This is a first son’s dream: I am going to be just like my father. A second son says, I will be different. The first son says, I am going to be just like Dad but better—cosmically better—and save the world.
Both Jamie and later Ben went through their father’s department at MIT and graduated with degrees in mechanical engineering. But like many middle sons, Stephen rejected his father’s line of work and went looking for one of his own. He went to Colgate, where he experimented with writing, painting, and what he later decided was more than his share of illegal substances. He wandered after college, too, tooling across the country on a customized Harley-Davidson in a brown leather motorcycle jacket and brown leather boots, a diamond in one ear. With his girlfriend, Stephanie—they had been together on and off since they were sixteen—Stephen backpacked in the Rocky Mountains. Wherever he lived, he picked up odd jobs painting and carpentering.
Stephen was now as sturdy as he was tall, with thick black hair, a clear, steady gaze, and a strong, square, cleft chin. He wore T-shirts and khakis and a three-day stubble.
Jamie’s forehead was higher and his cleft chin tapered to a point. He had the kind of bright pale face that signals health as much as good color. His high-wattage shine, along with his intensity, and his remarkably regular features, made him look like a man from the future. He became something of a clotheshorse. He liked expensive Eastern-establishment suits. Sometimes he dressed like the young Turks and techno-prophets: black Italian jackets with dark shirts and dark silk ties that set off his pale face and had their own mystic and expensive sheen.
Stephen was happy to be a twentysomething in the generation that called itself X, for expectations unknown. He was ironic, he was laconic, and he did not mind saying he was lazy. He enjoyed being a slacker.
“I’ve been sponging off my parents for years,” he used to say. “I’m totally a Gen Xer.”
“Stephen totally defines it,” said Jamie.
But the Heywood brothers stayed close. They were all exceptionally talented, and they had an old-fashioned style of family pride. When Ben graduated from high school, Stephen sent him a small check and a scrawled note:
What, a letter from Steve? This is for graduation, and also to tell you that I’m proud of you. You have managed to do a heck of a lot better than either James or I did in school, and I respect that. I also think that you have gotten what you deserve by getting into MIT. You should continue to do what you have done in the past, as I think you have something that 1 & 2 may be missing. Always remember, be a Heywood.
Eventually Stephen and his girlfriend landed in an apartment in San Francisco. Stephen put up a few notes on bulletin boards in hardware stores and found part-time jobs painting garages and building decks. After six months, he and Stephanie broke up.
By Alamo Square Park, there is a row of Victorians, the famous Painted Ladies, one of the only rows of fine old houses that survived the great San Francisco earthquake and fire of 1906. Stephen used to sit in the park and study the Painted Ladies. One day an eccentric architect, Mark Little, saw a card of Stephen’s in a hardware store. The architect built and restored fine houses with something like Victorian high style. He hired Stephen, first part-time, then full-time, and became his mentor; and eventually Stephen decided to restore a house on his own.
In 1996, he found a dilapidated cottage in the Crescent Park neighborhood of Palo Alto, which is just south of San Francisco. Stephen studied the neighborhood from his Harley. Palo Alto reminded him of Newtonville: palm trees instead of maples, but the same professional people, the same engineers, psychotherapists, professors on bicycles. He thought he understood real estate in Palo Alto, and the cottage was just what he was looking for. It was tiny, and it was a wreck, a junker, but it was surrounded by homes that were worth easily half a million, a million, and more.
Stephen was broke. His credit card debt was $15,000. But the other Heywoods helped. His brother Ben had just split up with his girlfriend, too—his fiancée. Ben quit his job at a bioengineering company, cashed in his stock options, and went partners on the cottage with Stephen. John and Peggy put up most of the down payment—calling it an investment. The brothers bought their Heartbreak Hotel for $325,000, which approached what their parents’ house was worth back in Newtonville.
After the signing, Stephen rode straight to the cottage on his Harley. He and Ben had gotten the place on a low bid because they had waived their right to an inspection. The owner was an old woman who had let it rot around her and then abandoned it. The tiny lot was overgrown with tall weeds, the stucco was mottled and crumbling, the asphalt roof leaked, the walls were stained, the halls were packed with junk, and half the wiring was dead. Stephen had to bushwhack to the front door, crawl through the junk in the hallways on his hands and knees, and plug one of the feed wires into the meter before he could turn on a light.
The brothers camped out in the place and hired half a dozen college dropouts and Ivy Leaguers at loose ends to share it and work with them. Stephen learned to draw blueprints, to pour foundations, to flirt with the planning lady at City Hall. He bought a black Ford pickup truck. He and Ben and their crew knocked down so many walls that they had to move out. After a year or two there was nothing much left of the cottage. Of the original frame, Stephen had saved only one beam, and whatever relics he had preserved were all shining, polished, varnished, and standing in new places. When the city inspector came by to see the work in progress, he crossed his arms, shook his head, annoyed and amused. I thought this was supposed to be a renovation job.
Stephen loved the project, right down to the blueprints. One of his cousins, David Searls, visited Palo Alto in the middle of the construction work. He remembers Stephen standing over a set of complicated plans. “It just struck me that it might have been a work of art to him,” he says. “It was sort of that pose.” The pose of the artist lost in his labors.
Three
“Anything Is Possible Now”
From the beginning it has been a great dream of Western Civilization that science can save. “Examining the body requires sight, hearing, smell, touch, taste, and reason,” Hippocrates said, about two thousand four hundred years ago. This is the first note of what is distinctive in Western medical tradition, a note you do not find expressed in any systematic way in the traditions of the mummy-wrappers of Egypt or the shamans of Tibet. It is part of a larger faith that reason can help us; and of course medicine is the most intimate and profound way that reason can help us. But how long it took to get much better than shamans through the use of reason.
One of the founding dates in science is the year 1543, when Copernicus’s De Revolutionibus (On the Revolutions) and Vesalius’s De Humani Corporis Fabrica Libri Septum (Seven Books on the Structure of the Human Body) appeared in print just a few weeks apart. But it was a long time until scientists could send any satellites revolving in orbit, and it was a long time before anatomists could do much more than anatomize. Vesalius’s beautiful charts did not cure anybody, they only showed readers how to perform more dissections. When Vesalius himself did cure the head wound of a sick prince, people thought he had practiced witchcraft, and he was forced to make a pilgrimage to the Holy Land. On the way home, his ship was wrecked on the island of Zante, near the Peloponnesus—named by the ancient Greeks for Pelops, a symbol of resurrection. Vesalius died on Zante.
A Spanish doctor named Michael Servetus argued for the circulation of the blood in 1553, but (for his many heresies) he was burned at the stake, like Giordano Bruno, who argued for life on a multitude of worlds.
The long rise of science that began in the Renaissance did little at first to change the prognoses and the lives of the sick. The best doctors knew this, and were humble. During a siege of Turin, the first military campaign of the great Renaissance surgeon Ambroise Paré, part of the castle was captured by one Captain le Rat. “He received an arquebus-shot in his right ankle, and fell to the ground at once, and then said, ‘Now they have got the Rat,’ ” wrote Paré.
“I dressed him, and God healed him.” That was the surgeon’s refrain in the 1500s: “I dressed him, and God healed him.”
A court physician to King James proved in 1628 that the blood does circulate and the heart is a pump. William Harvey gave confidence to generations thereafter that the body could be studied as a mechanism: Its organs worked like pumps, valves, filters, clocks. Our bodies are mechanisms that can be understood. But more than three hundred years had to pass before surgeons could act on that discovery of Harvey’s and fix the valves of the pump.
Likewise, naturalists looking through microscopes could see germs as long ago as the early 1700s. Their descriptions of what they saw excited people’s imaginations. Daniel Defoe in Journal of the Plague Year writes that plague “might be distinguished by the Party’s breathing upon a piece of Glass, where the Breath condensing, there might living Creatures be seen by a Microscope of strange, monstrous and frightful Shapes, such as Dragons, Snakes, Serpents and Devils, horrible to behold.” But it was not until the late 1800s that Robert Koch in Germany and Louis Pasteur in France established the germ theory of disease. And it was not until the discovery of antibiotics in the mid-twentieth century that doctors finally had powerful multipurpose weapons against infections.
In January 1901, in New York City, a small boy died of scarlet fever at the age of three. His name was John Rockefeller McCormick, and he was the first grandchild of John D. Rockefeller. Even for an heir of the richest man in the history of the world, doctors in 1901 could do nothing but sit up with the family while they prayed, and help them try to keep their composure. The one-word motto of the great nineteenth-century doctor Sir William Osler, the single word he offered as a proverb to graduating medical students, was aequanimitas. And aequanimitas, the equanimity of the ancients, was still almost all that doctors had to offer in 1901, not only for scarlet fever but also for typhoid fever, pneumonia, polio, tuberculosis, and flu. Doctors had nothing better in their black bags for diphtheria, dysentery, syphilis, or strep throat—which is how scarlet fever usually starts. Virtually every disease that had ever visited human beings in any millennium was still incurable.
Rockefeller hired a board, and the board bought the last thirteen acres of open land on the Upper East Side of Manhattan, between 64th Street and 68th Street, on a low cliff above the East River. Soon there was a stone gate at 66th Street and what is now York Avenue, and through the gate a drive lined with sycamores and wrought iron gas lamps, and at the head of the drive a tall somber laboratory, now called Founder’s Hall. There, for the first time in their lives, a few scientists could work on the problems of life full-time. This was the first experiment of its kind in America, and there were few like it anywhere else, besides the Pasteur Institute in Paris and the Koch Institute in Berlin. One of the celebrated German biologists who was lured to join the Rockefeller Institute wondered how he could find enough to do at a laboratory bench to fill a whole day.
By hiring the best scientists he could find and letting them work in this cloister at the edge of Manhattan, without obliging them to take on either students or patients and protecting them from responsibilities or distractions of any kind, Rockefeller hoped to help transform medicine. And he did. But it was not until 1944 that a few scientists working in the Rockefeller research hospital discovered that genes are made of DNA, work that led to the discovery of the double helix in Cambridge, England, in 1953, and the rise of genetic engineering.
By the last decade of the twentieth century, the power of human understanding had reached a point at which it was possible to view all of life as a project in molecular engineering, and the saving of life as nothing more than engineering and genetic carpentry. Now surgeons dreamed of operating on molecules inside the bodies of their patients—hammering, sawing, and polishing, like Stephen in his Heartbreak Hotel. They dreamed of teaching the body to heal and repair itself molecule by molecule. The molecular surgeons had a new and exalted maxim. To teach the body to heal itself molecule by molecule would be to heal like God.
The double helix became the greatest icon of science, and the new symbol and totem of medicine, where it replaced the ancient twining snakes of the caduceus. Molecular biologists started companies and made millions. A few dreamed of fortunes bigger than Rockefeller’s. But others admitted how little they knew. Most medical practice was still empirical. That is, doctors’ success with patients owed at least as much to experience, trial and error, as it did to scientific systems and theories. While knowledge of molecules grew explosively, the number of lifesaving drugs grew very, very slowly. Twenty-four centuries after Hippocrates, and after a century of biomedicine—of healing with the help of modern science—most drugs worked without anyone knowing why.
The question became: Now that scientists could anatomize at the level of genes and molecules, now that they could engineer there, how long until new cures?
Hope asked: How soon can we use this invisible anatomy to repair a dying nerve, brain, or heart?
Fear asked: How much of the body can we change without losing the patient we hoped to save? Will science change human nature? Will we change the human heart?
In the spring of 1997, while Stephen’s house was taking shape, the news of the birth of the cloned lamb Dolly seemed to illuminate the edge of medicine with power, glory, irrational exuberance, and terror. I remember the moment when I first realized how wild the mood was, not only for the world looking on, but for some of the scientists themselves. Early in March 1997, I went to Princeton to hear a lecture by one of the leaders in the field of advanced reproductive technologies, ART—the ART that created Dolly. The lecturer was Jacques Cohen, director of the Institute for Reproductive Medicine and Science of St. Barnabas in Livingston, New Jersey, who was always pressing the outer limits of what could be done at his infertility clinic.
That night as I drove to Princeton, lambs and colts were being born in the barns of Pennsylvania and New Jersey—farm animals conceived the old-fashioned way. In the trees the buds were making their preparations. By then the whole world was talking about cloning. Dolly had seemed to come out of nowhere, out of some secret underworld that now promised or threatened to change life on earth.
The news of Dolly’s birth was announced in the United States in the New York Times on its front page on Sunday, February 23, 1997: “Scientist Reports First Cloning Ever of Adult Mammal.” Near the top of her story, the reporter Gina Kolata quoted a Princeton biologist, Lee Silver, who was just finishing a book about ART; his title was Remaking Eden. Silver told Kolata that he would have to tear up his manuscript. “It’s unbelievable,” he said. “It basically means that there are no limits. It means all of science fiction is true. They said it could never be done and now here it is, done before the year 2000.” On March 4, President Clinton had called for a moratorium on the cloning of human beings “until our Bioethics Advisory Commission and our entire nation have had a real chance to understand and debate the profound ethical implications of the latest advances.” The chair of the commission was Harold Shapiro, the president of Princeton.
St. Barnabas is not far from Princeton and New York City; but that night it was as if we were meeting a master spy who came in from the cold for one evening from the other side. My friends and I waited for Jacques Cohen in the parking lot behind Lewis Thomas Laboratory, which is the home of molecular biology at Princeton. Cohen arrived in a Porsche and he brought with him the urbanity of a medical man and also the fresh and canny air of business. He was a quiet, contained, bald but youthful-looking man in his late forties. He spoke with a Dutch accent.
We ate in the Lewis Thomas Laboratory, which is a Doge’s palace of a building, designed by the architect Robert Venturi as a beautiful boast of the power of the molecular view of life. I sat across the table from Cohen. During dinner he stayed dry and deadpan most of the time. Now and then he flashed a wide, slightly embarrassed grin, sharing the absurdity of life. He confided to me that he had done a lot of work lately and not published it. He also sa
id that a day or two after the headlines about Dolly, he had gotten an offer from one of his patients.
“I’ve known him for years. The man called and said—I wasn’t sure if he was joking—‘One million dollars if you will clone me.’ ”
“What did you say?”
“I told him, ‘Add a zero.’ ”
For a moment Cohen kept his face expressionless. Then he flashed me his absurdist grin. I must have stared at him, because he repeated the story word for word to make sure I understood. “I wasn’t sure if he was joking…”
In other words, Cohen had spoken as ambiguously as his client, and made what could have been taken as a counteroffer.
Lee Silver sat at the head of the table. He would be sharing the podium with Cohen. Dolly and the New York Times had changed his life, he said. Unlike most of his colleagues, he had never felt shy about talking to the press. For years he had kept an album at home in which he pasted clippings from the local papers, the Princeton Packet, the Princeton Weekly Bulletin, and the Bergen Record. Now, since the story in the New York Times, he had been on twenty-two radio shows and three television shows. That day alone he had given two or three interviews. He had also buried his uncle and scattered a few spadefuls of earth over the coffin, according to the Jewish tradition. Dust you are and dust you will be.
Silver looked exhilarated and exhausted, like a prophet whose apocalypse has finally arrived. That month anyone who could speak boldly and authoritatively about cloning was talked hoarse. The bioethicist Art Caplan, at the University of Pennsylvania, was sometimes on more than one show at the same time: You flipped the channel and there he was again. Before Dolly his Web site had gotten 500 hits a day; now it got 17,000. At the Roslin Institute in Scotland, where Dolly was cloned, every phone rang all day. One scientist hurrying down a hall heard something in a broom closet. He opened the door and there was a phone in there, and it was ringing.
His Brother's Keeper Page 2