Thus continued my fashion education. It had started when the press made fun of the purple suit I wore to that first White House visit with Hillary Clinton. After that I had begun visiting New York fashion houses; my favorites were Oscar de la Renta and Carolina Herrera. I paid for all my own clothes and took to attaching an index card to each outfit, writing down what event it had been worn to, so that I could avoid duplications. Each season my a.s.sistant would remind me of the different occasions for which I would need a new dress or outfit: state dinners, annual galas, and the like. I would glance through the designers' "look books" and make selections, usually asking that the color or style be slightly altered. But in the book, that red dress had looked perfect. It had vaguely crossed my mind that someone else might see the dress and think exactly the same thing, but what were the odds of that woman wearing it to a White House party? I let the thought pa.s.s from my mind until December 3. Unfortunately, no one else had thought to check on how many of the red lace dresses had been sold around the country, and one of the women who wore hers to the White House that night was so infuriated that she returned it to the store and demanded they give her a refund.

My dress, however, had a long life. Not only did I wear it for the official White House holiday photo but I sent it to travel the country as part of the Heart Truth Red Dress campaign to raise awareness about heart disease.

When I arrived in the White House, if I had been asked what was the leading cause of death among American women, I would have replied cancer. But the correct answer is heart disease. In 2003 heart attacks and related diseases were responsible for one out of every three female deaths in the United States. Very few American women knew this devastating statistic, and thousands of doctors were insufficiently aware of the risk for women's heart health. Most modern heart procedures, like stents and angioplasty, had been developed for men. Even the instruments used by heart surgeons were designed to fit men's far larger arteries and veins. At the start of 2003, Dr. Elizabeth Nabel of the National Heart, Lung, and Blood Inst.i.tute asked me to be the amba.s.sador for Heart Truth, a campaign to educate women about the risk of heart disease, and what they could do to prevent it. The keys to prevention are exercising, maintaining a healthy weight, quitting smoking, and monitoring blood pressure and cholesterol. I immediately said yes.

My first message was that women's heart attack symptoms may be different from men's. For women, common symptoms are often extreme fatigue and pain in the neck or the jaw, not just pain in the arm or the chest, the most frequent symptoms for men. In September 2003, I visited St. Luke's Hospital in Kansas City, Missouri, where I discussed the warning signs of a heart attack. A local woman named Joyce Cullen watched me on television. That night, as she was getting into bed, Joyce began to feel ill. She remembered what I had said and told her husband to pray and rush her to the hospital.

Doctors performed heart surgery and saved her life. Joyce joined the Heart Truth campaign and began speaking to local churches and women's groups to try to save other lives. In February 2004, I invited her to the White House to help me launch American Heart Month. I heard from other women as well. A daughter told me how her mother's life was saved after they watched me discuss heart attack warning signs on the Rachael Rachael Ray show. Another woman dialed 9-1-1 because of an article I wrote in the show. Another woman dialed 9-1-1 because of an article I wrote in the AARP AARP Bulletin. This is the remarkable platform that a first lady has. By 2005 women's deaths from heart disease had fallen to one in four. The heightened attention in the media, especially in women's magazines, to heart health and the national effort to educate women and their doctors saved countless lives.

The Heart Truth campaign put me on the cutting edge of fashion when I unveiled its Red Dress Project during New York City's famed Fashion Week. More than one hundred top models and celebrities have walked the runway in red dresses to highlight the importance of heart health. Today the red dress emphasizing heart health has become almost as iconic as the pink ribbon for breast cancer. And my now famous 2006 Kennedy Center red dress has traveled the country to remind women to care for their hearts.

That December, George and I hosted a retirement dinner at the White House for Kofi Annan, the outgoing secretary-general of the United Nations. America has a long history with the UN; during the darkest days of World War II, President Franklin Roosevelt was the one to coin the name United Nations, and the organization's charter was signed in San Francisco in 1945. Kofi Annan had been a fierce opponent of the Iraq War but a good ally in working to combat violence, disease, and illiteracy around the globe.

During dinner in the upstairs Yellow Oval Room, Kofi Annan asked me about the

protesters who gather in Lafayette Park, across from the White House. He was most likely thinking of antiwar protesters, but in fact, many of the people who come in sun, rain, sleet, and snow are not protesting against something but are imploring the American president to do something. Many are pro-democracy protesters, demonstrating on behalf of freedom. We heard the chants of protesters asking George to do more to support human rights in Vietnam. "Mr. President," they called, "please say, 'Vietnam must be free.'" We heard voices calling for an end to political imprisonment in China or freedom for Tibet. Ethiopians came to hold candlelight vigils to call for greater freedoms and an end to civil war. We would look out and see hundreds of their flames waving in the darkness. Week after week people came asking for the United States to use its power and influence to make lives better in other corners of the world. They did not come out of anger or hate, I explained, but out of hope. Kofi Annan looked vaguely surprised, then nodded his head.

The theme of Christmas 2006 at the White House was "Deck the Halls and Welcome All," and the decor was primarily red. The tree in the visitors' reception room and another outside the Oval Office were decorated with ornaments made by artisans in the North Carolina community of Spruce Pine, which had been hard hit by the loss of manufacturing jobs when local textile factories shut their doors. Helped by a generous donation in 2003 from Gloria Houston, who wrote The Year of the Perfect Christmas The Year of the Perfect Christmas Tree, Spruce Pine had established nearly one hundred small businesses dedicated to Spruce Pine had established nearly one hundred small businesses dedicated to producing handmade Christmas decorations. They called their economic development program the Home of the Perfect Christmas Trees. I chose their hand-blown red gla.s.s b.a.l.l.s and Carolina snowflakes, woven from colored reeds. Roland Mesnier returned from retirement to make the gingerbread White House, using over three hundred pounds of dark chocolate and gingerbread and adding eight hundred hand-piped snowflakes. At the Hanukkah party, the Marine Band played the traditional Jewish tune "Hava Nagila," and guests began dancing the hora in a large circle around the central hall. To inscribe our holiday card, a scene of a glowing Oval Office exterior bathed in a fresh coating of snow, painted by the landscape artist James Blake, I chose Psalm 119, "Thy word is a lamp unto my feet, and a light unto my path."

For George and me, the holidays were once again the season of receiving lines, where we spent long hours shaking hands. To manage the receptions, sometimes two in a single night, Blake Gottesman, George's personal aide, started the practice of counting how many photos were taken in an hour. During the early parties of the season, we averaged about fifteen seconds per photo, but as the weeks progressed, we, and the everlonger lines, would whittle that down to about seven seconds. Each morning our staff would e-mail around the numbers from the previous night, but even at seven seconds, we could be standing, shaking hands, and smiling for hours in a single evening, so that every guest had a chance to be greeted by the president and the first lady.

For several years during the month of December, I had noticed pain in my left forearm. I brushed it off as coming from too many hours spent standing and holding my arm at my side. But this year, the pain continued into the spring, and it escalated after my hiking trip in Zion National Park. I scheduled an MRI, and the White House doctor, Richard Tubb, told me that I had a pinched nerve in a cervical vertebra. In August of 2007 the chief of neurosurgery at the George Washington University Hospital sc.r.a.ped away bone spurs and calcification that were pressing on the nerve in my neck. For the first time in months, I woke without any pain. Pinched nerves are harbingers of creeping age, and even though this required surgery, the press interest was not nearly as intense as when I had a small squamous cell skin cancer lesion, likely the result of too many hours spent around the Ranchland Hills Country Club pool in Midland, removed from my shin.

One of the White House correspondents caught sight of my postsurgical Band-Aid and asked me if I had been bitten by Barney.

In 2006, as always, we spent Christmas at Camp David with the girls and much of our extended family, and George made phone calls to our troops overseas. In November, following the midterm elections, George had replaced Secretary of Defense Donald Rumsfeld with former CIA chief Robert Gates. In Iraq, Saddam Hussein's yearlong trials had concluded; he was scheduled to be hanged on December 30. But that was not enough to turn the tide of bombings and violence; three thousand American troops had died since the war began. At this stage, George was convinced that the United States needed a new strategy. Many Americans now blamed him for the war; the attacks were shrill and personal. For popularity's sake, it might have been easier to withdraw U.S. forces, but the easy course is not always the right one. Instead, George chose to implement a policy known as "the surge."

On January 10, 2007, he announced to the American people that he had decided to commit some twenty thousand more U.S. troops to Iraq, to protect the Iraqi population, to isolate the extremists, to push the Iraqis to lead, and to create s.p.a.ce for political progress.

More than 70 percent of eligible Iraqi citizens had voted in the last election, but the nation still had a long road ahead.

Many in and out of government, including prominent Republicans and nearly every Democrat, opposed the surge. Many inside George's administration also disagreed with the plan. It was a hard and lonely decision, and it was one of his bravest moments in office.

Day in and day out, the criticism of George from all sides was withering. He was denounced and caricatured in ways far worse than his father had been. I survived it because George did. He is not a self-pitying man. He is not a man of outsize ego or arrogance, despite what his critics said. He simply did what he believed to be right and expected to be judged based on outcomes and history, not by daily headlines or pundits on talk shows. But it was still painful to see the man I loved, the man I knew, so misrepresented by his opponents to the American people. And the hardest part was knowing that our daughters saw it too. The dad who had held them as babies, who had loved them unconditionally, was now the target of mocking late-night comics and near hysterical cable television hosts. It hurt me to think of our daughters picking up the newspaper or reading the Internet or walking into a room where the television was on.

Their resilience in the face of this onslaught was remarkable. As a family we have listened to some of the worst things that can be said about us or someone we love, and never has our own love dimmed. But what we endured is a meanness of spirit, a viciousness, and a cruelty that I hope no political family will ever be subjected to again.

We could do nothing but wait and hope for the tide to turn. Our friends and our family waited with us. George had the unwavering love and support of his parents. He also had the special companionship of his youngest brother, Marvin, who lived in nearby northern Virginia. On the weekends, Marvin would call and say, "There's a great game

on, why don't we watch it together?" The two of them could lose themselves in sports for an hour or two, and in that easy way that brothers have, the unspoken language of friendship would pa.s.s between them. I had my sisters-in-law. Margaret Bush, Marvin's wife, came several times during the week when I was in Washington to exercise with me in the White House gym. George's sister, Doro Bush Koch, and her husband, Bobby, and their children frequently came for dinner and joined us at Camp David. The richness of their friendship and their love for me and for George was of great solace as we waited for improvement in Iraq. The Bush children had seen their father lead the nation during the Gulf War; now it was their brother, in a longer, more difficult fight. They understood, as few people could, the burdens of leading a nation in wartime. And this was a war unlike any our country had ever faced.

In World War II, we knew that if we crippled the enemy in one place, other fronts would weaken and eventually collapse. During the Cold War, the United States could cede some countries, such as Cuba or Eastern Europe or Vietnam, or even Afghanistan up until 1979, to the Soviets' sphere, and still the fundamental balance of power would remain unchanged. Yet in this new type of war, against not an army in uniform but a radical ideology bent on destroying the very framework of our shared civilization, we could not write off one country to the enemy. Never before in history had such small numbers possessed the potential to inflict such horrific damage. So wherever the terrorists were plotting destruction, we had to engage them. And wherever terrorist cells might be trying to gain a foothold, we had to turn them back. It was a war of terrorist acts and a contest of ideology, and we could not win unless we met them firmly on every front. We could not let Iraq fail, or let the United States fail in Iraq. We could never again allow a full-fledged haven for terror to flourish if we wanted to protect Americans inside the borders of our own nation. Nor could we give up on the millions of Iraqis who were hoping that the extremists would be turned back and a free society would have a chance to take hold. George chose the best way he thought to win, and we waited. And we prayed for the men and women who had pledged to fight for our country and for our freedoms.

The nasty personal criticisms of George had begun in earnest in 2004. In a May 2004 interview with her hometown paper, the San Francisco Chronicle, San Francisco Chronicle, Nancy Pelosi, Nancy Pelosi, the leader of the Democratic Party in the House of Representatives, said, "Bush is an incompetent leader. In fact, he's not a leader. He's a person who has no judgment, no experience and no knowledge of the subjects that he has decided upon." She went on, "Not to get personal about it, but the president's capacity to lead has never been there. In order to lead, you have to have judgment. In order to have judgment, you have to have knowledge and experience. He has none." In 2005, after being invited to a meeting at the White House, she called George "dangerous." Meanwhile, the Democratic leader in the Senate, Harry Reid of Nevada, called George a "loser" and a "liar." Subsequently, in a private, one-on-one meeting in the White House Cabinet Room, Reid said to George that he would stop calling him names. But he didn't stop. And he later told both Rolling Stone Rolling Stone and then The New York Times Magazine, The New York Times Magazine, with apparent pride, that he had "never" with apparent pride, that he had "never"

apologized for the liar comment.

These two congressional leaders also made those statements about the sitting United States president when the country was at war, though as George and I knew,

similar invectives had been hurled at presidents during wartime from the earliest days of our republic. Franklin Roosevelt had complained that "every senator is a law unto himself and everyone seeks the spotlight." Interestingly enough, when Pelosi and Reid were asked to suggest their own policy proposals, their answer invariably was withdraw from Iraq immediately, whatever the consequences.

Nevertheless, George and I repeatedly invited Harry and Landra Reid and Nancy and Paul Pelosi to the White House. They came for small gatherings and for black-tie dinners, and received invitations to major state events. When the Queen of England visited in the spring of 2007, Nancy Pelosi danced in the White House in her long ball gown.

Of course, I hated hearing all those terrible things said about my husband. The comments were uncalled for and graceless. While a president's political opponents, as well as his supporters, are ent.i.tled to make what they see as legitimate criticisms, and while our national debates should be spirited, these particular words revealed the very petty and parochial nature of some who serve in Congress. George, as president, would never have used such language about them. It demeans honest debate; it debases the office of the presidency; and just as importantly, it does little to produce good decisions or good policy. George did not use interviews to call political opponents "losers" or "liars," and if he had, the outcry would have been enormous. The president doesn't have the luxury of behaving like a smart-aleck kid on a school playground; he has to work not just with Congress but with leaders around the world. The c.o.c.kiest thing George did was say that he wanted to get Osama bin Laden "dead or alive."

Pelosi and Reid and others got to say whatever they wanted, and George and I were still polite. We still shook their hands in receiving lines and posed for photographs, and George did not exclude them from important meetings or White House events. He respected the offices that they held. Indeed, past congressional leaders, including Senator Lyndon Johnson and then Senate Majority Leader Mike Mansfield, who was a vocal critic of Johnson's during Vietnam, took great care not to utter uncivil words about their presidents in public.

In the Texas statehouse, the governor's office sits in the middle. George could walk down the hall to speak to legislators all the time, and he did. He worked in a thoroughly bipartisan manner. As president, George had great appreciation for the separation of powers, which lies at the heart of how our government works. But in Washington, Capitol Hill was like its own fiefdom, a cacophonous place where no one House member or U.S. senator has the ultimate responsibility for anything. No one has ultimate responsibility for our national security or for our economic security. It is easy to throw mud and pa.s.s the buck when there are 534 other people to hide behind. George didn't have that luxury. Every problem in the world comes to the desk of the President of the United States.

On the night of February 11, 2007, as Washington lay huddled under a deep chill, we lit the lights on the East Entrance and welcomed guests to celebrate Abraham Lincoln, on behalf of Ford's Theatre and the Abraham Lincoln Bicentennial celebration. Senator and Mrs. Harry Reid were two of our guests.

The White House in winter looks like something out of Abraham Lincoln's time, with the soft glow of light bathing it in creamy whites. Marine guards moved with

precision as each vehicle approached. In long dresses and tuxedos, the guests walked across the shiny tiled floors of what is called the booksellers' corridor on the ground floor. They then climbed the marble stairs up to the formal State Floor. Time and again, at this event and at many others, people's eyes would overflow as they reached the State Floor. To walk through the corridors, to enter the Green, Red, and Blue rooms, to stand where our own leaders have stood for generations is a deeply patriotic and moving experience. But tonight we had also invited them upstairs to see the Lincoln Bedroom and Sitting Room, whose renovations were now complete. In Lincoln's day, the room had not been a bedroom but the president's official office.

Working with the Committee for the Preservation of the White House, I had recreated the rug based on photographs of an 1861 English carpet that was in Lincoln's office. We commissioned it from the same company that had woven his original rug.

Hand-blocked wallpaper that approximated Lincoln's office design was used for the walls, and we reproduced the room's period marble fireplace mantel, which had been discarded in 1902. The bedroom furniture suite that we used had been purchased by Mary Todd Lincoln, and every other piece in the two rooms had been part of the White House collection when the Lincolns resided here. In the sitting room, I installed the only marble Victorian-era fireplace mantel that had survived the numerous White House expansions and renovations. On a simple Victorian desk in a corner of the bedroom, we displayed the fifth and last known copy of the Gettysburg Address written in Lincoln's hand. He had made this copy so that his words might be sold at auction to raise money to buy bandages for wounded Union troops.

In this room, on January 1, 1863, Lincoln had signed the Emanc.i.p.ation Proclamation, and night after night he had waited for word on his war. For this night, I had asked the Marine Strings to play a selection of Lincoln's favorite songs, including "Dixie." As the melodies drifted upstairs, echoing about these pieces of our history, some of the guests wiped tears from their eyes.

Three weeks later, on March 1, 2007, I was landing in the pitch darkness in a small Air Force plane on Midway Island, scene of one of the most b.l.o.o.d.y and decisive naval battles of World War II in the Pacific. Today the guns are silent and the island is the centerpiece of one of the largest environmental conservation efforts on earth. Midway is home to eighty people and about 400,000 pairs of Laysan albatross, as well as tropic birds, black noddies, white terns, and other nesting and migratory birds. In Hawaiian, the island has long been called Pihemanu, or "the loud din of birds." From November through July, planes are not allowed to land or depart during daylight because of fears that birds in flight will be sucked into the engines.

In the blackness, my staff and I rode on golf carts to aging military barracks; I spent the night in a tiny house belonging to Barry Christenson, the manager of Midway Atoll National Wildlife Refuge, and his wife, Elise. When I awoke, it was to a deserted island paradise of gleaming sands and rustling palms, with waters so clear that it was possible to see the fish beneath. We had to watch each step we took, for fear of stepping on an albatross nest or a young chick. On Midway Island the albatross have no natural predators; the danger to them comes instead from the seas. Parents fly low over the water, skimming the ocean top for fish and squid. They eat what they catch, then regurgitate the half-digested food to feed their babies. The tragedy is that an albatross cannot distinguish between a squid and a piece of floating plastic. Scattered across the sands and gra.s.ses were abandoned albatross nests and chick carca.s.ses, the remains of bird babies who had died after being fed. John Klavitter, a wildlife biologist, opened the partially decomposed bodies. Inside were plastic bottle caps and other refuse, including toothbrushes, cigarette lighters, and plastic tires from a child's toy.

Ocean currents in the Pacific have created a plastic garbage dump estimated to be twice the size of Texas. Most of its contents float just under the swells of the waves, where bits and pieces are ingested by bird and marine life. The Department of the Interior and the National Oceanic and Atmospheric Administration, as well as other U.S.

agencies, are working to mitigate this plastic debris and prevent new trash from acc.u.mulating. Twenty-one tons of debris had been collected around the Hawaiian Islands in 2006. But so much more needs to be done; there are 6.4 million million tons of trash polluting tons of trash polluting and destroying our global marine habitats.

In 2006 George had designated nearly 140,000 square miles of these vulnerable Pacific waters as a marine national monument. It is the single largest U.S. conservation area, bigger than all our national parklands combined. Among the string of tiny islands and atolls in these waters, Midway Island is the only spot inhabited by humans. But the entire region is home to some 14 million seabirds and seven thousand marine mammals, nearly two thousand of which cannot be found anywhere else on earth. The next morning, in Honolulu, I would christen the monument with its Hawaiian name, Papaha-naumokuakea.

On the Midway atoll, after stepping carefully around the albatross nests, Interior Secretary Dirk Kempthorne and I knelt in the dirt to replant native plants that were being crowded out by invasive species attacking the sh.o.r.es, another environmental danger. I stood in the water in my bare feet and fed endangered Hawaiian monk seals, of which only about thirteen hundred remain. And I saw the rusting antiaircraft guns and sh.e.l.l craters, the pitted runways and weapons depots where American soldiers and sailors had won their first major victory against the j.a.panese. We paused in silence to remember as the wind and birdcalls reverberated in our ears.

At the start of 2007, we received word that Queen Elizabeth of England wanted to make another visit to the United States, and the White House immediately sprang into action to host a state dinner in her honor. The preparations involved two social secretaries, Lea Berman, who was departing after over two years of service, and Amy Zantzinger, who would be with us through the remainder of George's term. We invited the violin virtuoso Itzhak Perlman to play for the queen. We decorated the State Dining Room with white roses in vermeil vases and used the gold-edged Clinton china. Our menu tastings, with our talented White House chef Cris Comerford, were done weeks in advance, and everything was designed to showcase the best of America with a nod to British favorites, from spring pea soup with caviar to a first course of Dover sole, followed by lamb with seasonal, local vegetables and salad. And the dinner was to be white tie. George of course didn't want to wear white tie, but at Buckingham Palace, Prince Philip and the queen's guests had donned them for us. So Condi Rice and I made an executive decision that this evening would be white tie as well, much to George's chagrin.

The arrival ceremony was perfect, under blue skies, with a twenty-one-gun salute and a parade by the Old Guard Fife and Drum Corps. That afternoon, Queen Elizabeth,

followed by George, greeted dozens of British expatriate and American schoolchildren, who came bearing flowers and shyly asking for autographs. We had invited Bar and Gampy to join us, and when the queen asked to visit the newly opened World War II Memorial, we suggested Gampy as her escort. The eighty-two-year-old World War II fighter pilot lent his arm to the woman who had been a beautiful teenage princess when the war raged. Then Princess Elizabeth had volunteered to drive and repair heavy transport vehicles only after her father, King George VI, refused her request to become a nurse. Now Gampy and the queen walked slowly through this monument to their shared past.

The guest list for this dinner was fun to compile, particularly the invitation I was waiting until the very end to extend. The queen is a fan of horse racing, and she had attended the Kentucky Derby the weekend before coming to the White House. I watched the derby on television, and the moment it ended, I called Amy Zantzinger with a request: invite the winning jockey, Calvin Borel. When she finally reached him, he thought it was a joke. Amy convinced him that indeed the White House was calling, and he said yes, he would attend, but he and his fiancee, Lisa Funk, had nothing to wear. After they heard about the invitation, the stores in Louisville, Kentucky, where the derby is run, stayed open on Sunday so that Lisa could find a dress. For Calvin, Amy arranged to rent a set of white tails from the same man who was outfitting George for the evening.

Both Calvin and Lisa were beaming when they walked through the receiving line, and then Calvin did the sweetest thing. It is strict protocol not to touch the queen, not even to shake her hand, until she extends hers to you first. But as Calvin stood between the queen and me, he wrapped his arms around both of us for the official photograph. All during the dinner, I could see Calvin and Lisa at a nearby table, and they looked so happy. He had his arm draped over her and an expression of bliss, winning the Kentucky Derby on Sat.u.r.day, and on Monday night dining with the Queen of England at the White House.

On the evening of June 5, George and I landed in Heiligendamm, Germany, site of the country's oldest seaside spa, nestled on the coast of the Baltic Sea, for the G8 Summit. I arrived and began my events, but by the afternoon of the seventh, I could barely stand up. My head inexplicably throbbed; I was horribly dizzy and nauseated. I went to bed, pulled up the covers, and for several hours felt so awful that I thought I might die right there in that hotel room.

I was not the only one to fall ill. Over the next day nearly a dozen members of our delegation were stricken, even George, who started to feel sick during an early morning staff briefing. For most of us, the primary symptoms were nausea or dizziness, but one of our military aides had difficulty walking and a White House staffer lost all hearing in one ear. Exceedingly alarmed, the Secret Service went on full alert, combing the resort for potential poisons. In the past year, there had been several high-profile poisonings, including one with suspected nuclear material, in and around Europe. The overriding fear was that terrorists had gotten control of a dangerous substance and planted it at the resort.

After my stay in bed, I managed to get up and return to the summit. George, who almost never gets sick, refused to postpone a meeting with French president Nicolas Sarkozy, but he canceled a press conference and remained in his room to rest during the G8's final morning meeting. Indeed, George felt so ill that he met with Sarkozy in his

hotel room and did not even stand up to greet him. Sarkozy walked over to the sofa to shake his hand and then sat nearby. The White House press office announced to the media that the president had contracted some kind of virus or stomach flu. European papers began scrutinizing every meal that George had eaten and even examined the Baltic fish that had been served.

We all recovered, although a few of the staff had lingering aftereffects; our military aide's gait has never returned to normal, nor has our senior staffer regained full hearing in that ear. The most concrete conclusion any doctors could reach was that we contracted a virus that attacks a nerve near the inner ear and is prevalent in Heiligendamm. But we never learned if any other delegations became ill, or if ours, mysteriously, was the only one.

Later in June, I returned to Africa, to follow the progress of the President's Malaria Initiative and our work to combat AIDS through PEPFAR. Jenna came with me.

She had just spent the better part of a year working with UNICEF in Central America, where she had met an AIDS orphan who she called Ana, a young woman who had suffered the trauma of contracting HIV/AIDS from her mother at birth and then lost both parents to the disease. As a teenager, Ana was s.e.xually abused in her grandmother's home. Jenna had been so moved by Ana's determination to build a new life for herself that she asked to write a book about her, Ana's Story Ana's Story.

In Zambia, Jenna and I glimpsed the widespread consequences of AIDS. Together we toured the Mututa Memorial Center, founded by Martha Chilufya, whose husband had died from AIDS. Mututa, whose name means "drumming" in the Bemba language, provides home-based care for some 150 Zambians living with AIDS. We sat in brilliant sunshine on the hot red earth, surrounded by baby dolls and bicycles. World Bicycle Relief had donated 23,000 bicycles to nonprofits in Zambia so that caregivers can ride through villages and out to the countryside to deliver medicines and check on neighbors.

Some of these men and women on bicycles had gone to their neighbors' houses and found them in bed, half dead from the ravages of AIDS. They would get them up, get them to a clinic, and get them started on antiretrovirals for another chance at life. As we sat in a circle listening to their stories, two girls told us about how they had each been victims of s.e.xual abuse and were now HIV-positive. Tears streamed down their cheeks as they spoke. Afterward, Jenna went over, took their hands, and said, "You are not alone. This story happens all over the world," and she told them about Ana. I added that Jenna had just written a book about this young woman. They raised their faces to ours and then they said, "I wish you would tell our stories. Write about us."

Since 2002 I had been following the repressive Burmese junta and its harsh treatment of the n.o.bel Peace Prize winner Aung San Suu Kyi. Elsie Walker, George's cousin and my good friend, who had once worked for the Dalai Lama, was a longtime advocate for Burmese human rights.

The Burmese are a tragic example of a people striving for democracy and being cruelly denied. The brutality of Burma's current military regime is even more ironic because the inhabitants of one of the earliest kingdoms there, the Pyu, eschewed war and jails and even, as legend has it, would not wear silk because they did not want to harm the silkworms. Like the ancient kingdoms of central Asia, Burma was invaded and conquered

by the Mongols, and it too felt the reach of imperial Britain. The first Anglo-Burmese War was the longest and most expensive in the history of the British Indian Empire. By 1885 Britain had annexed the entire kingdom and the Burmese king had been forced into exile in India. The j.a.panese invaded Burma during World War II, and late in the war, the Burmese joined with the British to oust j.a.pan from their soil. Burma gained its official independence in 1948, but it was marked by internal strife. A coup in 1962 placed it under control of the military. The military maintained power, despite repeated protests, until a 1990 election, which Aung San Suu Kyi's National League for Democracy won in a landslide.

The junta placed her under house arrest, nullified the election, and would not allow the National a.s.sembly to be convened. Although she was eventually allowed to move about Rangoon, Suu Kyi was returned to house arrest in 2000 and again in 2003.

While I was in the White House, some of what I did to aid the Burmese had to be done in secret. But by the fall of 2006, I could no longer remain publicly silent. To coincide with the annual opening of the UN General a.s.sembly in September of 2006, I convened a roundtable at the UN to address the deteriorating situation in Burma. While the United Nations uses "Myanmar," the word that the junta has selected to rename the country, for the meeting I sat under a map inscribed with the traditional name, "Burma."

As in Iraq and other nations, in Burma rape is routinely used as a weapon of war. The day of the roundtable, we heard stories of the victims. Among the oldest to be raped by government forces was a woman of eighty; the youngest was a girl of eight.

I followed that conference with op-eds in major newspapers and several meetings with the UN's special envoy to Burma, Ibrahim Gambari, and my office partic.i.p.ated in the weekly White House meeting on Burma. In May I joined the Senate Women's Caucus, comprising all the female senators, and we publicly appealed for Aung San Suu Kyi's release. In June I met with Burmese exiles and refugees at the White House. By August, Burma was dominating international headlines because of the government's brutal crackdown on Buddhist monks who had peacefully taken to the streets to protest soaring prices for fuel and other basic goods. The government responded with beatings and arrests. Here and abroad, the usual round of diplomatic protests were launched, but it was not enough. I decided to speak out.

I telephoned the new UN secretary-general, Ban Ki-moon, and asked him to denounce the junta's crackdown. I called for a new UN Security Council resolution against the regime, even though China and Russia had vetoed similar U.S. efforts just eight months before. Determined to help mobilize public opinion, I sent testimony to the Senate Foreign Relations Committee, wrote another op-ed for The Wall Street Journal, The Wall Street Journal, and gave interviews. The U.S. government imposed new sanctions, including sanctions aimed at the junta generals' personal wealth. I wanted the people inside Burma to know that we heard them, and the junta to know it too. Things might not change, but that is no excuse for not speaking out when the need and the opportunity arise.

On September 20, I hosted a tea at the White House. It was a special tea for what was called the First Lady's Prayer Group. The group had begun in 1993, as Hillary Clinton was entering the White House. The idea had come from Susan Baker, Jim Baker's wife, who was very close to Barbara and George Bush and was dismayed when they lost their bid for reelection. Susan already belonged to a Christian prayer group that

met each week and included women of all political backgrounds, including Janet Hall, wife of former Democratic congressman Tony Hall, and Holly Leachman, wife of a Washington Redskins chaplain who herself was a lay minister at the McLean Bible Church. Among the other members were Carolyn Wolf, wife of Republican congressman Frank Wolf, and Joanne Kemp, wife of former congressman Jack Kemp, whose husband would run for vice president against Bill Clinton and Al Gore in 1996. Grace Nelson, wife of Democratic Florida senator Bill Nelson, also joined. To a.s.suage her disappointment over the 1992 race, Susan suggested that her prayer group begin to pray for the new first lady, and they soon became known as the First Lady's Prayer Group.

Hillary Clinton met with them occasionally. When George and I moved to Washington, they began to pray for me and each week would send their prayers and Bible pa.s.sages to my office for encouragement. Many of these women became my good friends.

They were far from the only ones who prayed for the first lady and the president.

George has long said that the United States is a remarkable nation, maybe the only nation on earth where so many people pray for their president. We knew that people were praying for us, and we were raised up by their compa.s.sion. We are grateful for those millions of anonymous prayers.

In the early 1960s, my grandmother found a lump in her breast. She never told Mother or Daddy or me. She simply found a surgeon, checked herself into the hospital, and had her breast removed. On our next visit to El Paso, after she was well and healed, Grammee matter-of-factly mentioned that she had had a breast tumor. The cancer never spread, and two decades later, when she was eighty-two, Grammee died in her backyard, watering her flowers, from what must have been a stroke or a heart attack. Papa found her body amid the flower beds.

My mother is also a breast cancer survivor. Her lump was discovered during a routine mammogram a few years after Daddy died. She had a mastectomy in Midland with her own doctor. I was with Mother when she was wheeled into surgery, and we said a tearful good-bye in case she did not wake up. Afterward, I spent several days at her house caring for her, but she refused to allow a home health aide to come help her once I left. She told me, "I don't need any more help."

But I knew all too well the ravages of breast cancer, which had killed my former Midland next-door neighbor and close friend, Cathie Blackaller. In Dallas I had volunteered with the Komen Foundation when it was in its infancy. In the United States we have benefited from years of advocacy for breast cancer treatment and prevention.

There are still, though, many places where cancer remains a highly taboo topic and where it is difficult to mention the word "breast." One such region of the world was the Middle East, where many women live their lives shrouded behind abayas.

Health diplomacy is an important way for American women to reach out to other women around the world, and a key component of that health diplomacy was the U.S.Middle East Partnership for Breast Cancer Awareness and Research, launched in 2006 by the U.S. government, the Susan G. Komen Breast Cancer Foundation, and the M. D.

Anderson Cancer Center at the University of Texas. As this partnership took off, I became an advocate for women's health not just at home but overseas. In October 2007, I visited some of the countries hardest hit by breast cancer. In many Middle Eastern nations, breast cancer is the most commonly diagnosed cancer in women, and in some nations, such as the United Arab Emirates, it is the second leading cause of death.

I arrived after dusk in Abu Dhabi, one of the seven United Arab Emirates, and was. .h.i.t by a wall of searing, humid heat when I stepped off the plane. Sheikha Lubna Khalid Al Qasimi, the UAE's minister for foreign trade, was waiting to greet me. Sheikha Lubna was educated in California and is a member of the ruling royal family; she is the first woman to hold a ministerial post. We walked into the enormous and thoroughly modern gilt and marble dignitaries' airport terminal for the ancient Arab custom of offering tea to an honored guest. Then my motorcade left, illuminated by the brilliant reflected light from the skysc.r.a.pers that soar above Abu Dhabi.

The next morning I awoke to the hum of giant cranes and the skeletons of ma.s.sive buildings rising from what had less than a century ago been a desert home to nomadic fishermen and herders. In 2007 Fortune Fortune magazine had declared it the richest city in the magazine had declared it the richest city in the world. Yet its vast riches had done little to protect women from disease. In Abu Dhabi, breast cancer is the leading cause of death for women; only 36 percent of all women find their cancers when they are most treatable, in stage one or two. Many women do not want to be examined by a physician because they fear social ostracism if they are found to have breast cancer. Their husbands may leave them; their sons may turn their backs.

Their daughters may be considered unmarriageable.

Away from the glint of the city's modern towers, I gathered with breast cancer survivors inside a large circular tent whose walls were draped in billowy pink fabric. The emirates were a largely Bedouin society before the discovery of oil, and this tent, which had been erected within the walls of a hospital, spoke to those ancient traditions. The women who came to this Pink Majlis, literally, in Arabic, "the pink place of sitting," were veiled and covered. A few had sewn pink ribbons on the black cloth of their abayas. In a voice barely above a whisper, one survivor told me of having been abandoned by her husband. Another spoke proudly of how, when her hair fell out from chemotherapy, her husband and her two sons shaved their heads in solidarity. I listened to these women and heard in their voices the common fear of all women, the fear of a disease that causes sickness, disfigurement, and death.

Before I left Abu Dhabi, I visited the seaside palace of Sheikha Fatima, the widow of the late ruler of the emirates. Her home was decorated in marble and gold, and every table fairly groaned with enormous platters of food, overflowing bowls of fruits, and trays of dates and nuts. Abundance is the sign of hospitality. Sheikha Lubna joined us, along with many of Sheikha Fatima's female relatives, and it was a striking confluence of the changes in women's lives, behind the veil, in just a few generations. While the young, veiled women talked about partic.i.p.ating in Abu Dhabi's business and political life, Sheikha Fatima remained firmly rooted in traditional ways. She not only covered herself but she wore a leather face mask. Her husband, she told me, thought it was very provocative to see only the tiniest bit of her eyes.

The neighboring emirate city of Dubai is even hotter; it is the largest of the emirate states. Dubai had already begun a major initiative through the Chamber of Commerce and local businesses, including American-owned firms like FedEx, to create an education program about breast cancer. I marveled at the ma.s.sive buildings, the manmade islands, and the second largest man-made marina in the world. The entire city, a modern wonder where towers twist and point to the sky, has been fashioned on top of a sandy outcropping.

The third Middle Eastern partnership was located in Saudi Arabia. In the newly opened King Fahd Medical Center, I spoke to reporters as a female doctor watched me from behind a dividing wall, her entire body covered except for a thin opening for her eyegla.s.ses.

In the Saudi Kingdom, women contract breast cancer at far younger ages than in the United States, often a decade earlier. Over coffee in the city of Jeddah with breast cancer patients to "break the silence," I looked around and realized that every woman in the room was young, many two decades younger than I. Many were mothers with small children. One of the country's most outspoken cancer patients, and one of the first Saudi women to speak openly about her disease, is an obstetrician and gynecologist, Dr. Samia al-Amoudi. In 2007 she was forty-nine years old.

As we talked, a cancer survivor asked me what I thought of Saudi women. I told her the truth, that at first I had found it disconcerting to sit with women who were covered, that the covers seemed like barriers between us, closing them off from me, and that I had expected it would be difficult to talk to them, but I was wrong. It was surprisingly easy to talk about such an intimate subject as breast cancer. A woman held up a bit of her black abaya and said, "These covers may be black, but they're transparent,"

meaning that underneath we are all very much the same.

As our visit ended, two women gave me a black head scarf decorated with pink ribbons. Most of the women in the room were wearing them. As a sign of respect to them and to their disease, for a minute I placed the scarf over my head. The hastily snapped photo capturing the moment sp.a.w.ned a small uproar: by wearing the symbol of Saudi cancer survivors, I was thought to be endorsing veiling across the globe, as opposed to sitting with mothers and their daughters who were looking for hope when facing a disease that is, far too often, a death sentence.

From Saudi Arabia, I went on to Kuwait, where I met with a group of about twenty women leaders, including a lawyer, the first female government minister, and an a.s.sistant government undersecretary for tourism. I asked to meet with female leaders in nearly all of the countries I visited, but this meeting was special. Just a year before, in 2006, Kuwaiti women had won the right to vote. In pleading their case, the women's activist Roula al-Dashti had said, "Half a democracy is not a democracy." Twenty-seven women ran for office in the 2006 national elections, and while up to 58 percent of Kuwait's women voted for the first time, every female candidate lost.

Three of the women I met with had been among the candidates. We gathered in the home of a female Kuwaiti politician and member of the ruling family, Rasha AlSabah. We sat on thick, cushioned sofas around the edges of the room, and it was clear when they spoke that the women were deeply disappointed and hurt that other women had not turned out to elect them. Gently, I asked the women, What did you run on? What was your platform? And they looked surprised. It apparently had not occurred to them to run on issues, something we take for granted in our political campaigns. They had run simply on the fact that they were women. We forget when we look at other nations trying to democratize how much there is to be learned. I am reminded of the story of China when it began expanding its relations with the West at the close of the nineteenth century.

Vast numbers of traders, emissaries, missionaries, and other visitors saw Chinese women hobbling on bound feet. Shamed, China began to abandon the practice; it was formally banned in 1912. Yet even now, there are old women whose feet are wrapped in rags.

I mentioned to the Kuwaiti women that George in his campaigns, starting with the one to become governor of Texas, had run on specific issues that were important to him.