Super Medicine
At the Texas Medical Center doctors can rebuild your heart, give you new limbs, treat your cancer, save your children from affliction, and maybe even bring you back from the dead.
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The doctors went from the wards downstairs to an outpatient clinic, to which Mr. Dunkleberg had come that day for a bone marrow biopsy. This is a diagnostic procedure in which a doctor sticks an evil-looking metal tube into a patient’s hip bone, vigorously works it around in a circular motion, and extracts a small core of bone and marrow to send to the lab for tests. If done exactly right, it’s a painful procedure; if not, excruciating. Mr. Dunkleberg and his wife went into a small treatment room, where he lowered his trousers and a young doctor inserted the tube into his hip. “Now this doesn’t hurt,” the doctor said. “It’s pressure, it’s pressure, I’m pressing real hard, but it’s not pain.” Mr. Dunkleberg was clenching his jaw and grunting; his wife was wringing her hands. Watching, I suddenly began to sweat profusely and felt my stomach begin to turn. With the last of my composure, I edged out of the room and ran through the halls, past amputees and people with black radiation marks on their faces and no hair, out to the parking lot, thinking: How can these people possibly live with this?
I discovered the answer in talking to the Dunklebergs a few hours later: through great, inspiring courage and dignity. Since that day in Osborne when they had learned of the cancer, their lives, like those of all patients with serious cancer, had been completely shattered. Luckily, Rosalie Dunkleberg had insurance through her employer, a grocery store, that covered all her husband’s medical care, but there were still the travel and hotel bills to pay, and neither of the Dunklebergs was working. Their two teenage children were living by themselves back in Osborne. “Sometimes I kind of ask myself,” said Mr. Dunkleberg, “ ‘What have I done to deserve this?’ But I figure the good Lord must have some reason.” Whether or not He does, the Dunklebergs were managing to live through the disease with their pride and love intact.
After his first two weeks in Houston last summer, the doctors had prescribed a course of chemotherapy called CHOP-B (a mixture of five chemicals) and sent him home to take his treatment. This lasted six weeks. Mr. Dunkleberg would go to the hospital in Kansas for checkups and twice had to lie on a table for two and a half hours while the five chemicals dripped into his body through an intravenous line. It would be two days before he could hold down any food.
A week before they were to return to Houston for more tests, Mrs. Dunkleberg noticed a small knot on the right side of her husband’s neck. “When we got there,” she says, “they said, ‘Well, obviously the CHOP hasn’t done you any good, so we’ll give you MOPP.’ ” This was a combination of four chemicals given in two doses. One of the chemicals was nitrogen mustard, which is so powerful that when it was injected by syringe Mr. Dunkleberg felt like he was being hit with a sledgehammer. This time he got his chemotherapy at Anderson, and after two weeks the Dunklebergs drove home again.
There, once again, he got worse. His right shoulder — and then his whole right arm down to his fingers — started to swell. The Dunklebergs got back in their car and drove to Houston. This time Mr. Dunkleberg was in so much pain that he couldn’t drive, and when he arrived at M. D. Anderson he moved into a room at the hospital as an inpatient. Mrs. Dunkleberg moved in too, and slept on a cot in her husband’s room, where she bathed him and fed him and helped him into the bathroom. He underwent a course of thirteen daily treatments of radiation on the shoulder, and the swelling went down. But at the same time a new lump was growing on the right side of his chest; by the time the radiation treatment ended in late December the new lump was the size of half a walnut, black and foreign-looking.
If there was any bright side to the Dunklebergs’ lives, it was the way their family and town and the hospital staff had rallied around them. “This was the first Christmas we were ever away from the kids,” says Mrs. Dunkleberg. “So some friends put out a box for donations in the store where I worked to fly the kids down here. It filled right up. A woman in Osborne named Mabel Cornwall, who we call the Flying Farmer, flew them down the day after Christmas. This whole thing has brought the family closer together. The children — well, our daughter realized right away how serious it was. The boy at first wouldn’t give Dad a kiss good-bye. But the last couple of times he did. And the people here don’t treat you like a number. The doctors remember your name.”
On the day I met the Dunklebergs they were trying to decide whether to try a third course of chemotherapy that the doctors had suggested: a group of chemicals known as L6, followed by a course of high-dose methotrexate. Both of these treatments, given separately, were common, but only one other person had taken them in combination. As I came in, Mr. Dunkleberg was pushing away his dinner because, he said, “This hospital food I ain’t crazy about.” Chemotherapy does strange things to the appetite — once, for instance, the hospital kitchen was cooking roast beef while he was receiving chemicals, and from then on even the thought of roast beef made him nauseous. He is a doughty, stubborn man, and was as determined not to eat as he was determined to live.
Rosalie Dunkleberg was much more enthusiastic than her husband about trying the new chemotherapy. “If we were someplace else, like Wichita or Kansas City,” she said, “it might be different, I might have my doubts. But we know Houston is the best place in the world. If it was any other place I’d be skeptical.”
“The thing about it is,” said Mr. Dunkleberg, “here, when you’ve got four or five doctors on the same case, you know they’ve got something going. But I’ve still got a little question in my mind. It’s still experimental. I keep trying to think positive, but I don’t know what to do. At first I was just supposed to be here five days. Now it’s up to three weeks if we do this. I don’t know how this deal’s gonna go. I kind of want to go home.”
“Dad,” said Mrs. Dunkleberg, “I saw what happened when we went home.”
BUILDING THE DREAM
The M. D. Anderson Hospital is named for Monroe Anderson, the man who deserves the first measure of credit for the existence of the Texas Medical Center. Along with his brother, Frank and the Clayton brothers, Will and Ben, Monroe D. Anderson was a founder of the world’s largest cotton company, Anderson, Clayton & Company. For more than half a century Anderson, Clayton’s lawyers have been the firm of Fulbright & Jaworski, now the fifth-largest law firm in the country. Two of the men who built the firm, John H. Freeman and William B. Bates (the firm’s name was once Fulbright, Crooker, Freeman & Bates) were close friends of Anderson’s as well as his lawyers.
All these men were born in the late nineteenth century in fairly humble circumstances, all but Freeman moved to Houston as young men, and all of them saw their fortunes grow beyond their wildest dreams as the city grew. They were, in a way, simple men. They led quiet lives. When younger people asked them for advice, they were likely to say that the secret to a happy life was hard work, honesty, thrift, and religion. Reading through their old speeches and interviews, it’s hard to escape the conclusion that they saw the world as an uncomplicated place, a place where progress was good and virtue was rewarded. They were happy. They loved Houston. They wanted it to grow and prosper and win the admiration of the world. So they started the Texas Medical Center.
In the mid-thirties Monroe Anderson’s health began to fail. Anderson had no heirs to provide for, so he decided, partly for business reasons and partly for altruistic ones, to use his Anderson, Clayton stock to set up a foundation for good works. In 1936 he established the M. D. Anderson Foundation, with an endowment of $300,000 and himself, Bates, and Freeman as trustees. Three years later Anderson died and left the bulk of his fortune - $19 million, the largest estate ever in Texas at tht time — to the foundation. Bates and Freeman chose a new third trustee and began discussing how to give away the money.
Of the original trustees, only Freeman is still alive. He is 92 years old now, nearly blind and legally deaf but mentally lucid. He still keeps an office at Fulbright & Jaworski, where he works with a green eyeshade perched on his forehead. “Back in the thirties,” he says, “we got the idea of establishing a white-collar hospital with Mr. Anderson’s money. In those days the very rich could take care of any expense from health problems. And the very poor could get it free. But the fellow in the middle — no provision was made for him.
“While we were considering that, the Legislature appropriated $500,000 for a state-owned cancer hospital and research facility, to be run by the University of Texas. We decided to abandon the idea of the white-collar hospital if we could get the cancer hospital. We told the university, if you put it in Houston and call it M.D. Anderson Hospital, we’ll provide a site and give another $500,000 to assist in the building and also help in the upkeep and maintenance.”
The white-collar hospital had been a good idea, but now destiny was calling the Anderson Foundation trustees. Destiny’s personal representative in Houston was Dr. Ernst William Bertner, a strong-willed, big-thinking man who was one of the city’s leading physicians. The son of a German immigrant, Bertner grew up in Colorado City. In 1913, while in training in New York, he happened to administer an anesthetic to the most powerful citizen of Houston, Jesse Jones. Jones was so impressed by Bertner that he asked him to come down to Houston as house doctor at a new hotel he was building, the Rice. Bertner accepted, and in the early forties he and his wife lived in an apartment on the same floor of the Rice as the John Freemans. Bertner became friendly with all the Anderson Foundation trustees, and he began to tell them that they could build a great medical center in Houston, one that would one day have a $100 million worth of buildings and, yes, overshadow the Mayo Clinic. The trustees thought Bertner was a little overoptimistic about what could be done, but his basic idea of a medical center caught their imaginations.
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