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.
3
Diagnosis and Treatment
A fter 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 Dick. 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.
C ervical 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 vagina. 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 scraping cells from the cervix with a curved glass pipette and examining them under a microscope for precancerous changes that TeLinde and a few others had identified years