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By Root 1028 0

room, paramedics pumping on their chests. At those moments, I realized how my father had received dismal care in Queens. I didn’t have all the details about my father’s treatment, but I learned at MGH that removing pints of blood as away to “unload” the burden on a failing heart was a dated and discarded approach. And though my father struggled to breathe as fluid built up in his lungs, causing pulmonary edema, he wasn’t intubated and placed on a ventilator, which would have assured delivery of oxygen to his heart and other vital organs. At MGH, modern interventions were rapidly marshaled to try to save a stricken man’s life. After doctors placed a tube in the trachea to supply oxygen, powerful medications called pressors were given to prevent the circulatory system from collapsing. When these measures were not enough, a counterpulsation balloon pump was placed into the aorta, acting as a surrogate heart to move blood through the body and sustain life. And if this proved insufficient, a team of cardiac surgeons would take the patient to the operating room to try to open his coronary vessels. Each time the ER team, working with cardiologists and cardiac surgeons, saved the life of a heart attack victim, I rejoiced.

But the joy soon gave way to sadness. I could not unhinge my mind from the fact that the doctor in the Queens hospital had glaring gaps in knowledge and ability. If my father had been given proper care, perhaps he could have been saved. Perhaps not. But if not, there would be no searing sense of regret.

So the culture of my upbringing and the trauma of my father’s death made me a believer in modern medicine, its power and its promise. After my residency at MGH, I sought like-minded physicians with whom to train and work. I considered but ultimately did not choose cardiology. Rather, I entered a field that was less advanced at the time: oncology. The understanding of cancer in the 1970s was primitive. But soon came the DNA revolution with molecular biology. Mapping genes pinpointed the mutations that transformed a healthy cell into a cancerous one. Cancer cells then grow without restraint and spread from the tissue of origin to invade and destroy other parts of the body. I decided I would dedicate myself in the laboratory and the clinic and prove that even under the most dire circumstances of malignancy, science had answers. UCLA Medical Center offered one of the most intensive training programs in the nation, and I went there.

My mentors at UCLA were maximalists in treatment, firmly committed to doing everything all the time. And that determination when treating life-threatening illnesses often made sense. UCLA was home to one of the country’s first bone marrow transplantation centers. During my training, I was part of the team transplanting patients with fatal blood diseases like leukemia. Bone marrow transplantation was an attempt at medical resurrection; patients were brought to the brink of death and then given blood stem cells to try to rescue them. The first years of marrow transplant were grim: All the patients suffered terrible toxicity from the treatment, and very few survived. Yet Dr. E. Donnall Thomas in Seattle and others were believers—like Salk and Sabin, who believed it was possible to eradicate polio. Belief is necessary for progress against deadly and disabling diseases. Don Thomas persisted with stubborn determination in advancing the therapy of marrow transplantation. The treatment was refined, and while still fraught with complications, it ultimately was proven curative for a wide variety of blood-related cancers. Thomas was awarded the Nobel Prize in 1990 in recognition of the countless lives this procedure had saved.

These kinds of successes shaped my approach to cancer treatment. I was drawn to what Stephen J. Gould—the Harvard biologist who developed mesothelioma, a rare and usually lethal malignancy, and lived twenty years after the diagnosis—called the “tail of the curve.” In his essay “The Median Isn’t the Message,” Gould discussed how, as an evolutionary biologist, he understood