A boy was dying. A 2-year-old named Nic Volker weighed less than some 6-month-olds. Holes formed on his bottom, stool was leaking, and the doctors couldn’t stop it.
Nothing in the medical literature described what was happening to Nic. After four years of barely staving off death, the doctors tried a Hail Mary, something never done before. They scanned Nic’s genes in search of a diagnosis.
“One in a Billion: The Story of Nic Volker and the Dawn of Genomic Medicine” is the unique medical narrative book that does more than lay out one case study devoid of context. Authors Mark Johnson and Kathleen Gallagher composed a fast-paced narrative that interweaves science, ethics and insight into the behemothic bureaucracy of hospital care.
The authors won a Pulitzer Prize for Explanatory Reporting in 2011 for their series in the Milwaukee Journal Sentinel about this case. It drew fame in the medical community, posing new questions about the limits of diagnostic medicine and the ethics of studying patients’ genes.
The newspaper stories were similarly fast-paced and emotional, but the book does more. It lays out how genomic medicine — sequencing a patient’s genes for medical purposes — is being used across the country, where it’s failing to live up to expectations and how this one case set the ethical standard for informing patients about genetic mutations.
When doctors scan your genes, they find not only diseases you may one day contract, they also might find your siblings’ genetic mutations. Should they know if they have a treatable disease like breast cancer? What about the incurable, like Parkinson’s?
I struggle with medical stories. I never took anatomy, and I barely passed science for liberal arts in college. Yet I read “One in a Billion” in days.
Johnson and Gallagher explain the science in narrative scenes, using action to explain concepts like how DNA shapes our lives.
From the beginning, they also develop the cast of characters with distinct descriptions that make it easy to keep each doctor apart. They shift perspective often, showing how Amylynne and Sean Volker respond to their son’s illness but also how the many doctors and researchers struggle to find an answer.
The authors do the seemingly impossible: They explain the bureaucracy of hospitals. Amylynne believes she’s protecting her son by demanding only her hand-picked doctors. One of his doctors, Alan Mayer, believes she is compromising her son’s care by alienating staff, to the point that some no longer feel motivated to fight for Nic.
Doctors and nurses are not two-dimensional heroes. Some resent Amylynne for her demands. Some refuse treatment in part out of a fear of being blamed if it doesn’t work. Everyone is human and presented in their humanness. Amylynne and Sean’s marriage struggles. Nic’s siblings don’t understand their mother’s absence.
The chapters are mercifully short, often five to six pages, which allow the authors to avoid a glut of too much information. Some narrative journalists linger on only a few scenes long after the point where anything interesting has happened. Here, instead, the authors choose many scenes that present action, conflict and character development, but last only a few pages. Nic is brought into an intensive-care unit. The authors show he’s dying and why. The doctors pump him with antibiotics — “a shotgun, not a rifle,” the doctor says of the medicines — then the attention shifts to Nic’s tempestuous recovery through his mother’s emotional journals. The authors know there’s no need to linger for 20 pages on this one scene.
The authors could have shown off their five years of work and been praised for a hefty book that dives deep into the groundbreaking science. But they aim to reach not just readers of the New England Journal of Medicine but also fans of “General Hospital.”
This is a book that explains the past, present and future of medical care, and it gives hope that this new science might provide more definitive diagnoses and new treatments.