Prologue: The Woman in the Photograph
The narrator, Rebecca Skloot, describes a photograph of a young Black woman, well-dressed and smiling, that she keeps on her wall. This woman is Henrietta Lacks. Cells from her cervix were used to develop the first immortal cell line, HeLa, which was indispensable to the creation of chemotherapy, vaccines, gene mapping, and other major innovations. HeLa cells are used in laboratories around the world, and have even been sent up in space to study the effects of space travel on human tissues.
Rebecca Skloot first heard of Henrietta during a community college biology course she took as a high school student. The professor explains the process of mitosis (cell division), and points out that a mistake in that division process is what gives rise to cancer. He explains that they know this because of a cancer patient named Henrietta Lacks who died in 1951. Scientists at that time had been struggling to keep human cells alive in culture, but the samples taken from Henrietta's cervix kept producing and dividing normally every 24 hours, and they never stopped. The professor casually mentions that Henrietta was a Black woman, and then moves on.
Rebecca was intensely curious about this woman and her life, but couldn't find any information about her. As she entered college, she persisted in her curiosity about Henrietta, and was able to find a few interviews with her family members in Black-centric magazines. Henrietta's family was angry that the medical industry was benefiting financially from her cells while they were still struggling to survive. Rebecca becomes particularly curious about Henrietta's youngest daughter, Deborah, who seems to stand apart in the photos and doesn't give any interviews.
Rebecca becomes determined to tell the story of both the HeLa cell line and the woman they came from, a journey that will put her in contact with a wide variety of people and eventually lead to the publication of this book.
She and Deborah would eventually become close friends, despite their major differences (Skloot is white and raised in the Northwest; Deborah is a Black woman from a dangerous neighborhood in the South, and is intensely religious).
(This chapter switches to first person from the perspective of Deborah.) Deborah marvels at her mother's contributions to science. Every time she goes to the doctor, she mentions that she's Henrietta Lacks' daughter and likes to listen to the doctors exclaim over the contributions that her mother's cells made to science.
However, Deborah is also angry about the fact that other people have financially benefited from the cells they took from her mother without permission, even as Henrietta's surviving relatives struggle to afford treatment. As angry as she is, though, Deborah just wants to know more about who her mother was.
1. The Exam … 1951
In 1951, David Lacks drives his wife Henrietta to the Johns Hopkins Hospital near Baltimore. Henrietta explains to the doctor that she feels a "knot on her womb." She had previously told this information only to her two cousins, Margaret and Sadie. Though Henrietta had been experiencing pain for well over a year, she had assumed it was just related to her pregnancies.
After the birth of her youngest child, Joseph, Henrietta finds her underwear covered in blood despite the fact that it isn't her time of month. She takes a bath an examines herself, and finds a hard lump like a marble on her cervix.
Henrietta's husband Day takes her to Johns Hopkins, which is twenty miles away but unfortunately the only one in the area that accepts Black patients. A review of Henrietta's medical records reveals that she suffers from a variety of untreated conditions, including breathing problems, syphilis, gonorrhea, and unexplained vaginal bleeding. Henrietta has not sought follow-up for these serious conditions, which is because of the expense, difficulty, and communication gaps involved in seeking hospital care.
The gynecologist, Howard Jones, examines her and finds a very peculiar mass on her cervix. However, it's clear to him that the news isn't going to be good - the mass wasn't described in medical records detailing Henrietta's last delivery only a few months earlier, so it has grown at a very unusual rate.
2. Clover … 1920–1942
Henrietta was born in 1920 and named Loretta Pleasant (no one knows how she came to be called Henrietta). She was one of ten children; after her mother died giving birth to her tenth child, her father distributed the children among relatives. Henrietta was raised by her grandfather Tommy Lacks, who was already raising another grandchild that his daughter had conceived out of wedlock, who was named David Lacks. Everyone called him Day.
Henrietta, David, and the rest of the children in the family took care of farm animals and harvested crops, particularly tobacco. Most of the children dropped out of school in their elementary years, but Henrietta stayed until sixth grade. The children would sometimes accompany her grandfather to sell the tobacco crop; during this time, the white farmers slept in private rooms but Black farmers had to stay in the underbelly of the warehouse with the animals.
As they grew into teenagers Henrietta and her cousins entertained themselves by organizing horse races. Henrietta often cheered for Day, but sometimes cheered for another cousin, "Crazy" Joe Grinnan. He'd earned that nickname because of his profound love for Henrietta, which had made him attempt suicide twice when she rejected his advances.
Soon, Henrietta and Day, who had been sharing a room since Henrietta was only four, started having children together. Their first child was named Lawrence, and Henrietta gave birth to him when she was only fourteen. Their second child, Lucile, was born four years later, but she was epileptic and nonverbal. Day and Henrietta married when she was twenty years old, a match that Henrietta's sister Gladys disapproved of strongly. “Crazy” Joe stabbed himself in the chest with a pocketknife on the day that Henrietta married.
World War II started a few years after the marriage, which caused disruption in the tobacco industry, resulted in financial struggles for the family. Fred Garrett, a financially successful cousin who worked in a steel mill up north in Baltimore. Black men were given the dirtiest and most dangerous jobs in the steel mill, but they also made wages that were impressive to their impoverished farming relations – Fred made eighty cents an hour. Fred convinces Henrietta’s husband Day to get a job at the steel mill; when Fred is drafted into the war a few months later, he tells Day to bring Henrietta to be with him in Baltimore. Henrietta and her two children left Virginia and joined Day in Baltimore.
3. Diagnosis and Treatment … 1951
Henrietta goes about her daily tasks until she gets the results from her biopsy, indicating that she has Stage I cervical cancer.
The diagnostic criteria for what counts as cervical cancer was in flux at this time. Henrietta’s gynecologist, Howard Jones, was in a debate with his boss Richard Wesley TeLinde, on this topic. TeLinde insisted that carcinoma in situ, which was believed not be serious at the time, should be treated aggressively by removing the cervix, uterus, and part of the vagina.
It was only since 1941 that physicians could even detect early-stage cervical cancer. George Papanicolaou had created the Pap smear in 1941, which allowed doctors to identify abnormal cellular changes before they turned into cancer. However, many doctors were unsure of how to interpret the results, since it was hard to identify the different stages of cervical cancer under a microscope. They frequently confused infections with cancer, resulting in unnecessary surgeries and untreated malignancies.
Faced with a large number of women dying from metastasized cancer when doctors had previously only diagnosed them with a bacterial infection, TeLinde created a study to prove that carcinoma in situ was worthy of aggressive treatment. TeLinde drew on data and records from impoverished and Black patients who never consented to having their information shared in such a way. He discovered that 62% of women with invasive cancer had first had carcinoma in situ. TeLinde realized that if he could grow living samples from normal cervical tissue and both types of cancerous tissue, he could prove his theory correct.
He contacted George Gey and his wife Margaret, who led tissue culture research at Hopkins. The two had been determined to develop human cells that could survive in culture, which would enable scientists to understand how cancer grew and developed. TeLinde and Gey started taking samples from any woman with cervical cancer at Hopkins, including Henrietta.
Henrietta didn’t tell any of her friends or family that she had cancer right away. She told her husband only that she needed to go back for treatment. Henrietta received radium treatments to shrink her cervical cancer, which was the invasive type. Howard Kelly had brought samples of radium back to the United States in the early 1900s after visiting Pierre and Marie Curie in France. He later died of cancer, most likely caused by exposure to radium. Before the treatment, the surgeon on duty cut two dime-sized pieces of tissue from Henrietta’s cervix, but never asked her if she consented to this procedure. Then he packed several pieces of radium next to Henrietta’s cervix and took the dish with her cells back to Gey’s lab.
4. The Birth of HeLa … 1951
At Gey’s lab, his twenty-one year old lab assistant Mary Kubicek eats her lunch, and accepts the sample (from Henrietta) that the aide brings. She has no reason to think this sample might be special, so she continues eating her lunch.
Mary was fresh out of college with a degree in physiology, and performed much of the intricate but tedious work of cutting and tweezing samples. Trying to get human cells to live in culture instead of the body was proving a nearly insurmountable obstacle, and the Geys were trying to develop a medium that would keep them alive, using ingredients such as umbilical cord blood and chicken plasma. Contamination was a huge issue, but Margeret, who had been trained as a surgical nurse, was excellent at preventing the flow of microorganisms. She imposed these rigorous methods on Mary as well. She carefully dons clean surgical clothes and disinfects both her equipment and the general area before touching Henrietta’s sample. She labels it with the first two letters of the patient’s first and last name – HeLa.
George Gey had been born to a poor white family in Pittsburgh, and he paid for his university education and medical degree by working in carpentry and construction. In medical school, he rigged a microscope with a time-lapse motion picture camera to take photos of cell division. His ingenuity infused his lab work – he and his wife Margaret essentially constructed their lab from scratch,. George was a visionary who created a large rolling drum that turned like a cement mixer, allowing the culture medium to stay in constant motion as if it was still in the human body. Mary put Henrietta’s sample into this machine and let it turn.
Henrietta stays at the hospital a few more days, undergoing more uncomfortable medical tests. Unbeknownst to her, cells from her cervical cancer are growing at an incredible rate in the Gey lab; they not only survived where all the other samples had died, they doubled their numbers every twenty-four hours. It was the cells taken from Henrietta’s cervical cancer that showed this remarkable growth; cells from Henrietta’s cervix died like all the others.
When George Gey mentions this remarkable achievement to his colleagues, some of them asked for samples to use in their own experiments, and Gey agreed.
This section begins with a description of the photograph of Henrietta Lacks that will become a recurring motif throughout the book—she "Looks straight into the camera and smiles, hands on hips, dress suit neatly pressed, lips painted deep red. It’s the late 1940s and she hasn’t yet reached the age of thirty. Her light brown skin is smooth, her eyes still young and playful, oblivious to the tumor growing inside her—a tumor that would leave her five children motherless and change the future of medicine." (pg. 1) This photo appears numerous times throughout the book - Courtney Speed keeps a copy of it, Deborah is shocked to find it in a biology textbook, and so on. This photo of the young and vibrant woman represents Rebecca Skloot's efforts to humanize Henrietta, whose name has been forgotten even by the scientists who use her cells in research.''
Henrietta's idyllic youth, compared to a fairy tale (pg. 42), serves as a foil to her painful death and her unexpected afterlife as the HeLa cell line. This section also introduces one of the major themes, the Dehumanization of Henrietta Lacks. She is first treated as merely a disease, and later as a source of strangely immortal cells.
This section also introduces readers to Rebecca Skloot's unique handling of the complex history of the HeLa cell line. She features the voice of Deborah, Henrietta's only surviving daughter, immediately after her own introduction, thus giving the Lacks family a voice in a history in which they have often been silenced. She also carefully handles delicate matters within the Lacks family, such as the tendency for cousins to marry and the widespread nature of syphilis infections. These things are contextualized within the wider experiences of the Lacks family: because members of the family knew they could trust each other, they were more likely to marry relatives; additionally, because the Lacks family feared doctors and often lacked the funds to receive medical care, they were unlikely to receive treatment for syphilis when exposed to it.
Rebecca Skloot is also careful in her handling of the other characters involved in the HeLa saga, such as the Geys. Though the Geys enabled the widespread distribution of the HeLa cell line without consulting any member of the Lacks family and could easily be depicted as the villains of the story, Rebecca instead portrays them as dedicated scientists working hard in their labs. They are also products of their context in the same way that the Lacks family members are - it wasn't customary to ask patients for consent. Moreover, by mention the poverty in which George Gey grew up, Rebecca connects them thematically to the Lacks family, who also endured poverty.
The description of Henrietta's discovery of her cervical cancer has prompted controversy. in 2015, a parent in Tennessee took issue with the scene in which Henrietta discovers her cervical cancer ("With the door closed to her children, husband, and cousins, Henrietta slid a finger inside herself and rubbed it across her cervix until she found what she somehow knew she’d find: a hard lump, deep inside, as though someone had lodged a marble just to the left of the opening to her womb" (pg. 17)). This parent called the scene pornographic, and urged the school system to remove all copies of the book from its shelves. Rebecca Skloot replied that “a parent in Tennessee has confused gynaecology with pornography and is trying to get my book banned from the Knoxville high school system [...] I choose to focus on those stories, and I hope the students of Knoxville will be able to continue to learn about Henrietta and the important lessons her story can teach them. Because my book is many things: It’s a story of race and medicine, bioethics, science illiteracy, the importance of education and equality and science and so much more. But it is not anything resembling pornography" (Flood, 2015). See the Website Links section of this note for more details.