Borrowing Life: How Scientists, Surgeons, and a War Hero Made the First Successful Organ Transplant a Reality PDF

Wounded soldiers arriving by train at the Valley Forge Military Hospital in Phoenixville, Pennsylvania, May, 1943 Copyright © 2020 by Shelley Fraser Mickle Photograph credits listed on this page All rights reserved, including the right of reproduction in whole or...

Wounded soldiers arriving by train at the Valley Forge Military Hospital in Phoenixville, Pennsylvania, May, 1943 Copyright © 2020 by Shelley Fraser Mickle Photograph credits listed on this page All rights reserved, including the right of reproduction in whole or in part in any form. Charlesbridge and colophon are registered trademarks of Charlesbridge Publishing, Inc. At the time of publication, all URLs printed in this book were accurate and active. Charlesbridge and the author are not responsible for the content or accessibility of any website. An Imagine Book Published by Charlesbridge 85 Main Street Watertown, MA 02472 (617) 926-0329 www.imaginebooks.net Ebook design adapted from printed book designed by Ronaldo Alves Library of Congress Cataloging-in-Publication Data Names: Mickle, Shelley Fraser, author. Title: Borrowing life : How scientists, surgeons, and a war hero made the first successful organ transplant a reality/ by Shelley Fraser Mickle. Description: Watertown, MA : Charlesbridge, | Includes bibliographical references and index. Identifiers: LCCN 2019015877 (print) | LCCN 2019019421 (ebook) | ISBN 9781632892294 (ebook) | ISBN 9781623545390 (reinforced for library use) Subjects: LCSH: Kidneys—Transplantation—Boston—History. | Transplantation of organs, tissues, etc—History. | Peter Bent Brigham Hospital—History. Classification: LCC RD575 (ebook) | LCC RD575.M53 2020 (print) | DDC 617.4/610592—dc23 LC record available at https://lccn.loc.gov/2019015877 Ebook ISBN 9781632892294 v5.4 a For Parker Discovery consists of seeing what everybody has seen and thinking what nobody has thought. —Albert Szent-Györgyi Illness…has its inspirations. —Albert Camus  Contents Cover Title Page Copyright Dedication Epigraph A Note to Readers PART I 1 Joe 2 Charles 3 Franny 4 Death Was Unacceptable 5 Peter 6 Curiosity Awakened PART II 7 “Just Gimme a Coupla Aspirin. I Already Got a Purple Heart” 8 “The Rest Is All Decorations” 9 Please Airdrop One First-Rate Artificial Leg 10 “You Were No Raving Beauty the First Time I Saw You, Either” 11 “So I Can’t Be Too Bad” 12 Doable 13 Not Exactly Cinderella’s Mice 14 “Give the Kid a Chance” 15 “My Mind, You Know, Never Lets Me Rest” 16 “By the Way, This Patient Has an Identical Twin” PART III 17 Happy Years 18 In Terrible Shape 19 “You Get Out of Here and Go Home” 20 “Freedom from Burden” 21 “Oh, Dear, Haven’t You Heard?” 22 Chasing the Holy Grail 23 “Some Have Wondered Why We Continued…” 24 “Thanks for the Second Drink” 25 Send in the Dogs 26 “It Was a Good Time to Be Alive” Photo Insert Epilogue Acknowledgments Appendix: Becoming a Kidney Donor Chronology Notes Bibliography Photograph List and Credits About the Author  A Note to Readers THIS STORY BEGINS during World War II, six months after D-Day, when the worst fighting was still ahead. The Battle of the Bulge had just started; the crossing of the Rhine River was three months away. To tell it well, I must begin at an unexpected place. I say unexpected because when two young men came together that January of 1945—one a burned pilot, the other a surgeon determined to save him—they had no idea they were about to take the first step in making one of the most valuable contributions to mankind in the twentieth century. While this story is mostly about what scientists and surgeons can achieve —given curiosity, a passion for science, a large dollop of compassion, and a little luck—it’s a whole lot about how a science fiction-like dream pushed two American surgeons and a British scientist to scale the wall of what was deemed to be impossible. Over a decade they pioneered the giving and taking of organs that one of the surgeons called “spare-parts surgery,” or borrowing life, which in no way belittled the ultimate gift of retrieving life for one so close to losing it. In the late 1960s I knew two of the three. The American ones. I was too young and dumb to know I was walking among giants. The British one I know now by the energy of his words. And those of his wife, whose touching memoir gives us an idea of what it was like to love Peter Medawar, a scientist so important to the understanding of the universe of the immune system that his colleagues compared him to Galileo. Yes, Jean Medawar, like the wives of all these men, is unequivocally part of this narrative. As is Miriam Woods, who gives clear meaning to the words “in sickness and in health” as she devotedly rushed to be with her husband after a horrendous World War II plane crash. So here are four gripping love stories. In fact, before anyone answers that all-powerful question, Will you marry me?, they should ask: Will you love me like Miriam loved Charles, like Joe loved Bobby, like Franny loved Laurie, like Jean loved Peter? Surgeon Joe Murray performed the first successful kidney transplant in December 1954 in a five-and-a-half-hour surgery—so monumental that it is immortalized in an oil painting hanging in the Countway Library in Boston next to the painting of the first surgery performed with ether. It is that important. Joe himself is a study in star stuff. At birth he was given gifts— those of both heredity and tradition. His family practiced irrepressible cheer as a matter of habit. His questing intelligence, unwavering buoyancy, uncommon dexterity, and an extraordinary compassion for those who suffered—especially for those who had to walk out into the world with a horrendous facial deformity, particularly children—seem almost superhuman. He said in his Nobel Prize lecture in 1990 that his life as a surgeon-scientist gave him the rewarding experience of witnessing “human nature in the raw: fear, despair, courage, understanding, hope, resignation, heroism.” Indeed, his part in this story allows us to get our minds around the slippery concept of hope—and how not to lose it. Joe was not just one among many in the greatest generation, he was the kind of man who evokes prayers of please God, make more like him. Francis (“Franny”) Moore had the mettle of old New England running in his veins, the kind of grit that could make a man want to found a nation. Extraordinarily gifted as a surgeon-scientist, he was also extraordinarily gifted as a leader. And he had vision. He could foresee the promise of organ transplantation as a viable treatment for devastating injury and disease, thus opening the gates for the monumental first organ transplant in 1954. But that was not all. His understanding of how the body reacts to surgery still affects every patient who comes through a hospital door. It was said that when Franny entered a room, it was like being in the midst of a full-scale orchestra performing a roof-raising symphony. He was that commanding. Paternal, wanting to take over and fix everything for everyone, he was loath to waste a minute, as if time and suffering were his enemies on the battlefield of sickness. Even his secretary said of him that “Dr. Moore lives life on a different plane.” In short, he was like many esteemed people in history: he didn’t have to do what he did. Born wealthy and privileged, he was driven by that elusive trait that we all wish for ourselves and for our children, and yet can’t quite name. Simply put: Get off your duff and pursue excellence for its own sake. He would become the youngest surgeon to ever be named the Moseley Professor of Surgery at Harvard. Peter Brian Medawar—how can we even grasp the whole of who he was? After witnessing a Spitfire crash near his home in Oxford, England, during the Battle of Britain, he became so haunted by the suffering of the burned pilot that he focused his brilliant mind on unveiling the secrets of the body’s immune system to supply long-lasting skin grafts. His learning to bamboozle the body’s system of defense to manipulate rejection established a new field of science, immunogenetics. In fact, Peter would make such a monumental contribution to the understanding of human biology that he was awarded the Nobel Prize in Medicine when he was only forty-five. So here is this story: blending the horrors of war with the boldness of youth and the clenched-teeth defiance to not relinquish hope, it begins in December 1944 and will continue to be told well beyond today. Because borrowing life to extend the lives of those suffering from organ failure has enabled scientists of the present and future to apply the immune system’s exquisite power to treating cancer and other ravaging diseases. War—what is it good for? Beyond the absolute answer, nothing, there is that other little nudge: to find ways to preserve life. When historian Edward Gibbon wrote in the 1700s that “hope [is] the best comfort of our imperfect world,” he knew what we humans were facing. No, this is not quite a fairy tale, but it is close. The main difference is that the villain is not human. It’s death. —Shelley Fraser Mickle Spring, 2020 PART I  1 Joe THE WOUNDED CAME EVERY DAY. They came straight from the front lines— from Europe, Africa, Italy, China, the Pacific. They came by trainloads in railroad cars, stacked in bunks, one over the other. Brought into the wards on gurneys, they soon swelled the Valley Forge Military Hospital in Phoenixville, Pennsylvania, into the largest in the United States: three thousand patients. A hundred buildings. Tunnels connected the buildings to outfox the weather. Day and night, the staff never stopped moving. That fall of 1944, a young man briskly walked through the halls. Like all medical students in America, he had been drafted after Japan’s attack on Pearl Harbor. Slim, athletic, a few inches under six feet, Joe Murray was swallowed up by the official uniform of all medical personnel. At a distance, you might even mistake his heavily starched white coat and pants to be walking on their own. At twenty-five, after only nine months of surgical training, he had been assigned to Valley Forge to await overseas duty. When first called up, he’d tried to join the navy. But because of his myopia, he was turned away, and the army became his only option. He was still laughing at the irony that for all his childhood photographs, his mother had dressed him in sailor suits. With his rimless glasses reflecting the glare of the overhead hospital lights, he did not seem anything other than the prized student of his fifth- grade class in Milford, Massachusetts, or the salutatorian at his high school graduation. He was simply too understated to catch much attention. His presence was akin to the subtle movement of the earth’s seasons. He was that constant, that reliable, that fueled by a hidden power. Over the more than ninety years that he would live, he would keep many of the traits he showed as a callow young lieutenant at the beginning of the war—humming songs as he worked, upbeat, quick to connect with others by asking, “And where are you from?” Of course, the songs would change, and in the 1960s he would begin singing his favorite Louis Armstrong song, “What a Wonderful World,” his tenor voice delivering words that expressed exactly his view on life: “I hear babies cry, I watch them grow…and I think to myself what a wonderful world.” Eventually he would have six children over seventeen years, so those words would take on richer meaning. And after his first grandchildren discovered his gentle nature and grand achievements, they poked fun at him by nicknaming him “Holy Joe.” Yes, throughout the years of his long life, he would stay much as he was that winter of 1944: wiry, thin, athletic, and fearless. His questing intelligence could be daunting. As his brown hair disappeared, friends would say that his head was simply too occupied to grow hair—grass doesn’t grow on a busy street! His reverence for all life never waned. He would continue to pry an insect from a window screen and flick it outside rather than squash it. To eat burned toast for breakfast. To drink chocolate syrup straight from the can. And to give no reasons. The delight in such childlike whimsy was its own excuse for being. Indeed, he was so unassuming and cheerful, few would guess that he was fueled by a secret sweet stubbornness. Not the bullheaded sort that could stop action, but the unrelenting kind that could calmly spend hours picking a rusty lock to release whatever was captive. From his Irish grandparents and Italian mother he learned a cheerfulness that perhaps only immigrants fully understand. To them, getting into America was a lucky charm that pessimism should never tarnish, so Joe grew up in a household with the Pollyannaish outlook that every glass was not just half full but a fountain, overflowing. Already, in his twenties, he had a spray of smile lines at the edges of his glasses and parentheses of smile tracks around his mouth. That winter of 1944, as he went from room to room at the Valley Forge Hospital checking on patients, he probably hummed tunes from that year’s hit parade, “Sentimental Journey” and “Don’t Fence Me In.” Music was his passion—as well as a lingering desire. While in medical school, he had walked to the Boston Conservatory to take piano lessons until his unrelenting honesty demanded that he quit. Explaining away his small talent with characteristic humor, he said he was going to marry musical talent instead. Indeed, his fiancée, Bobby Link, was studying piano and voice. The following June they were to be married in a church in upstate New York, and Joe’s greatest worry was being sent overseas. Being separated from Bobby would be agony. Thankfully, work at Valley Forge kept his mind distracted from that. The sheer number of patients was daunting. With only nine months of surgical training, he was barely prepared for a normal hospital, much less one like this. Five days a week, from eight in the morning to three in the afternoon, three operating rooms were running with two surgeries performed in each. By the end of the day, Joe often had completed twenty to twenty-five operations. After each, the used instruments were taken away, sterilized, and quickly brought back, so that in five to ten minutes he could begin the next. And the wounded never stopped coming. Since outstanding surgeons were brought to Valley Forge from across the country, the military hospital provided a great education. By a quirk of nature, Joe was garnering notice in the operating room, for he was left- handed, and since his elementary school teachers had insisted he conform to a right-handed world, he was now ambidextrous. He could conquer puzzles of anatomy by getting into tight spots in ways that other surgeons couldn’t. He could use both right- and left-handed surgical instruments, which meant he never had to change his angle of attack. To get at a patient from the other side, he didn’t have to walk around the operating table, which saved that patient from more time under anesthesia. Most of all, his thoughts centered on Bobby. Starting off their married life in this countryside of rolling hills, surrounded by Amish and Mennonite communities, would be idyllic. Because of gas rationing, he carpooled the twenty miles from his rented cottage to the hospital with a technician who also worked there, and they often passed horse-drawn buggies. Hardships of war would not be hardships but problems to solve. Housekeeping would be a puzzle. Tires, gasoline, meat, butter, canned vegetables, sugar, shoes—all were rationed. Ration cards had been issued to over a hundred million Americans. Corn syrup was a substitute for sugar. Most civilians grew their own vegetables in victory gardens because food was needed for the troops. By 1943, there were some twenty million victory gardens throughout the United States. But Joe and Bobby had already agreed to brush wartime difficulties aside. They felt optimistic and hoped for a large family. He could hardly wait to have Bobby in Phoenixville with him. The previous June, after the invasion of Normandy, the Allied forces were aiming for the Rhine River, hoping to cross it in March. The Battle of the Bulge had started in December 1944. The year before, when General Eisenhower announced the surrender of Italy on September 8, 1943, Hitler had sent his troops swarming into the Italian countryside because the Allies were so close to the German-occupied Balkans. The fighting there turned especially vicious. In the winter of 1943–44, US soldiers faced agonies that few Americans knew about. GIs battled not just German troops but also frostbite. Trench foot was epidemic. The war was now a war of attrition. Dead bodies were wrapped in bloody bed sacks, waiting for pickup. Scavenging dogs ate the throats of the dead, while at home in America, people were noting how the war had lifted the grip of the Great Depression. War production sent money flowing. As a first lieutenant at Valley Forge, Joe had no control over his future. He had no idea where he would be sent. What he knew above all else was that having to leave Bobby to go overseas would be the most pain he could ever experience. What he did not know was that, during that first winter in Valley Forge, he would meet a young pilot, who, as they worked together to cheat death, would change both their lives and lay the groundwork for borrowing life in the give-and-take of human organs. To achieve that, he would need someone to balance out his gentle nature. He needed a protector, some bold fellow-surgeon to step forward, one who was willing to buck traditional thinking, to clear the way.  2 Charles AT ONLY TWENTY-TWO, Charles Woods was a crackerjack pilot, so good that he was instructing other pilots, not just in flying, but in “Flying the Hump”—one of the most necessary and dangerous missions in World War II. He was tall, just under six feet, and handsome. Resembling the soldier Audie Murphy, the war hero turned movie star, Charles would become known not for the medals he acquired, but for what he had lost. The morning of December 23, 1944, he was asleep on a cot in a tent at the airbase in Kurmitola, India. It was four o’clock in the morning. Five hours before, he had returned from a round trip to Lyuliang, China, where he had delivered 28,000 gallons of aviation fuel to the US pilots known as the Flying Tigers. Too tired to change clothes, he had simply fallen asleep in his flight suit, and now he felt a hand shaking him awake to fly the route again. Never before had there been anything like this long-range, around-the- clock mission. When Nazi Germany invaded Poland in September 1939, marking the official beginning of World War II, China had already been at war with Japan for two years. In a covert mission directed by President Franklin Roosevelt, nonmilitary pilots were hired to fly combat missions against the Japanese. These were known as the Flying Tigers, hunkering down in China, unknown to the public, secret and fierce. After the Japanese attack on Pearl Harbor prompted America to enter the war, the Flying Tigers officially became part of the US military. Above board, heroic now, helping China drive out the Japanese, they would eventually inspire a movie, starring John Wayne.  Since there was no airfield in the China–Burma area from which to deliver fuel to the Tigers in Lyuliang, US pilots flew the lifeblood fuel from Kurmitola. The route was five hundred miles over the Himalayan Mountains, hence the name, “Flying the Hump.” It was as challenging as flying ever gets, which was why Charles wanted to fly it. Dream-bitten with the idea of being a pilot since a young boy, he was now considered among the best. Flying the Hump was a hazardous route. There were no radio navigation aids, and the weather was always abysmal. If it wasn’t snowing in the Himalayas, it was sleeting. There were surging updrafts and wind shears. To avoid ice forming on his plane’s wings and frosting his windshield, Charles figured out that he could drop his plane into the lower mountain peaks where the air was warmer. He flew the Hump every day. Already he had flown it more than a hundred times, and he never dwelled on the dangers. The planes were B-24 Liberators converted from bombers to fuel carriers. With four engines and three-bladed propellers, the planes had huge gas containers snuggled in their bellies. The delivery of each plane’s 28,000 gallons of fuel was a lifeline for the Tigers, a significant hope for the Chinese suffering brutal Japanese aerial attacks. Cities were bombed, killing hundreds. Chinese citizens stacked up the bodies of their dead like cordwood to line the streets. The Flying Tigers were a critical line of defense for the Chinese, defending them from Japanese attacks, and Charles was a link in that lifeline. Now he was teaching other pilots his tricks, sharpening their skills to Fly the Hump. And stay alive. Planes were frequently lost in the peaks of the Himalayas. The statistics for all combat pilots told the cold reality: fighter and bomber pilots in Europe were so often lost that their average combat life expectancy was fifty-six flying hours. With every mission, more than 10 percent of the planes were lost. Each pilot averaged two missions a week, so that the life expectancy of a World War II pilot was only thirty days. For those Flying the Hump, the statistics were even worse. Every ninety days, 100 percent of the planes were lost. For this reason, pilots did not expect to live long, and they kept to themselves. Rarely making friends was a given. Hanging out at the officers’ club was not their habit, either. They were too tired. They ate, slept, and flew. Of the danger, Charles said, “I tried not to think about it. I accepted it as part of my job, and when I was told to fly, I flew.” With those harsh statistics, the army was constantly in need of pilots. So, Charles’s job as an instructor was to make sure there was a steady supply for the mission. Not just the route, but the combat flying hours were also brutal: 140 to 150 combat hours every month. Compared to today’s commercial pilots, who are restricted to resting after flying 100 hours, Charles was piling up unheard of records. Often, while the Chinese drained the fuel from the planes into their holding tanks, the Hump pilots would lie down under the wing of their plane and take a nap, then remount the cockpit to start back to hand off the next five-hundred-mile trip to another American pilot. Maybe Charles’s grim childhood gave him the grit to take on such a mission. When his divorced mother struggled to support him and his older brother, she placed the boys in an orphanage near their home in Alabama. Charles was five, and he never saw his mother again. A year later, when a loving family adopted him, he lost touch with his brother, too. The scar of being abandoned never completely faded. No wonder a dream of leaving his troubles—soaring above earth in silent air except for the comforting roar of engines that could keep him airborne—took hold of him, and took hold of him hard. Right after graduating from high school, he took a bus to Windsor, Ontario, to enlist in the Royal Canadian Air Force. In 1940, Canada, as part of the British Commonwealth, was already at war with Germany. The Canadian military was eager for young men, and Charles was eager for the chance to learn to fly. For him, basic training in Canada was a snap. He had abundant talent to fuel his pilot dreams. After graduation, skilled and ready as a Canadian Air Force pilot, armed with the invincibility of being barely twenty, he spent the next two years flying missions in England and North Africa. Nearly a year before America entered the war, an impromptu meeting caught him off guard. Totally unexpected and deeply affecting, the experience knocked him into unknown territory that can be summed up by one word: Miriam.  January 3, 1941, eight o’clock in the evening. Nearly a year before the Japanese attack on Pearl Harbor, Charles was visiting his home in Alabama from the Canadian Air Force base, when a friend set him up on a blind date. She was small, eighteen years old. “Where you from?” he asked her. “Hartford,” she said. “That’s just around the corner from where I live! How come I haven’t seen you around?” “Maybe you weren’t looking.” Her playfulness and sass were exactly the traits that made Charles know this girl named Miriam was very likely his match. After all, when he had been living at the orphanage, his spirited daring became legend. One day he stuck a safety pin in the lock to the door that led to the orphanage roof. When it opened, he directed other kids up behind him just to see what they could see. Even after he was caught and punished, he never regretted taking the risk. For two years, he dated Miriam. After America entered the war, when he switched to the Army Air Corps and was assigned to India to Fly the Hump, he married her. They had a son, and it was this family and Miriam’s daily letters that brightened his days at the airbase in Kurmitola. Since Irving Berlin’s song “White Christmas” had come out in 1942, it was playing in a lot of places that December, expressing soldiers’ longing to be home, and the song had become a beloved wartime standard. Two days before Christmas, the song was being heard almost everywhere, and Charles assumed he would be spending the holiday in India, alone. On that morning of December 23, 1944, a jeep took him and his crew out to his plane. It was not yet daylight. The runway was lit, bordered with lights. Since he had already served two years with the Canadian Air Force, flying in Europe and North Africa, he didn’t really need to sign up with the US Army Air Corps after the Pearl Harbor attack. But he had his reasons, and they all had to do with what he foresaw Hitler doing. To him, Hitler was more than a funny little man with a mustache. He feared what Hitler’s victories could mean, that the dictator’s designs on world domination threatened America. He agreed with what President Roosevelt made clear in his speeches: that air power made an invasion of America possible, that all democracies were in peril. Charles saw the dangers to the world through the same lens as the president, and re-enlisted. Being assigned to Fly the Hump was an honor; it meant he was one of the best. His recent assignment to teach new pilots what he already knew about the mission increased the risks. But turning the controls over to an inexperienced pilot-in-training was part of his job. That morning, the new pilot was a young captain named Stalmacher. For a dozen flights, Stalmacher had never been commander of a mission over the Himalayas. He had always been a copilot. This was his day to earn a plane of his own. No doubt he shared the same love of risk and daring as all pilots. A hunger for being on the edge—when you don’t really ever believe, not really, that you will lose your life—made up the moments that infused living with a deep realization of being alive. This was the characteristic all pilots shared. And Charles had that characteristic in abundance. Stalmacher, too, except perhaps he also was inclined to overthink things and prepare too methodically. A pilot, similar to a surgeon, cannot be timid. Acting boldly, buoyed by superhuman confidence, surgeons and pilots share traits of daring and love of danger. The good ones have a propensity for ignoring all other reality but the job at hand—and succeeding. Stalmacher was chatting about how he thought he’d soon be given his own plane. In the back of the jeep were Donald Hoag, the flight engineer, and Skip Rodriguez, the radio operator. The four men climbed into the plane: Hoag and Rodriguez in the rear and Woods and Stalmacher in the cockpit. It was still dark, and the lighted six- thousand-foot asphalt runway was like a ribbon cutting through the Indian jungle. Charles said his usual takeoff prayer: Dear God, please be with us, and then removed his gloves and helmet, as most aviators did, to give him more dexterity and closer vision on takeoff. The fact that he did would have disastrous consequences in a matter of minutes. Stalmacher revved the engine. The propellers began loudly turning.  The plane’s takeoff power increased, and Stalmacher moved the plane to the head of the runway. Charles called off the two-page checklist, talking to Hoag and Rodriguez on the intercom. He radioed the tower: “B-24 ready for takeoff.” “Have a good flight,” the controller said, his usual reply. The takeoff ritual seemed to diminish the mission’s life-or-death danger. Stalmacher punched the throttle while holding the brakes as the engines reached full power. With 28,000 gallons of fuel weighing 65,000 pounds, the plane needed plenty of runway to take off. It was like a lumbering elephant. To become airborne, the B-24 would have to reach 120 miles an hour. Charles reminded Stalmacher of this. “Don’t worry about me, captain,” Stalmacher replied, smiling. “I can handle her all right.” “I figured you could,” Charles encouraged. The plane sped down the runway. Stalmacher, despite his attempts to seem relaxed, wasn’t. He came off as too careful, robotically following a script and not operating on intuition and feel. For a moment Charles thought that, as commander, he could pull the flight and go back. But what would be his excuse: that Stalmacher wasn’t ready? After all, Stalmacher was a pilot-in-training. It was Charles’s job to see that these pilots-in-training reached the next level. Still, Charles was concerned; he had a feeling, a gut feeling, a foreboding. But he overrode it. Seeing the dial register a hundred miles per hour, Stalmacher lifted the plane’s nose. “She’s too high,” called out Charles. Stalmacher lowered the nose. “One hundred ten,” said Charles. “One hundred fifteen. One hundred twenty.” As Charles yelled “One hundred twenty,” Stalmacher pushed the brakes with his feet, thinking the plane was in the air and that he needed to stop the wheels from spinning. Suddenly, the nose of the plane pitched forward. In that moment, the speed dropped to ninety miles an hour. There was less than six hundred feet of runway left. Not enough to build up again to the 120-mile-an-hour takeoff speed.  Charles reached for the controls. He had three choices. He could slam down on one brake, making the aircraft spin around. The gear would break loose. The gas tanks would probably rupture, and the plane would explode. Or, he could pull back on the control wheel and gamble on lifting the craft off the ground. But whenever that maneuver had been used with a B-24, the plane had stalled and rolled into a ball of fire. In those crashes, no one survived. Charles decided his best chance was to shut off the power, stand on the brakes to reduce the plane’s speed so that when it rolled off the runway, it would sink into the dirt. If the plane were moving slowly enough, and if Charles could keep it on a straight path, it might come to rest without ripping a fuel tank. He yanked off the power and stood on the brakes. He fought the controls as the plane plowed off the runway into the dirt at the end, scraping off the nose wheels and gear. Stalmacher was battling the controls on his side of the cabin, too. The plane skidded ahead, straight, scraping a wide swath in the Indian jungle next to the runway. It slowed to sixty miles an hour, fifty, forty, thirty-five, thirty. It was coming to a stop. But then the plane shuddered as it hit a fallen tree. Gasoline spewed out. A spark set it off. Charles yelled to the crew, “Let’s get out of here!” The fuel tank exploded, and a hurricane of flames swept over them. Charles held his breath and closed his eyes, hoping to spare them from the flames. He began unfastening his seat belt. He opened his eyes briefly and saw Stalmacher beating at flames on his flight suit. With his eyes shut again, Charles slid the panel on the cockpit open and lunged forward to let his weight carry him ten feet below to the burning ground. Breaking his fall with his hands, he rolled over and sprang to his feet. He ran for the darkness beyond the circle of fire. He turned to look back at the plane. Only the tips of the wings were visible. The rest of the big B-24 lay disintegrating inside the inferno. Acting on reflex, thinking there was nothing else to do, he sat on a mound of dirt to wait for his crewmates. Seeing the cuffs and neck of his flight suit smoldering, he slapped out the fire with his hands. Soon people from small houses and shacks on the outskirts of the field surrounded him. Several helped him pull off his flight suit. Two others removed his paratrooper boots. His eyes swelled shut. “Does anybody speak English?” he asked. “Yes,” a voice said. “I’m British.” “Could you see about getting me an ambulance?” As soon as he said it, he regretted it. What did he need an ambulance for? “Straight away, sir,” someone said. Then he added, “Has anybody seen the other men in my crew?” Nobody answered. He was the only one who made it out. And only later would he realize how severely he was burned.  3 Franny TWO YEARS BEFORE, on the Saturday after Thanksgiving, radio stations were broadcasting football championships all across America. Francis Moore, twenty-nine years old, affectionately nicknamed Franny, was on call as a surgical resident at Massachusetts General Hospital in downtown Boston. The night had been slow with few demands on his time. He was in the upstairs residents’ lounge listening to the games. Unlike Joe, he had been exempt from the military draft because of bronchial asthma he’d battled since childhood. Told that “your job is right here,” essential to the home front, he’d gone straight from medical school into his internship and residency. And now, after graduating from Harvard Medical School in 1939, he was on his way to being a surgeon. With America at war, surgical training was compressed from the usual five or six years to twenty-seven months, a severe challenge. Teaching hospitals were turning out surgeons for the war effort by the thousands. Harvard Medical School would not admit a woman until 1945, but nurses were in great need and their training was expedited as well, most often to four weeks. Tall, with dark hair to eventually turn a distinguishing silver, Franny came from men and women who settled in Vermont, Maine, and Boston— all well-educated, successful, and resourceful. While his father and grandfathers were hard-driving and high-achieving, it was his mother, Caroline Seymour Daniels, who was the intellectual in the family. Educated in Connecticut and Vermont, she read the classics in both Latin and Greek and was always ready to engage in a lively intellectual discussion on any topic. Along with these inherited traits of intellect and temperament, Franny also had an imposing physical presence. His handsome, patrician features— longish nose, oval face, intense but kind eyes—were coupled with a resonant voice. His take-charge air became, in short, that old slippery thing we call charisma. To him life was music, well done, a performance to echo. In a sense, he embodied the traditional New England virtues of ambition, humility, and a dry wit. With not a jot of athletic ability whatsoever, he had long, dexterous fingers that, paired with a musical talent, could fly over a piano keyboard. He was even adept enough as a musician to write a musical for the Hasty Pudding Club when he was an undergraduate at Harvard. He played the piano to accompany the cast singers and in April 1934 took the show on the road. While the cast performed his musical, Hades! The Ladies?, he sat at the piano, playing cheerfully, nodding along, his eyes connecting with the singers to keep them in rhythm. When Eleanor Roosevelt heard that the show was on the road, she invited them to the White House for tea in the East Room. Franny played the piano while the cast sang. And since he’d looked up the Hasty Pudding show in which Franklin Roosevelt, as an undergraduate at Harvard, had played the part of a chorus girl, Franny and the cast sang some of the president’s songs. The president’s famous bellowing laugh, no doubt, roared through the White House. As the son of one of America’s ingenious entrepreneurs, Franny didn’t have to worry that as a surgical resident he was making only twenty-five dollars a month with a wife and young children to support. Even he would admit that he had grown up spoiled: household help, chauffeurs, summer vacations in New England and Wyoming, fine cars, the best education. In the early 1900s, his father had drifted from New England to Chicago where he bought a patent for a rail anchor, known as an anticreeper, to keep a rail from rippling under the wheels of a heavy train. From that, his family became not just financially secure, but wealthy, eventually buying a large house in an affluent area outside of Chicago on the shore of Lake Michigan. At twelve, Franny had appendicitis. At fourteen, he had a busted knee. Admiring the surgeon who took care of him, he saw that few could claim such an exemplary life. He saw competence, the ability to relieve pain, and the reverence given to men of medicine. His eventual decision to become a surgeon was not grounded in ambitions that his parents had for him. He simply saw surgery as the most fascinating and rapidly advancing field of science. But he was also caught by something more difficult to describe, something that mellowed his take-charge temperament. It modulated his natural showmanship, filled him with a bottomless supply of compassion, and propelled him toward excellence—at least in her eyes: Laurie. As if thrown off a cliff, the shock of falling in love was a force he could not control. At fifteen, he was mired in a mix of lust, the certainty of a soul mate for life, and an irreversible need to have her—not just temporarily but forever. A year younger, petite Laurie was an only child of wealthy parents. Her elfin face, short brown, wavy hair, and steady eyes spoke of a steadfast character and a ready playfulness, which Franny knew attracted not just him. Everyone fell in love with her, so he had to hurry to snap her up. Since she lived in a large house about a mile from his parents’ home, he would borrow the family car to drive there almost every night, all through high school. After a couple of years, his father said that when anyone else got behind the wheel of the car, it would automatically go to Laurie’s. The intensity of their relationship lasted through Franny’s four years at Harvard and Laurie’s college years at Sarah Lawrence, remaining so strong that just before he began his first year of medical school, they announced they wanted to get married. No one was surprised. Marrying so early in a medical career was almost unheard of. Franny didn’t care. And his and Laurie’s parents made it financially possible. On that night of November 28, 1942, when Laurie was home, looking after their young family, Franny was at Massachusetts General Hospital with the football radio broadcast winding down. At ten-thirty he heard the whine of a siren. Hearing a siren heading to Mass General was not uncommon. But then, he heard the whine of another, then another and another. Quickly, he put on his white coat and ran downstairs, holding his pocket to keep his stethoscope from falling out. By the time he walked into the hall leading to the emergency room, dead bodies were lined up in rows. The smell of burned clothes and hair permeated that side of the building. Only three years out of medical school, he was swept up in a tragedy of historic proportions. Indeed, the Cocoanut Grove fire would be one of the worst civilian disasters in American history. Going from patient to patient, overwhelmed with so many to help, he saw nurses trying to relieve the overwhelming pain of those with burns. They gave morphine freely, sometimes overdosing victims and hastening their deaths. Other nurses began writing an M in lipstick on the foreheads of patients to prevent duplicate doses of morphine. Several hours later Franny finally learned exactly what had happened. A thousand young people had crowded into the Cocoanut Grove nightclub, most of them soldiers with their sweethearts, to celebrate the holiday break before going overseas. And to rib each other over the football scores in the title games. The nightclub, near the center of downtown Boston, close to Boston Common, was under new management. Redecorated with imitation palm trees and drapes, it was overcrowded that night. At about ten-fifteen some of the decorations caught fire, and within five minutes the entire nightclub was an inferno. More than four hundred people died instantly. The fire, much like the fuel explosion from Charles’s crash, spread through the nightclub within seconds, stoked by the flammable drapes. It likely started in a basement lounge, possibly from a match or a cigarette. The burning decorations and drapes set off chemical reactions. Instantly, oxygen was used up in the tightly closed restaurant and carbon monoxide filled the building. Carbon monoxide poisoning turns human blood cherry pink rather than deep red. The faces of some of those who reached the hospital only minutes from dying had that deceptively healthy-looking color. Burning wall paint and dyes in the drapes set off poisonous gases, leading to effects similar to those World War I soldiers suffered from mustard-gas poisoning. One naval officer, who made it to the hospital from the fire, ran from room to room looking for his friends and collapsed, dying from the secretions in his lungs that drowned him. The fire department put out the flames within thirty minutes, but the tragedy was so awful that radio newscasts kept repeating the details. The public was horrified. Of the four hundred who died, a large number succumbed to suffocation so suddenly that they were found sitting at tables, unburned, rigid in death, clutching drink glasses. Two months after the fire, Franny was still treating nine severely burned patients in the hospital. Eventually one of the nightclub owners was judged guilty of negligence and sent to prison.  While learning how to treat fluid loss, burn shock, infection, and respiratory tract injury, how to perform grafting, and how to monitor a dozen body chemicals, Franny became an expert in burn therapy. For the next five years, the navy and army funded his research with the side effect that his heroic role in the tragedy, and his guidance in preparing for other disasters, made him nationally known. And revered. Two years later, his advancements in treating burns were known to other physicians, especially to those at the burn unit at Valley Forge. And Joe, equipped with that knowledge, was following the latest protocol for the young men who came every day, straight from the battlefields, horribly burned. Most were pilots. Most were hanging onto life by sheer will, like Charles. This first contribution of knowledge that Franny passed on to Joe would be the lead-in to a career that would connect Charles, Franny, Joe, and a young scientist in Britain who also saw horrors of war he could never forget.  4 Death Was Unacceptable WHEN JOE WALKED into the room at the Valley Forge Hospital where Charles lay, he saw a pilot, three years younger than he was, with no nose, no eyelids, no ears, and only a raw opening where his mouth had been. This was the worst burn case Joe had ever seen. Ordinarily, someone burned this severely would not live but a few moments after the fire. But there was Charles, burned over most of his body, his face completely erased by the fire, and teetering on the edge of life. Clearly, he was holding on with teeth-clenched defiance. Recognizing this, Joe immediately knew that losing Charles was not acceptable. Not only was he young and deserving of life and quality of life, but he had already fought so hard to stay alive. As the youngest of four physicians to take care of Charles, Joe acquired most of his knowledge about the treatment for burns from articles Franny had published in academic journals. Those studies informed the Valley Forge burn unit, so they all knew the most immediate danger to Charles was suffocation. The swelling in his burned airway was restricting air flow. Right away they placed tubes in his lungs to keep the air coming, and then they turned their attention to the fluids leaking from his burn wounds. Skin is the body’s ultimate protection—holding in fluids and keeping out foreign invaders—and Charles had little dermal layer left to shield him. He was burned over 70 percent of his body. His body’s fluids were leaking out. He was dying of dehydration. The only way to stop the loss and build a protection against infection was to quickly take healthy skin from some part of his body to graft over his wounds. Known as autografts, those self- harvested skin bandages were standard treatment for burns. But Charles was burned so severely, he had no healthy skin available to harvest. Furthermore, he was too weak to withstand such an operation. A single alternative was left: borrowing skin from someone else. Taking skin from another body and surgically applying it in what is known as an allograft was only a stopgap measure. It was well known that in ten to fourteen days, that skin would shrink, turn gray, and slough off in the process of rejection when the body perceived the borrowed skin to be foreign. However, there was always the chance that an allograft could buy enough time for scar to form to stave off fluid loss and infection, and hence save a life. The process had been witnessed for centuries. Why tissue rejection happened no one knew. How was even more of a mystery. But centuries of medical history had documented the short life of allografts, and there were no exceptions. Only in one situation had borrowed skin been found to escape rejection and that was skin shared between identical twins. Eight years before, Dr. James Barrett Brown, a plastic surgeon in St. Louis, had cross-grafted skin of identical twins, establishing that allografts could be traded back and forth between them with perfect success. But Charles had no twin. As he lay close to death that January of 1945, he was running a constant fever. Knowledge from Franny’s research forewarned that burn victims who made it through the first threat of suffocation were, almost always, killed by infection. At the time of the nightclub fire, penicillin was an experimental drug. But with the advent of World War II, it had become essential. A serendipitous 1928 discovery that mold released a substance that repressed bacteria led to the discovery of penicillin, but the miracle drug was not available to the general public. In June 1942, there was only enough penicillin to treat ten patients from the Cocoanut Grove fire. However, by July 1943, the War Production Board had drawn up a plan to use new research of fermentation on corn steep liquor to mass-produce the miracle antibiotic. In a worldwide search for a mold to kick-start mass production, a moldy cantaloupe was found in a market in Peoria, Illinois. That melon, along with the newfound fermentation method, allowed 2.3 million doses of penicillin to be produced in time for the invasion of Normandy in June 1944—also just in time for Charles to benefit the following December. On his trip to the States, he had been given several doses. As Joe studied the young pilot with his devastating injuries, he realized that Charles had used up all his strength getting back to the States, and infection threatened to sap the rest. The trip from India to Valley Forge had been brutal. Right after the crash, Charles had been lifted onto a cargo plane and flown two hundred miles away to a hospital in Calcutta. His record as a courageous pilot gave him priority status to be rushed to the Valley Forge Hospital, the best for the treatment of burns. But that was ten thousand miles away. Charles was so weak that he could fly only one day. He would then have to rest in a hospital somewhere. With no eyelids, he could not blink to keep his eyes moist. Nurses were constantly applying Vaseline to his eyes, then bandaging them. Gauze and tape covered his face and hands. He could rely only on the sound of voices around him to know what was happening. At each stop, a forklift removed his stretcher on a wooden platform, and he was taken into an infirmary for a small meal of baby food and to have his bandages replaced. Several times he heard people talking around him as if he were already dead. The cargo planes were bumpy and torturous. He was jiggled and bumped. For a while, there was no pain. He figured his nerve endings must have been seared in the fire, and he was numb. But after a few weeks, the pain started. At first, he asked for painkillers, and then feared becoming addicted and willed himself to withstand the pain by traveling in his mind from one memory to another. From Calcutta, he was flown to rest in Basra, Iraq, and then to Cairo and Casablanca. Finally, for the last leg of the journey, he was assigned a full- time nurse who helped keep him hydrated. The pilot of the plane also climbed to a higher altitude to make a smoother ride for him. Stopping to refuel in Reykjavik, the cargo plane then sped toward the hospital in Pennsylvania. The trip had taken six agonizing weeks. Now Joe and the team of doctors knew they had to think outside the box to build Charles a dermal layer. And to do so immediately. They needed to find a donor. Even though in a matter of a week Charles’s body could perceive the transplanted skin as foreign, and his immune system would attack and kill it, an allograft was worth risking to save his life.  As the team of four was considering what to do, one suggested they might take skin from a cadaver. Even with so many sick men in the Valley Forge Hospital, the likelihood that a dying man could become Charles’s donor in time to save him seemed a long shot. But it was the only one they had.  5 Peter IN SEPTEMBER 1939, Peter Medawar, a twenty-four-year-old zoology graduate student, was living in a rented house in Oxford, England, with his wife, Jean, and their young daughter. They were all on the back lawn, Peter reading, Jean working in the vegetable garden, when they heard a plane and looked up to see it coming over the rooftops toward them. Jean picked up their daughter, and they all rushed into the homemade bomb shelter in the basement. War with Germany had just been declared. Oxford was swamped with London evacuees. German planes had been bombing London but were rarely expected in Oxford. Still, it was a horrifying sight to see the plane coming toward them and to think it might be German, stocked with bombs. The British service had not called up Peter. The recruiting board had said that as a scientist he should undertake research that might be “of service to the medical establishment”—meaning anything that could treat war wounds. Peter himself suspected that the real reason was that his feet were too big to fit into the military boots issued to inductees. His feet matched his six-foot-five height and, as he liked to say with self-deprecating wit, were also “flat,” which probably would have disqualified him from combat anyway. Like everyone else, when the war was declared, he and Jean hunkered down—draping their house windows with blackout curtains and practicing food rationing, even raising their own supply of chickens. But when they found themselves too tender-hearted to wring their chicken’s necks, they comically used leftover ether from Peter’s lab. Stoically, they had even prepared themselves for the worst. When Hitler’s Minister for Propaganda, Joseph Goebbels, began making radio broadcasts laying out his ideas on racial purity, Peter surmised that if Germany won the recent air attacks on Britain, he would qualify for the Nazi firing squad. His father was Lebanese; his complexion was dark. That day, after Peter heard the roar of a bomber and shepherded his young family into their homemade air-raid shelter, he waited, staying calm for the sake of Jean and their daughter, while listening for what was happening outside. Soon, they heard a loud thump and a horrifying explosion. Running out, Peter saw the plane had crashed in their neighbor’s garden. The flames were rooftop high, rising over the neighborhood. It was British, flown by one of the Spitfire pilots defending against Hitler’s Luftwaffe. The neighbors pulled the young airman out and rushed him to the nearby hospital. Sixty percent of his body was burned. With his physicians at their wits’ end for what they could do for him, one suggested to Peter that “he lay aside his intellectual pursuits and take a serious interest in real life.” He asked Peter to think about the burned pilot and come up with some bright ideas as to how he might be treated. Peter returned to the hospital to visit the young pilot and saw things he could not un-see. Wavering on the edge of life, the man’s suffering was haunting. Shaken, Peter realized his scientific background was a means to develop new treatments. He knew that skin grafts were the only way to outlast dehydration and infection. So, why not make skin grafts last longer? Why not prevent rejection? Why not find a way to successfully borrow skin from an unrelated donor? Why not pursue the underlying questions to find answers that would be far-reaching and elemental? Why not probe the mysteries to ask and answer how exactly does the body tell the difference between its own and other living cells? How does the body discriminate between self and non-self? His mind had always been so restless. So fidgety with its constant need to make sense of things! Here now was a place for his questing intellect to land, to take hold of a subject that could benefit untold millions, as well as to last far beyond his own lifespan. He now asked himself, “How could I allow myself to fritter away my time as I did?” It was then he decided that he would have no more of those experiments he called “messings about.” From that moment, his career as a scientist was fixed. Armed with a pair of dissecting scissors, a few rabbits, and mice, Peter practically began living in a dilapidated laboratory. Since he knew the process of rejection was too complicated to unravel in time to help the young pilot, his first focus was on multiplying usable skin over the burned pilot’s own body. Obsessed with unlocking biology’s secrets, he stayed at the lab until late at night, joking that he kept the night watchmen and cleaning staff from being lonely. His unique scientific strength came from his student days when he had spent long hours learning the technique of tissue culture. Growing living cells outside the body at body temperature and in a nutrient culture medium had been going on for a decade, but using tissue culture to solve biological problems had not gotten off the ground. Thus far, scientists had been delighted and beguiled by the sheer beauty of the cultivated cells under a microscope. As a student, Peter had spent long hours doing bench science—work in the laboratory with no patient contact—learning to preserve and harden tissues for microscopic study. Realizing that he had to master the orthodox technique for culturing tissues, he dehydrated and impregnated them with paraffin wax and used a precision instrument to cut them into slices of a thousandth of a millimeter thick. Then he mounted the very thin slices on glass slides and stained them with a variety of natural or synthetic dyes to bring out the various structures in the tissues that differentiated them. He became so adept at this bench science that when one of his revered professors remarked one day that he was writing a history of the use of dyes in preparing tissues for microscopic observation, Peter, still a graduate student, offhandedly offered, “I expect you [know] Leeuwenhoek used saffron as a microscopic stain.” His professor was stunned by the breadth of Peter’s knowledge, even of the obscure methods used by the Dutch pioneer who developed the microscope. It was clear that Peter was a step ahead, already in a realm that few scientists could match. But mainly there had never been anyone before who could blur all the boundaries between basic and clinical science. Similar to the complex thought required to comprehend a galaxy in a new universe, his mind could grasp the worlds of medical and basic science and see possibilities that no one else saw. With his immediate goal to save the burned pilot, his first thought was to use tissue culture to expand the available skin. He was pursuing the idea of making what he thought of as a skin soup. He collected spare bits of leftover skin from a plastic surgeon’s operations and tried to grow them in tissue culture. Naively, he thought they could be used to seed the raw areas of the burned pilot’s skin to generate small islands of tissue to spring up. Applying the watery creation was frustrating. But he and his plastic- surgeon colleagues applied the “soup” as best they could. They watched and waited and then disappointingly found that none of the epidermal seeds grew. He went back to the drawing board. His next idea was to expand available skin. He froze skin samples and, with a special instrument, cut the tissue into slices a tenth of a millimeter thick. These could then be spread evenly with a fine paintbrush on the wounds. But again, the seeds did not take. About this time Peter realized he wasn’t doing that poor airman any good at all. Indeed, the burned pilot died of infection. Painfully, Peter realized he had to absorb his failures as lessons from which he could learn. He moved on to explore the most basic and far-reaching question: how to exchange skin between those who are not closely related without the foreign tissue being rejected. In that answer lay a whole new universe of life-saving possibilities. Despite the allure of pursuing the secrets of the body’s exquisite powers of discrimination, he knew the studies would take many years, for he would be unveiling the ultimate understanding of the body’s immune system. Later, he would write: “A scientist who wants to do something original and important must experience, as I did, some kind of shock that forces upon his intention the kind of problem that should be his duty and will become his pleasure to investigate.” Peter’s investigative pleasure had taken flight. For the next fourteen years he worked each day and half the night to unlock the biological secrets of how the body recognizes tissue that is borrowed, foreign to itself—all with the end goal of saving lives. But in that year of 1939, his research would bring no help to the crashed Spitfire pilots; nor would it help Charles, when he lay near death more than five years later. Yet Peter Brian Medawar was onto something. No one ever doubted that Peter was extraordinary. His biggest surprise, which he himself discovered, was the depth to which he could love. Six-foot-five and eye-catchingly handsome, he was often the subject of his colleagues’ curiosity and veiled envy. As a colleague said, “One could feel that too much was given to one man—handsome, brilliant, charming, a beautiful wife, wonderful children.” All agreed he was staggeringly intelligent and “if you played a game of bridge with Medawar’s mother, it would become painfully clear where Peter got his IQ.” He met Jean on his twentieth birthday, February 28, 1935. They were both sitting in the same zoology lecture hall at Oxford University. The Oxford system of education, the most extravagant education in the world, assigned a tutor to each student in a one-on-one private system of instruction that starts as soon as a tutor summons his student for an interview. It is then that a subject is chosen for the student to study for a passing grade, equal to a bachelor’s degree. When Peter had tried for a scholarship to Oxford University from his public school, he had failed and entered at the age of seventeen for the “Michaelmas” (autumn) term of 1932. Soon, it became apparent Peter couldn’t narrow down a field of interest to study. So, he simply named natural sciences as a catch-all concentration. Drawn to what he considered “the grandeur of the concepts that informed evolution, heredity, epigenesis [the theory that individuals develop from instructions written in the unstructured egg rather than enlarging from a preformed entity], comparative anatomy, anthropology, demography and ecology,” his mind was too far-reaching to be corralled into the study of one subject. To simplify his interests for the sake of requirements, he finally said he would “read” zoology. “Jean Taylor Shinglewood,” he later said, “was the most beautiful woman student in Oxford. I fell in love with her, of course, but I did not meet her much socially because I was not a very well-off student and we tended to move in different circles.” That day of his birthday in 1935, when they were both sitting on hardwood benches in the zoology lecture hall, Jean saw that Peter wore a cheap chain-store jacket and a shirt of bright blue knit, obviously chosen because it needed no ironing. “His hair was black and curly and there was a lot of it. When he was thinking he twiddled the front part absentmindedly, making twists which he forgot about. They made him look mildly diabolical.” During the lecture, most students took notes. Peter wrote only a word or two on a piece of paper, then at the end of class, crumpled it up and threw it away. When someone asked him why, he answered, “Because it’s all in the textbooks.” It was Jean who made the first move. As she headed toward him, ready to ask a made-up question as an excuse to speak to him, a classmate caught her and whispered, “I suppose you’ve heard he’s not English. He’s got Arab blood, you know.” Missing her timing, she later approached him in the library. She went to where he was sitting and asked in a whisper that he explain the meaning of the word heuristic in a book on philosophy she was reading. After he told her, she went back to her place, then realized she had not remembered a bit of what he had told her. Willing to risk looking like a fool, she went back and admitted that she hadn’t remembered what he’d told her. Patiently, he whispered again that heuristic came from the Greek eureka, meaning “I have found it,” which also turned out to be their own heuristic moment. From then on, they were rarely separated. He sported gentlemanly manners, a crisp British accent, a dry, wicked sense of humor, and soon he and Jean were sharing an outlook that Peter called “the human comedy,” or “the human predicament.” He considered the British class system ridiculous and said that there was only one race of people, the human race. As he watched some interchange between people, or the development of some situation, he’d cut an eye at Jean and utter “RTL”—shorthand for “rich tapestry of life.”  When she began spending time with him in his apartment, she saw he had one pan, a gas ring to cook on, and only cheap pats of ground beef. His landlady suspected he smoked opium because his cigarettes smelled odd. Certainly, he looked avant-garde enough to fuel such gossip. About this time, Jean began wondering if she were entering a relationship like the one described in George Eliot’s Middlemarch between the characters Dorothea Brooke and the dazzling intellectual Mr. Casaubon, with his sterile, prune- dried intellect that would never produce. No doubt Jean was pondering the likely fate of many wives of that period: that she would disappear into her husband’s life, known only by his career and accomplishments. Or lack of them. Well, if so, she was willing to take her chances. “I only knew that [Peter] was an uncut diamond, packed with light and fire…and I wanted to be with him permanently. Later on, it became obvious and everyone saw it.” Indeed, he once admitted that if he had not found Jean, to understand and love him, he would have had a nervous breakdown, unable to commit his energies to science. He didn’t propose. They just knew they never wanted to be separated.  6 Curiosity Awakened ON THE AFTERNOON that the medical team treating Charles decided to find a skin donor for him as a stopgap measure to save his life, they learned that a young man who worked on one of the wards had died suddenly that morning. His parents lived only twenty miles away. Quickly, one of the team doctors drove there to talk to them, who—when they understood the gravity of Charles’s teetering condition and the hope that their son’s body might offer—signed the papers to allow the surgical team to use his skin. Right away, Charles was rushed to the operating room. The allografts harvested from the cadaver were placed on the worst of his burns. One team of surgeons worked on his face, while Joe and another surgeon used tweezers to position little squares of new skin on Charles’s hands. To Joe, it felt as if he were planting seeds, preparing the soil to accept and grow the precious pieces of skin. He also realized that the deformities of Charles’s face and hands were worse than any he had ever seen. If the skin grafts worked to save his life, the surgical team would have to spend many months, and even years, giving him a new face and usable hands. But, of course, all that depended on whether the allografts could keep him alive long enough for scar to form. And scarring had its own complications: restricting movement and creating hideous deformities. Wait and see was their only plan. Each day Joe studied Charles’s wounds and the health of the borrowed skin. He dreaded the day he would see the borrowed skin turn gray and shrink with the first signs of rejection. But on day fourteen, the cadaver skin was still alive. Even beyond day fourteen, the cadaver skin was still spreading. The borrowed skin even held its healthy color.  The allografts taken from the dead boy were lasting longer than any research predicted. Why? Why was Charles’s body not rejecting the allografts in the usual time? Fascinated, Joe and the treatment team watched as the cadaver skin grafts lasted nearly a month. This was a scientific phenomenon. A phenomenon that seemed truly miraculous. Giving rein to his curiosity, Joe’s mind spun with questions, possibilities, and theories. And curiosity had always driven his intellect. As a boy in Milford, Massachusetts, he would come upon ants making trails on the paths he walked in the woods. He had always wondered: was the same ant the leader every time? Of course, there was no way to discover that answer, but in his adulthood, whenever he saw an ant, he would laugh while remembering his boyhood inquisitiveness. And now, despite the many years that had passed, his curiosity was still the same: once awakened, it refused to be ignored. The case of Charles’s skin grafts was taking root in his memory, returning over and over with a relentless demand for answers. One thing was clear: Charles’s body had somehow tricked his immune system. Joe made a list of possibilities: could there be a closer kinship between the tissues of certain unrelated individuals than science could yet identify? Was Charles’s body simply too weak to attack the foreign grafts? Even more compelling: if successful skin grafts between identical twins were possible, then why not organs as well? While there was no scientific explanation for Charles’s seemingly miraculous survival, there was, however, an answer to unlock beneath the unexpected survival of the borrowed skin from a boy who had died. — JOE KNEW THE MEDICAL LITERATURE: transplanting tissues between individuals would never be possible. The Biological Basis of Individuality by Dr. Leo Loeb discussed the impossibility at length, and some considered his book dogma. As early as the eighteenth century, experimental transplants in humans and animals had been tried, but always the results failed from the biological force that formed a barrier when the body perceived the transplanted tissue to be foreign. The give-and-take of organs was science fiction. Serious consideration of transplanting organs was even labeled crazy. And there was plenty of evidence to support that view. One need only look at the fantasy figures in art to see how, over the centuries, the human mind played with the idea of transplanting features from one to another. In mythology, the chimera is a female with a lion’s head, a goat’s body, and a dragon’s tail. The Minotaur has a human body and the head of a bull. The Sphinx, a woman’s head and a lion’s body. Even a mermaid is a grafting of a woman’s body and a fish’s tail. For a while, bizarre attempts to borrow the sexual prowess of animals or of other humans became a fad. In Chicago in 1916, Dr. Frank Lydston, eager to regain youth, transplanted slices of human testicles into the scrotum of patients, including his own! Physicians carried out similar rejuvenation dreams using prisoners, claiming to discover what a Viennese sexologist and hormone researcher called “a charm to wean us from the vulgar habit of growing old.” However, the view that transplantation was a half-baked idea, and impossible—along with the fact that most of the medical community embraced that view—did not intimidate Joe. He vowed to plunge into what was deemed unfeasible and explore it for himself. The fact that Charles was alive, and his allografts had lasted nearly a month, proved that what was expected was not always the outcome. While scrubbing for surgery with other young surgeons, Joe began bringing up the subject of tissue transplantation. The conversations were thrilling and heartening. Furthermore, he had his own personal experience to add to the subject. From what he had witnessed with Charles, the idea of sharing organs between two individuals did not seem so great a leap now. — THAT LEAP WOULD soon land in a different world. War was helping to push medicine into a golden age. Desperate measures gave rise to innovation. And innovation was producing a flood of new treatments that were shared across borders, even between countries at war. One of these would later play a significant role in Joe’s quest to borrow organs. And, strangely enough, it began with sausage casing and tomato cans—the humble parts used by a young physician in Nazi-occupied Holland as he began to build the first dialysis machine. The fact that he was doing it under the noses of the Nazis made it that much more exciting. Strangely enough, too, it was inspired by the brutal bombings that destroyed cities, crushing thousands of victims. During the London attacks, when people were dug out of the rubble, alive, it was found that their kidneys had stopped functioning from shock. However, if they could be kept alive for days or weeks, their kidneys often healed and spontaneously recovered, doing their essential job of cleansing the blood, ridding it of wastes in the form of urine. Blood transfusions had been found to be the prime treatment for shock, and since by then the Red Cross had learned how to store blood close to battle sites, many of the crushed victims survived the temporary renal failure that became known as crush syndrome. A new reverence for the resilience of the pair of glands—fist-sized, riding on either side of the spine, shaped like beans, hence the name “kidney bean”—gave rise to the idea of developing a bridge, an artificial kidney of some kind to tide a crushed victim over to that magic hour when their kidneys healed. In 1938, Willem Kolff, a young doctor at the University of Groningen, was caring for a young man slowly dying from kidney failure. Feeling helpless to relieve his patient’s agony, he was further distressed by the boy’s mother when he told her that her son would die. She was dressed in Sunday black, with a white lace cap, and in her grief she was inconsolable. Frustrated and distraught, Kolff was suddenly struck with an idea. If he could only dialyze the boy’s blood, remove twenty grams of urea and other toxic products, he might relieve his patient’s nausea and other symptoms. Saving the boy’s life might even be possible. Right away, Kolff went to a professor of biochemistry, who showed him the wonders of cellophane tubing made from sausage casing. Intrigued, Kolff worked on constructing his idea under the Nazis, who were too ignorant to understand what he was doing. He fiddled with the sausage casing, winding it around tomato cans, then passed the boy’s blood across it with salt water on the other side. The idea was that the sausage membrane would cleanse the blood when small molecules passed through. Despite his long hours of working, the boy died. Even though Kolff was unable to save his patient’s life, he knew he had an idea worth pursuing. Failure followed failure. When so many of his other patients died, his professor told him to stop. Kolff didn’t stop. He worked on the project whenever his professor was away. His method was labor intensive. After filling the tubing with urea-poisoned blood, he rocked it on a board in a saline bath. After a half hour of dialysis, all the urea had passed out of the blood. In time, he perfected his method when two developments made it successful: heparin, the chemical substance that prevents blood from clotting, and the manufacture of long cellophane tubing to replace the humble sausage casing. He next built several apparatuses, paying for all the parts himself. None was made well enough to use clinically. Then fate intervened. Kolff’s Jewish professor of medicine committed suicide and was replaced by a Dutch Nazi as head of the department. Kolff began making plans to leave. The final push came on May 10, 1940, when he and his wife were on the top floor of the hospital and saw a huge mushroom cloud from bombs dropped by the German Luftwaffe on Rotterdam. They fled to Kampen, a small city in the north. There, he engaged a local company, following his design, to produce a machine that became the first artificial kidney. Of the fifteen patients he treated in 1943, only one survived, but he had a method to at least relieve suffering. He also wondered if he were not in an occupied country but in the United States would he be more successful. Undaunted, he built more dialysis machines. In 1944, he published his findings in a Scandinavian journal, but during the war, Scandinavian literature was not read in America. It would be only after the war that American physicians would learn of what Kolff described in Dutch as an “artificial kidney.” In 1945, he saved his first patient and sent what few dialysis machines he had to hospitals in other war-torn countries. His last disappeared behind the Iron Curtain in Poland. In 1945, Joe was unaware of Kolff’s artificial kidney. But his ideas, prompted by Charles’s long-lasting borrowed skin, were intersecting with Kolff’s innovations. Borrowing a kidney might be another way to extend a patient’s life. Even more far-reaching, transplanting organs might lead to a future shift in the treatment of disease. In only two years, Kolff’s and Joe’s ideas would come together in Boston at the perfect time with the perfect team of Franny and Peter. First, though, the war would have to end. PART II  7 “Just Gimme a Coupla Aspirin. I Already Got a Purple Heart” WITH HIS EYES BANDAGED, Charles relied on hearing voices to know what was happening around him. He marveled that, at times, people talked over him as if he did not exist. “My God,” he heard a nurse say, “I bet he doesn’t weigh eighty pounds. He’s nothing but bones.” Knowing that by now Miriam had been told of the crash, he listened for footsteps that might be hers. Privately, he was chewing on a worry that he could not mention to anyone. Cycling in his mind, fading in and out with his pain medications, was the scene from a movie he recalled in which a man lives hidden away in Paris wearing a mask because his face is so hideous. After he falls in love with the heroine of the story, he takes off his mask and the girl screams in terror. When Miriam saw him, would she scream in terror? And then, “Charles?” The voice was familiar. “Charles?” On the brink of consciousness, he wanted to identify the voice as hers and said aloud, “Miriam? Is that you?” He heard only the sound of running feet. “She’ll be right back,” a nurse said. Faint with the shock of seeing him, she had indeed run out of the room. But then, composed, she came back in. Touching his leg, with her voice steady now, she said, “Hello, Charles. It’s good to see you.” “I’ll be all right now, Miriam. Now that you’re here.” She stayed all afternoon. She sat beside him, leaning in, telling him that she had been given rooms nearby. “And they’re going to let me stay. I have Freddie with me. We’re going to stay in rooms set aside just for us. I can be here every day.” Freddie, now ten months old, was being looked after by one of the other families of patients who were staying in the rooms that Miriam spoke of. What Charles did not know was that those rooms had been set aside for the families of patients expected to die. All around him other injured soldiers were also stoically fighting off death with a studied nonchalance, a favorite expression being, “Just gimme a coupla aspirin. I already got a Purple Heart.” Daily, Charles’s dressings were changed and his body chemicals monitored. More cadaver allografts were placed over his burns. But until his life was clearly out of danger, Joe and the other team of surgeons could not consider building him a new face, as well as a pair of hands. First they needed to make him a pair of eyelids. Since his eyes were at risk of infection, and, therefore, blindness, nurses covered them with dressings and antibiotic ointments twenty-four hours a day. As he lay there, unable to see, but feeling that he was moving past the point of dying, he thought he might begin imagining his future. Moments of his childhood came awake in his memory, in particular one day in spring. He was five, walking barefoot in the creek that ran in front of the house where he and his older brother Jack lived with their mother. It was in the small Alabama town where he’d been born, and the house, with its gray- weathered wood—a shack, really—rested on stilts. He could recall the sloshing of the creek between his toes, and the feel of the mud and the way he crawled with Jack under the house to play, building dirt roads and sliding on their bellies like movie cowboys sneaking up on robbers. It was as if he could again smell and feel the dirt, and he remembered vividly hearing a Model T drive up and stop. From under the house, he and Jack watched the legs of a man jump the creek and walk toward the house’s rickety steps. They heard him knock at the door. Their mother answered and then the sound of her voice was followed by a haunting silence. The man came down the steps and leaned down to look at them. Their eyes met. He was holding a cardboard box. He coaxed them out. “How old are you, son?” he asked. Charles held up five fingers. Jack said, “Six.” “I’m taking you to a nice place to live,” he said. “You’ll like it there. There are lots of boys your ages there.” He led them to the car. Jack cried. Charles looked at his older brother, stunned; Jack never cried. The man ushered them into the backseat of the Model T and drove them to an orphanage with the cardboard box of clothes on the seat beside them. From that day, the family Charles had known was lost to him. Now Miriam was coming every day, spending hours with him. As he became stronger and the threat of his death receded, she took an apartment in town for herself and Freddie. Each day she came, she told him about the exploits of their toddler. This was the family he had started as his own. Before he had left for the war, he and Miriam had dreamed of having many children. Would she, still? A dread tormented his thoughts. Would Miriam still want the life they had once envisioned? Other unknowns were eating at him. What would he do with the rest of his life? Would he be able to provide for the large family they had dreamed of? Would he fall into depression and despair, and give up? Would the trauma of the crash become emotionally crippling? Another more dangerous unknown—private, not to be spoken of— threatened: would Miriam still want him? Would the love knot they had constructed in their youth be enough to make it through this? — CHARLES’S AMERICA WAS CHANGING. War production was pumping $300 million a day into the economy, making the joblessness of the Great Depression recede like a bad memory. The war that involved 100 million people from more than thirty countries was making America a world power. The American GI—the initials standing for “General Issue”—was now recognized everywhere as a conquering hero. Yet, the wet-behind-the-ears adolescent who left home frequently came back with dull eyes and the stuff- of-war traumatic despair. The irony was that while the GI became a comic book or TV character portrayed as slightly befuddled and food for laughs, he was actually battle-hardened and haunted. In combat, GIs didn’t shave or get their hair cut—not because they wanted to look cool—but because they lacked razors, shaving cream, mirrors, and hot water.  GI suffering was also felt at home: many on the home front sacrificed and suffered the loss of sons, brothers, husbands, and fathers. But the signs that war was good for the American economy were obvious. The famous journalist Edward R. Murrow warned: “We are the only nation in this war which has raised its standard of living since the war began—if hardships do things to the mind, so do comforts.” That January of 1945, when Joe first met Charles, Franklin D. Roosevelt had just been inaugurated for his fourth term. Until 1937, a US president was always inaugurated on March 4, a tradition that FDR was the first to break. And for his fourth term, feeling the effects of post-poliovirus and heart failure, the president stood at the South Portico of the White House to deliver a simple five-minute speech, all the length of time he could stand. Fearing muscle loss in his thumbs, he secretly practiced writing his name to be able to pen his signature in public. Despite his haunting fears that the poliovirus that had struck him twenty-four years before was returning to claim the rest of him, he had been successful in assuring the American people he was fit to bring the war to a close. And he was determined not just to end the war but to prevent all others. His dream to establish an organization, among what he called global neighbors, to hash out their differences was becoming a reality. The United Nation’s first meeting was set for that next April. First, though, he needed to end the war, and to do so by preventing his greatest nightmare, which his joint chiefs had predicted. They warned that invading Japan would extend the war into 1946 and cost the lives of up to a million Americans. To avoid that nightmare, he beguiled and humored the brutal Russian dictator, Joseph Stalin, by calling him “Uncle Joe,” getting him to promise to join the Allies to fight Japan within two months of the surrender of Germany. He also got Stalin to agree that Russia would become part of the United Nations, the organization he passionately engineered while president as an instrument for keeping peace. And he was excited to attend its first meeting as its first American delegate that late April in San Francisco. It would be a meeting he would not live to see. Nor would he witness the cosmic force unleashed on Japan at the end of that summer.  Since October 1939, Roosevelt had known of the possibility of a bomb so powerful it could end the war. But atomic scientists were a breed of their own; few understood what they studied or even how to pronounce nuclear physicist. It was a German-Jewish female scientist, Lise Meitner, who, in March 1938, was bombarding uranium with neutrons in a laboratory in Berlin, when she found astonishing results that led to understanding what unleashing the universe’s power could mean in making a bomb. With such a weapon, Hitler could rule the world or destroy it. As Hitler’s men came after Lise, she fled to Sweden, settling near the esteemed physicist Niels Bohr. Soon German physicists began migrating to America. And, in a comic twist, just before Bohr escaped to America, he poured some of his heavy water—necessary for slowing down neutrons to release nuclear power— into a large beer bottle and put it in his refrigerator. There it would sit through five years of Nazi rule. On January 16, 1939, Bohr received a telegram from Lise describing how she and an assistant had split an atom, freeing 200 million volts of electricity. It was then that Bohr and other physicists predicted that if uranium could be harnessed, it could be twenty million times as powerful as TNT. That was when two physicists decided to warn the president. Since they didn’t have access to FDR, they went to see Einstein, who, shuffling in slippers, answered the door. When he heard why they had come, he said that the possibility of a chain reaction in uranium had not occurred to him, but, realizing the danger of Hitler having physicists capable of producing an atomic bomb, he wrote a letter to Roosevelt. When the letter arrived, the president, eating breakfast, asked an aide to read it to him. Understanding the threat posed by such a massive bomb being built in Germany, Roosevelt said, “What you are after is to see that the Nazis don’t blow us up.” And so the war took on another dimension. The public knew nothing of the prospect of an atomic bomb. Few did know. But for those who did, it became imperative that America get the bomb before Hitler. While it was easy to understand what harnessing the power of the universe as a weapon of war could mean, there were others eager to understand the new science that had been unveiled for purposes of good. Among those would be Joe Murray and Franny Moore, who, ten years later, would begin exploring the use of nuclear radiation to break the age- old barrier of rejection in a desperate patient brave enough to borrow an organ. But until then, the step-by-step development of the bomb would shift into a world trying to understand what science had unveiled. — SOON AFTER PETER and Jean met and were still getting to know each other, Jean, though completely attracted to him and totally in love with him, could not help wondering about his character. Was he solid? Could he be counted on? A major test came one night in his apartment when she became sick. Trying to cover up her nausea, she failed to overcome it and, much to her horror, threw up in his one and only skillet. Peter gently hustled her into a taxi back to her college dorm. Furthermore, he never mentioned her embarrassing moment, which she knew had come from drinking too much wine. The next morning, she knew that yes, he was brilliant, but he was also sound: he could be relied upon in a crisis. She also knew she had found her life’s calling: to take care of him and to help him succeed as the brilliant scientist he seemed destined to be. But there were problems with her family accepting him. His dark complexion and thick curly hair often led to suspicions that he was not English and therefore unsuitable for Jean. When Peter explained that his mother was Edith Muriel Dowling, a quite wonderful English woman, and his father was Nicholas Medawar, a Lebanese businessman, the facts made little difference. Of course, Jean married Peter anyway. When her source of income from her family was cut off, she didn’t care. From almost the moment she met Peter, she dedicated her life to him, gladly and completely. Born a twin, Jean was the one to survive, becoming the oldest of three daughters of an American mother and an English father, a physician who, by the time Jean met Peter, was very frail. Perhaps being the sole survivor of twins, she was raised with a sense of destiny and the confidence to go with it. Soon after she met Peter, she convinced him to take an examination “for honors” at the end of his studies. Not only did she know he was brilliant enough to catch up, but the accomplishment would come with a graduate student stipend that would help them to marry. What taught her even more about Peter was a crisis that came near the end of the two years they had known each other. She was supposed to produce some kind of respectable research to be awarded a BS degree. Panicked, because she had set up a hypothesis to discover the function of lymphocytes, generally known as white blood cells, she despaired that the work was not coming together. Already, it was known that white blood cells poured into the blood every day, but their numbers in the circulation did not increase. Why? She was trying to find out if primitive white blood cells developed from other white blood cells, or had a special function of their own. The new and complicated universe of the immune system was being studied from many angles, and Jean, although daunted by the complexities, was adding her part—even if slight. Of course, it didn’t hurt that she was being driven by fear that she would not graduate without a written thesis, so she worked relentlessly and with constant panic. Her lab was next to Peter’s in the pathology building. And he, sensing her distress, came forward. Not only did he guide her as she wrote her thesis, but he also typed the whole shebang at blistering speed— with two fingers. He saved her. And furthermore, he never teased her about her panic or the fact that she squeaked past the requirements of a degree. In the following months, as their relationship deepened, tiffs started. In what Peter called interruptions to their “being the greatest of friends,” he had to sort out their feelings, which he did rather bluntly. He realized that when Jean was badgering him to pay attention to something she wanted to show him and he didn’t look up or listen, she became upset. He realized his obsessiveness and apologized, telling her, “You have first claim on my love, but not on my time.” This later led to Jean’s tactic of asking, “Peter, are you thinking?” If he said yes, she did not talk. Other times, she would pull his arm and say, “Look, Peter, do look,” and he would glance at whatever it was rather than look, smile at her, and say, “Yesss—lovely.” Then he would go back to thinking.  In time, when Jean fully understood the value of the work he was doing, she could then laugh at his obsessive ways. Always, their strongest bond was a “hopeful attitude in life, faith in what science might achieve, and a deep commitment to each other.” Embracing the French poet Saint- Exupéry’s view that “Love does not consist of gazing at each other, but in looking outward together in the same direction,” they set the date for their wedding. Two days before Peter’s twenty-second birthday, they married in the Oxford Registry Office, then followed it up with a sherry party in their Banbury Road flat. Soon, Jean began to savor a joke on him as they set up housekeeping. If a spider got into the house from the garden and sat looking down at them from the ceiling, she would ask him what kind it was and then tease him that she was living with a zoology genius who couldn’t identify anything. It was she who had to catch the specimen and return it to the garden. In those early months of their marriage, when she had sudden pangs of worrying about how deep his regard for her went—brought on mostly by seeing his many women friends, all of whom clearly adored him—she soon realized she was being foolish. She was his passion. His work was his life. There was no time, or desire, for anything else. He had found his calling, and nothing could prevent him from answering the needs of his work, not even Jean. Indeed, in their long-married life of fifty years, there would be many more crises for him than for her. But from the very earliest moments, their bond was strong and deep, never to be broken. With the war as the canvas for their early married life, Peter’s research was urgent. Dedicated to finding a way to treat Spitfire pilots who bailed out of their burning planes, he knew first he had to find out what went on inside grafts of donated skin before he could come up with a treatment. He kept asking: if blood can be transfused, why can’t skin be exchanged? The War Wounds Committee gave him a grant, and he left home for two months to work in the burns unit of Glasgow Royal Infirmary. Jean and their young daughter stayed in Oxford, while he moved into a low-rate hotel on the streetcar line to the infirmary. There, he teamed up with a Scottish plastic surgeon, Tom Gibson.  A badly burned older woman came into the infirmary. She had fallen onto her gas fire with injuries so severe, her life was hanging by a thread. Since her brother was willing to supply enough skin for grafting, Peter knew he would now be able to study foreign grafts from a close relative as they were rejected. Surgeon Tom Gibson covered her wounds with tiny patches of her brother’s skin, as well as skin from the woman herself. At regular intervals, he removed one graft from each site to examine under a microscope. Peter set up a workbench in the pathology department to prepare the graft samples himself—an arrangement that suited his restless quest for answers. After only a few days, he saw that both grafts, the one from the patient and those from her brother, looked very much the same. Yet, after a few more days, the grafts began to look different. Those from her brother were invaded by the white blood-borne cells known to attack an intruder into the body. It was then natural for Peter to test the fate of a second set of donor grafts after the first had been rejected. Both he and Gibson theorized that the second set from her brother would not survive as long as the first set. And they were right. Immediately, the second set of donor grafts were set upon and destroyed. Furthermore, Peter and the surgeon saw blood vessels invading the graft, a sign of inflammation that impaired the healing process. Ordinarily, inflammation is a useful immune system reaction to help fight infections as small blood vessels dilate to increase blood flow to a site. However, when the body becomes somehow confused and attacks itself with chronic inflammation, serious conditions develop, such as in autoimmune diseases. For the first time, Peter had unveiled a biological force signaling the body to attack a tissue perceived to be foreign. It was the same specific adaptive response as the one that leads to the elimination of bacteria or viruses, organisms foreign to the body. Most importantly, Peter had illuminated the body’s powers of defense. This was significant science that would be known as the “second set” phenomenon. A decade later, this finding would be monumental to Joe and Franny in their attempts to transplant an organ and bypass rejection, for it suggested that the rejection process acted very similarly to an allergic response. And, indeed, if rejection was an immunological process similar to the body recognizing an allergy, then couldn’t it be potentially manipulated? As far back as Louis Pasteur’s work in the late 1870s, it was known that something foreign could invade cells. But when Pasteur discovered general bacteria—to be called “germs,” from the Latin germen meaning offshoot— medical practice began to embrace protecting the human body against germs, which was enough of a world-shaking discovery for Pasteur to become known as the “Father of Modern Medicine.” From that moment, the practice of medicine changed. Instruments were sterilized in boiling water, and general hygiene was valued and adopted. Ten years later, Russian zoologist Élie Metchnikoff looked into a microscope at a water flea and saw amoeba-like cells eating vegetable matter, which reminded him of pus, a discovery that pushed the knowledge of disease even further. He designed other studies to show white blood cells assaulting and digesting disease germs. Metchnikoff turned his observations into a cellular view of resistance, likening it to the body’s ability to form an army to “fight infection.” And the idea of white blood cells took off. Now Peter’s study of the burned woman’s borrowed skin grafts proved that the immune system had something akin to a memory. The system could recall a previous invader. It was a simple yet mysterious reaction, and Peter had illuminated the science that had mystified observers for hundreds of years when some fell sick in epidemics while others didn’t. Somehow the body remembered the first attack, built weapons against the intruder, and recognized and repelled it swiftly when it tried to invade a second time. In a sense, Peter had discovered that the human body has not just one brain, but two, the second being the immune system acting in concert to protect well-being, all in the name of survival. He had put the principles of the body’s defense on display, and, right away, he and his surgeon coauthor Tom Gibson published their results in 1943 in the Journal of Anatomy in an article titled “The Fate of Skin Homografts in Man.” Only one year