Steve Jobs

layers around his pain receptors, causing him to suffer more. And he was prone to extreme mood swings, marked by prolonged bouts of anger and depression, which further suppressed his appetite.
    Jobs’s eating problems were exacerbated over the years by his psychological attitude toward food. When he was young, he learned that he could induce euphoria and ecstasy by fasting. So even though he knew that he should eat—his doctors were begging him to consume high-quality protein—lingering in the back of his subconscious, he admitted, was his instinct for fasting and for diets like Arnold Ehret’s fruit regimen that he had embraced as a teenager. Powell kept telling him that it was crazy, even pointing out that Ehret had died at fifty-six when he stumbled and knocked his head, and she would get angrywhen he came to the table and just stared silently at his lap. “I wanted him to force himself to eat,” she said, “and it was incredibly tense at home.” Bryar Brown, their part-time cook, would still come in the afternoon and make an array of healthy dishes, but Jobs would touch his tongue to one or two dishes and then dismiss them all as inedible. One evening he announced, “I could probably eat a little pumpkin pie,” and the even-tempered Brown created a beautiful pie from scratch in an hour. Jobs ate only one bite, but Brown was thrilled.
    Powell talked to eating disorder specialists and psychiatrists, but her husband tended to shun them. He refused to take any medications, or be treated in any way, for his depression. “When you have feelings,” he said, “like sadness or anger about your cancer or your plight, to mask them is to lead an artificial life.” In fact he swung to the other extreme. He became morose, tearful, and dramatic as he lamented to all around him that he was about to die. The depression became part of the vicious cycle by making him even less likely to eat.
    Pictures and videos of Jobs looking emaciated began to appear online, and soon rumors were swirling about how sick he was. The problem, Powell realized, was that the rumors were true, and they were not going to go away. Jobs had agreed only reluctantly to go on medical leave two years earlier, when his liver was failing, and this time he also resisted the idea. It would be like leaving his homeland, unsure that he would ever return. When he finally bowed to the inevitable, in January 2011, the board members were expecting it; the telephone meeting in which he told them that he wanted another leave took only three minutes. He had often discussed with the board, in executive session, his thoughts about who could take over if anything happened to him, presenting both short-term and longer-term combinations of options. But there was no doubt that, in this current situation, Tim Cook would again take charge of day-to-day operations.
    The following Saturday afternoon, Jobs allowed his wife to convene a meeting of his doctors. He realized that he was facing the type of problem that he never permitted at Apple. His treatment was fragmented rather than integrated. Each of his myriad maladies was being treated by different specialists—oncologists, pain specialists, nutritionists, hepatologists, and hematologists—but they were not being co-ordinatedin a cohesive approach, the way James Eason had done in Memphis. “One of the big issues in the health care industry is the lack of caseworkers or advocates that are the quarterback of each team,” Powell said. This was particularly true at Stanford, where nobody seemed in charge of figuring out how nutrition was related to pain care and to oncology. So Powell asked the various Stanford specialists to come to their house for a meeting that also included some outside doctors with a more aggressive and integrated approach, such as David Agus of USC. They agreed on a new regimen for dealing with the pain and for coordinating the other treatments.
    Thanks to some pioneering science, the team of doctors had been able to keep Jobs one step ahead of the cancer. He had become one of the first twenty people in the world to have all of the genes of his cancer tumor as well as of his normal DNA sequenced. It was a process that, at the time, cost more than $100,000.
    The gene sequencing and analysis were done collaboratively by teams at Stanford, Johns Hopkins, and the Broad Institute of MIT and Harvard. By knowing the unique genetic and molecular signature of Jobs’s tumors, his doctors had been able