Steve Jobs

There was a kernel of truth to this, albeit a small one. One of the hormones created by the pancreas is glucagon, which is the flip side of insulin. Glucagon causes your liver to release blood sugar. Jobs’s tumor had metastasized into his liver and was wreaking havoc. In effect, his body was devouring itself, so his doctors gave him drugs to try to lower the glucagon level. He did have a hormone imbalance, but it was because his cancer had spread into his liver. He was in personal denial about this, and he also wanted to be in public denial. Unfortunately that was legally problematic, because he ran a publicly traded company. But Jobs was furious about the way the blogosphere was treating him, and he wanted to strike back.

He was very sick at this point, despite his upbeat statement, and also in excruciating pain. He had undertaken another round of cancer drug therapy, and it had grueling side effects. His skin started drying out and cracking. In his quest for alternative approaches, he flew to Basel, Switzerland, to try an experimental hormone-delivered radiotherapy. He also underwent an experimental treatment developed in Rotterdam known as peptide receptor radionuclide therapy.

After a week filled with increasingly insistent legal advice, Jobs finally agreed to go on medical leave. He made the announcement on January 14, 2009, in another open letter to the Apple staff. At first he blamed the decision on the prying of bloggers and the press. “Unfortunately, the curiosity over my personal health continues to be a distraction not only for me and my family, but everyone else at Apple,” he said. But then he admitted that the remedy for his “hormone imbalance” was not as simple as he had claimed. “During the past week I have learned that my health-related issues are more complex than I originally thought.” Tim Cook would again take over daily operations, but Jobs said that he would remain CEO, continue to be involved in major decisions, and be back by June.

Jobs had been consulting with Bill Campbell and Art Levinson, who were juggling the dual roles of being his personal health advisors and also the co-lead directors of the company. But the rest of the board had not been as fully informed, and the shareholders had initially been misinformed. That raised some legal issues, and the SEC opened an investigation into whether the company had withheld “material information” from shareholders. It would constitute security fraud, a felony, if the company had allowed the dissemination of false information or withheld true information that was relevant to the company’s financial prospects. Because Jobs and his magic were so closely identified with Apple’s comeback, his health seemed to meet this standard. But it was a murky area of the law; the privacy rights of the CEO had to be weighed. This balance was particularly difficult in the case of Jobs, who both valued his privacy and embodied his company more than most CEOs. He did not make the task easier. He became very emotional, both ranting and crying at times, when railing against anyone who suggested that he should be less secretive.

Campbell treasured his friendship with Jobs, and he didn’t want to have any fiduciary duty to violate his privacy, so he offered to step down as a director. “The privacy side is so important to me,” he later said. “He’s been my friend for about a million years.” The lawyers eventually determined that Campbell didn’t need to resign from the board but that he should step aside as co-lead director. He was replaced in that role by Andrea Jung of Avon. The SEC investigation ended up going nowhere, and the board circled the wagons to protect Jobs from calls that he release more information. “The press wanted us to blurt out more personal details,” recalled Al Gore. “It was really up to Steve to go beyond what the law requires, but he was adamant that he didn’t want his privacy invaded. His wishes should be respected.” When I asked Gore whether the board should have been more forthcoming at the beginning of 2009, when Jobs’s health issues were far worse than shareholders were led to believe, he replied, “We hired outside counsel to do a review of what the law required and what the best practices were, and we handled it all by the book. I sound defensive, but the criticism really pissed me off.”

One board member disagreed. Jerry York, the former CFO at Chrysler and IBM, did not say anything publicly, but he confided to a reporter at the Wall Street Journal, off the record, that he was “disgusted” when he learned that the company had concealed Jobs’s health problems in late 2008. “Frankly, I wish I had resigned then.” When York died in 2010, the Journal put his comments on the record. York had also provided off-the-record information to Fortune, which the magazine used when Jobs went on his third health leave, in 2011.

Some at Apple didn’t believe the quotes attributed to York were accurate, since he had not officially raised objections at the time. But Bill Campbell knew that the reports rang true; York had complained to him in early 2009. “Jerry had a little more white wine than he should have late at night, and he would call at two or three in the morning and say, ‘What the fuck, I’m not buying that shit about his health, we’ve got to make sure.’ And then I’d call him the next morning and he’d say, ‘Oh fine, no problem.’ So on some of those evenings, I’m sure he got raggy and talked to reporters.”

Memphis

The head of Jobs’s oncology team was Stanford University’s George Fisher, a leading researcher on gastrointestinal and colorectal cancers. He had been warning Jobs for months that he might have to consider a liver transplant, but that was the type of information that Jobs resisted processing. Powell was glad that Fisher kept raising the possibility, because she knew it would take repeated proddings to get her husband to consider the idea.

He finally became convinced in January 2009, just after he claimed his “hormonal imbalance” could be treated easily. But there was a problem. He was put on the wait list for a liver transplant in California, but it became clear he would never get one there in time. The number of available donors with his blood type was small. Also, the metrics used by the United Network for Organ Sharing, which establishes policies in the United States, favored those suffering from cirrhosis and hepatitis over cancer patients.

There is no legal way for a patient, even one as wealthy as Jobs, to jump the queue, and he didn’t. Recipients are chosen based on their MELD score (Model for End-Stage Liver Disease), which uses lab tests of hormone levels to determine how urgently a transplant is needed, and on the length of time they have been waiting. Every donation is closely audited, data are available on public websites (optn.transplant.hrsa.gov/), and you can monitor your status on the wait list at any time.