A Civil Action (2 page)

1

When the Reverend Mr. Bruce Young arrived at Woburn Trinity Episcopal Church in the summer of 1966, he was twenty-eight years old and ambitious. Trinity was his first church. It was a plain but sturdy-looking building, with a steeply peaked roof, a white clapboard exterior, and three small stained-glass windows along each side. The new minister could see that the church had fallen on hard times. Weeds had invaded the lawn, which was brown and scabrous in spots, with patches of bare earth showing through. The bushes needed trimming, the shingles on the roof had curled, and the Gothic-style front doors needed paint. Even in the best of times, the church, which was built in 1902, had never been prosperous.

By the time Bruce Young arrived, only about fifty parishioners, most of them nearly old enough to remember when the church was new, still attended the Sunday service. Young often remarked that Trinity was the only Episcopal church on the planet without a lawyer or a doctor in its congregation. Young and his wife, who had a degree in social
work, agreed that Woburn was a good place to begin a career but not a place they intended to stay for long.

Woburn, a city of thirty-six thousand situated twelve miles north of Boston, needed paint, too. A few blocks south of Trinity Episcopal, past a Sunoco station, an Army-Navy recruiting center, and several pizzerias, lay the town square. It was a small island, surrounded by city traffic, dominated by a towering bronze statue of a Civil War veteran. On pleasant days a few workers from City Hall would eat lunch on the square’s park benches. Each spring the city’s public works department cultivated tulips, marigolds and petunias in the square, but the department could not afford a full-time gardener. The weeds competed for space, and each year by midsummer the weeds had gained a clear advantage.

The town square was surrounded by two- and three-story buildings, the heart of Woburn’s once bustling commercial district. The buildings dated to the turn of the century, but many of the original brick and stone façades had been covered by plastic tiles, orange and lime green, a style fashionable in the 1950s, Woburn’s last period of prosperity. Many of the storefronts were dusty, their windows streaked with dirt, the doorways filled with small piles of windblown debris. Marram’s Shoes & Tuxedos and the pet supply shop had recently gone out of business. In the grimy window of Perillo’s Sub Shop, a sign read
CLOSED
, under which someone (perhaps Perillo himself) had added
FOR GOOD
. Several pizzerias survived, along with the Woburn Bowladrome, the Tanner’s Bank, and Mahoney’s Barber Shop, established in 1899.

Woburn’s first commercial enterprise had been a tannery, built by the Wyman brothers in 1648. Back then the land was densely wooded, hilly in the west and north, flatter in the east where the Aberjona River flowed through marsh and bog. The Wyman brothers prospered until King Phillip’s War, when John Wyman’s eldest son was killed by Indians in a swamp fight. That season the Wyman leathers spoiled in the tanning fats. Another tanner named Gershom Flagg cleared an acre of forest near the Town Meeting House and built his dwelling and tannery. By the Civil War, Woburn had twenty tanneries, matching Philadelphia in the production of leather. The city acquired the nickname Tan City. The most prosperous bank in town was the Tanner’s Bank, and now the high school football team called itself the Tanners.

The leather trade supported other industries. In 1853 Robert Eaton founded a chemical factory in northern Woburn, along the banks of the Aberjona River, and supplied the tanneries with the chemicals—blue vitriol, Glauber’s salt, sulfuric acid—necessary to produce leather. At the turn of the century, Eaton’s factory was one of the largest chemical plants in the country. But the tanning industry began to wane after World War II. By the late 1960s it had been eclipsed by competition from abroad. A decade later, only the J. J. Riley Tannery in east Woburn, near the Aberjona River, still produced leather. That tannery’s immense red-brick smokestack, two hundred feet tall with the name J. J. Riley inscribed vertically on it, could be seen from the town square, almost a mile distant.

To attract new businesses the city cleared and developed many acres of land in northeastern Woburn for industrial parks. Scandal arose when several city officials were discovered to have an undisclosed financial interest in the land, but development proceeded nonetheless. Up on Commerce Way, near Interstate 93, several small manufacturing and trucking firms moved in. Robert Eaton’s old chemical factory on the banks of the Aberjona River was taken over by Monsanto. W. R. Grace, another chemical giant, built a small plant on land that had once been an orchard. Woburn didn’t lack for industry, but somehow there was never enough money to fix all the cracked sidewalks or the potholes in the street.

Bruce Young had planned to stay in Woburn for only about five years. There was plenty of ministering to do in Woburn, but a poor parish like Trinity Episcopal could sap a young man’s energy and ambition. After a few years Young had made some inquiries about moving on. But the sort of parish he was seeking didn’t open up every day, and when it did, he faced stiff competition.

His Woburn parishioners liked him, but even the fondest had to admit that he was not a stirring public speaker. He read rather than declaimed his Sunday sermons, and his voice tended to trail on in a monotone. To his credit, he recognized this shortcoming and kept his sermons brief. He was always available for counseling, and his advice was usually sound. He had a manner that made him seem truly interested in the problems people brought to him. He had a particular talent for ministering to the sick and infirm, and beginning in January 1972, his sixth year at Trinity Episcopal, the sick became the heart and soul of his ministry.

2

Jimmy Anderson’s parents thought he had a cold. It was January, a season for viruses, and his older brother and sister both had the classic symptoms, too—coughs, runny noses, slight temperatures. Even his mother, Anne, had not been feeling particularly well. By mid-week, however, everyone except Jimmy, who was three years old, seemed to be on the mend. He had a fever that waxed and waned, and his appetite had decreased considerably. He was pale, and Anne noticed several bruises on his limbs and torso, which struck her as odd because the child had been in bed most of the time. She and her husband, Charles, decided to take him to the family pediatrician the next morning.

The pediatrician, Dr. Donald McLean, was alarmed by Jimmy’s appearance. The fever suggested an infection, and indeed the child had some upper respiratory congestion. But this did not look like an ordinary infection to McLean. At the very least, the child was seriously anemic, with a profound pallor and lethargy. McLean thought the bruises might indicate a deficiency of platelets, the blood component that acts as a clotting mechanism. He performed a quick physical examination and found slightly enlarged lymph nodes but nothing else remarkable. Pallor, bruises, and a persistent fever: the clinical signs pointed to a blood disorder.

McLean suspected that Jimmy Anderson had leukemia, but he did not mention this suspicion to the Andersons. Leukemia is a rare disease, occurring in fewer than four out of one hundred thousand children each year. McLean wanted to see the results of a blood test before he made a diagnosis. It was late Saturday morning, but McLean arranged for the lab to analyze the boy’s blood sample that afternoon. He told the Andersons he should know more by then, and asked them to call him.

On the way home from the doctor’s office, Anne said to Charles: “I think he has leukemia.” The tone of her voice as much as what she’d said caused Charles to turn and look at his wife. She looked very frightened, and that in turn frightened Charles.

When Charles called Dr. McLean that afternoon, the doctor’s voice was grave. “There appears to be a problem with your son’s blood. We’re going to have to do some more tests to find out exactly what’s wrong.” He told Charles he would set up an appointment for Jimmy on Monday
morning at Massachusetts General Hospital. He made no mention of leukemia, and Charles did not press him for a diagnosis. “If he knew what Jimmy had, he would have told us,” Charles said to Anne.

The Andersons had guests for dinner that Saturday night. In the kitchen, Anne wept. Nothing Charles said could dissuade her from the conviction that Jimmy had leukemia. The disease held a particular terror for Anne. In 1950, when she was fourteen years old and growing up in Somerville, a girl who lived in her neighborhood had gotten leukemia and died within a matter of weeks. Anne had never been close to the girl, but they’d known each other in passing. Word of the girl’s death had spread in hushed, whispered conversations around Anne’s junior high school. For the first time in her life, Anne understood mortality and death. The disease seemed especially frightening to her because it was such a mystery. It struck suddenly, it was invariably fatal, and no one knew what caused it.

On Monday morning, January 31, Anne and Charles drove to Boston with their son. Jimmy Anderson was examined by Dr. John Truman, the chief of pediatric hematology at Massachusetts General, Boston’s biggest hospital. “Thin, sad-faced 3½ year old with history of pallor and easy bruisability,” noted Truman. “Presents with moderate generalized lymphadenopathy and occasional bruises, but no petechiae. Spleen not palpable.”

Truman performed a bone marrow aspiration (“difficult pull with scant return”) which revealed 32 percent blast cells. Blasts are primitive white blood cells that multiply rapidly but are incapable of developing to maturity. Their numbers left no doubt in Truman’s mind about the diagnosis: acute lymphocytic leukemia.

That afternoon, Truman brought Anne and Charles into his office and told them what he had found. Anne remembered that the winter day was cold and clear, and that the afternoon sun angled through the blinds. She felt oddly distant, as if she were hearing Truman from afar, her attention drawn to the motes of dust that floated in the sunlight.

The next few weeks were very important, said Truman. He would attempt to induce a remission in James by using a combination of powerful drugs and radiation. The chances of a successful remission were good. There was, however, a 10 percent chance that James might die during
the next four weeks. The greatest danger was not from the leukemia itself but from an opportunistic infection. Chemotherapy would kill cancerous cells in the blood and bone marrow, but it would also suppress the body’s ability to fight infection. A common childhood illness—the chicken pox, for example, or even a cold—could prove fatal.

When Truman began working with leukemic children in the early 1960s, there was no effective treatment for leukemia. Most children died within weeks of diagnosis. But in the last two years, great advances had been made by the St. Jude Children’s Research Hospital in Memphis. Truman explained to the Andersons the nature of the new treatment program, which was known as the St. Jude protocol. After the initial dosage of chemotherapy and radiation, which would take about a month to complete, James would have to return to the hospital’s outpatient clinic on a regular basis over the next three years. He would follow a maintenance program that included periodic doses of chemotherapy. The regimen, although aggressive and with many side effects, appeared promising. If James went into remission with the first round of chemotherapy, said Truman, his chances of surviving for the next five years were 50 percent or better.

Truman also talked about what caused childhood leukemia. Most parents, he had found, worried that they had done something wrong, or that they could perhaps have prevented the disease. Truman tried to allay the parents’ fears. The cause of acute lymphocytic leukemia was not known, he would tell them. Because that answer seemed so barren, he usually continued with a small disquisition on what was known. Some types of leukemia can be caused by ionizing radiation, or by chemicals like benzene. But that type—acute myelocytic—was not what James had. Some scientists also suspected that viruses might cause leukemia in humans. Viruses were believed to cause leukemia in cats, cows, birds, and rodents, and scientists at Harvard were currently trying to isolate a leukemia virus in cats. But that disease, Truman explained, was a very different illness from the one that afflicted humans.

Jimmy Anderson began the St. Jude protocol on Tuesday, the day after his diagnosis. He received several blood transfusions in an attempt to increase his platelet count. Truman examined the boy each day, looking for signs of infection or new bruises and petechiae, the cluster of small, purplish skin hemorrhages characteristic of leukemia. Anne came to the hospital early every morning. At first she returned home to
sleep at night, but soon she began spending the nights with her son in his hospital room. Anne’s mother came to Woburn to look after the two older children.

By the end of the first week, James’s platelet count was still low but holding steady; he had no new bruises or petechiae. He was losing hair and experiencing severe nausea because of the drugs, but Truman felt he was clinically stable. By the end of the month there was no evidence of leukemic cells in either his peripheral blood or bone marrow. He had entered remission precisely on schedule. Everything had gone according to plan, and Truman felt optimistic about the boy’s recovery.

Anne Anderson was thirty-five years old the winter her son became ill. She was a handsome woman, tall and big-boned, from Norwegian ancestry, with high cheekbones, striking blue eyes, and blond hair. She had grown up in Somerville, across the Charles River from Boston, the youngest of four children, the only girl in a family of modest means. After high school, she went to work at the Somerville Public Library. When she was twenty-four years old, still living at home, she met Charles Anderson on a blind date. He was a year older than she, the son of a longshoreman. He had ideas about getting ahead in life. He’d gone to college and he wanted to work in computers. Charles and Anne courted for a year, and then, in 1961, they married.