When Jonathan returned to Julianna’s room, Jimmy met him at the door. “It worked!!” Jonathan walked into the room and Julianna flashed him a wide, wide grin.
As Jonathan and Marion traveled back to New York on the train, he told her, “This discovery will be a landmark in the history of medicine.”
“Your mother would be so pleased, don’t you think?” Marion said.
“Yes, but her pleasure would be tempered by the discovery being limited to just treating one specific disease. The crusade most certainly includes every incremental victory, just as Richard the Lionheart won one Mediterranean coastal town after another to isolate Jerusalem. The Holy Grail—well, that has to be a blockbuster. It has to cut a wide swath through disease to open up all possibilities in medicine—chemotherapeutic treatment, successful elective surgeries, isolation of viruses, protection of soldiers from wartime disease. Indeed. A blockbuster.”
PART III
YELLOW GRAIL
1934–1942
Chapter Twenty-nine
TIP OF THE ICEBERG
“See there, that’s the Mississippi.”
“Are you sure? It looks so small.”
“Well, we’re five thousand feet in the air.”
“Oh, Dios mio. This is as close to God as I want to get until I meet Him. Are you sure you can land this?” Jimmy was flying Jonathan, Marion and his wife Sarah to Iowa City to meet with Frederick Specht. Inspired by the medical advances that had saved his life and his mother’s, Jimmy wanted to follow the family tradition, though he did not have the temperament to endure all those years of study. He liked to be moving, doing things. That was one reason why flying was such a thrill—the ability to go anywhere, any time. He went into the business of medical devices and by 1934 he was well established in the field. He had also met and married Sarah Marquez and started a family. He found that he enjoyed innovating in business, and now he wanted to enlist Frederick Specht to help him with his latest idea.
To Sarah’s immense relief, they landed safely and descended the plane to the Spechts’ applause. While Helene gave Sarah and Marion a walking tour of the town, the three men sat on a bench on the east bank of the Iowa River looking up at the new hospital complex. Frederick perched his feet on a knotty old tree stump and asked, “How is your mother, Jimmy?”
“For someone who is sixty-two she’s doing great. She finally retired from practice, and has become a full-time grandma now. And we need her. George is seven, Julie is six, and Patricia just about four.”
“How is she doing with her diabetes?”
“The insulin worked a real miracle for her. Mom can even keep up with the kids – at least with help from our nanny.”
“Your father would be proud of his grandchildren.”
Jimmy looked out over the river. “I wish he could have seen my kids, but at least my mother did.” He stood and gazed into the sky. “Say! How about a ride in the plane?” Specht laughed and waved off the idea.
“I got the bug for flying when I was in World War I. I was one of the first persons in Chicago to own a plane. Boy, planes have really improved in the last decade.”
“I wish medicine had done as well,” Jonathan growled. “The only medical discovery of note was pertussis vaccine—whooping cough is a childhood infection of the past. But no other discoveries occurred until last year. With medicine’s pattern of fits and starts I predict this decade will be very productive. It has started well!”
Jimmy settled himself back on the bench, knowing that his uncle would give them all the details. “We finally identified the virus that caused the Spanish Influenza.”
“Yes, I heard that. It’s called...,” Frederick began, but Jonathan was not to be stopped.
“The H1N1 virus. Doctor Ernest Goodpasture finally discovered a method to isolate viruses. He makes a small hole in an egg with a sterile needle, injects the virus into the egg and quickly seals the hole so bacteria are excluded. The virus multiplies in the egg yolk.”
“Very clever,” said Frederick. “A simple idea that works well. It’s a little like—”
“Unfortunately,” Jonathan said, tapping the bench, “this technique doesn’t work for all viruses. For instance, we can’t get polio to grow. But what a brilliant idea! Now we can isolate influenza, measles, and rickettsia like typhus. That means we can make vaccines for these viral diseases. Imagine control of typhus.”
Frederick looked at Jonathan for a moment, and then Jimmy, who raised his eyebrows encouragingly. “It has started well for orthopedics too,” Frederick offered, and waited to make sure Jonathan had nothing more to say. “This new hip nail is the first effective fixation device that’s been designed. Doctor Marius Smith-Petersen in Boston had an idea that had escaped other minds. It’s an I-beam nail with sharp phalanges so it cuts through bone yet has rotational stability to hold the fractured parts together. This advance opens the door for a new era of mechanical devices for surgery.”
“That’s exactly the kind of thing I came to talk to you about Frederick,” Jimmy said enthusiastically.
“Yes, you said you had a business idea that for some reason you think I can help you with.”
Jimmy leaned toward Specht. “It has become clear to me, Frederick, that medicine’s discoveries are going to multiply. Look at the success Eli Lilly has had with insulin. Bayer made a fortune on aspirin – at least until we opened up their proprietary rights after the war. The same kind of thing can happen with orthopedics.”
“You are very optimistic, Jimmy. How is this going to happen? Twenty percent of the men are out of work. The farmers here can’t make a profit on what they raise. Many of the people I treat can’t eat properly when they return home from my hospital, much less pay me.”
“Frederick, you’re right—I am an optimist. Things are looking up—sure, unemployment is still pretty high, but the economy is coming back.”
“I still say we shouldn’t have gone off the gold standard,” Jonathan began, but Jimmy continued talking.
“And even with the bad economy there are new ideas. An economic downturn doesn’t cause the creative mind to stop. I’m here in Iowa City because of the new device for hip fractures. Medicine is going to be big business soon. There are already some outfits, but my crystal ball says they’re small potatoes. The hip nail is the tip of the iceberg. My Uncle Jonathan wants cures for disease, but I think the future is greater in medical discoveries that fix the human machine. That’s what insulin does. It doesn’t cure diabetes, but it repairs the altered body. Your hip nail puts the broken body back together.”
“I’d like to see that, Frederick,” Jonathan interjected.
“And you shall, and not so long from now. So, Jimmy, what’s your business plan? What am I good for?”
“Frederick, I’m building for the future. I envision orthopedics as being a lucrative business opportunity in medicine. Everyone owns a car now—”
“And they crash them—thirty thousand deaths from automobile accidents last year. Who knows how many fractures occur?”
“A couple of orthopedic companies have been started,” Frederick said, thinking out loud. “A man named Zimmer, out of Warsaw, Indiana, sells mostly braces and splints. But Jimmy, there are not many products for a company to sell now.”
“What if we pay doctors royalties for their inventions, and provide the money needed for their research? I bet devices would soon be available for fractures, straightening the spine, and arthritic joints.” Jimmy explained his vision: with safer anesthesia, sterile gowns and drapes, gloves and masks, steam sterilization of instruments and antiseptic chemicals for skin and wounds, the threat of infection was not the deterrent it was prior to World War I. Implantation of devices inside the body was a possibility now, whereas before any device was simply a source of infection.
Frederick frowned. “To receive payment for research or a device is foreign to doctors. Doctors don’t invent things because they want to make money—they do it because they have a vision tha
t drives them to heights others are not capable of. Marie and Pierre Curie did not patent radioactivity—in fact they showed their methodology to anyone who was interested. The vaccines have been distributed by the laboratories that made them, not by drug companies. If the business of medicine gets big, government will impose regulations, just like Teddy Roosevelt did with the Pure Food and Drug Act. So it is not going to be good for doctors in the long run,” he concluded firmly. “Jonathan, what do you think about all this?”
Jonathan, who had heard about Jimmy’s plan in detail, smiled slowly and said to Frederick, “Let’s forget about the money for a moment. If doctors want to remain poor as a church mouse, business will be happy to accommodate them. But let me ask you a question in return. How do you find out about new devices in your field?”
“Well, I read the journals, and I correspond with the other doctors I know...and sometimes there are some announcements in the newspapers about things.”
“What if you had someone whose job it was to find out about new devices and the like, and they came to you on a regular basis to tell you about them?”
Frederick raised an eyebrow at Jonathan and replied carefully, “Well, that would be useful, I suppose.”
“You know it would be,” Jimmy said emphatically. “That’s what I want to offer you. You have to buy the things anyway, and I’m giving you a much easier and more efficient way to do that.”
Frederick looked at Jimmy and then at Jonathan and rubbed his chin thoughtfully. “A company that distributes medical products and informs doctors about what’s new, that could be helpful.”
“There you go,” Jimmy smiled. “My company will disseminate information and distribute products. I will buy up devices and sell them to doctors and hospitals. The Sullivan Foundation can fund research to motivate and accelerate innovation.”
The two of them stopped talking as the whistle of the four o’clock train pierced the air. Frederick stood up. “Jonathan, you asked about seeing the hip nail. Come back to the hospital with me. I have a patient arriving on this train who has a problem with his hip. Jimmy, let me tell you something about the hip nail. It was invented by Marius Smith-Petersen, who had the idea while riding home on a train from a medical conference in 1925. It took him more than five years to finalize it. So you see your investments will have to be for the long term, not the quick buck.”
In Frederick’s office, he pulled a three-inch long triflange nail from his desk drawer that would be used to secure the two fragments of a hip fracture and hold the bones aligned and stable while the bone cells grow together across the break. Jonathan said, “It seems so simple, Frederick. Why didn’t someone design this years ago?”
Frederick shrugged. “The key is the shape. Before, only round nails and smooth nails were used. You know, a round peg in a round hole. But it quickly worked loose. This design stays in place.” Fixation of the fracture meant patients could get out of bed, which in turn meant that a hip fracture was no longer sure death from pneumonia, urinary infections, bedsores, or blood clots caused by bed rest.
“The other deterrent has always been infection. Not only do we open the body to the bone, but we put a metal device into the bone. The device can have bacteria on it and the blood supply to the bone is disrupted by the fracture so healing is compromised and germs have an environment in which they can flourish. All we can do to guard against that is to be scrupulously clean and keep the surgical environment perfectly sterile.”
“No wonder Uncle Jonathan is always desperately looking for a chemotherapeutic drug to kill germs,” Jimmy frowned. “What a day that will be for medicine!”
Frederick agreed to work with Jimmy in building the Sullivan Company’s medical business. He knew as well as Jimmy that devices were the future of orthopedics. Jonathan recognized this advance to be just as important as a new drug. These devices influenced cell action too. If bone-forming cells, osteoblasts, were subjected to constant motion they quit working. Then fibroblasts took over and formed fibrous tissue, and that prevented the bone from healing. Patients couldn’t walk on bones linked by soft tissue, but bone cells that were stable formed new bone.
Frederick brought Jonathan along to meet his new patient. Wesley Johnson was a farmer, short, stocky, and sturdy. Now he was completely incapacitated and without the hip nail operation was destined to die. Frederick shook his hand and introduced him to Jonathan. “Doctor Sullivan is a colleague of mine who would like to observe the operation. So, let me ask you, Wesley, what exactly happened?”
Johnson sighed heavily. “I was fixing a few holes on the house roof like I do every year after winter is over. The shingles broke free and that was all she wrote. I rolled off and hit the ground. I figured I was a goner.” Wesley shook his head. “Might as well be a goner if I can’t work my farm. I just hope you can fix me up good, doctor. Life’s hard enough already with the drought and the Depression.”
“I’ll get it done, Wesley,” Frederick said.
The next morning Jonathan stood next to Frederick as they scrubbed their hands and arms using sinks next to the operating room. Jimmy stood off to the side watching. There were two operating rooms at the north end of the orthopedic hospital, isolated from each other and each with its own fresh air supply. Everyone in the operating room wore a surgical scrub suit, a hat, and a mask. If the person was to be next to the operating table, a sterile gown and surgical gloves were added. Jonathan thought of how surgery was performed when he trained in the 1890s—in an open amphitheatre with multiple curving rows of seats ascending above a pit in which the surgeon operated on the patient. No one wore gloves or a mask or a hat to cover hair. A surgical apron was worn over the surgeon’s suit. No wonder infection rates were prohibitive and elective surgery avoided, he thought. Even with these modern improvements in the operating room environment, infection rates could still be ten to fifty percent depending on the surgery.
Wesley Johnson was lying supine on the operating table with sterile drapes covering his body except for the left hip area. Frederick made a longitudinal incision down the front of the hip from the prominent bone at the top of the pelvis down into the groin. Beneath the skin and fat, Jonathan and an assistant separated two muscles with retractors. Frederick incised the capsule that enclosed the hip and suddenly blood spurted out. “Blood from the fracture,” he explained. Using bone forceps he aligned the two fractured fragments of the hip bone. “Hold these, Jonathan.”
Jimmy was standing on tiptoes against the wall trying to follow Specht’s moves. He knew Jonathan’s colleague Spanezzi was working to modify this part of the operation, not opening the hip but rather manipulating the leg as a way of reducing the fracture and then confirming it was aligned by x-ray. It was inevitable that the operation would be modified, as every treatment was as doctors used it.
Frederick made a stab incision on the side of the hip and the scrub nurse handed him the flanged nail. He punctured the outside of the femur bone with the sharp tip of the nail and then began to hammer it slowly into the bone. Tap, tap, tap. With his gloved hand he felt the fracture site to be sure it did not separate as the nail was malletted. Tap, tap, tap again. “I’ve crossed the fracture,” he announced. Ten more blows and the nail was secured in the bone.
Frederick cradled the leg in his hands and moved it in a circular fashion, then bent it and straightened it. Jonathan watched the hip bone move as a unit. “Amazing. Solid as a rock.”
“Yes, he’ll be out of bed and walking on crutches within five days. There is more than one way to battle the Captain of Death. And his sergeant, Bed Sores.” Jonathan and Frederick shared a laugh. Jimmy, against the wall, thought excitedly of the number of these hip nails he could sell.
Jonathan, Jimmy and Frederick sat in the doctor’s lounge after the operation. “It really is exciting when we get a new truly effective treatment for patients,” Frederick said. “We can do so much more than we could thirty years ago when I first treated patients. We have tamed so much of the biologic chaos
Nature causes, even without a miracle drug.” Frederick looked at his hands, his fingers pressed together to form a steeple. “There are men like Welch and his protégés who are great research scientists. They are driven by their scientific prowess and the seduction of unraveling the mystery of the human body, always trying to grasp something one step beyond their current reach.”
“That sounds like you, Uncle Jonathan!” Jimmy said. Jonathan nodded in affirmation.
“And then there are physicians like me. My calling requires more of a human touch. Without patients there is a void in me no laboratory or great discovery can ever fill. The joys and suffering of my patients will always be mine to bear because I connect with those I treat. Medicine’s improvements have enriched my life because I can better relieve the suffering of my patients.”
Chapter Thirty
DEVIL’S BLOOD
—1936—
The scraping metal sounds of the stool sliding down towards her legs sent a shiver up Marion’s spine. She closed her eyes tightly as her feet were gently lifted into the icy steel stirrups and the blanket rolled back off her legs. One of the nurses moved the lamps closer to her lower limbs and a second nurse positioned herself next to the doctor to assist him. The squeak of soft rubber could be heard over the nurses’ voices as Phil donned his gloves.
Marion had come to see Phil, now respected as one of the original general surgeons in New York City, because she knew something was wrong. The cramping in her abdomen had finally subsided but she could still feel the sticky sensation of drying blood between her legs. She knew enough about miscarriages to recognize the symptoms.
“Are you pregnant?” Phil asked.
“Up until today, I didn’t have any reason to think so. I haven’t had any symptoms. I thought I was past all that anyway.” Although she and Jonathan still enjoyed each other, they had never even had a hint of a pregnancy since Jackson. Surely, if an accidental pregnancy was to occur it would have happened years earlier.
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