The Emperor of All Maladies. Siddhartha Mukherjee
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and nauseated from chemotherapy, children barely able to hold their heads and bodies upright, let alone be paraded publicly as optimistic mascots for cancer treatment. Looking frantically through the patient lists, Farber and Koster found a single child healthy enough to carry the message—a lanky, cherubic, blue-eyed, blond child named Einar Gustafson, who did not have leukemia but was being treated for a rare kind of lymphoma in his intestines.
Gustafson was quiet239 and serious, a precociously self-assured boy from New Sweden, Maine. His grandparents were Swedish immigrants, and he lived on a potato farm and attended a single-room schoolhouse. In the late summer of 1947, just after blueberry season, he had complained of a gnawing, wrenching pain in his stomach. Doctors in Lewiston, suspecting appendicitis, had operated on his appendix, but found the lymphoma instead. Survival rates for the disease were low at 10 percent. Thinking that chemotherapy had a slight chance to save him, his doctors sent Gustafson to Farber’s care in Boston.
Einar Gustafson, though, was a mouthful of a name. Farber and Koster, in a flash of inspiration, rechristened him Jimmy.
Koster now moved quickly to market Jimmy. On May 22, 1948, on a warm Saturday night in the Northeast240, Ralph Edwards, the host of the radio show Truth or Consequences, interrupted his usual broadcast from California and linked to a radio station in Boston. “Part of the function of Truth or Consequences,” Edwards began, “is to bring this old parlor game to people who are unable to come to the show. . . . Tonight we take you to a little fellow named Jimmy.
“We are not going to give you his last name because he’s just like thousands of other young fellows and girls in private homes and hospitals all over the country. Jimmy is suffering from cancer. He’s a swell little guy, and although he cannot figure out why he isn’t out with the other kids, he does love his baseball and follows every move of his favorite team, the Boston Braves. Now, by the magic of radio, we’re going to span the breadth of the United States and take you right up to the bedside of Jimmy, in one of America’s great cities, Boston, Massachusetts, and into one of America’s great hospitals, the Children’s Hospital in Boston, whose staff is doing such an outstanding job of cancer research. Up to now, Jimmy has not heard us. . . . Give us Jimmy please.”
Then, over a crackle of static, Jimmy could be heard.
Jimmy: Hi.
Edwards: Hi, Jimmy! This is Ralph Edwards of the Truth or Consequences radio program. I’ve heard you like baseball. Is that right?
Jimmy: Yeah, it’s my favorite sport.
Edwards: It’s your favorite sport! Who do you think is going to win the pennant this year?
Jimmy: The Boston Braves, I hope.
After more banter, Edwards sprung the “parlor trick” that he had promised.
Edwards: Have you ever met Phil Masi?
Jimmy: No.
Phil Masi (walking in): Hi, Jimmy. My name is Phil Masi.
Edwards: What? Who’s that, Jimmy?
Jimmy (gasping): Phil Masi!
Edwards: And where is he?
Jimmy: In my room!
Edwards: Well, what do you know? Right here in your hospital room—Phil Masi from Berlin, Illinois! Who’s the best home-run hitter on the team, Jimmy?
Jimmy: Jeff Heath.
(Heath entered the room.)
Edwards: Who’s that, Jimmy?
Jimmy: Jeff . . . Heath.
As Jimmy gasped, player after player filed into his room bearing T-shirts, signed baseballs, game tickets, and caps: Eddie Stanky, Bob Elliott, Earl Torgeson, Johnny Sain, Alvin Dark, Jim Russell, Tommy Holmes. A piano was wheeled in. The Braves struck up the song, accompanied by Jimmy, who sang loudly and enthusiastically off-key:
Take me out to the ball game,
Take me out with the crowd.
Buy me some peanuts and Cracker Jack,
I don’t care if I never get back
The crowd in Edwards’s studio cheered, some noting the poignancy of the last line, many nearly moved to tears. At the end of the broadcast, the remote link from Boston was disconnected. Edwards paused and lowered his voice.
“Now listen, folks. Jimmy can’t hear this, can he? . . . We’re not using any photographs of him, or using his full name, or he will know about this. Let’s make Jimmy and thousands of boys and girls who are suffering from cancer happy by aiding the research to help find a cure for cancer in children. Because by researching children’s cancer, we automatically help the adults and stop it at the outset.
“Now we know that one thing little Jimmy wants most is a television set to watch the baseball games as well as hear them. If you and your friends send in your quarters, dollars, and tens of dollars tonight to Jimmy for the Children’s Cancer Research Fund, and over two hundred thousand dollars is contributed to this worthy cause, we’ll see to it that Jimmy gets his television set.”
The Edwards broadcast lasted eight minutes. Jimmy spoke twelve sentences and sang one song. The word swell was used five times. Little was said of Jimmy’s cancer: it lurked unmentionably in the background, the ghost in the hospital room. The public response was staggering. Even before the Braves had left Jimmy’s room that evening, donors had begun to line up outside the lobby of the Children’s Hospital. Jimmy’s mailbox was inundated241 with postcards and letters, some of them addressed simply to “Jimmy, Boston, Massachusetts.” Some sent dollar bills with their letters or wrote checks; children mailed in pocket money, in quarters and dimes. The Braves pitched in with their own contributions. By May 1948, the $20,000 mark set by Koster had long been surpassed; more than $231,000 had rolled in. Hundreds of red-and-white tin cans for donations for the Jimmy Fund were posted outside baseball games. Cans were passed around in film theaters to collect dimes and quarters. Little League players in baseball uniforms went door-to-door with collection cans on sweltering summer nights. Jimmy Days were held in the small towns throughout New England. Jimmy’s promised television—a black-and-white set with a twelve-inch screen set into a wooden box—arrived and was set up on a white bench between hospital beds.
In the fast-growing, fast-consuming world of medical research in 1948, the $231,000 raised by the Jimmy Fund was an impressive, but still modest sum—enough to build a few floors of a new building in Boston, but far from enough to build a national scientific edifice against cancer. In comparison, in 1944, the Manhattan Project spent242 $100 million every month at the Oak Ridge site. In 1948, Americans spent more than $126 million243 on Coca-Cola alone.
But to measure the genius of the Jimmy campaign in dollars and cents is to miss its point. For Farber, the Jimmy Fund campaign was an early experiment—the building of another model. The campaign against cancer, Farber learned, was much like a political campaign: it needed icons, mascots, images, slogans—the strategies of advertising as much as the tools of science. For any illness to rise to political prominence, it needed to be marketed, just as a political campaign needed marketing. A disease needed to be transformed politically before it could be transformed scientifically.
If Farber’s antifolates were his first discovery in oncology, then this critical truth was his second. It set off a seismic transformation in his career that would far outstrip his transformation from a pathologist to a leukemia doctor. This second transformation—from a clinician into an advocate for cancer research—reflected the transformation of cancer itself. The emergence of cancer from its basement into the glaring light of publicity would change the trajectory of this story. It is a metamorphosis