Summary
Chapter 16. “Spending Eternity in the Same Place” … 1999
During Rebecca Skloot’s visit with Henrietta’s cousin Cootie, her told her that Henrietta’s relatives had stopped talking about her when she died, and that her cells had lived longer than her memory.
Cootie told Rebecca to talk to Henrietta’s other cousin Cliff, who lives in a run-down house with the windows patched by newspaper. He is a friendly elderly man with a number of health problems, and offers to show Rebecca the family cemetery where Henrietta is buried.
Cliff points to an abandoned log cabin, and tells Rebecca that it’s the house where Henrietta grew up. Exploring the structure, Rebecca finds a woman’s shoe and wonders if it belonged to Henrietta.
Behind the abandoned house is the family cemetery. Many of the graves are marked with index-card-sized metal plates, because most people in the family were too poor to afford marble headstones. Cliff and Rebecca identify the tombstone of Henrietta’s mother; Henrietta herself does not have a headstone, but Cliff says she is probably buried near her mother.
Cliff says he doesn’t quite understand the significance of the HeLa cells, but he shouts to Henrietta’s grave that her cells are still living. He also remarks that both the Black and white sides of the Lacks family are buried in the same place, and he hopes they’ve worked out their problems by now.
Henrietta’s great-grandmother was a slave on a tobacco plantation, and Henrietta’s great-grandfather was a white slave owner named Alfred Lacks. When he died, he divided his land among five Black heirs, which prompted his white brother to sue him to divide the land. The court split the inheritance between the two parties, and the Black-owned portion eventually became Lacks Town.
Race still shapes life in Clover, though most people insist that it’s not so bad. Still the Ku Klux Klan is active in a nearby town, and the white Lackses refuse to acknowledge their Black relations.
Rebecca visits Carlton and Ruby, two white relatives of Henrietta; they were distant cousins before becoming husband and wife. They have more than a hundred grandchildren and great-grandchildren. When Rebecca mentions the Black Lackses, Ruby dismisses them as “the coloreds,” and says the two sides of the family don’t mix. Ruby insisted that the Black Lackses only took on the surname because they were owned on the Lacks plantation, not because they are Lacks descendants.
Gladys, Henrietta’s sister, agrees that the two sides of the family don’t mix. Gladys takes out a letter from her youngest sister, Lillian, who had won the lottery and became suspicious of people asking her questions about her life and family. Because of this, she had decided to pretend that she was Puerto Rican instead of Black.
Chapter 17. Illegal, Immoral, and Deplorable … 1954–1966
During the HeLa production process, one scientist – Chester Southam – became concerned that the cells could infect researchers with cancer. In order to test his theories, he injected a leukemia patient with HeLa cells, telling her that he was testing her immune system. Hard cancerous nodules appeared at the site of the injection, then disappeared. However, the cancer recurred in several of the patients, in one case metastisizing to the lymph nodes.
Southam wanted to test his theory in patients who did not already have cancer. He placed an ad in a prison newsletter, and recruited over 150 volunteers. (Prisoners would later be considered a vulnerable population for biomedical research, since they were unable to give informed consent, but this guideline did not become widespread until a few decades after Southam’s research.) When asked why they agreed to these potentially dangerous medical tests, the prisoners said they wanted to repay their debts to society.
Southam found that the healthy patients were able to fight off the cancer completely, and that their immune systems actually responded more quickly each time. Eventually, Southam would inject hundreds of people with HeLa cancer cells without their knowledge or consent, including nearly every gynecological surgery patient who came through the doors of Sloan-Kettering Memorial Hospital. He had a theory that since people who had cancer rejected the cells more slowly than people who didn’t have cancer, he could use this test to find undiagnosed cases of cancer.
Southam didn’t inform patients of the test because he didn’t want to cause “unnecessary” fear by using the word cancer. However, he was the primary beneficiary of this withholding of information, since most patients would probably have refused to participate in this untested and dangerous clinical trial if they had known what was truly happening.
Southam would probably have continued these experiments for an unknown amount of time if three young Jewish doctors hadn’t refused to cooperate with him in 1963, citing the horrific experiments that Nazis perpetrated on Jewish prisoners.
In 1947, the Nuremberg trials led to the executions of several Nazi doctors for these horrendous experiments. They also led to the first establishment of a code for biomedical research, which established that “the voluntary consent of the human patient is absolutely essential.” This code, however, did not have the status of law in the United States.
The first legal case that mentioned informed consent took place in 1957, when a young man was paralyzed by a spinal surgery that his doctor insisted was totally safe.
The three Jewish doctors who worked with Southam resigned from the hospital, citing his illegal study as the cause. Southam just had a resident carry out the injections instead. However, a member of the hospital's board, named William Hyman, supported the scientists and sued the hospital to access the medical records of the patients involved in the study. Many of the patients were not given the chance to receive informed consent about the study, and others wouldn't have been able to understand even if they had - same spoke only Yiddish and others suffered from mental ailments.
Newspapers seized on the court case. Patients involved in the study contacted lawyers, and other research scientists rushed to support Southam, saying that everyone was doing research in this way. Southam had his medical license revoked for a year but then became president of the American Association for Cancer Research.
Eventually, this incident led to the establishment of review boards, composed of professionals and laypeople, which would approve all scientific studies. Still, the damage had already been done - a publication in the New England Journal of Medicine described twenty-two studies with consent violations comparable to Southam's, including cases where children had been intentionally infected with hepatitis.
Chapter 18. “Strangest Hybrid” … 1960–1966
The HeLa cell line, among other things, was used to test the effects of space travel on human cells. A sample of HeLa was launched into space with the Discoverer XVIII satellite; this experiment demonstrated that space travel made HeLa divide even more quickly, though it had no effect on ordinary human cells.
HeLa was also used on earth. Scientists noticed that all cells in culture either died or immediately became cancerous. A Navy doctor named Hyatt experienced this firsthand when he attempted to transplant human skin cells onto a burn victim, only for the transplant to become cancerous. Hyatt removed the graft and didn't attempt any more transplants.
Scientists noticed that all of the spontaneously-developed cancer cells behaved like HeLa, which led some scientists to wonder if their other samples had become contaminated by HeLa. Cell biology had been necessary for crucial scientific breakthroughs such as the revelation that cigarettes caused cancer, but the field was still somewhat disorganized - scientists did not keep good records on their work. In order to ensure pure samples, the NIH developed a cell bank at the American Type Cell Collection (ATCC), which had long been used to track samples of bacteria, fungi, and other substances.
The ATCC contacted the Geys to obtain an original sample of HeLa, but George Gey had given all of them to other researchers; however, Wiliam Scherer offered some HeLa samples. The ATCC found that some of their cell samples, which they'd believed were from animals like dogs and pigs, were actually from primates. However, they correctly labeled these samples and moved on.
When cells are infected with certain viruses in culture, they clump together and sometimes fuse, combining genetic material from the two cells. This was an important scientific technique because it allowed scientists to study human genetics. In the 1960s, two scientists named Henry Harris and John Watkins fused HeLa cells with mouse cells, and later with chicken cells. This offered important new possibilities for the development of gene therapies, but also created a media firestorm. Newspapers said that scientists were creating "mouse-men," and published drawings of strange half-human, half-mouse monstrosities.
Though Harris and Watkins tried to explain that they were just fusing cells in Petri dishes, the media misperception stuck. This was not the only negative development that would occur in cell culture science.
Chapter 19. “The Most Critical Time on This Earth Is Now” … 1966–1973
Deborah Lacks became pregnant with her first child at 16, but Bobette supported her as she finished school. Deborah's son was named Alfred Jr after his father Alfred "Cheetah" Carter.
Deborah's brother Lawrence had opened a convenience store. However, the youngest child, Joe, was constantly getting in trouble for aggression and fighting; he was discharged from the military for being psychologically unsuited for military life.
Shortly after returning home, Joe was repeatedly harassed by a neighborhood boy named Ivy. After Ivy beat Joe up for talking to his cousin, Joe was determined to get revenge. The next morning, Joe walked up to Ivy and stabbed him to death.
For a week, Joe evaded justice by staying with friends and family, but he was so violent and unstable that they eventually urged him to turn himself in. Joe pled guilty and was sentenced to fifteen years in prison, where he began to read the Koran and eventually converted to Islam, changing his name to Zakariyya Bari Abdul Rahman.
Deborah married Cheetah, the father of her child, when she was eighteen. Despite the birth of a daughter, LaTonya, Cheetah started abusing drugs and became increasingly violent towards Deborah, once breaking a plate over the side of her face. One night, he beat her severely and she pushed him down the stairs, then locked him outside to sleep in the snow.
At Bobette's urging, Deborah moved back to her father's apartment and took on two jobs in order to support her family.
Chapter 20. The HeLa Bomb … 1966
In 1966, a geneticist named Stanley Gartler took the podium at the Conference on Cell Tissue and Organ Culture, and told the assembled scientists that all of their cell cultures were contaminated by HeLa. Though he was little-known in the field, he had studied the genetic markers of eighteen different cell lines and found that they contained a rare genetic marker, glucose-6-phosphate dehydrogenase-A, found almost exclusively in Black Americans. Because some of the other cell lines were known to be from Caucasians and HeLa was known to be from a Black woman, Gartler concluded that there was a serious contamination problem.
Scientists would later discover that HeLa cells were remarkably hardy: they could float through the air on dust particles or scientists shoes, and make their way into culture dishes, where they filled all available space. HeLa cells had even colonized samples stored at the ATCC.
This was a huge blow to the field, because if it was true, then all the conclusions that scientists had derived from their specialized research on cells were worthless. This also explained the peculiar finding that all normal cells eventually died or turned cancerous - they didn't spontaneously change, they were taken over by HeLa. One scientists who were present said it was as though Gartler had dropped a turd in the punch bowl.
The scientists returned to their labs and ran tests for the unusual genetic marker in their cell samples. They found that is was present in many of their samples. Hyatt, the Navy doctor who had attempted the skin transplant, found that this transplant had become contaminated with HeLa cells.
In order to identify contaminated samples, scientists developed a test for to identify HeLa cells in culture, which would lead them to Henrietta's surviving relatives.
Chapter 21. Night Doctors … 2000
Sonny finally agrees to meet Rebecca Skloot. He says she needs to talk to the oldest Lacks child, Lawrence, before anyone else will speak with him. He drives her over to meet Lawrence. On the way, Sonny talks about what little he remembers about his mother - she cooked well, was hospitable and kind.
Sonny drops Rebecca off at Lawrence's house and leaves. Lawrence is a tall and imposing man, but he cooks for Rebecca and welcomes her in. He talks to her about his childhood and what he remembers about his mother; however, he has forgotten most of it because the memories are too painful. Lawrence proudly discusses the contributions of his mother's cells to modern science, but then confesses he doesn't actually understand what a cell is. Rebecca gives him a short lesson in cell biology, which he appreciates.
Sonny returns suddenly, and brings a guest - Day Lacks, Henrietta's husband, who is now a frail elderly man with severe gangrene of the feet. The noise wakes Bobette, who comes down to get her morning cup of coffee (even though it's 2 in the afternoon). Rebecca asks if Deborah will be joining them as well, but the brothers tell Rebecca that Deborah doesn't want to talk to white strangers right now.
Day gives Rebecca a scripted account of Henrietta's death. He emphasized that he only allowed the autopsy on Henrietta because the doctors at Hopkins said it might help save his children from cancer one day.
Bobette and the rest of the family express their suspicion of the medical system, relaying stories from the Black community of Baltimore about the Hopkins doctors that snatched Black people off the street for medical experiments.
These stories have some truth. Slave owners frequently conducted horrific medical experiments on their slaves, and other slave owners used this fear to scare their slaves into submission. Later, "night doctors" would exhume Black bodies from cemeteries in order for use in medical schools.
Lawrence and his family believed that Hopkins had been established in a Black-majority neighborhood for this purpose. However, the truth is more complicated. Johns Hopkins, the founder of the hospital, had actually freed his slaves before the Emancipation and had stipulated that the hospital would serve people of all races. However, this did not stop Hopkins doctors from conducting unethical medical tests, such as a study in which doctors contaminated houses with lead and then encouraged landlords to rent them to families in order to study the effects of lead poisoning on children's bodies.
Henrietta's surviving family is frustrated by the fact that her cells were taken without anyone's consent, and that other people have grown rich off them while the Lacks family struggles to get health insurance.
Analysis
This section introduces themes of medical ethics, especially connected to the experiments of Chester Southam, who injected live cancer cells into prisoners and sick patients in order to see if their bodies would fight it off. Today, this would be considered too dangerous and unnecessary to be approved by a review board. Even if it was approved, Southam would need to explain the risks and potential benefits of the experiment to each of the potential participants, and receive their consent to proceed. Southam's experiments violate the principles of autonomy and beneficence that guide modern medical ethics. (See the "Medical Ethics" section for more information.)
Chapter 21 discusses fear of "night doctors" in Black communities, which connects to the theme of racism in medicine. Though Rebecca does not think there is evidence that "night doctors" actually kidnapped children from Black communities for use in medical experiments, these urban legends do speak to the fact that Black people endured experimental medical treatments that probably would not have been conducted on white people. This is compounded by the fact the Black people continue to experience barriers to medical access even today (see Links section).
The theme of scientific miscommunications is expressed in the description of the 1960s experiments of Harris and Watkins, in which they fused mouse and human cells in culture, only to be reviled by newspapers for creating horrific "mouse-men." Their experiments never generated a living being, but instead only cells in culture. However, the general public was unable to understand the nuances of their experiment, which lead to unnecessary suspicion and outrage.
The theme of racism is explored when the reader is introduced to the two sides of Lacks family who continue to live in Virginia. For example, Ruby (one of the white relatives of the Lacks family) insisted that the Black Lackses are not in fact related to the white Lackses, they just took on the surname because they were owned by the white Lackses and lived on their plantation. Both sides insist that racism isn't really an issue in Clover today, but evidence such as the treatment of Henrietta Lacks and the continuing activities of the local Ku Klux Klan seem to indicate that such assertions are a form of denial rather than an accurate statement of fact.
Chapter 20 introduces Stanley Gartler, a young geneticist who points out that multiple cell lines are contaminated with HeLa cells. His brave but shocking statement does not endear him to the wider scientific community, who are infuriated that their carefully conducted experiments may have been compromised by a strange force outside their control. This once again indicates that sometimes scientific can be motived by factors other than pure inquiry. Gartler's insight is important for scientific research, but it is also important because it drives scientists to better map the HeLa genome, which leads them to Henrietta's surviving relatives, most of whom have no idea about the research that is being conducted with her cells.
