Steve Jobs

Powell became the troller of the organ-donation websites, checking in every night to see how many were on the wait lists, what their MELD scores were, and how long they had been on. “You can do the math, which I did, and it would have been way past June before he got a liver in California, and the doctors felt that his liver would give out in about April,” she recalled. So she started asking questions and discovered that it was permissible to be on the list in two different states at the same time, which is something that about 3% of potential recipients do. Such multiple listing is not discouraged by policy, even though critics say it favors the rich, but it is difficult. There were two major requirements: The potential recipient had to be able to get to the chosen hospital within eight hours, which Jobs could do thanks to his plane, and the doctors from that hospital had to evaluate the patient in person before adding him or her to the list.

George Riley, the San Francisco lawyer who often served as Apple’s outside counsel, was a caring Tennessee gentleman, and he had become close to Jobs. His parents had both been doctors at Methodist University Hospital in Memphis, he was born there, and he was a friend of James Eason, who ran the transplant institute there. Eason’s unit was one of the best and busiest in the nation; in 2008 he and his team did 121 liver transplants. He had no problem allowing people from elsewhere to multiple-list in Memphis. “It’s not gaming the system,” he said. “It’s people choosing where they want their health care. Some people would leave Tennessee to go to California or somewhere else to seek treatment. Now we have people coming from California to Tennessee.” Riley arranged for Eason to fly to Palo Alto and conduct the required evaluation there.

By late February 2009 Jobs had secured a place on the Tennessee list (as well as the one in California), and the nervous waiting began. He was declining rapidly by the first week in March, and the waiting time was projected to be twenty-one days. “It was dreadful,” Powell recalled. “It didn’t look like we would make it in time.” Every day became more excruciating. He moved up to third on the list by mid-March, then second, and finally first. But then days went by. The awful reality was that upcoming events like St. Patrick’s Day and March Madness (Memphis was in the 2009 tournament and was a regional site) offered a greater likelihood of getting a donor because the drinking causes a spike in car accidents.

Indeed, on the weekend of March 21, 2009, a young man in his midtwenties was killed in a car crash, and his organs were made available. Jobs and his wife flew to Memphis, where they landed just before 4 a.m. and were met by Eason. A car was waiting on the tarmac, and everything was staged so that the admitting paperwork was done as they rushed to the hospital.

The transplant was a success, but not reassuring. When the doctors took out his liver, they found spots on the peritoneum, the thin membrane that surrounds internal organs. In addition, there were tumors throughout the liver, which meant it was likely that the cancer had migrated elsewhere as well. It had apparently mutated and grown quickly. They took samples and did more genetic mapping.

A few days later they needed to perform another procedure. Jobs insisted against all advice they not pump out his stomach, and when they sedated him, he aspirated some of the contents into his lungs and developed pneumonia. At that point they thought he might die. As he described it later:

I almost died because in this routine procedure they blew it. Laurene was there and they flew my children in, because they did not think I would make it through the night. Reed was looking at colleges with one of Laurene’s brothers. We had a private plane pick him up near

Dartmouth and tell them what was going on. A plane also picked up the girls. They thought it might be the last chance they had to see me conscious. But I made it.

Powell took charge of overseeing the treatment, staying in the hospital room all day and watching each of the monitors vigilantly. “Laurene was a beautiful tiger protecting him,” recalled Jony Ive, who came as soon as Jobs could receive visitors. Her mother and three brothers came down at various times to keep her company. Jobs’s sister Mona Simpson also hovered protectively. She and George Riley were the only people Jobs would allow to fill in for Powell at his bedside. “Laurene’s family helped us take care of the kids—her mom and brothers were great,” Jobs later said. “I was very fragile and not cooperative. But an experience like that binds you together in a deep way.”

Powell came every day at 7 a.m. and gathered the relevant data, which she put on a spreadsheet. “It was very complicated because there were a lot of different things going on,” she recalled. When James Eason and his team of doctors arrived at 9 a.m., she would have a meeting with them to coordinate all aspects of Jobs’s treatment. At 9 p.m., before she left, she would prepare a report on how each of the vital signs and other measurements were trending, along with a set of questions she wanted answered the next day. “It allowed me to engage my brain and stay focused,” she recalled.

Eason did what no one at Stanford had fully done: take charge of all aspects of the medical care. Since he ran the facility, he could coordinate the transplant recovery, cancer tests, pain treatments, nutrition, rehabilitation, and nursing. He would even stop at the convenience store to get the energy drinks Jobs liked.

Two of the nurses were from tiny towns in Mississippi, and they became Jobs’s favorites. They were solid family women and not intimidated by him. Eason arranged for them to be assigned only to Jobs. “To manage Steve, you have to be persistent,” recalled Tim Cook. “Eason managed Steve and forced him to do things that no one else could, things that were good for him that may not have been pleasant.”

Despite all the coddling, Jobs at times almost went crazy. He chafed at not being in control, and he sometimes hallucinated or became angry. Even when he was barely conscious, his strong personality came through. At one point the pulmonologist tried to put a mask over his face when he was deeply sedated. Jobs ripped it off and mumbled that he hated the design and refused to wear it. Though barely able to speak, he ordered them to bring five different options for the mask and he would pick a design he liked. The doctors looked at Powell, puzzled. She was finally able to distract him so they could put on the mask. He also hated the oxygen monitor they put on his finger. He told them it was ugly and too complex. He suggested ways it could be designed more simply. “He was very attuned to every nuance of the environment and objects around him, and that drained him,” Powell recalled.