Clover

Henrietta Lacks was born Loretta Pleasant in Roanoke, Virginia, on August 1, 1920. No one knows how she became Henrietta. A midwife named Fannie delivered her into a small shack on a dead-end road overlooking a train depot, where hundreds of freight cars came and went each day. Henrietta shared that house with her parents and eight older siblings until 1924, when her mother, Eliza Lacks Pleasant, died giving birth to her tenth child.

Henrietta's father, Johnny Pleasant, was a squat man who hobbled around on a cane he often hit people with. Family lore has it that he killed his own brother for trying to get fresh with Eliza. Johnny didn't have the patience for raising children, so when Eliza died, he took them all back to Clover, Virginia, where his family still farmed the tobacco fields their ancestors had worked as slaves. No one in Clover could take all ten children, so relatives divided them up-one with this cousin, one with that aunt. Henrietta ended up with her grandfather, Tommy Lacks.

Tommy lived in what everyone called the home-house-a four-room log cabin that once served as slave quarters, with plank floors, gas lanterns, and water Henrietta hauled up a long hill from the creek. The home-house stood on a hillside where wind whipped through cracks in the walls. The air inside stayed so cool that when relatives died, the family kept their corpses in the front hallway for days so people could visit and pay respects. Then they buried them in the cemetery out back.

Henrietta's grandfather was already raising another grandchild that one of his daughters had left behind after delivering him on the home-house floor. That child's name was David Lacks, but everyone called him Day, because in the Lacks country drawl, house sounds like hyse, and David sounds like Day.

Young Day was what the Lacks family called a sneak baby: a man named Johnny Coleman had pa.s.sed through town; nine months later Day arrived. A twelve-year-old cousin and midwife named Munchie delivered him, blue as a stormy sky and not breathing. A white doctor came to the home-house with his derby and walking stick, wrote "stillborn" on Day's birth certificate, then drove his horse-drawn buggy back to town, leaving a cloud of red dust behind.

Munchie prayed as he rode away, Lord, I know you didn't mean to take this baby. She washed Day in a tub of warm water, then put him on a white sheet where she rubbed and patted his chest until he gasped for breath and his blue skin warmed to soft brown.

By the time Johnny Pleasant shipped Henrietta off to live with Grandpa Tommy, she was four and Day was almost nine. No one could have guessed she'd spend the rest of her life with Day-first as a cousin growing up in their grandfather's home, then as his wife.

As children, Henrietta and Day awoke each morning at four o'clock to milk the cows and feed the chickens, hogs, and horses. They tended a garden filled with corn, peanuts, and greens, then headed to the tobacco fields with their cousins Cliff, Fred, Sadie, Margaret, and a horde of others. They spent much of their young lives stooped in those fields, planting tobacco behind mule-drawn plows. Each spring they pulled the wide green leaves from their stalks and tied them into small bundles-their fingers raw and sticky with nicotine resin-then climbed the rafters of their grandfather's tobacco barn to hang bundle after bundle for curing. Each summer day they prayed for a storm to cool their skin from the burning sun. When they got one, they'd scream and run through fields, s.n.a.t.c.hing armfuls of ripe fruit and walnuts that the winds blew from the trees.

Like most young Lackses, Day didn't finish school: he stopped in the fourth grade because the family needed him to work the fields. But Henrietta stayed until the sixth grade. During the school year, after taking care of the garden and livestock each morning, she'd walk two miles-past the white school where children threw rocks and taunted her-to the colored school, a three-room wooden farmhouse hidden under tall shade trees, with a yard out front where Mrs. Coleman made the boys and girls play on separate sides. When school let out each day, and any time it wasn't in session, Henrietta was in the fields with Day and the cousins.

If the weather was nice, when they finished working, the cousins ran straight to the swimming hole they made each year by damming the creek behind the house with rocks, sticks, bags of sand, and anything else they could sink. They threw rocks to scare away the poisonous cottonmouth snakes, then dropped into the water from tree branches or dove from muddy banks.

At nightfall they built fires with pieces of old shoes to keep the mosquitoes away, and watched the stars from beneath the big oak tree where they'd hung a rope to swing from. They played tag, ring-around-the-rosy, and hopscotch, and danced around the field singing until Grandpa Tommy yelled for everyone to go to bed.

Each night, piles of cousins packed into the crawl s.p.a.ce above a little wooden kitchen house just a few feet from the home-house. They lay one next to the other-telling stories about the headless tobacco farmer who roamed the streets at night, or the man with no eyes who lived by the creek-then slept until their grandmother Chloe fired up the woodstove below and woke them to the smell of fresh biscuits.

One evening each month during harvest season, Grandpa Tommy hitched the horses after supper and readied them to ride into the town of South Boston-home of the nation's second-largest tobacco market, with tobacco parades, a Miss Tobacco pageant, and a port where boats collected the dried leaves for people around the world to smoke.

Before leaving home, Tommy would call for the young cousins, who'd nestle into the flat wagon on a bed of tobacco leaves, then fight sleep as long as they could before giving in to the rhythm of the horses. Like farmers from all over Virginia, Tommy Lacks and the grandchildren rode through the night to bring their crops to South Boston, where they'd line up at dawn-one wagon behind the next-waiting for the enormous green wooden gates of the auction warehouse to open.

When they arrived, Henrietta and the cousins would help unhitch the horses and fill their troughs with grain, then unload the family's tobacco onto the wood-plank floor of the warehouse. The auctioneer rattled off numbers that echoed through the huge open room, its ceiling nearly thirty feet high and covered with skylights blackened by years of dirt. As Tommy Lacks stood by his crop praying for a good price, Henrietta and the cousins ran around the tobacco piles, talking in a fast gibberish to sound like the auctioneer. At night they'd help Tommy haul any unsold tobacco down to the bas.e.m.e.nt, where he'd turn the leaves into a bed for the children. White farmers slept upstairs in lofts and private rooms; black farmers slept in the dark underbelly of the warehouse with the horses, mules, and dogs, on a dusty dirt floor lined with rows of wooden stalls for livestock, and mountains of empty liquor bottles piled almost to the ceiling.

Night at the warehouse was a time of booze, gambling, prost.i.tution, and occasional murders as farmers burned through their season's earnings. From their bed of leaves, the Lacks children would stare at ceiling beams the size of trees as they drifted off to the sound of laughter and clanking bottles, and the smell of dried tobacco.

In the morning they'd pile into the wagon with their unsold harvest and set out on the long journey home. Any cousins who'd stayed behind in Clover knew a wagon ride into South Boston meant treats for everyone-a hunk of cheese, maybe, or a slab of bologna-so they waited for hours on Main Street to follow the wagon to the home-house.

Clover's wide, dusty Main Street was full of Model As, and wagons pulled by mules and horses. Old Man Snow had the first tractor in town, and he drove it to the store like it was a car-newspaper tucked under his arm, his hounds Cadillac and Dan baying beside him. Main Street had a movie theater, bank, jewelry store, doctor's office, hardware store, and several churches. When the weather was good, white men with suspenders, top hats, and long cigars-everyone from mayor to doctor to undertaker-stood along Main Street sipping whiskey from juice bottles, talking, or playing checkers on the wooden barrel in front of the pharmacy. Their wives gossiped at the general store as their babies slept in a row on the counter, heads resting on long bolts of fabric.

Henrietta and her cousins would hire themselves out to those white folks, picking their tobacco for ten cents so they'd have money to see their favorite Buck Jones cowboy movies. The theater owner showed silent black-and-white films, and his wife played along on the piano. She knew only one song, so she played happy carnival-style music for every scene, even when characters were getting shot and dying. The Lacks children sat up in the colored section next to the projector, which clicked like a metronome through the whole movie.

As Henrietta and Day grew older, they traded ring-around-the-rosy for horse races along the dirt road that ran the length of what used to be the Lacks tobacco plantation, but was now simply called Lacks Town. The boys always fought over who got to ride Charlie Horse, Grandpa Tommy's tall bay, which could outrun any other horse in Clover. Henrietta and the other girls watched from the hillside or the backs of straw-filled wagons, hopping up and down, clapping and screaming as the boys streaked by on horseback.

Henrietta often yelled for Day, but sometimes she cheered for another cousin, Crazy Joe Grinnan. Crazy Joe was what their cousin Cliff called "an over average man"-tall, husky, and strong, with dark skin, a sharp nose, and so much thick black hair covering his head, arms, back, and neck that he had to shave his whole body in the summer to keep from burning up. They called him Crazy Joe because he was so in love with Henrietta, he'd do anything to get her attention. She was the prettiest girl in Lacks Town, with her beautiful smile and walnut eyes.

The first time Crazy Joe tried to kill himself over Henrietta, he ran circles around her in the middle of winter while she was on her way home from school. He begged her for a date, saying, "Hennie, come on ... just give me a chance." When she laughed and said no, Crazy Joe ran and jumped straight through the ice of a frozen pond and refused to come out until she agreed to go out with him.

All the cousins teased Joe, saying, "Maybe he thought that ice water might'a cool him off, but he so hot for her, that water nearly started boiling!" Henrietta's cousin Sadie, who was Crazy Joe's sister, yelled at him, "Man you so much in love with a girl, you gonna die for her? That ain't right."

No one knew what happened between Henrietta and Crazy Joe, except that there were some dates and some kisses. But Henrietta and Day had been sharing a bedroom since she was four, so what happened next didn't surprise anyone: they started having children together. Their son Lawrence was born just months after Henrietta's fourteenth birthday; his sister Lucile Elsie Pleasant came along four years later. They were both born on the floor of the home-house like their father, grandmother, and grandfather before them.

People wouldn't use words like epilepsy, mental r.e.t.a.r.dation, or neurosyphilis to describe Elsie's condition until years later. To the folks in Lacks Town, she was just simple. Touched. She came into the world so fast, Day hadn't even gotten back with the midwife when Elsie shot right out and hit her head on the floor. Everyone would say maybe that was what left her mind like an infant's.

The old dusty record books from Henrietta's church are filled with the names of women cast from the congregation for bearing children out of wedlock, but for some reason Henrietta never was, even as rumors floated around Lacks Town that maybe Crazy Joe had fathered one of her children.

When Crazy Joe found out Henrietta was going to marry Day, he stabbed himself in the chest with an old dull pocketknife. His father found him lying drunk in their yard, shirt soaked with blood. He tried to stop the bleeding, but Joe fought him-thrashing and punching-which just made him bleed more. Eventually Joe's father wrestled him into the car, tied him tight to the door, and drove to the doctor. When Joe got home all bandaged up, Sadie just kept saying, "All that to stop Hennie from marrying Day?" But Crazy Joe wasn't the only one trying to stop the marriage.

Henrietta's sister Gladys was always saying Henrietta could do better. When most Lackses talked about Henrietta and Day and their early life in Clover, it sounded as idyllic as a fairy tale. But not Gladys. No one knew why she was so against the marriage. Some folks said Gladys was just jealous because Henrietta was prettier. But Gladys always insisted Day would be a no-good husband.

Henrietta and Day married alone at their preacher's house on April 10, 1941. She was twenty; he was twenty-five. They didn't go on a honeymoon because there was too much work to do, and no money for travel. By winter, the United States was at war and tobacco companies were supplying free cigarettes to soldiers, so the market was booming. But as large farms flourished, the small ones struggled. Henrietta and Day were lucky if they sold enough tobacco each season to feed the family and plant the next crop.

So after their wedding, Day went back to gripping the splintered ends of his old wooden plow as Henrietta followed close behind, pushing a homemade wheelbarrow and dropping tobacco seedlings into holes in the freshly turned red dirt.

Then one afternoon at the end of 1941, their cousin Fred Garret came barreling down the dirt road beside their field. He was just back from Baltimore for a visit in his slick '36 Chevy and fancy clothes. Only a year earlier, Fred and his brother Cliff had been tobacco farmers in Clover too. For extra money, they'd opened a "colored" convenience store where most customers paid in IOUs; they also ran an old cinderblock juke joint where Henrietta often danced on the red-dirt floor. Everybody put coins in the jukebox and drank RC Cola, but the profits never amounted to much. So eventually Fred took his last three dollars and twenty-five cents and bought a bus ticket north for a new life. He, like several other cousins, went to work at Bethlehem Steel's Sparrows Point steel mill and live in Turner Station, a small community of black workers on a peninsula in the Patapsco River, about twenty miles from downtown Baltimore.

In the late 1800s, when Sparrows Point first opened, Turner Station was mostly swamps, farmland, and a few shanties connected with wooden boards for walkways. When demand for steel increased during World War I, streams of white workers moved into the nearby town of Dundalk, and Bethlehem Steel's housing barracks for black workers quickly overflowed, pushing them into Turner Station. By the early years of World War II, Turner Station had a few paved roads, a doctor, a general store, and an ice man. But its residents were still fighting for water, sewage lines, and schools.

Then, in December 1941, j.a.pan bombed Pearl Harbor, and it was like Turner Station had won the lottery: the demand for steel skyrocketed, as did the need for workers. The government poured money into Turner Station, which began filling with one-and two-story housing projects, many of them pressed side by side and back-to-back, some with four to five hundred units. Most were brick, others covered with asbestos shingles. Some had yards, some didn't. From most of them you could see the flames dancing above Sparrows Point's furnaces and the eerie red smoke pouring from its smokestacks.

Sparrows Point was rapidly becoming the largest steel plant in the world. It produced concrete-reinforcing bars, barbed wire, nails, and steel for cars, refrigerators, and military ships. It would burn more than six million tons of coal each year to make up to eight million tons of steel and employ more than 30,000 workers. Bethlehem Steel was a gold mine in a time flush with poverty, especially for black families from the South. Word spread from Maryland to the farms of Virginia and the Carolinas, and as part of what would become known as the Great Migration, black families flocked from the South to Turner Station-the Promised Land.

The work was tough, especially for black men, who got the jobs white men wouldn't touch. Like Fred, black workers usually started in the bowels of partially built tankers in the shipyard, collecting bolts, rivets, and nuts as they fell from the hands of men drilling and welding thirty or forty feet up. Eventually black workers moved up to the boiler room, where they shoveled coal into a blazing furnace. They spent their days breathing in toxic coal dust and asbestos, which they brought home to their wives and daughters, who inhaled it while shaking the men's clothes out for the wash. The black workers at Sparrows Point made about eighty cents an hour at most, usually less. White workers got higher wages, but Fred didn't complain: eighty cents an hour was more than most Lackses had ever seen.

Fred had made it. Now he'd come back to Clover to convince Henrietta and Day that they should do the same. The morning after he came barreling into town, Fred bought Day a bus ticket to Baltimore. They agreed Henrietta would stay behind to care for the children and the tobacco until Day made enough for a house of their own in Baltimore, and three tickets north. A few months later, Fred got a draft notice shipping him overseas. Before he left, Fred gave Day all the money he'd saved, saying it was time to get Henrietta and the children to Turner Station.

Soon, with a child on each side, Henrietta boarded a coal-fueled train from the small wooden depot at the end of Clover's Main Street. She left the tobacco fields of her youth and the hundred-year-old oak tree that shaded her from the sun on so many hot afternoons. At the age of twenty-one, Henrietta stared through the train window at rolling hills and wide-open bodies of water for the first time, heading toward a new life.

CHAPTER 3

Diagnosis and Treatment

After her visit to Hopkins, Henrietta went about life as usual, cleaning and cooking for Day, their children, and the many cousins who stopped by. Then, a few days later, Jones got her biopsy results from the pathology lab: "Epidermoid carcinoma of the cervix, Stage I."

All cancers originate from a single cell gone wrong and are categorized based on the type of cell they start from. Most cervical cancers are carcinomas, which grow from the epithelial cells that cover the cervix and protect its surface. By chance, when Henrietta showed up at Hopkins complaining of abnormal bleeding, Jones and his boss, Richard Wesley TeLinde, were involved in a heated nationwide debate over what qualified as cervical cancer, and how best to treat it.

TeLinde, one of the top cervical cancer experts in the country, was a dapper and serious fifty-six-year-old surgeon who walked with an extreme limp from an ice-skating accident more than a decade earlier. Everyone at Hopkins called him Uncle d.i.c.k. He'd pioneered the use of estrogen for treating symptoms of menopause and made important early discoveries about endometriosis. He'd also written one of the most famous clinical gynecology textbooks, which is still widely used sixty years and ten editions after he first wrote it. His reputation was international: when the king of Morocco's wife fell ill, he insisted only TeLinde could operate on her. By 1951, when Henrietta arrived at Hopkins, TeLinde had developed a theory about cervical cancer that, if correct, could save the lives of millions of women. But few in the field believed him.

Cervical carcinomas are divided into two types: invasive carcinomas, which have penetrated the surface of the cervix, and noninvasive carcinomas, which haven't. The noninvasive type is sometimes called "sugar-icing carcinoma," because it grows in a smooth layered sheet across the surface of the cervix, but its official name is carcinoma in situ, which derives from the Latin for "cancer in its original place."

In 1951, most doctors in the field believed that invasive carcinoma was deadly, and carcinoma in situ wasn't. So they treated the invasive type aggressively but generally didn't worry about carcinoma in situ because they thought it couldn't spread. TeLinde disagreed-he believed carcinoma in situ was simply an early stage of invasive carcinoma that, if left untreated, eventually became deadly. So he treated it aggressively, often removing the cervix, uterus, and most of the v.a.g.i.n.a. He argued that this would drastically reduce cervical cancer deaths, but his critics called it extreme and unnecessary.

Diagnosing carcinoma in situ had only been possible since 1941, when George Papanicolaou, a Greek researcher, published a paper describing a test he'd developed, now called the Pap smear. It involved sc.r.a.ping cells from the cervix with a curved gla.s.s pipette and examining them under a microscope for precancerous changes that TeLinde and a few others had identified years earlier. This was a tremendous advance, because those precancerous cells weren't detectable otherwise: they caused no physical symptoms and weren't palpable or visible to the naked eye. By the time a woman began showing symptoms, there was little hope of a cure. But with the Pap smear, doctors could detect precancerous cells and perform a hysterectomy, and cervical cancer would be almost entirely preventable.