A few months after Truex’s death, a memorial service for him was held at USC; it was attended not only by family members but also by many of Truex’s old team-mates from his college and Air Force days. Jim Slosson was there too. As a more lasting memorial, his family and friends endowed a college scholarship for athletes from Warsaw High School. There is also a Max Truex Memorial interscholastic track meet that is held in Indiana every May.
Max’s mother, Lucile, died exactly nine months after Max, on Christmas Eve of 1991. She had been in frail health, but the shock of her son’s death accelerated her own, Kay believes. Kay stayed on in Boston for a year so that Gene could graduate from high school, and then she and the younger children moved back to Fresno, the city of her birth. In 1993 she attended her 30th high school reunion, and there she ran into Michael De Justo, a classmate she had been out of touch with for decades. Within a few months they married.
During all the years since Truex’s death, neither Kay nor anyone else in the family learned what Rebecca Folkerth found in his brain – not even after her findings were published. Kay tells me that she did have a phone conversation with Folkerth some time after her husband’s death, but all she learned from that was that he had not suffered a stroke. As to whatever else Folkerth said during the conversation, Kay said, ‘I could not for the life of me understand what she was saying to me.’ Thus it is possible that Folkerth did describe what she found, but did so in technical language that failed to communicate much to a layperson like Kay.
It wasn’t until the summer of 2005, when I met Kay in Fresno, that she learned about what had happened and saw Folkerth and Durso’s published report. She was of course surprised to learn that none of the foetal brain cells had survived, and shocked to see the photographs of the nodules, hair, and other foetal tissues that were growing in the ventricular system of Truex’s brain.
Kay did take issue with one thing in the report. Folkerth and Durso, citing Kay as their source, had written in the summary of their report that Max had died after a ‘several-hours interval of progressive lethargy and breathing difficulties’ – a description that would be very compatible with an impairment of brainstem function. ‘That is completely incorrect,’ said Kay. She reiterated that Max had not complained of tiredness until a few minutes before his death, and had not shown any breathing difficulties until the very last moments of his life. ‘I think they went back after the fact,’ she said, meaning that Folkerth and Durso misremembered what Kay had told them in a manner that fit in better with their pathological findings. To be fair to Folkerth and Durso, the main text of the report does not state that Truex had breathing difficulties for hours prior to his death, but only tiredness.
I had thought that Kay might react to what she learned with considerable hostility toward Iacono, but she didn’t – not in the couple of hours I was with her, at least. On the contrary, she re-emphasised her belief that Iacono had acted out of good intentions and that Max himself had urged Iacono to go ahead with the procedure. ‘If this [report) is true, it’s very sad in a way,’ she commented, ‘because it means that what Max set out to do to help himself may have actually gone completely the other direction.’
Iacono stopped doing foetal transplants in 1989, after he had operated on a total of 25 to 30 patients, all of them in China. ‘When you start adding up the negative aspects of foetal grafts,’ he told me, ‘including the risks of immunosuppression as well as infection from the foetus and contamination from these other things, the risks of foetal grafts are pretty high.’ In a paper published in 1994, Iacono argued that foetal transplantation was a less successful treatment for Parkinson’s disease than another neurosurgical procedure called pallidotomy, which involves destruction of part of a brain region called the pallidum. At the time I visited Iacono he was specialising in pallidotomy operations: he did them, as he put it, in ‘industrial numbers’.
Some other centres, such as Curt Freed’s, continue to perform the transplants, with mixed results: about one-third of the patients have been greatly helped, some have seen little change in their condition, and a few have developed disabling side-effects of the procedure, such as involuntary flailing movements. In Freed’s hands, the transplanted cells do survive, and no patients have been afflicted by the teratoma-like growths that Max Truex experienced.
In the waiting room of Iacono’s Redlands office, I noticed a life-size portrait of a surgeon operating, with a man standing next to him guiding his scalpel. Oddly, that man was wearing neither gown nor mask nor gloves. It took me a moment to figure out the reason: that man was Jesus. Iacono had become quite religious since the Truex days, and he no longer approved of abortion or of using aborted foetal tissue for science. ‘I went from “I don’t care what I’m doing here with a foetal graft” to becoming a right-to-lifer,’ he said. ‘I’d see these little guys, and after a while you realise you can tell how they’re going to grow up and what their personality’s going to be like; you can almost name them.’
After my meeting with him in 2000, things did not go well for Iacono. In October 2001, California’s Loma Linda University Medical Center, where Iacono was doing his surgery, revoked his privileges, meaning that he could no longer operate there. According to the California Medical Board and newspaper accounts, the hospital’s action was provoked by a laundry list of misbehaviours, starting in 1992 with an episode of ‘inappropriate language and inappropriate touching’. In 1994, Iacono allegedly used some drugs that were not approved by the FDA. This was followed in 1998 by ‘yelling and abusive behaviour toward staff’, which earned him an official reprimand and six months of anger-management therapy. In May 1999, Iacono was said to have become angry with a scrub technician in the operating room, and to have grabbed her hand, causing an injury. In the spring of 2000, according to the allegations, he told a nurse, within earshot of a deceased patient’s family, that she had ‘killed’ the patient. And at some unspecified time, Iacono was accused of having allowed a medically unqualified nurse practitioner to drill holes through patients’ skulls.
Following the loss of his surgical privileges at Loma Linda, Iacono applied for privileges at another hospital, Desert Regional Medical Center in Palm Springs. But, according to the California Medical Board, Iacono falsely answered ‘no’ to a question about whether he had ever had his surgical privileges suspended or revoked. Because of this and the other alleged actions by Iacono, the Medical Board brought a formal accusation against him in 2004, and in September 2005 Iacono was ordered to surrender his medical licence, meaning that his medical career in California was over. Two years later, while flying alone from Los Angeles to Mississippi, he crashed into a mountainside in New Mexico and was killed. He was 55 years old.
Why did Truex agree to participate in a project that he must have realised was hazardous in the extreme, and which quite likely killed him? Why did he agree to be operated on by someone who had absolutely no previous experience in this kind of work, in an absurdly remote location, and without any kind of regulatory control? In part, of course, it was simply his desperate desire for relief from his incurable and progressive illness. But also, he placed a great deal of trust in Iacono. He was a family friend, after all. And Iacono, whatever failings he may have had, was an extraordinarily vivid and persuasive talker. At our meeting in 2000, after lecturing me for several hours Iacono left the room and a medical student who had been sitting in on our meeting turned to me and said, ‘You haven’t seen him at his finest. He gets very dynamic – a very charismatic fellow!’
Then Iacono popped back in and said to me, hopefully in jest, ‘My Mafia friends can track you down and cut your tongue out if this doesn’t work out for us.’
METEOROLOGY: All Quiet on the Western Front
‘EARLIER ON TODAY, apparently, a woman rang the BBC and said she’d heard that there’s a hurricane on the way,’ said Britain’s best-known weatherman, Michael Fish, on an October evening in 1987. ‘Well, if you’re watching, don’t worry – there isn’t.’ Then the hurricane struck. Eighteen people died, and losses mounted into the billions.
That, at least, is a synopsis of events as they have engraved themselves in the memory of Britons who survived the Great Storm of October 15 and 16, 1987. Fish himself sees it all a bit differently. He was talking about the weather in America. The videotape was doctored. The French let him down. His forecast wasn’t wrong. He wasn’t even on duty that evening. And there was no hurricane.
Untangling what actually transpired before and during the storm presents quite a challenge. For one thing, meteorology is an arcane science. Take the term ‘baroclinic instability,’ a key concept in the analysis of the 1987 storm. A baroclinic instability is the condition when isobaric-isopycnal solenoids are nonzero. Got it? I think not.
Also, as befits an arcane science, its practitioners stick together like glue. The debacle of October 16 – if it was a debacle – was followed by an orgy of collective amnesia in which any hint of scientific failure – if there was a failure – was masked, denied, or erased from the record. It wasn’t till more than 20 years later that a trio of (non-British) meteorologists broke ranks and laid out how the forecast
should
have been done.
One thing is clear: there was a hurricane – in America. Its name was Hurricane Floyd, but it shouldn’t be confused with the monster of that name which devastated the Carolinas 12 years later. (That one led to the permanent retirement of ‘Floyd’ from the christening book of tropical storms.) By comparison, the Floyd of October 1987 was a timid thing – in fact it carried official hurricane status for only a few hours on the night of Monday, October 12, as it traversed the Florida Keys. Then it weakened to a tropical storm, crossed the Bahamas without causing unusually severe damage, and petered out.
Floyd didn’t make it as far as Europe, but its influence did. By October 14, energy propagating downstream from the remnants of the hurricane had helped establish a deep east-west trough of low pressure in the north-eastern Atlantic, off the coast of Spain. To the northwest of the trough, frigid air descended from the arctic; to the south, warm, moist air was being carried north-eastward over Spain. The resulting steep north-south gradient in temperature was the ultimate energy source for the storm, making it an ‘extra-tropical cyclone’. (Depending on their location, storms of this type may be referred to more specifically as ‘mid-latitude cyclones’ or ‘European wind storms’.) A true hurricane, in contrast, is born in tropical waters and feeds off the
vertical
temperature gradient between the warm ocean surface and the cold air aloft.
I discussed the events of 1987 with Thomas Jung, a German research meteorologist based at the European Centre for Medium Range Weather Forecasts (ECMWF) in Reading, Berkshire. Jung and his colleagues have re-created, within the safe confines of a modern supercomputer, the ferocious conditions of the Great Storm.
‘When you have these temperature gradients, the wind increases with height,’ Jung said. ‘This is the so-called geostrophic wind, which produces a very large shear, and a baroclinic instability develops, and then you have development of strong storms.’ Explaining this a little: a geostrophic wind is a wind that blows in a direction parallel with the isobars – the lines of equal pressure that are the main element of weather charts. You might think the wind would turn left, cross lots of isobars, and fill up the low-pressure trough. Indeed, the pressure gradient is trying to make it do exactly that, but it doesn’t succeed because another, equally strong, force is trying to make the wind turn right. That other force is the Coriolis force that results from the Earth’s rotation. The two forces balance out and so the wind simply charges straight ahead along the isobars. The wind’s speed is proportional to the pressure gradient: that is, it gets faster as the isobars become more closely spaced.
Near the Earth’s surface, however, the wind is slowed by friction and turbulence. This causes the Coriolis force (which is proportional to speed) to become weaker, so the wind in the lower parts of the atmosphere does turn somewhat to the left, crosses isobars, and runs partway down the pressure gradient. Thus there is a shearing action between the slower, leftward-turning wind at lower levels and the faster, straight-ahead wind at higher altitude. The shearing action generates an unstable situation called a baroclinic instability, which involves a complex interaction between pressure, density and temperature at different locations and altitudes; I confess that I don’t understand the details, but the outcome is a vortex – a counter-clockwise spinning action that winds up low-pressure troughs into the high-energy systems called extra-tropical cyclones. These are often visible as comma-shaped cloud systems in satellite images of the Earth’s middle latitudes.
Extra-tropical cyclones are good things, because they very efficiently convey heat and moisture from the tropics toward the poles, thus making living conditions more tolerable for everyone. Still, the fact that they originate in instabilities is a problem, especially for weather forecasters. An instability is a knife-edge-like situation. ‘If there is a small perturbation, it grows and grows and grows,’ said Jung. ‘The problem is that if this happens with the atmosphere itself, it is likely also to happen with any error in your forecast.’