Chapter 1
Each First Lady has approached the role in her own way.
I vowed to make the most of my platform, particularly when it came to getting COVID under control, supporting military families and community colleges (as I had for eight years as Second Lady), promoting cancer research, and advocating for women’s health.
Still, I was a reluctant participant in politics.
Growing up in a middle-class home in Willow Grove, Pennsylvania, the daughter of a World War II veteran, the oldest of five girls, I was happiest off on my own in the corner with a stack of books.
My reverie was interrupted by the sight of a figure walking toward Joe and me through the sand.
This wasn’t surprising—people come up to us all the time.
They want to talk about politics or just say hi.
We’re always up for it. Well, Joe is always up for it.
I send him to the store, and he returns three hours later, having taken two dozen selfies and called somebody’s mother to sing her “Happy Birthday.” I’m an introvert, so I do my best. When Joe and I stand together onstage, I often give him a little squeeze to signal, Okay, wrap it up.
People want to go home. Sometimes when I do that, he tells the crowd, “Jill just pinched me because she thinks I’m going on too long! ”
That’s Joe Biden, a politician in the best sense of the word—shaking everybody’s hands, listening intently as they share their concerns and their hopes and the latest news of their college sports teams. Joe was that way as a senator, as vice president, and as president.
People flock to him for handshakes and hugs, and he is delighted by all of it.
If he’s talking to you, he never has a more important place to be—even when he does have a more important place to be.
So I expected this beach conversation would likely go on for a while.
The woman put both her hands on Joe’s chair, leaned into him, and said, “I’m a doctor. How did your doctor not pick up this cancer diagnosis earlier?”
Well, that was not the “hello” I’d expected, though it was a fair question, one that I had struggled with myself.
Two months earlier, we’d been shocked to discover, along with the rest of the world, that Joe had stage IV prostate cancer that had metastasized to his bones.
Ever since his surprise late-stage cancer diagnosis, people had been offering well-wishes tinged with confusion—how was it possible no one caught it before it spread?
Joe, always the optimist, thanked the woman for her concern and said, “I have the best doctors. I’m going to get through this.”
For my part, I didn’t want to think about cancer just then.
Joe and I had been enjoying a rare tranquil day.
Once his cancer diagnosis was mentioned, his expression changed.
Mine, too. I forced a smile. Thank you for your care, Doctor, I thought, but I hope you’ll understand this isn’t the right time to discuss this.
We’re in our bathing suits, and we’re trying to relax.
So much about the past year has been a total shock. I’ve found myself asking again and again, How did we end up here?
As the novelist James Salter wrote, “There are stories one must tell and years when one must tell them.” The time to discuss those four years in the White House—so much that I’ve avoided even letting myself think about—is now.
I’ll begin with what would have been my answer to the concerned doctor on the beach and anyone else with the same question.
In the year before we left the White House, Joe began waking up repeatedly at night.
This symptom, I knew, was common in men his age, and almost always caused by something benign.
Joe never missed his annual physical—at his February 28, 2024, exam at Walter Reed Medical Center, his doctor proclaimed him “a healthy, active, robust 81-year-old male, who remains fit to successfully execute the duties of the Presidency”—and he had access to the best medical care available.
Right there in the residence, there’s a fully staffed twenty-four-hour doctor’s office.
You stop in because you have a headache, because your throat is sore, because you need your flu shot or COVID booster.
Knowing that Joe would prefer to speak about any urological issues with his male doctors rather than with his wife, I alerted one of them to make sure they knew. “He was up seven times last night,” I said. “I’m worried about him.”
Now that the doctors had been made aware of the issue, I trusted that Joe would be examined and treated. But as far as I could tell, the issue persisted. Even knowing this, I never imagined that the cause of this very common symptom of age would turn out to be cancer.
While it surely sounds old-fashioned that I spoke about the issue to the doctors rather than to Joe directly, it’s always been the nature of our relationship that we’ve maintained a veil of discretion around personal health.
When I went through menopause, I never spoke about it with him, even though I experienced two years of horrible insomnia, and when I did manage to fall asleep I was jolted awake by night sweats.
Back in Wilmington, I realized that Joe’s symptoms had gotten worse, and I encouraged him to make an appointment with a urologist.
Joe went up to Thomas Jefferson University Hospital in Philadelphia for the appointment. At the very first examination, the doctor said, “There’s something here. We need to find out what it is.” He sent Joe for a biopsy May 15.
We got a call later that same day. The urologist told us that Joe had cancer, and he ordered various other tests to find out if the cancer had spread.
One of the questions we’ve been asked is why Joe hadn’t had a recent prostate exam.
That was a question I had, too. I’ve since learned that the American Urological Association doesn’t recommend routine prostate-specific antigen (PSA) screening for men older than seventy.
The thinking is that prostate cancer usually spreads more slowly in older men.
Cancer at that age doesn’t tend to affect life expectancy, which for men in the US is about seventy-six.
Sometimes the risk of performing a biopsy in an older man can outweigh the benefits.
Due to a high PSA, Joe’s cancer appeared to be advanced.
We still had hope, though, that the cancer was localized to his prostate.
Joe went for a PET scan, also at Jefferson Hospital, on May 16.
We waited for the scan results in an exam room that was the size of a closet.
It had a curtain, not a door. Joe was in the exam chair, and I was sitting on a chair they’d brought in for me.
The results didn’t take long, about half an hour. The doctor opened the curtain. As soon as I saw her face, I knew.
“I’m sorry,” she said. “Oh, I’m so sorry.” She wouldn’t stop saying “I’m sorry.”
Stage IV. It had spread to his bones.
Prostate cancer is very common—one in eight men receive the diagnosis in their lifetime, and it is highly treatable when found early.
So many men have notably had it and treated it successfully—John Kerry, Robert De Niro, Ben Stiller, Colin Powell, Warren Buffett…
Yet, in all the cases I knew about, they’d caught it earlier; it hadn’t spread to their bones.
I walked out of that closet of a room, past the Secret Service.
Breathe, I kept repeating to myself as I headed to the ladies’ room to compose myself before I faced anyone.
Then the questions began—starting with what course of treatment would be best. We had to act fast. We needed a plan.
Joe could do radiation and hormone therapy.
Thanks to that regimen, he would have every hope of many more years left.
His doctors said that it was unlikely the cancer would kill him; he would likely live out his natural life.
Breathe.
The press statement went out May 18. Joe’s staff, the younger staffers in particular, were devastated.
But we couldn’t dwell in the grief because we were put immediately on the defensive, accused of having hidden his illness.
The question became: How was it possible that the president of the United States, the most powerful man in the world, a man who has a medical team—not just a doctor, a medical team—around him twenty-four hours a day could wind up with cancer so advanced?
Joe couldn’t stub his toe without ten people wanting to run at him waving bales of gauze.
You put the president in bubble wrap, and he ends up with stage IV prostate cancer? It made no sense.
Truly, I did not know what to say to people who were baffled like that doctor on the beach.
I felt the same way. I was stunned. And yet, I didn’t want to waste too much energy looking back and asking how this could have happened.
We had no time to lose. He had to get started on treatment.
Joe went in for a bone density test on May 21, and the next day he began hormone therapy.
The hormone pills can cause serious side effects, particularly fatigue and moodiness. That has been true for Joe.
As anyone who’s ever loved someone through a major illness knows—and I went through it with both my parents, and both Joe’s parents, and, most excruciatingly, with Beau—you live in a world of questions: What time is the physical therapist coming?
Did he take his medicine? What did he have for breakfast?
How much water is he drinking? He didn’t sleep well last night—do I need to call the doctor?
Worry becomes your constant companion.
Since 2009, as Second and First Lady, whenever I traveled across America, I saw the endurance of what I consider core American values: truth, loyalty, faith, community, service.
Republican and Democrat families might disagree on the economy or social issues, but they share a love of country and a respect for the right to disagree.
While Joe was in office, I think he and I both erred on the side of silence, dignity, and letting news cycles run their course.
Others might react to every slight, seize every opportunity to spin something to their advantage.
We would stay out of the fray, play by the rules, ignore the ludicrous attacks, and assume that people would discern the truth.
I preferred the path of discretion. I think many English teachers would opt to spend their free time reading rather than talking, and that is true of me.
I’m from an era and a family in which we didn’t speak openly about issues like mental health, drugs, sex, or anything uncomfortable.
When I hear some of the things that have been said of us, I find it baffling that anyone could believe them.
I’ve been accused of either having been too involved in Joe’s presidency or too hands-off.
In the former scenario, I was some sort of puppet master; in the latter, it was my job to tell Joe not to run for president in 2024, or to drop out of the race sooner.
On the campaign trail for Joe when he was running for president way back in July 1987, I stood at a podium in Iowa and spoke to the question of who a First Lady should be.
What did I know then? I was a senator’s wife with three kids ranging in age from first grade to college, teaching high school English, wearing my favorite navy-and-white shoulder-padded suit because it made me feel confident.
But the answer I gave wasn’t too far from what I would say now:
There is one objective—and that is to make Americans feel proud of their First Lady and to feel that in some way she is a reflection of their lives and their values.
My own personal view is that the First Lady should respond to the concerns and the interests of today’s American women.
Women who are mothers, who are spouses, and who are wage earners.
Women who are struggling to balance all three roles.
And I think they would identify with a First Lady who is also trying to balance those three roles.
Many years later, I actually found myself balancing those roles as First Lady, and it was the honor of my life. I’m full of gratitude for the opportunity I was given to play a part in the country’s history, even if my call to the office came under circumstances I never anticipated.
What I think I brought to my role as First Lady is the same thing I bring to my friendships and my family: the values I grew up with.
I don’t have any illusions about how tough life is, or how complicated human nature is.
I’ve had an incredible life. Still, I think most of what’s consumed me is universal to all women—how to balance work, family, my place in the community, my obligations to myself.
I still believe that service is the highest calling, that small acts of kindness matter, and that deep down we are more alike than different.
One of my favorite songs is Luke Bryan’s “Most People Are Good.” Even with all the evidence I’ve seen to the contrary, that’s something I still believe, too.
The Danish philosopher S?ren Kierkegaard said, “Life can only be understood backwards, but it must be lived forwards.” I’ve been pushing forward so relentlessly that only now can I stop to make sense of everything.
It’s finally come time to sort through all that’s happened—for my own understanding, and for the sake of history.