Lawmaker by day, good Samaritan by night, Sen. Bill Frist (R-Tenn.) is a wealthy doctor-turned-politician who occasionally attends art openings at his family-endowed museum-but prefers to spend his vacations visiting remote African villages to dispense lifesaving care.

It goes without saying that he pilots his own plane.

So Frist fits neatly into the melodramatic script of Trent Lott’s fall from power, cast as the new majority leader called on to rescue the party in a moment of peril. “He really shows the true compassionate conservatism,” says Sen. Kay Bailey Hutchison (R-Tex.).

But this plot twist raises a thorny question that only time will answer: Can those delicate surgeon’s fingers manage the backslapping, arm-twisting, hand-holding and pocket-picking that comprise the sometimes grubby backroom reality of a Senate leader’s life?

His supporters point to the bills Frist has co-sponsored with politicians as wily and seasoned as Sen. Edward M. Kennedy (D-Mass.), and to his acclaimed leadership of the National Republican Senatorial Committee, where he captained the recent campaign to regain the Senate majority.

They also acknowledge that Frist’s background-well-born, expensively educated and drawn to the notoriously independent life of the superstar surgeon-was not an obvious preparation for his new life of haggling and dealmaking. “There are a lot of key senators who don’t really think they need any leadership,” a Capitol Hill veteran said. “Leadership is not a problem in the Senate. Followership is.”

The expertise that has made Frist an effective force in health care legislation will become relevant in a smaller-though still important-segment of his life. The close working relationship he has forged with President Bush will be, at least initially, viewed with some suspicion by senators who resent the role the White House is perceived to have played in Lott’s demise. And the idealism that Frist says motivated him to run for the Senate in 1994 will be a difficult candle to keep burning when the winds of political expedience start gusting.

Frist spoke of the difficult balance between nitty-gritty politics and a Dr. Kildare idealism in a recent Boston Globe interview. “There is this tension between two forces I am engaged in, between raw political power versus . . . the real quest, the real drive for substantive issues.” It is a tension that will only grow.

William F. Frist, 50, is the son of a Tennessee legend, the late Thomas H. Frist, physician to six governors and founder of the Hospital Corporation of America, now known as HCA. The future senator grew up in Nashville’s wine-sipping GOP precinct Belle Meade, an exclusive suburb, and went to school at the elite, all-boys Montgomery Bell Academy before heading off to Princeton and then to Harvard Medical School. He was a daredevil lad, speeding on motorcycles at 15 and making his first solo flight a year after that.

Though Frist invested from an early age in HCA stock-the basis of his multimillion-dollar fortune-he decided that he would never play a role in the company that his father and brother, Thomas Frist Jr., built into the largest chain of for-profit hospitals in the country. Instead, Frist threw himself with consuming intensity into becoming a transplant surgeon. In an episode that he now says he deeply regrets, Frist toured animal shelters around Boston, offering to care for stray cats that he then killed for medical experiments.

“Medical school,” he wrote, “was in the business of stripping human beings of everything but the raw, almost insane, ambition you must have simply to get through.”

Frist’s background was Southern, but not Deep South. Nashville was home to an established black middle class and a thriving Jewish community. By living in New Jersey, Boston and Northern California, Frist became a cosmopolitan member of the American wealthy elite. It suggesting that he may have more in common with the last majority leader from Tennessee-Howard Baker-than with the two more recent GOP leaders, hardscrabble Kansan Robert J. Dole or Lott, the son of a Pascagoula shipyard worker.

After his training, Frist returned to Nashville to practice at Vanderbilt University’s well-respected hospital-again avoiding the family chain. He specialized in transplant work, heart and lung replacements, sometimes flying his plane to retrieve an organ, then rushing it back for installation.

The distance he maintained from HCA probably saved his political life.

In the late 1980s, the Frist family company was swallowed in a hostile takeover, and Frist’s father and brother ceded management control to the owners of what became Columbia/HCA. In 1997, FBI raids on company hospitals turned up widespread Medicare fraud. According to attorneys for the whistleblowers who revealed the massive overbilling, HCA engaged in illegal practices even before the takeover. But Thomas Frist Jr. returned to the helm of the company as unpaid chairman and chief executive, and worked to restore trust in the company.

This week, HCA (the old name is back) announced that it would pay the federal government $631 million to settle fraud claims-bringing the total payments by the company to $1.7 billion.

When Frist challenged Sen. James Sasser (D-Tenn.) in 1994, he disclosed that $13 million of his $20 million in assets was in HCA stock. Much of his wealth, and that of his wife and three sons, is in limited blind trusts with a value of between $10 million and $35 million, according to his 2001 financial disclosure report.

But this distance from HCA has not entirely shielded Frist from attack. “With the health system in crisis, Republicans are considering a Senate majority leader who made his millions from a family-run company that defrauded Medicare, overstated expense statements, billed for services ineligible for reimbursements and paid kickbacks to physicians to encourage referrals to HCA facilities,” said Physicians for a National Health Program, which has clashed with Frist over health care issues.

Spending $3.7 million of his own money, Frist capitalized on the Republican tide of 1994 to crush Sasser by 14 percentage points. In the eight years since then, he has personified the Bush administration dream of conservatism with a friendly face. Frist is “part of the conservative core of the caucus,” a leading Republican said yesterday, “but stylistically he is cool; he has a different set of credentials and a more bipartisan, moderate demeanor than a lot of people with identical voting records.” Frist has voted with Lott, for example, more than 90 percent of the time.

Being the first physician elected to the Senate in more than 50 years is a big part of that. Republicans have played up his medical expertise, drawing credibility from Frist’s medical degree on such key issues as patients’ rights, Medicare and prescription drug benefits. “Dr. Bill Frist” is the preferred mode of address for Bush and Senate colleagues. Party leaders get dreamy-eyed when they picture the new majority leader saving a life on the Capitol grounds-as Frist has done a couple of times in the past eight years. (Once, he resuscitated a collapsed tourist; another time, he tended to the grievously wounded gunman who killed two Capitol police officers. )

Frist has basked in the attention. He appears regularly as a party spokesman on television. On one of his missionary trips to Africa-Frist is a devout Presbyterian-he toured AIDS-ravaged countries with rock star Bono. And his recent book on bioterrorism-billing him as “the Senate’s only doctor”-was a bestseller.

The publisher of Frist’s book confirmed yesterday that Eli Lilly and Co. helped boost the book by purchasing 5,000 copies, which the pharmaceutical giant distributed in 13 cities as part of an educational effort to help health care professionals deal with bioterrorism. Jed Lyons, president and CEO of Rowman & Littlefield, said the sales had resulted from the company’s marketing to corporations, and neither Frist nor his staff had had anything to do with the sale or were aware of it. Under Frist’s contract, Lyons said, all royalties go to two Tennessee charities designated by the senator. “Bill Frist is way too smart to risk his reputation by trying to make a special sales arrangement with corporations that could embarrass him,” Lyons said.

Nevertheless, Frist has close ties to Lilly, which has been a major contributor to his campaign and to the NRSC when he was chairman. Frist wrote a provision, enacted into law, that restricted the ability of plaintiffs to sue the company for injuries resulting from Thimerosal, a mercury-based preservative used in vaccines against childhood diseases. The Lilly provision was quietly woven into the legislation creating the Department of Homeland Security .

Even his political opponents say Frist has been an astute and willing negotiator on health care issues-though seldom willing, in the end, to stray far from his conservative views. Rich Tarplin, assistant secretary for legislation at the Department of Health and Human Services during the Clinton administration, recalled working with Frist on a law in 1997 that vastly strengthened the Food and Drug Administration’s regulation of tobacco. Tarplin said he was struck by Frist’s “ability to synthesize very, very complex subject matter”-a facility Frist demonstrated two years later when they worked together on highly charged legislation to revise the nation’s method of allotting human organs for transplants.

Frist has also worked to provide greater access to health care in impoverished communities-including programs to train minority doctors and nurses. A policy analyst called Frist “a Boy Scout in all the positive ways,” though a political consultant added that he can come across as “sickly sweet and condescending.”

Smooth demeanor, mixed with dependable conservatism, has helped to make Frist a favorite in the Bush administration. Though he volunteered in 1992 to support the first President Bush’s reelection campaign, Frist caught the attention of Team Bush when he was touted by then-Sen. Paul Coverdell (R-Ga.), the Bush liaison in the Senate. Coverdell’s death in 2000 left a hole in the campaign, and Frist stepped in. Soon after, he found himself co-chairing the GOP platform committee.

For a while, at least, his closeness to the White House may trouble more than help him. Senate insiders predict he will be watched closely by GOP senators who resent a president trying to tell them-directly or indirectly-what to do. Democrats likely will dare him to stand up to Bush whenever they see a chance.

In one recent example, several Democrats chastised Frist for failing to get the $500 million he said was needed to fight AIDS in Africa. After initial promises, the White House cut the funding dramatically, then restored it in phases, then killed it in a larger fight over spending. Frist has said he still hopes to get the money.

Almost since his arrival in Washington, people have wondered how high the doctor would rise. Lott told friends several years ago that Frist was a likely successor. Others believe he has his sights on the White House in 2008. By stepping up to the current crisis, Frist has turned such speculation into a stern test. It has been said that politics isn’t brain surgery-but it isn’t heart surgery, either.

Staff writers Amy Goldstein and Dan Morgan contributed to this report.

© 2002 The Washington Post Company

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