Q: What motivated you to write BREAKTHROUGH?
A: It all began with an article about Elizabeth Hughes and the discovery of insulin in The New York Times Magazine, which was brought to my attention by a friend, Arthur Ainsberg. As we discussed the article, it became clear to us that it was a story we had to tell. That conversation would change both of our lives.
The research was very exciting. It felt like detective work. Between the two of us, we visited medical centers, universities, libraries, archives, and other sites of significance located in twenty-five cities and towns in eight states and four countries over the course of five years.
The research was especially personal for me, because I have a strong connection to some of the places where this story took place. I spent many happy summers as a child in Silver Bay in upstate New York, as did my mother. Incredibly, I sat in the pews of the Helen Hughes memorial chapel decades before I began this project, never imagining that I would someday write about it.
Also, during the course of writing this book, I became a mother. This experience had a profound impact on my understanding of the choices that Antoinette and Charles Evans Hughes and other parents were forced to make about their diabetic children. Their courage inspired me all through the writing of the book.
Q: What was the most surprising thing you and Arthur discovered during your research?
A: There were several really powerful moments during the research process that we’ll never forget. One was standing at the Hughes’s family plot at Woodlawn Cemetery in the Bronx and seeing the graves of Elizabeth’s entire family – her grandparents, parents and siblings – and finding Elizabeth’s own grave missing. Elizabeth Hughes Gossett, when she died in 1981, was cremated. When Leonard Thompson, the first human recipient of insulin died, his pancreas was preserved in a jar. Even today it can be seen in a display at the Banting Institute in Toronto. Elizabeth’s cremation ensured that no part of her would suffer that fate.
Another moment that I’ll always remember happened in Toronto. Our research seemed to indicate that Charles Evans Hughes had intervened on behalf of Frederick Banting after the patent office rejected Banting’s application to patent insulin – but we couldn’t prove it. We searched high and low for evidence to prove our theory. I think we’ll always remember the day we sat side-by-side at a long oak table at the University of Toronto archives; going through boxes and boxes of papers. And then suddenly it was in my hands: a letter written by Charles Evans Hughes to the patent office urging them to reconsider Banting’s application.
Q: Can you talk about the process of writing BREAKTHROUGH?
A: To me, writing is miraculous. There is a bit of the divine in it, the mysterious. Often, ideas appear to me as scenes – I quite literally see them – and this may be related to my graduate education at the Iowa Playwrights Workshop.
As a playwright, I’m accustomed to collaboration. In this particular project it was great to have another set of eyes to pore over the boxes and boxes and boxes of documents. Having two perspectives on the same, very complex material was a big advantage. In sorting out the material for Breakthrough there was much to consider: so many plot lines, so much political and historical context, two different national cultures, not to mention all the scientific detail. It was hard to get my mind around it, so having two minds really helped increase the creative bandwidth. We owe a debt of gratitude to all of the people who helped us along the way – the archivists and historians, research assistants and librarians, tour guides and docents, readers and editors. We couldn’t have done it without you!
As for the writing itself, each project seems to dictate its own schedule, its own pace, its own idiosyncratic ritual. Some stories insist on being written on a keyboard, others can only be written on yellow legal pads with rollerball pens. Some like to be written in quiet; others in a loud café. Some come all at once. Others reveal themselves at an agonizingly slow pace. In each case, the story leads me, teaches me. I am its student and servant. Breakthrough was primarily written on my laptop at my dining room table, because the stacks of research materials were too voluminous to fit on my desk!
Q: Is there diabetes in your family?
A: My first exposure to diabetes was via my uncle. He had been a U. S. Marine Corps fighter pilot in the Pacific in the Second World War. Despite having overcome daunting odds in the skies, he developed insulin-dependent diabetes during peacetime, safe at home. He was fairly private about his illness but one summer we took a family vacation with him and I saw then that diabetes is a disease that demands almost constant attention. He was extremely diligent about his diet and checking his blood sugar but his diabetes ultimately led to the stroke that killed him.
Q: What was it like to write about medical research? Do you have a medical background?
A: Much of my career as a writer and editor has involved translating complex, jargon-y, or technical language –- such as financial analysis or computer instructions -- into readily accessible English. I wasn’t intimidated by the medical terminology; I just accepted that I might have to work harder to understand it than someone with medical training. But even if I’d had a medical background, there would have been some necessary translating. Medical research was very different almost a century ago than it is now.
In any case, I didn’t want Breakthrough to be a book that only people with a medical background could understand. I think the reader’s experience of Breakthrough is of a human story, not a medical one. It’s about history, politics, individual character, and ethical dilemmas. It’s about decisions under duress. I hope that someone who is reading Breakthrough is asking “What’s going to happen next?” and “What would I do in that situation?” and not, “What’s sodium citrate?” It’s a powerful story and I feel honored to share it.
Q: Any last thoughts?
A: There are 23.6 million people in the United States, or 7.8% of the population, who have diabetes. As many as three million Americans have Type 1 diabetes, meaning that they are completely dependent on insulin to stay alive. Every day, forty children are diagnosed with Type 1 diabetes in the United States. Nearly everyone who picks up Breakthrough will have some personal connection to the disease. We hope that our book provides them with a great read and also helps diabetics around the globe and in the future. A portion of the proceeds from the sale of this book will be donated to the Juvenile Diabetes Research Foundation and the Life for a Child Program of the International Diabetes Federation.