2,500 years ago a woman in Sicily lost her battle with cancer. The scars of the disease left marks on her skull and may help researchers solve the mystery why she was buried in such a way that she seemed to be guarding 50 other people who eventually followed her into the afterlife.
The woman’s skull was found in 2014 near the town of Baucina, in Sicily, Italy. Live Science reports it had been buried in an artificial cave. The “extremely peculiar position” – the face of the skull facing towards the grave’s co-inhabitants – piqued the excavators’ interest. Was this person meant to watching or protecting the others?
The 2,500-year-old skull of a woman with cancer was found facing into an artificial cave that holds at least 50 burials. ( Roberto Miccichè, Giuseppe Carotenuto & Luca Sìneo )
It is believed the woman died when she was between the ages of 35 and 50 years old. 14 holes are evidence that the cancer had spread to her skull by then. Roberto Miccichè, study researcher and anthropology professor at the University of Palermo, told Live Science that the tomb containing the skull had been looted at some point in the past. All the grave goods were removed and the bones of the other individuals had been disturbed.
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Nonetheless, Miccichè said, “We can assume that it [the skull] was found undisturbed in its original position, as grave robbers have used another way to get into the cave immediately above the entrance.”
A paper on the skull’s analysis was published in a special issue focusing on cancer in the International Journal of Paleopathology . In it, the authors explain that the skull is one of the oldest known examples of metastatic cancer (MC) in Western Europe. They were able to reach that conclusion through CT and 3D imaging, which they utilized for an analytical approach to paleopathology. The morphology of the lesions on the skull and the biological profile they found for the remains hints that the origins of the woman’s disease may have begun as breast cancer.
Four views of the skull. (Roberto Miccichè, Giuseppe Carotenuto & Luca Sìneo )
The researchers have put forward two possible explanations for the skull’s unusual position based on the evidence they have gathered through the digital image analysis and the state of the tomb.
First, the marks on her skull and other symptoms of the woman’s disease may have seemed strange and caused others in her community to associate her with death. Miccichè seems to be most convinced by this hypothesis, “Personally, I agree with this interpretation, as the clinical appearance of metastases on the skull [with its scattered holes] may have impressed the afterlife perception of people who lived beside the individual.”
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The second possibility is that the woman had a high social status in her community and the cancer may have had nothing to do with the position of burial. As Miccichè said , “Another possibility could be connected to a particular role occupied in life within the ancient community by the person to whom the skull belonged. Both of these interpretations are very hard to prove, as we do not have many similar cases that we can use for comparison purposes.”
Thus the mystery continues, but so does the research. The scientists have decided to further explore ancient perspectives on death and illness in Sicily . This should give them a better understanding of the social and sacred context for the unusual burial of the Iron Age skull.
Dolmen created by an ancient tribe in Avola, east Sicily. (S. Piccolo/ CC BY 3.0 )
A Nazi by Any Other Name
From 1933 to 1945, Germany was ruled with an iron fist by Adolf Hitler and his Nazi Party. They eventually used Refuge in Audacity to execute millions of people they found undesirable, with about half (using the 12 million death figure) being Jewish, the rest being various other groups that often got picked on in Europe: political prisoners (especially communists), gay people (along with other perceived sexual deviants), Romani, Slavs, Jehovah's Witnesses, disabled and mentally ill people, etc. The Nazis were also one of the primary drivers in starting the most destructive war in human history, which killed even more people. (Estimates range from 40 to 80 million, based on what you include. Typically reported as the midpoint, 60.) Under Nazi control, the German military committed widespread atrocities across Europe, from soldiers partaking in looting, burning, and killing civilians throughout occupied territory, to pilots strafing crowds of fleeing refugees. The result is that they are considered by Western culture to be one of the most evil groups of people that ever lived, and therefore easy and acceptable to make look bad.
For that reason, ever since then, people have created villains who are clearly analogous to the Nazis. These pseudo-Nazis can generally range from sympathetic people who got swept up in the chaos to a simplified bunch of Psychos for Hire who joined the army simply so they can massacre inferior races. While the former is better depth-wise, making these Nazis By Any Other Name too sympathetic can result in a Draco in Leather Pants.
Of course, since the Nazis themselves stole symbolism, slogans, and rituals from other historical sources (and racism looooong predates their existence), much of what is associated with them today is actually far Older Than They Think. (In some cases such as the Non-Nazi Swastika, the symbols may even have had a perfectly innocent connotation before the Nazis got their dirty hands on it.) So a few examples commonly given merely reflect generic totalitarian, cult-of-personality, and/or dictatorship elements. Manga, Anime, and other forms of Japanese entertainment will also borrow from Imperial Japan: for example, the killing of surrendering soldiers, or attempts to stamp out culture. Further justification for this trope in more recent years has been the outlawing of Nazi swastikas and related imagery in Germany and other places, leading to the use of similar-looking symbols that weren't previously associated with fascism.
Any strong German ruler (Frederick the Great, Bismarck, Barbarossa, Merkel note ironic because actual neo-Nazis hate her . ) or right-wing German political movement (any one) is at risk of getting this treatment, especially in works from 1970 to 1990.
A subtrope of Fictional Political Party and Does This Remind You of Anything?. Compare with Putting on the Reich, Scary Dogmatic Aliens, and Space Jews. Compare and contrast with Gratuitous Nazis, where actual Nazis are used (where one wouldn't expect to find them) just to have some villains that can be instantly identified as evil. Visit the scenic Reichstropen for more about Those Wacky Nazis and their imitators. For empire builders who consider themselves inherently superior to all other races/nations but don't necessarily partake of other Nazi ideology or imagery, see Master Race. And if they're Played for Laughs, that's Adolf Hitlarious. See Commie Nazis for an evil political party that borrows elements (including just symbolic elements) from both the Nazis and the Communists (especially the Soviet Union).
Conversely, comparing someone unfairly to Hitler or Nazis is well known as a violation of Godwin's Law.
Truth in Television given the existence of Neo-Nazism, but No Real Life Examples, Please! Referring to any individual, Real Life group or movement as this will cause a massive Flame War.
You just can't keep a good character down. Even in a setting where Death Is a Slap on the Wrist, a hero can't keep his heroics up forever (nor do most want to) and even if super-villains and world-spanning disasters can't kill him, old age definitely will. But while a man can't beat the Reaper forever, the identity he holds is contained in a vessel consisting of little more than a name and a mask, meaning that if he cannot continue his Legacy, someone else can.
A Legacy Character is a character whose identity is passed down to them from an older character in the form of a title, job or persona for the newer character to assume. There are many ways this can come about:
- A mentor may pass their mantle on to their sidekick or the sidekick willfully takes up the mantle in the event of their mentor's retirement/death.
Outside of the work, Legacy Characters are especially popular as superheroes and action heroes, or any job that involves a Secret Identity. Long-Runners that span multiple generations of characters are the most likely to use them, but they can also be created as part of a back-story, such as a Secret Legacy.
Adaptations of a work with Legacy Characters to other media often only reference the current or best known holder of the legacy, only referencing other incarnations as a Mythology Gag. Younger heroes carrying the mantle often get a Rogues Gallery to match their predecessors, either via villains having kids of their own (much to the parent's chagrin), or younger villains "honoring" their own villainous legacy.
This may become Generation Xerox if everyone around the Legacy Character is also a Legacy Character. If the Legacy Character is a descendant (probably because Lamarck Was Right), you've got yourself a Spin-Offspring. If an already existing superhero takes the legacy, it may end up as a Second Super-Identity.
- Affirmative Action Legacy: A white male hero gains a successor who is female or belongs to a minority.
- The Chosen Many
- Collective Identity: An alias is used by more than one person at the same time.
- Dying to Be Replaced
- Legacy Immortality: Whenever the current hero dies, someone else takes up the identity to make it appear as if the hero can't die.
- Legacy Launch
- Legacy of the Chosen
- Passing the Torch
- Secret Legacy
- Sidekick Graduations Stick
- Take Up My Sword
- Taking Up the Mantle
In recent years, passing the torch to a minority character has become a popular choice.
Compare The Nth Doctor, Legacy of the Chosen. If the young character, parent, and grandparent each make a unique name for themselves instead of passing down a persona it's Three Successful Generations. If the character is a vessel instead of a person, see Legacy Vessel Naming.
George Herbert Walker Bush was born in Milton, Massachusetts  on June 12, 1924. He was the second son of Prescott Bush and Dorothy (Walker) Bush.  His paternal grandfather, Samuel P. Bush, worked as an executive for a railroad parts company in Columbus, Ohio,  while his maternal grandfather and namesake, George Herbert Walker, led Wall Street investment bank W. A. Harriman & Co.  Walker was known as "Pop", and young Bush was called "Poppy" as a tribute to him.  The Bush family moved to Greenwich, Connecticut in 1925, and Prescott took a position with W. A. Harriman & Co. (which later merged into Brown Brothers Harriman & Co.) the following year. 
Bush spent most of his childhood in Greenwich, at the family vacation home in Kennebunkport, Maine, [b] or at his maternal grandparents' plantation in South Carolina.  Because of the family's wealth, Bush was largely unaffected by the Great Depression.  He attended Greenwich Country Day School from 1929 to 1937 and Phillips Academy, an elite private academy in Massachusetts, from 1937 to 1942.  While at Phillips Academy, he served as president of the senior class, secretary of the student council, president of the community fund-raising group, a member of the editorial board of the school newspaper, and captain of the varsity baseball and soccer teams. 
World War II
On his 18th birthday, immediately after graduating from Phillips Academy, he enlisted in the United States Navy as a naval aviator.  After a period of training, he was commissioned as an ensign in the Naval Reserve at Naval Air Station Corpus Christi on June 9, 1943, becoming one of the youngest aviators in the Navy.  [c] Beginning in 1944, Bush served in the Pacific theater, where he flew a Grumman TBF Avenger, a torpedo bomber capable of taking off from aircraft carriers.  His squadron was assigned to the USS San Jacinto as a member of Air Group 51, where his lanky physique earned him the nickname "Skin". 
Bush flew his first combat mission in May 1944, bombing Japanese-held Wake Island,  and was promoted to lieutenant (junior grade) on August 1, 1944. During an attack on a Japanese installation in Chichijima, Bush's aircraft successfully attacked several targets, but was downed by enemy fire.  Though both of Bush's fellow crew members died, Bush successfully bailed out from the aircraft and was rescued by the USS Finback.  [d] Several of the aviators shot down during the attack were captured and executed, and their livers were eaten by their captors.  Bush's survival after such a close brush with death shaped him profoundly, leading him to ask, "Why had I been spared and what did God have for me?"  He was later awarded the Distinguished Flying Cross for his role in the mission. 
Bush returned to San Jacinto in November 1944, participating in operations in the Philippines. In early 1945, he was assigned to a new combat squadron, VT-153, where he trained to take part in an invasion of mainland Japan. On September 2, 1945, before any invasion took place, Japan formally surrendered following the atomic bombings of Hiroshima and Nagasaki.  Bush was released from active duty that same month, but was not formally discharged from the Navy until October 1955, at which point he had reached the rank of lieutenant.  By the end of his period of active service, Bush had flown 58 missions, completed 128 carrier landings, and recorded 1228 hours of flight time. 
Marriage and college years
Bush met Barbara Pierce at a Christmas dance in Greenwich in December 1941,  and, after a period of courtship, they became engaged in December 1943.  While Bush was on leave from the Navy, they married in Rye, New York, on January 6, 1945.  The Bushes enjoyed a strong marriage, and Barbara would later be a popular First Lady, seen by many as "a kind of national grandmother".  [e] They have six children: George W. (b. 1946), Robin (1949-1953), Jeb (b. 1953), Neil (b. 1955), Marvin (b. 1956), and Doro (b. 1959).  Their oldest daughter, Robin, died of leukemia in 1953. 
Bush enrolled at Yale College, where he took part in an accelerated program that enabled him to graduate in two and a half years rather than the usual four.  He was a member of the Delta Kappa Epsilon fraternity and was elected its president.  He also captained the Yale baseball team and played in the first two College World Series as a left-handed first baseman.  Like his father, he was a member of the Yale cheerleading squad  and was initiated into the Skull and Bones secret society. He graduated Phi Beta Kappa in 1948 with a Bachelor of Arts degree, majoring in economics and minoring in sociology. 
After graduating from Yale, Bush moved his young family to West Texas. Biographer Jon Meacham writes that Bush's relocation to Texas allowed him to move out of the "daily shadow of his Wall Street father and Grandfather Walker, two dominant figures in the financial world", but would still allow Bush to "call on their connections if he needed to raise capital."  His first position in Texas was an oil field equipment salesman  for Dresser Industries, which was led by family friend Neil Mallon.  While working for Dresser, Bush lived in various places with his family: Odessa, Texas Ventura, Bakersfield and Compton, California and Midland, Texas.  In 1952, he volunteered for the successful presidential campaign of Republican candidate Dwight D. Eisenhower. That same year, his father won election to represent Connecticut in the United States Senate as a member of the Republican Party. 
With support from Mallon and Bush's uncle, George Herbert Walker Jr., Bush and John Overbey launched the Bush-Overbey Oil Development Company in 1951.  In 1953 he co-founded the Zapata Petroleum Corporation, an oil company that drilled in the Permian Basin in Texas.  In 1954, he was named president of the Zapata Offshore Company, a subsidiary which specialized in offshore drilling.  Shortly after the subsidiary became independent in 1959, Bush moved the company and his family from Midland to Houston.  There, he befriended James Baker, a prominent attorney who later became an important political ally.  Bush remained involved with Zapata until the mid-1960s, when he sold his stock in the company for approximately $1 million. 
In 1988, The Nation published an article alleging that Bush worked as an operative of the Central Intelligence Agency (CIA) during the 1960s Bush denied this allegation. 
Entry into politics
By the early 1960s, Bush was widely regarded as an appealing political candidate, and some leading Democrats attempted to convince Bush to become a Democrat. He declined to leave the Republican Party, later citing his belief that the national Democratic Party favored "big, centralized government". The Democratic Party had historically dominated Texas, but Republicans scored their first major victory in the state with John G. Tower's victory in a 1961 special election to the United States Senate. Motivated by Tower's victory, and hoping to prevent the far-right John Birch Society from coming to power, Bush ran for the chairmanship of the Harris County Republican Party, winning election in February 1963.  Like most other Texas Republicans, Bush supported conservative Senator Barry Goldwater over the more centrist Nelson Rockefeller in the 1964 Republican Party presidential primaries. 
In 1964, Bush sought to unseat liberal Democrat Ralph W. Yarborough in Texas's U.S. Senate election.  Bolstered by superior fundraising, Bush won the Republican primary by defeating former gubernatorial nominee Jack Cox in a run-off election. In the general election, Bush attacked Yarborough's vote for the Civil Rights Act of 1964, which banned racial and gender discrimination in public institutions and in many privately owned businesses. Bush argued that the act unconstitutionally expanded the powers of the federal government, but he was privately uncomfortable with the racial politics of opposing the act.  He lost the election 56 percent to 44 percent, though he did run well ahead of Barry Goldwater, the Republican presidential nominee.  Despite the loss, the New York Times reported that Bush was "rated by political friend and foe alike as the Republicans' best prospect in Texas because of his attractive personal qualities and the strong campaign he put up for the Senate". 
U.S. House of Representatives
In 1966, Bush ran for the United States House of Representatives in Texas's 7th congressional district, a newly redistricted seat in the Greater Houston area. Initial polling showed him trailing his Democratic opponent, Harris County District Attorney Frank Briscoe, but he ultimately won the race with 57 percent of the vote.  In an effort to woo potential candidates in the South and Southwest, House Republicans secured Bush an appointment to the powerful United States House Committee on Ways and Means, making Bush the first freshman to serve on the committee since 1904.  His voting record in the House was generally conservative. He supported the Nixon administration's Vietnam policies, but broke with Republicans on the issue of birth control, which he supported. He also voted for the Civil Rights Act of 1968, although it was generally unpopular in his district.   In 1968, Bush joined several other Republicans in issuing the party's Response to the State of the Union address Bush's part of the address focused on a call for fiscal responsibility. 
Though most other Texas Republicans supported Ronald Reagan in the 1968 Republican Party presidential primaries, Bush endorsed Richard Nixon, who went on to win the party's nomination. Nixon considered selecting Bush as his running mate in the 1968 presidential election, but he ultimately chose Spiro Agnew instead. Bush won re-election to the House unopposed, while Nixon defeated Hubert Humphrey in the presidential election.  In 1970, with President Nixon's support, Bush gave up his seat in the House to run for the Senate against Yarborough. Bush easily won the Republican primary, but Yarborough was defeated by the more conservative Lloyd Bentsen in the Democratic primary.  Ultimately, Bentsen defeated Bush, taking 53.5 percent of the vote. 
Ambassador to the United Nations
After the 1970 Senate election, Bush accepted a position as a senior adviser to the president, but he convinced Nixon to instead appoint him as the U.S. Ambassador to the United Nations.  The position represented Bush's first foray into foreign policy, as well as his first major experiences with the Soviet Union and China, the two major U.S. rivals in the Cold War.  During Bush's tenure, the Nixon administration pursued a policy of détente, seeking to ease tensions with both the Soviet Union and China.  Bush's ambassadorship was marked by a defeat on the China question, as the United Nations General Assembly voted to expel the Republic of China and replace it with the People's Republic of China in October 1971.  In the 1971 crisis in Pakistan, Bush supported an Indian motion at the UN General Assembly to condemn the Pakistani government of Yahya Khan for waging genocide in East Pakistan (modern Bangladesh), referring to the "tradition which we have supported that the human rights question transcended domestic jurisdiction and should be freely debated".  Bush's support for India at the UN put him into conflict with Nixon who was supporting Pakistan, partly because Yahya Khan was a useful intermediary in his attempts to reach out to China and partly because the president was fond of Yahya Khan. 
Chairman of the Republican National Committee
After Nixon won a landslide victory in the 1972 presidential election, he appointed Bush as chair of the Republican National Committee (RNC).   In that position, he was charged with fundraising, candidate recruitment, and making appearances on behalf of the party in the media.
When Agnew was being investigated for corruption, Bush assisted, at the request of Nixon and Agnew, in pressuring John Glenn Beall Jr., the U.S. Senator from Maryland to force his brother, George Beall the U.S. Attorney in Maryland, who was supervising the investigation into Agnew. Attorney Beall ignored the pressure. 
During Bush's tenure at the RNC, the Watergate scandal emerged into public view the scandal originated from the June 1972 break-in of the Democratic National Committee, but also involved later efforts to cover up the break-in by Nixon and other members of the White House.  Bush initially defended Nixon steadfastly, but as Nixon's complicity became clear he focused more on defending the Republican Party. 
Following the resignation of Vice President Agnew in 1973 for a scandal unrelated to Watergate, Bush was considered for the position of vice president, but the appointment instead went to Gerald Ford.  After the public release of an audio recording that confirmed that Nixon had plotted to use the CIA to cover up the Watergate break-in, Bush joined other party leaders in urging Nixon to resign.  When Nixon resigned on August 9, 1974, Bush noted in his diary that "There was an aura of sadness, like somebody died. The [resignation] speech was vintage Nixon—a kick or two at the press—enormous strains. One couldn't help but look at the family and the whole thing and think of his accomplishments and then think of the shame. [President Gerald Ford's swearing-in offered] indeed a new spirit, a new lift." 
Head of U.S. Liaison Office in China
Upon his ascension to the presidency, Ford strongly considered Bush, Donald Rumsfeld, and Nelson Rockefeller for the vacant position of vice president. Ford ultimately chose Nelson Rockefeller, partly because of the publication of a news report claiming that Bush's 1970 campaign had benefited from a secret fund set up by Nixon Bush was later cleared of any suspicion by a special prosecutor.  Bush accepted appointment as Chief of the U.S. Liaison Office in the People's Republic of China, making him the de facto ambassador to China.  According to biographer Jon Meacham, Bush's time in China convinced him that American engagement abroad was needed to ensure global stability, and that the United States "needed to be visible but not pushy, muscular but not domineering." 
Director of Central Intelligence
In January 1976, Ford brought Bush back to Washington to become the Director of Central Intelligence (DCI), placing him in charge of the CIA.  In the aftermath of the Watergate scandal and the Vietnam War, the CIA's reputation had been damaged for its role in various covert operations, and Bush was tasked with restoring the agency's morale and public reputation.  [f] During Bush's year in charge of the CIA, the U.S. national security apparatus actively supported Operation Condor operations and right-wing military dictatorships in Latin America.   Meanwhile, Ford decided to drop Rockefeller from the ticket for the 1976 presidential election he considered Bush as his running mate, but ultimately chose Bob Dole.  In his capacity as DCI, Bush gave national security briefings to Jimmy Carter both as a presidential candidate and as president-elect. 
Bush's tenure at the CIA ended after Carter narrowly defeated Ford in the 1976 presidential election. Out of public office for the first time since the 1960s, Bush became chairman on the Executive Committee of the First International Bank in Houston.  He also spent a year as a part-time professor of Administrative Science at Rice University's Jones School of Business,  continued his membership in the Council on Foreign Relations, and joined the Trilateral Commission. Meanwhile, he began to lay the groundwork for his candidacy in the 1980 Republican Party presidential primaries.  In the 1980 Republican primary campaign, Bush faced Ronald Reagan, who was widely regarded as the front-runner, as well as other contenders like Senator Bob Dole, Senator Howard Baker, Texas Governor John Connally, Congressman Phil Crane, and Congressman John B. Anderson. 
Bush's campaign cast him as a youthful, "thinking man's candidate" who would emulate the pragmatic conservatism of President Eisenhower.  In the midst of the Soviet–Afghan War, which brought an end to a period of détente, and the Iran hostage crisis, in which 52 Americans were taken hostage, the campaign highlighted Bush's foreign policy experience.  At the outset of the race, Bush focused heavily on winning the January 21 Iowa caucuses, making 31 visits to the state.  He won a close victory in Iowa with 31.5% to Reagan's 29.4%. After the win, Bush stated that his campaign was full of momentum, or "the Big Mo",  and Reagan reorganized his campaign.  Partly in response to the Bush campaign's frequent questioning of Reagan's age (Reagan turned 69 in 1980), the Reagan campaign stepped up attacks on Bush, painting him as an elitist who was not truly committed to conservatism.  Prior to the New Hampshire primary, Bush and Reagan agreed to a two-person debate, organized by The Nashua Telegraph but paid for by the Reagan campaign. 
Days before the debate, Reagan announced that he would invite four other candidates to the debate Bush, who had hoped that the one-on-one debate would allow him to emerge as the main alternative to Reagan in the primaries, refused to debate the other candidates. All six candidates took the stage, but Bush refused to speak in the presence of the other candidates. Ultimately, the other four candidates left the stage and the debate continued, but Bush's refusal to debate anyone other than Reagan badly damaged his campaign in New Hampshire.  He ended up decisively losing New Hampshire's primary to Reagan, winning just 23 percent of the vote.  Bush revitalized his campaign with a victory in Massachusetts, but lost the next several primaries. As Reagan built up a commanding delegate lead, Bush refused to end his campaign, but the other candidates dropped out of the race.  Criticizing his more conservative rival's policy proposals, Bush famously labeled Reagan's supply side-influenced plans for massive tax cuts as "voodoo economics".  Though he favored lower taxes, Bush feared that dramatic reductions in taxation would lead to deficits and, in turn, cause inflation. 
After Reagan clinched a majority of delegates in late May, Bush reluctantly dropped out of the race.  At the 1980 Republican National Convention, Reagan made the last-minute decision to select Bush as his vice presidential nominee after negotiations with Ford regarding a Reagan-Ford ticket collapsed.  Though Reagan had resented many of the Bush campaign's attacks during the primary campaign, and several conservative leaders had actively opposed Bush's nomination, Reagan ultimately decided that Bush's popularity with moderate Republicans made him the best and safest pick. Bush, who had believed his political career might be over following the primaries, eagerly accepted the position and threw himself into campaigning for the Reagan-Bush ticket.  The 1980 general election campaign between Reagan and Carter was conducted amid a multitude of domestic concerns and the ongoing Iran hostage crisis, and Reagan sought to focus the race on Carter's handling of the economy.  Though the race was widely regarded as a close contest for most of the campaign, Reagan ultimately won over the large majority of undecided voters.  Reagan took 50.7 percent of the popular vote and 489 of the 538 electoral votes, while Carter won 41% of the popular vote and John Anderson, running as an independent candidate, won 6.6% of the popular vote. 
As vice president, Bush generally maintained a low profile, recognizing the constitutional limits of the office he avoided decision-making or criticizing Reagan in any way. This approach helped him earn Reagan's trust, easing tensions left over from their earlier rivalry.  Bush also generally enjoyed a good relationship with Reagan staffers, including his close friend Jim Baker, who served as Reagan's initial chief of staff.  His understanding of the vice presidency was heavily influenced by Vice President Walter Mondale, who enjoyed a strong relationship with President Carter in part because of his ability to avoid confrontations with senior staff and Cabinet members, and by Vice President Nelson Rockefeller's difficult relationship with some members of the White House staff during the Ford administration.  The Bushes attended a large number of public and ceremonial events in their positions, including many state funerals, which became a common joke for comedians. As the President of the Senate, Bush also stayed in contact with members of Congress and kept the president informed on occurrences on Capitol Hill. 
On March 30, 1981, while Bush was in Texas, Reagan was shot and seriously wounded by John Hinckley Jr. Bush immediately flew back to Washington D.C. when his plane landed, his aides advised him to proceed directly to the White House by helicopter in order to show that the government was still functioning.  Bush rejected the idea, as he feared that such a dramatic scene risked giving the impression that he sought to usurp Reagan's powers and prerogatives.  During Reagan's short period of incapacity, Bush presided over Cabinet meetings, met with congressional leaders and foreign leaders, and briefed reporters, but he consistently rejected the possibility of invoking the Twenty-fifth Amendment.  Bush's handling of the attempted assassination and its aftermath made a positive impression on Reagan, who recovered and returned to work within two weeks of the shooting. From then on, the two men would have regular Thursday lunches in the Oval Office. 
Bush was assigned by Reagan to chair two special task forces, one on deregulation and one on international drug smuggling. Both were popular issues with conservatives, and Bush, largely a moderate, began courting them through his work. The deregulation task force reviewed hundreds of rules, making specific recommendations on which ones to amend or revise, in order to curb the size of the federal government.  The Reagan administration's deregulation push had a strong impact on broadcasting, finance, resource extraction, and other economic activities, and the administration eliminated numerous government positions.  Bush also oversaw the administration's national security crisis management organization, which had traditionally been the responsibility of the National Security Advisor.  In 1983, Bush toured Western Europe as part of the Reagan administration's ultimately successful efforts to convince skeptical NATO allies to support the deployment of Pershing II missiles. 
Reagan's approval ratings fell after his first year in office, but they bounced back when the United States began to emerge from recession in 1983.  Former Vice President Walter Mondale was nominated by the Democratic Party in the 1984 presidential election. Down in the polls, Mondale selected Congresswoman Geraldine Ferraro as his running mate in hopes of galvanizing support for his campaign, thus making Ferraro the first female major party vice presidential nominee in U.S. history.  She and Bush squared off in a single televised vice presidential debate.  Public opinion polling consistently showed a Reagan lead in the 1984 campaign, and Mondale was unable to shake up the race.  In the end, Reagan won re-election, winning 49 of 50 states and receiving 59% of the popular vote to Mondale's 41%. 
Mikhail Gorbachev came to power in the Soviet Union in 1985. Rejecting the ideologically rigidity of his three elderly sick predecessors, Gorbachev insisted on urgently needed economic and political reforms called "glasnost" (openness) and "perestroika" (restructuring).  At the 1987 Washington Summit, Gorbachev and Reagan signed the Intermediate-Range Nuclear Forces Treaty, which committed both signatories to the total abolition of their respective short-range and medium-range missile stockpiles.  The treaty marked the beginning of a new era of trade, openness, and cooperation between the two powers.  President Reagan and Secretary of State George Shultz took the lead in these negotiations, but Bush sat in on many meetings. Bush did not agree with many of the Reagan policies, but he did tell Gorbachev that he would seek to continue improving relations if he succeeded Reagan.   On July 13, 1985, Bush became the first vice president to serve as acting president when Reagan underwent surgery to remove polyps from his colon Bush served as the acting president for approximately eight hours. 
In 1986, the Reagan administration was shaken by a scandal when it was revealed that administration officials had secretly arranged weapon sales to Iran during the Iran–Iraq War. The officials had used the proceeds to fund the anti-communist Contras in Nicaragua. Democrats had passed a law that appropriated funds could not be used to help the Contras. Instead the administration used non-appropriated funds from the sales.  When news of affair broke to the media, Bush stated that he had been "out of the loop" and unaware of the diversion of funds.  Biographer Jon Meacham writes that "no evidence was ever produced proving Bush was aware of the diversion to the contras," but he criticizes Bush's "out of the loop" characterization, writing that the "record is clear that Bush was aware that the United States, in contravention of its own stated policy, was trading arms for hostages".  The Iran–Contra scandal, as it became known, did serious damage to the Reagan presidency, raising questions about Reagan's competency.  Congress established the Tower Commission to investigate the scandal, and, at Reagan's request, a panel of federal judges appointed Lawrence Walsh as a special prosecutor charged with investigating the Iran–Contra scandal.  The investigations continued after Reagan left office and, though Bush was never charged with a crime, the Iran–Contra scandal would remain a political liability for him. 
1988 presidential election
Bush began planning for a presidential run after the 1984 election, and he officially entered the 1988 Republican Party presidential primaries in October 1987.  He put together a campaign led by Reagan staffer Lee Atwater, and which also included his son, George W. Bush, and media consultant Roger Ailes.  Though he had moved to the right during his time as vice president, endorsing a Human Life Amendment and repudiating his earlier comments on "voodoo economics," Bush still faced opposition from many conservatives in the Republican Party.  His major rivals for the Republican nomination were Senate Minority Leader Bob Dole of Kansas, Congressman Jack Kemp of New York, and Christian televangelist Pat Robertson.  Reagan did not publicly endorse any candidate, but he privately expressed support for Bush. 
Though considered the early front-runner for the nomination, Bush came in third in the Iowa caucus, behind Dole and Robertson.  Much as Reagan had done in 1980, Bush reorganized his staff and concentrated on the New Hampshire primary.  With help from Governor John H. Sununu and an effective campaign attacking Dole for raising taxes, Bush overcame an initial polling deficit and won New Hampshire with 39 percent of the vote.  After Bush won South Carolina and 16 of the 17 states holding a primary on Super Tuesday, his competitors dropped out of the race. 
Bush, occasionally criticized for his lack of eloquence when compared to Reagan, delivered a well-received speech at the Republican convention. Known as the "thousand points of light" speech, it described Bush's vision of America: he endorsed the Pledge of Allegiance, prayer in schools, capital punishment, and gun rights.  Bush also pledged that he would not raise taxes, stating: "Congress will push me to raise taxes, and I'll say no, and they'll push, and I'll say no, and they'll push again. And all I can say to them is: read my lips. No new taxes."  Bush selected little-known Senator Dan Quayle of Indiana as his running mate. Though Quayle had compiled an unremarkable record in Congress, he was popular among many conservatives, and the campaign hoped that Quayle's youth would appeal to younger voters. 
Meanwhile, the Democratic Party nominated Governor Michael Dukakis, who was known for presiding over an economic turnaround in Massachusetts.  Leading in the general election polls against Bush, Dukakis ran an ineffective, low-risk campaign.  The Bush campaign attacked Dukakis as an unpatriotic liberal extremist and seized on the Willie Horton case, in which a convicted felon from Massachusetts raped a woman while on a prison furlough, a program Dukakis supported as governor. The Bush campaign charged that Dukakis presided over a "revolving door" that allowed dangerous convicted felons to leave prison.  Dukakis damaged his own campaign with a widely mocked ride in an M1 Abrams tank and a poor performance at the second presidential debate.  Bush also attacked Dukakis for opposing a law that would require all students to recite the Pledge of Allegiance.  The election is widely considered to have had a high level of negative campaigning, though political scientist John Geer has argued that the share of negative ads was in line with previous presidential elections. 
Bush defeated Dukakis by a margin of 426 to 111 in the Electoral College, and he took 53.4 percent of the national popular vote.  Bush ran well in all the major regions of the country, but especially in the South.  He became the first sitting vice president to be elected president since Martin Van Buren in 1836 and the first person to succeed a president from his own party via election since Herbert Hoover in 1929.  [g] In the concurrent congressional elections, Democrats retained control of both houses of Congress. 
Bush was inaugurated on January 20, 1989, succeeding Ronald Reagan. In his inaugural address, Bush said:
I come before you and assume the Presidency at a moment rich with promise. We live in a peaceful, prosperous time, but we can make it better. For a new breeze is blowing, and a world refreshed by freedom seems reborn for in man's heart, if not in fact, the day of the dictator is over. The totalitarian era is passing, its old ideas blown away like leaves from an ancient, lifeless tree. A new breeze is blowing, and a nation refreshed by freedom stands ready to push on. There is new ground to be broken, and new action to be taken. 
Bush's first major appointment was that of James Baker as Secretary of State.  Leadership of the Department of Defense went to Dick Cheney, who had previously served as Gerald Ford's chief of staff and would later serve as vice president under his son George W. Bush.  Jack Kemp joined the administration as Secretary of Housing and Urban Development, while Elizabeth Dole, the wife of Bob Dole and a former Secretary of Transportation, became the Secretary of Labor under Bush.  Bush retained several Reagan officials, including Secretary of the Treasury Nicholas F. Brady, Attorney General Dick Thornburgh, and Secretary of Education Lauro Cavazos.  New Hampshire Governor John Sununu, a strong supporter of Bush during the 1988 campaign, became chief of staff.  Brent Scowcroft was appointed as the National Security Advisor, a role he had also held under Ford. 
End of the Cold War
During the first year of his tenure, Bush put a pause on Reagan's détente policy toward the USSR.  Bush and his advisers were initially divided on Gorbachev some administration officials saw him as a democratic reformer, but others suspected him of trying to make the minimum changes necessary to restore the Soviet Union to a competitive position with the United States.  In 1989, all the Communist governments collapsed in Eastern Europe. Gorbachev declined to send in the Soviet military, effectively abandoning the Brezhnev Doctrine. The U.S. was not directly involved in these upheavals, but the Bush administration avoided gloating over the demise of the Eastern Bloc to avoid undermining further democratic reforms. 
Bush and Gorbachev met at the Malta Summit in December 1989. Though many on the right remained wary of Gorbachev, Bush came away with the belief that Gorbachev would negotiate in good faith.  For the remainder of his term, Bush sought cooperative relations with Gorbachev, believing that he was the key to peace.  The primary issue at the Malta Summit was the potential reunification of Germany. While Britain and France were wary of a re-unified Germany, Bush joined West German Chancellor Helmut Kohl in pushing for German reunification.  Bush believed that a reunified Germany would serve American interests.  After extensive negotiations, Gorbachev agreed to allow a reunified Germany to be a part of NATO, and Germany officially reunified in October 1990 after paying billions of marks to Moscow. 
Gorbachev used force to suppress nationalist movements within the Soviet Union itself.  A crisis in Lithuania left Bush in a difficult position, as he needed Gorbachev's cooperation in the reunification of Germany and feared that the collapse of the Soviet Union could leave nuclear arms in dangerous hands. The Bush administration mildly protested Gorbachev's suppression of Lithuania's independence movement, but took no action to directly intervene.  Bush warned independence movements of the disorder that could come with secession from the Soviet Union in a 1991 address that critics labeled the "Chicken Kiev speech", he cautioned against "suicidal nationalism".  In July 1991, Bush and Gorbachev signed the Strategic Arms Reduction Treaty (START I) treaty, in which both countries agreed to cut their strategic nuclear weapons by 30 percent. 
In August 1991, hard-line Communists launched a coup against Gorbachev while the coup quickly fell apart, it broke the remaining power of Gorbachev and the central Soviet government.  Later that month, Gorbachev resigned as general secretary of the Communist party, and Russian president Boris Yeltsin ordered the seizure of Soviet property. Gorbachev clung to power as the President of the Soviet Union until December 1991, when the Soviet Union dissolved.  Fifteen states emerged from the Soviet Union, and of those states, Russia was the largest and most populous. Bush and Yeltsin met in February 1992, declaring a new era of "friendship and partnership".  In January 1993, Bush and Yeltsin agreed to START II, which provided for further nuclear arms reductions on top of the original START treaty.  The collapse of the Soviet Union prompted reflections on the future of the world following the end of the Cold War one political scientist, Francis Fukuyama, speculated that humanity had reached the "end of history" in that liberal, capitalist democracy had permanently triumphed over Communism and fascism.  Meanwhile, the collapse of the Soviet Union and other Communist governments led to post-Soviet conflicts in Central Europe, Eastern Europe, Central Asia, and Africa that would continue long after Bush left office. 
Invasion of Panama
During the 1980s, the U.S. had provided aid to Panamanian leader Manuel Noriega, an anti-Communist dictator who engaged in drug trafficking. In May 1989, Noriega annulled the results of a democratic presidential election in which Guillermo Endara had been elected. Bush objected to the annulment of the election and worried about the status of the Panama Canal with Noriega still in office.  Bush dispatched 2,000 soldiers to the country, where they began conducting regular military exercises in violation of prior treaties.  After a U.S. serviceman was shot by Panamanian forces in December 1989, Bush ordered the United States invasion of Panama, known as "Operation Just Cause". The invasion was the first large-scale American military operation in more than 40 years that was not related to the Cold War. American forces quickly took control of the Panama Canal Zone and Panama City. Noriega surrendered on January 3, 1990, and was quickly transported to a prison in the United States. Twenty-three Americans died in the operation, while another 394 were wounded. Noriega was convicted and imprisoned on racketeering and drug trafficking charges in April 1992.  Historian Stewart Brewer argues that the invasion "represented a new era in American foreign policy" because Bush did not justify the invasion under the Monroe Doctrine or the threat of Communism, but rather on the grounds that it was in the best interests of the United States. 
Faced with massive debts and low oil prices in the aftermath of the Iran–Iraq War, Iraqi leader Saddam Hussein decided to conquer the country of Kuwait, a small, oil-rich country situated on Iraq's southern border.  After Iraq invaded Kuwait in August 1990, Bush imposed economic sanctions on Iraq and assembled a multi-national coalition opposed to the invasion.  The administration feared that a failure to respond to the invasion would embolden Hussein to attack Saudi Arabia or Israel, and wanted to discourage other countries from similar aggression.  Bush also wanted to ensure continued access to oil, as Iraq and Kuwait collectively accounted for 20 percent of the world's oil production, and Saudi Arabia produced another 26 percent of the world's oil supply. 
At Bush's insistence, in November 1990, the United Nations Security Council approved a resolution authorizing the use of force if Iraq did not withdrawal from Kuwait by January 15, 1991.  Gorbachev's support, as well as China's abstention, helped ensure passage of the UN resolution.  Bush convinced Britain, France, and other nations to commit soldiers to an operation against Iraq, and he won important financial backing from Germany, Japan, South Korea, Saudi Arabia, and the United Arab Emirates.  In January 1991, Bush asked Congress to approve a joint resolution authorizing a war against Iraq.  Bush believed that the UN resolution had already provided him with the necessary authorization to launch a military operation against Iraq, but he wanted to show that the nation was united behind a military action.  Despite the opposition of a majority of Democrats in both the House and the Senate, Congress approved the Authorization for Use of Military Force Against Iraq Resolution of 1991. 
After the January 15 deadline passed without an Iraqi withdrawal from Kuwait, U.S. and coalition forces began a conducted a bombing campaign that devastated Iraq's power grid and communications network, and resulted in the desertion of about 100,000 Iraqi soldiers. In retaliation, Iraq launched Scud missiles at Israel and Saudi Arabia, but most of the missiles did little damage. On February 23, coalition forces began a ground invasion into Kuwait, evicting Iraqi forces by the end of February 27. About 300 Americans, as well as approximately 65 soldiers from other coalition nations, died during the military action.  A cease fire was arranged on March 3, and the UN passed a resolution establishing a peacekeeping force in a demilitarized zone between Kuwait and Iraq.  A March 1991 Gallup poll showed that Bush had an approval rating of 89 percent, the highest presidential approval rating in the history of Gallup polling.  After 1991, the UN maintained economic sanctions against Iraq, and the United Nations Special Commission was assigned to ensure that Iraq did not revive its weapons of mass destruction program. 
In 1987, the U.S. and Canada had reached a free trade agreement that eliminated many tariffs between the two countries. President Reagan had intended it as the first step towards a larger trade agreement to eliminate most tariffs among the United States, Canada, and Mexico.  The Bush administration, along with the Progressive Conservative Canadian Prime Minister Brian Mulroney, spearheaded the negotiations of the North American Free Trade Agreement (NAFTA) with Mexico. In addition to lowering tariffs, the proposed treaty would affected patents, copyrights, and trademarks.  In 1991, Bush sought fast track authority, which grants the president the power to submit an international trade agreement to Congress without the possibility of amendment. Despite congressional opposition led by House Majority Leader Dick Gephardt, both houses of Congress voted to grant Bush fast track authority. NAFTA was signed in December 1992, after Bush lost re-election,  but President Clinton won ratification of NAFTA in 1993.  NAFTA remains controversial for its impact on wages, jobs, and overall economic growth. 
Economy and fiscal issues
The U.S. economy had generally performed well since emerging from recession in late 1982, but it slipped into a mild recession in 1990. The unemployment rate rose from 5.9 percent in 1989 to a high of 7.8 percent in mid-1991.   Large federal deficits, spawned during the Reagan years, rose from $152.1 billion in 1989  to $220 billion for 1990  the $220 billion deficit represented a threefold increase since 1980.  As the public became increasingly concerned about the economy and other domestic affairs, Bush's well-received handling of foreign affairs became less of an issue for most voters.  Bush's top domestic priority was to bring an end to federal budget deficits, which he saw as a liability for the country's long-term economic health and standing in the world.  As he was opposed to major defense spending cuts  and had pledged to not raise taxes, the president had major difficulties in balancing the budget. 
Bush and congressional leaders agreed to avoid major changes to the budget for fiscal year 1990, which began in October 1989. However, both sides knew that spending cuts or new taxes would be necessary in the following year's budget in order to avoid the draconian automatic domestic spending cuts required by the Gramm–Rudman–Hollings Balanced Budget Act of 1987.  Bush and other leaders also wanted to cut deficits because Federal Reserve Chair Alan Greenspan refused to lower interest rates, and thus stimulate economic growth, unless the federal budget deficit was reduced.  In a statement released in late June 1990, Bush said that he would be open to a deficit reduction program which included spending cuts, incentives for economic growth, budget process reform, as well as tax increases.  To fiscal conservatives in the Republican Party, Bush's statement represented a betrayal, and they heavily criticized him for compromising so early in the negotiations. 
In September 1990, Bush and Congressional Democrats announced a compromise to cut funding for mandatory and discretionary programs while also raising revenue, partly through a higher gas tax. The compromise additionally included a "pay as you go" provision that required that new programs be paid for at the time of implementation.  House Minority Whip Newt Gingrich led the conservative opposition to the bill, strongly opposing any form of tax increase.  Some liberals also criticized the budget cuts in the compromise, and in October, the House rejected the deal, resulting in a brief government shutdown. Without the strong backing of the Republican Party, Bush agreed to another compromise bill, this one more favorable to Democrats. The Omnibus Budget Reconciliation Act of 1990 (OBRA-90), enacted on October 27, 1990, dropped much of the gasoline tax increase in favor of higher income taxes on top earners. It included cuts to domestic spending, but the cuts were not as deep as those that had been proposed in the original compromise. Bush's decision to sign the bill damaged his standing with conservatives and the general public, but it also laid the groundwork for the budget surpluses of the late 1990s. 
-Bush's remarks at the signing ceremony for the Americans with Disabilities Act of 1990 
The disabled had not received legal protections under the landmark Civil Rights Act of 1964, and many faced discrimination and segregation by the time Bush took office. In 1988, Lowell P. Weicker Jr. and Tony Coelho had introduced the Americans with Disabilities Act, which barred employment discrimination against qualified individuals with disabilities. The bill had passed the Senate but not the House, and it was reintroduced in 1989. Though some conservatives opposed the bill due to its costs and potential burdens on businesses, Bush strongly supported it, partly because his son, Neil, had struggled with dyslexia. After the bill passed both houses of Congress, Bush signed the Americans with Disabilities Act of 1990 into law in July 1990.  The act required employers and public accommodations to make "reasonable accommodations" for the disabled, while providing an exception when such accommodations imposed an "undue hardship". 
Senator Ted Kennedy later led the congressional passage of a separate civil rights bill designed to facilitate launching employment discrimination lawsuits.  In vetoing the bill, Bush argued that it would lead to racial quotas in hiring.   In November 1991, Bush signed the Civil Rights Act of 1991, which was largely similar to the bill he had vetoed in the previous year. 
In August 1990, Bush signed the Ryan White CARE Act, the largest federally funded program dedicated to assisting persons living with HIV/AIDS.  Throughout his presidency, the AIDS epidemic grew dramatically in the U.S. and around the world, and Bush often found himself at odds with AIDS activist groups who criticized him for not placing a high priority on HIV/AIDS research and funding. Frustrated by the administration's lack of urgency on the issue, ACT UP, dumped the ashes of HIV/AIDS victims on the White House lawn during a viewing of the AIDS Quilt in 1992.  By that time, HIV had become the leading cause of death in the U.S. for men aged 25–44. 
In June 1989, the Bush administration proposed a bill to amend the Clean Air Act. Working with Senate Majority Leader George J. Mitchell, the administration won passage of the amendments over the opposition of business-aligned members of Congress who feared the impact of tougher regulations.  The legislation sought to curb acid rain and smog by requiring decreased emissions of chemicals such as sulfur dioxide,  and was the first major update to the Clean Air Act since 1977.  Bush also signed the Oil Pollution Act of 1990 in response to the Exxon Valdez oil spill. However, the League of Conservation Voters criticized some of Bush's other environmental actions, including his opposition to stricter auto-mileage standards. 
Points of Light
President Bush devoted attention to voluntary service as a means of solving some of America's most serious social problems. He often used the "thousand points of light" theme to describe the power of citizens to solve community problems. In his 1989 inaugural address, President Bush said, "I have spoken of a thousand points of light, of all the community organizations that are spread like stars throughout the Nation, doing good."  During his presidency, Bush honored numerous volunteers with the Daily Point of Light Award, a tradition that was continued by his presidential successors.  In 1990, the Points of Light Foundation was created as a nonprofit organization in Washington to promote this spirit of volunteerism.  In 2007, the Points of Light Foundation merged with the Hands On Network to create a new organization, Points of Light. 
Bush appointed two justices to the Supreme Court of the United States. In 1990, Bush appointed a largely unknown state appellate judge, David Souter, to replace liberal icon William Brennan.  Souter was easily confirmed and served until 2009, but joined the liberal bloc of the court, disappointing Bush.  In 1991, Bush nominated conservative federal judge Clarence Thomas to succeed Thurgood Marshall, a long-time liberal stalwart. Thomas, the former head of the Equal Employment Opportunity Commission (EEOC), faced heavy opposition in the Senate, as well as from pro-choice groups and the NAACP. His nomination faced another difficulty when Anita Hill accused Thomas of having sexually harassed her during his time as the chair of EEOC. Thomas won confirmation in a narrow 52–48 vote 43 Republicans and 9 Democrats voted to confirm Thomas's nomination, while 46 Democrats and 2 Republicans voted against confirmation.  Thomas became one of the most conservative justices of his era. 
Bush's education platform consisted mainly of offering federal support for a variety of innovations, such as open enrollment, incentive pay for outstanding teachers, and rewards for schools that improve performance with underprivileged children.  Though Bush did not pass a major educational reform package during his presidency, his ideas influenced later reform efforts, including Goals 2000 and the No Child Left Behind Act.  Bush signed the Immigration Act of 1990,  which led to a 40 percent increase in legal immigration to the United States.  The act more than doubled the number of visas given to immigrants on the basis of job skills.  In the wake of the savings and loan crisis, Bush proposed a $50 billion package to rescue the savings and loans industry, and also proposed the creation of the Office of Thrift Supervision to regulate the industry. Congress passed the Financial Institutions Reform, Recovery, and Enforcement Act of 1989, which incorporated most of Bush's proposals. 
Bush was widely seen as a "pragmatic caretaker" president who lacked a unified and compelling long-term theme in his efforts.    Indeed, Bush's sound bite where he refers to the issue of overarching purpose as "the vision thing" has become a metonym applied to other political figures accused of similar difficulties.       His ability to gain broad international support for the Gulf War and the war's result were seen as both a diplomatic and military triumph,  rousing bipartisan approval,  though his decision to withdraw without removing Saddam Hussein left mixed feelings, and attention returned to the domestic front and a souring economy.  A New York Times article mistakenly depicted Bush as being surprised to see a supermarket barcode reader   the report of his reaction exacerbated the notion that he was "out of touch".  Amid the early 1990s recession, his image shifted from "conquering hero" to "politician befuddled by economic matters". 
At the elite level, a number of commentators and political experts deplored the state of American politics in 1991–1992, and reported the voters were angry. Many analysts blamed the poor quality of national election campaigns. 
1992 presidential campaign
Bush announced his reelection bid in early 1992 with a coalition victory in the Persian Gulf War and high approval ratings, Bush's reelection initially looked likely.  As a result, many leading Democrats, including Mario Cuomo, Dick Gephardt, and Al Gore, declined to seek their party's presidential nomination.  However, Bush's tax increase had angered many conservatives, who believed that Bush had strayed from the conservative principles of Ronald Reagan.  He faced a challenge from conservative political columnist Pat Buchanan in the 1992 Republican primaries.  Bush fended off Buchanan's challenge and won his party's nomination at the 1992 Republican National Convention, but the convention adopted a socially conservative platform strongly influenced by the Christian right. 
Meanwhile, the Democrats nominated Governor Bill Clinton of Arkansas. A moderate who was affiliated with the Democratic Leadership Council (DLC), Clinton favored welfare reform, deficit reduction, and a tax cut for the middle class.  In early 1992, the race took an unexpected twist when Texas billionaire H. Ross Perot launched a third party bid, claiming that neither Republicans nor Democrats could eliminate the deficit and make government more efficient. His message appealed to voters across the political spectrum disappointed with both parties' perceived fiscal irresponsibility.  Perot also attacked NAFTA, which he claimed would lead to major job losses.  National polling taken in mid-1992 showed Perot in the lead, but Clinton experienced a surge through effective campaigning and the selection of Senator Al Gore, a popular and relatively young Southerner, as his running mate. 
Clinton won the election, taking 43 percent of the popular vote and 370 electoral votes, while Bush won 37.5 percent of the popular vote and 168 electoral votes.  Perot won 19% of the popular vote, one of the highest totals for a third-party candidate in U.S. history, drawing equally from both major candidates, according to exit polls.  Clinton performed well in the Northeast, the Midwest, and the West Coast, while also waging the strongest Democratic campaign in the South since the 1976 election.  Several factors were important in Bush's defeat. The ailing economy which arose from recession may have been the main factor in Bush's loss, as 7 in 10 voters said on election day that the economy was either "not so good" or "poor".   On the eve of the 1992 election, the unemployment rate stood at 7.8%, which was the highest it had been since 1984.  The president was also damaged by his alienation of many conservatives in his party.  Bush blamed Perot in part for his defeat, though exit polls showed that Perot drew his voters about equally from Clinton and Bush. 
Despite his defeat, Bush left office with a 56 percent job approval rating in January 1993.  Like many of his predecessors, Bush issued a series of pardons during his last days in office. In December 1992, he granted executive clemency to six former senior government officials implicated in the Iran-Contra scandal, most prominently former Secretary of Defense Caspar Weinberger.  The charges against the six were that they lied to or withheld information from Congress. The pardons effectively brought an end to the Iran-Contra scandal. 
According to Seymour Martin Lipset, the 1992 election had several unique characteristics. Voters felt that economic conditions were worse than they actually were, which harmed Bush. A rare event was the a strong third-party candidate. Liberals launched a backlash against 12 years of a conservative White House. The chief factor was Clinton's uniting his party, and winning over a number of heterogeneous groups. 
After leaving office, Bush and his wife built a retirement house in the community of West Oaks, Houston.  He established a presidential office within the Park Laureate Building on Memorial Drive in Houston.  He also frequently spent time at his vacation home in Kennebunkport, took annual cruises in Greece, went on fishing trips in Florida, and visited the Bohemian Club in Northern California. He declined to serve on corporate boards, but delivered numerous paid speeches and served as an adviser to The Carlyle Group, a private equity firm.  He never published his memoirs, but he and Brent Scowcroft co-wrote A World Transformed, a 1999 work on foreign policy. Portions of his letters and his diary were later published as The China Diary of George H. W. Bush and All The Best, George Bush. 
During a 1993 visit to Kuwait, Bush was targeted in an assassination plot directed by the Iraqi Intelligence Service. President Clinton retaliated when he ordered the firing of 23 cruise missiles at Iraqi Intelligence Service headquarters in Baghdad.  Bush did not publicly comment on the assassination attempt or the missile strike, but privately spoke with Clinton shortly before the strike took place.  In the 1994 gubernatorial elections, his sons George W. and Jeb concurrently ran for Governor of Texas and Governor of Florida. Concerning their political careers, he advised them both that "[a]t some point both of you may want to say 'Well, I don't agree with my Dad on that point' or 'Frankly I think Dad was wrong on that.' Do it. Chart your own course, not just on the issues but on defining yourselves".  George W. won his race against Ann Richards while Jeb lost to Lawton Chiles. After the results came in, the elder Bush told ABC, "I have very mixed emotions. Proud father, is the way I would sum it all up."  Jeb would again run for governor of Florida in 1998 and win at the same time that his brother George W. won re-election in Texas. It marked the second time in United States history that a pair of brothers served simultaneously as governors. 
Bush supported his son's candidacy in the 2000 presidential election, but did not actively campaign in the election and did not deliver a speech at the 2000 Republican National Convention.  George W. Bush defeated Al Gore in the 2000 election and was re-elected in 2004. Bush and his son thus became the second father–son pair to each serve as President of the United States, following John Adams and John Quincy Adams.  Through previous administrations, the elder Bush had ubiquitously been known as "George Bush" or "President Bush", but following his son's election the need to distinguish between them has made retronymic forms such as "George H. W. Bush" and "George Bush Sr." and colloquialisms such as "Bush 41" and "Bush the Elder" more common.  Bush advised his son on some personnel choices, approving of the selection of Dick Cheney as running mate and the retention of George Tenet as CIA Director. However, he was not consulted on all appointments, including that of his old rival, Donald Rumsfeld, as Secretary of Defense.  Though he avoided giving unsolicited advice to his son, Bush and his son also discussed some matters of policy, especially regarding national security issues. 
In his retirement, Bush generally avoided publicly expressing his opinion on political issues, instead using the public spotlight to support various charities.  Despite earlier political differences with Bill Clinton, the two former presidents eventually became friends.  They appeared together in television ads, encouraging aid for victims of Hurricane Katrina and the 2004 Indian Ocean earthquake and tsunami. 
Bush supported Republican John McCain in the 2008 presidential election,  and Republican Mitt Romney in the 2012 presidential election,  but both were defeated by Democrat Barack Obama. In 2011, Obama awarded Bush with the Presidential Medal of Freedom, the highest civilian honor in the United States. 
Bush supported his son Jeb's bid in the 2016 Republican primaries.  Jeb Bush's campaign struggled however, and he withdrew from the race during the primaries. Neither George H.W. nor George W. Bush endorsed the eventual Republican nominee, Donald Trump  all three Bushes emerged as frequent critics of Trump's policies and speaking style, while Trump frequently criticized George W. Bush's presidency. George H. W. Bush later said that he voted for the Democratic nominee, Hillary Clinton, in the general election.  After the election, Bush wrote a letter to president-elect Donald Trump in January 2017 to inform him that because of his poor health, he would not be able to attend Trump's inauguration on January 20 he gave him his best wishes. 
In August 2017, after the violence at Unite the Right rally in Charlottesville, both Presidents Bush released a joint statement saying, "America must always reject racial bigotry, anti-Semitism, and hatred in all forms[. . ] As we pray for Charlottesville, we are all reminded of the fundamental truths recorded by that city's most prominent citizen in the Declaration of Independence: we are all created equal and endowed by our Creator with unalienable rights."  
On April 17, 2018, Barbara Bush, died at the age of 92  at her home in Houston, Texas. Her funeral was held at St. Martin's Episcopal Church in Houston four days later.   Bush, along with former Presidents Barack Obama, George W. Bush (son), Bill Clinton and fellow First Ladies Melania Trump, Michelle Obama, Laura Bush (daughter-in-law) and Hillary Clinton were representatives who attended the funeral and who took a photo together after the service as a sign of unity, which went viral online.  
On November 1, Bush went to the polls to vote early in the midterm elections. This would be his final public appearance. 
Death and funeral
After a long battle with vascular Parkinson's disease, Bush died at his home in Houston on November 30, 2018, at the age of 94.   At the time of his death he was the longest-lived U.S. president,  a distinction now held by Jimmy Carter.  He was also the third-oldest vice president. [h] Bush lay in state in the Rotunda of the U.S. Capitol from December 3 through December 5 he was the 12th U.S. president to be accorded this honor.   Then, on December 5, Bush's casket was transferred from the Capitol rotunda to Washington National Cathedral where a state funeral was held.  After the funeral, Bush's body was transported to George H.W. Bush Presidential Library in College Station, Texas, where he was buried next to his wife Barbara and daughter Robin.  At the funeral, former president George W. Bush eulogized his father saying,
"He looked for the good in each person, and he usually found it." 
In 1991, The New York Times revealed that Bush was suffering from Graves' disease, a non-contagious thyroid condition that his wife Barbara also suffered from.  Later in life, Bush suffered from vascular parkinsonism, a form of Parkinson's disease which forced him to use a motorized scooter or wheelchair. 
Bush was a lifelong Episcopalian.  He cited various moments in his life deepening of his faith, including his escape from Japanese forces in 1944, and the death of his three-year-old daughter Robin in 1953.  His faith was reflected in his Thousand Points of Light speech, his support for prayer in schools, and his support for the pro-life movement (following his election as vice president).  
Polls of historians and political scientists have ranked Bush in the top half of presidents. A 2018 poll of the American Political Science Association's Presidents and Executive Politics section ranked Bush as the 17th best president out of 44.  A 2017 C-Span poll of historians also ranked Bush as the 20th best president out of 43.  Richard Rose described Bush as a "guardian" president, and many other historians and political scientists have similarly described Bush as a passive, hands-off president who was "largely content with things as they were".  Professor Steven Knott writes that "[g]enerally the Bush presidency is viewed as successful in foreign affairs but a disappointment in domestic affairs." 
Biographer Jon Meacham writes that, after he left office, many Americans viewed Bush as "a gracious and underappreciated man who had many virtues but who had failed to project enough of a distinctive identity and vision to overcome the economic challenges of 1991–92 and to win a second term."  Bush himself noted that his legacy was "lost between the glory of Reagan . and the trials and tribulations of my sons."  In the 2010s, Bush was fondly remembered for his willingness to compromise, which contrasted with the intensely partisan era that followed his presidency. 
In 2018, Vox highlighted Bush for his "pragmatism" as a moderate Republican president by working across the aisle.  They specifically noted Bush's accomplishments within the domestic policy by making bipartisan deals, including raising with tax budget among the wealthy with the Omnibus Budget Reconciliation Act of 1990. Bush also helped pass the Americans with Disabilities Act of 1990 which The New York Times described as "the most sweeping anti-discrimination law since the Civil Rights Act of 1964.  In response to the Exxon Valdez oil spill, Bush built another bipartisan coalition to strengthen the Clean Air Act Amendments of 1990.   Bush also championed and signed into a law the Immigration Act of 1990, a sweeping bipartisan immigration reform act that made it easier for immigrants to legally enter the county, while also granting immigrants fleeing violence the temporary protected status visa, as well as lifted the pre-naturalization English testing process, and finally "eliminated the exclusion of homosexuals under what Congress now deemed the medically unsound classification of “sexual deviant” that was included in the 1965 act."   Bush stated, "Immigration is not just a link to our past but its also a bridge to America's future". 
According to USA Today, the legacy of Bush's presidency was defined by his victory over Iraq after the invasion of Kuwait, and for his presiding over the Dissolution of the Soviet Union and the German reunification.  Michael Beschloss and Strobe Talbott praise Bush's handling of the USSR, especially how he prodded Gorbachev in terms of releasing control over the satellite states and permitting German unification—and especially a united Germany in NATO.  Andrew Bacevich judges the Bush administration as “morally obtuse” in the light of its “business-as-usual” attitude towards China after the massacre in Tiananmen Square and its uncritical support of Gorbachev as the Soviet Union disintegrated.  David Rothkopf argues:
Family history, medications may be to blame
“People who have a history of bleeding more than normal during medical procedures and women who get heavy periods may notice they bruise easily as well,” Strey said. “This may be concerning for a possible underlying bleeding disorder and should be reported. Anyone with a family member who has a bleeding disorder who also bleeds or bruises easily should discuss this with his or her health care provider.”
Prescription and over-the-counter medications and nutrition supplements can make you bruise more easily. Some medications and supplements associated with bruising include:
- NSAIDs (aspirin, ibuprofen and naproxen)
- Blood thinners
- Some steroids
- Vitamin E
- Fish oil
Bring a list of your medications and how long you’ve been taking them if you plan to see a doctor about bruising.
Older adults bruise more easily because their skin is thinner and they tend to have less muscle and fat to cushion their blood vessels from injury. People who have fair skin often bruise easily. Drinking alcohol can make you more prone to easy bruising and bumping into things.
Bruising occasionally indicates a more serious medical condition. Vitamin C or K deficiency, bleeding disorders such as hemophilia or Von Willebrand disease, or cancer can cause bruising.
Powers and Abilities
Spider Physiology: Spider-Man possesses the proportionate powers of a spider, granted to him from an irradiated Common House Spider (Achaearanea tepidariorum) which bit Peter Parker that was apparently already mutated from prior exposure to certain frequencies of radiation and received a final, lethal dose during Parker's attendance of the exhibition. ⎷] The radioactive, complex mutagenic enzymes in the spider's blood that were transferred at the time of the bite triggered numerous body-wide mutagenic changes within Parker, granting him superhuman strength, speed, toughened flesh, and numerous arachnid-like abilities. ⎷] That mutation granted him an "enhanced chromosome pattern." ]
Ezekiel Sims revealed to Peter that his powers were not of scientific origin, but were a sign that he had become a totemic avatar of the Web of Life and Destiny. ] While Peter initially struggled to accept this, he later came to the conclusion that both were plausible, ] and has had his powers mystically augmented on a number of occasions.
Nick Fury's intel classified him as power level 8. ⎹]
- Wall-Crawling: Spider-Man's exposure to the mutated spider venom induced a mutagenic, cerebellum-wide alteration of his engrams resulting in the ability to mentally control the flux of interatomic attraction (electrostatic force) between molecular boundary layers. This overcomes the outer electron shell's normal behavior of mutual repulsion with other outer electron shells and permits the tremendous potential for electron attraction to prevail. The mentally controlled sub-atomic particle responsible for this has yet to be identified. This ability to affect the attraction between surfaces is so far limited to Spider-Man's body (especially concentrated in his hands and feet) and another object, ] with an upper limit of several tons per finger. At one point, Spider-Man was able to prevent Anti-Venom from taking his mask off by making it stick to his face. ]
- Mark of Kaine:Kaine, the relatively amoral clone of Spider-Man, has shown the ability to use his wall-crawling abilities in a more offensive manner, burning distinctive scars, known as the Mark of Kaine in the face of his victims. Later Spider-Man himself used a variation of the same ability to escape from the Green Goblin by making his fingertips cling to his face and tearing them away, digging five deep wounds in Norman's face. ] Despite the obvious offensive potential of such an ability, Peter claims that it is unlikely he will use it again, as it was a move born out of anger and desperation. ] In later events during the Grim Hunt arc, due to Peter's rage at Sasha Kravinoff over everything she put him and his 'spider family' through, he used his version of the Mark of Kaine on her, ripping the skin off her face in the shape of a handprint, proclaiming "My brother wanted to give you this." ] He has also been able to use the Mark of Kaine to rip Iron Man's armor off, piece by piece. ] Limits to this ability seem to be psychosomatic, and the full nature of this ability has yet to be established.
- Superhuman Strength: Spider-Man possesses superhuman strength enabling him to press lift many tons. He was shown to easily swing a 3-ton wrecking ball using steel chains. ] Spider-Man's physical strength is sufficient enough to enable him to lift and throw objects as heavy as a big rig semi-truck with ease, Ζ] and land a jet he estimated had a landing weight between 175,000-215,000 pounds. ] He must also pull his punches and kicks unless fighting someone of similar or greater physical durability. Otherwise, his blows would prove fatal to a normal human being. ] He has demonstrated that he is strong enough to knock out people with normal durability with as little as a tap to the head. As such, he rarely lets himself use all of his strength - after Doctor Octopus had taken over Spider-Man's body, he easily punched off the Scorpion's (a foe normally regarded as physically tougher than Spider-Man) jaw as he hadn't known of Spider-Man's true strength. ] Spider-Man's physical strength also extends into his legs, enabling him to be able to jump to a height of several stories in a single bound. ] Spider-Man demonstrated this when he leaped over thirty feet vertically into the air when he first leaped out of the way of an oncoming car it should also be noted that when he first discovered his powers as a teenager, they had not developed to that of his prime.
- Superhuman Speed: Spider-Man is capable of running and moving at speeds that are far beyond the natural physical limits of the finest human athlete. ΐ] Spider-Man is fast enough to catch up to an accelerating car while on foot, but prefers to travel by webs. ] Spider-Man moves faster than the eye can follow ]]] he has even moved so fast he appears as a blur. ] Spider-Man was able to easily outrun multiple goblin masquerade on goblin gliders, and outmaneuver their ranged attacks at the same time. ] In close combat, he was even able to dodge an all-out assault from Blurr (Jeffrey Walters) for an extended period of time. ]
- Superhuman Stamina: Spider-Man's advanced musculature produces fewer fatigue toxins during physical activity than an ordinary human. This allows him to exert himself physically for much longer periods of time before fatigue begins to impair him. At his peak, Spider-Man can physically exert himself at his peak capacity for several hours before the build-up of fatigue toxins in his blood begins to impair him. Several accounts depict Spider-Man as able to hold his breath for eight minutes or more. ]]]]
- Superhuman Durability: Spider-Man's body is physically tougher and more resistant to some types of injury than the body of a normal human. His body is more resistant to impact forces than anything else. He can withstand great impacts, such as falling from a height of several stories or being struck by an opponent with super strength. Events which would severely injure or kill a normal human, leave him with little to no discomfort. In the past, he has survived multiple blows from the likes of The Hulk, as well as surviving a point-blank missile explosion. ] Spider-Man's body is durable to the point where tensing his super-strong muscles while being punched in the torso by a trained heavyweight boxer caused the attacker's wrists to break. Spider-Man has stated that he must roll with punches thrown by people without similar strength or durability, in order to avoid breaking their wrists. Spider-Man is durable enough to survive getting beaten down by Colossus and Magik when they were powered up by the Phoenix Force. ] His arm was strong enough to block Quicksilver while the speedster was in motion. ]
- Superhuman Agility: Spider-Man's agility, balance, and bodily coordination are all enhanced to levels that are far beyond the natural physical limits of the finest human athlete. Spider-Man is extraordinarily limber and his tendons and connective tissues are twice as elastic as the average human being is despite their physical strength. He has the combined agility and acrobatic prowess of the most accomplished circus aerialists and acrobats. He can also perform any complicated sequence of gymnastic stunts such as flips, rolls, and springs. He can easily match or top any Olympic record at gymnastics apparatus such as flying rings, climbing ropes, horizontal bars, trampolines, and even comparable to the likes of Daredevil. ]]
- Regenerative Healing Factor: Spider-Man is able to rapidly heal and regenerate from harm faster and more extensively than normal humans are capable of. ΐ] After getting his powers, he soon found that his eyesight was repaired, discarding his glasses. ] During a battle with a villain called the Masked Marauder, Spider-Man was rendered completely blind. However, after about two hours, his sight was perfect, albeit sensitive for nearly an hour after. ] He also healed a broken arm, ] in just one night. ]] And, in his encounter with Firebrand, Spider-Man suffered severe third-degree burns, but completely recovered in a little over two days. Although, he privately admitted that he can't heal "Wolverine-quick." ] Despite all this feats, Spider-Man himself doesn't consider he has a healing factor. ]
- Enhanced Immune System: Due to his accelerated metabolism, Spider-Man has a higher tolerance for drugs and diseases than normal humans, and he can recover from the effects of larger doses rapidly. ] During an encounter with the Swarm, Spider-Man was incapacitated by thousands of bee stings but recovered in less than 24 hours. ] His resistance and recovery time to other toxins and diseases varies, but is typically significantly higher than normal. ] Spider-Man's unique physiology even allowed him to recover from the effects of vampirism as stated by Blade, his radioactive blood would kill the enzymes responsible for his transformation and revert him to normal. ] Spider-Man was able to recover completely from acid being spat into his eyes by the new Vulture although the extent of the damage may have been restricted due to his superhuman durability ] however, Spider-Man has the normal human tolerance for alcoholic beverages. ]
- Superhuman Equilibrium: Spider-Man possesses the ability to achieve a state of perfect equilibrium in any position imaginable. He seems able to adjust his position by instinct, which enables him to balance himself on virtually any object, no matter how small or narrow. ]
- Superhuman Reflexes: Spider-Man's reflexes are similarly enhanced and are currently about forty times greater than those of an ordinary human. ] In combination with his spider-sense, the speed of his reflexes allows him to dodge almost any attack, or even gunfire, given sufficient distance. ]]⏥] Spider-Man has even been shown in some cases, to be able to dodge gunfire using just his reflexes without his spider-sense. ]
- Spider-Sense: Spider-Man possesses a precognitive danger or "spider" sense which warns him of potential or immediate danger by the manifestation of a tingling sensation in the back of his skull, and links with his superhuman kinesthetics, enabling him to evade most any injuries unless he cognitively overrides his automatic reflexes. The precise nature of this sense is unknown, though the Master Weaver states it is enabled by his connection to the Web of Life and Destiny. ] It appears to be a simultaneous clairvoyant response to a wide variety of phenomena (everything from falling safes to speeding bullets to thrown punches), which has given several hundredths of a second warning, which is sufficient time for his reflexes to allow him to avoid injury. The sense also can create a general response on the order of several minutes: he cannot discern the nature of the threat by the sensation. He can, however, discern the severity of the danger by the strength of his response to it. Spider-Man's spider-sense is directional and can guide him to or away from hidden weapons and enemies. Sudden and extreme threats can cause his spider-sense to react with painful intensity. Spider-Man can also sense and dodge attacks directed randomly or by artificial intelligence. Using his spider-sense to time his enhanced reflexes, Spider-Man can casually dodge attacks up to and including automatic-weapons fire, provided there is sufficient distance. His spider-sense is sufficiently well-linked to his reflexes to the point that a threat can trigger them even when Spider-Man is asleep or stunned. His spider-sense has helped him preserve his secret identity since it alerts him to observers or cameras when changing into or out of his costume. The spider-sense does react to those who Peter does not consider to be a threat, such as Aunt May, or when a fellow hero makes a bluff while playing poker. Spider-Man can choose to ignore his spider-sense, and distraction or fatigue diminishes its effectiveness. Spider-Man's fighting style incorporates the advantage that his "spider-sense" provides him. His body begins to produce more adrenaline after the sense is triggered, an extension of the 'fight or flight syndrome.' Even when he does not have the use of his eyes, Spider-Man can still use his Spider-Sense in a similar fashion to Daredevil's Radar Sense to help him see by sensing the direction the danger is coming from by listening on the loudest noise around him. This was first used after Spider-Man was temporarily blinded by a device ] but was recently used again to help locate the new Vulture after his acidic breath blinded him. ] As a result of the Venom symbiote bonding to Spider-Man, it and its offspring do not trigger his spider-sense -- a trait that sometimes has been attributed to symbiotes in general. ]
- Radio Frequency Detection: Peter's spider-sense also enables him to track certain radio frequencies, which he has used to his advantage via his Spider-Tracers. ]]
Upgrades: Spider-Man received several upgrades in recent years as a result of two different adventures, the first via the genetic manipulations of the Queen, and subsequently during the Other's evolution. These powers were later presumably removed following the One More Day saga.
Following an encounter with an enemy known as the Queen, and her genetic manipulations of Peter's body, his Spider powers were augmented to varying degrees.
- Enhanced Superhuman Strength: Originally able to lift 10 tons, he could now lift about 15 tons.
- Psychic Alignment with Arthropods: Peter's spider-sense improved, creating a psychic alignment with his environment, specifically a more empathic and sympathetic relationship with spiders and insects. While connected to the varying populations of spiders he was unable to communicate with them directly or command them.
- Biological/Organic Webbing Generation: Spider-Man was also gifted with the ability to organically produce his own silk webbing from glands within his forearms, limited by his body's health and nutrition. These organic webs had many of the same properties as Spider-Man's artificial webbing, so he had no trouble utilizing them, though they required a week to decay rather than two hours. The silk was released through a spinneret near each wrist containing a central web spigot orifice used for web-slinging and draglines, supplemented by several radial minor spigots for other types of webs connected to specialized glands.
After a near-death experience fighting Morlun, Spider-Man became the receptacle of a powerful Spider-Totem called the Other, causing his body to undergo a metamorphosis that granted him greater power than ever before after literally shedding his skin. Following his bargain with Mephisto, Peter no longer possessed the Other's powers, which were later bestowed to his clone Kaine.
- Enhanced Wall-Crawling: Spider-Man's wall-crawling abilities were heightened even further, allowing him to stick to a surface with any part of his body, for example, his back.
- Enhanced Superhuman Strength: Spider-Man's superhuman strength was enhanced as a result of his evolution by the Other, allowing him to lift up to 20 tons.
- Enhanced Superhuman Durability, Speed, Agility, and Reflexes: Spider-Man's durability, speed, agility, and reflexes were all enhanced even further as a result of his evolution, allowing him to run fast enough to chase an automobile, perform even greater feats of agility, and react much quicker than ever before.
- Psychological Awareness of Environment: Perhaps as an upgrade to his spider-sense and his psychic alignment with arthropods, Spider-Man received psychological awareness of his environment as a whole, allowing him to traverse across any environment without fear, even when blinded or in extremely dark conditions. Spider-Man could ascertain non-threatening information, such as detecting the concealed presence of loved ones.
- Night Vision: Spider-Man received enhanced night vision as a part of his evolution by the Other, allowing him to see in pitch-black conditions.
- Vibration and Air Current Sense via Hair and webbing: Along with night vision, Spider-Man gained superhuman sensitivity via touch, allowing the hairs on his body to sense air currents around him and vibrations via his webbing.
- Augmented Regenerative Healing Factor: Spider-Man had his healing factor enhanced, thereby gained the ability to almost instantaneously recover from severe injuries such as broken bones and large amounts of tissue damage in a matter of minutes. Ambushed by the Rhino he received heavy bodily damage, only to heal minutes later without medical attention. Peter was heavily beaten and drugged, suffering multiple fractures and blood loss by the Jack O' Lantern and Jester during the superhuman Civil War, yet was completely healed a few hours later.
- Hibernation Healing: Only used once. Peter was able to come back from near-death due to making a cocoon with his webbing and hibernating within it. He also shed his skin to heal, as most spiders due once in their lifetime.
- Stingers: Spider-Man developed retractable, razor-sharp stingers that were located within his arms beneath his wrists. They released a polyamine venom, causing direct trauma and/or flaccid paralysis via interference with nerve impulse transmission. While a typical injection could paralyze a normal adult human for several hours, the impalement proved fatal to the nigh-invulnerable Morlun. While Ero, later revealed to be the Other's manifestation, initially stated the stingers could only be used against supernatural threats, Parker was able to subconsciously extend his stingers in response to stress later on.
- Fangs: Spider-Man grew a mouth full of razor-sharp fangs that he used to land the fatal blow to Morlun.
Mindwipe after "Brand New Day"
Although not technically a power, the worldwide mindwipe of Spider-Man's identity as Peter Parker was part of Mephisto's deal to save Aunt May in "Brand New Day" and Dr. Strange's spell in "One Moment in Time." Spider-Man is aware that the whole world has forgotten his secret identity and describes it to Mister Fantastic as a "psychic blind spot," where any evidence which could lead to Spider-Man being Peter Parker, people would not be able to connect the dots, or they would come up with the wrong solution but would accept it as the right one regardless. Not only people's memory was affected, but also every electronic and paper file was modified to have "inexplicable" gaps wherever any data useful to identifying him or his family members would otherwise be. If Spider-Man was to unmask himself - or be unmasked, then any related people witnessing the incident would have their memories returned. Mister Fantastic claims to be able to duplicate the "firewalls" for himself and the Fantastic Four, allowing Spider-Man to safely tell them his identity without fear of compromising his secret. Due to the events of the Spider-Island arc, (when Peter put a video of him having spider-powers on the Internet in hopes of inspiring other spider-powered New Yorkers to better use their powers) while Spider-Man's identity is still kept secret from the mindwipe, the effects of the psychic blindspot supplied by Dr. Strange has been weakened, making it possible for someone to correctly suspect that Peter Parker is Spider-Man if they are able to even if the world as a whole doesn't remember. As a result, Carlie Cooper broke up with Peter after she realized his secret, ] and later Norman Osborn figured out his identity when Jameson said that even throwing "his girl" off a bridge didn't stop the wall-crawler from defeating him. ] The Hulk later revealed that he still remembered Peter's identity, although apparently Banner doesn't retain the same knowledge. According to Doctor Strange, the spell can only be conjured once.
After being exposed to Connors' Enervator during his fight against the Lizard and Iguana, ] Peter was later transformed into Lizard which seemingly granted him the powers of the Lizard. ⏘] ]
On at least four occasions, Spider-Man has bonded to symbiotes from the planet Klyntar -- three of them have taken on the appearance of a black costume with white eyes, white patches on the hands, and large stylized spider emblems on the chest and back.
The first symbiote Peter bonded to while on Battleworld and brought with him to Earth, not realizing it was alive and sentient. ] ] Horrified and disgusted by the notion of permanently sharing his body with it, he rejected and tried to kill it. ] ] The symbiote survived - replicating Spider-Man's powers as a result of being bonded to him - and took on the moniker "Venom." Developing an intense love/hate obsession with Peter, it bonded to a series of subsequent hosts - most notably Eddie Brock - in order to either kill or re-bond to him. ] Peter was briefly infected by a virus engineered from the Venom symbiote's biomass, which transformed him into a slender doppelgänger of Venom. ] When Norman Osborn was bonded to the Carnage symbiote, Eddie loaned the Venom symbiote to Spider-Man so that he could defeat the Red Goblin. ]
While teaching at the Jean Grey School for Higher Learning, Spider-Man and his class investigated an attack on the S.W.O.R.D space station by a group of symbiote-possessed Brood. In order to take on the symbiote-controlled Deathbird, Spider-Man temporarily bonded to one of the symbiotes controlling it with help from No-Girl. The symbiote managed to overcome No-Girl and take over Spider-Man, transforming him into a monster similar to Venom, but immediately afterward it was separated from him and jettisoned into space. ]
Peter eventually bonded to a symbiote again. When Lee Price was using the Mania symbiote to control criminals, he infected Spider-Man as well. However, the hero was freed from his control by Agent Anti-Venom. ⏮]
When the Poisons attacked Earth, Spider-Man was bonded to a symbiote by a Poisoned version of the Punisher. After failing to remove it in the same manner he had originally expunged the Venom symbiote, Peter deduced that it had been altered to augment the bonding process and set out to find who had done this to them. ] In the end, the symbiote was removed from him and returned to the Klyntar's planet with the rest of its abducted brethren. ]
When Loki created the Tri-Sentinel, Peter gained the powers of the Enigma Force. ] ⎞] With those powers, he even managed to take on the likes of Magneto, Dr. Doom and Hulk.
- Enhanced Superhuman Strength: Spider-Man's superhuman strength was enhanced as a result of the Enigma Force, allowing him to throw the Hulk all the way to space, with only a single punch.
- Enhanced Superhuman Durability, Speed, Agility, and Reflexes: Spider-Man's durability, speed, agility, and reflexes were all enhanced even further as a result of becoming Captain Universe.
- Flight: Spider-Man gained the ability to fly. His speed was so fast, he was able to get the Hulk from space in some minutes.
- Energy Blasts: Spider-Man gained the ability to shoot concentrated energy blasts from his hand.
- Enhanced Spider-Sense: Spider-Man's spider-sense was enhanced to the extent that it allowed him to sense everything.
- Superhuman Sight and Hearing: Spider-Man was able to hear and see danger from far away.
- Molecular Change: Spider-Man could use this ability to make his webbing as hard as Adamantium or simply change its shape.
During the fight with the Hulk, a device called The Biokenitic Energy Absorber, had absorbed Hulk's gamma radiation and struck Spider-Man. This turned Spider-Man into Spider-Hulk, while seemingly possessing Hulk's powers, for a short time. ]
Spider-Man would turn back into the Spider-Hulk after being exposed by the gamma energy of Red Hulk and be able to hold his own when fighting Hulked-Out Thor and other people who have also been turned into Red Hulks. ]
Spider-Man has briefly transformed into the Spider-Hulk again when Loki attempted to expel Banner's gamma radiation from his body in an attempt to help him, only for the radiation to be absorbed by Spider-Man's also-mutated physiology. With the aid of the Fantastic Four, Spider-Man was able to devise a means of transferring the energy back to Banner, with the Hulk later thanking Peter for choosing to stay with Banner as he transformed back into the Hulk. ]
In an attempt to cripple Spider-Man's spider-sense through the use of a spider-jammer, Tiberius Stone unintentionally augmented the spider-sense to an overwhelming degree. ] Spider-Man was able to sense every potential threat, ranging from a tiny paper cut to a static shock, however, the effect was only temporary, as Tiberius managed to perfect his spider-jammer. ]
After having his body temporarily swapped with Doctor Octopus, ] Peter acquired the same equipment which gave the original Doctor Octopus his abilities:
- Tentacles: Doctor Octopus' superhuman abilities derive from the four mentally-controlled, electronically-powered, telescoping, prehensile titanium-steel tentacles attached to a stainless steel harness encircling his body from lower chest to waist. Each tentacle, approximately five inches in diameter, terminates in three single-jointed pincers. The pincers are able to rotate in relation to the arm for 360 degrees, in a screwdriver-like twisting motion. Each tentacle segment contains four high-efficiency electric motors equipped with a clutched, helical-gear train, independently mounted on frictionless gimbals and housed in four thin, overlapping layers of titanium-niobium steel. The titanium-steel alloy is light, has high-tensile strength, a high melting point, and high thin-wall rigidity. The motors get their power from a small nuclear-powered thermo-electric generator, which can provide several hundred watts per hour for up to five years before needing to replace its U-239 core. The tentacles have been modified since the time of the original accident to include high-efficiency battery packs (enabling movement when cutting off from the central power source) and individual micro-circuit control modules (enabling each arm to perform certain pre-programmed actions when Octopus loses conscious control). In the event that Octopus loses consciousness, the control module of each arm has enough pre-programmed conditional responses in its memory chip to enable it to perform a relatively complex sequence of actions, such as saving his life. The trauma of his arm or arms being separated from the harness causes a period of disorientation in which his arms flail about uncontrollably until the pre-programming takes over.
- Telepathic Control over Tentacles: Octopus can control the actions of his artificial arms psionically, even when they have been severed from his body and are separated from him by vast distances (a distance of 900 miles has been recorded).
- Telescoping: Each tentacle is approximately six feet long at full contraction, but can extend to a maximum of 24 feet in length.
- Superhuman Striking Force: Each tentacle is capable of moving at a speed of ninety feet per second and strike with the force of a jackhammer.
- High-Wind Generation The tentacles can generate 50 miles per hour winds if spun like a giant fan.
- Wall-Climbing and Traveling: By combining the intrinsic strength of both his tentacles and the pincers, Doctor Octopus can scale stone, brick, or concrete walls by rending "handholds" in the surface of the wall. Octopus is able to use his tentacles for traversing horizontal distances as well. At full extension, he can travel high above the ground as if on stilts, either using two tentacles or for maximum speed (approximately 50 miles per hour), four tentacles.
- Sensation Feeling: Although there are no nerve endings throughout the length of his artificial arms, Octopus can "feel" basic sensations with them. As a result of the mutagenic changes from exposure to radiation during the accident, electrical connections have been made from his chest harness to his spine. Thus, Doctor Octopus can mentally perceive "tactile" sensations by feeling the amount of electrical resistance that the pincer's electric motors feel when the pincers grasp an object.
Indomitable Will: Spider-Man has a strong force of will, completely free of evil and temptation. For years, he has struggled to balance his life as a student and his superhero duties. He is able to emerge from defeat even stronger. His mental strength is also shown when he successfully wrestles control of nanobots from Doctor Octopus. ] Through the psychological profiles conducted by Maria Hill, she has stated that nobody has as strong an ingrained identity as Spider-Man, further demonstrating the extent of his willpower. ] His willpower is so strong that he has been considered as the greatest of all the Spider-Totems in the Multiverse by Ben Reilly of Earth-94. ] Despite this, he has been taken over by symbiotes on numerous occasions, ] ] and there have been times where he has seriously considered and even attempted to kill his opponents. ] ]
Gifted Intellect: Peter Parker possesses a natural talent for science, standing out as a top student in high school and college. He developed inventions such as his Web-Shooters and his signature web formula, ⎷] and the Spider-Tracers when he was still in high school. ] Peter's intellect has as well earned him a place among the think tank Horizon Labs, ] as well as an acknowledgement by some of the Earth's most brilliant minds such as Hank Pym. ] In addition, Peter's college IQ scores were the same as those posted by Reed Richards at the same age. ] Peter was also able to hack into Stark Industries system to override Tony Stark's control command over the Iron Spider Armor, ] and discover Parker Particles, a force of energy tied into the continuous expansion of the universe that offers greater power than the Phoenix Force, according to Reed Richards. ]
Expert Inventor/Engineer: With his knowledge and expertise in mechanics, robotics and engineering Peter has been able to use his amazing intellect and resources at Horizon Labs to create many inventions such as the four Spider-Armors, the Spidey Stealth Suit, his famous Web-Shooters, the Cryo-Cube 3000 and the noise reduction headphones. At Parker Industries he invented a magnitude of devices including but not limited to the Anti-Electro Netting which successfully de-powered Electro, ] an antidote for the Zodiac poison, ] and easy to apply holographic plating. ]
Skilled Photographer: Peter is a very skilled photographer and has worked for the Daily Bugle and the Front Line as a photographer. ]
Talented Teacher: Peter is a naturally talented teacher and has taught science at Midtown High. ]
Master Acrobat: Thanks to his great strength and phenomenal equilibrium, Parker is an excellent athlete, excelling in all gymnastic fields and being able to perform every acrobatic stunt ever performed, including others that can never be performed by even an Olympic acrobat. ]
Spider-Man defeating Spider-Woman.
Master Martial Artist: Peter has through time become an excellent hand-to-hand combatant utilizing a fighting style that directly complements his superhuman abilities. His methods are volatile, enabling him to rival practically all types of combatants. In addition to this, Peter has been trained by Captain America in unarmed combat. ⎺] After temporarily losing his spider-sense, Peter received formal combat training from Shang-Chi and together created a new martial art style dubbed "the Way of the Spider." However, since the return of his spider-sense, Peter let his training lapse. ]
Bilingual: In addition to speaking English, Peter has also learned Mandarin. ]
Peter is capable of lifting approximately 10 tons in his original body. He was formerly able to lift 15 tons after being mutated by the Queen, and then 20 tons during The Other event. After both mutations were undone as a result of Mephisto's alteration of reality, Spider-Man's strength level has remained unspecified. Peter has been shown to be able to lift cars with ease and even tanks. Under extreme amounts of stress or when sufficiently enraged, Peter is known for cutting loose and demonstrating even greater levels of strength, such as supporting the weight of the Daily Bugle building, ] landing a private jet, ] supporting a fraction of a stadium full of people that was about to collapse, ] breaking through Iron Man's armor, ] and even breaking through eight of Doctor Octopus' carbonadium tentacles. ] He has even been able to lift a large pile of iron-debris equivalent to the weight of a locomotive approximately 130 tons. ] While he wore the Spider-Armor MK IV, Peter's already superhuman strength level was enhanced even further to an unknown degree, to the point where he could easily grab Taskmaster's body and use it like a mace to knock out the Wrecker, easily overpower the Superior Octopus' tentacles, ] and stagger and knockback Hyperion with one of his punches. ] However since that suit was destroyed, he returned to his normal strength level. ]
Unlike many superheroes, Spider-Man does not have a weakness he is automatically vulnerable to, but in recent years methods have been created to render him vulnerable.
Spider-Sense Disruption: Spider-Man's Spider-Sense can lose its effectiveness if it is blocked or temporarily weakened by specialized equipment or certain drugs. It also would not trigger if it detects something that is not registered as a threat like the Spider-Man clones or the Venom symbiote, its offspring, Anti-Venom, or the Skrulls. When deprived of his spider-sense, Spider-Man becomes vulnerable to surveillance and attack, and web-slinging requires most of his concentration.
Ethyl Chloride: Perhaps as a side effect of gaining his powers, Spider-Man is susceptible to the pesticide ethyl chloride. This chemical is frequently used as a weapon by the Spider-Slayers. ] ]
Bad Luck: Not exactly a flaw or a disadvantage in his crime-fighting, Peter Parker's life is generally a complicated one. Peter has been forced on numerous occasions to lie to people close to him, be late in his commitments, get away from people, and so on for the sake of his secret identity. This inherent difficulty to get his superhero life secrecy, matched with the number of superhuman events and beings in New York and simply coincidence has, in turn, lead Peter to aggravate people around himself, even ones close to himself, and to, more often than not, run into trouble and embarrassment. Peter often remarks whenever he misses an opportunity to better his social life, improve his finances, or even get to work on time, (due to his super-heroics), "Typical Parker Luck."
No Driving Skill: Due to having his web-shooters since he was a teen and being busy fighting crime, Peter never learned to drive. This is one of the reasons which made the Spider-Mobile a terrible idea. Peter can neither fly a helicopter nor the Avengers' Quinjet. ]
Memory Loss: Peter doesn't remember certain events in his life due to Octavius' mindwipe when Peter tried to take his body back after Octavius switched their minds. ] He currently possesses 31 pieces of his memories left from the mindwipe. ]
Botswana supports a population of about 130,000 elephants, more than in any other country in Africa, according to the African Wildlife Foundation. The delta where these carcasses were found is home to about 15,000 of those elephants, according to The Guardian.
The loss of hundreds of elephants (a number that could climb if the culprit isn't discovered and addressed soon) may impact the country's ecotourism, which relies on elephants and other wildlife, and contributes 10% to 12% of Botswana's GDP, The Guardian reported.
"You see elephants as assets of the country. They are the diamonds wandering around the Okavango delta," said McCann, as reported by The Guardian. "It's a conservation disaster — it speaks of a country that is failing to protect its most valuable resource."
Thouless disagrees with the idea that these deaths represent a "conservation disaster," pointing to the fact that the deaths represent such a small percentage of the delta's total population.
However, that number could climb if the cause isn't determined and mitigated. As for whether or not the mortality is continuing, the last time we flew over the area in mid-June, we were still finding very fresh carcasses from elephants that had died a few days to a few weeks previously," Schlossberg told Live Science. "So, the mortality appears to have been continuing into June. We would not be surprised if elephants were still dying, but we would need to do another survey to confirm this."
Orks using humans as cattle where can I find this?
I keep seeing this mentioned whenever the War of the Beast is brought up, but I've never seen a scan or the like of it. All I know is that it happened and it sickened the Iron Warriors, which is an impressive feat.
Can somebody help me see this shit directly? I gotta know.
It's in a couple of places in "The Beast Arises." There's the perspective of a human captive and the Black Templars in Throneworld and the perspective of the Iron Warriors and Fists Exemplar in Echoes of the Long War.
Here's a bit of the latter:
There was a piston shock, flesh punctured, a breathless gasp.
The Apothecary’s narthecium punched a sampler into the nearest captive’s jugular. The man moaned piteously, legs wobbling, but the press of filthy bodies held him steady.
Zerberyn hovered his helm light over the man’s gasping mouth, his curiosity piqued by something he had seen there. As well as having no hair, the man also had no teeth and, now he checked, no fingernails: nothing with which he could conceivably do harm to himself or another. A rare and unsettling cocktail of pity and disgust settled in his gut like one of Reoch’s analgesic slimes. His roving beam paused on the face of a woman who opened her mouth placidly as though conditioned to associate light with water or food. There was something branded onto her cheek. Zerberyn moved closer. She remained as she was, mouth wide and waiting, even as Zerberyn enclosed her head in his gauntlet and turned it gently to the side.
The brand was that of a snake.
The man under Mendel Reoch’s ministration gave one last grunt as the Apothecary’s narthecium retracted.
‘There are dangerously high levels of synthetic growth enhancers, testosterone, and other steroids in his blood. I would need to return him to Dantalion’s apothecarion for more thorough investigations.’
Horror Autopilot Tesla Crash Kills Two, 30,000 Gallons of Water Before Firefighters Gave Up
A horror Tesla crash in Houston involving an auto-pilot Tesla car has claimed two lives. According to firefighters, the high energy batteries kept re-igniting – firefighters attempted to douse the battery fire for four hours, pouring 30,000 gallons of water onto the fire, before giving up and letting the fire burn itself out.
2 dead after fiery crash involving self-driving Tesla, authorities said
Monday, April 19, 2021 7:00AM
SPRING, Texas (KTRK) — Two people died in a fiery crash involving a 2019 Tesla Model S and its autopilot functionality while taking it for a test drive on Saturday night, according to authorities.
The flames reportedly took hours to extinguish, and Harris County Precinct 4 Constable Mark Herman said the investigation has led them to believe that there was no one driving the car when the crash occurred.
The crash happened just after 9 p.m. on Hammock Dunes Place in the Carlton Woods Creekside subdivision. The victims were said to have been a 59 and 69-year-old man, however police have not released their names yet.
The batteries on board the Tesla continued to ignite despite efforts to douse the flames, authorities said. It reportedly took around four hours and more than 30,000 gallons of water before firefighters decided to let the fire burn itself out.
…Read more: https://abc13.com/2-killed-in-fiery-tesla-crash-that-took-4-hours-to-extinguish/10525148/
It is unclear at this stage what caused the crash, though investigators have stated they believe no one was driving when the crash occurred. It is also not clear what the cause of death was.
Given the duration and intensity of the blaze, I’m guessing the only detailed data available might be whatever the autopilot uploaded to the Tesla mothership before it was consumed by the fire.
The lithium in Tesla batteries creates a fire which is far more dangerous than a gasoline fire, and almost impossible to extinguish. Think twice before you park a Tesla in your home garage – if the battery ignites, and firefighters cannot extinguish the blaze, you could lose the house.
Even if your house structure survives the fire, acute exposure to the smoke and lithium contamination of the house and surrounds could be an issue – lithium poisoning can cause long term dementia like neurological problems (pyramidal cell dysfunction), along with problems with speech and muscle weakness.
Lets just say if I see a big Lithium fire, I’m not planning to hang around and breath in the smoke.
Wiens told one of his surgeons, “Everything that you told my family that I would never do I’ve done. Tell me, what else can’t I do, so I can go ahead and get those out of the way.” Photograph by Dan Winters
God took Dallas Wiens’s face from him on a clear November morning four years ago. If you ask Wiens, he will say that it was neither an accident nor a punishment it was simply what had to happen. At the time, he was trying to paint the roof of the Ridglea Baptist Church, just off Route 30, in Fort Worth. He was twenty-three, and suffering from the complications of being young and living a life of trouble, heartache, and restlessness.
Wiens had been adrift since adolescence. At fourteen, a traumatic incident—something that he can’t bear to talk about—had shaken him, cut into the core of who he was. He promised himself never to smile again, to detach himself from any emotion. Although he had grown up in a Christian home, he decided to turn his back on God. He fought often at school. By eighteen, he had left home, and was using drugs, dealing drugs, and carrying guns. He joined the Army, to clean himself up, but he had a bad knee and trouble with authority, and so he left. He tried to keep away from Texas, but poverty drew him back, and he got a local girl pregnant. While she was giving birth, the baby nearly died. In the hospital, Wiens asked someone if it was O.K. to cry, and then cried like never before. When the baby was born, a tiny girl at twenty-seven weeks, he filled up with emotion. He married the mother of his child, thinking that it was the right thing to do, but the marriage fell apart. He wanted change. He wanted to reënlist, to escape the mess of his story, to be a good father, a better man. Like all of us, he kept trying to find his way.
Wiens needed civilian medical and psychological evaluations before returning to the Army, and for that he needed money, which is how he ended up at the Ridglea Baptist Church on November 13th, the day his face was destroyed. He found the job through his oldest brother, Daniel their uncle, Tony Peterson, was going to be working with them. They planned to do some touchup painting from a boom lift, which can hoist a man into the sky with a giant hydraulic arm. It was a small job. They debated where to position the machine, how far from the church, and decided that Wiens would go up. Daniel went around to the other side of the building. Wiens got into the lift and began operating the hydraulics. He seemed preoccupied, Peterson recalled he was staring straight ahead, unaware of the danger, as he rose and rose, until his forehead hit a high-voltage electrical wire suspended above him. The electricity gripped his body, coursing through his head and the left side of his torso. For about fifteen seconds, ionized gas enveloped him in an azure nebula. The smell of an electrical burn hung in the air. “All around the kid was blue,” Peterson said. “It lit him up, and it hung on to him. It seemed like forever. Shit, man, all I thought was ‘I just killed my nephew.’ ”
Once the electricity let Wiens go, his body slumped like clay onto the suspended platform. Peterson lost his composure and fell into hysteria. Daniel called 911. The Fort Worth police department does not keep recordings of 911 calls for more than a year, but notes taken by an operator hint at the depth of urgency: “WAS FRIED FROM A POWER . . . IS HANGING . . . THE POWER SOURCE IS LIVE. . . . THINKS HE IS POSSIBLY DECEASED.”
Within minutes, police and firefighters arrived. They lowered the lift and pulled Wiens’s body out. When a paramedic got there, she was mesmerized by the damage. Just above Wiens’s left ear, where he had hit the line, it seemed like hot candle wax had been poured over his skin. Daniel recalled, “He had like a little charred bald scar on the top of his head. When they stripped his shirt off, it was just a big gaping hole—and I know this sounds kind of nerdy, but I liken it to a lightsabre coming up and brushing him on the side.” The paramedic placed an oxygen mask over Wiens’s face, and his eyelids fluttered as he struggled to inhale. Daniel noticed that his eyes were red. “It was like someone had blown glue and sand into them,” he said.
Wiens’s lips were fused, his jaw was clenched, and he was not getting enough air. Worried that he was slipping away, the paramedic injected him with a paralytic and performed a field tracheotomy—a common procedure in the military but one that she had never done before. A helicopter then flew Wiens to Parkland Hospital, which is a Level 1 trauma center, meaning that it can provide the highest possible level of care for such an emergency. President John F. Kennedy was taken to Parkland after Lee Harvey Oswald shot him—and, later, Oswald was taken there. The hospital also houses one of the country’s largest and best burn centers. It sees more than six hundred burn victims a year, but when a doctor there, a surgeon with twenty-six years’ experience, later examined Wiens he was shocked. People with that type of physical trauma rarely became patients. Usually, they died.
Electrical burns can have an oddly mercurial impact on the human body. They can devastate tissue immediately, or they can have no effect at all, or they can have a delayed effect. The period of limbo can last days, and during that time doctors must wait for each cell in the affected area to “declare itself ” living or dead. Brett Arnoldo, the co-director of Parkland’s burn unit, explained to me, “In a high-voltage electrical injury, typically what you see is the tip of the iceberg. There is a lot of deep-tissue injury that you cannot recognize when you just look at the patient.”
Arnoldo was the admitting surgeon when Wiens was brought in. He examined his head and his torso and found that the “charred bald scar” that Daniel had noticed was actually exposed skull. It suggested that the burn would soon reveal itself to be profound. “Our thought was that this was highly likely to be a lethal injury,” Arnoldo recalled. When Wiens’s family arrived, a doctor recommended that they find a priest to administer last rites. Dallas’s mother, Lea Wiens, told me, “The moment we walked in the hospital, we were told that, and I was like, ‘Don’t think so—we’ll be taking him home.’ ” While the family waited anxiously for news, Wiens was taken to an intensive-care unit, and his wounds were cleaned. An anesthetist put him into a benzodiazepine-induced coma to spare him from the severity of the pain.
Soon enough, the cells throughout Wiens’s face began declaring themselves dead in a steady cascade, laying waste to skin, muscle, and bone. By late afternoon, half his face was showing signs of injury. After about a day, every feature was subsumed by swelling. Wiens’s lips were “black as a piece of charcoal,” his grandmother, Sue Peterson, recalled. His skin turned resinous, joining with muscle, fat, and even hair, in a semi-translucent shell.
“Damn, Toto! We’re back in Kansas!”
As the cells began to die off, doctors at Parkland raced to remove them, fearing that they would invite a fatal infection. The process, called debridement, is sometimes simple, requiring just a scalpel, and sometimes involves drills and chemicals. For Wiens, there were more than twenty complex procedures. They claimed his forehead, eyelids, nose, cheeks, and lips. With each debridement, Arnoldo informed Wiens’s family what needed to go, and, for the most part, the family accepted the news pragmatically. In a crisis, it is possible to regard parts of the human anatomy that would otherwise seem all-important as expendable, if it means that a life can be saved. But Wiens’s face—the living symbol of who he was—was steadily being dismantled, and at times the news that a particular feature had to be removed was difficult to bear. “I really did not want them to remove his teeth,” his grandmother told me. “He was such a nice-looking kid, and I knew that that would be an issue for him. I cried and cried over it.”
Surgeons are practiced in distancing their emotions from their work, but the invasiveness of the debridements affected them, too. “I have never been physically sick in the O.R.,” Arnoldo said. “But when I removed the midface—the nose, the lips, the soft tissue around the eyes—and carried those pieces of tissue to a back table, there was a moment where I felt like I could be physically ill. It was upsetting. You’re taking his identity away.”
Another surgeon told me that the amount of tissue that had to be debrided amazed him. “The issue with Dallas was that the burn was so deep that we couldn’t get down to anything living,” he said. After skin, fat, and muscle were removed, a drill was needed to burr the scorched skull. “We got down to bone,” he said in some areas, the bone had died all the way through. “After multiple trips to the operating room, he literally looked like a skull on top of a body. Everything was gone.”
Something about Wiens stimulated intense protectiveness among the Parkland staff almost at once. Even under deep sedation, his body spoke with its own force and charisma. Wiens is a small man. He weighed a bit more than a hundred pounds. But he had withstood the injury, and survived the complete removal of his face. “It was like a movie,” a nurse said. “It was surreal.”
While Wiens was in the I.C.U., his head was wrapped in Xeroform, gauze saturated with petroleum jelly and antiseptic—a provisional substitute for skin. But beneath the Xeroform and the damaged tissue the condition of his brain remained a mystery. In the aftermath of the electrocution, he had suffered from seizures. He could not swallow or breathe unassisted, and Arnoldo believed that he would probably never talk, eat, see, or smell again the doctors at Parkland were skeptical that he was anything short of severely brain-damaged. Still, Wiens’s family did not relinquish hope. They spoke to him. They held his body. One day in mid-December, about a month into the debridements, his mother, Lea, was by his bedside. She was holding his hand, and she was convinced that she felt him squeeze her fingers. She ran to the hospital staff to let them know “he was in there,” but they told her that it was probably just a reflex.
There would be little point in further surgery for a patient who was effectively brain-dead, so in early January a determined resident decreased Wiens’s sedation to see if he could communicate. Wiens began to stir, his head swinging from side to side. “Relax, buddy,” the resident said. Wiens calmed down, and began responding to basic commands. That day, Wiens’s parents, Lea and her husband, Mike, were standing beside their son in the I.C.U. Wiens was immobile, his brain separated from the world by nothing more than bone and raw tissue. But his ventilator had been removed, and Lea heard him whisper, “I’m thirsty. I hurt. And I love you.”
The fact that Wiens was “in there,” as Lea had hoped, was a cause for relief, but it also presented a conundrum: what next? Even if his brain was fully intact, it could not remain wrapped in bone and Xeroform forever. Somehow, Wiens’s face would have to be made whole again. At Parkland, the doctor who bore this responsibility was a young reconstructive surgeon named Jeffrey Janis, a warm, soft-spoken man from Ohio, where Wiens had spent some of his childhood. Janis knew that, to look human, Wiens needed a face. “The question was, how do you reconstruct it?” he recalled. “Usually, in plastic surgery, you replace like with like”—facial skin with facial skin—“but in this case there was so much tissue missing that we couldn’t borrow it from anywhere else. People aren’t walking around with spare parts.”
Janis and his team scoured the medical literature for guidance, but Wiens’s condition was so unusual that they found little of use. Eventually, they decided to take muscles from Wiens’s back and sides, and fix them to the front of his skull, like a blanket. If the muscle thrived after several weeks, they would graft skin from Wiens’s thigh over it. The process would involve multiple surgeries, and the results could not be predicted. At best, Wiens would be given an immobile and featureless tableau of skin, a blank human canvas, where his face had been. Janis thought that a prosthetics specialist he sometimes worked with could construct a convincing mask, based on photographs of Wiens’s face before the injury. After the surgeries healed, Janis intended to mount metal pegs on Wiens’s skull so that the mask could be held on with magnets. In essence, Wiens would become a man disguised as himself.
The plan was both minimalist and risky. Janis recalled thinking, “If it fails, then it is likely going to result in death, because you can’t just have someone walk out of the hospital as an uncovered skull on a body. It doesn’t work like that.”
Reconstructive surgery is an ancient art, dating back at least to the time of the Upanishads, in India. In about 600 B.C., Sushruta, a scholar from Varanasi, catalogued more than three hundred surgical procedures, among them what may be the first documented rhinoplasty, which involved using the leaf of a creeper as a measuring device. “A patch of living flesh equal in dimension to the preceding leaf should be sliced off from the region of the cheek and, after scarifying it with a knife, swiftly adhered to the severed nose,” Sushruta advised. A pedicle—a bridge of skin keeping the patch linked to the cheek—provided blood to the graft while it integrated with the nose, and was later removed. An ear, he noted, could be repaired the same way.
Sushruta’s treatises found their way to Renaissance Europe, and, in 1557, Gaspare Tagliacozzi, a professor in Bologna, described a form of rhinoplasty from Sicily that was much like Sushruta’s. He understood reconstructive surgery in psychological terms, explaining, “We restore, repair, and make whole those parts which nature has given but fortune has taken away, not so much that they delight the eye, but that they buoy up the spirit and help the mind of the afflicted.” The Catholic Church disagreed: it judged that he had been tampering with the will of God and excommunicated him. Although a few sympathetic doctors kept Tagliacozzi’s work alive, for the most part grafts became an object of ridicule. In 1909, the Boston Medical and Surgical Journal noted that by the eighteenth century rhinoplasty “sank into disuse and in course of time began to be considered impossible or fabulous.”
In the subsequent centuries, reconstructive techniques improved, but the principle remained the same: tissue used to repair a wound had to be taken from the patient’s own body otherwise, the immune system would attack and destroy it. This biological threshold was impermeable, the pathologist Leo Loeb argued, in “The Biological Basis of Individuality,” and many surgeons accepted it. Modern facial reconstructive surgery came about during the First World War, to repair the devastating injuries that resulted from mechanized warfare, but it was still limited to grafts from the patient. The field’s failures were as stark as its achievements. The Third London General Hospital opened a department, known as the Tin Noses Shop, to build masks for soldiers whose injuries could not be disguised by reconstruction. The program’s founder wrote, “My cases are generally extreme cases that plastic surgery has, perforce, had to abandon.”
“Would it kill ’em to bust us just once when we’re wearin’ nice suits?”
Nearly a century later, Janis was attempting something remarkably similar. In January, 2009, Wiens’s comatose body was wheeled into the O.R., for two days of surgery. After the muscles from his back and sides were moved to his face, the team covered them with pigskin. This was a temporary measure the pigskin would eventually break down, but it would give the muscles protection without wasting any of Wiens’s own skin, much of which was still healing. “He’s a very thin guy,” Janis recalled. “We wanted to be very conservative.”
After a week, Janis’s team replaced the pigskin with a synthetic product called Integra. Initially, the swelling was tremendous. “The nurses said, ‘What did you do to this guy?’ ” Janis recalled. “But, as the swelling went down, the muscles assumed the contours of the facial skeleton.” Three weeks later, the team grafted skin from Wiens’s thigh to his head. What resulted was not quite a face: smooth, undifferentiated skin travelled from above Wiens’s hairline down to a slit where the remainder of his mouth was. One of his eyes had to be removed another was inert, but the doctors had “buried” it protectively in soft tissue, in case it could one day be revived. Wiens had no nose, no lips. He was able to grow a beard on just a tiny patch of chin. He looked like a Mr. Potato Head without the features.
Once Wiens was back in the I.C.U., the doctors allowed him to regain consciousness, and soon he began talking. He was hard to understand, so his parents set up a dry-erase board at his bedside, and, though he had been blinded, he could write out some basic phrases. But his transition into consciousness was blurred by delirium. He was given a small computer to help him communicate, and in his mind’s eye he struggled to use it while he balanced atop a wall made from lashed-together wooden pilings.
Wiens had no memory of the electrocution or the hours leading up to it, but he later spoke of having had a religious experience. At the moment his head touched the high-voltage line, he had a profound sense of dying, of being sucked into an infinite void, which he understood to be Hell. “I saw every sin flash before my eyes, and then I felt a pain that I never before or since felt,” he said. “It wasn’t physical and it wasn’t internal. It was like being forsaken, that’s the only way to describe it. I remember crying out and hearing nothing, and it was utter impermeable darkness. It was basically separation completely from the divine, and then coming back with God’s arms around me, and an overwhelming sense of peace.”
Wiens had no grasp of how long he was in the abyss, he says, but eventually he emerged. “I woke up into a dream, knowing it was a dream,” he said. “I knew I was hurt bad.” REM sleep is not possible under deep sedation, but the induced coma had waxed and waned. At his bedside, Wiens’s mother asked him what being in the coma was like, and he told her that he dreamed that he had a missing leg, that his hip was in terrible pain, but that the rest of his body was intact. In the dream he was on a small boat, alone, lost in a vast ocean.
In the first days of his return to consciousness, neither Wiens’s family nor the hospital was prepared to tell him the extent of his injuries. Wiens did not feel pain in his face, as nearly all of it was insensate, but eventually he asked a nurse, “What’s wrong with me?” The nurse informed him in general terms, and his father later gave a fuller description. “He was upset, but handled it remarkably well,” Wiens’s mother recalled. The severity of facial injury rarely corresponds with the difficulty of psychological coping someone with a small disfigurement can be far more devastated than someone with overwhelming mutilation. In some cases, patients are euphoric.
Wiens told me, “I was pretty stoic about it, realizing that I had experienced worse.” He had started drinking when he was twelve the narcotics came soon afterward. “I cared about nothing and nobody. It was like that with my family, too.” But after his injury he appeared to be changed: he was still stubborn, still restive, but he seemed to possess a new inner calm. “He had to learn how to be patient with others and himself,” a nurse recalled. After his religious experience, Wiens embraced the faith that he had spurned. “I could never deny His existence,” he told me. Years earlier, when his daughter, Scarlette, was endangered during childbirth, he had prayed in a fit of anger. “I remember crying out to a God that I hated, begging Him not to take my daughter,” he said. Now, it seemed, he had been spared, too. One day in March, Wiens’s grandmother found him listening to Christian music. He told her, “I am putting some good things in my mind.”
After weeks of psychological preparation, Scarlette, now two years old, was brought to him. Avoiding his face, she grabbed his hands and exclaimed, “Daddy’s hands!” Wiens wept, thankful that he had no tears that she could see. “One time, he just mourned for everything that was up ahead of him,” the nurse said. His other brother, David, said, “He called me and told me, ‘I need you to come,’ and I rushed up to the hospital. And he kind of broke down: ‘I don’t want to do this anymore. I don’t want to keep fighting. This is bullshit. My life has been so miserable to begin with, and I really don’t have any reason to come out of this.’ I was sobbing, and I said, ‘Don’t give up on this.’ And the next night I went to see him, and he cleared the room, and he said, ‘That was really wrong of me. I’m sorry I put you through that. I’m not going to die. I’m fine.’ ”
In fact, Wiens began telling people that he would not undo his injury he had lost his face, but he had found family, religion, and a way to become a better person. “God took my whole life and gave me a new one,” he explained. One day, shortly before being discharged, he told Arnoldo, whose initial predictions had been so dire, “Everything that you told my family that I would never do I’ve done. Tell me, what else can’t I do, so I can go ahead and get those out of the way.”
Wiens moved into his grandparents’ home in May, 2009, and slowly began to practice walking, talking, and eating. He struggled to adjust to his blindness, and to build a relationship with his daughter. The reconstructed tissue was sometimes tight, and it restricted his movements, but some nerve endings appeared to be reviving. Wiens could taste, a little. Mostly, he felt grateful to be alive. He even wondered if he should turn down the prosthetic mask. His grandmother, who had helped raise him, referred to the reconstruction as his Melon Face. She told me, “I loved Dallas from the moment he was born. I learned to love that Melon Face. I could read it.”
When Wiens sometimes argued with her, she would turn to him and say, “Don’t look at me like that.” He told me, “It always struck me as funny, because I knew I wasn’t making any facial expressions, but she could tell exactly what I was thinking, whether it was skeptical, quizzical, or glaring. She was right pretty often.”
That October, the American Society of Plastic Surgeons held a conference in Seattle, and Janis was invited to join a panel called “The Greatest Saves,” in which surgeons present their accounts of lifesaving operations, and the audience decides which one is the medical feat of the year. When Janis guided the audience through Wiens’s unexpected recovery, they were deeply moved, and voted him the winner. The victory spoke to Parkland’s exceptional care and ingenuity, but it also raised a disconcerting question: What did it mean that the year’s greatest achievement in facial reconstruction was for a man who no longer had any semblance of a face?
“Those who can’t do, comment.”
One of the other nominees on the panel, a surgeon named Bohdan Pomahac, from Boston, argued that the field could do much more. Pomahac was frustrated by the limits of reconstructive surgery, and he explained how he had begun to think differently. His patient, a Vietnam War veteran named Jim Maki, had fallen onto the electrified rail of a T line, and had been left with a cavernous hole where his nose had been. Pomahac knew that rebuilding Maki’s midface was impossible, and he considered prosthetics inadequate. Still, he believed that there was an alternative: couldn’t he transplant the missing features from someone else? In the days of Leo Loeb’s “Biological Basis of Individuality,” the notion would have seemed impossible, but many breakthroughs had been made in transplantation the first successful kidney transplant, performed in 1954, proved that “individuality” was far more permeable than Loeb had believed.
Pomahac eventually removed the nose, cheeks, and hard palate from a patient who had died of heart failure and sutured them to Maki’s face. This was the second time a partial face transplant had been tried in America only half a dozen had been performed anywhere. The presentation concluded with a slide of Maki, just after the operation, standing calmly in front of a hospital exit, looking scarred and a little swollen but otherwise whole. Beneath the image, Pomahac had written, “Not life saving, but life giving.”
After Pomahac’s talk, Janis ran up to him and said, “I think I have a patient for you.”
Pomahac smiled and said, “I might be able to help.”
Janis, unable to contain his excitement, called Wiens. Here was an unimagined medical option, a procedure that would give him a new, living face. “Dallas,” he said, “I think I’ve seen a glimpse of the future.”
When I began to look into face transplantation, a surgeon I know told me to read Tom Wolfe’s “The Right Stuff.” The procedure was “frontier surgery,” he said—perhaps the final horizon in a field that is being surpassed by genetics and other, more exotic disciplines. A face transplant requires teams of twenty or thirty doctors, from specialties as diverse as immunology and prosthetics, operating for up to twenty hours—and, like a lunar-rocket launching, it results in a public event of demonstrable technical bravura. “You couldn’t have a good surgeon who didn’t believe in the concept of the hero,” a doctor told Joan Cassell for her 1991 book on the culture of surgeons, “Expected Miracles.” Several years ago, The Lancet asked the surgeon who conducted the first face transplant, a French doctor named Bernard Devauchelle, if he had a mentor. “I am an autodidact,” he said the historical figure he most identified with was Sir Edmund Hillary, “because he was the first man to conquer Everest.”
Bohdan Pomahac is this country’s leading specialist in face transplants. A tall, quiet-mannered man, forty years old, with neat hair and a goatee, he works at Brigham and Women’s Hospital, in Boston. He grew up in the Czech Republic, in the city of Ostrava, not far from Poland and Slovakia. After graduating from medical school, in 1996, he flew to the United States with savings from a small temp agency that he ran while studying. One afternoon, he showed up in the office of the Brigham’s chief of plastic surgery, Elof Eriksson, and asked if there was any research he could do. Pomahac did not speak English that well, but Eriksson thought that he had the attributes of a good surgeon: precision, ambition, and a willingness to push the limits of what is possible.
Eriksson had told Pomahac that there were no jobs available, but he gave him a tour of a laboratory and told him he could observe for the day. That evening, Pomahac returned and said that he was willing to work for free. “I’m not certain I want you to do that,” Eriksson said, and found money to give him a small stipend. In eight years, Pomahac went from researcher to associate director of the Brigham’s burn unit. He liked the restorative ethos of plastic surgery. Other doctors fought illness by removal: excising cancer, or debriding charred muscle and bone. Plastic surgeons rebuilt. “I always tell my patients, ‘We are the good guys,’ ” he said. “After the other doctors leave, we’re the ones who try to help the patient be functional and live a normal life.”
By the time Pomahac began going into the O.R., reconstructive surgery was able to accomplish remarkable things: doctors could stretch out skin on a patient’s arm, sculpt it into a nose, and move it to the face. But these procedures, done in multiple rounds, could be emotionally trying for the patient, and the results—though vastly better than the injury—rarely looked natural. Pomahac showed his wife reconstructions that he was proud of, and she said, “Are you kidding me?” He realized that his standard of success was biased by the limitations of his field: a pair of lips built from another kind of skin would never look like the original. “When you get out of that mental silo, you think, God, this is really not good enough,” he later told another doctor. “I wanted to beat the odds that patients could not get any better.”
Pomahac’s efforts took him to the frontier of a medical field that had only recently been settled. The transplants that are commonplace today—kidney, liver, heart—have been performed clinically for no more than thirty-five years. The protocols for them took years of aggressive trial and error to develop, with hundreds of patients suffering immensely, and yet scientists still do not fully understand how the body accepts foreign grafts. More than a third of all kidneys from deceased donors fail within five years, and more than half of all lung transplants. Recipients of organ donations are prone to serious health problems, from diabetes to cancer, and some are considerably more likely than their contemporaries to die within ten years.
The reason for these problems is straightforward: to get a patient’s body to accept foreign tissue, doctors must cripple the immune system just enough to allow a transplant to thrive but not so much that the patient dies. Lifelong regimens of powerful immunosuppressive drugs are administered to subvert the body’s internal defense system—the impulse to distinguish and defend me from not me. The Holy Grail in transplantation is a breakthrough that would induce the body to regard a foreign organ as its own. Some scientists speak of attaining “chimerism,” named for the mythical Chimera, which Homer described as “a thing of immortal make, not human, lion-fronted and snake behind, a goat in the middle.” If the Chimera’s easy hybridism could be clinically attained, then organs could be exchanged among patients without a biological price. People could be rebuilt like puzzles.
Many surgeons have long believed that until human chimerism, or something like it, is possible transplantation should be limited to vital internal organs, like the heart and the lungs for anything else, the biological price would be too high. Throughout medical history, exotic grafts—arms, legs, even heads—have either been a thing of the imagination or calamitous experiments. Around 300 A.D., Sts. Cosmas and Damian are said to have transplanted the leg of an Ethiopian gladiator to a Christian bell-tower keeper, but the story is more legend than historical account. Transplanting composite masses of different tissue—muscle, nerves, bone—especially if they included skin, was particularly challenging many surgeons were convinced that skin, which protects the body from the outside world, is the most antigenic tissue, meaning the most inclined to trigger a strong immune response if grafted onto a foreign body. In the First and Second World Wars, doctors attempted to transplant skin onto wounded soldiers, but the recipients’ bodies quickly destroyed the grafts. In 1964, a doctor in Ecuador attempted to transplant a hand using immunosuppression that had worked for kidneys. The results were disastrous, and after two weeks the hand had to be amputated.
It took the discovery of cyclosporine, a drug derived from an unusual fungus found in Norway, for surgeons to seriously consider performing a composite-tissue transplant again. Cyclosporine targeted parts of the immune system that attack grafted tissue, leaving the rest more or less intact. In 1981, not long after its discovery, a professor at the University of Texas suggested in The New England Journal of Medicine that it would soon be possible to transplant limbs the drug, he hoped, would cause Cosmas and Damian’s miraculous surgery to “become a fait accompli of the modern medical practice.” In 1998, doctors at the University of Louisville demonstrated that limb transplants in large mammals were possible with low doses of cyclosporine. By then, the only real obstacles preventing a return to the 1964 surgery were ethical: would it violate the Hippocratic oath?
“Conversation? I thought we were just meeting for coffee.”
The doctors at Louisville wanted to perform a hand transplant, but an international team based in France beat them to it. “I had this dream—I wanted to be first,” Jean-Michel Dubernard, a French surgeon who led the team, told me. As a young doctor, he had studied at the Brigham, under the surgeons who had performed the first kidney transplant. Known to friends as Max, he has a flamboyant manner and a reputation for brilliance. He conducted one of the first pancreas transplants, developing a new technique that was later widely adopted.
The team settled on a middle-aged patient from New Zealand, Clint Hallam, who told them that he had lost his hand in an industrial accident. A psychiatrist working with the surgeons declared that he had a “strong constitution and solid resolve,” and recommended him as a candidate. Twenty-five doctors would be involved in the operation nonetheless, Hallam was facing a medical abyss. The surgeons could not predict how he would react, physically or psychologically. They told him that the odds of the hand’s success were as good as flipping a coin.
“There was still the ethical objection to putting someone on potentially life-threatening immunosuppressants for a ‘quality-of-life’ operation,” one of the surgeons later wrote. “However, one may argue that such operations are already routine—kidney and pancreas transplants are done so that people do not have to endure a lifetime of dialysis or insulin injections and are not in themselves lifesaving.” The argument was not especially convincing. Most people with one hand can live independently, but people on kidney dialysis typically die far sooner than recipients of transplants. Hallam’s surgery was clearly experimental, but at least, in the event of failure, the hand could be removed.
The operation took place in September, 1998, and lasted fourteen hours. The donor, who had died in a motorcycle accident, was bigger than Hallam his forearm was longer and wider his skin was lighter, pinker, and less hairy. But when Hallam first saw the result he told his doctors, “My hand’s back. It’s almost like I’d lost an old friend years ago, and suddenly it’s back.” Within months, nerves began to show signs of regeneration. Sensation returned, expanding a few millimetres per day from forearm to fingertips. Eventually, Hallam could write, hold a phone, and eat with a fork and knife. But after he was discharged, in December, he became elusive. News broke that he had lied about his injury it had happened while he was serving time for committing fraud. Then Hallam stopped taking the immunosuppressive drugs. He told reporters that the medication made him feel nauseated and lose weight, that he experienced flulike symptoms, and that an independent doctor had recommended he go off the drugs to allow his immune system to fight the infection. His doctors believed that he was psychologically troubled. Dubernard said that, after one of his other transplant patients met with the Pope, Hallam went to Rome, hoping to get his own audience he was refused, and became more fixated on having the hand removed.
Once Hallam stopped immunosuppression, the hand became swollen and red tendons calcified, making it virtually immobile. He covered the hand, so that neither he nor anyone else could see it. “I’ve become mentally detached from it,” he told a reporter. “As it began to be rejected, I realized that it wasn’t my hand after all.” He begged his doctors to amputate they resisted, urging him to reconsider. They provided him with free immunosuppression, but when it ran out he made no effort to find more. The rejection returned in force, and Hallam called one surgeon to plead, “Help, I want it off.” His doctors finally agreed—although some of them blamed him for the failed procedure, calling him a con man and a psychopath. In February, 2001, they removed the hand.
For skeptics, Clint Hallam’s operation appeared to confirm a grave suspicion: composite-tissue transplants were about surgical heroism at the cost of good medicine. But a small community of researchers interested in face transplantation watched the surgery with enthusiasm. For anyone who thought that a limb could never be transplanted because skin was too antigenic, the operation was a breakthrough. “Clint Hallam caused me to question that dogma,” Peter Butler, a surgeon at the Royal Free Hospital, in London, told me. “It gave me the idea that you could potentially move the procedure to the face.” By 2002, ten hand transplants had been conducted, none with Hallam’s complications, and Butler and a colleague broached the idea of a face transplant in an article for The Lancet. Soon afterward, doctors in the United States, France, Spain, and China were racing to do one.
Among the competing surgeons and their critics, there were threats, accusations of plagiarism, and sore feelings. Journalists, meanwhile, rushed to discover the identities of potential patients. When the London tabloids picked up the story, they were filled with references to “Face/Off,” the film in which John Travolta and Nicolas Cage, as an F.B.I. agent and a killer, have their faces surgically exchanged and switch identities. Face transplants were portrayed as cosmetic surgery in extremis. “SWAP YOUR FACE,” the Daily Express blared. A proponent of the surgery told me, “Everyone had the Nicolas Cage ‘Face/Off’ point of view,” even though studies indicated that, because bone structure played a large role in facial appearance, recipients of face transplants would not look like their donors.
Amid the frenzy, the Royal College of Surgeons of England decided to assess the procedure. People with facial disfigurement were already wrestling with questions of selfhood and self-worth some had immense psychological challenges ahead of them. What did it mean to put them through a radical operation that might alter their identity in unknown ways? What were the chances that a face transplant would even function as expected? Could desperate patients balance the risks and give informed consent? What if a recipient refused his immunosuppression, as Hallam had? Or what if the transplants failed—say, at the rate that lungs did? A face could not be amputated like a hand. Doctors who were asked about the consequences of failure were blunt. “Absolutely terrifying,” one told a reporter. Another said, “Too horrible to imagine.”
The Royal College of Surgeons studied the issue for eight months and concluded that it was “unwise to proceed.” A French national ethics committee argued that it was “utopian” to think that severely disfigured patients could give “authentic consent,” and that “lifelong immunosuppressive therapy means that a person who was previously in a situation of major handicap enters into a life-threatening condition.” The committee ruled that a full face transplant was not justified. But it did allow that a procedure involving just “the triangle”—the nose, mouth, and chin—was less likely to risk psychological complications, and could be ethically done if it was clearly presented to patients as a high-risk experiment.
A year later, in 2005, a traumatically disfigured middle-aged woman turned up at a hospital in Amiens, a small city about seventy miles north of Paris. Her name was Isabelle Dinoire, and she lived in a quiet French town near Belgium. One night, Dinoire, who had been suffering from depression, had an argument with her daughter, took a handful of sleeping pills, and collapsed. When she awoke, she reached for a cigarette, but found it impossible to smoke. She had no mouth, no nose. While she was unconscious, her pet Labrador had mauled her face. A pool of blood surrounded her. “I went to see myself in the mirror, and then, I could not believe what I was seeing,” she later told Noëlle Châtelet, in a book titled “Le Baiser d’Isabelle.” She added, “It was too horrible.”
Centre Hospitalier Universitaire d’Amiens, or C.H.U. Amiens, is not a large facility, but it accepts hard cases from the area. The dog bite had left Dinoire looking cadaverous nothing covered her teeth or gums. “It was a terrific atrocity,” one of her doctors told me. Eating and speaking were nearly impossible. Already psychologically frail, she retreated into shock, losing her sense of time, even of who she was. “I cried in despair,” she told Châtelet. “I saw no exit.” Dinoire later told me that she could not imagine living without a face. “When you have no face, you are nothing,” she said. She adopted a cloistered life, leaving home rarely, and only behind a surgical mask.
The chief of maxillofacial surgery at C.H.U. Amiens, Bernard Devauchelle, thought that she might be a candidate for a face transplant, but when he tried to obtain the necessary authorization the hospital’s immunologist would not support him. “He was afraid because it was new,” Devauchelle told me. Eventually, he reached out to Max Dubernard. In addition to being a surgeon, and an expert on transplantation and immunology, Dubernard was a well-connected politician in the National Assembly he had experience obtaining approval for radical procedures.
“For me, he was a political man,” Devauchelle told me. “But when he came here he was a doctor. His first question was ‘Can I see the patient?’ And he had the same reflexes we did.” After evaluating Dinoire, Dubernard said to the other doctors, “It is evident”: here was a patient whose life had been devastated. He told me, “As a doctor, I had this way of thinking: if she was my daughter or mother, what would I do?” The debate about medical ethics suddenly faded into abstraction, and the team began to seek authorization, emphasizing that Dinoire’s situation was “an emergency.” Her scar tissue was tightening, causing her wound to become more pronounced. Her face was ebbing.