David and Goliath: Underdogs, Misfits, and the Art of Battling Giants

first at the hospital in the morning and the last to leave. But he remained never more than a step away from his tumultuous beginnings. He had a volcanic temper. He had no patience, no gentleness. One colleague remembers his unforgettable first impression of Freireich: “a giant, in the back of the room, yelling and screaming on the phone.” Another remembers him as “completely irrepressible. He would say whatever came into his mind.” Over the course of his career, he would end up being fired seven times, the first time during his residency when he angrily defied the head nurse at Presbyterian Hospital in Chicago. One of his former coworkers remembers Freireich coming across a routine error made by one of his medical residents. A minor laboratory finding had been overlooked. “The patient died,” the doctor said. “It wasn’t because of the error. Jay screamed at him right there in the ward, in front of five or six doctors and nurses. He called him a murderer, and the guy broke down and cried.” Almost everything said about Freireich by his friends contains a “but.” I love him, but we nearly came to blows. I invited him to my house, but he insulted my wife. “Freireich remains to this day one of my closest friends,” said Evan Hersh, an oncologist who worked with Freireich at the beginning of his career. “We take him to our weddings and bar mitzvahs. I love him like he is a father. But he was a tiger in those days. We had several terrible run-ins. There were times I wouldn’t speak to him for weeks.”
    Is it at all surprising that Freireich would be this way? The reason most of us do not scream “Murderer!” at our coworkers is that we can put ourselves in their shoes; we can imagine what someone else is feeling and create that feeling in ourselves. We can take that route because we have been supported and comforted and understood in our suffering. That support gives us a model of how to feel for others: it is the basis for empathy. But in Freireich’s formative years, every human connection ended in death and abandonment—and a childhood as bleak as that leaves only pain and anger in its wake.
    Once, in the middle of reminiscing about his career, Freireich burst into an attack on the idea that terminally ill cancer patients be given hospice care at the end of their lives. “You have all these doctors who want to do hospice care. I mean, how can you treat a person like that?” When Freireich gets worked up about something, he raises his voice, and his jaw sets. “Do you say, ‘You’ve got cancer, you’re certainly going to die. You’ve got pain and it’s horrible. I’m gonna send you to a place where you can die pleasantly’? I would never say that to a person. I would say, ‘You’re suffering. You’ve got pain. I’m going to relieve your suffering. Are you gonna die? Maybe not. I see miracles every day.’ There’s no possibility of being pessimistic when people are dependent on you for their only optimism. On Tuesday morning, I make teaching rounds, and sometimes the medical fellows say, ‘This patient is eighty years old. It’s hopeless.’ Absolutely not! It’s challenging, it’s not hopeless. You have to come up with something. You have to figure out a way to help them, because people must have hope to live.” He was nearly shouting now. “I was never depressed. I never sat with a parent and cried about a child dying. That’s nothing I would ever do in my role as a doctor. As a parent I might do it. My kids died, I’d probably go crazy. But as a doctor, you swear to give people hope. That’s your job.”
    Freireich continued on in this vein for several more minutes until the full force of his personality became nearly overwhelming. We all want a physician who doesn’t give up and who doesn’t lose hope. But we also want a physician who can stand in our shoes and understand what we are feeling. We want to be treated with dignity, and treating people with dignity requires empathy. Could Freireich do that? I was never depressed. I never sat with a parent and cried about a child dying. If we were asked if we would wish a childhood like Freireich’s on anyone, we would almost certainly say no because we could not imagine that any good could come of it. You can’t have a remote miss from that kind of upbringing.
    Or can you?

6.
    When Jay Freireich arrived at the National Cancer Institute in 1955, he reported to Gordon Zubrod, the head of cancer treatment. Zubrod