The narrative returns to 1951. After visiting Hopkins, Henrietta gets a diagnosis: she has a type of cervical cancer called epidermoid carcinoma. “Carcinoma” refers to the type of cell from which the cancer has formed; in this case, from the cells that cover and protect the surface of the cervix. During Henrietta’s treatment, both Dr. Jones and his supervisor, Dr. Richard TeLinde, are involved in a debate over what illnesses could be categorized as cervical cancer and how to treat them.
Skloot now begins to meld Henrietta’s personal story with the medical narrative of which she will quickly become a part. She also mentions the debate about cervical cancer at the time, emphasizing how little was known about women’s health during this time period—just another kind inequality that Henrietta had to face.
There are two types of cervical cancers: invasive, which means it has penetrated through the surface of the cervix, and noninvasive, also called “carcinoma in situ,” which instead grows smoothly over the surface of the cervix. In 1951, most oncologists believed that invasive carcinoma was deadly and that noninvasive was not, so they treated the former aggressively but essentially ignored the latter. TeLinde, however, asserted that carcinoma “in situ” is an early stage of invasive carcinoma.
Here we begin to learn more not only about Henrietta’s cancer, but about cervical cancer in general, as well the doctors who are treating Henrietta. Skloot keeps the book interesting and engaging by informing on several narratives at once.
Diagnosing carcinoma in situ had become possible only about a decade earlier, in 1941, due to the innovations of a researcher named George Papanicolaou, who had developed a test called the Pap smear. Before this test, early stage cervical cancer was not discoverable, and by the time a woman began to show symptoms, it was too late. During this time, 15,000 women a year were dying of cervical cancer; the Pap smear could decrease the death rate by over 70%. TeLinde was working to document what was and wasn’t cervical cancer, and to persuade surgeons to do biopsies on women before removing their uteruses, while also convincing the medical community of the dangers of carcinoma in situ.
We hear more about the progression of cervical cancer research and treatment during Henrietta’s illness, and about the staggering amount of women who are needlessly dying of this disease. Another theme here emerges: the unwillingness of the medical community to admit that it is wrong, even at the cost of patients’ lives. Although Skloot respects the advancements that scientists have made, she also remains clear-eyed about the stubbornness and arrogance common among some doctors and researchers.
Recently, TeLinde had presented his carcinoma in situ theory to a conference of pathologists and had faced a hugely negative reaction. His response was to review “all medical records and biopsies from patients who’d been diagnosed with invasive cervical cancer at Hopkins in the past decade” to see how many cases had started out as in situ. As with most researchers at the time, TeLinde would use poor patients from the charity wards for research without telling them, believing that this could act as a form of payment.
Skloot begins to focus in again, explaining how exactly the advancing field of cervical cancer research relates to Henrietta. She also illustrates the good and the bad of the medical community perfectly in the character of TeLinde. Although he deeply wishes to help women with cancer, he also sees no problem with using poor patients as guinea pigs without their consent.
For tissue samples, TeLinde went to George Gey, Hopkins’ head of tissue culture research. Along with his wife Margaret Gey, George Gey had been attempting to grow cancer cells in culture (outside the human body) in order to determine cancer’s cause and find a cure. The Geys’ ultimate goal was to grow the first immortal human cells, ones which would divide forever. In 1943, a group of researchers had done so with mouse cells, fueling George Gey’s obsession. He and TeLinde arranged a trade: TeLinde would provide Gey with cervical cancer tissue, and Gey would attempt to grow it.
The narrative moves ever closer to explaining exactly how Henrietta’s cervical cancer tumor transformed into a famous and immortal cell line. We also meet another important figure within the narrative: George Gey, who will come to represent the treacherous side of the medical establishment to Henrietta’s family, despite Gey’s own good intentions and scientific brilliance.
On February 5, 1951, Dr. Jones calls Henrietta to tell her the results of her biopsy. Henrietta tells no one in her family about the news, but asks her husband to take her to Hopkins the next day. She assures Day and the children that nothing is wrong. In the hospital, Henrietta signs a form giving Hopkins the right to perform “any operative surgical procedures…that they may deem necessary.” She follows a nurse into a “colored” ward, where Howard Jones and his helpers test “her urine, her blood, her lungs.” After two nights, Henrietta is prepared for radiation treatment, the usual method for combating cervical cancer.
This passage emphasizes another way in which the 1950s differed from the present: the secrecy and fear with which people viewed cancer and cancer treatments. Once again, Skloot takes care to emphasize that although Hopkins is treating Henrietta, they have also placed her in the “colored ward” for her treatment. Racism is everywhere, even within a supposedly enlightened, charitable establishment such as Hopkins.
Radium destroys living cells, and killed many who took it when it was marketed as a cure-all in the 1800s. It also, however, kills cancer cells. Hopkins had used radium since the early 20th century, following the lead of Dr. Howard Kelly, who had learned about radium from the famous Marie Curie and Pierre Curie, the couple that had discovered radium and its use against cancer. By the 1940s, researchers had found that radium was safer and more effective than surgery when it came to treating cervical cancer.
Like many medical treatments within this book, radium represents a double-edged sword—on one hand, it proves deadly when used in excess, as it originally was. On the other hand, it effectively kills deadly cancer cells and can be lifesaving. Both the use and misuse of radium help to emphasize one of Skloot’s larger points—that medicine both hinders and heals, and that it is often difficult, in early stages, to tell which it will do.
ForHenrietta’streatment, doctors use glass tubes of radium. They were sewn into containers called Brack plaques, named after a Hopkins doctor who invented them. He later died of cancer, probably from being exposed to radium, as did a resident of Dr. Kelly’s.
Skloot here reveals that doctors and researchers, too, have died in pursuit of knowledge. She consistently raises the stakes of her narrative, keeping up the suspense amidst the science.
The surgeon on duty, a man named Dr. Lawrence Wharton Jr., dilates the unconscious Henrietta’s cervix to treat her tumor. Although Henrietta has no idea that her cervix is going to be sampled, Wharton cuts out two pieces of tissue: one cancerous, and one healthy. He then inserts tubes filled with radium into Henrietta’s cervix. After the procedure, Wharton notes that Henrietta seems in “good condition,” and says that he has given her tissue to Dr. George Gey.
In this seemingly routine surgery, the fateful act of the book occurs, as a surgeon cuts out a sample of Henrietta’s cervix to give to Dr. Gey. Skloot relies on dramatic irony here, as we know the implications of this event, but the “characters” do not. Even here, Skloot also takes care to note that Henrietta is unconscious and cannot give consent.
Henrietta’s tissue samples travel to George Gey, who greets them eagerly. His assistants, however, believe that the samples will fail and die just like all the others.
The irony continues, as Gey’s assistants greet cells that will change the world with resignation and cynicism.