The Breakthrough

Chapter One

Patient 101006 JDS

Jeff Schwartz’s story begins in 2011, when researchers had discovered some of the secret handshakes cancer uses to trick our defender immune cells. Newly invented treatments blocked that handshake and unleashed the defenses in our blood. These drugs were available in trials, but not everybody knew about them.

Many cancer doctors were unaware of the new developments that might save their patients’ lives. Others refused to accept that such a breakthrough was possible. That refusal denied their patients the option to try it. It sometimes still does. It’s why Jeff Schwartz was willing to share his story.

Jeff Schwartz knows he was one of the lucky ones. His father died from lung cancer in the ’90s after increasingly ugly attempts to beat it—the usual protocols of cut, poison, and burn; surgery, chemo, and radiation. Just before the spring of 2011, Jeff was diagnosed with cancer too, kidney, stage 4.

So Jeff considers himself lucky, or blessed, or—he doesn’t really like to put too fine a point on it, you know? It wasn’t because he had some sort of influence or special knowledge or anything of the sort. What separated Jeff from the hundreds of thousands of people who died of the same disease during the same time was that he happened to live in California and happened to walk through the right door at the right time. That’s changed the way Jeff thinks about life and living. Now he hopes his story might reach someone else so they don’t have to be lucky.

I met with Jeff in his room on the forty-third floor of a hotel in midtown Manhattan. Jeff looks a little like a more biker version of Billy Joel post-booze and post–Christie Brinkley. He was dressed in jeans and a blue Izod shirt that hid the hard edges of the titanium cage that prevents his spine from collapsing. Surgeons had implanted it there, like he was Wolverine, after tumors had eaten away his spinal architecture. He told me about the cage. He pointed out the scars. These were facts, that was all, part of the story he was telling.

Jeff Schwartz had been a kid in Rockaway, Queens, who went through the public school system and drove a cab while he earned a degree in accounting and economics. His first job was at the mortgage desk of Lehman Brothers, his next at a Japanese bank run by Harvard MBAs. Neither was a good fit. Jeff was a music guy. He played guitar “pretty good,” he says; it was his secret identity, the other thing you tell people at parties when they ask what you do: “I’m an accountant, but really _______.” And maybe for good measure Jeff might talk about any of the hundred-plus Grateful Dead shows he’d seen, or how he’d been given Allman Brothers tickets for his bar mitzvah, or show you the first two measures of John Coltrane’s “A Love Supreme” tattooed around his left ankle like a musical mandala. Nights after the trading floor closed he’d head to the East Village to mix boards at CBGB and the Mudd Club for Talking Heads, Blondie, and Richard Hell and the Voidoids—he’s especially proud of assisting in the recording of Blank Generation. Maybe he wasn’t cool, he says, but he was on the scene.

His passion transitioned to his career because of baseball. He’d done a favor for a guy, and the guy thanked him with a pair of expensive tickets. Jeff had been a diehard Yankees fan his whole life. These were Mets tickets, great seats, really wrong team. So Jeff gave the tickets to a friend, who invited another friend and, long story short, that friend made him a job offer to be a junior guy with his company, a financial firm for clients in the music business. Jeff would come on as the young guy to help with the young talent. His first client was a new girl act, Joan Jett. That worked out for a few years, exciting times, and eventually he opened his own shop and moved out to Malibu.¹ His wife was a record company exec, they had a kid, they had a Lexus. He had an eye for talent and made 5 percent of what he made his clients,² and when one of his acts blew up, like Ke$ha or the Lumineers or Imagine Dragons, Jeff made good. But the real perk was his access. Stopping by their live shows was the coolest counterbalance to careful spreadsheets and checked math.

He admired the musicians, dug the music. But his value lay in the practical side. Music is a profession, though many musicians fail to realize it until it’s too late. “Most acts are one-hit wonders, guys smoking pot in their dorm room, they come up with a song that happens to be pretty good and then, that’s it,” Jeff says. “I tell my acts: If you don’t want to be serious then you’re wasting everyone’s time. Yeah, be a rock star, but this is how you’re going to buy your house. It’s going to be your retirement account. It’s how you’ll probably meet your wife or your husband. It’s more than lifestyle, it’s your life.” As far as he was concerned, the song you wish you wrote? It isn’t “Yesterday.” It’s “Tie a Yellow Ribbon ’round the Ole Oak Tree.” They’re both about remembering, but only one made a billion in Muzak covers alone.³

Jeff helped with the contracts, advised on royalty deals. There were writing fees and pennies from records or plays on streaming media, iTunes, Pandora, Spotify—the music world was changing fast in the early 2000s, and you had to watch every stream. The more digital the music got the more free it got, and the more it served as advertisement for the payoff of an international tour. Sending an act off was like christening a new trade ship after years of building. It could make or break, and Jeff wanted to be there.

And so in February 2011 he was in Portland, Oregon, watching the roadies set up for the first night of Ke$ha’s new tour and wondering if maybe he was pushing himself too hard. The 2011 “Get $leazy” tour—the dollar sign in place of the S being Ke$ha’s trademark—had packed shows scheduled across the Americas, Europe, Australia, and Japan. Jeff had taken Ke$ha on when she was a kid playing club dates. She’d blown up when Rihanna had signed her to open on her world tour, and now, at twenty-three years old, she was positioned to leave port and capitalize on the zeitgeist, with Jeff on deck to help steer the finances.

Jeff didn’t need to show up, but his presence there was a personal reminder to his talent. He was looking after their investment, and that investment was themselves. They should do the same. He really couldn’t avoid opening night, no matter how he felt. Which was too bad, because Jeff was feeling like crap.

He was always a little sick these days, a little weak, more than the usual morning stiffness—and the general ache now lasted all day. That came with hitting fifty, he knew that, the way his hair had gone white and thinned at the top. He’d adapted, wore it cut short with a white goatee. Late nights and discomfort were part of the rock-and-roll soul swap, same as the inevitable weight gain of late drive-through meals and no exercise. At least there was an upside—between the pain and the nausea, he was losing weight. He hurt, but he looked good. When he hit 180 pounds, he was happy to recognize his old silhouette in the hotel mirrors. But the weight kept dropping and he felt something else, a dread he couldn’t put his finger on.

Ke$ha, decked out in a rhinestone-studded leotard and laser-shooting sunglasses, ducked into the spotlight. Jeff felt cold. There was a pain in his side, or his belly, or his back—somewhere in the middle there. He wasn’t feeling any better as Ke$ha came back out in a star-spangled getup and fishnets to sing her hit, “Fuck Him He’s a DJ.” Jeff found a seat and watched the backup dancers and the band, professional musicians whose costumes were described as a cross between “Mad Max and prehistoric birds.” It was nearly midnight when Ke$ha finally performed a lap dance on an audience member duct-taped to a chair. An extra in a giant penis costume pogoed around the couple in a choreographed number.

Jeff checked his watch. The encore was thundering. Thank you, Portland, Oregon, and good night. Maybe, Jeff thought, he needed to just go lie down. But the pain he’d felt had been at a different level, and it didn’t go away. Ke$ha’s buses headed off to the next stop on the tour. Jeff stayed behind and quietly drove himself to the hospital.

A doctor looked him over. A phlebotomist took his blood. They ran the numbers, brought him back in, asked him to sit down. He remembers the doctor telling him that the first thing that stood out was his hemoglobin count. It was staggeringly low. With numbers like that, his blood didn’t have the means to transport oxygen to his muscles or his brain. That was probably what accounted for his exhaustion. But what accounted for the low hemoglobin? It might be cancer.

That suspicion led Jeff to the Angeles Clinic on LA’s Wilshire Boulevard—PET scans, the usual round of tests—and on President’s Day weekend Jeff was told: kidney cancer, stage 4. He didn’t know about stages, but he did know there wasn’t a stage 5.

He also didn’t know, and in the moment of shock wouldn’t have cared, that he was one of about sixty-three thousand people in the United States to get a diagnosis of kidney cancer that year. Of those, a far smaller percentage would get a diagnosis for the rare and specific cancer Jeff had. It was, in the language of cancer specialists, an especially “interesting” type of cancer, a particularly aggressive variety called sarcomatoid renal cell carcinoma.

“The doctors tell you, don’t go online when you get your diagnosis,” Jeff says. There’s no good that can come from trusting everything put up on the internet to interpret your fate. “But of course, that’s exactly what you do.”

He got as far as his car. He took out his phone and looked. The numbers, at first, looked—not bad, really. The five-year survival numbers, the standard numbers given for cancer at that point, were nearly 74 percent. That’s a passing grade, a majority, Jeff remembers thinking.

But then, reading further, he saw that the good number depended on other factors. The most important was how early you caught the disease.

The kidneys sit in the lower back, two filtering masses about the size of fists on either side of the spine, right about where you might hold someone to slow-dance at a junior high prom. They’re complex filters, composed of millions of tiny, capsule-shaped glomerular filters that sort out what the body needs from what it must discard. But like a demolition worker clearing out asbestos from a condemned building, those glomeruli are heavily exposed to all the concentrated toxins that come through the body. They are more likely to undergo DNA mutation as a result of that exposure, just as exposed skin catches more UV radiation and is more subject to the mutations that facilitate melanoma.

The survival rates Jeff was looking at were when you caught it early—when it was just in the kidney and the tumor was no larger than seven centimeters.

The United States doesn’t like metric measures, so it tends to translate them to nuts and fruits, and sometimes eggs and vegetables, to describe tumor size. For a five-centimeter, stage 1 tumor, the American Cancer Society site uses a lime. Stage 2 is a lemon, or a small orange, still localized as a mass within the kidney. Stage 3 means the tumor has started to spread within the kidney. The growing, spreading cancer—a peanut, a walnut, or an orange—if it’s stage 3, is still contained within the kidney area, so it can be more readily targeted by conventional cancer therapies—specifically surgery and radiation.

Since most of us have two kidneys, and can survive on one healthy functioning one, cutting out one whole kidney—what they call a radical surgery—is a common approach. But Jeff’s diagnosis was stage 4. That meant the tumors had entered the bloodstream and moved elsewhere, and possibly everywhere.

No matter where those mutated renal cells moved—they could fill the lung, lodge in and take over the liver—they would always be called “renal cancer.” (This naming system, as anachronistic as describing tumors in terms of fruits, changed because of cancer immunotherapy in 2017, itself a breakthrough.) And so when those mutated renal cells started colonizing his spine, Jeff’s cancer was “kidney cancer,” stage 4. And on the tiny screen of his flip phone, stage 4 kidney cancer looked really bad. The five-year survival rate hung at a guttering 5.2 percent, and it had been about 5.2 percent since the 1970s. The last new scientific advance for treating kidney cancer had been made thirty years ago. There isn’t any way to put a positive spin on that. You just close your phone, sit in your car, and wait until you’re calm enough to drive.

There really isn’t a good time to get a diagnosis like that, Jeff knew. Jeff was busy—but everyone is too busy for this sort of thing, and once he went through the usual reactions he realized that too. But hey, come on. He was really busy. His business was booming, his acts needed him, and he now had two little kids—one three years old, the other just a year. He wasn’t going to stop working, he wouldn’t make a big thing of it. He told only those clients who really needed to know, who’d need to make professional decisions. He told Ke$ha he was sick, didn’t say how sick. That seemed OK. Mostly, he decided to just keep moving forward.

Next, Jeff was referred to the larger affiliate hospital, the mothership, to see their kidney specialist. Maybe it was Jeff’s mood, but this doctor, he decided, was “a fucking prick.”

Let’s call him Dr. K. He had looked at the numbers. Stage 4 kidney cancer was pretty much a death sentence, especially in this rare agressive form, but there was always a chance. Dr. K started Jeff on a drug called Sutent. As the label promised, Sutent gave Jeff the usual symptoms of extreme nausea, lack of appetite, and daily dry heaves.