Jobs would later speculate that his cancer was caused by the grueling year that he spent, starting in 1997, running both Apple and Pixar. As he drove back and forth, he had developed kidney stones and other ailments, and he would come home so exhausted that he could barely speak. “That’s probably when this cancer started growing, because my immune system was pretty weak at that time,” he said.
There is no evidence that exhaustion or a weak immune system causes cancer. However, his kidney problems did indirectly lead to the detection of his cancer. In October 2003 he happened to run into the urologist who had treated him, and she asked him to get a CAT scan of his kidneys and ureter. It had been five years since his last scan. The new scan revealed nothing wrong with his kidneys, but it did show a shadow on his pancreas, so she asked him to schedule a pancreatic study. He didn’t. As usual, he was good at willfully ignoring inputs that he did not want to process.
But she persisted. “Steve, this is really important,” she said a few days later. “You need to do this.”
Her tone of voice was urgent enough that he complied. He went in early one morning, and after studying the scan, the doctors met with him to deliver the bad news that it was a tumor. One of them even suggested that he should make sure his affairs were in order, a polite way of saying that he might have only months to live. That evening they performed a biopsy by sticking an endoscope down his throat and into his
Steve Jobs by Walter Isaacson 592
intestines so they could put a needle into his pancreas and get a few cells from the tumor. Powell remembers her husband’s doctors tearing up with joy. It turned out to be an islet cell or pancreatic neuroendocrine tumor, which is rare but slower growing and thus more likely to be treated successfully. He was lucky that it was detected so early—as the by-product of a routine kidney screening—and thus could be surgically removed before it had definitely spread.
One of his first calls was to Larry Brilliant, whom he first met at the ashram in India. “Do you still believe in God?” Jobs asked him. Brilliant said that he did, and they discussed the many paths to God that had been taught by the Hindu guru Neem Karoli Baba. Then Brilliant asked Jobs what was wrong. “I have cancer,”
Jobs replied.
Art Levinson, who was on Apple’s board, was chairing the board meeting of his own company, Genentech, when his cell phone rang and Jobs’s name appeared on the screen. As soon as there was a break, Levinson called him back and heard the news of the tumor. He had a background in cancer biology, and his firm made cancer treatment drugs, so he became an advisor. So did Andy Grove of Intel, who had fought and beaten prostate cancer. Jobs called him that Sunday, and he drove right over to Jobs’s house and stayed for two hours.
To the horror of his friends and wife, Jobs decided not to have surgery to remove the tumor, which was the only accepted medical approach. “I really didn’t want them to open up my body, so I tried to see if a few other things would work,” he told me years later with a hint of regret. Specifically, he kept to a strict vegan diet, with large quantities of fresh carrot and fruit juices. To that regimen he added acupuncture, a variety of herbal remedies, and occasionally a few other treatments he
Steve Jobs by Walter Isaacson 593
found on the Internet or by consulting people around the country, including a psychic. For a while he was under the sway of a doctor who operated a natural healing clinic in southern California that stressed the use of organic herbs, juice fasts, frequent bowel cleansings, hydrotherapy, and the expression of all negative feelings.
“The big thing was that he really was not ready to open his body,” Powell recalled. “It’s hard to push someone to do that.” She did try, however. “The body exists to serve the spirit,” she argued. His friends repeatedly urged him to have surgery and chemotherapy. “Steve talked to me when he was trying to cure himself by eating horseshit and horseshit roots, and I told him he was crazy,” Grove recalled. Levinson said that he “pleaded every day” with Jobs and found it
“enormously frustrating that I just couldn’t connect with him.” The fights almost ruined their friendship. “That’s not how cancer works,” Levinson insisted when Jobs discussed his diet treatments. “You cannot solve this without surgery and blasting it with toxic chemicals.”
Even the diet doctor Dean Ornish, a pioneer in alternative and nutritional methods of treating diseases, took a long walk with Jobs and insisted that sometimes traditional methods were the right option. “You really need surgery,” Ornish told him.
Jobs’s obstinacy lasted for nine months after his October 2003 diagnosis. Part of it was the product of the dark side of his reality distortion field. “I think Steve has such a strong desire for the world to be a certain way that he wills it to be that way,” Levinson speculated.
“Sometimes it doesn’t work. Reality is unforgiving.” The flip side of his wondrous ability to focus was his fearsome willingness to filter out things he did not wish to deal with. This led to many of his great breakthroughs, but it could also backfire. “He has that
Steve Jobs by Walter Isaacson 594
ability to ignore stuff he doesn’t want to confront,”
Powell explained. “It’s just the way he’s wired.” Whether it involved personal topics relating to his family and marriage, or professional issues relating to engineering or business challenges, or health and cancer issues, Jobs sometimes simply didn’t engage.
In the past he had been rewarded for what his wife called his “magical thinking”—his assumption that he could will things to be as he wanted. But cancer does not work that way. Powell enlisted everyone close to him, including his sister Mona Simpson, to try to bring him around. In July 2004 a CAT scan showed that the tumor had grown and possibly spread. It forced him to face reality.
Jobs underwent surgery on Saturday, July 31, 2004, at Stanford University Medical Center. He did not have a full “Whipple procedure,” which removes a large part of the stomach and intestine as well as the pancreas. The doctors considered it, but decided instead on a less radical approach, a modified Whipple that removed only part of the pancreas.
Jobs sent employees an email the next day, using his PowerBook hooked up to an AirPort Express in his hospital room, announcing his surgery. He assured them that the type of pancreatic cancer he had
“represents about 1% of the total cases of pancreatic cancer diagnosed each year, and can be cured by surgical removal if diagnosed in time (mine was).” He said he would not require chemotherapy or radiation treatment, and he planned to return to work in September. “While I’m out, I’ve asked Tim Cook to be responsible for Apple’s day to day operations, so we shouldn’t miss a beat. I’m sure I’ll be calling some of you way too much in August, and I look forward to seeing you in September.”
One side effect of the operation would become a
Steve Jobs by Walter Isaacson 595
problem for Jobs because of his obsessive diets and the weird routines of purging and fasting that he had practiced since he was a teenager. Because the pancreas provides the enzymes that allow the stomach to digest food and absorb nutrients, removing part of the organ makes it hard to get enough protein. Patients are advised to make sure that they eat frequent meals and maintain a nutritious diet, with a wide variety of meat and fish proteins as well as full-fat milk products. Jobs had never done this, and he never would.
He stayed in the hospital for two weeks and then struggled to regain his strength. “I remember coming back and sitting in that rocking chair,” he told me, pointing to one in his living room. “I didn’t have the energy to walk. It took me a week before I could walk around the block. I pushed myself to walk to the gardens a few blocks away, then further, and within six months I had my energy almost back.”
Unfortunately the cancer had spread. During the operation the doctors found three liver metastases. Had they operated nine months earlier, they might have caught it before it spread, though they would never know for sure. Jobs began chemotherapy treatments, which further complicated his eating challenges.
The Stanford Commencement
Jobs kept his continuing battle with the cancer secret—he told everyone that he had been “cured”—
just as he had kept quiet about his diagnosis in October 2003. Such secrecy was not surprising; it was part of his nature. What was more surprising was his decision to speak very personally and publicly about his cancer diagnosis. Although he rarely gave speeches other than his staged product demonstrations, he accepted Stanford’s invitation to give its June 2005
commencement address. He was in a reflective mood after his health scare and turning fifty.
Steve Jobs by Walter Isaacson 596
For help with the speech, he called the brilliant scriptwriter Aaron Sorkin ( A Few Good Men, The West Wing). Jobs sent him some thoughts. “That was in February, and I heard nothing, so I ping him again in April, and he says, ‘Oh, yeah,’ and I send him a few more thoughts,” Jobs recounted. “I finally get him on the phone, and he keeps saying ‘Yeah,’ but finally it’s the beginning of June, and he never sent me anything.”
Jobs got panicky. He had always written his own presentations, but he had never done a commencement address. One night he sat down and wrote the speech himself, with no help other than bouncing ideas off his wife. As a result, it turned out to be a very intimate and simple talk, with the unadorned and personal feel of a perfect Steve Jobs product.
Alex Haley once said that the best way to begin a speech is “Let me tell you a story.” Nobody is eager for a lecture, but everybody loves a story. And that was the approach Jobs chose. “Today, I want to tell you three stories from my life,” he began. “That’s it. No big deal.
Just three stories.”
The first was about dropping out of Reed College.
“I could stop taking the required classes that didn’t interest me, and begin dropping in on the ones that looked far more interesting.” The second was about how getting fired from Apple turned out to be good for him. “The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything.” The students were unusually attentive, despite a plane circling overhead with a banner that exhorted “recycle all e-waste,” and it was his third tale that enthralled them. It was about being diagnosed with cancer and the awareness it brought: Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life. Because almost everything—all
