an 18-year-old man accidentally shot his 14-year-old half brother in the stomach.

Then, in Kansas City, Kan., three teenagers were shot inside a car, and two of them, one 16 and the other 17, were killed. Then, in a parking lot in High Point, N.C., a 14-year-old boy caught in crossfire was struck in the arm.

Finally, at 11:50 p.m. on an Ohio highway, 4-year-old Carter was stalked in his car seat.

Hill allowed The Washington Post to tell her son’s story and to interview him, his family, and his nurses and doctors because she wanted people to understand all that he endured.

What led to his shooting, she said, began earlier that night. She was leaving her mother’s apartment complex with Carter and Dahalia when they came upon the white Pontiac blocking the road. She honked and waited, until finally the car backed out of the way. It followed her onto the interstate. Then came the gunfire.

On average, 23 children 17 and younger were shot each day in the United States in 2015, according to a Post review of the most recent data from the Centers for Disease Control and Prevention and the U.S. Consumer Product Safety Commission. That’s at least one bullet striking a growing body every 63 minutes.

In total, an estimated 8,400 children were hit, and more died — 1,458 — than in any year since at least 2010. That death toll exceeds the entire number of U.S. military fatalities in Afghanistan this decade.

Many incidents, though, never become public because they happen in small towns or the injuries aren’t deemed newsworthy or the triggers are pulled by teens committing suicide.

Caring for children wounded by gunfire comes with a substantial price tag. Ted Miller, an economist who has studied the topic for nearly 30 years, estimated that the medical and mental health costs for just the 2015 victims will exceed $290 million.

None of those figures feels abstract to Denise Dowd. The emergency room doctor at Children’s Mercy Hospital in Missouri has treated at least 500 pediatric gunshot victims in a four-decade medical career that began as a nurse in Detroit. She’s written extensively for the American Academy of Pediatrics and several national medical journals, both about how to prevent children from falling victim to gun violence and, when they do, how it affects them, emotionally and physically.

Dowd can rattle off number after number to illustrate the country’s crisis, but few are more jarring than a study of 2010 World Health Organization data published in the American Journal of Medicine last year: Among highincome nations, 91 percent of children younger than 15 who were killed by gunfire lived in the United States.

Like so many others who have pushed for gun-violence prevention, Dowd saw an opportunity in the aftermath of the 2012 Sandy Hook Elementary School massacre, which left 20

W

FAMILY PHOTO

students and six staff members dead.

She and her colleagues contacted close to two dozen schools and civic organizations in their Midwest community, offering to give presentations about how to protect kids from finding the weapons and harming themselves or someone else.

Then, just as lawmakers in Washington rejected efforts to expand background checks on people buying firearms and dozens of state legislatures continued to ignore pleas that they require guns to be safely locked away, Dowd got her first and only response, from a PTA group. Exactly three women showed up for her speech.

“People just don’t want to talk about it,” said Dowd, who wishes those people understood what bullets do to kids’ bodies.

How rounds react upon impact can be random and chaotic. Their size, direction and velocity, which routinely exceeds 1,500 mph, all affect the path of destruction within a child.

Some bullets tumble inside the body after puncturing the skin, deflecting off bone before exiting at unpredictable angles that firstresponders often struggle to quickly identify.

Other bullets are designed to expand, creating a widening cavity as they shred through organs and arteries.

Dowd has seen the results in her young

Carter’s 7-yearold sister, Dahalia, was also in the back of the car when he was shot. Both vividly remember what happened that night.

hen the pediatric trauma bay’s door slid open, Carter, at 3-foot-3, looked tiny atop the adult-size gurney, appearing smaller still as he was wheeled into the swarm of adults and bright lights and blinking machines towering over him.

Eyes panicked and neck braced with a miniature cervical collar, he screamed through the oxygen mask strapped to his mouth, but the nurses and doctors at UH Rainbow Babies & Children’s Hospital later said they took that as a good sign: His airway remained intact.

Still, his odds seemed grim. According to the American Association of Neurological Surgeons, just 1 in 10 people who sustain a gunshot wound to the head survive it.

The emergency room staff checked Carter’s breathing and blood pressure. They sliced off his clothes with shears, then slid an IV into his left arm and strapped three stickers on his chest to monitor vital signs. Nearby, an orange-and-white cooler was packed with four liters of O-negative blood.

“One, two, three,” they counted, then rolled him onto his side and scanned every inch of his body, looking for cuts or bumps or more punctures. They pressed on his spine to make sure it hadn’t been severed.

As the morphine began to take effect, he was hustled down the hall to a dim room with a CT scanner.

At 12:46 a.m., the images arrived on the cellphone of Efrem Cox, a 34-year-old neurosurgeon. The doctor’s pulse pounded, he recalled.

The damage to Carter’s head was obvious. The bullet had struck the side of his skull, creating a nickel-sized crater in the bone before traveling 2.3 inches through the right frontal lobe and leaving an exit wound as big as a quarter. A fracture ran from one hole to the other.

Cox, who was at home, headed to his car.

The boy, he knew, needed immediate surgery.

By then, Carter had returned to the trauma bay.

“Please, God,” his mother said, pacing next to him as his grandmother, Annette Hill, hurried inside.

They had worked so hard to prevent something like this from happening to him. Carter wasn’t allowed to play with toy firearms, and even when he pretended that his grandmother’s back-scratcher was a rifle, she scolded him.

The family hated guns for a reason.

As a 7-year-old, Annette’s brother had been riding on the back of a bicycle when he was shot in the head. He had lived, but at 54, he still had a bullet in his brain and four decades of seizures in his past. Annette had never forgotten those times she’d wrapped cloth around a spoon and pressed it into her brother’s mouth so he wouldn’t bite off his tongue.

If her grandson survived, would that be his future, too?

SUNDAY, SEPTEMBER 24, 2017

15

COVER STORY “Gumma,” the boy murmured, using his nickname for her, so she walked over and sang him the “Barney” theme — “I love you, you love me” — as she had so many nights before.

“Boop,” Annette whispered at the end, gently bumping her finger against his ribs.

Now Operating Room 6 was prepped, and the neurosurgeons had arrived.

Carter was taken up the elevator to the second floor, where Cox saw him for the first time. Bits of brain, the doctor remembered, were visible along the side of the boy’s head, as blood and teardrops converged on his cheeks.

Carter’s eyes darted around the chilly operating room, searching masked faces for one that looked familiar. He found none. Terrified, he wet the blanket underneath him.

“It’s okay,” Cox told him, pausing to rub the boy’s arm.

The surgeon understood the stakes every time he worked on a child. He was still grieving for his own son, who had suffered from a devastating form of juvenile arthritis. The 2-year-old had died of respiratory failure in this hospital eight months earlier.

There was nothing the doctors could do.

“Put that aside,” Cox would tell himself before surgeries. He had treated at least 30 children struck by gunfire in his career, including a 17-year-old who had been shot clean through the back of his head on Cox’s first night as a neurosurgery intern in 2011. He had wrapped the fatal wound in dressing so the teenager’s mother wouldn’t see it. When the blood soaked through, the surgeon applied two more pads and wrapped it again.

“There’s nothing we can do,” he had told the distraught woman that night, but now, with Carter on the table in front of him, there was something he could do.

For so many reasons, that was remarkable.

If the bullet had been a higher caliber, it would have created a larger blast effect — like the ripple in a lake from the splash of a baseball vs. a marble — and ruptured blood vessels throughout his head. If it had struck a cerebral artery, he could have suffered a fatal hemorrhage before doctors ever saw him. If it had been designed to splinter on contact, his brain might have been pulverized. If it had pierced his left frontal lobe rather than his right, he may have been left unable to speak. If its trajectory had changed by just 30 degrees, it would have crossed over the brain’s midline and probably killed him.

Somehow, none of those things had happened. So, at 2:12 a.m., with Carter sedated and covered in blue drapes everywhere but on the front of his head, Cox pressed a scalpel into the apex of his small patient’s scalp. He needed to clean Carter’s wound to ward off infection, repair the cracked bone in the boy’s head and make sure there wasn’t more severe damage to his brain.

“It’s going to be okay, Mommy,” Carter’s sister, Dahalia, was saying in a room downstairs as she rubbed her mother’s back.

Across the top of the boy’s head, Cox said, he ran a foot-long incision from one ear to the other.

Children shot in the U.S. each year On average, 23 children were shot every day in the United States in 2015, according to an analysis of the most recent federal data.

FATAL

NONFATAL

TOTAL

2015

1,458

6,911

8,369

2014

1,330 7,537

8,867

2013

1,258 6,103

7,361

2012

1,301 5,675

6,976

2011

1,311 Unstable estimate

2010

1,337 7,531

8,868

The nonfatal shooting figures are federal estimates. Data for 2016 and 2017 had not been released at the time of publication.

Sources: Centers for Disease Control and Prevention, U.S. Consumer Product Safety Commission

The doctor peeled the skin down to just above the eyebrows and, with a drill, cut out a section of skull the size of a Zippo lighter. The surgeons washed out the opening and picked away four slivers of bone, none larger than half a Tic Tac. With the bleeding and swelling under control, Cox slid the slab of skull back in place and screwed it secure with star-shaped titanium plates covering each hole.

By 3:05 a.m., Carter’s incision was sewn shut.

He would live.

I

n his white Spider-Man underwear, Carter sat cross-legged on the floor, bouncing a plastic toy horse across the hotel room’s brown carpet. For a moment, he didn’t think about the scary men who chased him or how cold it was in the place with the masked people or why he looked so different now than he used to.

On his left arm, where the nurses had stuck the needle he hated, was a Daffy Duck bandage, and over the horizontal slice on the center of his forehead, where the bullet had popped out, was a white strip of medical tape. The hair on the front half of his head that the surgeons clipped had begun to grow back. And there, at the crest of his scalp, was the surgical scar: a jagged, elevated ridge, shaped like an upsidedown crescent moon and held together by a faintly visible coil of clear, dissolvable sutures.

It had been exactly one week since Carter’s surgery. Two men, both 21 with criminal histories, had been charged in the shooting, but Hill feared retaliation, so a victim advocates group had moved her and the kids to a hotel across town until they could figure out where to go next.

Carter and his sister hadn’t asked many questions, but both vividly remembered what had happened that day, which began with a visit to their grandmother’s home.

THE WASHINGTON POST

Hill was deeply thankful he had survived, but she so wanted to erase that night, to go back to the way things had been.

KLMNO WEEKLY

He had stood on a neighbor’s shoulders and dunked a basketball in a hoop. Dahalia had climbed on the playground until she saw a spider near the slide. In the apartment, they ate pork and greens and watched an “Avengers” movie, and when it was time to go, they all loaded into Hill’s SUV. Then, the kids and their mom got stuck in the road because of the white Pontiac.

Dahalia: “She was beeping her horn, and she was scooting up.”

Carter: “Mommy said, ‘Move.’ ” Dahalia: “We got on the freeway, and that’s when they was following us.”

Carter: “They keep on getting up and getting up and getting up.”

Dahalia: “I looked over and saw a man pull up a gun.”

Carter: “It sounded like” — pausing, to raise his voice — “BOW, BOW, BOW.” Dahalia: “They shoot the whole car up.”

Carter, on what the bullet felt like: “Hurt.”

Dahalia, on seeing her brother bleeding: “I was scared he was about to die.”

Carter, shrugging and slumping his head to one side, on why he was shot: “I don’t know.”

The boy already had woken up from his first nightmare, trembling. His doctors couldn’t predict whether he would suffer from seizures or developmental problems because of the injury, but his early progress had given them hope.

Hill was deeply thankful he had survived, but she so wanted to erase that night, to go back to the way things had been, before she’d talked to a social worker about finding the children counselors.

She saw glimpses of that old life, too, even in their cramped, temporary home.

“Can I play with her Barbies?” he’d started asking again about his sister.

Carter’s mother had tried to explain to him why, for now, he shouldn’t do front rolls on the carpet or attempt a handstand against the walls, but he mostly ignored her, and in a way that felt good because it felt normal.

When Dahalia pinned him to the bed and wouldn’t let him go unless he kissed her, Carter squirmed and laughed, but still refused.

Hill would soon buy her son a white wool cap to hide his scars. It made Carter, with those plum cheeks and brown eyes, look no different than he once did, at least on the outside.

That afternoon, as his mom sat on a bed scrolling through her phone, Carter, still only in his Spider-Man underwear, climbed up over the edge to join her. He picked up a remote and turned on the TV. On CNN, two men in suits were talking about the violence in a place named Charlottesville. None of that made sense to Carter, so he changed the channel, to HLN and a show called “Forensic Files.”

The camera zoomed in on a black pistol, its barrel turned toward the TV. Carter’s eyes widened, and his mouth slipped open. He stood on the bed, pointed at the screen and announced: “That’s the gun where I got shoot in my head.” ©The Washington Post

SUNDAY, SEPTEMBER 24, 2017

16

KLMNO WEEKLY

LIFESTYLE

The lost art of reading a map BY

J ENNY R OUGH

S

arah Savage was alone in the woods and didn’t know which way to turn. She had been eager to explore the Appalachian Trail when she moved to Pennsylvania and discovered that her house was near an access point. But not long after she took off from the trailhead, the path branched in different directions. She wasn’t carrying a cellphone or a map. Nervous, she turned back.

“I was afraid of getting lost. I didn’t know how to read a map or even that maps existed for where I was hiking,” said Savage, 49, who works in educational publishing.

But she liked the physical and emotional benefits of being out there, so she kept going back. She brought a map and followed the trail as best she could, yet she still felt apprehensive. “I had no sense of direction,” she said. “I wasn’t paying attention to north, south, east or west.”

Navigating is a use-it-or-lose-it skill and one that few hikers, cyclists or walkers employ anymore because of their increased dependence on GPS units, Garmin computers, Google Earth and similar technologies. According to a 2015 Pew Research Center survey, nine of 10 smartphone owners use their device to get directions or for other location-based services, up from 74 percent in 2013. That heavy reliance on devices can give people a false sense of security.

Nobody knows how many U.S. hikers get lost each year, according to Robert J. Koester, an instructor for the Virginia Department of Emergency Management and the chief executive of dbS Productions, which conducts search-andrescue training and publishes related information.

While a database that Koester created shows 24,000 formal search-and-rescue efforts a year, it’s imprecise, he said, given that many hikers get lost for only a short time. “Many are able to eventually reorient themselves, or are lucky enough to stumble across someone else,” he said. But for some hikers, the wrong turn

JONATHAN NEWTON/THE WASHINGTON POST

proves deadly.

Preventing such tragedies is one reason that Stacy Boone teaches land navigation classes through her company, Step Outdoors, which works in southwest Colorado and northern New Mexico. Boone organizes wilderness trips to teach inexperienced hikers and backpackers how to use a map and compass. She has earned the Triple Crown of Hiking, an award given to people who have completed the Appalachian Trail, the Continental Divide Trail and the Pacific Crest Trail. She says that knowing how to follow a map while traversing a trail, how to orient a map north and how to set a bearing are critical skills that have helped her in forests, mountains, canyons, fields and deserts, no matter how many twists and turns she has taken.

People tend to panic when they’re lost or think they’re lost, Boone said. And panic leads to irrational behavior. Her first rule?

Just stop. Drink water. Eat a snack.

Doing so will help you calm down.

It will also help you slow down.

Why it’s a mistake to count on a cellphone when you go hiking

“The classic behavior when you get lost is to speed up,” said Jamie O’Donnell, a field instructor with the National Outdoor Leadership School, a nonprofit based in Wyoming. “People think, ‘Oh, I need to work hard to get myself out of this.’

In doing that, they often make the situation worse by hiking fast.

They quit paying attention to terrain features.”

Once you’ve stopped and replenished your body, you can think more clearly.

“Then and only then, pull out your map,” Boone said.

That is, if you know how to use it. A map is nothing to dread or fear. A map is simply a bird’s-eyeview representation, drawn to scale, of a particular area. Topographic maps, which hikers use, typically show major highways, trails, waterways, vegetation (such as forests and meadows) and contour lines that depict elevation. It’s a low-tech version of what so many have come to depend on electronically.

Although many trail users frequently rely on electronic prompts

to provide a sense of direction, O’Donnell said, it’s important to understand its limitations.

“The GPS won’t tell you there is a mountain in the way or there is a huge river that won’t be safe to cross, but a map will,” he said. GPS units break. Batteries go dead.

Phones get dropped in streams.

Also, “turn-by-turn GPS [navigation] in which you see only one route and are always going straight ahead” doesn’t teach people to situate themselves on a route, said Nora Newcombe, a cognitive psychologist at Temple University.

Newcombe and her team of researchers are studying why some individuals are more directionally challenged than others. While answers are still unclear, “good navigators have better spatial working memories,” Newcombe said, and they anchor themselves in the wider world. For example, she said, they will think: “I was walking toward the lake and I turned left, and then I was walking parallel to the lake even though I couldn’t see it.”

To become a better navigator, pay attention to clues. Is the ground flat or sloped? Note the position of the sun in the sky. Keep an eye out for “handrails,” landmarks that parallel your course, such as a creek to one side. And remember: “Everything looks different when you spin your body and look backward,” O’Donnell said. “If you step off a trail to use the bathroom, turn back around and pick out some identifying markers, like a big oak tree that splits near the bottom.” You’ll know you need to pass it on the way back.

While it’s smart for hikers to have an inReach or SPOT satellite emergency device — which allows a user to trigger an SOS message from anywhere in the world — it’s still vital to know how to read a map.

“My concern is that when people get these devices, there’s an excuse to push the envelope because their confidence isn’t in their skills, it’s in their equipment,” Boone said. n © The Washington Post

SUNDAY, SEPTEMBER 24, 2017

17

LIFESTYLE

KLMNO WEEKLY

For kids these days, what’s the rush?

Dating?

Driving?

Teens are in no hurry to act like adults, study finds.

FAMILY PHOTO

Chiara Power, 15, of Washington state’s San Juan Island, says she’s more worried about college than she is about dating or drinking.

BY

T ARA B AHRAMPOUR

W

hen 17-year-old Quattro Musser hangs out with friends, they don’t drink beer or cruise around in cars with their dates. Rather, they stick to G-rated activities such as rock-climbing or talking about books.

They are in good company, according to a new study showing that teenagers are increasingly delaying activities that had long been seen as rites of passage into adulthood. The study, published this past week in the journal Child Development, found that the percentage of adolescents in the United States who have a driver’s license, who have tried alcohol, who date and who work for pay has plummeted since 1976, with the most precipitous decreases in the past decade.

The declines appeared across racial, geographic and socioeconomic lines and in rural, urban and suburban areas.

To be sure, more than half of teens still engage in these activities, but the majorities have slimmed considerably. Between 1976 and 1979, 86 percent of high school seniors had gone on a date; between 2010 and 2015, only 63 percent had, the study found.

During the same period, the portion that had ever earned money from working plunged from 76 percent to 55 percent. And the portion that had tried alcohol plummeted from 93 percent between 1976 and 1979 to 67 percent between 2010 and 2016.

Teens have also reported a steady decline in sexual activity in recent decades. The portion of high school students who’d had sex fell from 54 percent in 1991 to 41 percent in 2015, according to statistics from the Centers for Disease Control and Prevention.

“People say, ‘Oh, it’s because teenagers are more responsible, or more lazy, or more boring,’ but they’re missing the larger trend,” said Jean Twenge, lead author of the study, which drew on seven large time-lag surveys of Americans. Rather, she said, youths may be less interested in activities such

Are teens growing up more slowly?

High school seniors are driving, dating, drinking and working at far lower rates than they did 40 years ago.

Has driver’s license

Ever dated

Tried alcohol

Worked for pay

100 percent

90

86.93% 83 84.88

80

70

71.67%

72.24

61.20

60

56.64 55.88 50

1976

1986

1996

2006

2016

Note: Wording of a question about alcohol habits was changed in 1993. This chart uses data from 1993 onward. 2016 data about driving, dating and working is unavailable.

Source: Jean Twenge, analysis of data from “Monitoring the Future,” a survey by the Survey Research Center at the University of Michigan's Institute for Social Research SHELLY TAN/THE WASHINGTON POST

as dating, driving or getting jobs because in today’s society, they no longer need to be.

According to an evolutionarypsychology theory that a person’s “life strategy” slows down or speeds up depending on the person’s surroundings, exposure to a “harsh and unpredictable” environment leads to faster development, while a more resource-rich and secure environment has the opposite effect, the study said.

In the first scenario, “you’d have a lot of kids and be in survival mode, start having kids young, expect your kids will have kids young, and expect that there will be more diseases and fewer resources,” said Twenge, an author and psychology professor at San Diego State University.

A century ago, when life expectancy was lower and college education less prevalent, “the goal back then was survival, not violin lessons by 5,” Twenge said.

In that model, a teenage boy might be thinking more seriously about marriage, and driving a car and working for pay would be important for “establishing mate value based on procurement of resources,” the study said.

But the United States is shifting more toward the slower model, and the change is apparent across the socioeconomic spectrum, Twenge said. “Even in families whose parents didn’t have a college education . . . families are smaller, and the idea that children need to be carefully nurtured has really sunk in.”

The postponement of “adult activities” could not be attributed to more homework or extracurricular activities, the study said, noting that teens today spend fewer hours on homework than they did in the 1990s and the same amount of time on extracurriculars (with the exception of community service, which has risen slightly). Nor could the use of smartphones and the Internet be entirely the cause, the report said, because the decline began before they were widely available.

Musser, who lives in Portland, Ore., has had summer jobs, but he has never drunk alcohol and said he is not curious to try. To him, the idea that earlier generations of teens centered evening activities around procuring and drinking alcohol sounded mystifying.

In a city where it is easy to bike, take buses or ride-share, he doesn’t see much need to drive.

And as for dating: “It seems sort of ridiculous to be seriously dating someone in high school. I mean, what’s the plan there? Continuing to date through college and then eventually get married? That seems sort of unrealistic.”

Chiara Power, 15, of San Juan Island in Washington state has no interest in dating, driving, working for pay or drinking alcohol — and the rising costs of college keep her up at night.

“I’m already panicking and having nightmares about the student loans that I’ll never escape, and I’m worried that I’m going to end up homeless,” she said.

Her mother, Penelope Haskew, 45, feels mixed about her daughter’s preference for spending free time at home with her family.

“On the one hand, I know she’s safe, she’s not out getting pregnant or smoking pot or drinking or doing all kinds of risky stuff that I can imagine would be age appropriate,” she said. But Haskew wonders whether her daughter is missing out on life lessons those behaviors can teach. “Is that stuff necessary for human development? Do you have to be risk-taking as a teenager in order to succeed as an adult?” n

© The Washington Post

SUNDAY, SEPTEMBER 24, 2017

18

KLMNO WEEKLY

BOOKS

The lives profoundly shaped by war N ONFICTION

l

REVIEWED BY

M ARK A TWOOD L AWRENCE

F THE VIETNAM WAR An Intimate History

By Geoffrey C. Ward and Ken Burns Knopf.

612 pp. $60

ew histories of the Vietnam War shy away from contentious questions or bold conclusions. Was the United States right to wage war in Southeast Asia? Why did Washington fail to achieve its objectives?

What are the key lessons of the American defeat? Authors have clashed for years over the answers, making the war one of the most hotly disputed topics in all of American history.

Geoffrey C. Ward takes a different tack in his “intimate history,” the exceptionally engaging, if not wholly satisfying, companion book to “The Vietnam War,” the 18-hour documentary by famed filmmaker Ken Burns airing now on PBS. Rejecting clear-cut judgments, Ward aims instead to capture the war’s ambiguities by telling the story through the varied experiences and emotions of ordinary men and women whose lives were profoundly shaped by it.

“This was a war of many perspectives, a Rashomon of equally plausible ‘stories,’ ” Burns and his co-director for the television series, Lynn Novick, write in the book’s introduction. Both the documentary and the companion volume, they assert, give voice to “seemingly irreconcilable outlooks” reflected in “as many different perspectives as our narrative could accommodate.”

This approach will be familiar to anyone who has been watching Burns’s award-winning documentaries or read other accompanying books. On topics ranging from the Civil War to baseball to the Roosevelt family, Burns and his team have offered a broadly affirming vision of American history that provokes less by stirring debate than by tugging at viewers’ heartstrings with emotionally charged portraits of individuals at the center of their stories.

It’s unquestionably an appealing formula, and Ward’s companion book, a visually stunning tome weighing in at more than 600 pag-

HORST FAAS/ASSOCIATED PRESS/FLORENTINE FILMS

South Vietnamese civilians huddle after two days of heavy fighting at Dong Xoai in June 1965.

es, overflows with moving profiles of not just soldiers, sailors and airmen, but also doctors, nurses, prisoners, journalists, activists, and more. For example, Ward, who also wrote the script for the TV series, unfolds the life story of Denton “Mogie” Crocker of Saratoga Springs, N.Y. After growing up on stories of heroic fighting men, Crocker defied his adoring parents by enlisting in the Army in 1964, only to be cut down by machine gun fire two years later, just short of his 19th birthday, while trying to capture a hill in South Vietnam’s Central Highlands.

On the communist side, Ward tells the story of Nguyen Thanh Tung, a southern-born revolutionary who survives the war despite shrapnel wounds to her leg and unspeakable losses along the way.

Four of her brothers died fighting the French and another four battling the Americans.

These portraits are accompanied by a spectacular array of photographs. Predictably, the volume includes many old classics, including widely published photos of a South Vietnamese police chief executing a communist suspect and

an American chopper lifting off a rooftop during the final collapse of Saigon in 1975. But it also features hundreds of evocative images — many of them focused tightly on the facial expressions of everyday Americans and Vietnamese — likely to be unfamiliar even to experts on the war.

Ward provides a sprawling, almost encyclopedic account of decision-making by politicians, diplomats and generals, the relatively familiar stuff of many conventional histories of the war. Over 10 densely packed chapters, the book reaches back to the French colonial conquest of Vietnam and the early development of Vietnamese nationalism before delving into the peak years of U.S. embroilment. Every battle, diplomatic conference, treaty and turning gets its due.

In places, this narrative is superb. Ward draws skillfully, for example, on recent studies by historians who have conducted pathbreaking research into the Vietnamese side of the war. He convincingly lays out North Vietnamese calculations during the pivotal years of escalation, showing how

the hawkish communist leader Le Duan displaced moderates, including the revolutionary icon Ho Chi Minh, usually assumed to have been the mastermind of the communist war effort all the way until his death in 1969.

Still, Ward’s account of decision-making offers little that is entirely new and fails to probe many of the fascinating controversies driving inquiry into the war these days, a missed opportunity to add something of value beyond the television program.

On two questions — Would John F. Kennedy have avoided war if he had survived for a second presidential term? Was South Vietnamese leader Ngo Dinh Diem a legitimate nationalist with a reasonable claim to leadership? — the book includes fascinating short essays by leading scholars. But those features unaccountably disappear after Chapter 2, despite the numerous other issues worthy of such in-depth treatment.

Ward also disappoints by ending his story with the final collapse of South Vietnam in 1975. The book thus fails to consider how Americans have struggled to understand the war and draw lessons for the conduct of foreign and military policy over the past four decades, a history arguably just as important to the nation’s politics and psyche as the conflict itself.

The companion book, like the series, is a significant milestone in that history and will no doubt do much to determine how the war is understood for years to come. This is mostly a welcome prospect, for both book and series are inspired by humane desires to overcome painful division and draw attention to the human costs of war. For many of the debates that continue to make the war such a lively topic, however, readers will have to go elsewhere. n Lawrence, author of “The Vietnam War: A Concise International History,” teaches at the University of Texas.

SUNDAY, SEPTEMBER 24, 2017

19

BOOKS

KLMNO WEEKLY

Debut novel has intrigue, wonder

Sharapova serves up only tough love

F ICTION

N ONFICTION

l

REVIEWED BY

“T

J OHN F REEMAN G ILL

he World of Tomorrow,” the affable debut novel by Brendan Mathews, begins neither here nor there. All is in transition. It’s 1939, World War II is imminent, and we join the story aboard the MV Britannic en route from the Old World to the New. In the first-class dining room, Sir Angus MacFarquhar, “a Scottish Mr. Darcy,” is busy charming a table of wealthy Americans with his witty repartee. Angus’s real name is Francis Dempsey, however, and he is neither an aristocrat nor even a Scotsman; he is an impetuous Irish jailbird with cash swiped from the Irish Republican Army.

The possibility of dramatic transformation amid historical ferment is at the heart of “The World of Tomorrow,” a fat novel stuffed with well-drawn characters grappling with different versions of themselves. For Francis, a purveyor of illegal risqué books, living a double life seems like a surefire method of social advancement. But for his shellshocked younger brother, Michael, a former seminarian, the rupture in his self-conception is far more violent. Michael has been rendered deaf and mute by the same accidental explosion that left several IRA bomb makers dead and their money up for grabs. For him, life is divided into Before and After, and the schism in his identity is so acute that his mind conjures up a companion for him to “speak” with — an aloof white-haired gent who turns out to be the recently deceased Irish poet W.B. Yeats. The scenes of bickering between Michael and Yeats provide some of the book’s most pleasurable moments.

As Francis and Michael take up residence in the Plaza Hotel and reunite with their estranged brother, Martin, a jazz musician, the brothers encounter a range of other characters who are also confronting twinned opposites of themselves. Lilly Bloch, a Jewish

street photographer, is torn between pursuing her art as a single woman in America and returning to Nazi-occupied Prague, where her lover awaits. Tom Cronin, a peaceable Upstate farmer, finds himself slipping back into his old role as a hit man for one last job: extinguishing Francis Dempsey.

Mathews is an able prose stylist, and breathing life into so many diverse characters is no mean feat. But the book, like the men and women who populate its pages, is riven by conflicting identities. For all the craft Mathews lavishes on these intricate backstories, the sensational plot that binds the characters together feels like a somewhat facile screen story grafted onto a literary novel.

The novel’s pulpy action climax at the World’s Fair, meanwhile, is unconvincing, as its outcome relies on the credulity-straining gullibility of security officials.

If the period and milieu of “The World of Tomorrow” feel familiar, well, that’s because they are. Setting a debut novel in 1939 New York and naming it after the theme of the World’s Fair is either a bold or derivative act, given the long shadow cast by E.L. Doctorow, the colossus of New York historical fiction. In 1985, Doctorow published “World’s Fair,” an evocative best-selling novel in which the same 1939 expo figures prominently.

Mathews opts for a more panoramic lens, taking in great swaths of the city and a sprawling cast of characters. Paradoxically, his broad scope diminishes his story’s intimacy and the reader’s emotional engagement.

Still, Mathews has a flair for bringing street scenes to life, and his hopscotching narrative makes for an enjoyable tour of a vanished city. “The World of Tomorrow” is an appealing, if uneven, debut by a promising writer. n Gill is the author of “The Gargoyle Hunters.” This was written for The Washington Post.

M THE WORLD OF TOMORROW

By Brendan Mathews Little, Brown. 552 pp. $28

UNSTOPPABLE My Life So Far

By Maria Sharapova with Rich Cohen Sarah Crichton/FSG. 292 pp. $28

l

REVIEWED BY

M ICHAEL M EWSHAW

aria Sharapova admits that her memoir, “Unstoppable: My Life So Far,” was scheduled as part of her 2016 retirement tour, ending “at the US Open . . . just as this book hit the stores.” But then she tested positive for a banned substance and received a two-year suspension, reduced on appeal to 15 months. So she turned to Plan B — a comeback in the spring of 2017, leading up to the year’s last Grand Slam at Flushing Meadows, capped by publication of the book and her triumphant return to the top of the game.

Instead, she encountered bitter resentment from other players and harrumphing from the press.

She lost at her first tournament in Germany, withdrew injured from the Italian Open, was refused entry at the French Open and Wimbledon, and retired from a tournament in California with yet another injury. This prompted snarky online comments that she couldn’t win without chemical help. But the U.S. Open welcomed her with a wild card, and she reached the fourth round before losing and coming in for more criticism for receiving preferential court assignments.

One can only marvel at the fall of the five-time Grand Slam champion, the glamorous spokeswoman for luxury products and the richest female athlete in the world.

To convey this kind of calamity would require a Greek tragedy, not an as-told-to autobiography. But “Unstoppable” does offer clues to why Sharapova finds herself with few friends on the pro tour.

Sharapova was born to a monomaniacal father who taught himself tennis, then imposed it on his child. These events transpired in Russia after the nuclear meltdown at Chernobyl and the breakup of the Soviet Union, adding to the implausibility of the tale, which reads like a Horatio Alger story on steroids (Sharapova’s drug ban, by the way, was for meldonium, a heart medicine suspected of being

a performance enhancer, not for steroids). Leaving his wife in Russia, Yuri Sharapov bundled his daughter, age 7, off to Florida with $700 in his pocket and a conviction that they could crash an elite tennis academy and catapult the family into the American Dream.

For years, they survived on the kindness of strangers, Yuri’s native cunning, Maria’s talent and no small amount of luck. If Yuri was constructed of steel, Maria was forged out of titanium. She jokes that she willed herself to grow to be 6 foot 2, and although of limited speed and mobility, she never lacked “determination, tenacity. I do not quit. Knock me down ten times, I get up after the eleventh and shove the ball right back at you.” And every stroke she hit was punctuated by a banshee shriek.

Maria learned English from watching TV and received almost no formal education. She didn’t see her mother for years but professes to have no regrets about her childhood.

An outlier from the start, Sharapova viewed her estrangement as an advantage. She showed “no emotion. No fear. Like ice. I was not friends with the other girls, because that would make me softer, easier to beat.”

She worked with a rogue’s gallery of coaches, some positive influences, some exploitative, all ultimately discarded like sweaty socks on the locker room floor.

Tough love was all she understood and, later on, all she had to offer to romantic partners.

The memoir ends where it began, with Sharapova’s bravado about never quitting “until they take down the nets. Until they burn my rackets.” I’d recommend that the author of “Unstoppable” pause, reflect a bit deeper, and cut herself and everyone else more slack. n Mewshaw is the author of 21 books, most recently “Ad In Ad Out,” a collection of essays on tennis. This was written for The Washington Post.

SUNDAY, SEPTEMBER 24, 2017

20

KLMNO WEEKLY

OPINIONS

Trump’s welcome flirtation with the U.N. DAVID IGNATIUS writes a twice-a-week foreign affairs column for The Washington Post and contributes to the PostPartisan blog.

When you discount the rhetorical overkill, the most surprising thing about President Trump’s address to the United Nations on Tuesday was how conventional it was. He supported human rights and democracy; he opposed rogue regimes; he espoused a global community of strong, sovereign nations.

Pretty shocking stuff.

Because he’s Trump, the zingers got the headlines: He repeated his childish, snarky (but sort of funny) playground denunciation of North Korean leader Kim Jong Un. “Rocket Man is on a suicide mission.” And he offered a bombastic threat that if North Korea attacks the United States or its allies, “we will have no choice but to totally destroy” it.

Okay, got that: It’s a restatement of the existing U.S. policy of nuclear deterrence.

Trump also thanked China and Russia for their diplomatic help and pushed them to do more. He said the Iran nuclear deal was “an embarrassment” and its regional actions were a “scourge,” but he didn’t say he would tear up the deal. He appealed to the Iranian people, without exactly calling for regime change. He checked all the hard-liner boxes, in other words, without making any new commitments.

It was a well-cooked pudding, the sort of speech Trump might have given at his inauguration back in January if he hadn’t been so angry. Back then, he spoke like a wrecker (raging about “American carnage”). Now he’s using the alliterative phrases that are speechwriters’ earwigs, as in calling for “a renewal of will, a rediscovery of resolve and

RICHARD DREW/ASSOCIATED PRESS

President Trump addresses the United Nations General Assembly in New York on Tuesday.

a rebirth of devotion.” Stirring, pleasant to hear, otherwise incomprehensible.

The speech was reportedly written by Stephen Miller, a.k.a.

Darth Vader among many in the mainstream media, but this seemed to be Miller 2.0, and perhaps the language left his now-deposed mentor Stephen K. Bannon gnashing his teeth: What happened to the insurgent populist Trump who talked a year ago as if he wanted to topple the global order? This Trump seemed instead to embrace an updated version of it.

Trump’s address offered a heavier dose of nationalism and self-interest; he wanted to root collective action in sovereignty and reciprocity, rather than a vaguer “globalism.” He spoke about righteousness defeating evil, a “great reawakening of nations” and other fuzzy Reaganisms. But at its core, this was a speech that any president since Harry Truman probably could have delivered.

Trump was something of an

interventionist in his remarks.

He wanted to bash not just North Korea and Iran but also other undemocratic rogue regimes, such as Cuba and Venezuela. He even spoke up for human rights, decrying the authoritarian nations on the U.N. Human Rights Council.

Trump even invoked the Marshall Plan, the very cornerstone of the liberal international order. He added a Trumpian touch, saying it had been built with “three beautiful pillars” — sovereignty, security and prosperity. He was right in that, as in saying that North Korea shouldn’t be the United States’ responsibility, because “that’s what the United Nations is for.”

Watching Trump give his biggest speech since the inauguration, I was modestly reassured to see him operating within the four walls of rationality, albeit reading from a teleprompter. “Rocket Man” aside, the tone seemed a bit like the bipartisan legislative opening to Democrats Charles E.

Schumer and Nancy Pelosi.

After a miserable nine months, Trump is sick of losing.

He wants to “win,” and he evidently has realized that he can’t do so with a collection of right-wing outliers as his only allies. The U.N. speech, especially its repeated emphasis on the U.N. itself, struck me as the international version of his rebranding.

So what worries me about Trump’s speech? Oddly, it’s precisely that it was so conventional. If Trump is going to deal successfully with North Korea, he’ll truly have to think outside the box. If he wants a better, longer-lasting deal with Iran, he needs in some way to engage that nation and its people.

And most of all, Trump needs to bring America with him in making a reformed United Nations a place that actually solves problems. The Great Disrupter says he wants to revive the global community and make it work better. Okay, Mr. President, let’s see what you’ve got. n

SUNDAY, SEPTEMBER 24, 2017

21

OPINIONS

KLMNO WEEKLY

TOM TOLES

The sad part about Equifax hack BRIAN FUNG covers technology for The Washington Post, focusing on telecommunications, Internet access and the shifting media economy.

It’s been almost two weeks since Equifax first admitted it had been hacked in a massive breach affecting as many as 143 million consumers. Ever since, people have been begging Equifax to answer a simple question: “Am I on the list of victims?”

Much to America’s dismay, Equifax has yet to provide a firm response. It’s not clear when or if the country will ever get one. But the most depressing thing isn’t Equifax’s failure to tell consumers definitively whether they, individually, are at risk. The most depressing thing is that, at this point, the answer may not even matter.

“Once it’s out there, it’s out there,” said Justin Shipe, vice president of information security at CardConnect, a payment processor.

You may be clinging to some sliver of hope that perhaps your information is not yet “out there.” But with every subsequent breach, the likelihood of your never having been affected by hackers grows slimmer and slimmer.

What is the point of knowing whether Equifax was the one who leaked your data? Perhaps in the short term, you might become part of a class-action suit, and win a few dollars in the inevitable settlement. But in the long run, this knowledge doesn’t help you any more than discovering you were affected by the 2013 data breach at Target,

the 2014 incident at Home Depot and the 2015 break-in at the Office of Personnel Management.

If I knew I was affected, I’d take steps to protect myself, like freezing my credit, you say. To which I’d say: Why wait? Many Americans have already called to freeze their credit or place preemptive fraud alerts on their accounts, and they’re as in the dark right now as everyone else who isn’t Equifax. You don’t need knowledge that you were affected to protect yourself.

If Equifax told individuals whether their information was

leaked, couldn’t they trace cases of future identity theft to the hack? Experts say that’s extremely unlikely.

“If we see a large increase in identity fraud, we can potentially hypothesize that some of this increase was due to the Equifax breach, but there’s no way to prove this 100 percent,” said Richard White, the former chief information security officer for the U.S. Capitol Police. “The more time passes, the harder it becomes for a number of reasons, mainly [because of ] new cyberattacks that expose more information.”

Even if you could prove a link, what could you do with that revelation that you haven’t already done?

Let’s run a little thought experiment. Suppose you were a victim of not only the Equifax breach, but also the breaches at Target, Home Depot, OPM or Anthem. Now imagine that in 2020, you check your credit report and find out that somebody opened a fraudulent credit card account in your

You don’t need knowledge that you were affected to protect yourself.

name.

How would you know which breach produced the data that allowed criminals to create the new line of credit? How could you distinguish that from information gathered by gardenvariety social engineering attacks such as email phishing?

What would it even matter?

At that point, you’ve been compromised. Whether Equifax was the one to leak your data becomes irrelevant.

You should still be keeping a close eye on your credit reports for any suspicious or unusual activity, such as new loans or credit cards you didn’t ask for.

Under the Fair Credit Reporting Act, consumers are entitled to one free credit report from each of the three major reporting bureaus once a year. You can safely access your reports by visiting annualcreditreport.com.

You can also apply a temporary fraud alert to your credit, or freeze it entirely so that nobody can open new lines of credit in your name.

Equifax is likely to pay a high price for its failures. But in the grand scheme of things, the one question plaguing all of us has mostly become a pointless mental exercise.

And that’s the depressing part. n

SUNDAY, SEPTEMBER 24, 2017

22

KLMNO WEEKLY

OPINIONS

BY CLAYTOONZ.COM

Time to listen when women speak DANA MILBANK writes about political theater in the nation’s capital. He joined The Washington Post as a political reporter in 2000.

Over the weekend, the president of the United States retweeted to his 38 million Twitter followers a video clip doctored to show him driving a golf ball off the tee and between the shoulder blades of Hillary Clinton — “CrookedHillary” in the tweet — knocking the former secretary of state and Democratic presidential nominee to the ground.

Eighty-four thousand people “liked” this violent takedown of Trump’s former opponent.

A woman has been speaker of the House, another came within a whisker of the presidency, and others (Republican Sens. Lisa Murkowski of Alaska and Susan Collins of Maine) wield the decisive votes on health-care and other legislation. But recent events make it feel as if we’re in an earlier time, when a woman’s job in politics was simple: sit down and shut up. This no doubt is the work of a president who, by word and deed, made sexism safe again, giving license to shed “political correctness” and blame troubles on minorities, immigrants and women.

Trump’s golf tweet no doubt was inspired by the attention Clinton has gotten for her new book, which has been met with a predictable response: wishing the woman who won the popular vote would “shut up and go away” — as Fox News’s Greg Gutfeld put it.

Many reviewers and commentators said similar.

The public disagrees; the book is a No. 1 bestseller.

Clinton isn’t the only woman being told lately to shut up. When Rep. Pramila Jayapal (D-Wash.) rose on the House floor this month to oppose an amendment

by Rep. Don Young (R-Alaska), Young twice called Jayapal, 51, a “young lady,” and said she “doesn’t know a damn thing.”

(Young later apologized.)

This brought to mind Sen. Richard Burr (R-N.C.), who at two different hearings in July shut down Sen. Kamala D. Harris (DCalif.) when she aggressively questioned witnesses. Burr, chairman of the Senate Intelligence Committee, ordered her to be silent and lectured her about “courtesy.”

And this, in turn, echoed Majority Leader Mitch

BY WASSERMAN FOR THE BOSTON GLOBE

McConnell’s infamous silencing of Sen. Elizabeth Warren (DMass.) on the Senate floor in February when she read a letter from Coretta Scott King criticizing Jeff Sessions: “She was warned. . . . Nevertheless, she persisted.”

Another new book by another strong woman, NBC’s Katy Tur, recalls the abuse she suffered during the campaign when Trump taunted “Little Katy” and ordered her to “be quiet” during a news conference.

Alas, it’s not just words. The latest Senate attempt at Obamacare repeal, drafted by four men, would eliminate Obamacare’s requirement that insurers cover maternity care and funding for Planned Parenthood, one of the largest providers of women’s health care. Tweeted Sen. Mazie Hirono (D-Hawaii): “A group of men wrote a devastating health care bill & are now trying to push it through w/o debate. It’s almost like we’ve been here before.”

In the White House recently, Trump was meeting with advisers and lawmakers when, as The Post’s Ashley Parker and others recounted, House Minority Leader Nancy Pelosi (D- Calif.), the only woman in a room with 10 men, twice tried to answer a question. Both times, she was

spoken over. Finally, the former speaker of the House broke through. “Does anybody listen to women when they speak around here?” she asked.

Apparently not.

Pelosi described that memorable encounter to me when I saw her in New Haven, Conn., at the wake for Luisa DeLauro, the longest serving alderman in the city’s history and mother of Rep. Rosa DeLauro (DConn.). To me, Luisa DeLauro, who died recently at 103, was “Grandma Louise,” because I’m married to Rosa’s stepdaughter, Democratic pollster Anna Greenberg.

The funeral for Luisa, a pioneering woman in politics, juxtaposed with the outrageous treatment Pelosi endured in the White House days earlier, left me with an unwelcome realization about the persistence of sexism in this business. As a young woman of 19, serving as the secretary of the 10th Ward Democratic Club, Luisa was optimistic as she exhorted women to engage in politics in a 1933 article. Rosa read Luisa’s words from long ago at the funeral: “Come on, girls, let’s make ourselves heard.”

The “girls” are speaking, loudly.

But does anybody listen to women when they speak around here? n

SUNDAY, SEPTEMBER 24, 2017

23

KLMNO WEEKLY

FIVE MYTHS

Hurricanes BY

J EFFREY H ALVERSON

The Gulf Coast and Caribbean have been badly battered by hurri­ canes in recent weeks. Harvey submerged much of Houston, Irma roared through Florida and Maria has battered Puerto Rico and oth­ er Caribbean islands. The storms elicited a nation of nervous weather­watchers and exposed several myths.

MYTH NO. 1 A busy year of named storms will be dangerous and costly.

Actually, there is only some correlation between the total number of storms in a season and the number of storms making landfall. In 2004, there were 15 named storms, and eight struck the United States. In 2010, there were 19 named storms but only two U.S. landfalls. (The total in both years was well above the long-term average for the Atlantic.) It takes only one roaring storm for an inactive season to be considered awful: 1992 saw just seven storms, well below the average, but one of them was Hurricane Andrew, at the time the nation’s costliest hurricane.

How many storms make landfall depends on tropical currents, such as the trade winds, that steer hurricanes. These systems shift around and can strengthen or weaken. For instance, if the Bermuda High current moves closer to the U.S. mainland, as it did in 2004 and 2005, more storms land on our shores. If the Bermuda High moves closer to Africa, more tend to curve over the ocean.

MYTH NO. 2 A Category 4 storm will cause more damage than a Category 2.

The Saffir-Simpson hurricane intensity scale is based on the maximum sustained wind, which seems like the most meaningful metric. But size matters, too. Both the size of a storm’s wind “footprint” and the strength of its winds control the height of the storm surge. Compare

Hurricanes Charley (2004) and Ike (2008). Charley packed 120 mph sustained winds and was very small. Ike was about 10 times larger but considerably weaker, with 95 mph winds. Charley’s surge along Florida’s west coast was in the six-to-seven-foot range, while Ike devastated the TexasLouisiana coast with a very broad surge reaching 12 to 17 feet in height. The difference in surge heights largely reflected Ike’s much larger size.

Storm rainfall, which can be catastrophic, also has little to do with wind intensity. Some of our worst coastal flooding disasters from tropical cyclones have come from humble tropical storms: Allison, for example, brought inland Texas about 40 inches of rain in 2001.

MYTH NO. 3 Inland cities don’t need to worry about hurricanes.

It’s true that storms lose 50 percent of their wind intensity within 12 to 18 hours of landfall.

But hurricane remnants have surprisingly long reach. Many storms throughout U.S. history have projected formidable hazards hundreds of miles inland, sometimes days after landfall. And tropical remnants that join with preexisting weather systems, such as fronts and jet stream disturbances, have new sources of energy to sustain them.

Infamous examples include Camille (1969), which made landfall over Louisiana but killed half its victims days later in a horrific flood in Virginia’s Blue Ridge Mountains. Agnes (1972) made landfall in the Florida Panhandle but unleashed its

RICKY CARIOTI/THE WASHINGTON POST

Hurricane Irma lashes Fort Lauderdale, Fla., this month. Hurricanes’ winds are fearsome but are not their deadliest threat.

worst flooding in central Pennsylvania. And Ivan (2004) first struck Alabama but spun up a record-breaking swarm of damaging tornadoes across Northern Virginia and central Maryland.

MYTH NO. 4 The biggest threat from a hurricane is the wind.

Wind is only one of a deadly triad of impacts that hurricanes deliver. The storm surge — a sudden rise in sea level along the coast, where ocean water is pushed inland by the hurricane’s strongest winds — causes far more fatalities. The maximum surge is confined to the eyewall of the storm, but its effects can be broad: In 1876, a storm surge killed as many as 400,000 people in a single cyclone along coastal Bangladesh.

A recent study shows that, in the United States, the majority of hurricane-related deaths come from water.

Sometimes this means storm surge, but more often people drown in freshwater. Torrential rains often dump six to 12 inches or more, leading to flash flooding.

Hurricane Katrina (2005) produced the highest death toll of any hurricane — at least 1,000 —

since the Okeechobee hurricane in Florida in 1928, and most of the fatalities were drownings.

MYTH NO. 5 Forecasters hype the threat to push a climate change agenda.

The mission of the National Weather Service, which raised urgent warnings about the latest hurricanes, is to protect property and save lives. And it only makes sense for local news outlets and private forecasters to follow their lead; it is a standard, and responsible, practice for these organizations to post every official watch and warning issued by the hurricane center.

Furthermore, many scientists are cautious about the connection between hurricane activity and climate change. The National Oceanic and Atmospheric Administration, for instance, has said a detectable human influence has not yet been discovered, though it projects increases in hurricane intensity during the coming decades. n Halverson, a contributor to The Washington Post’s Capital Weather Gang, teaches meteorology at the University of Maryland Baltimore County.

This was written for The Post.

SUNDAY, SEPTEMBER 24, 2017

24

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