Читать книгу The Emperor of All Maladies - Siddhartha Mukherjee, Siddhartha Mukherjee - Страница 22

The House That Jimmy Built

Etymologically, patient means sufferer²⁴⁴. It is not suffering as such that is most deeply feared but suffering that degrades.

—Susan Sontag, Illness as Metaphor

Sidney Farber’s entire purpose²⁴⁵ consists only of “hopeless cases.”

—Medical World News, November 25, 1966

There was a time when Sidney Farber had joked about the smallness of his laboratory. “One assistant and ten thousand mice,”²⁴⁶ he had called it. In fact, his entire medical life could have been measured in single digits. One room, the size of a chemist’s closet, stuffed into the basement of a hospital. One drug, aminopterin, which sometimes briefly extended the life of a child with leukemia. One remission in five, the longest lasting no longer than one year.

By the early months of 1951, however, Farber’s work was growing exponentially, moving far beyond the reaches of his old laboratory. His outpatient clinic, thronged by parents and their children, had to be moved outside the hospital to larger quarters in a residential apartment building on the corner of Binney Street and Longwood Avenue. But even the new clinic was soon overloaded. The inpatient wards at Children’s had also filled up quickly. Since Farber was considered an intruder by many of the pediatricians at Children’s, increasing ward space within the hospital was out of the question. “Most of the doctors²⁴⁷ thought him conceited and inflexible,” a hospital volunteer recalled. At Children’s, even if there was space for a few of his bodies, there was no more space for his ego.

Isolated and angry, Farber now threw himself into fund-raising. He needed an entire building to house all his patients. Frustrated in his efforts to galvanize the medical school into building a new cancer center for children, he launched his own effort. He would build a hospital in the face of a hospital.

Emboldened by his early fund-raising success, Farber devised ever-larger drives for research money, relying on his glitzy retinue of Hollywood stars, political barons, sports celebrities, and moneymakers. In 1953, when the Braves franchise left²⁴⁸ Boston for Milwaukee, Farber and Koster successfully approached the Boston Red Sox to make the Jimmy Fund their official charity.

Farber soon found yet another famous recruit: Ted Williams—a young ballplayer of celluloid glamour—who had just returned after serving in the Korean War. In August 1953, the Jimmy Fund planned a “Welcome Home, Ted” party²⁴⁹ for Williams, a massive fund-raising bash with a dinner billed at $100 per plate that raised $150,000. By the end of that year, Williams was a regular visitor at Farber’s clinic, often trailing a retinue of tabloid photographers seeking pictures of the great ballplayer with a young cancer patient.

The Jimmy Fund became a household name and a household cause. A large, white “piggy bank” for donations (shaped like an enormous baseball) was placed outside the Statler Hotel. Advertisements for the Children’s Cancer Research Fund were plastered across billboards throughout Boston. Countless red-and-white collection canisters—called “Jimmy’s cans”—sprouted up outside movie theaters. Funds poured in from²⁵⁰ sources large and small: $100,000 from the NCI, $5,000 from a bean supper in Boston, $111 from a lemonade stand, a few dollars from a children’s circus in New Hampshire.

By the early summer of 1952, Farber’s new building, a large, solid cube perched on the edge of Binney Street, just off Longwood Avenue, was almost ready. It was lean, functional, and modern—self-consciously distinct from the marbled columns and gargoyles of the hospitals around it. One could see the obsessive hand of Farber in the details. A product of the 1930s, Farber was instinctively frugal (“You can take the child out of the Depression,²⁵¹ but you can’t take the Depression out of the child,” Leonard Lauder liked to say about his generation), but with Jimmy’s Clinic, Farber pulled out all the stops. The wide cement steps leading up to the front foyer—graded by only an inch, so that children could easily climb them—were steam-heated against the brutal Boston blizzards that had nearly stopped Farber’s work five winters before.

Upstairs, the clean, well-lit waiting room had whirring carousels and boxes full of toys. A toy electric train, set into a stone “mountain,” chugged on its tracks. A television set was embedded on the face of the model mountain. “If a little girl got attached to a doll,”²⁵² Time reported in 1952, “she could keep it; there were more where it came from.” A library was filled with hundreds of books, three rocking horses, and two bicycles. Instead of the usual portraits of dead professors that haunted the corridors of the neighboring hospitals, Farber commissioned an artist to paint full-size pictures of fairy-book characters—Snow White, Pinocchio, and Jiminy Cricket. It was Disney World fused with Cancerland.

The fanfare and pomp might have led a casual viewer to assume that Farber had almost found his cure for leukemia, and the brand-new clinic was his victory lap. But in truth his goal—a cure for leukemia—still eluded him. His Boston group had now added another drug, a steroid, to their antileukemia regimen, and by assiduously combining steroids and antifolates, the remissions had been stretched out by several months. But despite the most aggressive therapy, the leukemia cells eventually grew resistant and recurred, often furiously. The children who played with the dolls and toy trains in the bright rooms downstairs were inevitably brought back to the glum wards in the hospital, delirious or comatose and in terminal agony.

One woman whose child was treated for cancer in Farber’s clinic in the early fifties wrote, “Once I discover that almost all²⁵³ the children I see are doomed to die within a few months, I never cease to be astonished by the cheerful atmosphere that generally prevails. True, upon closer examination, the parents’ eyes look suspiciously bright with tears shed and unshed. Some of the children’s robust looks, I find, are owing to one of the antileukemia drugs that produces a swelling of the body. And there are children with scars, children with horrible swellings on different parts of their bodies, children missing a limb, children with shaven heads, looking pale and wan, clearly as a result of recent surgery, children limping or in wheelchairs, children coughing, and children emaciated.”

Indeed, the closer one looked, the more sharply the reality hit. Ensconced in his new, airy building, with dozens of assistants swirling around him, Farber must have been haunted by that inescapable fact. He was trapped in his own waiting room, still looking for yet another drug to eke out a few more months of remission in his children. His patients—having walked up the fancy steamed stairs to his office, having pranced around on the musical carousel and immersed themselves in the cartoonish gleam of happiness—would die, just as inexorably, of the same kinds of cancer that had killed them in 1947.

But for Farber, the lengthening, deepening remissions bore quite another message: he needed to expand his efforts even further to launch a concerted battle against leukemia. “Acute leukemia,” he wrote²⁵⁴ in 1953, has “responded to a more marked degree than any other form of cancer . . . to the new chemicals that have been developed within the last few years. Prolongation of life, amelioration of symptoms, and a return to a far happier and even a normal life for weeks and many months have been produced by their use.”

Farber needed a means to stimulate and fund the effort to find even more powerful antileukemia drugs. “We are pushing ahead as fast as possible,” he wrote in another letter—but it was not quite fast enough for him. The money that he had raised²⁵⁵ in Boston “has dwindled to a disturbingly small amount,” he noted. He needed a larger drive, a larger platform, and perhaps a larger vision for cancer. He had outgrown the house that Jimmy had built.