Part 4 (1/2)

Is it at all surprising that Freireich would be this way? The reason most of us do not scream ”Murderer!” at our coworkers is that we can put ourselves in their shoes; we can imagine what someone else is feeling and create that feeling in ourselves. We can take that route because we have been supported and comforted and understood in our suffering. That support gives us a model of how to feel for others: it is the basis for empathy. But in Freireich's formative years, every human connection ended in death and abandonment-and a childhood as bleak as that leaves only pain and anger in its wake.

Once, in the middle of reminiscing about his career, Freireich burst into an attack on the idea that terminally ill cancer patients be given hospice care at the end of their lives. ”You have all these doctors who want to do hospice care. I mean, how can you treat a person like that?” When Freireich gets worked up about something, he raises his voice, and his jaw sets. ”Do you say, 'You've got cancer, you're certainly going to die. You've got pain and it's horrible. I'm gonna send you to a place where you can die pleasantly'? I would never say that to a person. I would say, 'You're suffering. You've got pain. I'm going to relieve your suffering. Are you gonna die? Maybe not. I see miracles every day.' There's no possibility of being pessimistic when people are dependent on you for their only optimism. On Tuesday morning, I make teaching rounds, and sometimes the medical fellows say, 'This patient is eighty years old. It's hopeless.' Absolutely not! It's challenging, it's not hopeless. You have to come up with something. You have to figure out a way to help them, because people must have hope to live.” He was nearly shouting now. ”I was never depressed. I never sat with a parent and cried about a child dying. That's nothing I would ever do in my role as a doctor. As a parent I might do it. My kids died, I'd probably go crazy. But as a doctor, you swear to give people hope. That's your job.”

Freireich continued on in this vein for several more minutes until the full force of his personality became nearly overwhelming. We all want a physician who doesn't give up and who doesn't lose hope. But we also want a physician who can stand in our shoes and understand what we are feeling. We want to be treated with dignity, and treating people with dignity requires empathy. Could Freireich do that? I was never depressed. I never sat with a parent and cried about a child dying. If we were asked if we would wish a childhood like Freireich's on anyone, we would almost certainly say no because we could not imagine that any good could come of it. You can't have a remote miss from that kind of upbringing.

Or can you?

In the early 1960s, a psychologist named Marvin Eisenstadt started a project interviewing ”creatives”-innovators and artists and entrepreneurs-looking for patterns and trends. As he was a.n.a.lyzing the responses, he noticed an odd fact. A surprising number had lost a parent in childhood. The group he was studying was so small that Eisenstadt knew there was a possibility that what he was seeing was just chance. But the fact nagged at him. What if it wasn't chance? What if it meant something? There had been hints in the psychological literature. In the 1950s, while studying a sample of famous biologists, the science historian Anne Roe had remarked in pa.s.sing on how many had at least one parent who died while they were young. The same observation was made a few years later in an informal survey of famous poets and writers like Keats, Wordsworth, Coleridge, Swift, Edward Gibbon, and Thackeray. More than half, it turned out, had lost a father or mother before the age of fifteen. The link between career achievement and childhood bereavement was one of those stray facts that no one knew what to do with. So Eisenstadt decided to embark on a more ambitious project.

”It was 1963, 1964,” Eisenstadt remembers. ”I started with the Encyclopedia Britannica and then it turned into both Britannica and the Encyclopedia Americana.” Eisenstadt made a list of every person, from Homer to John F. Kennedy, whose life merited more than one column in either encyclopedia. That, he felt, was a rough proxy for achievement. He now had a list of 699 people. He then began systematically tracking down biographical information for everyone on the list. ”It took me ten years,” Eisenstadt says. ”I was reading all kinds of foreign-language books, I went to California and to the Library of Congress, and to the genealogical library in New York City. I tracked down as many parental-loss profiles as I could, until I felt I had good statistical results.”

Of the 573 eminent people for whom Eisenstadt could find reliable biographical information, a quarter had lost at least one parent before the age of ten. By age fifteen, 34.5 percent had had at least one parent die, and by the age of twenty, 45 percent. Even for the years before the twentieth century, when life expectancy due to illness and accidents and warfare was much lower than it is today, those are astonis.h.i.+ng numbers.

At the same time as Eisenstadt was pursuing his research, the historian Lucille Iremonger set out to write a history of England's prime ministers. Her focus was on the period from the beginning of the nineteenth century to the start of the Second World War. What sort of backgrounds and qualities, she wondered, predicted the kind of person capable of rising to the top of British politics at a time when it was the most powerful country in the world? Like Eisenstadt, however, she got sidetracked by a fact that, as she wrote, ”occurred so frequently that I began to wonder whether it was not of more than pa.s.sing significance.” Sixty-seven percent of the prime ministers in her sample lost a parent before the age of sixteen. That's roughly twice the rate of parental loss during the same period for members of the British upper cla.s.s-the socioeconomic segment from which most prime ministers came. The same pattern can be found among American presidents. Twelve of the first forty-four U.S. presidents-beginning with George Was.h.i.+ngton and going all the way up to Barack Obama-lost their fathers while they were young.2 Since then, the topic of difficult childhoods and parental loss has cropped up again and again in the scholarly literature. There is a fascinating pa.s.sage in an essay by the psychologist Dean Simonton, for example, in which he tries to understand why so many gifted children fail to live up to their early promise. One of the reasons, he concludes, is that they have ”inherited an excessive amount of psychological health.” Those who fall short, he says, are children ”too conventional, too obedient, too unimaginative, to make the big time with some revolutionary idea.” He goes on: ”Gifted children and child prodigies seem most likely to emerge in highly supportive family conditions. In contrast, geniuses have a perverse tendency of growing up in more adverse conditions.”

I realize these studies make it sound as if losing a parent is a good thing. ”People always kid me and say, 'Oh, you mean I'd be better off if I don't have parents, or if I murder my father?'” Eisenstadt says. ”The idea that some people could be successful without parents is a very threatening concept because the common idea is that parents help you. Parents are essential to your life.” And that, Eisenstadt stresses, is absolutely true. Parents are essential. Losing a father or a mother is the most devastating thing that can happen to a child. The psychiatrist Felix Brown has found that prisoners are somewhere between two and three times more likely to have lost a parent in childhood than is the population as a whole. That's too great a difference to be a coincidence. There are, clearly, an enormous number of direct hits from the absence of a parent.3 The evidence produced by Eisenstadt, Iremonger, and the others, however, suggests that there is also such a thing as a remote miss from the death of a parent. Your father can commit suicide and you can suffer from a childhood so unspeakable that you push it to the furthest corners of your memory-and still some good can end up coming from that. ”This is not an argument in favour of orphanhood and deprivation,” Brown writes, ”but the existence of these eminent orphans does suggest that in certain circ.u.mstances a virtue can be made of necessity.”4 When Jay Freireich arrived at the National Cancer Inst.i.tute in 1955, he reported to Gordon Zubrod, the head of cancer treatment. Zubrod a.s.signed him to the children's leukemia ward, on the second floor of the main hospital building in the center of campus.5 Childhood leukemia was then one of the most terrifying of all cancers. It struck without warning. A child as young as one or two would come down with a fever. The fever would persist. Then came a violent headache that would not let up, followed by infections, one after another, as the child's body lost its ability to defend itself. Then came the bleeding.

”Dr. Zubrod came around once a week to see how we were doing,” Freireich remembered, ”and he said to me, 'Freireich, this place is like an abattoir! There's blood all over the G.o.dd.a.m.n place. We have to clean it up!' It was true. The kids bled from everywhere-through their stool, urine-that's the worst part. They paint the ceiling. They bleed from out of their ears, from their skin. There was blood on everything. The nurses would come to work in the morning in their white uniforms and go home covered in blood.”

The children would bleed internally, into their livers and spleens, putting them in extraordinary pain. They would turn over in their beds and get terrible bruises. Even a nosebleed was a potentially fatal event. You'd squeeze the child's nose and put ice on it. That wouldn't work. You'd pack gauze into the child's nostrils. That wouldn't work. You'd call in an ear, nose, and throat specialist who would go in through the mouth and pack the nasal pa.s.sage from behind with gauze-which then had to be pulled forward into the nose. The idea was to apply pressure on the blood vessels from inside the nasal cavity. You can imagine how painful that was for the child. Plus, it rarely worked, so you'd take out the gauze-and the bleeding would start all over again. The goal of the second floor was to find a cure for leukemia. But the problem was that controlling the bleeding was so difficult that most of the children were dead before anyone could figure out how to help them.

”When they came to the hospital, ninety percent of the kids would be dead in six weeks,” Freireich said. ”They would bleed to death. If you're bleeding in your mouth and nose, then you can't eat. You stop eating. You try to drink. You gag. You vomit. You get diarrhea from the blood in the stools. So you starve to death. Or you get an infection and then you get pneumonia, then you get fever, and then you get convulsions, and then...” He let his voice trail off.

Doctors did not last long on the leukemia floor. It was too much. ”You got there at seven in the morning,” one physician who worked on the second floor in those years remembers. ”You left at nine at night. You had to do everything. I would come home every day, completely destroyed psychologically. I became a stamp collector. I would sit down at ten o'clock at night with my stamps, because it was the only way to take my mind off work. The parents were afraid. n.o.body would even go into the children's room. They would stand at the door. n.o.body wanted to work there. I had seventy kids who died on me that year. It was a nightmare.”6 Not for Freireich. I was never depressed. I never sat with a parent and cried about a child dying. Freireich teamed up with another researcher at NCI named Tom Frei. Together, they became convinced that the problem was a lack of platelets-the irregularly shaped cell fragments that float around in human blood. The leukemia was destroying the children's ability to make them, and without platelets their blood couldn't clot. This was a radical idea. One of Freireich's bosses at NCI-a world expert in the field of hematology named George Brecher-was skeptical. But Freireich thought Brecher wasn't counting the platelets correctly when he did his a.n.a.lysis. Freireich was meticulous. He used a more sophisticated methodology and zeroed in on subtle changes in the platelets at really low levels, and to him the connection was clear: the lower the platelet count, the worse the bleeding. The children needed fresh platelets-over and over again, in ma.s.sive doses.

The NCI blood bank wouldn't give Freireich fresh blood for his transfusions. It was against regulations. Freireich pounded on the table with his fists, shouting out, ”You're gonna kill people!” ”You have to be careful who you say that kind of thing to,” d.i.c.k Silver, who worked at NCI with Freireich, says. ”Jay didn't care.”

Freireich went out and recruited blood donors. The father of one of his patients was a minister, and he brought in twenty members of his congregation. Standard procedure in blood transfusions in the mid-1950s was steel needles, rubber tubes, and gla.s.s bottles. But it turned out that platelets stuck to those surfaces. So Freireich had the idea of switching to the brand-new technology of silicon needles and plastic bags. The bags were called sausages. They were enormous. ”They were this big,” said Vince DeVita, who was one of Freireich's medical fellows in those years. He held his hands far apart. ”And you have this kid, who is only this big.” He held his hands much closer together. ”It was like watering a flowerpot with a fire hose. If you don't do it right, you put the kids into heart failure. The clinical director of NCI at the time was a guy named Berlin. He saw the [sausage] and said to Jay, 'You're insane.' He told Jay he was going to fire him if he kept doing platelet transfusions.” Freireich ignored him. ”Jay being Jay,” DeVita went on, ”he decided if he couldn't do it, he didn't want to work there anyway.” The bleeding stopped.

Where did Freireich's courage come from? He's such an imposing and intimidating presence that it is easy to imagine him emerging from his mother's womb, fists already clenched. But MacCurdy's idea about near and remote misses suggests something quite different-that courage is in some sense acquired.

Take a look again at what MacCurdy wrote about the experience of being in the London Blitz: We are all of us not merely liable to fear, we are also p.r.o.ne to be afraid of being afraid, and the conquering of fear produces exhilaration....When we have been afraid that we may panic in an air-raid, and, when it has happened, we have exhibited to others nothing but a calm exterior and we are now safe, the contrast between the previous apprehension and the present relief and feeling of security promotes a self-confidence that is the very father and mother of courage.

Let us start with the first line: We are all of us not merely liable to fear, we are also p.r.o.ne to be afraid of being afraid. Because no one in England had been bombed before, Londoners a.s.sumed the experience would be terrifying. What frightened them was their prediction about how they would feel once the bombing started.7 Then German bombs dropped like hail for months and months, and millions of remote misses who had predicted that they would be terrified of bombing came to understand that their fears were overblown. They were fine. And what happened then? The conquering of fear produces exhilaration. And: The contrast between the previous apprehension and the present relief and feeling of security promotes a self-confidence that is the very father and mother of courage.

Courage is not something that you already have that makes you brave when the tough times start. Courage is what you earn when you've been through the tough times and you discover they aren't so tough after all. Do you see the catastrophic error that the Germans made? They bombed London because they thought that the trauma a.s.sociated with the Blitz would destroy the courage of the British people. In fact, it did the opposite. It created a city of remote misses, who were more courageous than they had ever been before. The Germans would have been better off not bombing London at all.

The next chapter of David and Goliath is about the American civil rights movement, when Martin Luther King Jr. brought his campaign to Birmingham, Alabama. There is one part of the Birmingham story that is worth touching on now, though, because it is a perfect example of this idea of acquired courage.

One of King's most important allies in Birmingham was a black Baptist preacher named Fred Shuttlesworth, who had been leading the fight against racial segregation in the city for years. On Christmas morning in 1956, Shuttlesworth announced that he was going to ride the city's segregated buses in defiance of the city's laws forbidding blacks from traveling with whites. The day before the protest, on Christmas night, his house was bombed by members of the Ku Klux Klan. The Klan was trying to do to Shuttlesworth what the n.a.z.is had been trying to do to the English during the Blitz. But they, too, misunderstood the difference between a near and a remote miss.

In Diane McWhorter's magnificent history of the civil rights campaign in Birmingham, Carry Me Home, she describes what happened as the police and neighbors came running toward the smoking ruins of Shuttlesworth's house. It was late at night. Shuttlesworth had been lying in bed. They feared he was dead: A voice rose from the wreckage: ”I'm not coming out naked.” And, after a few moments, Shuttlesworth emerged in the raincoat someone threw into the parsonage's rubble. He was not crippled, not bloodied or blind; he was not even deaf, though the blast had blown windows out of houses a mile away.... Shuttlesworth raised a biblical hand to the concerned neighbors, and said, ”The Lord has protected me. I am not injured.”...

A big cop was crying. ”Reverend, I know these people,” he said of the bombers. ”I didn't think they would go this far. If I were you, I'd get out of town. These people are vicious.”

”Well, Officer, you're not me,” Shuttlesworth said. ”Go back and tell your Klan brothers that if the Lord saved me from this, I'm here for the duration. The fight is just beginning.”

That's a cla.s.sic remote miss. Shuttlesworth wasn't killed. (A direct hit.) He wasn't maimed or badly injured. (A near miss.) He was unscathed. Whatever the Klan had hoped to accomplish had gone badly awry. Shuttlesworth was now less afraid than he had been before.

The next morning, members of his congregation pleaded with him to call off the protest. He refused. McWhorter continues: ”h.e.l.l, yeah, we're going to ride,” the cussing preacher said and addressed his board. ”Find you any kind of crack you can to hide in if you're scared, but I'm walking downtown after this meeting and getting on the bus. I'm not going to look back to see who's following me.” His voice deepened into the preacher register. ”Boys step back,” he ordered, ”and men step forward.”

A few months later, Shuttlesworth decided to personally take his daughter to enroll at the all-white John Herbert Phillips High School. As he drove up, a crowd of angry white men gathered around his car. Here is McWhorter again: To the child's disbelief, her father stepped out of the car. The men lunged at Shuttlesworth, baring bra.s.s knuckles, wooden clubs, and chains. Scampering west across the sidewalk, he was repeatedly knocked down. Someone had pulled his coat up over his head so that he couldn't lower his arms.... ”We've got this son of a b.i.t.c.h now,” a man yelled. ”Let's kill him,” the crowd screamed. From a white female cheering section came advice to ”kill the motherf.u.c.king n.i.g.g.e.r and it will be all over.” Men began smas.h.i.+ng the windows of the car.

So, what happened to Shuttlesworth? Not much. He managed to crawl back into the car. He went to the hospital and was found to have minor kidney damage and some scratches and bruises. He checked himself out that afternoon, and that evening from the pulpit of his church, he told his congregation that he had only forgiveness for his attackers.

Shuttlesworth must have been someone of great resolve and strength. But when he climbed unscathed out of the wreckage of his house, he added an extra layer of psychological armor. We are all of us not merely liable to fear, we are also p.r.o.ne to be afraid of being afraid, and the conquering of fear produces exhilaration....The contrast between the previous apprehension and the present relief and feeling of security promotes a self-confidence that is the very father and mother of courage.

And then what happened at Phillips High School? Another remote miss! Upon leaving the hospital, Shuttlesworth told reporters, ”Today is the second time within a year that a miracle has spared my life.” If one remote miss brings exhilaration, we can only imagine what two bring.

Not long afterward, Shuttlesworth brought a colleague, Jim Farmer, to meet with Martin Luther King at a church in Montgomery, Alabama. Outside, an angry mob had gathered, waving Confederate flags. They began to rock the car. The driver reversed and tried an alternate route, only to be blocked once more. What did Shuttlesworth do? Just like at Phillips High School, he got out of the car. Here again is McWhorter: c.o.ke bottles shattered car windows around him as he paused to register a strange smell, his first whiff of tear gas. Then he beckoned Farmer out of the car and strode into the mob. Farmer followed, ”scared as h.e.l.l,” trying to shrink his bon vivant's ample body into Shuttlesworth's thin shadow. The goons parted, their clubs went slack, and Shuttlesworth walked up to the doors of First Baptist without a thread on his jacket disturbed. ”Out of the way” was all he had said. ”Go on. Out of the way.”

That's three remote misses.

Losing a parent is not like having your house bombed or being set upon by a crazed mob. It's worse. It's not over in one terrible moment, and the injuries do not heal as quickly as a bruise or a wound. But what happens to children whose worst fear is realized-and then they discover that they are still standing? Couldn't they also gain what Shuttlesworth and the Blitz remote misses gained-a self-confidence that is the very father and mother of courage?8 ”The officer who took Shuttlesworth to jail,” McWhorter writes of another of Shuttlesworth's many run-ins with white authority, ”struck him, kicked him in the s.h.i.+n, called him a monkey, and then goaded him, 'Why don't you hit me?' Shuttlesworth replied, 'Because I love you.' He folded his arms and smiled the rest of the way to jail, where, forbidden to sing or pray, he took a nap.”

The work that Freireich had done in stopping the bleeding was a breakthrough. It meant that children could now be kept alive long enough that the underlying cause of their illness could be treated. But leukemia was an even harder problem. Only a handful of drugs were known to be of any use at all against the disease. There were the cell-killing drugs 6-MP and methotrexate, and there was the steroid prednisone. But each was potentially severely toxic and could be given in limited doses only, and because it could be given in limited doses only, it could wipe out only some of a child's cancer cells. The patient would get better for a week or so. Then the cells that had survived would start to multiply, and the cancer would come roaring back.

”One of the consultants at the clinical center was a man named Max Wintrobe,” Freireich said. ”He was world-famous because he wrote the first textbook of hematology, and he had written a review of the current state of the treatment of leukemia in children. I have a quotation from him that I show my students to this day. It says, 'These drugs cause more harm than good because they just prolong the agony. The patients all die anyway. The drugs make them worse, so you shouldn't use them.' This was the world's authority.”

But Frei and Freireich and a companion group at the Roswell Park Memorial Inst.i.tute in Buffalo led by James Holland became convinced that the medical orthodoxy had it backwards. If the drugs weren't killing enough cancer cells, didn't that mean that the children needed more aggressive treatment, not less? Why not combine 6-MP and methotrexate? They each attacked cancer cells in different ways. They were like the army and the navy. Maybe the cells that survived 6-MP would be killed by methotrexate. And what if they added prednisone into the mix? It could be the air force, bombing from the air while the other drugs attacked from the land and sea.

Then Freireich stumbled across a fourth drug, one derived from the periwinkle plant. It was called vincristine. Someone from the drug company Eli Lilly brought it by the National Cancer Inst.i.tute for researchers to study. No one knew much about it, but Freireich had a hunch that it might work against leukemia. ”I had twenty-five kids dying,” he said. ”I had nothing to offer them. My feeling was, I'll try it. Why not? They're going to die anyway.” Vincristine showed promise. Freireich and Frei tried it out on children who no longer responded to the other drugs, and several went into temporary remission. So Frei and Freireich went to the NCI's research oversight board to ask for permission to test all four drugs together: army, navy, air force, marines.

Cancer is now routinely treated with drug ”c.o.c.ktails,” complicated combinations of two or three or even four or five medications simultaneously. But in the early 1960s, it was unheard of. The drugs available to treat cancer in those years were considered just too dangerous. Even vincristine, Freireich's prized new discovery, was utterly terrifying. Freireich learned that the hard way. ”Did it have side effects? You bet,” he said. ”It caused serious depression, neuropathies. The kids got paralyzed. When you get a toxic dose, you end up in coma. Of the first fourteen children we treated, one or two actually died. Their brains were totally fried.” Max Wintrobe thought the humane approach was not to use any drugs at all. Freireich and Frei wanted to use four, all at once. Frei went before the NCI advisory board to ask for approval. He got nowhere.

”There was a senior hematologist on the board by the name of Dr. Carl Moore, who happened to be a friend of my father's from St. Louis,” Frei remembered years later. ”I had always considered him a friend, too. But my presentation struck him as being outrageous. He didn't deal in pediatric diseases like childhood leukemia, so he talked about Hodgkin's disease in adults. He said that if you have a patient who has widespread Hodgkin's disease, then it's best to tell that patient to go to Florida and enjoy life. If patients are having too many symptoms from their Hodgkin's disease, you treat them with a little X-ray or possibly a little nitrogen mustard, but give the smallest dose possible. Anything more aggressive than that is unethical, and giving four drugs at a time is unconscionable.”

Frei and Freireich were desperate. They went to their boss, Gordon Zubrod. Zubrod had been through the wars with Freireich over the platelets controversy. He had only reluctantly approved the vincristine experiment. He was responsible for what happened on the second floor. If somehow things didn't go well, he would be the one hauled before a congressional committee. Can you imagine? Two renegade researchers are giving experimental and highly toxic c.o.c.ktails of drugs to four- and five-year-olds at a government laboratory. He had grave reservations. But Frei and Freireich persisted. Actually, Frei persisted; Freireich isn't the kind of person who can be trusted with a delicate negotiation. ”I couldn't have done anything without Tom,” Freireich admitted. ”Frei is the inverse of me. He is deliberate and very humane.” Yes, the drugs were all poisons, Frei argued. But they were poisonous in different ways, which meant that if you were careful with the dosages-and if you were aggressive enough in the way you treated the side effects-the children could be kept alive. Zubrod gave in. ”It was crazy,” Freireich said. ”But smart and correct. I thought about it and I knew it would work. It was like the platelets. It had to work!”

The trial was called the VAMP regimen. Some of the clinical a.s.sociates-the junior doctors a.s.sisting on the ward-refused to take part. They thought Freireich was insane. ”I had to do it all myself,” Freireich said. ”I had to order the drugs. I had to mix them. I had to inject them. I had to do the blood counts. I had to measure the bleeding. I had to do the bone marrows. I had to count the slides.” There were thirteen children in the initial round of the trial. The first was a young girl. Freireich started her off with a dose that turned out to be too high, and she almost died. He sat with her for hours. He kept her going with antibiotics and respirators. She pulled through, only to die later when her cancer returned. But Frei and Freireich were learning. They tinkered with the protocol and moved on to patient number two. Her name was Janice. She recovered, as did the next child and the next child. It was a start.

The only problem was that the cancer wasn't gone. A handful of malignant cells was still lurking. One bout of chemotherapy wouldn't be enough, they realized. So they started up another round. Would the disease return? It did. They needed to try again. ”We gave them three treatments,” Freireich said. ”Twelve of the thirteen relapsed. So I decided, there's only one way to do this. We are going to continue treating them every month-for a year.”9 ”If people thought I was crazy before, now they thought I was completely crazy,” Freireich went on. ”These were children who seemed completely normal, in complete remission, walking around, playing football, and I was going to put them in the hospital again and make them sick again. No platelets. No white cells. Hemorrhage. Infection.” VAMP wiped out the children's immune system. They were defenseless. For their parents, it was agony. In order to have a chance at life-they were told-their child had to be brought savagely and repeatedly to the brink of death.

Freireich threw himself into the task, using every ounce of his energy and audacity to keep his patients alive. In those days, when a patient developed a fever, the physician took a blood culture, and when the results came back, the doctor matched the infection with the most appropriate antibiotic. Antibiotics were never given in combination. You gave a second antibiotic only when the first one stopped working. ”One of the first things Jay said to us was, no deal,” DeVita remembered. ”These kids spike a fever, you treat them immediately, and you treat them with combinations of antibiotics, because they're going to be dead in three hours if you don't.” DeVita had an antibiotic that he had been told should never be administered in the spinal fluid. Freireich told him to give it to a patient-in the spinal fluid. ”Freireich told us to do things,” DeVita said, ”that we had been taught were heretical.

”He was subject to so much criticism,” DeVita continued. ”The clinical a.s.sociates thought that what he was doing was completely nuts. He carried the weight of it. They would insult him-especially the guys from Harvard. They used to stand in the back of the room and heckle. He would say something, and they would say, 'Sure, Jay, and I'm going to fly to the moon.' It was awful, and Jay was there, all the time, hovering over you, looking at every lab test, going over every chart. G.o.d help you if you didn't do something for one of his patients. He was ferocious. He would do things and say things that got him into trouble, or go to some meeting and insult someone and Frei would have to come in and smooth things over. Did he care what people thought of him? Maybe. But not enough to stop doing what he thought was right.10 ”How Jay did it,” he said finally, ”I don't know.”

But we do know, don't we? He had been through worse.

In 1965, Freireich and Frei published ”Progress and Perspectives in the Chemotherapy of Acute Leukemia” in Advances in Chemotherapy, announcing that they had developed a successful treatment for childhood leukemia.11 Today, the cure rate for this form of cancer is more than 90 percent. The number of children whose lives have been saved by the efforts of Freireich and Frei and the researchers who followed in their footsteps is in the many, many thousands.

Does this mean that Freireich should be glad he had the childhood he had? The answer is plainly no. What he went through as a child no child should ever have to endure. Along the same lines, I asked every dyslexic I interviewed the question posed at the beginning of the previous chapter: Would they wish dyslexia on their own children? Every one of them said no. Grazer shuddered at the thought. Gary Cohn was horrified. David Boies has two boys who are both dyslexic, and watching them grow up in an environment where reading early and well counted for everything nearly broke his heart. Here were one of the top producers in Hollywood, one of the most powerful bankers on Wall Street, and one of the best trial lawyers in the country-all of whom recognized how central their dyslexia was to their success. Yet they also knew firsthand what the price of that success was-and they could not bring themselves to wish that same experience on their own children.