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So here’s the plan: saying or doing much that could be held against her. As attorney general, she Kamala is going to walk up to Rodney Scott’s Whole Hog declined to support two ballot measures BBQ from the left. At 12:50 p.m., Rodney Scott will greet to end the death penalty. She declined her. She’ll enter through the side door and order at the to support making drug possession a second register, from the woman in the red shirt. Kamala, misdemeanor. She declined to support Scott, and Maya Harris—that’s Kamala’s sister and cam- legalizing pot. She declined to support a paign chair—will sit and eat. Kamala will then exit through ballot measure reforming California’s bru- the front door and walk around back to look at the smoker. tal three-strikes law. The point is: She had She’ll reenter through the front, cross the dining room, power. She kept most of it in reserve. More and exit through the side door to take reporters’ questions. important than fixing the broken criminal- justice system, it seemed, was protecting Rodney Scott’s Whole Hog, on the corner of King and her status as a rising star. She had earned Grove Streets in Charleston, South Carolina, is perfect— that reputation by the time the first major the kind of fast-casual, deeply American spot almost any profile of her was written: San Francisco voter can get behind: local pit master anointed by Anthony Magazine, 2007. The article also described Bourdain, outdoor seating under tasteful white Christmas her as “maddeningly elusive.” lights, wooden tables with wrought-iron legs, red stools. In the hour leading up to Kamala’s arrival, men walking and It takes Harris a minute, but she decides biking slowly down Grove Street give way to police cars, on a pulled-pork sandwich, with corn bread followed by unmarked cars. At T minus 10, the campaign’s and collard greens, and a banana pudding 23-year-old South Carolina communications director, Jeru- to split with Maya. They sit and eat, ignor- salem Demsas, asks, “Can we get Rodney out here?” She ing the two dozen recording devices in places Scott, handsome and regionally beloved, on his their faces, talking about Scott’s vinegar- mark to the left of the door. After Demsas leaves, Scott mut- based BBQ sauce and his recipe for banana ters, “People with warrants must be running off the block.” pudding—good territory for Harris, as she’s a serious cook. Nearby, there are a It’s all happening before you can even see her, so thick few appalled customers, including a family and aggressive is the press: the 20-plus reporters with that has driven 40 minutes to celebrate the TV cameras, boom mics, lenses larger than some dogs. father’s birthday and has no idea what’s Kamala shakes Scott’s hand; touches his arm; smiles happening, no idea even who Harris is, and her big, open, I-am-so-happy-to-be-with-you-right-now would just like this rugby squad of report- smile. She’s shorter, even in heels, than one expects. But ers to move aside long enough for their son she’s magnetic, authoritative, warm—leaning in, nod- to refill his drink. But for the most part, the ding, gesturing with both hands, moving those hands patrons are dazzled by Harris, whose star from a voter’s biceps or shoulder to a position of deep quality drew 20,000 people to her kick- appreciation over her heart. off rally in Oakland. The dynamism she displayed there made the event feel like a Kamala wends through the scrum of press, makes her cause, or a concert—Kamalapalooza—and way to the counter, and finds the woman in the red shirt, gave her campaign significant momentum. (Laurene Pow- who happens to be Scott’s wife. Kamala greets her with a ell Jobs, the president of Emerson Collective, which is the two-handed clasp (a simple shake would come across as majority owner of The Atlantic, has provided financial sup- too formal and masculine). Then, right there, a decision port to the Harris campaign.) needs to be made on the fly:What is Kamala going to order? After 15 minutes, right on schedule, Harris sets down Kamala Harris—the Democratic presidential hope- her napkin and walks around back. She takes some photos ful and 54-year-old junior senator from California—is a near the smoker with Scott’s family and looks deeply into prosecutor by training. She knows well that any misstep, the eyes of his adorable 10-year-old son. She tells him she’s anything you say or do, can and will be held against you. giving a speech later and she’d like him to let her know Her fundamental, almost constitutional, understanding what he thinks of it. Then she walks back through the res- of this has made her cautious, at times enragingly so. taurant and exits, as planned, through the side door so she can gaggle with the press. (NB: Gaggle is now a verb in Harris’s demographic identity has always been radical. American politics, meaning “to answer questions shouted She was San Francisco’s first female district attorney, first at you by a group of reporters.”) black district attorney, first Asian American district attor- ney. She was then California’s first female attorney general, Here, again, Harris is graciously, militarily on point. All first black attorney general, first Asian American attorney good politicians stick to a script, but Harris speaks like a general. She was the second black woman, ever, to win a woman who knows that facts are ammunition. Everything seat in the United States Senate. But in office, she’s avoided you say can and will be used against you. Just this week she’s been in the weeds, so to speak, with Reefergate, a kerfuffle that arose when Harris was asked on the Breakfast Club radio show what music she’d listened to when she smoked pot in college and she said Tupac and Snoop Dogg. Social media erupted with gotchas, as those artists didn’t release songs until after she’d graduated. 48 M A Y 2 0 1 9 THE ATLANTIC

Harris’s spokesperson said that she’d been answering a play, one that Hillary Clinton, frankly, could have bene- different question, about the music she listens to now, but even so The New York Times, The View, MSNBC, and Fox & fited from. If you wear the same outfit every single day, Friends all picked up the story. Harris’s own father, who is Jamaican, flamed her on Jamaica Global Online for insin- pretty soon the haters will run out of snarky things to say uating that she supported legalized pot because she was Jamaican: “My dear departed grandmothers … as well as about your appearance and move on. my deceased parents, must be turning in their grave right now to see their family’s name, reputation and proud Among Harris’s core traits, arguably her Shakespearean- Jamaican identity being connected, in any way, jokingly or not with the fraudulent stereotype of a pot-smoking joy tragedy trait, the one so central to her character that it has seeker.” The uproar caused the former Obama speech- writer Jon Favreau to flip out on Pod Save America: “Don- the potential to lift her to the highest post ald Trump is president … We cannot be talking about this fucking shit again with the Democratic candidates.” in the land but could also take her down, Harris on the trail is her discipline. It is what has allowed her in South Carolina. But Harris, today, gaggling, is in top form: We don’t to play the long game, to protect her future. Once a stiff and need a tragedy to enact commonsense gun reform. This It has also infuriated constituents over the guarded campaigner, economy is not working for working people. Every Amer- years who wanted Harris to take a stand she’s learned how ican needs a path to success. We need to speak truth. If and fight for them today, not when she to radiate warmth. Harris’s campaign has a mantra, that’s it: truth truth truth truth truth. She delivers her talking points while dressed, reached a higher office. Yet Harris, on the as she always is, in her uniform of dark suit, pearls, black heels. I know—you think I shouldn’t be writing about her trail, seems bolder than she has in the past. She’s declared clothes. But the clothes themselves are a smart, cautious that she’s for reparations, for the Green New Deal, for decriminalizing sex work and legalizing pot. She comes PHYLLIS B. DOONEY across as a woman who is cashing in her chips, taking all the political and social capital she was safeguarding for all those years and putting it on the table, declaring that her moment is now. She’s a black female prosecutor; we have a racist, misogynist, possibly criminal president. All of that caretaking of her political future—what was it for if not this? THE ATLANTIC MAY 2019 49

By Harris’s side, on the road, is not her husband, Doug In 1971, when Harris was 7, Shirley Chisholm dropped by. Emhoff, a Los Angeles lawyer she married in 2014, but She was exploring a bid for president. her sister, Maya, who was a top policy adviser for Hillary When I asked Maya about her relationship with her sis- Clinton’s 2016 presidential campaign and, before that, the ter, Kamala raised her eyebrows and cocked her head, like, vice president for democracy, rights, and justice at the This had better be good. “Well, she’s a big sister and …” Maya Ford Foundation and the executive director of the ACLU paused and turned to Harris.“Are you going to qualify that?” of Northern California. When the world is following you Harris, laughing, declined. So Maya continued: “She with boom mics and long knives, Maya told me, “it’s good was protective … Maybe just a liiiiiiiittle bossy.” If there to know there are people with you 100 percent. Ride or was a problem in the schoolyard, Harris would assess the die. Not going anywhere.” situation and make sure Maya was okay. The two orga- Harris’s parents, Shyamala Gopalan and Donald Harris, nized a children’s protest to overturn a no-playing policy met in Berkeley, California, in the early 1960s, in the civil- in their apartment building’s empty courtyard. Do I even rights movement. They’d both come to the United States need to say it? They won. to study at UC Berkeley: Shyamala, at age 19, from a Brah- When Harris was in middle school, Shyamala took man family in India, to pursue a doctorate in endocrinol- a post at McGill University and moved with her daugh- ogy and nutrition; Donald, from Jamaica, for a doctorate in ters to Montreal. Harris attended high school there. At economics.As withalmost everything elsein her life, Harris Howard University, in Washington, D.C., she chaired has a set of stock stories she tells about her upbringing, all the economics society, argued on the debate team, and of which are laid out in her heav- pledged the AKA sorority, the ily vetted, surprise-free mem- Growing up at protests, first black sorority in the coun- oir, The Truths We Hold, which Harris writes, she’d try, whose alumnae show up was released two weeks before at Harris’s campaign events in she announced her candidacy. seen the mechanics force, dressed in AKA pale pink (The big vulnerable reveal in it of fighting for “justice and green, a squadron of extra is that Harris had to take the bar aunts. At UC Hastings College exam twice.) As a girl, she loved from the outside.” She of the Law, in San Francisco, the outdoors; her father yelled wanted insider power, Harris “found her calling,” as at her, “Run, Kamala! As fast as establishment power. she writes in her memoir, and you can. Run!” Her mother sang decided to become a prosecutor. along to Aretha Franklin; her This was not an easy sell for dad played Thelonious Monk. her parents. Shyamala believed, They divorced when Harris as Harris writes, that America was 7. Before that, the family had “a deep and dark history of attended protests together. At people using the power of the one, Harris, a toddler, started prosecutor as an instrument of fussing. Her mother bent down injustice.” Among Shyamala’s and asked, “What do you want?” closest friends was Mary Lewis, Harris said, “Fweedom!” a professor and public intellec- Shyamala, the daughter of tual who helped lead the black- a diplomat father and a mother consciousness movement in who educated fellow Indian women about birth control the Bay Area. Donald Harris, meanwhile, had become an through a bullhorn, was barely 5 feet tall, and formida- economics professor at Stanford University, the first black ble. She was supposed to return to India for an arranged man in his department and one of about 10 black faculty marriage. She refused. “She had literally no patience for members total. He was a left-leaning iconoclast who wrote mediocrity,” Maya said. Her outlook was: “Be your best. and taught about uneven economic development around If you’re going to do something, be the best. Work hard, the world, particularly across racial lines, long before many the whole way.” En route to becoming a prominent breast- Americans had ever heard the phrase income inequality. cancer researcher, she raised her girls primarily as a single Colleagues found his progressivism threatening—he was mother. She took Harris with her to her lab when neces- called “too charismatic, a pied piper leading students away sary and directed her to wash test tubes. She covered the from neoclassical economics,” in The Stanford Daily. kitchen in their small apartment with waxed paper and Yet growing up at protests, Harris writes, she’d seen the made lollipops and other candy. If she bought gifts, she mechanics of fighting for “justice from the outside.” That set up a game in the style of Let’s Make a Deal. What do dynamic did not appeal to her. She wanted insider power, you want—Door No. 1 (the bedroom) or Door No. 2 (the establishment power. “When activists came marching kitchen)? Inside, the girls would find a blue bike with tas- and banging on doors,” Harris writes, “I wanted to be on seled handlebars or an Easy-Bake Oven. In Harris’s tell- the other side to let them in.” Shyamala interrogated this ing, Shyamala didn’t coddle. If her children came home logic. As Harris says, both in her book and in speeches, “I from school with a problem, she would ask, “Well, what had to defend my choice as one would a thesis.” did you do?,” in order to push them to solve it themselves. It was the choice of a woman who likes control. Even She raised her daughters in the black community, taking sitting with Maya, post-barbecue, in a corridor of a black them to Berkeley’s black cultural center, Rainbow Sign, church in South Carolina before a town hall—when Harris where Maya Angelou read poetry and Nina Simone sang. is laughing and slightly slouched in her chair, seemingly 50 M A Y 2 0 1 9 THE ATLANTIC

relaxed—she’s a woman who maintains things out. She’d stopped watching the news and read- a tight grip on the narrative. No detail is too small. ing the paper, which was so unlike her, and she was tired. “I stay with her a lot when I’m in D.C.,” She was sleeping a lot. And I was with Maya says, trying to tell me a story about how Harris likes to take care of people. (I her in the hospital. I was sitting next to Harris at her law-school experienced this myself. I showed up that her—here’s the bed,” Harris says, motion- graduation in 1989, with day with a cough, and Harris instantly ing to her side, “and she was turned that her mother, Shyamala offered me cough drops and green tea.) way. We were just spending time together. Gopalan (center) and And she said, looking away, with her eyes her first-grade teacher, Harris corrects Maya, quietly but closed, I’m sure: ‘What’s going on with Frances Wilson. firmly: “Always.” the campaign?’ “Always … almost always,” Maya says. “Okay, mostly.” “I said, ‘Well, Mommy, they said they’re gonna kick Harris stands her ground: “Always.” my ass.’ My mother leaned over and looked at me and Maya—a Stanford Law School grad and one of the youngest people ever appointed had the biggest smile. Just the biggest smile on her face.” dean of a law school—drops the point. Harris will talk about cooking, spe- Harris laughs. I ask what the smile meant. She says, cifically and in great detail, if you ask her. She’ll even get out her iPad and show you “Bring it on. Good luck to them.” the recipes she’s marked from The New COURTESY OF KAMALA HARRIS York Times’ cooking section, which she America—at least the blue parts—came to see Harris reads in the campaign van, after events, to relax. Chicken as its potential savior in June 2017, when she questioned Cacciatore With Mushrooms, Tomatoes, and Wine— then–Attorney General Jeff Sessions about the Russia what’s oppo research going to do with that? I can tell you investigation. Sessions sat at a desk before the Senate that her go-to dinner is roast chicken and that she’s cooked Intelligence Committee, his mouth pursed in a boyish almost every recipe in Alice Waters’s The Art of Simple Food. smirk, his white hair looking as though his mother had In the kitchen, she’s a fundamentalist. “Salt, olive oil, a combed it for him, Harris regal on the dais above. Here lemon, garlic, pepper, some good mustard—you can do was a man thinking he was going to get away with some- almost anything with those ingredients.” thing, as he nearly always had. Then, in view of the world But turn the discussion to this moment in her life, to and this very smart black woman 18 years his junior, he taking her shot—how she’s going to both protect this began to realize he was not. opportunity and go all out; where the line is between being too cautious and too open—and the specificity dis- Harris, detailed notes in hand, had no patience for his appears. First she pivots away from caution. “I wouldn’t “I do not recall”s and his long-winded responses to run say cautious as much as smart. We have to be smart. We out the clock. She just calmly and repeatedly demanded have to be strategic.” (This is a favorite move. For more an answer to her question: “Did you have any commu- than a decade Harris has talked about being “smart” on nication with any Russian businessmen or any Russian crime rather than “tough” or “soft.”) Then she turns to nationals?” Her mental clarity was terrifying. truth. “We have to speak truths, and in speaking those truths, some people are surprised that I’m actually saying Sessions broke down after three and a half minutes. that on a stage … So we have to push it.” “I’m not able to be rushed this fast!,” he said. “It makes Lord knows we are all desperate for a president who me nervous.” values truth. But that wasn’t what I was getting at. There are a great many truths in the world. I wanted to know Justice Brett Kavanaugh’s Supreme Court confirmation which ones were on her mind. Where is she going to be hearings, in September 2018, cemented many Americans’ bold? Where does she feel she needs to hold back? belief that Harris was the woman to go after Trump. “Have “I guess a lot of how I decide [what to] talk about is based on what people tell me they want to discuss,” Har- ris says. “Not so much what they want to discuss as what are the concerns for them.” This is going nowhere. “Certainly I do think in specifics. And when I’m in a smaller group where there’s more latitude to have a real conversation …” I have limited time. I drop the question and move on, which of course was Harris’s goal. It is truly a shame that Shyamala Gopalan isn’t here for this—her two daughters together, Kamala running for president of the United States. She died 10 years ago. She had colon cancer, and when the end was near, Harris visited her in the hospital while running for attorney general. “She was starting to tune THE ATLANTIC MAY 2019 51

you discussed [Special Counsel Robert] Mueller or his Historically, the prosecutor’s office has been a hard place to run from on the left. You investigation with anyone at Kasowitz Benson Torres, the will never really be the progressive. By defini- tion, you are defending the state. On the stump, law firm founded by Marc Kasowitz, Presi- Harris reframes her prosecutorial role: “My whole life, I’ve only had one client: the people,” As California dent Trump’s personal lawyer?” which sounds nice coming from the mouth of attorney general, Harris—who, like any good prosecutor, a public servant. What voter is not for that? Yet when Harris entered a courtroom stating that Harris referred knows not to pose a question to which she she was there to argue “for the people,” she to herself as the doesn’t already have the answer—asked was not the voice of the underdog. She was the state’s “top cop.” this nearly verbatim six times, shining a voice of enforcement, the voice of the law. hot and unflattering spotlight on Kava- Jeff Adachi, the city’s longtime elected pub- lic defender (who died of an apparent heart naugh, who responded, in order, as capillaries appeared attack at age 59 not long after I interviewed him for this article), met Harris when she was a first- to burst all over his face: year law student at Hastings. “Did she always have the charm and ambition she’s known for 1. “Ah …” today? Yeah,” he told me. Adachi was “a little SASHA ARUTYUNOVA 2. “I’m not remembering, but if you have something …” surprised,” he said, when Harris aligned her- 3. “Kasowitz? Benson? …” self “with law enforcement and wanting to put 4. “Is there a person you’re talking about?” people behind bars,” because “we had prob- 5. “I’m not remembering, but I’m happy to be refreshed ably talked about politics before and she was or if you want to tell me who you’re thinking of …” always seen as more of a liberal progressive.” 6. “Do I know anyone who works at that firm? I might But there were very few prosecutors of color know … I would like to know the person you’re thinking of.” at the time, and very few women, and, Adachi said, the prosecutor path was “seen as a step- Harristhensaid,“Ithinkyou’rethinkingofsomeoneand ping stone to do something bigger or greater.” you don’t want to tell us.” Finally Senator Mike Lee of Utah raised an objection and stalled her line of questioning. When Harris ran for district attorney, in 2003, she challenged Terence Hallinan, her former boss, from the right. He was entan- gled in Fajitagate, a preposterous scandal that involved three off-duty police officers beating up two residents and then demanding their takeout fajitas. The public saw the depart- ment as an unprofessional and incompetent bunch of good ol’ boys. (Hallinan had a low conviction rate, and he did not help his repu- tation when he handed members of the Fajitagate grand jury a blank indictment form and asked them to fill in the names of the officers they thought should be charged.) Harris enlisted her mother to stuff envelopes and brought an ironing board to neighborhood campaign stops, to use as a portable table. She wasn’t a natural. She felt awkward talking about herself with strangers. She’d had a much-discussed relationship with future San Francisco Mayor Willie Brown, who was 31 years older and estranged from his wife. Brown was a local kingmaker. Still, Harris did not assume that he would anoint her. Dur- ing the campaign, her longtime mentee Lateefah Simon took a BART train into the Mission early one weekday. “It’s, like, 7:30 in the morning—legit,” she told me. “I’m coming up the escalator and I see Kamala Harris, by herself, in a suit at 16th and Mission.” The intersection then smelled like feces and was filled with drug dealers. Simon looked at Harris like, Are you stupid? What are you doing here, dressed like that, when people are still high from the night before? “I’m trying to win this race!” Harris told her. “She had on pearls!,” Simon said. Once in office, Harris got straight to work cleaning up Hallinan’s mess. She painted the office walls, which no one had done in years. She replaced the jam-prone copy 52 M A Y 2 0 1 9 THE ATLANTIC

machine. If staffers tried to leave for the evening before high-school degrees. But Back on Track served only 300 Harris thought they should, she shouted, “Well, I guess people; Harris never took the program to scale. She also justice has been done! Everybody’s going home.” mentored young women, among them Lateefah Simon, She endured one major scandal, over a rogue tech in who went from being a high-school dropout to becoming a her crime lab. The tech stole cocaine and mishandled evi- MacArthur genius-grant winner in 10 years, which has dence, which was bad enough. got to be a record. But then Harris, likely thinking When Harris was district Simon now runs the she could address the issue qui- attorney, if staffers Akonadi Foundation, in Oak- etly, failed to follow procedure land, dedicated to eliminating and inform the defense lawyers tried to leave for the structural racism. The two met in the cases involved. One thou- evening before she when Simon was 22 years old, sand cases had to be thrown out. thought they should, with a 4-year-old daughter. At the time, Harris was running a Nevertheless, in her first three years as DA, San Fran- she shouted, “Well, child-exploitation task force; cisco’s conviction rate rose I guess justice has Simon showed up at a meeting from 52 to 67 percent. She to advocate for young women even created a new category of been done! Everybody’s who’d been trafficked by pimps crime—truancy—and punished going home.” and then charged with prostitu- parents who failed to send their tion instead of being treated as children to school. Then, as victims of rape. Harris listened now, no one contested the link to Simon, recognized her intel- between high-school gradua- ligence, and took her potential tion and a person’s future in a seriously. “I was like, Who is well-paying job as opposed to this woman? No one listens to jail. Harris still talks about this. us,” Simon told me. “People She stirs outrage at America’s hate us. We’re garbage, in pol- collective failure to invest in the icy and in public.” education of other people’s children, often citing the statistic that nearly 80 percent of all prisoners are high-school dropouts or GED recipients. But is arresting a mother whose life is so frayed that she can’t get her child to school the best way to set that child on the path to success? Many, particu- larly in the black community, answered no. They still do. “Identity politics is stupid,” says Phoenix Calida, a co-host of The Black Podcast, “if you’re not going to enact identity policy.” Harris ran against the death penalty, and, in what was arguably the first and last truly controversial decision she’s made in her political career, she stuck to her position and did not seek capital punishment when a San Francisco cop was killed in the line of duty several months into her tenure. The pressure to reverse her campaign promise was intense. Senator Dianne Feinstein, who’d served as San Francisco’s mayor from 1978 to 1988, chastised Harris for not doing so at the slain officer’s funeral. Still, Harris kept her promise—and paid for it. No police union endorsed her for 10 years. One plausible read of her political history sug- gests that this experience, less than a year into elected office, taught her to fear and avoid tak- ing a stand. Harris calls herself a progressive pros- ecutor, which she’s not, though she did lift up individual lives. She started one of the first prisoner reentry programs in the coun- try, Back on Track. It helped young, first-time drug offenders find jobs and services and earn THE ATLANTIC MAY 2019 53

Harris helped Simon raise money and throw events to have a black woman as the president,” Faison contin- for her organization. She insisted that Simon enroll in col- ued. But “it doesn’t matter if you’re black or not if your lege, and when Simon said that was impossible—she was policies are not for black people. And her policies are not already working and raising a daughter alone—Harris supportive of black families.” talked about Maya, who’d had a daughter herself at age To be fair, while in office, Harris did institute implicit- 17 and then graduated from UC Berkeley and Stanford bias training for police officers. She did test a large Law School. The powerful, polished black woman who backlog of rape kits. And she did negotiate well with the believed that Simon could be a powerful, polished black nation’s five largest mortgage firms in the aftermath of woman too blew Simon’s mind: “This was before Olivia the 2008 economic crisis. She walked away from an offer Pope!” But Harris’s role as DA took some getting used of $4 billion of debt relief for California homeowners and to. “Why would you want to do that?” Simon asked. “I so called Jamie Dimon, the chairman of JPMorgan Chase. deeply knew what was happening with girls in the system, She told him his side needed to come up with more and the DA was our nemesis. money, much more. She ended The DA and the pimp, right? “It doesn’t matter if up with $20 billion. The DA and the pimp.” She won her Senate seat on Harris’s race for California you’re black or not the night Trump was elected. By attorney general was extremely if your policies are then Harris was walking the line tight—so tight that her oppo- not for black people. she’s on now: using “fearless” nent, Steve Cooley, gave a vic- as a campaign slogan despite tory speech on Election Night, And her policies are not letting fear stop her from tak- which he had to retract the next supportive of black ing positions. Trump has been day. She campaigned as a pro- families,” Tanya Faison, a productive foil for her, high- gressive, figuring, perhaps, that lighting the value of her legal many people think they sup- of Sacramento’s Black Lives training, casting her discipline port criminal-justice reform Matter chapter, says. as flattering and calm rather more than they actually do. than pinched and nervous. “They like these talking points In Washington, she hasn’t and these platitudes,” Phoe- done much—let’s be honest, nix Calida says. Let’s be smart who in the Senate has in recent on crime. “But her tough-on- years? She introduced a few bills: crime policies—nobody’s really one, with Kentucky Republican gonna complain, because they Rand Paul, to study reforming feel safe.” the cash-bail system; another, Harris’s record in that office with 13 Democratic colleagues, is marked more by what she didn’t do than what she did. to begin addressing the high mortality rates black women She did not support a ballot initiative reforming Califor- face in childbirth. She also introduced, with fellow Demo- nia’s three-strikes law, which incarcerated people for life cratic presidential candidate Cory Booker and Republican for petty crimes (an interesting family moment, because Tim Scott, a bill to make lynching a hate crime. This last Maya, while working at the ACLU of Northern California, one was classic Harris: tough on crime, seemingly progres- had championed a proposition to take three strikes down). sive, entirely risk-free. It passed the Senate unanimously. She did not join the fight against solitary confinement. She did not support two state ballot propositions to end the death penalty (and when a federal court in Califor- By 4:30 p.m., 1,000 people had packed into the gym nia struck down the death penalty as unconstitutional, of Charleston’s Royal Missionary Baptist Church, where she appealed the decision). She did not support legaliz- the scoreboard read 2020 and AKA sorority sisters rolled ing pot. She did not advocate for reopening several high- in wearing full pink-and-green dress uniform. They are not profile cases, including a capital one widely suspected even a little ambivalent about their candidate. She’s theirs; to have resulted in a wrongful conviction. She did not they love her. Who among us hasn’t been scarred by an prosecute Steven Mnuchin, the CEO of OneWest Bank early humiliation and retreated from hard decisions? They and Trump’s pick for Treasury secretary, for more than asked where the reserved AKA section was. 1,000 foreclosure violations. She did not take an aggres- Backstage, Harris chatted her way through the photo sive stance on officer-involved shootings—most notably, line, a mainstay of the contemporary American political she did not endorse a bill requiring independent inves- campaign: local officials and other VIPs get what is basi- tigations of them and declined to use the power of the cally a school photo with the candidate—in this case, next office to investigate the killing of Mario Woods, who was to a state flag, backed by a royal-blue drape. She has an shot 26 times by five police officers in 2015. amazing ability to focus on the person right in front of her, PHYLLIS B. DOONEY Harris has since taken strong progressive positions. even as a large and impatient crowd claps and shouts “KA- But some of her constituents still feel burned. “Califor- MA-LA” for her to come onstage. nia has had the most police killings, and we haven’t had “I ate with Rodney Scott today, so I’m happy,” Harris any officers ever charged,” Tanya Faison, the lead orga- announced to cheers when she finally appeared. Micro- nizer for Sacramento’s Black Lives Matter chapter, told phone in hand, she slipped into a subtle southern accent. me. “That was on her watch.” Sure, “it would be beautiful “We have to restore in our country truth and justice, truth 54 M A Y 2 0 1 9 THE ATLANTIC

and justice,” she said. The crowd, right there with her, challenging an incumbent president, but these are not called out: “Amen!” “That’s right!” ordinary times, and this is not an ordinary election.’ ” This Charleston event was a 1/20th-scale model of Harris’s campaign-kickoff rally in Oakland. There, Har- That line passed, and Harris moved on to pablum like ris had clapped along with her 20,000 supporters as she made her way to the podium. Just the sight of a strong “Let’s remember: In this fight we have the power of the peo- female candidate who was not Clinton came as a relief. Many Democrats remain traumatized by 2016, the ple.” But Harris is a target. She knows it. Reports of hate matchup of a deliberate and dutiful woman, straining to mop up all messes, against an impetuous, state-trashing crimes increased 17 percent during Trump’s first year in bully. But in dropping her guard a little, Harris has been trending away from Clinton and toward Michelle office. In late February, a Coast Guard officer was accused Obama—adopting a persona that’s less programmed, hipper, and more relaxed, all of which is more likable. Of of plotting to kill Harris, along with 19 others, including course, we care intensely about likability, especially in our female candidates, so perhaps shucking the appear- journalists, activists, and Democratic politicians. The ance of restraint is a prudent A-student decision as well. very fact of her campaign, Harris standing out there every Harris’s campaign is shorter on specifics than Clin- ton’s was (perhaps, again, in reaction to Clinton). It’s day before crowds of thousands, presenting herself to shorter on specifics than some of her fellow 2020 candi- dates’ campaigns, though she did lay out, in her Oakland the American people—some of whom will merely dissect speech, a basic platform, designed to appeal to a liberal base, not attract independents: Medicare for all; univer- her record; others of whom will see her sal pre-K and debt-free college; a $500-a-month tax cut for low-income families; women’s reproductive rights; a female body and her brown skin, and want Alumnae of the path to citizenship for immigrants. her dead—is bold and brave. “Through AKA sorority, which Then, at minute 32 of the speech, in a moment that her career it’s been a very serious thing,” Harris pledged at managed to be both subtle and shocking, Harris addressed Harris’s close friend and adviser Debbie Howard University, turn the thing almost nobody wants to say but everybody who Mesloh told me. “She and I talked about it out to her campaign is close to Harris thinks about: her personal risk. “As Rob- [regarding] Obama … The first day he had events in pink-and- ert Kennedy many years ago said, ‘Only those who dare Secret Service. The first time I saw him in green dress uniform. to fail greatly can ever achieve greatly.’ He also said, ‘I do not lightly dismiss the dangers and the difficulties of a bulletproof vest.” Even at the relatively small book talk Harris gave at the cozy Wilshire Ebell Theatre, in Los Angeles, a security guard stood behind her, not even off in the wings, visible to the audience the whole time. After Harris finished speaking in Oakland, her family joined her onstage: her husband, Doug, who is white; her sister, Maya; Maya’s husband, Tony West, who is black (and currently the chief legal officer at Uber, formerly the third lawyer from the top in Obama’s Justice Depart- ment); Maya’s daughter, Meena; Meena’s partner and chil- dren. The family is beautiful and the family looks like the future—and not the future in which white nationalists win.

It’s hard not to be ambivalent about a cautious person, colored sequined coat, a chessboard of turquoise, purple, particularly a person who has been working for you but yellow, green, and sky blue. The jacket was just about the holding back, saving for the future. In truth, it’s hard not furthest fashion choice imaginable from Harris’s stan- to feel ambivalent about all the candidates. There are so dard dark blazer. Still, Rutherford, a good saleswoman, many contenders, more of them popping up like white- encouraged Harris, a good candidate, to try it on, and haired crocuses every day. One is too old. (Well, two are Harris did. She looked in the mirror, the horde of jour- too old.) One’s too mean to her staff. One said she was nalists to her back. “This really would be perfect for the Native American and she’s not. One Instagrammed his Pride parade,” she said. trip to the dentist. So many Americans have conflicting A nice, unguarded human moment. The jacket was desires for this election. They want a transformative leader way too big, and she’ll almost certainly never wear it any- who will push this country forward. They want a rescue, a where but the parade. But you’d have to be a monster— captain to steady our faltering ship of state and restore the and a tone-deaf politician—not to want to support rule of law. Most of all, they want a winner—whoever that Rutherford. Harris bought the coat. is, just tell them, they’ll vote that way. They want a sure That afternoon, Harris held another town hall, this time thing. They need a sure thing. And then they feel scared at Columbia’s Brookland Baptist Church, and sitting in her and frustrated by all the options, because that’s not how car in the church parking lot, waiting for the doors to open, the system works. was 77-year-old Gladys Carter. Among the many lines Among the many Carter had fought in the civil- Harris offers on the stump is: lines Harris offers rights movement. She was I intend to win this. You don’t heartbroken and horrified by quite expect to hear a woman on the stump is: the turn her country had taken say that. But Harris has become I intend to win this. with Trump’s election, and very good at tapping into the You don’t quite she admired how Harris had emotions of a crowd of Demo- handled Kavanaugh. But she crats and delivering what they expect to hear a had questions about criminal want to hear. The 2020 Demo- woman to say that. justice. “Some African Ameri- cratic National Convention is 15 cans in my circle of friends months off, though. Over the have expressed concern about next year, the campaign is sure her actually imprisoning a lot to get ugly—Trump hasn’t even of our people, more so than given Harris a nickname yet. I she did the others,” Carter said. asked her whether she thought “They say they have to really that, as a black woman, she had think hard before they’re able an extra-narrow lane of accept- to trust her. She’s got to prove able behavior to maneuver that she’s willing to come out in. “I don’t think so,” she said. and do some things differently.” Then she downgraded that At the same time, Carter felt sentiment. “I hope not.” that Americans have deeper, Has the United States dealt even more pressing problems— with its own racism and misogyny enough to elect a black namely, our dangerous, lying president. Maybe a tough woman president? There’s little rational basis for saying female prosecutor is our best hope. “This country has been yes. But there was little rational basis for believing that a controlled by white males for how many years? The way man named Barack Hussein Obama could win the White things are right now—they screwed it up.” House either, let alone a huckster named Donald Trump. Harris made it home for dinner with her husband That Friday night, on the 110-mile ride from Charles- that evening. She slept in her own bed, in her own house, ton to Columbia, South Carolina, Harris read recipes where she likes to relax by curling up on the couch in her online. She flagged one for salted-caramel cookies and sweatpants and reading more recipes. But by that night, emailed it to Lily Adams, her communications director, social media had pounced on her brief moment of spon- who happens to be former Texas Governor Ann Richards’s taneity, making fun of her sequined jacket, her amazing granddaughter. (Adams later laughed and said, with genu- technicolor coat, harping on how stupid and frivolous it ine affection, “When do you think I’m going to bake these? is for a woman to be trying on clothes on the presidential I’m going to New Hampshire with you on Monday.”) campaign trail. In the morning Harris, Maya, and Adams, and the It’s not easy out there. You can’t expect much forgive- whole rugby team of journalists, met up on Columbia’s ness on Lady Street. Yet Harris, as ever, is playing the Lady Street—yes, Lady Street—for some retail politics. long game. She often repeats her most succinct one- First stop was Styled by Naida, a vintage-clothing store line pitch to prospective voters: “We’re going to need run by Naida Rutherford, who grew up in the foster-care somebody who knows how to prosecute the case against system and was homeless before she steadied herself this president.” economically by hosting stylish garage sales. It was She packed a bag for New Hampshire: all dark suits. another ideal campaign stop: Rutherford, the success story, helped Harris pick out a hat and a black belt. Then, Elizabeth Weil is a writer at large for The New York as Maya paid for the items, Harris noticed a brightly Times Magazine. She lives in San Francisco. 56 M A Y 2 0 1 9 THE ATLANTIC

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LOU ORTENZIO WAS A TRUSTED WEST VIRGINIA DOCTOR WHO GOT HIS PATIENTS—AND HIMSELF—HOOKED ON OPIOIDS. NOW HE’S TRYING TO RESCUE HIS COMMUNITY FROM AN EPIDEMIC HE HELPED START. The PENANCE of DOC By SAM QUINONES 59

W doctors overprescribed narcotic pain- killers, thinking they were doing the E L L PA S T S E V E N one evening in 1988, after the nurses and right thing for suffering patients. They the office manager had gone home, as he prepared to see the last had been influenced by pain specialists of his patients and return some phone calls, Dr. Lou Ortenzio who said it was the humane thing to do, stopped by the cupboard where the drug samples were kept. encouraged by insurance companies that said it was the most cost-effective thing Ortenzio, a 35-year-old family practitioner in Clarksburg, West to do, and cajoled by drug companies Virginia, reached for a box of extra-strength Vicodin. The box con- that said it was a safe thing to do. tained 20 pills, wrapped in foil. Each pill combined 750 milligrams of acetaminophen, the active ingredient in Tylenol, with 7.5 milli- Opioid painkillers were promoted as grams of hydrocodone, an opioid painkiller. a boon for doctors, a quick fix for a com- plicated problem. By the end of the 1990s, Ortenzio routinely saw patients long after normal office hours Ortenzio was one of his region’s leading ended. Attempting to keep up with the workload on this day, he prescribers of pain pills. It was a sign of had grown weary and was suffering from a tension headache; he the times that he didn’t think there was needed something to keep him going. He unwrapped a pill, a sam- anything wrong with that. ple left by a drug-company sales rep, certain that no one would ever know he’d taken it. Ortenzio popped the pill in his mouth. C LARKSBURG SITS atop rolling hills in “It was a feeling like I’d never felt before,” he told me recently. northern West Virginia, “I’m tense and nervous, and that anxiety is crippling.” The pill took the anxiety away. The sense of well-being lasted for four halfway between Pitts- hours, carrying him through the rest of the night’s work. burgh and Charleston. Back then, Ortenzio was one of Clarksburg’s most beloved physicians, the kind of doctor other doctors sent their own fami- Lou Ortenzio came lies to see. His patients called him “Doc O.” He made time to lis- ten to them as they poured out the details of their lives. “To me, here in 1978, a recently married young he wasn’t like a doctor; he was more like a big brother, somebody I could talk to when I couldn’t talk to anybody else,” says Phyllis resident out of the University of Maryland Mills, whose family was among Ortenzio’s first patients. When Mills’s son was born with a viral brain infection and transferred School of Medicine. “Small-town living to a hospital in Morgantown, 40 miles away, Ortenzio called often to check on the infant. Mills never forgot that. seemed so much better than suburban As a physician in a small community with limited resources, life,” he told me as we drove around town Ortenzio did a bit of everything: He made rounds in a hospital intensive-care unit and made house calls; he provided obstetric one afternoon. “In Clarksburg, every block and hospice care. Ortenzio loved his work. But it never seemed to end. He started missing dinners with his wife and children. The had something going. We had mom-and- long hours and high stress taxed his own health. He had trouble sleeping, and gained weight. It took many years, but what began pop grocery stores in every neighborhood. with that one Vicodin eventually grew into a crippling addiction that cost Ortenzio everything he held dear: his family, his prac- All these houses were occupied by teach- tice, his reputation. ers, downtown business owners, and peo- The United States is in the midst of the deadliest, most wide- spread drug epidemic in its history. Unlike epidemics of the past, ple who worked in glass factories.” this one did not start with mafias or street dealers. Some people have blamed quack doctors—profiteers running pill mills—but Coal mining was the state’s dominant rogue physicians wrote no more than a fraction of the opioid pre- scriptions in America over the past two decades. In fact, the epi- industry, but in Clarksburg, the glass demic began because hundreds of thousands of well-meaning business boomed. Glass manufacturing had arrived at the turn of the 20th cen- tury, drawn by the state’s high-quality river sand and rich fields of natural gas. Pittsburgh Plate Glass opened a factory in Clarksburg in 1915 and for years was one of the world’s leading plate-glass produc- ers. Anchor Hocking employed 800 peo- ple making tumblers, bottles, fruit bowls. The city had family-owned factories too: Rolland Glass, Harvey Glass, and others. Unlike simple resource extraction, glassmaking required sustained techno- logical investment to meet new demands from the marketplace. The mass produc- tion of plate glass made skyscrapers pos- sible. Picture windows and sliding-glass doors made small homes look bigger and more luxurious. The industry forged a middle class in Clarksburg and even gave the city a cosmopolitan air. The glass fac- tories attracted artisans from France and Belgium; French was commonly heard on the streets for years. 60 MAY 2019 THE ATLANTIC

Glass manufacturing helped forge a middle class in Clarksburg, but by the mid-1980s the industry, and the city, was in decline. Clockwise from top left: Lou Ortenzio; the abandoned Anchor Hocking glass factory; glass collected from the city’s streets; downtown Clarksburg.

Each neighborhood was a self-contained world, with its own grown up and lived locally and who cultivated long-term relation- churches, grocery stores, and school; many had a swimming pool. ships with doctors. One of the reps for Eli Lilly was a deacon in High-school sports rivalries were fierce, and football games drew a local Catholic church. Once a week, he would visit Ortenzio’s large crowds. When Victory played Roosevelt-Wilson, or Wash- office in a business suit, with information about the drugs Lilly ington Irving went up against Notre Dame, people knew to arrive produced. Like many in his profession in those years, he avoided early to find a seat. hard-sell tactics. Ortenzio grew to rely on the salesman’s coun- sel when it came to pharmaceuticals. Once, when the Food and By the late 1970s, Clarksburg’s older physicians were retir- Drug Administration removed a Lilly drug from the market, the ing. Like many small towns at the time, it had trouble attract- rep dropped by Ortenzio’s office, embarrassed and apologetic. ing young professionals. Ortenzio was among the few physicians who moved there to fill the void. He and two other young doc- Before long, Ortenzio and his wife saw Clarksburg as home. tors opened a practice in 1982. Almost immediately, Ortenzio They found a two-story, three-bedroom house in the Stealey was seeing 40 to 50 patients a day. neighborhood, southwest of downtown and at the foot of a hill. They set off to the bank for a 30-year loan. To their surprise, they The people who came to see him were mostly older; many had were denied. “The house won’t keep its value that long,” the served in World War II. They had the aches and pains to show for banker told them. “The best we can give you is a 15-year loan.” a lifetime of hard work in the glass factories or at the gas com- pany, but they had retired with something approaching financial T HE BANKER WA S RIGHT. It wasn’t yet clear, security. They owned homes and cars, had pensions and good amid the bustle of Main Street and Friday-night health insurance. football, but the city’s prospects were fading. Ortenzio’s patients suffered from the ailments of the old— Newer glass technologies required large facto- arthritis, diabetes, hypertension—and most of them did so stoically. This was partly generational and partly an Appalachian ries, which meant stretches of flat land rare in inheritance. One man, Ortenzio remembered, came to him thin and wasted away from cancer. “The disease was advanced, but West Virginia. Mexico and Japan emerged as he put up with it. I said, ‘Why didn’t you come in earlier?’ He said, ‘Well, I wouldn’t want you to think I was complainy.’ That was the competition in glass manufacturing, and plastic and aluminum Appalachian line—‘I wouldn’t want you to think I was complainy.’ ” emerged as alternatives to glass. Pittsburgh Plate Glass had closed Ortenzio grew into his adopted city. In 1992, he established a free clinic where Clarksburg’s uninsured could get medical care. in 1974. Anchor Hocking left in 1987. Its hulking concrete plant is The county chamber of commerce named him Citizen of the Year for that. He had been trained to treat patients holistically. Most slated for demolition, but for now it remains, just off Highway 50. of what a doctor needs to know to make a diagnosis, his profes- sors had taught him, could be learned from taking time to listen to By the mid-1980s, the city was in decline. Glasswork was the patient. X-rays and lab tests were mostly to confirm what you gleaned from asking questions and paying attention to the answers. replaced by telemarketing. Downtown, locally owned stores He’d also been trained to help his patients help themselves. Part of his job was to teach them how to take care of their bodies. Pills were began to disappear. Homeowners yielded to renters, many a last resort. This careful approach endeared him to his patients, but it lengthened his day. “He would have office hours until 11:30 relying on Section 8 assistance from the government. The city at night,” says Jim Harris, a friend and the director of the free clinic. “People waited until then because he was worth the wait.” eventually had to destroy dozens of abandoned homes, leav- Drug salesmen visited him weekly. It was a stodgy profession ing streets with toothless gaps. The swimming pools, too, slowly back then. Ortenzio remembers the reps as older men who had closed; resident associations lacked the money to maintain them. Ortenzio drove me by the massive Robert C. Byrd High School, home of the Eagles. It was built in 1995 to consolidate two smaller high schools in Clarksburg, whose population had receded. Replacing neighborhood schools with one centralized school allowed for better course offerings. But Byrd is far from any stu- dent’s home. School consolidation extinguished the sports rival- ries that had brought people together each week. Without local schools, neighborhoods lost their social centers. 62 M A Y 2 0 1 9 THE ATLANTIC

Lou Ortenzio began to see people in ORTENZIO SHOULD HAVE NOTICED economic as well as physical pain. Many WHAT THE PILLS WERE DOING, were depressed, worn out by work or the fruitless search for it. Obesity became a TO HIS PAT IENTS AND HIS COMMUNIT Y, more common problem. Some patients BUT HE WAS LESS AND LESS HIMSELF. began to ask whether he could get them on workers’ compensation or disabil- When glassmaking new cadre of pain specialists began to argue that narcotic pain pills, ity. Others left to seek job opportunities departed Clarks- derived from the opium poppy, ought to be used more aggressively. in New York, North Carolina, Florida. “I burg, locally owned Many had watched terminal cancer patients die in agony because was always calling people out of state tell- stores began to doctors feared giving them regular doses of addictive narcotics. To ing them how sick their parents or grand- disappear as well. them, it was inhumane not to use opioid painkillers. parents were,” he said. The city eventually had to destroy The specialists began to push the idea that the pills were non- When Ortenzio had opened his practice, dozens of aban- addictive when used to treat pain. Opioids, they said, could be he’d tended to see young people only for prescribed in large quantities for long periods—not just to termi- pregnancies or the occasional broken leg. doned homes, nal patients, but to almost anyone in pain. This idea had no scien- By the mid-1980s, younger people were leaving streets with tific support. One author of an influential paper later acknowl- showing up in larger numbers. They were edged that the literature pain advocates relied on to make their coming in with ailments that their parents toothless gaps. case lacked real evidence. “Because the primary goal was to and grandparents had borne in silence— destigmatize, we often left evidence behind,” he said. headaches, backaches, the common cold. “The new generation that came in the Nevertheless, an alliance of specialists who saw their medical 1980s, those kids began to have the expec- mission as eradicating pain was soon joined by the pharmaceuti- tation that life should be pain-free,” Orten- cal companies that manufactured opioids. Medical institutions— zio said. “If you went to your physician and the Department of Veterans Affairs, the Joint Commission on you didn’t come away with a prescription, Accreditation of Healthcare Organizations, hospitals and medi- you did not have a successful visit.” cal schools across the country—bought into this approach as well. The shift was not peculiar to Clarks- By the late 1990s, medical schools, when they taught pain burg. Americans young and old were management at all, focused on narcotics. By the early 2000s, becoming accustomed to medical mira- doctors were being urged to prescribe the drugs after almost cles that allowed them to avoid the conse- any routine surgery: appendectomy, ACL repair, wisdom-tooth quences of unhealthy behavior—statins extraction. They also prescribed them for chronic conditions for high cholesterol, beta-blockers and such as arthritis and back pain. Chronic pain had once been ACE inhibitors for hypertension and treated with a combination of strategies that only sometimes heart failure, a variety of new treatments involved narcotics; now it was treated using opioids almost exclu- for diabetes. Fewer patients showed up sively, as insurance companies cut back on reimbursing patients for annual physicals or wanted to hear for long-term pain therapies that did not call on the drugs. what they could do to improve their well- ness. They wanted to be cured of what- The U.S. drug industry, meanwhile, was investing heavily in ever was ailing them and sent on their marketing, hiring legions of young salespeople to convince doc- way. Usually that involved pills. tors of their drugs’ various miracles. Nationwide, the number of pharmaceutical sales reps ballooned from 38,000 in 1995 to The medical establishment, to a large 100,000 a decade later. The old style of drug rep, grounded in degree, abetted this shift. In the 1980s, a medicine or pharmacy, largely passed from the scene. “It went from a dozen [salesmen] a week to a dozen a day,” Ortenzio remembered. “If you wrote a lot of scrips, you were high on their call list. You would be marketed to several times a day by the same company with different reps.” Most drug companies in America adopted the new sales approach. Among them was Purdue Pharma, which came out with a timed-release opioid painkiller, OxyContin, in 1996. Pur- due paid legendary bonuses—up to $100,000 a quarter, eight times what other companies were paying. To improve their sales numbers, drug reps offered doctors mugs, fishing hats, lug- gage tags, all-expenses-paid junkets at desirable resorts. They brought lunch for doctors’ staff, knowing that with the staff on their side, the doctors were easier to influence. Once they had THE ATLANTIC MAY 2019 63

Left: A resident of the Mission, a shelter that opened in 1969 with a few beds, for alcoholics and homeless veterans. Today, many of its 120 beds are occupied by opiate addicts. Right: A set of house rules. the doctor’s ear, reps relied on specious and misinterpreted data Ortenzio’s longtime patient, had two daughters who abused the to sell their product. Purdue salespeople promoted the claim pills. Theirs did not come from Ortenzio, at least not directly, but that their pill was effectively nonaddictive because it gradually the supply of pills was exploding, due in large part to doctors like released an opioid, oxycodone, into the body and thus did not him who were overprescribing them. create the extreme highs and lows that led to addiction. Ortenzio should have noticed what the pills were doing, to The reps were selling more than pills. They were selling time- his patients and his community, but he was less and less himself. saving solutions for harried doctors who had been told that an After his late-night encounter with Vicodin in 1988, he had begun epidemic of pain was afoot but who had little time, or training, to his own slide into addiction. By the late 1990s, he was using 20 to address it. For a while, Ortenzio still suggested exercise, a balanced 30 pills a day, depleting even the plentiful supply of free samples diet, and quitting smoking, all of which can alleviate chronic pain. from the ubiquitous sales reps. But his patients, by and large, didn’t want to hear any of this, and he was busy. So he, too, gradually embraced pain pills. Nothing Desperate to get his hands on more pills, he found a friend he ended an appointment quicker than pulling out a prescription pad. could trust, a middle-aged accountant and a patient of his. “I’m in some trouble,” Ortenzio told him. “If I write you this prescrip- T HE NUMBER OF PEOPLE on pain pills grew tion, can I ask you to fill it and bring it back to me?” from a tiny fraction of Ortenzio’s practice to well over half of his patients by the end of the 1990s. “Sure thing,” the man said, without asking for an explanation. “If you gotta have it, you gotta have it. You’re the doc.” The shift was gradual enough at first that he Soon a dozen or so trusted patients were helping Ortenzio. He didn’t recognize what was happening. Patients knew he was out of control and needed help—even the amount of acetaminophen he was consuming was toxic—but he feared that with medical problems unrelated to pain mi- seeking treatment for his addiction might cost him his medical license. Around 1999, he found a new way to get his fix. He began grated to other doctors. Still, Ortenzio was working 16-hour days, writing prescriptions in his children’s names. seeing patients who had been scheduled for the afternoon at 9 p.m. Ortenzio could plainly see that the claim that these pills were nonaddictive was untrue. He would try to quit and feel the symp- The more drugs Ortenzio prescribed, the more he was sought toms of withdrawal. “I couldn’t be away from my supply,” he said. His patients, too, were terrified of going without. One, a out by patients. Many would use up a month’s supply before the nurse at a local hospital suffering from chronic pain as well as depression and anxiety, would approach him in his office park- month was out; in need of more pills, they were insistent, whee- ing lot, often bearing gifts of quilts or canned goods, insisting that she needed her pills that morning, that she couldn’t wait for dling, aggressive. Many lied. Some would curse and scream her monthly appointment. when Ortenzio told them that he couldn’t write them a new pre- scription yet, or that he wanted to lower their dosage. The pills were soon on the streets of Clarksburg as well. They replaced beer and pot at many high-school parties. Phyllis Mills, 64 M A Y 2 0 1 9 THE ATLANTIC



Ortenzio saw no way to break the cycle the pills had created In October 2005, prosecutors charged for the people in his care. He never found a way to get his patients Ortenzio with health-care fraud and down to lower doses of narcotics. They rebelled when he sug- fraudulent prescribing. That year, 314 gested tapering; just cutting people off made them sick. The area West Virginians died from opioid over- didn’t have enough pain clinics or addiction specialists to refer doses, more than double the number of them to, and insurance companies wouldn’t reimburse for many people five years earlier. By 2006, accord- pain treatments that did not involve pills. Without good alterna- ing to the Centers for Disease Control tives for his patients, he kept on writing prescriptions. and Prevention, physicians were writing 130 opioid prescriptions for every 100 A DDICTION AND OVERWORK had estranged West Virginians. Ortenzio from his wife and children. As Clarksburg declined, his wife moved the In March 2006, Ortenzio pleaded guilty. His sentencing occurred shortly kids to Pittsburgh to find better schools. In after a 2005 Supreme Court decision made federal sentencing guidelines non- 2004, after more than a decade of living in A regular mandatory and individual sentences up devotional service to judges’ discretion. Despite what he’d different cities, they divorced. Raised Catho- done, Ortenzio was still beloved in Clarks- held in the burg. More than 100 people wrote to the lic but without much feeling for the Church, Ortenzio joined a Mission’s cafeteria judge on his behalf. He received five years of supervised release plus 1,000 hours of Protestant congregation. Ultimately, he found Jesus in his exam community service, and was ordered to pay $200,000 in restitution. He would room. During an appointment one day, he and a patient, a Bap- serve no prison time, but he did lose his medical license. tist, talked of his search for redemption. The patient knelt with At 53, Ortenzio was unemployed. A Ortenzio on the linoleum floor and prayed for the doctor. Orten- temp agency offered him a landscaping job at the Stonewall Resort, where, as a doctor, zio marks that moment as his new beginning. He had advantages he had taken his family for Sunday brunch. He’d never worked outdoors in his life, but many addicts don’t have: a home and a car, financial resources, he took the job. It paid $6.50 an hour. generous friends and colleagues, and, later, the support of a sec- He worked at the resort for a couple of months, then as the janitor at a local com- ond wife. He managed to taper off the drugs. A couple of months munity center before returning to Stone- wall as a full-time groundskeeper. He also later, he was baptized in a deep section of Elk Creek, where bap- found a night job. tisms have taken place since the early 1800s. Tom Dyer is one of northern West Vir- ginia’s leading defense attorneys; Orten- Not long after that, federal agents raided his office. They zio had been his client. One night in 2006, Dyer ordered a pizza from Fox’s Pizza interrogated his staff and confiscated hundreds of patient Den in Bridgeport, a town near Clarks- burg. When the doorbell rang, he opened records. The investigation dragged on for nearly two years. His the door and there stood Lou Ortenzio, holding a pie. It took a minute before Dyer children had to testify before a grand jury that they knew nothing realized: Doc O was now a pizza-delivery guy. “I was just speechless,” Dyer told me. about the prescriptions their father had written in their names. “I made pizza deliveries where I used to make house calls,” Ortenzio said. “I deliv- ered pizzas to people who were former patients. They felt very uncomfortable, felt sorry for me.” But, he said, “it didn’t bother me. I was in a much better place.” Ortenzio eventually left pizza deliv- ery. But the way he told me the story, the job was an important step in his recovery: Every pie he delivered liberated him. He was free of the lies he’d told his colleagues, his family, and himself to hide his addic- tion. He liked hearing kids screaming “The pizza guy’s here!” when he knocked on the door. “You make people happy,” he said. “That was what I liked about being a doctor.” 66 M A Y 2 0 1 9 THE ATLANTIC

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T ODAY, ORTENZIO population; many rely on support from former residents who spends his days trying commute in from elsewhere on Sundays. The place these to atone. He does this churches once held in this community has been taken by new churches proclaiming a gospel of prosperity, insisting through constant work. that God wants us all to be rich. And by ministries such as Cele- brate Recovery. There are places in and Ortenzio coordinates the training of recovery coaches at the around Clarksburg church, people who can help addicts as they try to wean them- selves from narcotics. Addiction, however, seems as present where addicts can get help, and Ortenzio as ever in Clarksburg. At the Mission one day, I met a group of recovering young drug users. Several of them had started out on can be found at most of them. heroin but then turned to meth. In Clarksburg and many other parts of the country, meth is coming on strong, poised to be the The Mission opened in 1969, in fourth stage in an epidemic that began with prescribed pills, then moved to heroin, and then to fentanyl. Meth seems to reduce the Clarksburg’s Glen Elk neighborhood, at symptoms of withdrawal from opioids, or maybe it’s just a way to get high when anything will do. Whatever the case, like the the time a small red-light district with various forms of opioids before it, meth is now in plentiful sup- ply in Clarksburg. bars and backroom gambling. The shel- A couple of years ago, Ortenzio decided to open a sober- ter started with a few beds, intended living house downtown, where recovering addicts could spend six months or more stabilizing their lives. He said God had for alcoholics and homeless veterans. A instructed him to undertake the project, and had told him, in fact, where to do it—in a house right around the corner from the neon-blue JESUS SAVES sign outside has duplex where Clarksburg’s first resident overdosed on fentanyl. In 2017, more than two West Virginians a day were being claimed remained illuminated for all the years Top: Lou Ortenzio by opioids. Recovering addicts needed places where they could beside one of maintain sobriety. “We thought, This is going to be great. They’ll since, as the shelter has expanded. Today, Clarksburg’s throw a parade for us,” says Ben Randolph, a businessman whom abandoned Ortenzio helped recover from pill addiction. many of its 120 beds are occupied by opi- neighborhood pools. Instead, the idea of a sober-living house outraged many in oid addicts. Ortenzio managed town. The principals of two local schools were concerned that the house was too close to their campuses. Owners of local busi- One afternoon, I met Ortenzio in a small, to overcome his nesses worried that the house might further tarnish the city’s own addiction to image. “The property value of the homes around it are going to windowless office at the Mission. Now 66, narcotic painkillers plummet. You’re going to have both drug dealers and recovering and today spends addicts in one area, so they’ll have a captive market,” one resi- he is thin, gray-haired, and bespectacled; his time helping dent told The Exponent Telegram. he dresses in a hoodie, blue jeans, and other addicts But Ortenzio persisted, and a bank eventually granted him recover, at the a mortgage. Since July 2017, he has run a six-bed home for men, sneakers. He does a bit of everything at Mission (bottom) with daily supervision and no problems—no spike in crime and elsewhere. nearby, no complaints of loitering—reported so far. A similar the Mission, from helping the addicted home for women opened last May. Nevertheless, the episode showed where the city, perhaps even the country, was when it find treatment to helping them find a coat, came to addiction: afflicted mightily and wanting it to go away, but not knowing how to make that happen. or shoes for their children, or a ride to the probation department. He is a volunteer adviser there, too, and at the county’s drug court, where he guides addicts through the criminal-justice system. Ortenzio is also involved with two newer initiatives, which suggest the chal- lenges of repairing the damage done by opioids. A wood-beamed downtown church is home to Celebrate Recovery, a Christian ministry founded in Orange County, California. Celebrate Recov- ery has grown nationwide due in large part to the opioid epidemic. On the cold Tuesday night I visited, the service fea- tured an electric band singing the kind of fervid new gospel music that is common to nondenominational Christianity: “You are perfect in all of your ways …” Ortenzio is Celebrate Recovery’s lay pastor in Clarksburg, running its weekly services. The flock is about 100 or so strong. One evening, a young mother named Sarah stood before the congrega- tion to give her testimony. Sarah’s story started with parents who married too young and divorced before she was 3. It CLARKSBURG’S TRADITIONAL CONGREGATIONS HAVE DWINDLED. IN THEIR PLACE featured father figures who were coal ARE CHURCHES PROCLAIMING A GOSPEL miners and truck drivers and a stepfather OF PROSPERITY AND MINISTRIES SUCH AS CELEBRAT E RECOVERY. who molested her repeatedly, beginning when she was 8. Then a life of illicit drugs, marriage, divorce, and addiction to pre- scription pain pills. Clarksburg’s traditional congrega- tions have dwindled along with the city’s 68 M A Y 2 0 1 9 THE ATLANTIC

L O U O RT E N Z I O WA S T H E F I R S T Clarks- burg doctor prosecuted for improperly pre- scribing pain pills. He was the first person most residents I talked with recall as putting a different face on addiction. He was the first to show that this was a new kind of drug plague, and the first to puncture the idea that the supply came from street dealers. He was also the first to publicly work at his own recovery without shame. He was not, however, alone. In 2005, another local doc- tor, Brad Hall, gathered with members of the West Virginia State Medical Association concerned about addiction among physicians in a state that cannot afford to lose them. They started the Physician Health Program, which has helped some 230 West Virginia doctors with substance-abuse problems get confidential treatment and retain their license to practice. Many are overworked, as Ortenzio had been. Some were self- treating emotional and physical problems. About a quarter abused opioids. Ortenzio managed to escape drugs, but he’s still living with the effects of his addiction. He is working to repair his relation- ship with his youngest son; Ortenzio didn’t attend his wedding and has yet to meet a young grandson. He leans on his faith to keep him going. Many of his encounters with addicts prompt sud- den, public prayers, Ortenzio bowing his head as he clasps the person’s shoulder. His faith has humbled him, relieving him of a sense of hubris that got him into trouble as a doctor: the idea that he could heal an entire community, if he just kept the office open a few hours longer. Doc O will never practice medicine again. Yet his work at the Mission doesn’t seem so different from his routine as a family physician, tending to the needs of one person after another. One morning, he took a resident to a clinic, then talked on the phone with an addicted doctor living in a halfway house. A pastor from the coalfields of southern West Virginia called to ask how to set up a Celebrate Recovery ministry in his large but dying church. A 24-year-old mother of four from a West Virginia mountain town was looking for $225 to pay the utilities for an apartment she was trying to rent. Ortenzio promised to reach out to the Mission’s supporters for a donation. As the morning wore on, a gaunt 26-year-old man from North Carolina, a construction worker addicted to heroin and meth, showed up to report that he’d had five of his teeth pulled. The dentist had prescribed a dozen hydrocodone pills. The con- struction worker couldn’t fill the scrip without proper ID, which he didn’t possess. Ortenzio sat and listened as the young man, slumped beneath a baseball cap, stared at the floor and insisted on his need for the painkiller. The dentist had probably figured that the fellow had lost a lot of teeth, that a dozen pills weren’t many. If that were the case, it would mark a change. Not that long ago, the dentist might have prescribed 20 to 40 pills. Ortenzio offered the construction worker a prayer. The man clearly still wanted the drugs. Ortenzio, who as a doctor had pre- scribed pills by the hundreds each day, could only give him pack- ets of ibuprofen. “You want to stay away from hydrocodone,” he said. Sam Quinones is a Los Angeles–based journalist and the author of three books of narrative nonfiction, including his latest, Dreamland: The True Tale of America’s Opiate Epidemic. THE ATLANTIC MAY 2019 69



T H E H E A L T H R E P O R T THE TROUBLE WITH DENTISTRY BY FERRIS JABR You likely don’t need to go to the dentist every six months. Those microcavities might heal without a filling. And you may want a second opinion before getting that root canal. An inquiry into a profession that’s much less scientific—and far more prone to gratuitous procedures—than you might think. ILLUSTRATIONS BY ARSH RAZIUDDIN THE ATLANTIC MAY 2019 71

IN THE EARLY 2000S Terry Mitchell’s dentist retired. For a while, long period of time. And he trusted Lund He also chiseled out her bridge, replacing Mitchell, an electrician in his 50s, stopped completely. He figured that if he needed it with two new ones that left a conspicu- seeking dental care altogether. But when the treatments, then he might as well get ous gap in her front teeth. Altogether, the one of his wisdom teeth began to ache, them before things grew worse. work cost her about $70,000. he started looking for someone new. An acquaintance recommended John Roger Meanwhile, another of Lund’s In early 2012, Lund retired. Brendon Lund, whose practice was a convenient patients was going through a similar expe- Zeidler, a young dentist looking to expand 10-minute walk from Mitchell’s home, in rience. Joyce Cordi, a businesswoman his business, bought Lund’s practice and San Jose, California. Lund’s practice was in her 50s, had learned of Lund through assumed responsibility for his patients. situated in a one-story building with clay 1-800-DENTIST. She remembers the ser- Within a few months, Zeidler began to roof tiles that housed several dental offices. vice giving him an excellent rating. When suspect that something was amiss. Finan- The interior was a little dated, but not dingy. she visited Lund for the first time, in 1999, cial records indicated that Lund had been The waiting room was small and the decor she had never had so much as a cavity. To spectacularly successful, but Zeidler was minimal: some plants and photos, no fish. the best of her knowledge her teeth were making only 10 to 25 percent of Lund’s Lund was a good-looking middle-aged guy perfectly healthy, although she’d had a reported earnings each month. As Zeidler with arched eyebrows, round glasses, and small dental bridge installed to fix a rare met more of Lund’s former patients, he graying hair that framed a youthful face. congenital anomaly (she was born with noticed a disquieting trend: Many of them He was charming, chatty, and upbeat. At one tooth trapped inside another and had undergone extensive dental work—a the time, Mitchell and Lund both owned had had them extracted). Within a year, much larger proportion than he would Chevrolet Chevelles, and they bonded Lund was questioning the resilience of have expected. When Zeidler told them, over their mutual love of classic cars. her bridge and telling her she needed root after routine exams or cleanings, that they canals and crowns. didn’t need any additional procedures at Lund extracted the wisdom tooth with that time, they tended to react with sur- no complications, and Mitchell began see- Cordi was somewhat perplexed. Why prise and concern: Was he sure? Nothing ing him regularly. He never had any pain the sudden need for so many procedures at all? Had he checked thoroughly? or new complaints, but Lund encouraged after decades of good dental health? When many additional treatments nonetheless. she expressed uncertainty, she says, Lund In the summer, Zeidler decided to take A typical person might get one or two always had an answer ready. The cavity on a closer look at Lund’s career. He gathered root canals in a lifetime. In the space of this tooth was in the wrong position to treat years’ worth of dental records and bills for seven years, Lund gave Mitchell nine root with a typical filling, he told her on one Lund’s patients and began to scrutinize canals and just as many crowns. Mitchell’s occasion. Her gums were receding, which them, one by one. The process took him insurance covered only a small portion of had resulted in tooth decay, he explained months to complete. What he uncovered each procedure, so he paid a total of about during another visit. Clearly she had been was appalling. $50,000 out of pocket. The number and grinding her teeth. And, after all, she was cost of the treatments did not trouble getting older. As a doctor’s daughter, Cordi WE HAVE A FRAUGHT RELATIONSHIP him. He had no idea that it was unusual to had been raised with an especially respect- undergo so many root canals—he thought ful view of medical professionals. Lund with dentists as authority figures. In casual they were just as common as fillings. The was insistent, so she agreed to the proce- conversation we often dismiss them as payments were spread out over a relatively dures. Over the course of a decade, Lund “not real doctors,” regarding them more gave Cordi 10 root canals and 10 crowns. as mechanics for the mouth. But that dis- dain is tempered by fear. For more than a 72 M A Y 2 0 1 9 THE ATLANTIC

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century, dentistry has been half-jokingly as truth. But this supposed commandment benefits of a given dental intervention, or compared to torture. Surveys suggest that of oral health has no scientific grounding. there is simply not enough research to say up to 61 percent of people are apprehen- Scholars have traced its origins to a few anything substantive one way or another. sive about seeing the dentist, perhaps potential sources, including a toothpaste 15 percent are so anxious that they avoid advertisement from the 1930s and an illus- Fluoridation of drinking water seems the dentist almost entirely, and a smaller trated pamphlet from 1849 that follows the to help reduce tooth decay in children, but percentage have a genuine phobia requir- travails of a man with a severe toothache. there is insufficient evidence that it does ing psychiatric intervention. Today, an increasing number of dentists the same for adults. Some data suggest acknowledge that adults with good oral that regular flossing, in addition to brush- When you’re in the dentist’s chair, the hygiene need to see a dentist only once ing, mitigates gum disease, but there is power imbalance between practitioner every 12 to 16 months. only “weak, very unreliable” evidence and patient becomes palpable. A masked that it combats plaque. As for common but figure looms over your recumbent body, Many standard dental treatments—to invasive dental procedures, an increasing wielding power tools and sharp metal say nothing of all the recent innovations number of dentists question the tradition instruments, doing things to your mouth and cosmetic extravagances—are likewise of prophylactic wisdom-teeth removal; you cannot see, asking you questions you not well substantiated by research. Many often, the safer choice is to monitor cannot properly answer, and judging you have never been tested in meticulous clini- unproblematic teeth for any worrying all the while. The experience simultane- cal trials. And the data that are available developments. Little medical evidence ously invokes physical danger, emotional are not always reassuring. justifies the substitution of tooth-colored vulnerability, and mental limpness. A resins for typical metal amalgams to fill cavity or receding gum line can suddenly The Cochrane organization, a highly cavities. And what limited data we have feel like a personal failure. When a dentist respected arbiter of evidence-based medi- don’t clearly indicate whether it’s better to declares that there is a problem, that some- cine, has conducted systematic reviews repair a root-canaled tooth with a crown thing must be done before it’s too late, who of oral-health studies since 1999. In these or a filling. When Cochrane researchers has the courage or expertise to disagree? reviews, researchers analyze the scien- tried to determine whether faulty metal When he points at spectral smudges on an tific literature on a particular dental inter- fillings should be repaired or replaced, X-ray, how are we to know what’s true? In vention, focusing on the most rigorous and they could not find a single study that met other medical contexts, such as a visit to a their standards. general practitioner or a cardiologist, we A masked are fairly accustomed to seeking a second figure looms over “The body of evidence for dentistry opinion before agreeing to surgery or an your recumbent body, is disappointing,” says Derek Richards, expensive regimen of pills with harsh side wielding power tools the director of the Centre for Evidence- effects. But in the dentist’s office—perhaps and sharp metal Based Dentistry at the University of because we both dread dental procedures instruments, doing Dundee, in Scotland. “Dentists tend to and belittle their medical significance— things to your mouth want to treat or intervene. They are more the impulse is to comply without much akin to surgeons than they are to physi- consideration, to get the whole thing over you cannot see. cians. We suffer a little from that. Every- with as quickly as possible. body keeps fiddling with stuff, trying well-designed studies. In some cases, the out the newest thing, but they don’t test The uneasy relationship between den- findings clearly justify a given procedure. them properly in a good-quality trial.” tist and patient is further complicated by For example, dental sealants—liquid plas- an unfortunate reality: Common dental tics painted onto the pits and grooves of The general dearth of rigorous procedures are not always as safe, effec- teeth like nail polish—reduce tooth decay in research on dental interventions gives tive, or durable as we are meant to be- children and have no known risks. (Despite dentists even more leverage over their lieve. As a profession, dentistry has not yet this, they are not widely used, possibly be- patients. Should a patient somehow mus- applied the same level of self-scrutiny as cause they are too simple and inexpensive ter the gumption to question an initial medicine, or embraced as sweeping an to earn dentists much money.) But most diagnosis and consult the scientific litera- emphasis on scientific evidence. “We are of the Cochrane reviews reach one of two ture, she would probably not find much to isolated from the larger health-care sys- disheartening conclusions: Either the avail- help her. When we submit to a dentist’s tem. So when evidence-based policies are able evidence fails to confirm the purported examination, we are putting a great deal being made, dentistry is often left out of of trust in that dentist’s experience and the equation,” says Jane Gillette, a dentist intuition—and, of course, integrity. in Bozeman, Montana, who works closely with the American Dental Association’s WHEN ZEIDLER PURCHASED LUND’S Center for Evidence-Based Dentistry, which was established in 2007. “We’re practice, in February 2012, he inherited a kind of behind the times, but increasingly massive collection of patients’ dental his- we are trying to move the needle forward.” tories and bills, a mix of electronic docu- ments, handwritten charts, and X-rays. By Consider the maxim that everyone August, Zeidler had decided that if any- should visit the dentist twice a year for thing could explain the alarmingly abun- cleanings. We hear it so often, and from dant dental work in the mouths of Lund’s such a young age, that we’ve internalized it patients, he would find it in those records. He spent every weekend for the next nine 74 M A Y 2 0 1 9 THE ATLANTIC

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months examining the charts of hundreds dentist will strengthen the tooth with a was doing the exact opposite of that—it of patients treated in the preceding five filling or crown. In the rare case that infec- was very hard, very hard to accept that years. In a giant Excel spreadsheet, he tion returns, the patient must go through someone was willing to do that.” logged every single procedure Lund had the whole ordeal again or consider more performed, so he could carry out some advanced surgery. Zeidler knew what he had to do next. basic statistical analyses. As a dental professional, he had certain Zeidler noticed that nearly every time ethical obligations. He needed to confront The numbers spoke for themselves. Lund gave someone a root canal, he also Lund directly and give him the chance to Year after year, Lund had performed cer- charged for an incision and drainage, account for all the anomalies. Even more tain procedures at extraordinarily high known as an I&D. During an I&D, a den- daunting, in the absence of a credible rates. Whereas a typical dentist might per- tist lances an abscess in the mouth and explanation, he would have to divulge form root canals on previously crowned drains the exudate, all while the patient his discoveries to the patients Lund had teeth in only 3 to 7 percent of cases, Lund is awake. In some cases the dentist slips a bequeathed to him. He would have to was performing them in 90 percent of small rubber tube into the wound, which tell them that the man to whom they had cases. As Zeidler later alleged in court continues to drain fluids and remains in entrusted their care—some of them for documents, Lund had performed invasive, place for a few days. I&Ds are not routine two decades—had apparently deceived costly, and seemingly unnecessary proce- adjuncts to root canals. They should be them for his own profit. dures on dozens and dozens of patients, used only to treat severe infections, which some of whom he had been seeing for occur in a minority of cases. Yet they were THE IDEA OF THE DENTIST AS POTENTIAL decades. Terry Mitchell and Joyce Cordi were far from alone. In fact, they had not Whereas charlatan has a long and rich history. even endured the worst of it. medicine has In medieval Europe, barbers didn’t just reckoned with trim hair and shave beards; they were also Dental crowns were one of Lund’s some of its own surgeons, performing a range of minor op- most frequent treatments. A crown is tendencies erations including bloodletting, the admin- a metal or ceramic cap that completely toward excessive istration of enemas, and tooth extraction. encases an injured or decayed tooth, and misguided Barber surgeons, and the more specialized which is first shaved to a peg so its new “tooth drawers,” would wrench, smash, shell will fit. Crowns typically last 10 to treatment, and knock teeth out of people’s mouths 15 years. Lund not only gave his patients dentistry has with an intimidating metal instrument superfluous crowns; he also tended to lagged behind. called a dental key: Imagine a chimera of a replace them every five years—the mini- hook, a hammer, and forceps. Sometimes mum interval of time before insurance extremely common in Lund’s practice. In the results were disastrous. In the 1700s, companies will cover the procedure again. 2009, for example, Lund billed his patients Thomas Berdmore, King George III’s for 109 I&Ds. Zeidler asked many of those “Operator for the Teeth,” described one More than 50 of Lund’s patients also patients about the treatments, but none of woman who lost “a piece of jawbone as big had ludicrously high numbers of root them recalled what would almost certainly as a walnut and three neighbouring molars” canals: 15, 20, 24. (A typical adult mouth have been a memorable experience. at the hands of a local barber. has 32 teeth.) According to one lawsuit that has since been settled, a woman in her In addition to performing scores of Barber surgeons came to America as late 50s came to Lund with only 10 natural seemingly unnecessary procedures that early as 1636. By the 18th century, dentistry teeth; from 2003 to 2010, he gave her nine could result in chronic pain, medical was firmly established in the colonies as a root canals and 12 crowns. The American complications, and further operations, trade akin to blacksmithing (Paul Revere Association of Endodontists claims that a Lund had apparently billed patients for was an early American craftsman of arti- root canal is a “quick, comfortable proce- treatments he had never administered. sanal dentures). Itinerant dentists moved dure” that is “very similar to a routine fill- Zeidler was alarmed and distressed. from town to town by carriage with carts of ing.” In truth, a root canal is a much more “We go into this profession to care for dreaded tools in tow, temporarily setting radical operation than a filling. It takes lon- patients,” he told me. “That is why we up shop in a tavern or town square. They ger, can cause significant discomfort, and become doctors. To find, I felt, someone yanked teeth or bored into them with hand may require multiple trips to a dentist or drills, filling cavities with mercury, tin, gold, specialist. It’s also much more costly. or molten lead. For anesthetic, they used arsenic, nutgalls, mustard seed, leeches. Root canals are typically used to treat Mixed in with the honest tradesmen— infections of the pulp—the soft living core who genuinely believed in the therapeutic of a tooth. A dentist drills a hole through power of bloodsucking worms—were a tooth in order to access the root canals: swindlers who urged their customers to long, narrow channels containing nerves, have numerous teeth removed in a single blood vessels, and connective tissue. The sitting or charged them extra to stuff their dentist then repeatedly twists skinny metal pitted molars with homemade gunk of files in and out of the canals to scrape away dubious benefit. all the living tissue, irrigates the canals with disinfectant, and packs them with a In the mid-19th century, a pair of rubberlike material. The whole process American dentists began to elevate their usually takes one to two hours. After- trade to the level of a profession. From ward, sometimes at a second visit, the 1839 to 1840, Horace Hayden and Chapin 76 M A Y 2 0 1 9 THE ATLANTIC

Harris established dentistry’s first college, potentially damaging the heart and lungs. major medical associations around the scientific journal, and national associa- Poor oral health is associated with narrow- world have long endorsed evidence- tion. Some historical accounts claim that ing arteries, cardiovascular disease, stroke, based medicine. The idea is to shift Hayden and Harris approached the Uni- and respiratory disease, possibly due focus away from intuition, anecdote, versity of Maryland’s School of Medicine to a complex interplay of oral microbes and received wisdom, and toward the about adding dental instruction to the cur- and the immune system. And some conclusions of rigorous clinical research. riculum, only to be rebuffed by the resident research suggests that gum disease can Although the phrase evidence-based medi- physicians, who declared that dentistry be an early sign of diabetes, indicating a cine was coined in 1991, the concept began was of little consequence. But no definitive relationship between sugar, oral bacteria, taking shape in the 1960s, if not earlier proof of this encounter has ever surfaced. and chronic inflammation. (some scholars trace its origins all the way back to the 17th century). In contrast, Whatever happened, from that point Dentistry’s academic and profes- the dental community did not begin on, “the professions of dentistry and medi- sional isolation has been especially detri- having similar conversations until the cine would develop along separate paths,” mental to its own scientific inquiry. Most writes Mary Otto, a health journalist, in her recent book, Teeth. Becoming a practicing physician re- quires four years of medi- cal school followed by a three-to-seven-year resi- dency program, depending on the specialty. Dentists earn a degree in four years and, in most states, can immediately take the na- tional board exams, get a license, and begin treating patients. (Some choose to continue training in a spe- cialty, such as orthodontics or oral and maxillofacial surgery.) When physicians complete their residency, they typically work for a hospital, university, or large health-care organiza- tion with substantial over- sight, strict ethical codes, and standardized treat- ment regimens. By con- trast, about 80 percent of the nation’s 200,000 active dentists have indi- vidual practices, and although they are bound by a code of ethics, they typically don’t have the same level of oversight. Throughout history, many physicians have la- mented the segregation of dentistry and medi- cine. Acting as though oral health is somehow divorced from one’s over- all well-being is absurd; the two are inextricably linked. Oral bacteria and the toxins they produce can migrate through the bloodstream and airways, THE ATLANTIC MAY 2019 77

mid-1990s. There are dozens of journals can publish a guideline in a journal, but focused upon surgical procedures to treat and organizations devoted to evidence- passive dissemination of information is the symptoms of disease,” Mary Otto based medicine, but only a handful clearly not adequate for real change.” writes. “America’s dental care system con- devoted to evidence-based dentistry. tinues to reward those surgical procedures Among other problems, dentistry’s far more than it does prevention.” In the past decade, a small cohort of struggle to embrace scientific inquiry has dentists has worked diligently to pro- left dentists with considerable latitude to “Excessive diagnosis and treatment are mote evidence-based dentistry, hosting advise unnecessary procedures—whether endemic,” says Jeffrey H. Camm, a dentist workshops, publishing clinical-practice intentionally or not. The standard euphe- of more than 35 years who wryly described guidelines based on systematic reviews mism for this proclivity is overtreatment. his peers’ penchant for “creative diagno- of research, and creating websites that cu- Favored procedures, many of which are sis” in a 2013 commentary published by rate useful resources. But its adoption “has elaborate and steeply priced, include the American Dental Association. “I don’t been a relatively slow process,” as a 2016 root canals, the application of crowns want to be damning. I think the majority commentary in the Contemporary Clinical and veneers, teeth whitening and filing, of dentists are pretty good.” But many Dentistry journal put it. Part of the prob- deep cleaning, gum grafts, fillings for have “this attitude of ‘Oh, here’s a spot, lem is funding: Because dentistry is often “microcavities”—incipient lesions that do I’ve got to do something.’ I’ve been con- sidelined from medicine at large, it simply not require immediate treatment—and tacted by all kinds of practitioners who are does not receive as much money from the superfluous restorations and replace- upset because patients come in and they government and industry to tackle these ments, such as swapping old metal fillings already have three crowns, or 12 fillings, or issues. “At a recent conference, very few for modern resin ones. Whereas medicine another dentist told them that their 2-year- practitioners were even aware of the exis- has made progress in reckoning with at old child has several cavities and needs to tence of evidence-based clinical guide- least some of its own tendencies toward be sedated for the procedure.” lines,” says Elliot Abt, a professor of oral excessive and misguided treatment, den- medicine at the University of Illinois. “You tistry is lagging behind. It remains “largely Trish Walraven, who worked as a den- tal hygienist for 25 years and now man- ages a dental-software company with her husband in Texas, recalls many troubling cases: “We would see patients seeking a second opinion, and they had treatment plans telling them they need eight fillings in virgin teeth. We would look at X-rays and say, ‘You’ve got to be kidding me.’ It was blatantly overtreatment—drilling into teeth that did not need it whatsoever.” Studies that explicitly focus on over- treatment in dentistry are rare, but a re- cent field experiment provides some clues about its pervasiveness. A team of re- searchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly se- lected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings. Similarly, in an investigation for Reader’s Digest, the writer William Ecenbarger vis- ited 50 dentists in 28 states in the U.S. and received prescriptions ranging from a sin- gle crown to a full-mouth reconstruction, with the price tag starting at about $500 and going up to nearly $30,000. A multitude of factors has conspired to create both the opportunity and the motive for widespread overtreatment in dentistry. In addition to dentistry’s 78 M A Y 2 0 1 9 THE ATLANTIC

FROM THE NATIONAL BOOK AWARD-WINNING AUTHOR OF ARCTIC DREAMS HORIZON “Literary “ E P I C. . . journalism, memoir A bracing masterpiece for and travelogue: a broken world— the crowning SO COMPELLING achievement of a IT DESERVES ITS legendary scribe.” OWN GENRE.” —OUTSIDE MAGAZINE —WASHINGTON POST “A celebration and “In these investigation of the chronicles we get impulse to explore. to share the travels that helped shape In his intensity, Lopez’s extraordinary his clarity, and his capacity for wonder, mind and heart. BARRY LOPEZ A GREAT GIFT IS UNMATCHED.” TO US ALL.” —ELIZABETH —BILL KOLBERT McKIBBEN “STRAIGHT-UP MAGNIFICENT. To read H O R I Z O N is to be transported to wondrous landscapes far beyond the pale, and thereby obtain an astounding perspective on our increasingly uncertain future.” —JON KRAKAUER KNOPF

seclusion from the greater medical com- those meetings went, he offered a single that was unnecessary and billing for treat- munity, its traditional emphasis on proce- sentence—“I decided shortly thereafter to ment which was never performed.” The dure rather than prevention, and its lack take legal action”—and declined to com- suit was settled for a confidential amount. of rigorous self-evaluation, there are eco- ment further. (Repeated attempts were From 2014 to 2017, 10 of Lund’s former nomic explanations. The financial burden made to contact Lund and his lawyer for patients, including Mitchell and Cordi, of entering the profession is high and rising. this story, but neither responded.) sued him for a mix of fraud, deceit, bat- In the U.S., the average debt of a dental- tery, financial elder abuse, and dental school graduate is more than $200,000. One by one, Zeidler began to write, call, malpractice. They collectively reached a And then there’s the expense of finding an or sit down with patients who had previ- nearly $3 million settlement, paid out by office, buying new equipment, and hiring ously been in Lund’s care, explaining what Lund’s insurance company. (Lund did not staff to set up a private practice. A dentist’s he had uncovered. They were shocked and admit to any wrongdoing.) income is entirely dependent on the num- angry. Lund had been charismatic and pro- ber and type of procedures he or she per- fessional. They had assumed that his diag- Lund was arrested in May 2016 and re- forms; a routine cleaning and examination noses and treatments were meant to keep leased on $250,000 bail. The Santa Clara earns only a baseline fee of about $200. them healthy. Isn’t that what doctors do? County district attorney’s office is prose- “It makes you feel like you have been vio- cutingacriminalcase againsthimbasedon In parallel with the rising cost of den- lated,” Terry Mitchell says—“somebody 26 counts of insurance fraud. At the time of tal school, the amount of tooth decay in performing stuff on your body that doesn’t his arraignment, he said he was innocent many countries’ populations has declined need to be done.” Joyce Cordi recalls a of all charges. The Dental Board of Califor- dramatically over the past four decades, nia is seeking to revoke or suspend Lund’s mostly thanks to the introduction of mass- Joyce Cordi’s license, which is currently inactive. produced fluoridated toothpaste in the new dentist 1950s and ’60s. In the 1980s, with fewer says her X-rays Many of Lund’s former patients worry genuine problems to treat, some practi- resemble those about their future health. A root canal is tioners turned to the newly flourishing of someone who not a permanent fix. It requires mainte- industry of cosmetic dentistry, promot- had reconstructive nance and, in the long run, may need to ing elective procedures such as bleaching, facial surgery be replaced with a dental implant. One of teeth filing and straightening, gum lifts, following a Mitchell’s root canals has already failed: and veneers. It’s easy to see how dentists, The tooth fractured, and an infection hoping to buoy their income, would be car crash. developed. He said that in order to treat the tempted to recommend frequent exams infection, the tooth was extracted and he and proactive treatments—a small fill- “moment of absolute fury” when she first underwent a multistage procedure involv- ing here, a new crown there—even when learned of Lund’s deceit. On top of all the ing a bone graft and months of healing be- waiting and watching would be better. It’s needless operations, “there were all kinds fore an implant and a crown were fixed in equally easy to imagine how that behavior of drains and things that I paid for and the place. “I don’t know how much these root might escalate. insurance company paid for that never canals are going to cost me down the line,” happened,” she says. “But you can’t read Mitchell says. “Six thousand dollars a pop “If I were to sum it up, I really think the dentalese.” for an implant—it adds up pretty quick.” the majority of dentists are great. But for some reason we seem to drift toward this “A lot of them felt, How can I be so stu- Joyce Cordi’s new dentist says her attitude of ‘I’ve got tools so I’ve got to fix pid? Or Why didn’t I go elsewhere?” Zeidler X-rays resemble those of someone who something’ much too often,” says Jeffrey says. “But this is not about intellect. It’s had reconstructive facial surgery follow- Camm. “Maybe it’s greed, or paying off about betrayal of trust.” ing a car crash. Because Lund installed her debt, or maybe it’s someone’s training. new dental bridges improperly, one of her It’s easy to lose sight of the fact that even In October 2013, Zeidler sued Lund teeth is continually damaged by everyday something that seems minor, like a filling, for misrepresenting his practice and chewing. “It hurts like hell,” she says. She involves removal of a human body part. It breaching their contract. In the lawsuit, has to wear a mouth guard every night. just adds to the whole idea that you go to Zeidler and his lawyers argued that Lund’s a physician feeling bad and you walk out reported practice income of $729,000 to What some of Lund’s former patients feeling better, but you go to a dentist feel- $988,000 a year was “a result of fraudu- regret most are the psychological repercus- ing good and you walk out feeling bad.” lent billing activity, billing for treatment sions of his alleged duplicity: the erosion of the covenant between practitioner and IN THE SUMMER OF 2013, ZEIDLER patient, the germ of doubt that infects the mind. “You lose your trust,” Mitchell says. asked several other dentists to review “You become cynical. I have become more Lund’s records. They all agreed with his that way, and I don’t like it.” conclusions. The likelihood that Lund’s patients genuinely needed that many “He damaged the trust I need to have treatments was extremely low. And there in the people who take care of me,” Cordi was no medical evidence to justify many says. “He damaged my trust in mankind. of Lund’s decisions or to explain the phan- That’s an unforgivable crime.” tom procedures. Zeidler confronted Lund about his discoveries in several face-to- Ferris Jabr is a writer based in Portland, face meetings. When I asked Zeidler how Oregon. His work has been anthologized by the Best American Science and Nature Writing series. 80 M A Y 2 0 1 9 THE ATLANTIC

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ELEGY for the AMERICAN CENTURY IN T H E 199 0s, W H EN RICHARD HOLBROOKE ENDED A WAR IN THE BALKANS, AMERICAN INFLUENCE SEEMED POISED TO REACH NEW HEIGHTS. INSTEAD, IT BEGAN TO DECLINE. A REPORT ON THE DECAY OF PA X A MERICANA. By GEORGE PAC K E R 82 M A Y 2 0 1 9 THE ATLANTIC



W H AT ’ S C A L L E D T H E American other towns. Following careful plans, the gunmen would surround a century was really just a little more town, block the exits, and go house to house while local Serbs pointed than half a century, and that was the out the Muslim and, in fewer cases, Croat families. The paramilitaries span of Richard Holbrooke’s life. It would send the residents out into the street, then loot and destroy the began with the Second World War houses. Women, children, and old people were driven out of town and the creative burst that followed— and forced to make their way to the relative safety of Croatia. Men were separated into groups. Those whose names appeared on lists of the United Nations, the Atlantic local notables were taken away and never seen again. alliance, containment, the free The others were sent to concentration camps, where they were starved and made to live in their own filth. The gunmen tormented world—and it went through dizzying their prisoners with tales of wives raped and children murdered. They ordered them to perform sexual acts on one another. They forced lows and highs, until it expired the day them to dig mass graves and fill them with the corpses of their friends, their kin. In some towns the paramilitaries were less discriminating before yesterday. The thing that brings on doom to great powers—is it and killed every last Muslim. But the goal was everywhere the same: to make the place purely Serb, to render it impossible for Bosnia’s simple hubris, or decadence and squander, a kind of inattention, loss different groups to live together ever again. of faith, or just the passage of years? At some point that thing set in, When the gunmen came to Prijedor, the baker hid in the woods and watched the Serbs destroy his house. His neighbors—whom and so we are talking about an age gone by. It wasn’t a golden age— he’d known for years and considered friends—found him and turned him over to the paramilitaries. The neighbors did this with- there was plenty of folly and wrong—but I already miss it. The best out remorse. It was the first sign of hatred that the baker had ever seen in them, and the suddenness of it stunned him. When Hol- about us was inseparable from the worst. Our feeling that we could do brooke asked why the Serbs had done these things, the baker said simply, “I don’t know.” He was lucky to be a baker and not a notable. anything gave us the Marshall Plan and Vietnam, the peace at Dayton He was taken to the concentration camp at Manjača, from which he escaped across the border to Croatia, where he became one of the and the endless Afghan War. Our confidence and energy, our reach war’s 2 million refugees. and grasp, our excess and blindness—they were not so different from All of this was called by an ugly euphemism that reflected the thinking of the perpetrators: ethnic cleansing. On an earlier trip to Holbrooke’s. He was our man. That’s the reason to tell you this story. Bosnia, in August, Holbrooke had seen its immediate aftermath: the destroyed houses of Muslims alongside a lonely intact Serb He served as a diplomat under every Democratic president from house, the wrecked factories, the fields of rotting corn, the armed Serb bullies, the Muslims lined up to sign away all their property John F. Kennedy to Barack Obama, from Vietnam to Afghanistan. and then be crammed onto buses heading for Croatia. Now he was talking with the survivors. But his egotism alienated superiors and colleagues, and he never There was a factory worker from Sanski Most whose Serb fore- reached his lifelong goal of becoming secretary of state. He wasn’t man came to his house one night in a group of uniformed and armed Serbs. They ordered him to leave the house, and then they blew it a grand strategist, but his frenetic public presence made him the up, and the whole time the foreman avoided looking him in the eye. There was a man whose 70-year-old mother had been raped and embodiment of certain ideas in action. His views, like everyone’s, was still trapped in Sanski Most. Could Holbrooke help get her out of Bosnia? There was an old man who had to drag himself across the emerged from his nervous system, his amygdala, the core of his bunks to show Holbrooke how the Serb guards had broken his leg. “These Serbs are so awful that they bring their little sons of 10 years character, where America stood for something more than just its old to the camps to watch them beat us,” the old man said. own power. He believed that power brought responsibilities, and “Not all the Serbs are so bad,” a younger man said. “But those who refused to participate were killed by the other Serbs right at if we failed to face them the world’s suffering would worsen, and the beginning.” eventually other people’s problems would be ours, and if we didn’t The stories were all the same. A savage and inexplicable fever had spread overnight through their friends and neighbors of many act, no one else would. Not necessarily with force, but with the full years, and now everything was finished. weight of American influence. That was the Holbrooke doctrine, As Holbrooke started to leave, the baker brought out a dirty plas- tic bag from under his mattress. Inside was a pair of small figures, vindicated at Dayton, where he ended a war and brought an uneasy three or four inches tall, in blond wood. Human figures, with nearly featureless faces and heads bowed and hands together behind their peace to Bosnia. The country owed its existence to the liberal inter- backs. The baker had carved them with a piece of broken glass while he was interned at the Manjača camp, where the prisoners nationalism of Pax Americana. Now that those words are history, had stood bound for hours with their heads down to avoid being beaten. The mute simplicity of the figures evoked immense sorrow. and we’ve retreated into a nationalism whose ugliness more and As Holbrooke held them they seemed to burn in his hand. He was too moved to do more than mumble a few words and return them. more reminds me of Balkan politics, we should revisit Bosnia to see what’s lost when America decides to leave the world alone. I. FORMER YUGOSLAVIA DECEMBER 1992 It was very cold but there was not yet snow on the ground. The refu- OPENING SPREAD: BERNARD BISSON/SYGMA/GETTY gee camp was in a barracks town called Karlovac, an hour outside Zagreb, the Croatian capital. Three thousand Bosnian Muslims, mostly men, lived in two concrete buildings. The Bosnians were sleeping in metal bunk beds stacked three high on concrete floors, with clothing draped from the bed frames. In the musty air they waited and waited for word of a new home in another country. The internationals wanted them to return someday to Bosnia, but the men had no such desire. Holbrooke, who was in the Balkans on behalf of the International Rescue Committee, a refugee organization with a board of promi- nent men and women, including him, leaned forward with his hands behind his back and stood listening to a young man in a group sprawled on the bunks. He was a baker from Prijedor, a small town in northern Bosnia. The town had been majority Muslim until war broke out in the spring. Then Bosnian Serb paramilitaries came to Prijedor— and to Zvornik, Bijeljina, Omarska, Orašac, Bišćani, Sanski Most, and 84 M A Y 2 0 1 9 THE ATLANTIC

“No,” the baker said. “Please take them back to your country and could bribe their way out. UN officials had to negotiate with Serb show them to your people. Show the Americans how we have been forces to let humanitarian supplies into Sarajevo—just enough got treated. Tell America what is happening to us.” through to keep the city on life support and the outside world satis- fied. The United Nations, too, was part of the siege. T HE COLD WAR WAS OVER. Bill Clinton was about to en- ter the White House, and the United States was at the peak The siege lines hardly ever changed. The point for the Serbs was of global power. But the country and its new president were not to take Sarajevo but to pound it and watch it die. too self-absorbed and distracted to know how to lead the world, or whether they even wanted to. Holbrooke was 51 and in the prime of When Holbrooke emerged from the car, the sky was the color of his career, but he couldn’t get a job in the new administration—his dirty milk. All around were destroyed cars. Across the road stood the shameless ambition had put off too many important people. Instead shelled and burned tower of the Sarajevo daily, Oslobođenje, which of sitting around his New York apartment while the phone didn’t continued to publish out of a basement bomb shelter. Children were ring, he decided to spend the week after Christmas in the Balkans. picking through a garbage pile for scraps of wood. He wanted to see the war for himself. With Holbrooke, egotism and idealism were uneasily balanced. Then Holbrooke saw someone he knew—John Burns, the New York Times correspondent in Sarajevo, leaving a press conference, In central Bosnia he ran into an old friend from his Vietnam a bit of a wreck himself. Burns suggested that Holbrooke stay in years who was there on a humanitarian mission. They forged a UN his quarters at the Holiday Inn. It would be an interesting place to identity card for Holbrooke and headed to Sarajevo in a Danish spend New Year’s Eve. armored personnel carrier. Holbrooke sat in front in his oversize helmet and overstuffed, antiquated flak jacket. It was New Year’s The last stretch of the trip took Holbrooke down a wide boule- Eve, and the Serb fighters at the checkpoint had already started vard known as Sniper Alley, into the center of Sarajevo. It was the drinking, there was a woman wearing a lot of makeup, and in the 271st day of the siege. holiday mood they allowed the foreigners through, including Hol- brooke and his suspicious card. In the late afternoon the group Snow was falling over the city, over the blackened high-rises and reached the Sarajevo airport. The buildings were damaged, the the fresh graves and the Serb batteries in the mountains. runway littered with debris. The airport was under UN control, and the Blue Helmets had orders to let no unauthorized Bosnians leave, On Bosnian radio the announcer was saying, “The war criminal though the lucky few who scraped together 1,000 German marks Radovan Karadžić has said he will not abandon sovereignty over territories which the Serbian people consider their own.” A reporter for Oslobođenje was burning his books in his fireplace to keep warm. A classroom of elementary schoolchildren was receiving a lesson on land mines from Italian peacekeepers. Children with cardboard ILLUSTRATION BY LA TIGRE THE ATLANTIC MAY 2019 85

guns were running down a street. A man wiped away tears as he read Around noon he got a ride in an unarmored car on the exposed a letter from his daughter, who had reached safety in Split. road to the airport. His guide negotiated with the Danish peace- keepers, but their credentials made them a low priority. Holbrooke In a small, crowded apartment somewhere in the city, people sat on the floor reading. He took out his journal and wrote: were singing, clapping, hugging, kissing, raising plastic cups to toast the new year by candlelight. If I don’t make my views known to the new team, I will not have done enough to help the desperate people we have just seen; but The Holiday Inn was a yellow-and-brown concrete cube missing if I push my views I will appear too aggressive. I feel trapped. most of its windows. In the months before the war, the hotel had been the headquarters of Karadžić’s political party. Now the upper Suddenly there was room on a Canadian C-130. As darkness rooms were occupied by Bosnian soldiers, and the hotel was run fell the plane climbed straight up into the sky and veered away by a criminal gang with connections at the top of the government. from Sarajevo. The entrance faced Sniper Alley and Serb guns in the high-rises just across the river, so guests entered through the back, driving at high II. speed into the underground garage. There was no water and no heat, and rarely electricity. The room rate was $150 a night. BLOOD OF OUR BLOOD Burns slept and worked in room 305 and used room 306 for stor- The question in the Balkans was always how far back to go. Serb age, stockpiling 2,000 liters of fuel in the bathroom after he caught nationalists went back to 1389, the year the Serbs fought the Turks the garage attendant siphoning his supply to sell on the black mar- to a draw at the Field of Blackbirds in Kosovo and opened the way ket and replacing the stolen fuel with water. Holbrooke was billeted for the Ottoman empire to conquer the lands of the South Slavs up in room 306. to the gates of Vienna. The Croatian president, Franjo Tudjman, liked to start with the breakup of the Roman empire. President After setting down his things, he knocked on Burns’s door. They Alija Izetbegović of Bosnia began his autobiography by noting that sat and talked amid the maps and gear—two small generators, a Bosnia was first mentioned as a distinct territory in A.D. 958. Every word processor, and a satellite data transmitter. They had met few centuries some new foreign conquerors—Slavs, Ottomans, in Beijing when Burns was a correspondent there, and again in Austrians—swept through the Balkan Peninsula, leaving a shifting Manila just after the fall of Imelda Marcos, when they explored the pattern of identities and faiths. The Croats were Roman Catholics, abandoned presidential palace together and rummaged through the Serbs were Orthodox, the Muslims were converted to Islam by the Marcoses’ closets and Holbrooke tied one of the first lady’s bras the Turks. The Serbs used Cyrillic script while the Croats and the around his head, with the cups as ears. Muslims wrote in Latin, but they spoke pretty much the same lan- guage. They intermarried. You couldn’t tell them apart by looking Burns gave Holbrooke his view: This was no war of ancient at them. They had a violent history, but they didn’t have a genetic hatreds in which all sides were equally guilty. There were aggressors predisposition to exterminate one another. and victims. Burns had interviewed the Serb gunners in the hills and seen how clear a view they had of the hospital locked in their artil- Or you could go back to the start of the 20th century, when lery range, of the mother and child caught in their high-powered two Balkan wars pushed the Ottomans out of Europe, expanded scopes. In the center of Sarajevo, a mosque, a Catholic cathedral, an the Serb kingdom, and inflamed the nationalisms that burst out in Orthodox church, and a synagogue stood within a few steps of one Sarajevo on June 28, 1914, producing the First World War and then, another, and all of them were damaged. Sarajevo had been a mixed at the Versailles Peace Conference, the Kingdom of Serbs, Croats, city forever, and now an army of fascists was destroying it. Nothing and Slovenes, which became the Kingdom of Yugoslavia. Or, more would stop the killing except intervention from outside. to the point, you could go back to the Second World War—still a liv- ing memory when Yugoslavia entered its death throes in the early T H E Y W E N T D OW N S TA I R S to join other reporters in ’90s. Hitler and Mussolini attacked the country in April 1941. Serbs the cold, smoky restaurant for a $30-a-plate New Year’s were targeted and slaughtered as an enemy race. Croatia became Eve dinner, served at room temperature by waiters who a nominally independent state under a puppet regime of home- did their best to keep up appearances in black bow ties and green grown fascists known as the Ustashe, who subscribed to a belief Holiday Inn jackets. Sarajevo appealed to the part of Holbrooke that in their own Germanic origins and racial superiority. The Ustashe had never stopped being a young adventurer with a sense of dark killed 400,000 Croatian Serbs, along with tens of thousands of absurdity whose favorite novel was Catch-22. Jews, Roma, and Communist Partisans. Bosnia was absorbed into the Ustashe’s Croatia, which held Muslims to be Islamized Croats. After dinner, the reporters invited Holbrooke to a party in the Old Town. “You’ll see something right out of Dante’s Inferno,” Burns said. Nationalism turned out to be stronger than communism The party was in an art school on the Miljacka River, just past the or democracy. It might be the spot where World War I began. It was called the Hole in the Wall Club, strongest idea in the world. because you entered by climbing over the rubble of a mortar round and through a gaping hole. Inside it was dark and noisy and thick with cigarette and pot smoke. A live band was playing Stones songs. For- eign do-gooders and reporters and Bosnian aesthetes were crowded next to the small stage, dancing, shouting, hugging, drinking local plum brandy and UN beer. At the stroke of midnight they all threw beer on one another. Everyone was young and beautiful and joyous, and Holbrooke danced in his flak jacket, but he never lost his detach- ment. He sensed the desperation beneath the wild spirits. On the first day of 1993, he woke up around 7:30. Sarajevo lay under a crust of snow. Serb guns were ringing in the new year. A cold fog was settling low over the city. A storm was coming, and so was a Bosnian-army offensive. 86 M A Y 2 0 1 9 THE ATLANTIC

A Bosnian Muslim covers a person killed during fierce fighting in Sarajevo between the Yugoslav army and Muslim fighters. May 3, 1992. DAVID BRAUCHLI/AP One million people were killed in Yugoslavia during World War II, republics. It stirred among Bosnia’s Muslims, who were barely even the great majority of them Serbs. This was the collective memory, the considered a nation. But by far the most aggressive strain was Serb. buried ordnance, dug up by ambitious politicians half a century later. Someone once said that, for Serbs, nationalism was such addictive stuff that they couldn’t take even one sip. It had the irresistible taste Or you could go back to 1987. This was the year a Yugoslav of bitterness, flavored with the sediment of ancient grievances, dis- Communist Party boss named Slobodan Milošević realized that he tilled to a dangerous potency that induced hallucinations of purifi- could rise further and faster if he picked up the forbidden flag of cation and revenge. It was the drink of political losers. Maybe that’s Serbian nationalism. Josip Broz Tito, the half-Croat, half-Slovene true of nationalism everywhere. Partisan leader who had ruled Yugoslavia since the end of the war, held the country together through a skillful mix of repression, de- E THNIC NATIONALISM WASN’T POSSIBLE in Bosnia centralization, and the balancing of tribes. But after Tito’s death without massive killing, because it was the most mixed of in 1980, the whole thing began to come undone. Communism was all the Yugoslav republics. So Bosnian nationality would now a bankrupt ideology that left the souls of Belgrade intellectuals have to be civic—open to all citizens regardless of ethnicity. But empty. Some of them sat around in cafés over cigarettes and glasses when the first free elections were held across Yugoslavia, in 1990, of plum brandy and dreamed up an idea that was big and exciting the winners of the parliamentary election in Bosnia were the three enough to fill the place left by communism. It was the simplest idea parties formed along ethnic lines. in the world: I am what I am. We are Serbs, history’s victims. Blood of our blood. This land is ours. Izetbegović, an intellectual and political activist who had spent much of the 1980s in prison as a threat to Yugoslav state security, Nationalism turned out to be stronger than communism or led the Muslim party. A psychiatrist-poet named Radovan Karadžić, democracy, stronger than religious belief, stronger than universal who had recently spent 11 months in jail on charges of writing fake brotherhood and peace. It might be the strongest idea in the world. medical reports in exchange for free building materials for his It was stirred up in 1986 in a manifesto written by a group of Serb weekend home, became the head of the Bosnian Serb party. Its scholars—a pot of sweeping political grievances brought to a boil by other leaders were a philosopher, a Shakespeare scholar, a biology a rumor that a gang of Albanians in Kosovo had sodomized a Serb professor, and a cement smuggler who had gone to prison with farmer, though an examination showed that the farmer had tried to Karadžić for embezzlement. The dominance of intellectuals in the pleasure himself in his field by sitting on the wide end of a beer bottle. cast of Balkan war criminals shouldn’t surprise you. The leader of the Shining Path was an ex-philosopher. Pol Pot became a Marxist The idea spread through the rest of Yugoslavia. It stirred among while studying in Paris. Ideas can be killers. Slovenes, who considered themselves more Austrian than Slav, and among Croats, whose leader, Tudjman, a retired general, seemed In the fall of 1991, after Croatia and Slovenia had already to style himself after Francisco Franco—pompous, racist, entertain- seceded from Yugoslavia, Karadžić stood up in the Bosnian assem- ing fantasies of glory for his people and himself. It stirred among bly and warned the Muslims of what awaited them if they followed: Albanians, 90 percent of the population of Kosovo, an autonomous “The Muslims cannot defend themselves if there is war. How will region of Serbia, who wanted equal status with the other Yugoslav THE ATLANTIC MAY 2019 87

you prevent everyone from being killed in Bosnia-Herzegovina?” imposed on Bosnia, unilaterally if necessary, so that the Muslims WILLIAM J. CLINTON PRESIDENTIAL LIBRARY The Bosnian Serb parliamentary leader was threatening genocide. could defend themselves, and hit the Bosnian Serbs with limited air strikes to prevent them from slaughtering the Muslims before The logic that drove Bosnia’s Muslims and Croats to vote over- weapons started flowing in. The policy’s main purpose was to keep whelmingly for independence in early 1992 was defensive: The the United States from getting pulled in deeper. The problem was alternative was to remain under threat and humiliation in a dwin- that no one seemed to believe in it. Clinton’s pollster told him that dling Yugoslavia that was becoming Greater Serbia. Most Serbs Americans were against unilateral action in Bosnia but that public boycotted the referendum. Milošević, now the president of Serbia, opinion was malleable. Clinton kept postponing a final decision, secretly ordered the formation of a Bosnian Serb army, 90,000 and Anthony Lake, the national security adviser, sensing the presi- strong, and sent Serb officers from Bosnia home to take posses- dent’s aversion to the whole mess, refrained from pushing one on sion of the Yugoslav army’s heavy weapons. He backed the new him. On May 1, Clinton finally sent Secretary of State Warren Chris- army with paramilitary terror squads from Serbia. Milošević would topher to Europe to sound out the allies, who had thousands of UN finance and control the Serb fighters in Bosnia while keeping his peacekeeping troops in Bosnia and an official position of neutrality. fingerprints invisible. His plan was to create a corridor across north- ern Bosnia that would connect a Serb statelet in Croatia with Mother It was a disastrous trip. Christopher read through the various Serbia, and to turn the Drina River valley along the Bosnia-Serbia options in his briefing book with his head down, no eye contact, like border into a buffer zone. Both regions had Muslim majorities that a lawyer arguing a case in which he’d lost all conviction. By the time needed to be eliminated. he got to lift and strike, the British had practically tuned out. The same happened in Paris, Brussels, and Rome. “I’m here in a listen- The ethnic cleansing began in early April with massacres in the ing mode,” Christopher said—words that had never crossed Dean border towns of Bijeljina and Zvornik. Izetbegović, unprepared for Acheson’s lips, words the Europeans didn’t expect or even want to war, issued a general mobilization order. Serbs set up barricades hear from the American secretary of state, with the hour of Europe around Sarajevo and cut up the city into ethnic enclaves. On April 5, getting darker by the minute. But Christopher invited the Europeans 100,000 citizens of all backgrounds gathered to march for a multi- to answer as they did: We have troops in Bosnia; you don’t. Either put ethnic Sarajevo. Serb snipers opened fire and killed a young medical your men where your policy is or find another policy, because lift and student from Dubrovnik. The next day, the European community strike is going to get our peacekeepers killed.SinceClinton had vowed recognized independent Bosnia, followed immediately by the United never to send troops into the conflict, the UN mission became the States. That night, Serb gunmen on an upper floor of the Holiday Inn prime reason to do nothing but stand by while the killing continued. fired down into a crowd in front of Parliament and killed six people. The Yugoslav army seized the airport, and within days the Serbs’ The Bosnians expected nothing from Europe. A genocide hap- heavy guns in the suburbs and hillsides around Sarajevo were rain- pened there every generation or two. Why would they think they ing shells down on the city. The siege had begun. By summer Bosnian Serb forces, led by a brutal general named Ratko Mladić, controlled 70 percent of Bosnia. That wouldn’t change for the next three years. They named their territory the Republika Srpska, with Karadžić as its president. “We don’t have a dog in that fight,” James Baker, the U.S. secre- tary of state, said. George H. W. Bush kept having to be reminded what the war was about. “Don’t get bogged down in a guerrilla war where you don’t know what the hell you’re doing and you tie the hands of the military,” he said—wasn’t that the lesson of Vietnam? Bosnia wasn’t America’s problem. It was an age-old blood feud on another continent. “This is the hour of Europe,” a diplomat from Luxembourg proclaimed. “It is not the hour of the Americans.” But Europe talked and talked while night fell on Bosnia. The only hope was the new American president. III. A B L O ODY LI T T LE T R I B A L WA R As a candidate, Bill Clinton had vowed to take strong action in Bos- nia. As president, he couldn’t make up his mind what to do. While Washington talked, the siege of Sarajevo entered its sec- ond year. The Serbs closed in on Srebrenica and 56 civilians were killed in an artillery barrage, many of them children playing soccer. War broke out between Muslims and Croats in Mostar; the Croats followed the Serbs in the business of ethnic cleansing and setting up concentration camps. Muslim soldiers were so starved for weapons that they handed off guns at their shift changes and paid kids to collect brass bullet casings in the streets to be reloaded at an ammu- nition factory outside Sarajevo. After three months of talking, Clinton’s team came up with a pol- icy. It was called “lift and strike”: lift the arms embargo the UN had 88 M A Y 2 0 1 9 THE ATLANTIC

President Bill Clinton meets with Richard Holbrooke through multilateral institutions. It was the foreign policy of global- ization. What did a bloody little tribal war have to do with that? and other Bosnian-conflict negotiators on a Virginia In the Oval Office on May 6, Clinton told Colin Powell, the military base. August 23, 1995. chairman of the joint chiefs of staff, and Les Aspin, the secretary of defense, that Balkan Ghosts had made a deep impression on him. were special? With America it was different. Haris Silajdžić, the Aspin returned to the Pentagon and called Lake. “He’s going south Bosnian prime minister, retained enough faith in the decency of on this policy. His heart isn’t in it.” Christopher got the news in the American people—our innocence, Graham Greene would Europe and came home. A travel book based on a travel book had have said—that he made countless trips to Washington to appear fallen into the young president’s hands, and he changed his mind on Larry King Live and testify on Capitol Hill, where he denounced about Bosnia. Foreign policy makes no sense. the arms embargo by telling a congressional committee that he and his family deserved the chance to decide how they would die. Vietnam haunted Clinton, who had demonstrated against the Enough interviews, enough testimony, and Silajdžić believed that war and avoided serving in it. Somalia haunted him too, after 19 Americans would do the right thing. U.S. troops were killed by Somali militiamen in Mogadishu in Octo- ber 1993. If America decided to use force in Bosnia, people would Clinton was reading a book that his wife had given him, Balkan die far outside the control of policy makers in the Situation Room. Ghosts, by a journalist named Robert D. Kaplan. It portrayed the But people were already dying while America stood by and watched region as soaked in the blood of ancient tribal hatreds—these peo- on CNN. The lessons of Vietnam were complex and perhaps the ple had been fighting one another forever. Kaplan, in turn, had trav- wrong ones for Bosnia. Perhaps, just as getting into Vietnam had eled around the Balkans avidly reading Rebecca West’s enormous been the essential mistake of the Cold War, staying out of Bosnia classic, Black Lamb and Grey Falcon, about her journey through would be the essential mistake of the post–Cold War era. That was Yugoslavia just before World War II, a book with a strong pro-Serb the view of the journalists in Sarajevo—their stories and images car- and anti-Muslim bias. Where Europeans saw a war of civilizations, ried the opposite message of the Vietnam reporting. Bosnia stood Americans threw up their hands at incomprehensible Old World Vietnam on its head. Perhaps ongoing slaughter in a small, far-off trouble. We don’t understand other people’s nationalism—even place could actually harm American interests. Perhaps the United though we have our own, racial kind—because we made our repub- States had to learn to use force in a limited way, and to rebuild bro- lic out of a universal and very optimistic idea. Blood and soil are for ken countries. Perhaps that was being pragmatic. history’s losers. Vietnam did not cast a shadow on Holbrooke. He wasn’t con- We understand it better now that the American century is over flicted about Bosnia. Twenty-four hours in Sarajevo had inoculated and some of us sound more and more like Serbs. But in 1993 we him against the uncertainty of his former colleagues. And Vietnam had just won the Cold War, and we bestrode the world. Democratic had given him a feel for the reality of other countries, of the people enlargement replaced containment as the foreign policy of the new caught in the tragedies of history. “Must be engaged in Europe,” he era. America’s grand strategy would be to expand the circle of mar- wrote on a scrap of paper. “Need and desire for US engagement ket democracies around the world by supporting free trade, help- (1947, not 1919).” ing economies liberalize, enlarging NATO to the east, and working I V. “SEE IF WE CAN RESURRECT A STRONG AMERICAN LEADERSHIP ROLE” In the summer of 1994, Bill Clinton and Warren Christopher reluc- tantly made Holbrooke assistant secretary of state, and gave him the task of trying to end the Balkan catastrophe, now entering its fourth year. Holbrooke took to recording his own story on microcassettes. Tomorrow I leave for Sarajevo. It will be my third trip to the war zone in the last 25 months, but this one will be different—I’ll be traveling with a large official contingent, which will certainly inhibit me greatly. Nonetheless, I’m awfully glad that my previous trips have prepared me for all this. Everything I’m hearing about the region and its problems, plus the political and bureaucratic binds that we’re in, makes me increasingly depressed. Objectively, the correct thing to do is to put military pressure on the Serbs. They are the aggressors, and their irredentist goals threaten the entire region. But I’m not sure the American public or its leadership has the will for it, the British and French are clearly opposed and say they will pull out of peacekeeping operations to protect their own troops, and the risks are enormous—even greater if we’re not ready to follow through. It’s an agonizing problem, and it’s been much worse by its mishandling over the last year and a half. Although I remain strongly of the view that the arms embar- go is immoral and should be lifted so the Bosnian Muslims can THE ATLANTIC MAY 2019 89

defend themselves, getting there from here is extremely dif- power by getting out from under punishing UN sanctions through a ficult in the present framework. Keeping the Bosnians alive peace deal. He fell to quarreling with his Bosnian Serb allies, because through covert resupply strikes me as a better option, but I Karadžić and Mladić, intoxicated by years of battlefield success, had haven’t had much luck with that one yet. decided to seize as much remaining territory as possible before the Muslim and Croat forces could turn the war around. The conflict The Europeans will not use NATO force to help the Muslims, reached its climax in the summer of 1995, with the Serb massacre of and the United States will not put ground troops into the region. thousands of Muslim men and boys near Srebrenica, and a Croat- The resulting stalemate is certain to doom the Muslims, except Muslim offensive that pushed the Serbs out of territory in Croatia perhaps as a rump state. The Muslim offensive in Bihać triggered and northern Bosnia that they’d held from the start. In August, just the Serbian counteroffensive, which as of this morning is on the when Holbrooke was getting ready to quit his job, the Clinton admin- brink of total success. Karadžić and Mladić, seeing an opportu- istration finally settled on a plan to use American diplomacy, backed nity to break the will of their enemies before the winter breaks by NATO jets, to end the war. Holbrooke was sent to the Balkans to them in their isolation, have gone for broke, and the West is un- try to negotiate a peace deal among the three warring leaders. able to figure out how to react. The allied response was pathetic. We therefore stand today on the edge of the end of our policy At last he had something to do, far from his agonies in Washing- in the region. The search for a new policy is unavoidable, and ton. A metabolic conversion was about to catalyze all his petty and that new policy will inevitably be at the expense of the Muslims. destructive traits into single-minded purpose. The mission would focus the light in his eyes and engage everything he loved—speed, I feel sick about being a part of such a policy. I don’t feel history, America, even a little mischief. He had been waiting all his responsible, however, as I inherited a terrible hand. Nobody life for this chance. wants to say outright that the war is lost for the Muslims in its current mode and that we should salvage a rump state in the At Milošević’s palace in Belgrade, Holbrooke was greeted like triangular wedge that runs from the Croatian coast up through an old drinking buddy. When the white-jacketed waiter offered Sarajevo to the Tuzla plain, to seek a cease-fire and preserve glasses of mineral water and fruit drinks, Holbrooke asked, “May the international status of the state. No one wants to agree I take two?,” and Milošević replied, “Ambassador, take three.” He to that, and yet no one wants to put enough energy into the reached one of his thick hands into a pocket of his blue blazer, took effort to make the Muslims win. The effort to save the Mus- out a document written in Serbian, and gave it to Holbrooke. “This lims now would require NATO airpower and American ground paper creates a joint Yugoslav–Republika Srpska delegation for all troops—something which is impossible to achieve. I had hoped future peace talks.” The delegation would have six members—three to construct a policy that would get us through the winter with from Belgrade and three from Pale, the Bosnian Serb headquarters. the status quo, but the Bihać offensive killed that opportunity. Its leader, Milošević himself, would break any tie. From now on he would negotiate for the Republika Srpska—removing the biggest Nixon and Kissinger, confronting the inevitable disaster in obstacle to getting an agreement. Vietnam, figured out a way to pretend that it was peace with honor to the American public, even though it was a sellout of the Milošević lit a big Cuban cigar. Holbrooke pressed him. “How South Vietnamese. They blamed the Congress, they took some do you know that your friends from Pale will—” very muscular steps and said they’d done everything they could, and they misrepresented the nature of the deal with Saigon. I’m “They are not my friends,” Milošević spat. “It is awful just to be not suggesting we do the same thing. That level of cynicism is in the same room with them for so long. They are shit.” unacceptable, and in any case not something that this adminis- tration is capable of, since it lacks coherence and discipline. But The talking and eating and drinking went on for eight hours. the fact remains that we must confront our dilemma, we must Milošević drank steadily, getting buzzed and then sobering up several confront the horrendous situation we’re in, set up some priori- times, while Holbrooke lifted his glass of Scotch or slivovic to his lips ties, and see if we can resurrect a strong American leadership and barely sipped. He didn’t stick to talking points—he had no real role. It’s going to be very hard to do. talking points—but let the conversation run its meandering course while looking for openings. Milošević digressed about Serbian wine, Tony Lake prevents action and yet refuses to take any himself. the Ottoman empire, World War II, his banking days in New York, Warren Christopher is willing to act but only uncertainly and with the economic future of Serbia. Holbrooke let him go on, enjoying the ambivalence, and only after checking with everyone else. The parley, and then always brought them back to the war. president seems totally uninvolved. I am under constant attack from Tony and lack support of the seventh floor, except from So a connection formed, with the tense familiarity of two card- [Christopher’s adviser] Strobe [Talbott]. That support is shaky playing rogues. Once, in the middle of an endless session, Hol- because the price is so high for him, and because he doesn’t like brooke phoned his friend Leslie Gelb in New York. “Hey, man. I’m confrontation. Yet there’s nothing more to be done except soldier here in Slobo’s office. I told him you were a Cuban-cigar smoker too, on. I feel like my government career is slowly coming to an end. and I asked him if he’d give you some. He said he’d send you a box, I don’t see how I can continue under the present circumstances, but I wouldn’t believe him, because he lies all the time. Don’t you although I will try. I’m already trying to think of ways to leave with lie all the time, Slobo?” honor, dignity, and a reputation that isn’t destroyed. Milošević was even more direct, sprinkling fuck all over his so-so V. English, needling Holbrooke: “Richard Charles Albert Holbrooke. Why do you have all those names?” Or: “Why is your collar always THEATER WITH MORTAL STAKES up? You’re a politician—all you politicians have something like that. With Tudjman it’s his hair; with you it’s your collar.” By 1995 the Croatian army had become the strongest force in the war, and Milošević knew that the game was nearly up. His objec- Thomas Mann called art “a very serious jest.” Holbrooke’s diplo- tive shifted from establishing Greater Serbia to preserving his own macy was theater with mortal stakes. Large groups of reporters began to follow his team’s every move, waiting in the lobby of the Hyatt hotel across the Sava River from Milošević’s office, or outside Tudjman’s palace in Zagreb, and Holbrooke would pause to give them a spontaneous and perfectly crafted paragraph of non-news, 90 M A Y 2 0 1 9 THE ATLANTIC

careful to keep expectations low, because it did him no good to raise equal entities, one Serb, the other Muslim-Croat. Holbrooke’s first them. He went without sleep for a day or two then crashed for a few regret was pressuring the Muslims to accept the name Republika hours. He gave the impression of being always in motion, sweeping Srpska—Izetbegović said it was like a “Nazi name”—for the Serb with his entourage in and out of airports and hotels, crowding each entity. Republika Srpska became a curse that the negotiators hung day with meetings deep into the night, always pushing the pace. around Bosnia’s neck. The second regret was forcing the Croatian This created momentum for the next small breakthrough, and each and Bosnian armies to stop short of Banja Luka and accept a cease- breakthrough added more speed and power. The experience exhila- fire in early October. rated him, and when he had to spend a whole day in Geneva confer- ring with European diplomats and got his first full night’s sleep, in By then the map had been transformed on the battlefield: From a luxury hotel, he fell into exhaustion and wanted to get back to the 70–30 in favor of the Serbs, the Muslim-Croat federation now had Balkans, where the tense, sleepless hours with warlords restored more than half of Bosnia. The cease-fire ended the shooting, but his energy. If he had a strategy, it was this: He set himself in motion previous cease-fires had broken down. All the devilish questions and caused others to move, and things became possible that never that had started and sustained the war—who got what land, how happened with everyone at rest. Bosnia would function as a state—remained to be worked out at a peace conference scheduled for several weeks off. Having spent In mid-September, after days of NATO bombs falling on Serb two months shuttling among the Balkan leaders, Holbrooke did positions, Holbrooke forced Karadžić and Mladić to end the siege not think the chances of success were good. of Sarajevo in exchange for a halt to the bombing. He brought the What if he had let Banja Luka fall? It would have been the end of the Republika Srpska. Bosnia today would be a multiethnic state, messy but whole. The war would have had a winner. And there would have been no Dayton. VI. DAYTON, OHIO 1995 LUCA BRUNO/AP A U.S. Air Force F-15 takes off from a base in The obvious place for a peace conference was Paris or Geneva. Hol- brooke didn’t want either. Those sparkling cities had seduced dip- Italy as part of the NATO force maintaining the lomats who spent years talking and talking about Vietnam, eating well and sightseeing, while the killing continued on the other side UN’s no-fly zone over Bosnia. April 12, 1993. of the world. Holbrooke wanted the United States to host the con- ference, and on a military base, where there would be maximum signed agreement to Sarajevo. At the presidential palace—bullet- American control, no distractions, and no temptation to linger. He scarred, sandbagged, nylon sheeting over the windows, doorknobs wanted the success to be American and he was willing to risk an falling off—Izetbegović; his prime minister, Haris Silajdžić; and his American failure, and although he was a mere assistant secretary foreign minister, Muhamed Sacirbey (Holbrooke called them “Izzy, of state, the success or failure would also be his own, because this Silly, and Mo”), were deeply unhappy with the bombing halt. They was Holbrooke’s show and he was going to gamble everything for seemed to prefer the siege to continue as long as NATO was pun- his country and himself. ishing the Serbs. Sacirbey told Holbrooke that his negotiations had contaminated him with the stench of the Serbs. Almost no one else liked the idea of an American venue. Why risk damaging the president just before an election year? But they But when Holbrooke walked outside, a large crowd that had deferred to Holbrooke, who had brought the talks this far. gathered across the street began to cheer. An aide told him to wave. Holbrooke normally used his broad shoulders and barrel chest to He selected Wright-Patterson Air Force Base, outside Dayton, dominate a room or a street. His size and energy gave Bosnians an Ohio, one of the biggest military bases in America: 8,000 acres almost physical sense that here at last was a diplomat who intended sprawled across flat farm country, 23,000 employees, an airstrip to solve their problem. But this time he raised his hand slowly, awk- two and a half miles long. The delegations touched down on the wardly. He was close to tears. The siege had lasted 42 months. night of October 31, and Holbrooke was the first on the red carpet to shake each arriving president’s hand. Near the entrance to the The Bosnian Serb army was collapsing, and Croatian and Bos- base were four two-story brick barracks around a rectangular park- nian forces were a dozen miles from Banja Luka, a Serb stronghold ing lot—the Visiting Officers’ Quarters. These became the tempo- throughout the war. Milošević begged Holbrooke not to let Banja rary home of the national delegations. The Bosnians and Croatians Luka fall. If it fell, another several hundred thousand refugees faced each other from the north and south ends of the parking lot, would pour into Serbia, possibly threatening Milošević’s regime. the Serbians and Americans from the east and west; the Europeans But Izetbegović saw in Banja Luka the Serbs’ Sarajevo. What justice occupied a fifth barracks just outside the quadrangle. The housing to pay them back by raining shells on their biggest city! He had not blocks had long, narrow corridors and cramped rooms, with vinyl had enough time to get used to seeing the Serbs in panic and defeat. trim and shabby furniture, like a $49-a-night motel. Holbrooke hardly ever looked back, but in the coming years he The only places to eat on base were the Officers’ Club, a short would have two regrets about Bosnia. By the fall of 1995 all sides drive away, and Packy’s Sports Bar & Grill, in the concrete-block knew that a peace deal would create a Bosnian state of two roughly Hope Hotel and Conference Center, 200 yards across a grassy field from the barracks. Workers laid a winding path over the grass and lined it with ground lights, a modest touch of elegance. But in the history of international diplomacy nothing was less elegant than Wright-Patterson. THE ATLANTIC MAY 2019 91

Holbrooke greets Slobodan Milošević upon his arrival he’d found his redeemer, and just setting foot in the United States, BETH KEISER/AP; ARIC R. SCHWAN/STATE DEPARTMENT where harsh coverage greeted Milošević as the evil mastermind in Dayton, Ohio, for peace talks. October 31, 1995. of the war, was a sort of victory. He wanted to hold on to power in Serbia, and he wanted sanctions lifted. Holbrooke had tried to And yet this mix of the outsize and the drab—this American, suspend them before the talks began as an incentive for a deal, specifically midwestern atmosphere, at once banal and imposing but Anthony Lake and Madeleine Albright, the U.S. ambassador and earnest—told the gilded palaces of Europe, You have the history to the United Nations, had blocked him. The ongoing strangle- and the beauty, but you failed to end this war on your continent. Noth- hold made Milošević vulnerable—he left Belgrade fearing that ing happened until the Americans got involved—until the uncouth, a military coup might occur in his absence or that assassination sleepless Holbrooke barged in. might await his return—and at Dayton he started out in no mood to negotiate. But he was ready to go further than anyone else for He arrived nervous and exhausted. He had been crisscrossing the peace. Karadžić and Mladić were not among the Bosnian Serbs at Atlantic and racing among Europe’s capitals for two months, sleeping Dayton; as indicted war criminals, they would have been arrested three hours a night and taking 10-minute catnaps, eating heavy food, by U.S. authorities. grinding through nonstop meetings. His face was pale and puffy. Now he had arranged for the entire Balkan cast to reassemble 5,000 miles The Bosnians were the wild card. Izetbegović hated to negotiate, away, inside the security fence of an American base. because it required him to make decisions, and any decision would either plunge his people back into war or ratify Serb atrocities. He I keep thinking of live theater—Holbrooke as a producer- saw the peace talks as a kind of blackmail, and he found the false director, an impresario. He refused to sell tickets: The enormous niceties of diplomatic chat over meals with people who wanted to international press corps was confined to a featureless building at destroy him so unpleasant that he withdrew to his quarters. He the far end of the base and fed a meager diet of daily briefings. He slept badly at Dayton and woke up in the middle of the night with relegated the Europeans to minor players—their lengthy procedural his heart pounding, as if he were about to have a heart attack. “I discussions drove him crazy, and he soon handed off their morn- felt crucified,” he later wrote. His two top advisers, Silajdžić and ing meetings to his deputy. He also held Washington at bay, seeing Sacirbey, hated each other. They were fighting for their political every question or objection as intolerable meddling. future—postwar Bosnia would not have room for all three leaders. There were hundreds of extras at Dayton, but the drama was No one could be sure of a final position from the Bosnians. They stripped down to half a dozen characters. The set was so intimate wanted an undivided Sarajevo, and they also wanted the other that they could see the lights in barracks windows and know who enclaves, including Srebrenica, now held by the Serbs, and they else was awake. The plot advanced in random encounters on the wanted the land they and the Croatians had recently taken, and parking-lot asphalt. Holbrooke created this claustrophobic stage they wanted war criminals prosecuted at The Hague. The Bosnians as if its emptiness might force the characters to face the truths that were like an assault victim too traumatized and embittered to watch he would show them. the perpetrator cop a plea. There was no fixed closing date, though he didn’t think the cast The three sides were so hostile that after the first day of the con- could last longer than two weeks at Wright-Patterson. He came ference, they held no formal meetings again until the very last day. without a schedule or a script—this was an improv piece that could This was not the United States and North Vietnam arguing about shut down at any moment. the shape of the table and then repeating their official positions year after year. It wasn’t chess between two grand masters like Henry He thought he would probably fail. And yet here he was, thrust- Kissinger and Zhou Enlai. It was diplomacy in its most human form, ing himself into every scene. the bruising collisions of raw psyches. Tudjman, the Croatian president, came to Dayton the winner O N T H E F I R S T N I G H T, Holbrooke took Milošević to of the Balkan wars. His entire country was now ethnically cleansed, Packy’s, the sports bar in the Hope Hotel. Haris Silajdžić except for eastern Slavonia, the region across the Danube River from and an American diplomat were sitting at a table near a wall Serbia where the war had begun. Eastern Slavonia was all Tudjman of wide-screen TVs. Silajdžić was a Sarajevo academic, just turned 50, wanted from Dayton—he would go back to war for it if necessary—so with a modern vision of multiethnic Bosnia, but he was moody, given he was able to come and go from Zagreb with his obsequious retinue, to sullen glooms, rages, and vengeful hard-line stands. Holbrooke, playing the other two sides against each other for his own gain. always formal with Izetbegović, could deal with Silajdžić as an equal. Since Izetbegović was an unwilling negotiator, Holbrooke knew that Milošević wanted peace at Dayton. He wanted the Americans Dayton would come down to getting these two men, Silajdžić and to help get him out of what he had started years ago. In Holbrooke Milošević, to talk. But at Packy’s they ignored each other, barely shaking hands. Milošević was in a foul temper over sanctions. He told Holbrooke that his whole approach to the negotiations was stupid. “You don’t understand the Balkans.” “I’m sure I don’t, Mr. President, but we’re here to make peace, and I hope you’ll help us.” The bar food, Milošević declared, was “shit.” After that first night he reserved a table at the slightly more upscale Officers’ Club and held forth over Scotch and lobsters flown in from Maine by an American sympathizer. He went shopping at a mall across from the base and bought a pair of Timberland shoes for his wife, and seemed prepared to stay in Dayton forever. 92 M A Y 2 0 1 9 THE ATLANTIC

T HE SYMBOL OF THE WAR was Sarajevo. The Bosnian Dayton. Holbrooke let the Bosnians keep them, and when Milošević Serbs wanted to carve up Yugoslavia’s most mixed city came to talk to Izetbegović in his suite on Sunday afternoon, one chart into ethnic districts, like Cold War Berlin or East and West was propped up between the couch and a side table, with a single line Jerusalem—Karadžić even proposed a wall. The Muslims wanted it visible at the top: “Federation Gets 58% of the Territory.” Milošević as Bosnia’s undivided capital, in federation territory. Holbrooke was hadn’t realized how much he had given up, and whenever he tried to adamant that there could not be another Berlin Wall at the end of the find out, Holbrooke—who had access to a computerized military map 20th century in Sarajevo; the Americans proposed a third, federal in a secure room across the hall from his suite—avoided telling him. model, like the District of Columbia. The discussions went in circles. Milošević hurried out of the Bosnian barracks to the American On Saturday, November 18, Holbrooke took a walk around the quarters and found Holbrooke in his room. “You tricked me!” he parking lot with Milošević and threatened to shut everything down. yelled. “How can I trust you?” The talks had gone on for almost three futile weeks. “Sarajevo must be settled at Dayton,” he said. Milošević was willing to give up just about anything for a deal— even a Serb cemetery in the hills above Sarajevo—but he wouldn’t “Okay.” Milošević laughed. “I won’t eat today until we solve back down from the standing agreement, which gave the Serbs Sarajevo.” 49 percent of Bosnia, and the Americans couldn’t ask him to. A little later, Milošević came into Holbrooke’s suite. “Okay, okay. So Milošević and Silajdžić stared at maps in a small conference The hell with your D.C. model. It’s too complicated. It won’t work. room of the American barracks and argued over where the 7 per- I’ll solve Sarajevo.” cent would come from all evening, past midnight, into the early- morning hours. Silajdžić wasn’t yielding, demanding a reservoir Holbrooke was stunned. Milošević was going to give up the here and a village there for the Bosnians. “You’re going to take away Bosnian capital. That was how much he had come to despise his my pants, too,” Milošević moaned, but he acceded to Silajdžić’s Bosnian Serb clients. They are shit. He told Holbrooke not to breathe demands and kept looking for his 7 percent. Dayton had come down a word to the Bosnian Serbs in his delegation—Milošević had com- to carving up slices of land. pletely shut them out, refusing to show them a single map. Crucial boundary lines remained to be drawn, but the whole city, includ- In the map room across the hall from Holbrooke’s suite, com- ing its Serb-held districts, would go to the besieged. “You deserve puter engineers had transformed aerial footage of Bosnia shot by Sarajevo because you dug a tunnel and went in and out like foxes,” NATO bombing planners into a 3-D video game. Using a joystick, Milošević later told Silajdžić. “You fought for it and those cowards viewers could fly over the entire country and see its features in fine killed you from the hills.” detail. When Holbrooke brought Milošević and his sidekick, Presi- dent Momir Bulatović of Montenegro, to experience this wonder of S U N DAY DAW N E D C OL D. Despite Sarajevo, no one American technology, he suddenly realized that there was hardly believed there was time and will to resolve everything, and anything on the screen to see—no houses or villages, just mountains a sense of imminent failure set in. Holbrooke, who was and rocks. He pointed this out to the two leaders. going through cycles of collapse and recovery, told the Americans to pack their bags and take them out to the parking lot, in full view “That’s right,” Bulatović said, “but that is Bosnia.” of the other delegations, for transport to the airstrip. It was a bluff, Holbrooke put his head in his hands. “This is going to ruin my and it failed miserably. By evening the bags were back in the rooms. marriage, ruin my life. Look at what you’re fighting for. There’s nothing there.” John Menzies, a U.S. diplomat, had put together a pair of charts Around 3:30 a.m., Silajdžić came up with an idea: Give the Serbs on poster board to show the Bosnians all they had gained thus far at a hunk of the terrain in western Bosnia that Muslim and Croat forces Holbrooke, Warren Christopher (center), and others map possible territorial trade-offs among Serbs, Croats, and Muslims. November 1995. THE ATLANTIC MAY 2019 93

had taken just before the cease-fire. Silajdžić considered most of it visit by President Clinton was canceled, and the next day, Tuesday, worthless, and Milošević just wanted to get to 49 percent, and sud- November 21, everyone would go home. Holbrooke looked shattered. denly they were shaking hands. It was four in the morning. Warren The Balkan leaders were all crazy, he told Carl Bildt, the former Swed- Christopher called for a bottle of his favorite California chardonnay. ish prime minister, who was leading the European delegation, but the They all toasted one another around a small circular table. Bosnians—the war’s victims, for whom the Americans had gone so far and done so much—the Bosnians enraged him more than anyone. Tudjman was fast asleep, so his foreign minister, Mate Granić, He suspected they wanted the talks to fail so they could go back to was summoned to give the Croatian blessing. Izetbegović was also fighting and win the war. If so, they would no longer have the Ameri- roused, and he arrived wearing his pajamas under an overcoat, cans behind them. looking unhappy. Granić, bald and mild-mannered, studied the map and flew into a rage. All the land that Silajdžić had given to the T HERE WAS ONE PERSON who would not let Dayton fail. Serbs was Bosnian Croat. Granić pounded the map and shouted, Milošević ran into Bildt in the parking lot and begged “Impossible! Zero point zero percent chance that my president will him to keep trying to get the Serbs their 49 percent: “Give accept this!” He stormed out. Milošević and Silajdžić sat in silence. me something—hills, rocks, swamps, anything will do. It doesn’t The peace had lasted just over half an hour. matter anymore.” He berated Holbrooke’s deputy: “You can’t let this happen. You’re the United States. You can’t let the Bosnians Izetbegović was staring at the northeastern corner of the map. push you around this way. Just tell them what to do.” The town of Brčko, where Bosnia, Croatia, and Serbia converged along the Sava River, had been in Serb hands since the ethnic On Tuesday morning it snowed. Milošević, the man most cleansing of 1992. It occupied the narrow chokepoint between the responsible for millions of individual tragedies during the past four two chunks of Bosnian Serb territory, joining them to each other and years in the Balkans, was standing in the parking lot. He was waiting to Serbia. For this reason the Serbs considered Brčko strategically for Holbrooke to come out of an early staff meeting at which he was vital. Every diplomatic map had given Brčko to them. Milošević thanking his American colleagues for their valiant effort to end the kept pushing for a wider corridor—10 miles—through Brčko, while war. Kati Marton, Holbrooke’s wife, spotted Milošević outside in Silajdžić wanted to narrow it down to a 30-yard underpass beneath the snow and rushed him into Holbrooke’s crowded and unspeak- a railroad bridge. Earlier that night, Izetbegović had urged Silajdžić ably messy room. to claim Brčko outright. The prime minister had replied that this would end the talks. Now Izetbegović was staring at Brčko on the “Okay, okay,” Milošević told the Americans. “I will walk the final map. Silajdžić had left it to the Serbs. Holbrooke knew that some- mile for peace.” He would agree to submit the status of Brčko to inter- thing was wrong. “What do you think, Mr. President? Can we finish national arbitration in a year. It was the last card he had to play. the negotiation right now?” Holbrooke instantly recovered his strength. “Chris,” he told the Izetbegović always took a long time to answer difficult questions. secretary of state when they were alone and he’d locked the door “I cannot accept this agreement,” he said quietly in English. for privacy, “the next meeting may be the most important of your entire tenure as secretary.” Christopher was listening hard. “We “What did you say?” Christopher demanded. can get this agreement—or we can lose it. Forget Washington. It’s Izetbegović repeated himself, louder this time. entirely in our hands. We must go into the meeting with an absolute Silajdžić threw his papers on the table. “I can’t take this any- determination to succeed.” more!” he shouted as he rushed from the room. Sunday had been the longest day at Dayton, and it ended in dis- They went next door to the Bosnian barracks. They refused to mal failure. sit down. From the doorway, Holbrooke presented Milošević’s offer. Izetbegović, Silajdžić, and Sacirbey listened. Holbrooke repeated it. O N MONDAY the sun shone and the exhausted delegates wandered outside, running into one another in the parking “Do you accept the Brčko arbitration?” lot, stopping to talk as if in a daze. That night Christopher Izetbegović experienced a moment of confusion. He hadn’t went to see Izetbegović. The Bosnian president spent 10 minutes expected Milošević to give in. The pause seemed to last forever. reciting the history of Muslim grievances against Serbs and Croats, Then he said, “It is not a just peace.” Another eon of silence. “But until Christopher finally lost his immaculate temper. Almost trem- my people need peace.” bling, his voice rising, he scolded the Bosnians for their irrational “Then it’s all right,” Holbrooke said. To Silajdžić he looked like behavior and gave Izetbegović one hour to change his mind, or a man who had just been pulled back from the gas chamber. He else the conference would end. The hour went by, and Izetbegović murmured to Christopher, “Let’s get out of here fast.” answered the ultimatum. Croatia would yield 1 percent of Muslim land in Bosnia to the Serbs—but now he wanted Brčko. This was a new VII. demand, and the Americans rejected it out of hand. THE DECAY OF PAX AMERICANA With the knowledge that the conference would close down in the morning, Izetbegović went to bed and enjoyed his first good Let’s give Holbrooke his due. He ended a war. Well, he and others— night of sleep in a long time. He would not have to be the Bosnian but without Holbrooke I don’t know who would have stepped forward president who acquiesced to the results of genocide. to cajole and bully and outlast the Balkan warlords until they sat down together for the initialing ceremony in the B-29 conference room at And Holbrooke? It was the worst day of his diplomatic life. He the Hope Hotel that Tuesday afternoon, and the signing ceremony had hardly slept in three nights. He had no more moves, no more the next month in Paris. He was once asked what tactics he had used. lines. His incomprehensible stamina was spent. The show had col- “Persistence,” he said. “A kind of relentless harassment of the parties lapsed, and much of the blame would fall on him. At a meeting with into concessions that they were not ready to make unless pressured the Europeans he slumped in his chair, shoes and socks off, shirt by the United States with the credible threat of the use of force.” open, trousers rumpled, and said, “That’s it, we’re leaving.” The end of the war came much too late for the living and the It wasn’t a bluff. The delegations were asked to review a press dead. Izetbegović was right; the peace was not just. What the Serbs release announcing the failure of the peace conference. A planned 94 M A Y 2 0 1 9 THE ATLANTIC

gained by murder they were allowed to keep by agreement. You Though the response might or might not include force, it had to can’t blame Holbrooke for that. By the time he took over, the Repub- be intervention, early and persistent—whereas Americans like to lika Srpska was a stubborn fact. The time to reverse it was in 1992 show up late, in large numbers, then impose a quick solution and or ’93—and back then Holbrooke wanted to intervene on the side of move on. Managing chaos didn’t have much of a constituency in the victims. But by 1995 his only purpose was ending the war. That the United States. was what the Bosnians needed more than anything. Izetbegović felt crucified at Dayton, but when he returned to Sarajevo his people The argument over how to use America’s superpower was mostly cheered him for bringing peace. On New Year’s Eve, three years with ourselves. We had no rivals. The circumstances were unique. after Holbrooke spent the night shivering in the Holiday Inn, Sara- The Dayton Accords placed Russian troops in postwar Bosnia jevans attended an outdoor concert in front of city hall. under NATO command—the first and last time that happened. NATO was expanding to the very borders of the former Soviet History is efficiently brutal with our dreams. Dayton wasn’t the Union, and Holbrooke brushed off the concerns of people like Kiss- highest peak after all. It wasn’t the Marshall Plan or the opening inger about provoking the old Russian paranoia. What did Russia to China. It solved a nasty problem, but it didn’t create something have to fear from the West? We wanted to include it in the enlarging new and big. For those who lived through the war, who suffered on circle of European democracies, and never mind NATO. One virtue the inside or cared on the outside, Bosnia was immense, it was all of realpolitik is that it gives you a feel for the interests of other peo- that mattered. But Holbrooke devoted three years of his life to a ple, and Kissinger thought Holbrooke was too much a swaggering small war in an obscure place with no consequences in the long run American to understand why Russia might imagine that it was being beyond itself. The disproportion between effort and significance— encircled. The risk in his doctrine was a kind of liberal imperialism. Milošević found Holbrooke in Some Europeans—some Americans, too—thought we took his room. “You tricked me!” he the wrong lesson from Bosnia: that America only had to throw its yelled. “How can I trust you?” weight around to get results. These skeptics would draw a straight line from Dayton to Iraq, and in Holbrooke they saw the humani- I respect him for it. But Dayton did not mark a new path onward and tarian face of American hubris. I didn’t think so. I thought he repre- upward in the American story. It was closer to the end of something. sented what was best about us. It looks more complicated now, but I’d still take him over the alternatives. It didn’t seem that way at first. It seemed as if Holbrooke might be the author of a new doctrine. If you ask me when America’s long decline began, I might point to 1998. We were flabby, smug, and self-absorbed. Imagine a presi- Think of the late ’90s. Microsoft, Tomahawks, Titanic. Our dent careless enough to stumble into his enemies’ trap and expend economy, military, and culture were unchallenged, apparently un- his power on a blue dress. Imagine a superpower so confident of challengeable. It hasn’t been like that before or since. Those years perpetual peace and prosperity that it felt able to waste a whole year were, you could say, the high-water mark of the American century. on Oval Office cocksucking. Not even al-Qaeda, which blew up two But there was no Clinton doctrine. There was barely a Clinton foreign American embassies in East Africa that August, could get our seri- policy, other than the president’s boundless confidence in globaliza- ous attention—Clinton’s response, a barrage of cruise missiles, was tion. Everything seemed to be getting better on its own—and if people derided left and right for following the script of Wag the Dog. The were killing one another in eastern Congo or the southern Balkans, Republicans decided that destroying the president was more urgent what did it really have to do with America? than the national interest, and they attacked his every move at home and abroad. Our leaders believed they had the luxury to start tearing Holbrooke wanted more. He was that rare American in the tree- one another apart, and they’ve never stopped. Did any country ever tops who actually gave a shit about the dark places of the Earth. You combine so much power with so little responsibility? Slowly, imper- could call it an updated version of the liberal internationalism of ceptibly at first, we lost that essential faith in ourselves. Roosevelt, Truman, and Kennedy. The enemies were now murky civil wars, second-rank tyrants, mass atrocities, failed states. Kiss- T HE AMERICAN CENT URY ended in Baghdad and Hel- inger would not have recognized these as subjects of high national mand, in Aleppo and Odessa, and in Beijing. It also ended interest, but Holbrooke, never a practitioner of pure realpolitik, was in Wisconsin and in Silicon Valley and, maybe above all, in alive to the present. Washington, D.C. It ended from overreach and exhaustion, rising competition, the rapid changes and broken promises of globalization, “This is no time for fin de siècle malaise,” he said in a speech in and the failure of our own middle-class democracy, which, when it 1997. “The post–Cold War era demands a thoughtful examination was thriving, gave us an influence that exceeded even our power. and the design of new tools to meet its challenges—many of them both humanitarian and political. So far into this new, as yet unnamed Another place where the American century ended was Bosnia. era, we have only shown a capability to react, which costs dearly in Twenty years after Dayton, five years after Holbrooke died when lives and money. Managing chaos is the foreign-policy challenge of his aorta tore open during a meeting in Secretary of State Hillary the 1990s … If we were too brash and bold at times during the Cold Clinton’s office, a woman in Sarajevo named Aida began to experi- War era, we are too complacent (or indifferent) and cautious today.” ence insomnia. Though she had lived through the entire siege, she never counted herself among the hundreds of thousands of Bos- Chaos was an even tougher problem than the Soviet Union, less nians with post-traumatic stress disorder, but now, two decades predictable, more in need of local knowledge and the help of allies. after the war, she lay awake night after night, unable to take her eyes off the American presidential campaign on TV. Something about the people at Donald Trump’s rallies was deeply familiar to Aida— their clothes, their faces, their teeth, the men’s mustaches, the women’s hair and makeup, the illogic of their grievances, their rage, their need for an enemy. She knew these people, and as she watched them her heartbeat raced, her breathing turned rapid and shallow. THE ATLANTIC MAY 2019 95

She began having flashbacks, not to the war but to the years just Dayton. So Croat nationalists, who want an entity of their own, are before it, when things once unacceptable even to think suddenly blocking the formation of local governments, which paralyzes the became commonplace to say, until every boundary of decency was entire mad system of interlocking jurisdictions created at Dayton. erased. Moments in the American campaign brought up uncanny counterparts from those years in the Balkans. Late one night, during To stop the war, the negotiators had to come up with an un- the Republican National Convention, Aida suddenly heard the voices governable country. The constitution of Bosnia-Herzegovina— of 1 million Serbs in the streets of Belgrade shouting for the head of Annex 4 of the accords—created a state that has two entities (the a Kosovar leader—“Arrest Vllasi! Arrest Vllasi!”—while Milošević Muslim-Croat federation and the Republika Srpska), three presidents cupped his ear and goaded them: “I can’t hear you!” In Cleveland (one from each of the main ethnic groups), 10 cantons, 14 legal sys- they were chanting “Lock her up! Lock her up!” tems, and 152 ministries. The patient survived but remains deformed. Aida knew where it would all lead, and she tried to warn her Foreigners, including Holbrooke, saw the Dayton agreement as a American friends that Trump was going to win. They found this placeholder for the evolution of a future state. They expected Serbs, hilarious, especially when she offered them a refuge in her country, Croats, and Bosniaks to move past the war and start building a nor- in her house—a hiding place in Bosnia after the shit hit the fan in mal country—if not the generation that fought the war, then the next America and her Bay Area friends realized that the other side had all generation of Bosnians, who would care more about all the oppor- the weapons. Trump’s victory inspired no “I told you so”s from Aida. tunities of the 21st century than about tribal hatreds. Annex 4 would After all, she had refused to see her own war coming. give way to a new constitution that would clear out the bureaucratic plaque, consign the geriatric nationalists to the past, and create a After the Cold War, grand strategists proposed various scenarios functional modern state of equal citizens. Eventually, Bosnia would for the future of the world: liberal capitalist triumph, the clash of take its place in the European Union and, perhaps, NATO. civilizations, great-power rivalry, borderless anarchy. Nationalism didn’t make the short list. The squalid, murderous politics of dying None of this happened. Bosnia remains ethnically cleansed. The Yugoslavia was an atavistic embarrassment, a throwback to what refugees were supposed to return to their homes after the war, but Bismarck, in a fit of irritable prescience, called “some damned fool- very few of them did. Annex 4 is still the constitution, and the war ish thing in the Balkans.” The fratricidal wars of the 1990s had noth- continues by peaceful means. The country is ruled by the heirs, poli- ing to do with the age of high-speed globalization that would soon tical and sometimes biological, to the three nationalist movements erase national identities and make us all networked cosmopolitans. that made war. They denounce one another publicly and stoke mutual fears at election time, but behind the scenes they’re cro- The warlords turned out to be ahead of their time. Kurt Bassuener, nies who collaborate to stay in power and fatten themselves off the an American expert on Bosnia, calls Trump “America’s first Balkan same spoils system. The governing structure cast at Dayton ensures president.” His public performances sound like translations from the that nationalists will keep winning elections and ruling like mafia Serbian. For Aida, Trump’s rule told her that Bosnia no longer has bosses. Ethnic politics produces rampant corruption that chokes anyone to count on. Europe ceased being a noble idea when populist the economy and stunts social change. Most jobs are controlled by demagogues put up razor-wire fences to keep out refugees. Now the political patronage and sold for thousands of dollars in bribes; youth American idea is gone, too. “After the United States’ values collapsed, unemployment is above 60 percent; the birth rate is below replace- who’s there to look up to?” Aida asks. “Who? The Middle East? Asia? ment level; more than half the population lives outside the country; China? They don’t have any compassion. Russia?” and tens of thousands of Bosnians leave every year, most for Ger- many. But in spite of the daily tension and grimness, in spite of all Not long ago I went looking for Holbrooke’s ghost in the rocky the wartime Kalashnikovs hidden in closets and rocket launchers patch of southeastern Europe where he had staked his personal claim buried in backyards, Bosnians say that there won’t be another civil on history. Maybe this will surprise you, but there are no Richard war, because Bosnia doesn’t have enough people left to fight one. Holbrooke Streets or Squares or statues in Sarajevo. Not one thing is named after the man most responsible for the fact that people are Bassuener, who worked in Bosnia for 11 years, called the Dayton drinking Turkish coffee at outdoor tables in the Old Town. When I agreement “a warlord-containment system which is also a warlord- pointed this out to Aida, she said, “I don’t need a monument to Dick wish-fulfillment system.” It created a country in which almost no Holbrooke. I’m a monument to Dick Holbrooke. I am the Richard one is happy. “Everybody knows that they personally lost the war, Holbrooke Walking Monument.” and the fuckers in the black Audis won.” Holbrooke is still remembered in Bosnia, but without much grati- January 9 is Republika Srpska Day—the day when Bosnian Serbs tude, because the war never really ended. Dayton put a stop to the celebrate the birth, in 1992, of their dream country, christened with killing, and I never met a Bosnian of any origin who expressed regret a “Nazi name.” In 2016 Bosnia’s high court ruled Republika Srpska for that. Željko Komšić, who lost his mother to a sniper’s bullet as Day discriminatory and therefore illegal, but a ceremony is still held she was drinking coffee in her Sarajevo apartment in 1992, was a sol- annually, defiantly, in Banja Luka, the capital of the Serb entity. This dier in the Bosnian army in 1995 and up to his chest in snow when he past January 9, the streets of Banja Luka were draped in Serb flags, heard that the parties had reached an agreement in Dayton. “I have and Serb police officers, dressed in paramilitary uniforms and bear- no words to describe to you the happiness and the joy I felt,” he said. ing automatic rifles, goose-stepped through the main square as they “Do you know how happy I was that I was actually going home?” sang the Republika Srpska national anthem, and the Night Wolves, a gang of pro-Putin Russian bikers, joined the parade, and locally Last October, Komšić was elected as the Croat member of the manufactured black armored vehicles, called “Despots,” rolled past country’s three-person presidency. He has an office in the restored the assembled dignitaries. Afterward, sequined dancers performed presidential building in Sarajevo. Apart from a few bullet holes in a folk ballet of eternal love for Republika Srpska called The Birth. the exterior walls, there’s no trace of the war—except that Komšić is You might have thought it was the early ’90s. presiding over a government that can’t form itself. Because he is not a Croat nationalist and won election with the help of votes from Bos- Milorad Dodik is the Serb member of Bosnia’s presidency. In the niaks (as Bosnian Muslims call themselves), rival Croat politicians years after Dayton, when Western money and personnel were pour- claim that Komšić does not represent the Croat people, and that this ing into the country, he talked like a liberal and was the Americans’ lack of representation violates the rights granted to each group by favorite Bosnian Serb politician. But in 2006, in the run-up to an 96 M A Y 2 0 1 9 THE ATLANTIC

Bosnian Co-president Milorad Dodik (left), a hard-line Serb nationalist, on Republika Srpska Day in Banja Luka. January 9, 2018. MIOMIR JAKOVLJEVIC/ANADOLU AGENCY/GETTY election, the same epiphany that had transformed Milošević into a themselves as Bosnians first. They want to live in a state that grants Serb nationalist two decades earlier now illuminated Dodik’s path, rights to individuals, not groups. They vote for multiethnic civic par- and he saw his future in making the Republika Srpska great again. ties that campaign on democracy and the rule of law, such as Naša In the years since then, Dodik has consolidated power and personal Stranka, or “Our Party,” which is led by a Serb but did well in last wealth as a virulent nationalist. His avowed goal is a separate state October’s local elections in Sarajevo and elsewhere. Citizens might for Bosnian Serbs. be fewer in number than constituent peoples, but they, too, point to Dayton for support. In his address on Republika Srpska Day, Dodik spoke as if he were the president of an independent country, not the Serb mem- In March 2018, the body of a 21-year-old Serb named David ber of the three-headed presidency of a country called Bosnia. “We Dragičević was found in the mud by a river on the edge of Banja don’t want to deprive others of their freedom, we just want it to be Luka. The police declared the deceased a petty criminal and his known that we are ready to fight and defend our own freedom,” he death an accident caused by drugs, but the findings contained so said. “In 1995 the Dayton peace agreement was created, and the many gaps and contradictions that Banja Lukans, led by David’s Serbs stood behind it. But … Bosnia-Herzegovina is not our desire; grieving parents, began to challenge what they believed to be a it is something we had to accept. We were forced into it by an inter- cover-up of official mischief. The daily protests became a move- national negotiating process.” He concluded with a warning: “I love ment called Justice for David. It continued to grow throughout the the Republika Srpska. I love the Serb people. I don’t hate anybody. year. On some evenings tens of thousands of people filled Banja All of our friends are welcome, be they Croats or Bosniaks, from Luka’s main square. Non-Serbs drove up from the federation to everywhere, from far and near. But when you come here, you will participate, and there were solidarity protests in Sarajevo and find people who know what they want, and they will not hurt you Tuzla. David’s father and the father of a young Bosniak who had with anything—but make sure you don’t hurt them.” been mysteriously killed joined hands in Sarajevo. On November 21, the anniversary of the Dayton Accords, a huge crowd came out in T HE DAYTON AGREEMENT contains two opposing forms Banja Luka. Demonstrators held up signs declaring the human of nationalism—one ethnic, one civic—and the real battle rights granted by the agreement and stolen by the authorities. for Bosnia lies between them. The preamble to Annex 4 says, “Bosniacs, Croats, and Serbs, as constituent peoples (along Justice for David is the first movement to unite Bosnians across with Others), and citizens of Bosnia and Herzegovina hereby deter- ethnic lines, against the ills that afflict them all—corruption, patron- mine that the Constitution of Bosnia and Herzegovina is as follows.” age, police abuse, official impunity. Nothing like it has ever happened The whole contradiction is right there, in the unwieldiness of that in Bosnia, and it alarmed the fuckers in black Audis. On December 30, one sentence. Bosnia has constituent peoples—three worth nam- Dodik’s police assaulted the demonstrators in Banja Luka’s main ing, to be exact, along with unidentified Others, such as Jews and square in order to clear the streets ahead of Republika Srpska Day. Roma—and it has citizens. The constitution seems to place citizens in a separate category from constituent peoples. Citizens think of The protests moved around the corner, to the plaza in front of an Orthodox cathedral. Several nights after January 9, 150 people assembled outside the church. It was a smaller gathering than THE ATLANTIC MAY 2019 97