David and Goliath: Chapter 5: Emil “Jay” Freireich Summary & Analysis

Emil “Jay” Freireich is the son of Hungarian immigrants who lived in Chicago in the 1920s and 30s. When Jay was a young boy, his father committed suicide. This was shortly after the stock market crash of 1929, when the family lost everything. In the aftermath of his father’s death, Freireich’s mother worked in sweatshops, leaving him with a nanny whom he came to see as his real mother. They were devastatingly poor and only able to eat protein once a week. At one point, Freireich’s mother married and older Hungarian man, but Freireich hated him and came to resent his mother because she fired his nanny, the only person to whom he was close. By the time Gladwell interviews him, Freireich is 84, but he has an impeccable memory. All the same, he can’t remember his nanny’s name because he has blocked out the painful memories of that period.  

Switching tracks, Gladwell describes the British government’s concerns during World War II. The government feared what would happen to London if German forces bombed it, since the city was largely defenseless. There were predictions that 1.2 million people would get wounded and that nearly the entire population would flee to the countryside. For this reason, psychiatric centers were built just outside the city, as the government anticipated the need to calm mass hysteria. Then, in 1940, the Germans actually bombed London, and though 40,000 people were killed and 60,000 were wounded, none of the government’s predictions about the citizens’ reactions came true. Rather than descending into panic, Londoners remained relatively calm. In fact, the vast majority of the citizens showed a sense of “indifference,” and though many people attribute this toughness to the stereotypically British “stiff upper lip,” Gladwell argues that the city’s reaction says more about adversity than temperament.

To make his point, Gladwell references the work of J. T. MacCurdy, a psychiatrist studying morale. MacCurdy divided the London bombing victims into three categories: the directly impacted, the “near misses,” and the “remote misses.” The people who were directly impacted were the ones the bomb killed. The “near misses” were the people close to the explosion who were perhaps injured (or, at the very least, shaken) by the experience. Finally, the “remote misses” were the people who felt the explosion but weren’t close enough to be in true danger. After reading diary entries and speaking with a number of remote misses, MacCurdy learned that people who survived the bombings ended up feeling somewhat invincible. One woman even wrote in her diary that, after hunkering down and feeling the earth shake, she felt “pure and flawless happiness,” and she was elated and refreshed by the experience.

Gladwell argues that the reason London as a whole didn’t descend into chaos during the German bombing (which took place on a nightly basis for eight months) is that the bombardment simply created a large number of “remote misses,” thereby emboldening the vast majority of the citizens instead of demoralizing them. This demonstrates that traumatic events impact people in different ways. In other words, one experience can destroy a person’s life while emboldening and strengthening somebody else. Similarly, dyslexia can make a person’s life too difficult, since not everyone has the ability or resources to overcome the challenges the disorder presents. At the same time, though, it can also push people to do things they might not otherwise have done, thereby leading to their success. Accordingly, Gladwell believes people ought not to make the assumption that there’s only one way to respond to hardship.

When Jay Freireich was a child, he came down with tonsillitis. The doctor who removed Freireich’s tonsils became his hero, and from then on he dreamed of becoming a physician himself. In high school, Freireich’s physics teacher encouraged him to pursue a college education, so his mother borrowed money from a woman in the Hungarian immigrant community to pay for tuition. In this way, Freireich became a doctor and his larger-than-life personality made him stand out among his colleagues. When talking about Freireich, Gladwell says, most of his colleagues tell stories about his temper, though they all have great admiration for him. In one conversation, Freireich complains to Gladwell about the idea of hospice care, arguing that doctors should never simply give up and allow patients to die. To illustrate his point, he says he’s never been depressed or hopeless as a doctor, even when working on the hardest cases of his career.

Gladwell admits that most people want their doctors to empathize with them. Freireich, however, isn’t interested in doing this. Instead, he’s interested in doing what he can to save his patients, even if that means forgoing emotional pleasantries. Considering the effect Freireich’s upbringing had on his adult personality and success as a doctor, Gladwell acknowledges that nobody would wish “a childhood like Freireich’s on anyone,” since it seems like there’s nothing to benefit from such a difficult life. And yet, he also indicates that this assumption might not be all that accurate. The question becomes, then, whether or not a difficult childhood can function like a “remote miss” instead of a “direct hit.”

To answer this question about the possible benefits of childhood adversity, Gladwell references a psychological analysis from the 1960s, when a psychologist studying creative and innovative people noticed that an inordinate amount of successful individuals had lost one of their parents at a young age. In keeping with this, a historian studying England’s prime ministers discovered the same phenomenon. What’s more, 12 of the first 44 presidents of the United States lost their fathers when they were children or adolescents. Gladwell notes that there’s also evidence to suggest that, while “gifted children” often fall short of greatness when they’ve benefitted from healthy, happy childhoods, many geniuses emerge from hardship. This, in turn, indicates that it is, in fact, possible for childhood hardship to function like a “remote miss” instead of a direct hit.

As a young man in 1955, Freireich is assigned to work in the children’s leukemia ward of the National Cancer Institute. His superior, Gordon Zubrod, gives him this responsibility knowing it’s a very bleak posting. At this point in time, childhood leukemia is one of the most difficult illnesses to treat, since it comes on suddenly and leads to great agony. Worst of all, leukemia makes people bleed, meaning that the children in the leukemia ward start bleeding from seemingly every part of their bodies, including the pores of their skin. The ostensible goal of Freireich’s posting is to find a cure for childhood leukemia, but this is a nearly impossible task because he also has to focus on the immediate chaos of keeping children from bleeding to death—not to mention cleaning the floors of blood and trying to get the patients to eat.

Doctors working on the children’s leukemia ward don’t last long. Freireich, however, is capable of forging onward, proving that what he said about never getting depressed about a patient’s situation is indeed true. Instead of giving up hope, he joins forces with another researcher named Tom Frei, and together they hypothesize that one of the major problems posed by leukemia is that the children aren’t producing enough platelets (“irregularly shaped cell fragments that float around in human blood”), which means their blood won’t clot. Freireich and Frei’s bosses are hesitant to go along with this idea, but the two researchers remain undeterred, determining to give the children multiple blood infusions to help them build up their platelet counts. However, the blood banks won’t give them blood. “You’re gonna kill people!” Freireich yells, prompting one of his colleagues to warn him against saying such things—but he doesn’t care.

Instead of using blood from the National Cancer Institute’s blood bank, Freireich recruits donors. He also innovates the process of transforming the infusions themselves, since platelets stick to steel needles: he uses silicon needles and plastic bags. People think Freireich is crazy to give children so much blood at once, since a miscalculation could kill them. And though one of Freireich’s bosses threatens to fire him if he doesn’t stop, he continues anyway. As a result, the children stop bleeding.

Gladwell considers what it takes for someone to act with courage, determining that “courage is what you earn when you’ve been through the tough times and you discover they aren’t so tough after all.” To further illustrate this point, he tells the story of Fred Shuttlesworth, a black preacher and activist in Birmingham, Alabama who survived multiple acts of violence during the civil rights movement. In 1956, the Ku Klux Klan tried to stop Shuttlesworth from executing his plan to ride the city’s segregated buses. To do this, they bombed his house the night before the protest, but when police officers and community members saw his smoldering, ruined house, he walked out of the wreckage unharmed. The incident, Gladwell argues, made him even less afraid of going through with his original plan. The following day, he rode the segregated buses. 

Several months after the close call at his home, Fred Shuttlesworth takes his daughter to enroll at an all-white high school. When he drives up to the school, an angry mob of white men surrounds the vehicle, but he still gets out. The men break his car windows and beat him, but he’s able to get back in the car and drive away without sustaining life-threatening injuries. Shortly thereafter, Shuttlesworth brings a friend to a local church to meet Martin Luther King, Jr., and when they arrive, there’s yet another angry mob of white men. Nevertheless, Shuttlesworth calmly gets out and walks through the crowd, safely ushering his guest into the church. In this way, Gladwell suggests, Shuttlesworth is only emboldened by each of the violent encounters he survives. 

Gladwell returns to Freireich’s attempt to cure childhood leukemia. By finding a way to stop children from bleeding to death, Freireich manages to keep them alive long enough to focus on what, exactly, is causing the illness in the first place. He knows of several drugs that effectively attack leukemia, but each drug has toxic side effects that threaten patients’ lives in large doses. Instead of letting this discourage him, though, Freireich decides (along with Frei and another colleague) to continue studying the drugs, eventually realizing that they could administer a “cocktail” of medications, since they all have different side effects. This means each drug can still be administered in small amounts without negatively affecting the patients. The combination of drugs also mounts a multi-tiered attack on the illness, not allowing it to regenerate since, when a reasonable amount of one drug stops working, another kicks in. 

Freireich’s colleagues and superiors are skeptical of his idea to treat leukemia with so many dangerous drugs, since some of these medications are capable of paralyzing children, causing depression, and generally wreaking havoc on the body. Most people refuse to get on board, but Freireich and Frei’s boss, Zubrod, finally gives them the green light. Still, Freireich’s colleagues refuse to help him conduct the trial, so he has to do everything himself: prepare the drugs, inject them, monitor the patients’ blood, and test their marrow. In the first of 13 cases approved for study, Freireich gives a little girl a dose that is too high, and though she recovers, she later dies. But Freireich doesn’t give up, and the approach begins to work on other patients.

Freireich and Frei’s idea to treat leukemia with a “cocktail” of drugs works, but not entirely. After a while, the leukemia comes back, so Freireich decides it’s necessary to administer the concoction of medication every month for an entire year. This is a hard thing to convince people of, since many of the children in remission seem perfectly fine until their leukemia returns. For this reason, parents and doctors alike think Freireich is crazy for wanting to make these children’s lives miserable by giving them toxic drugs on such a regular basis. But he doesn’t care what other people think. He continues as planned, and the multiple rounds of treatment work. Freireich is able to do this, Gladwell argues, because he has “been through worse.” And because of this, there is now a 90 percent cure rate for this kind of childhood leukemia.