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 later, on that fateful day in December 1944, Charles would be so horribly burned that Joe, as a young surgeon with a leaning toward basic science, would naturally be keeping up with current literature. And Peter’s findings would inspire his own ideas as he contemplated the idea of borrowing organs, especially skin. Innovative treatments to save the lives of burned pilots arriving daily at Valley Forge were constantly of interest. And Peter’s publication was earth-shaking. Joe noted that until then, Dr. James Barrett Brown’s observation in St. Louis in 1937 that skin between identical twins could be shared without rejection was the only ray of light in the problem of tissue and organ replacement. But now “with Gibson and Medawar’s clear description of the second set phenomenon, the rejection process was seen to be not immutable; instead it implied an allergic or immunological process which potentially might be manipulated.”

In other words, tricking the body to accept a foreign tissue now seemed possible.

Soon, Peter and Tom Gibson’s work of the second set phenomenon would also be known as acquired immunity. This groundbreaking view made it clear that skin tissue from an unrelated donor, even from one closely related, was rejected because the body perceived it not of itself, but as that of a foreign invader. Furthermore, the body would even remember it if it were grafted another time. This ability was indeed what Peter liked to refer to as the body’s exquisite power of memory.

And it was revolutionizing science. For hundreds of years the problem of rejection was believed to be insoluble. Breaking the rejection barrier was viewed as being no more possible than changing one’s blood group. Peter had revised that belief. He had now taken his first step in establishing a new field of science: immunogenetics.

To Joe and Franny, who wanted to explore transplanting organs, Peter’s findings were especially encouraging. His large mind was stretching the minds of others, throwing open doorways into the possible.

Yet Peter’s most difficult work was ahead. He now had to duplicate and expand his findings as well as explore the possibility of manipulating the body’s power of rejection. The next years would be the most intense studies he had ever undertaken, especially since there were no trained technicians to call upon.

In time, the answers would all be with rabbits, mice, cows, and Czechoslovakian chickens.