The pediatrician, Dr. Donald McLean, was alarmed by Jimmy’s appearance. The fever suggested an infection, and indeed the child had some upper respiratory congestion. But this did not look like an ordinary infection to McLean. At the very least, the child was seriously anemic, with a profound pallor and lethargy. McLean thought the bruises might indicate a deficiency of platelets, the blood component that acts as a clotting mechanism. He performed a quick physical examination and found slightly enlarged lymph nodes but nothing else remarkable. Pallor, bruises, and a persistent fever: the clinical signs pointed to a blood disorder.
McLean suspected that Jimmy Anderson had leukemia, but he did not mention this suspicion to the Andersons. Leukemia is a rare disease, occurring in fewer than four out of one hundred thousand children each year. McLean wanted to see the results of a blood test before he made a diagnosis. It was late Saturday morning, but McLean arranged for the lab to analyze the boy’s blood sample that afternoon. He told the Andersons he should know more by then, and asked them to call him.
On the way home from the doctor’s office, Anne said to Charles: “I think he has leukemia.” The tone of her voice as much as what she’d said caused Charles to turn and look at his wife. She looked very frightened, and that in turn frightened Charles.
When Charles called Dr. McLean that afternoon, the doctor’s voice was grave. “There appears to be a problem with your son’s blood. We’re going to have to do some more tests to find out exactly what’s wrong.” He told Charles he would set up an appointment for Jimmy on Monday morning at Massachusetts General Hospital. He made no mention of leukemia, and Charles did not press him for a diagnosis. “If he knew what Jimmy had, he would have told us,” Charles said to Anne.
The Andersons had guests for dinner that Saturday night. In the kitchen, Anne wept. Nothing Charles said could dissuade her from the conviction that Jimmy had leukemia. The disease held a particular terror for Anne. In 1950, when she was fourteen years old and growing up in Somerville, a girl who lived in her neighborhood had gotten leukemia and died within a matter of weeks. Anne had never been close to the girl, but they’d known each other in passing. Word of the girl’s death had spread in hushed, whispered conversations around Anne’s junior high school. For the first time in her life, Anne understood mortality and death. The disease seemed especially frightening to her because it was such a mystery. It struck suddenly, it was invariably fatal, and no one knew what caused it.
On Monday morning, January 31, Anne and Charles drove to Boston with their son. Jimmy Anderson was examined by Dr. John Truman, the chief of pediatric hematology at Massachusetts General, Boston’s biggest hospital. “Thin, sad-faced 3½ year old with history of pallor and easy bruisability,” noted Truman. “Presents with moderate generalized lymphadenopathy and occasional bruises, but no petechiae. Spleen not palpable.”
Truman performed a bone marrow aspiration (“difficult pull with scant return”) which revealed 32 percent blast cells. Blasts are primitive white blood cells that multiply rapidly but are incapable of developing to maturity. Their numbers left no doubt in Truman’s mind about the diagnosis: acute lymphocytic leukemia.
That afternoon, Truman brought Anne and Charles into his office and told them what he had found. Anne remembered that the winter day was cold and clear, and that the afternoon sun angled through the blinds. She felt oddly distant, as if she were hearing Truman from afar, her attention drawn to the motes of dust that floated in the sunlight.
The next few weeks were very important, said Truman. He would attempt to induce a remission in James by using a combination of powerful drugs and radiation. The chances of a successful remission were good. There was, however, a 10 percent chance that James might die during the next four weeks. The greatest danger was not from the leukemia itself but from an opportunistic infection. Chemotherapy would kill cancerous cells in the blood and bone marrow, but it would also suppress the body’s ability to fight infection. A common childhood illness—the chicken pox, for example, or even a cold—could prove fatal.
When Truman began working with leukemic children in the early 1960s, there was no effective treatment for leukemia. Most children died within weeks of diagnosis. But in the last two years, great advances had been made by the St. Jude Children’s Research Hospital in Memphis. Truman explained to the Andersons the nature of the new treatment program, which was known as the St. Jude protocol. After the initial dosage of chemotherapy and radiation, which would take about a month to complete, James would have to return to the hospital’s outpatient clinic on a regular basis over the next three years. He would follow a maintenance program that included periodic doses of chemotherapy. The regimen, although aggressive and with many side effects, appeared promising. If James went into remission with the first round of chemotherapy, said Truman, his chances of surviving for the next five years were 50 percent or better.
Truman also talked about what caused childhood leukemia. Most parents, he had found, worried that they had done something wrong, or that they could perhaps have prevented the disease. Truman tried to allay the parents’ fears. The cause of acute lymphocytic leukemia was not known, he would tell them. Because that answer seemed so barren, he usually continued with a small disquisition on what was known. Some types of leukemia can be caused by ionizing radiation, or by chemicals like benzene. But that type—acute myelocytic—was not what James had. Some scientists also suspected that viruses might cause leukemia in humans. Viruses were believed to cause leukemia in cats, cows, birds, and rodents, and scientists at Harvard were currently trying to isolate a leukemia virus in cats. But that disease, Truman explained, was a very different illness from the one that afflicted humans.
Jimmy Anderson began the St. Jude protocol on Tuesday, the day after his diagnosis. He received several blood transfusions in an attempt to increase his platelet count. Truman examined the boy each day, looking for signs of infection or new bruises and petechiae, the cluster of small, purplish skin hemorrhages characteristic of leukemia. Anne came to the hospital early every morning. At first she returned home to sleep at night, but soon she began spending the nights with her son in his hospital room. Anne’s mother came to Woburn to look after the two older children.
By the end of the first week, James’s platelet count was still low but holding steady; he had no new bruises or petechiae. He was losing hair and experiencing severe nausea because of the drugs, but Truman felt he was clinically stable. By the end of the month there was no evidence of leukemic cells in either his peripheral blood or bone marrow. He had entered remission precisely on schedule. Everything had gone according to plan, and Truman felt optimistic about the boy’s recovery.
Anne Anderson was thirty-five years old the winter her son became ill. She was a handsome woman, tall and big-boned, from Norwegian ancestry, with high cheekbones, striking blue eyes, and blond hair. She had grown up in Somerville, across the Charles River from Boston, the youngest of four children, the only girl in a family of modest means. After high school, she went to work at the Somerville Public Library. When she was twenty-four years old, still living at home, she met Charles Anderson on a blind date. He was a year older than she, the son of a longshoreman. He had ideas about getting ahead in life. He’d gone to college and he wanted to work in computers. Charles and Anne courted for a year, and then, in 1961, they married.
They lived in a small apartment in the Boston area until, in 1965, they began looking for a house. They had often visited Woburn, where Anne’s best friend from childhood, Carol Gray, had moved with her family several years earlier. Carol and her husband had told a real estate agent that they wanted a house in the country, something close to Boston but with plenty of trees and some open spaces, and the agent had taken them to eastern Woburn.
In the mid-1960s, east Woburn had a pleasing rural aspect. The Aberjona River, a narrow, placid stream, only a few feet wide and waist-deep, ran through a marshland of reeds, cattails, and grassy tussocks. Much of the land on either side of
the river valley had been farmed, and several small farms, an orchard or two, and open fields still remained. Along the river itself, at the edge of the marshes, grew copses of maple, oak, and hickory.
To Anne and Charles, east Woburn seemed like a fine place to settle down. Anne particularly liked the Pine Street neighborhood, not far from where Carol lived. It was a small enclave of about a dozen streets, a mile and a half from the center of town. It occupied the ridge of a low bluff that sloped gently to the east, to the marshlands of the Aberjona. The streets were quiet and shaded by trees, the homes modest, many of them constructed before World War II. No one with money to burn would look for a house in the Pine Street neighborhood, yet once people settled there they seemed to stay for a long while. Charles found the house, a ranch-style built in the early 1950s. It had three small bedrooms and a large picture window in the living room. The shingle siding needed paint, the kitchen floor needed new linoleum, but the price was only $17,900.
Once the Andersons settled in, they began attending Trinity Episcopal Church. Reverend Young was delighted to have new members join his flock, youthful ones at that. Charles and the minister were about the same age and they quickly became friends. In a short while, Charles began serving on the church’s board, and then, at Young’s request, as treasurer of the church.
Jimmy Anderson returned home from the hospital in mid-February. Some of the Andersons’ Pine Street neighbors came to visit, bearing casseroles and baked goods. One woman, Kay Bolster, who lived a block away on Gregg Street, mentioned to Anne that two families on either side of her each had a young boy with leukemia. Kay thought Anne might find some solace in talking to other parents who were going through the same experience. One of the mothers, Joan Zona, was a regular customer at the beauty parlor where Kay worked. Joan was a warm, outgoing woman, said Kay, although she had the impression that Joan was having a difficult time coping with her son’s illness. The boy, whose name was Michael, was not doing well in treatment. The other family, the Nagles, Kay knew only in passing, although from what she had heard it appeared the Nagle boy was doing well.
Shortly after Kay’s visit, Anne phoned Joan Zona. Joan seemed eager for company and invited Anne over for coffee. They spent two hours together that first day. When Anne left, she and Joan hugged each other. The visits and phone conversations with Joan soon became part of Anne’s daily life. “Joan and I sort of hung on to each other,” recalled Anne some years later.
Michael Zona, the youngest of Joan’s four children, was being treated at the Children’s Hospital in Boston on a protocol similar to Jimmy’s. He had been diagnosed ten months before Jimmy, and Joan knew all about the hospital routines, the drugs and radiation, the side effects, knowledge that she readily shared with Anne.
One thing after another befell young Michael Zona, like toppling dominoes, and it seemed that nothing could intervene to save him. His problems had started with a mild cough that had gotten progressively worse. The family doctor had treated him with cough syrup and antibiotics, but he had failed to improve. One night when Michael complained that he couldn’t breathe, Joan took him to the emergency room. At first, the doctors thought he was suffering from bronchial asthma. Then they discovered a tumor the size of an olive in the mediastinum, a lymphosarcoma, between his right and left lungs. He underwent radiation treatments. A bone marrow biopsy later revealed that he had acute lymphocytic leukemia, the same disease Jimmy Anderson had.
Anne thought it strange that three cases of leukemia should occur in the same neighborhood, within a few blocks of each other. She wondered if it was coincidence, or if a virus of some sort was circulating. Dr. Truman, she remembered, had mentioned that some cancer researchers suspected a virus might cause childhood leukemia. Although she knew that was an unproven hypothesis, she and Carol Gray spent hours speculating about it.
Anne mentioned her suspicions to Joan Zona, too. Joan agreed that three cases of leukemia in the same small neighborhood did seem unusual, but she did not dwell on the subject the way Anne did. She was too preoccupied with Michael’s downward spiral to care about much else. In June 1972, while Jimmy was in remission and his prospects looked good, Michael Zona relapsed. His doctors attempted to induce a second remission with an experimental drug called Adriamycin, a highly toxic drug that causes deterioration of the heart muscles at levels near the therapeutic dose for leukemia. The therapy worked, and by July Michael was again in remission. It was short-lived, however. In late October, with his blood counts still alarmingly low, Michael’s doctor performed a bone marrow aspiration and found that 25 percent of the cells were blasts. Michael had relapsed for a second time. The cycle began again: another protocol was attempted, and yet another remission was induced. But the chances for Michael’s long-term survival were not good.
During a visit to the clinic at Massachusetts General that spring, Anne told Dr. Truman about the Zonas and the Nagles. Wasn’t it unusual, she asked, that there were three cases in the same neighborhood?
Truman listened in his polite, attentive manner, tall frame slightly stooped, but he would admit later that he did not give Anne’s question any serious consideration. He’d learned over the years that parents of children with leukemia tended to develop a heightened awareness of the illness. Everywhere they turned it seemed they encountered a reference to it, or someone else whose child had it. To Truman, this was not an uncommon psychological phenomenon. Many years later, in a deposition, Truman recalled his reaction to Anne’s queries: “My response was that on the basis of the number of children with leukemia that I was aware of at the time, and considering the population of the city of Woburn, I did not think the incidence of leukemia appeared to be increased. In essence, I dismissed her suggestion.”
Nor did it occur to Truman a year later, in June 1973, that there was anything unusual about the illness of a two-and-a-half-year-old boy from east Woburn named Kevin Kane, Jr. The boy had been referred to Truman from Winchester Hospital, where his mother, a nurse, had taken him because of a persistent fever, pallor, and irritability. Two weeks earlier he had been treated unsuccessfully for a respiratory infection that did not respond to penicillin. His history on presentation at Winchester Hospital included several respiratory infections as well as recurrent episodes of earaches. Winchester referred Kevin Kane to Dr. Truman at Massachusetts General with a “high suspicion” of acute lymphocytic leukemia. Truman confirmed the suspicion. He began treating Kevin Kane on a chemotherapy regimen similar to the St. Jude protocol. The child responded well. At four weeks, a bone marrow aspiration revealed that he was in remission.
Kevin Kane, Sr., and his wife, Patricia, lived with their four children on Henry Avenue in east Woburn. Henry Avenue curved around the perimeter of a low bluff overlooking the Aberjona marsh. From the back door of the Kanes’ house, looking east across the expanse of marsh, you could see the houses of the Pine Street neighborhood a quarter of a mile away. If you looked closely, you could see Orange Street and, through the trees, the red-shingled ranch house of the Andersons.
Anne found out about the Kanes’ child from Carol Gray, whose fourteen-year-old son delivered the Woburn Daily Times every afternoon along Henry Avenue. In the summer of 1973, as Carol’s son made his rounds, he learned that one of the Kanes’ children had leukemia. He reported the news to his mother, who went immediately to the phone and called Anne. “What the hell is going on here?” Carol said to Anne.
With the discovery of yet another leukemia case, Anne began writing down some of her thoughts. She made the first of many lists of the cases she knew about, writing in a spiral notebook the names of the children, their addresses, their ages and the dates when she figured they had been diagnosed.
The notion that each case shared some common cause began to obsess her. “The water and the air were the two things we all shared,” she said in a deposition some years later. “And the water was bad. I thought there was a virus that might have been transmitted through the water, some kind of a leukemia virus. The wate
r had never tasted right, it never looked right, and it never smelled right. There were times when it was worse than others, usually during the summer, and then it was almost impossible to drink. My mother would bring some water from Somerville to the house on weekends, probably about three quarts, which we used as drinking water. The rest of the time, when we could mask the flavor of it with Zarex or orange juice or coffee or whatever, then we used water from the tap. But you couldn’t even mask it. It ruined the dishwasher. The door corroded to such a degree that it had to be replaced. The prongs that hold the dishes just gave way and broke off. On a regular basis, the pipes under the kitchen sink would leak, and under the bathroom sink. The faucets had to be replaced. The bathroom faucet dripped constantly. It seemed like no sooner would I get everything fixed and we’d have another problem.”
3
Long before Jimmy’s diagnosis, Anne’s neighbors in east Woburn would talk among themselves about the water the way most other people would talk about the weather. Like the weather, it seemed there was nothing one could do about the water, although people kept trying.
When Carol Gray moved to Woburn in 1961, there had been nothing unusual about the water. But by the time Anne and Charles moved into their house on Orange Street, in 1965, people in east Woburn had started to notice a change. “Does the water taste funny to you?” Anne had asked Carol during her first summer in Woburn. “Or is it just me?”
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