Die Once Live Twice (29 page)

“Did you brush your teeth this morning?” Jonathan squinted at Jimmy’s mouth.

“Yes, but...why?”

“Oh, just wondering how healthy you are. An ad in the Toronto paper said brushing teeth and using Listerine for halitosis will prolong your life by killing germs!” He laughed. “The business of medicine makes more money than doctors now. Listerine is an $8 million product.”

“Do you know the greatest danger to humans since World War I, Uncle Jonathan?”

Jonathan laughed again. “Yes. The fly! Lucia put screen doors on the clinic to keep out flies. They all carry disease, so say the radio ads. Lucia is covering all her food with this new cellophane, too!”

Best walked into the room with a big smile. “Your result is just what I wanted to see. Now, we will do the real test with insulin.”

First, there were more tests that morning—more blood chemistries, an EKG, and even an ophthalmoscopic exam of Julianna’s retinal vessels. When her midday meal arrived, Julianna exclaimed, “My goodness!” The plastic tray held a potato, bread with butter and jam, even a small piece of apple pie. “This is my favorite restaurant.”

Her fork was shaking as she picked it up to begin eating. This meal could be her last if the insulin failed to lower the high blood sugar this food would cause.

“La Hospitalia. World famous cuisine,” young Best joked. “I’ll stay here with you. We’ll measure your blood sugar in thirty minutes and then administer the dose of insulin we think appropriate. A positive result will be evident by thirty minutes after that.”

Jonathan stood. “Julianna, I’ll return in an hour. I’m going to take a walk.”

Needing to work off his nervous energy, Jonathan walked around the hospital ten times. The implications of success for Julianna were simple: life or death. If insulin controlled her blood sugar she could live many years. If not, she died. The implications of success for medicine were more complex. All the previous cures and effective treatments discovered were for infections, especially those that affected children. Diabetes was not an infection, though it certainly was a prominent cause of death among adults. This would be medicine’s first victory over a fatal disease acquired in adulthood. Success would stimulate every research laboratory, too, confirming the belief of researchers that their work could lead to the ultimate clinical success. Instead of a patient dying, they could give patients a second chance at living.

When Jonathan returned to Julianna’s room, Jimmy met him at the door. “It worked!!” Jonathan walked into the room and Julianna flashed him a wide, wide grin.

As Jonathan and Marion traveled back to New York on the train, he told her, “This discovery will be a landmark in the history of medicine.”

“Your mother would be so pleased, don’t you think?” Marion said.

“Yes, but her pleasure would be tempered by the discovery being limited to just treating one specific disease. The crusade most certainly includes every incremental victory, just as Richard the Lionheart won one Mediterranean coastal town after another to isolate Jerusalem. The Holy Grail—well, that has to be a blockbuster. It has to cut a wide swath through disease to open up all possibilities in medicine—chemotherapeutic treatment, successful elective surgeries, isolation of viruses, protection of soldiers from wartime disease. Indeed. A blockbuster.”

1934–1942

Chapter Twenty-nine

“S
ee there, that’s the Mississippi.”

“Are you sure? It looks so small.”

“Well, we’re five thousand feet in the air.”

“Oh, Dios mio. This is as close to God as I want to get until I meet Him. Are you sure you can land this?” Jimmy was flying Jonathan, Marion and his wife Sarah to Iowa City to meet with Frederick Specht. Inspired by the medical advances that had saved his life and his mother’s, Jimmy wanted to follow the family tradition, though he did not have the temperament to endure all those years of study. He liked to be moving, doing things. That was one reason why flying was such a thrill—the ability to go anywhere, any time. He went into the business of medical devices and by 1934 he was well established in the field. He had also met and married Sarah Marquez and started a family. He found that he enjoyed innovating in business, and now he wanted to enlist Frederick Specht to help him with his latest idea.

To Sarah’s immense relief, they landed safely and descended the plane to the Spechts’ applause. While Helene gave Sarah and Marion a walking tour of the town, the three men sat on a bench on the east bank of the Iowa River looking up at the new hospital complex. Frederick perched his feet on a knotty old tree stump and asked, “How is your mother, Jimmy?”

“For someone who is sixty-two she’s doing great. She finally retired from practice, and has become a full-time grandma now. And we need her. George is seven, Julie is six, and Patricia just about four.”

“How is she doing with her diabetes?”

“The insulin worked a real miracle for her. Mom can even keep up with the kids – at least with help from our nanny.”

“Your father would be proud of his grandchildren.”

Jimmy looked out over the river. “I wish he could have seen my kids, but at least my mother did.” He stood and gazed into the sky. “Say! How about a ride in the plane?” Specht laughed and waved off the idea.

“I got the bug for flying when I was in World War I. I was one of the first persons in Chicago to own a plane. Boy, planes have really improved in the last decade.”

“I wish medicine had done as well,” Jonathan growled. “The only medical discovery of note was pertussis vaccine—whooping cough is a childhood infection of the past. But no other discoveries occurred until last year. With medicine’s pattern of fits and starts I predict this decade will be very productive. It has started well!”

Jimmy settled himself back on the bench, knowing that his uncle would give them all the details. “We finally identified the virus that caused the Spanish Influenza.”

“Yes, I heard that. It’s called...,” Frederick began, but Jonathan was not to be stopped.

“The H1N1 virus. Doctor Ernest Goodpasture finally discovered a method to isolate viruses. He makes a small hole in an egg with a sterile needle, injects the virus into the egg and quickly seals the hole so bacteria are excluded. The virus multiplies in the egg yolk.”

“Very clever,” said Frederick. “A simple idea that works well. It’s a little like—”

“Unfortunately,” Jonathan said, tapping the bench, “this technique doesn’t work for all viruses. For instance, we can’t get polio to grow. But what a brilliant idea! Now we can isolate influenza, measles, and rickettsia like typhus. That means we can make vaccines for these viral diseases. Imagine control of typhus.”

Frederick looked at Jonathan for a moment, and then Jimmy, who raised his eyebrows encouragingly. “It has started well for orthopedics too,” Frederick offered, and waited to make sure Jonathan had nothing more to say. “This new hip nail is the first effective fixation device that’s been designed. Doctor Marius Smith-Petersen in Boston had an idea that had escaped other minds. It’s an I-beam nail with sharp phalanges so it cuts through bone yet has rotational stability to hold the fractured parts together. This advance opens the door for a new era of mechanical devices for surgery.”

“That’s exactly the kind of thing I came to talk to you about Frederick,” Jimmy said enthusiastically.

“Yes, you said you had a business idea that for some reason you think I can help you with.”

Jimmy leaned toward Specht. “It has become clear to me, Frederick, that medicine’s discoveries are going to multiply. Look at the success Eli Lilly has had with insulin. Bayer made a fortune on aspirin – at least until we opened up their proprietary rights after the war. The same kind of thing can happen with orthopedics.”

“You are very optimistic, Jimmy. How is this going to happen? Twenty percent of the men are out of work. The farmers here can’t make a profit on what they raise. Many of the people I treat can’t eat properly when they return home from my hospital, much less pay me.”

“Frederick, you’re right—I am an optimist. Things are looking up—sure, unemployment is still pretty high, but the economy is coming back.”

“I still say we shouldn’t have gone off the gold standard,” Jonathan began, but Jimmy continued talking.

“And even with the bad economy there are new ideas. An economic downturn doesn’t cause the creative mind to stop. I’m here in Iowa City because of the new device for hip fractures. Medicine is going to be big business soon. There are already some outfits, but my crystal ball says they’re small potatoes. The hip nail is the tip of the iceberg. My Uncle Jonathan wants cures for disease, but I think the future is greater in medical discoveries that fix the human machine. That’s what insulin does. It doesn’t cure diabetes, but it repairs the altered body. Your hip nail puts the broken body back together.”

“I’d like to see that, Frederick,” Jonathan interjected.

“And you shall, and not so long from now. So, Jimmy, what’s your business plan? What am I good for?”

“Frederick, I’m building for the future. I envision orthopedics as being a lucrative business opportunity in medicine. Everyone owns a car now—”

“And they crash them—thirty thousand deaths from automobile accidents last year. Who knows how many fractures occur?”

“A couple of orthopedic companies have been started,” Frederick said, thinking out loud. “A man named Zimmer, out of Warsaw, Indiana, sells mostly braces and splints. But Jimmy, there are not many products for a company to sell now.”

“What if we pay doctors royalties for their inventions, and provide the money needed for their research? I bet devices would soon be available for fractures, straightening the spine, and arthritic joints.” Jimmy explained his vision: with safer anesthesia, sterile gowns and drapes, gloves and masks, steam sterilization of instruments and antiseptic chemicals for skin and wounds, the threat of infection was not the deterrent it was prior to World War I. Implantation of devices inside the body was a possibility now, whereas before any device was simply a source of infection.

Frederick frowned. “To receive payment for research or a device is foreign to doctors. Doctors don’t invent things because they want to make money—they do it because they have a vision that drives them to heights others are not capable of. Marie and Pierre Curie did not patent radioactivity—in fact they showed their methodology to anyone who was interested. The vaccines have been distributed by the laboratories that made them, not by drug companies. If the business of medicine gets big, government will impose regulations, just like Teddy Roosevelt did with the Pure Food and Drug Act. So it is not going to be good for doctors in the long run,” he concluded firmly. “Jonathan, what do you think about all this?”

Jonathan, who had heard about Jimmy’s plan in detail, smiled slowly and said to Frederick, “Let’s forget about the money for a moment. If doctors want to remain poor as a church mouse, business will be happy to accommodate them. But let me ask you a question in return. How do you find out about new devices in your field?”

“Well, I read the journals, and I correspond with the other doctors I know...and sometimes there are some announcements in the newspapers about things.”

“What if you had someone whose job it was to find out about new devices and the like, and they came to you on a regular basis to tell you about them?”

Frederick raised an eyebrow at Jonathan and replied carefully, “Well, that would be useful, I suppose.”

“You know it would be,” Jimmy said emphatically. “That’s what I want to offer you. You have to buy the things anyway, and I’m giving you a much easier and more efficient way to do that.”

Frederick looked at Jimmy and then at Jonathan and rubbed his chin thoughtfully. “A company that distributes medical products and informs doctors about what’s new, that could be helpful.”

“There you go,” Jimmy smiled. “My company will disseminate information and distribute products. I will buy up devices and sell them to doctors and hospitals. The Sullivan Foundation can fund research to motivate and accelerate innovation.”