On a gray, late-spring morning, America’s doctor stands at a curb on the mostly abandoned Mall, waiting for an interminable streetlight to change.
Someone might see him. Someone might disapprove. Someone might misinterpret him as a man who doesn’t play by the rules.
Adams is the man who once gently put patients to sleep, applying the chemicals that are the tools of an anesthesiologist, then gently woke them up. The patients usually wanted succor, a soothing voice. They wanted someone to be nice to them during a stressful time.
Nice.
Talk to anyone who knows Adams well and the word will eventually come up.
Years removed from regular stints in the operating room, Adams finds himself in an administration that often comes off as an empire of mean, defined by a White House spoiling for a fight. He’s never been alone in a room with the president, but as a member of the administration he’s inextricably tangled with President Trump in the public eye. During the covid-19 pandemic, the president’s detractors have become his detractors, or at least that’s the way it feels to him.
Why? He wonders sometimes.
After all, he says once the streetlight finally turns, “I’m a nice person.”
“Yes, it does make things hard in a political world like Washington, D.C.,” Adams says in one of a series of interviews. “Nice gets you into trouble. Nice means that you trust people. That you don’t automatically have that guard up that sometimes you need to have in this political world.”
The test now for the surgeon general, and by extension for his patient — the United States of America — is whether nice will work. Can a nice guy wrangle and guide a confused and angry nation? Should America’s Doctor wag a finger, scare us into submission? Issue orders? Doctors’ orders? Or does this worried nation need a light touch in the midst of this dangerous pandemic?
Adams came to Washington three years ago to tackle another problem — the raging opioid crisis — by drawing from a painful personal history with a brother who has struggled with substance abuse. Yet he has been thrust into the role of the pandemic surgeon general.
His is not the commanding voice of authority from on high such as that of the bearded and wise elder surgeon general, C. Everett Koop. The 45-year-old Adams, instead, wants to gently coax the country to safety and good health.
Stung by controversies he didn’t expect, he’s engaging in a reset of the public-facing, and most essential, part of his job. Shifting his focus away from the glare that accompanies appearances with the president, and the perilous turf of national television. In both forums, his choice of words — and the way they’ve been interpreted — have sometimes blown up on him.
Was he an apologist for Trump’s much-panned response to the pandemic? Was he insensitive to the root causes of higher infection rates among people of color? He was appointed to be a communicator, an especially significant role as one of the few high-ranking African Americans in the Trump administration. But on the biggest stage of his career, he’s searching for the right way to calibrate his voice.
Whether he was benched from those high-profile spotlights or left them by mutual consent, the end result is that Adams has been getting more granular, deploying nice in smaller settings by targeting covid-19 hot spots around the country, where he thinks he can be more effective.
Quietly, he’s been preparing to embark on a series of previously unannounced, talk-show style conversations with regional celebrities. He’s not revealing the participants yet, but the idea is to sit down for long chats with well-known figures — say, a rapper in Los Angeles or a star athlete in Houston — that would be edited into what his team is calling short “episodes,” rather than traditional public service announcements, to air in specific cities and states where case are spiking.
Adams wants to speak “directly” to the public, he says, “as opposed to having my words filtered through an unfriendly, at times, media — many of whom have issues with the administration.”
'I was too nerdy'
Jerome Adams could barely breathe.
He was 7 or 8 years old, and he’d been hit by an asthma attack so severe that the doctors in Southern Maryland thought he might die. They put him in a helicopter pointed toward Children’s National Hospital in Washington.
It was his first glimpse of the Capitol, and it came from the sky.
Growing up in humble circumstances in rural Mechanicsville, Md. — a child of poorly paid teachers — his life was a bundle of risk. He was the latchkey kid living in a dusty home that triggered his asthma. The kid who nobody forced to take his medicine.
He remembers the place as “Confederate territory,” a perception made all the more meaningful to him because so many of his schoolmates were white. More than three decades before his warning — like that of the surgeons general before him — would appear on cigarette packs, he harvested tobacco with his father to earn extra money for the family.
He didn’t fit the profile that he thought the world expected of a young black man.
“I was too nerdy because I was in [advanced classes at] school. I wasn’t athletic enough because of my asthma,” he says. “I have spent my whole life not being black enough.”
His family’s travails have seemed relentless. An uncle died of cancer in prison after being put behind bars for crimes related to his substance abuse. Another uncle is an alcoholic. His parents have struggled with a host of health problems. His brother Phillip has been in and out of prison because of crimes related to his substance-abuse problems.
A while back, Adams — a father of three — took his two sons to visit his brother in prison. They asked about the barbed wire. He wanted his boys to see what drugs could do to a person, but he also wanted his brother to know the family “wasn’t ashamed of him.”
Adams launched his career far from the places of his family’s troubles, studying medicine in Indiana and working as an anesthesiologist at Sidney & Lois Eskenazi Hospital in Indianapolis, one of the nation’s largest public health hospitals. His patients’ problems weren’t academic to him, says Virginia Caine, recalling a long “intense” conversation when her young colleague Adams counseled and calmed one of their patients, a 50-something diabetic black man in need of a toe amputation to prevent the spread of infection.
In 2014, Adams — an independent who says he’s “resisted the idea of political parties” — was named Indiana’s health commissioner by then-Gov. Mike Pence, a strict social conservative and staunch Republican.
“I had my doubts about working with him,” Adams would say three years later at his surgeon general swearing-in ceremony. “The rumor was he was old school — and not like the pop culture old-school that the kids talk about — but older, super-conservative from Southern Indiana old school.”
Adams’s glittering reputation as a public health official would be sealed during his second year in office when the state was confronted by one of the largest rural outbreaks of HIV and hepatitis C, spurred by an out-of-control opioid addiction crisis.
Pence resisted starting a needle-exchange program, as did many conservatives in the state legislature. Adams flooded the governor with scientific research. Pence eventually relented.
“He navigated some very treacherous waters,” says fellow physician Woody Myers, a former Indiana health commissioner and friend of Adams who is now a Democratic candidate for governor.
It would fall to Adams to persuade the local law enforcement officials and community leaders to buy in. He went to diners and porch stoops, driving two hours to rural Scott County, where the outbreak had taken place.
“By showing up,” says Myers, Adams “put a face on this.”
The success of Pence and Adams in reducing infection rates drew national praise. But a Yale University School of Public Health study would later conclude that the crisis could have been avoided if Indiana officials had taken action earlier.
The outbreak had begun three years before Adams became Indiana health commissioner, but the criticism, which spilled into his tenure, still stings. The researchers he calls “armchair epidemiologists” just didn’t understand, he says, that gentle persuasion takes time.
'Stuck in between two worlds'
The calls began as soon as word spread that Adams was being considered by Trump for the surgeon general post following the nasty 2016 presidential campaign.
“How could you work for him?” his wife, Lacey Adams, remembers people asking her husband.
Adams found the questions vaguely insulting, saying that the same might not be asked of a soldier dedicated to protecting the country, no matter who was president.
“I’m really stuck in between two worlds,” he says one recent afternoon. “In one instance, people say they don’t want you working for the administration, or that you should quit because you’re a person of color. Then they complain that the administration doesn’t have enough people of color.”
Lacey Adams, who is white, began receiving hate mail from racists. “I can’t believe you’re ruining our race,” they’d say. Or, “this is so disgusting. You may have been an attractive white woman, but you’ve ruined yourself.”
She tried to shrug it off. But, at times, it scared her.
“We really just had no clue what we were walking into,” she says.
Surgeons general have little power beyond the pulpit and often don’t make news until they upset the public or politicians with what they say — as Joycelyn Elders did during the Clinton administration.
Adams occupies a comfortable but not particularly grand office by the standards of Washington. He’s not in the Cabinet. He reports to the assistant secretary of health, who reports to the secretary of health and human services.
Adams came into office motivated to focus on stock public health issues: opioid addiction, mental health, childhood obesity.
Then came covid-19.
And the poem.
In February, during the annual health-policy wonks’ Twitter blitz of cutesy limericks and poems, Adams tweeted:
“Roses are red
Violets are blue
Risk is low for #coronarvirus
But high for the #flu
So get your #FLUSHOT!”
Trump had been playing down the threat from the virus, even saying it would just go away as the weather warmed. Now his handpicked national doctor was being labeled an enabler of Trump’s false assessments.
Adams was trying to be “light,” he says, and draw attention to deaths caused by the flu, which at the time exponentially outpaced covid-19 mortality figures in the United States, though the latter were soaring abroad. He still doesn’t think he was being “dismissive” of the virus. But as the death toll rose in the months to follow — and criticism of Trump’s many false and tepid responses increased — Adams’s tweet wasn’t going away.
“Everything is more complicated than a tweet,” Adams says. “Every projection we’ve had on this has been wrong. . . . No one has been 100 percent right on covid.”
What was becoming clear was that Adams was no longer having lengthy one-on-one conversations in Indiana. He was living in a sound bite, Twitter-condensed world, a reality that was hammered home emphatically the next month during a discussion on CNN about the trio of 70-somethings most likely to face off in the 2020 election — Trump and the Democrats, Sen. Bernie Sanders of Vermont and former vice president Joe Biden of Delaware.
Adams observed that Trump is “healthier than what I am.” Again, he was cast by critics in the role of Trump shill.
Recently, in an interview at his office, Adams tries to explain his remark more fully, saying he was referring to what he considers the top three medical history risks factors for covid-19, including chronic lung disease (asthma), diabetes and high blood pressure, and the president has none. Adams says Trump takes three medications a day. Adams, who exercises regularly, and looks fit, takes nine. He ticks off a few — drugs to address prostate issues, a prediabetic condition, asthma and high blood pressure — before deciding not to overshare.
As he sits down at his office conference table for the interview, Adams — who has been encouraging Americans to wear masks, even taping a video to show how to make them from household items, such as T-shirts — asks for permission to remove his own. He says he can do so because it’s an environment he can control.
Since the pandemic has exploded, Adams had been periodically generating the wrong kind of headlines. But it wasn’t until April that “everything kind of blew up,” as his wife, Lacey, puts it.
During a televised White House coronavirus briefing, Adams urged people of color to take precautions to protect their families: “We need you to do this, if not for yourself, then for your abuela. Do it for your granddaddy. Do it for your Big Mama. Do it for your pop-pop.”
Before he left the stage, social media was inflamed and Adams was asked to comment on the fact that many people found his language offensive. He tried to explain that his family used similar terms and that he’d been talking to the NAACP that week, a not-so-subtle suggestion that the nation’s preeminent African American civil rights group had helped shape his thinking and his approach. Still his critics were coming at him hard and fast.
Rep. Maxine Waters, a California Democrat, issued a statement that Trump had found “a new vessel by which to spew his racist dog whistles.”
Others lamented that by warning people of color to avoid alcohol, tobacco and drugs, he was being paternalistic. He was blaming communities of color who were suffering disproportionately during the pandemic, rather than addressing systemic disparities.
The full context of his remarks, however, is more nuanced. He actually was urging everyone to avoid behaviors that increased their risks, while noting that it was an especially important message for people of color because of their high infection rates and underlying health and economic disparities.
Moments before he said “Big Mama,” he’d addressed problems that placed people of color at greater risk: “Only 1 in 5 African Americans and 1 in 6 Hispanics has a job that lets them work from home. People of color are more likely to live in densely packed areas and in multigenerational housing, which create higher risk for spread of a highly contagious disease like covid-19. We tell people to wash their hands, but a study showed 30 percent of the homes on Navajo Nation don’t have running water.”
And he’d pledged that the administration was going to do something about those deficits, including “targeted outreach to communities of color, and increasing financial, employment, education, housing, social and health supports so that everybody has an equal chance to be healthy.” (Since then, Adams says, he’s stepped up “virtual engagements” with community leaders, set in motion plans for his more intimate public service campaign, and is hopeful that a major upcoming report on community health and economic prosperity will spur improvements for people of color.)
But, after the April news conference, all anyone seemed to want to talk about was Big Mama.
“I understood what he was trying to do,” said Leana Wen, a former Baltimore health commissioner who is a visiting professor at George Washington University’s School of Public Health. “I believe it was misinterpreted. It was taken out of context.”
In the education of a surgeon general, it was the hardest lesson of all.
“That was me speaking to people the way I would speak to someone in my doctor’s office or someone who came up to me on the street and asked me a question,” Adams says. “That was me being nice and trying to be empathetic, but not realizing the political frame and context of me being at the White House and standing at a podium in between the president and vice president.”
And that was when Adams began to fade from view, for the most part stepping out of the national spotlight for more modest regional appearances, where he says he was getting fewer politically charged questions. Was he forced? He wouldn’t exactly say.
“For the entire task force and for other people we’re trying to figure out where we can have the greatest impact,” Adams says. “I think it was obvious to a lot of people that, gosh, with this political framing and you standing me up behind this podium, people are going to misinterpret or frame differently these conversations.”
'I'm begging you'
In June, Trump held a campaign rally at an indoor arena in Tulsa.
Two days before the event, Adams paused for a few moments in his office to reflect on the president’s plans. Trump never asked the surgeon general’s opinion, Adams says. But if he had, Adams says, he wouldn’t have given “a thumbs up or thumbs down.”
Instead, he says, he would have explained the risks — including the increased chances of spread in an event held inside, rather than outside — and prevention measures. He’d let others decide instead of dictating a decision that he had no authority to make.
“That has rarely, if ever, been my approach,” Adams says. “We live in a world, a country, where people very much value their freedom.”
Asserting that freedom may end up costing lives. Last week, a Tulsa health official, said Trump’s rally “likely contributed” to a “dramatic” spike in coronavirus cases in the city. At least eight Trump staffers involved in the rally, including two Secret Service employees, have tested positive.
Even as infection rates continue to soar in states that have reopened, Adams has not called for a return to shutdown orders. Instead, in a recent public service announcement, he lays out preventive measures that will help the country “get back to school, back to work, back to worship.” If people can’t stay six feet apart, he says, “please, I’m begging you, wear a face covering.”
Still, he’s walked a fine line on face masks. Recently he told a Fox affiliate in Washington, D.C., that he opposed a national face-mask mandate and that such decisions should be left to local officials.
Trump’s numerous false and misleading statements during the covid-19 crisis create a unique problem for Adams and the other medical experts around him — the time they want to spend talking about health gets eaten up by questions about the politics of the pandemic.
“It’s not my job to denounce the president every time people get mad at him,” Adams says.
Adams likes to say that nothing in medicine is 100 percent. But his critics yearn for a surgeon general who will be more definitive.
“It’s clear to me that he’s equivocating because the president of the United States is not telling the truth,” says Leslie Dach, a longtime Democratic power player who now chairs Protect Our Care, a healthy advocacy group, and coordinated the Ebola response of the Obama administration’s Health and Human Services Department. “That’s the box that he’s in. If the Hippocratic oath is to do no harm, he violates the Hippocratic oath every day.”
But there’s so much Adams would rather be talking about than Trump, Trump, Trump. In the coming months, besides his anticipated new covid-19 public service announcement campaign, he’s planning to flood the zone with “calls to action” and surgeon general’s updates.
Most address health disparities in minority communities. Maternal mortality and high-risk pregnancies, hypertension, suicide prevention, the first major update on the surgeon general’s position on oral health in three decades.
He also plans to dive, with renewed emphasis, into fighting the epidemic that might have been his legacy if the world had not been turned upside down by a pandemic: the opioid crisis.
He’d like to get back to talking about keeping people healthy, which is what he thought he’d been sent to Washington to do. If he has his way, he’ll get Congress to invest in community health programs, and he’ll try to sell lawmakers on doing so by pointing out that the minority populations he’s targeting are a pipeline of recruits for the U.S. military.
“If I can frame health through the national security lens, I am more likely to get initiatives funded than if I frame it through a health lens,” Adams says.
He won’t be demanding anything from lawmakers. He hopes to coax it out of them.
“I’m 45 approaching 50,” Adams says, “and I figure if being nice and empathetic has gotten me this far, then I will continue to lean into it.”
Alice Crites contributed to this report.