By the beginning of 2008 it was clear to Jobs and his doctors that his cancer was spreading. When they had taken out his pancreatic tumors in 2004, he had the cancer genome partially sequenced. That helped his doctors determine which pathways were broken, and they were treating him with targeted therapies that they thought were most likely to work.
He was also being treated for pain, usually with morphine-based analgesics. One day in February 2008 when Powell’s close friend Kathryn Smith was staying with them in Palo Alto, she and Jobs took a walk. “He told me that when he feels really bad, he just concentrates on the pain, goes into the pain, and that seems to dissipate it,” she recalled. That wasn’t exactly true, however. When Jobs was in pain, he let everyone around him know it.
There was another health issue that became increasingly problematic, one that medical researchers didn’t focus on as rigorously as they did cancer or pain. He was having eating problems and losing weight. Partly this was because he had lost much of his pancreas, which produces the enzymes needed to digest protein and other nutrients. It was also because both the cancer and the morphine reduced his appetite. And then there was the psychological component, which the doctors barely knew how to address: Since his early teens, he had indulged his weird obsession with extremely restrictive diets and fasts.
Even after he married and had children, he retained his dubious eating habits. He would spend weeks eating the same thing—carrot salad with lemon, or just apples—and then suddenly spurn that food and declare that he had stopped eating it. He would go on fasts, just as he did as a teenager, and he became sanctimonious as he lectured others at the table on the virtues of whatever eating regimen he was following. Powell had been a vegan when they were first married, but after her husband’s operation she began to diversify their family meals with fish and other proteins. Their son, Reed, who had been a vegetarian, became a “hearty omnivore.” They knew it was important for his father to get diverse sources of protein.
The family hired a gentle and versatile cook, Bryar Brown, who once worked for Alice Waters at Chez Panisse. He came each afternoon and made a panoply of healthy offerings for dinner, which used the herbs and vegetables that Powell grew in their garden. When Jobs expressed any whim—carrot salad, pasta with basil, lemongrass soup—Brown would quietly and patiently find a way to make it. Jobs had always been an extremely opinionated eater, with a tendency to instantly judge any food as either fantastic or terrible. He could taste two avocados that most mortals would find indistinguishable, and declare that one was the best avocado ever grown and the other inedible.
Beginning in early 2008 Jobs’s eating disorders got worse. On some nights he would stare at the floor and ignore all of the dishes set out on the long kitchen table. When others were halfway through their meal, he would abruptly get up and leave, saying nothing. It was stressful for his family. They watched him lose forty pounds during the spring of 2008.
His health problems became public again in March 2008, when
When Jobs introduced the iPhone 3G in June 2008, he was so thin that it overshadowed the product announcement. In
Joe Nocera of the
Partly due to concern about Jobs’s weight loss, Apple’s stock price drifted from $188 at the beginning of June 2008 down to $156 at the end of July. Matters were not helped in late August when
That month Doug Morris of Universal Music was scheduled to meet with Jobs at Apple. Instead Jobs invited him to his house. Morris was surprised to see him so ill and in pain. Morris was about to be honored at a gala in Los Angeles for City of Hope, which raised money to fight cancer, and he wanted Jobs to be there. Charitable events were something Jobs avoided, but he decided to do it, both for Morris and for the cause. At the event, held in a big tent on Santa Monica beach, Morris told the two thousand guests that Jobs was giving the music industry a new lease on life. The performances—by Stevie Nicks, Lionel Richie, Erykah Badu, and Akon—went on past midnight, and Jobs had severe chills. Jimmy Iovine gave him a hooded sweatshirt to wear, and he kept the hood over his head all evening. “He was so sick, so cold, so thin,” Morris recalled.
The blogosphere erupted with speculation about his health, much of which had the odious smell of truth. Jobs was furious and felt violated. He was also annoyed that Apple wasn’t being more active in pushing back. So on January 5, 2009, he wrote and released a misleading open letter. He claimed that he was skipping Macworld because he wanted to spend more time with his family. “As many of you know, I have been losing weight throughout 2008,” he added. “My doctors think they have found the cause—a hormone imbalance that has been robbing me of the proteins my body needs to be healthy. Sophisticated blood tests have confirmed this diagnosis. The remedy for this nutritional problem is relatively simple.”
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
