James Harrison at around age four, Junee, Australia.

When James wasn’t battling some ailment, he was outdoors every moment he could grab, playing cricket or inventing battles, games, and races with his best friends, Ronny and Johnny Marshall.

One weekend afternoon, the three boys decided it was time for a race to the railroad tracks on their bikes. James had Ronny perched on the handlebars of his rickety bike, while Johnny was on his own bike, gunning to pass them. The boys had a block to go before crossing the train tracks that sliced through Junee. The whistle of the approaching train propelled them forward like the starter pistol at a race. James stood in his seat, gripped his handlebars, and glanced back at his competition.

“Holy smokes!” Johnny yelled.

Just then, a truck of some sort careened around the corner, coming out of nowhere. James veered but wasn’t quick enough and smashed headlong into the back of the fast-moving vehicle. Johnny veered and just missed the pileup but slid across the road. Slowly, unsteadily, the bruised and battered boys picked themselves up.

“Crikey—what happened?” James said, helping Ronny up.

James scratched his head with a bleeding hand and said, “How did the medics get here so fast?”

“You idiot!” said one of the boys. “Look!”

When the reality of what had happened set in, the ribbing began: Only James Harrison would run into the back of an ambulance.

These were the kind of scrapes and scares that punctuated James Harrison’s boyhood. But when he landed back in the hospital in 1951, it was for something far more serious than bruises, cuts, and bad colds. James, now fourteen, had caught something he couldn’t shake. A bug had turned into bronchitis and then triple pneumonia. Penicillin was doing nothing to prevent the infection from spreading from one lung to the other. The tissue of James’s lungs was inflamed, and he coughed constantly, complaining of sharp chest pains.

James was transported to St. Vincent’s Hospital in Sydney in a bid to save his life. There, James’s mom and dad, Peggy and Reginald, met with a young surgeon, Harry Windsor, who had honed his skills as a doctor during World War II, serving mostly in New Guinea with the Australian Army Medical Corps. Dr. Windsor had made a name for himself at St. Vincent’s through his pioneering work in heart valve surgeries. He had established the thoracic surgery department, and even organized the hospital’s staff cricket team, serving as coach. He endeared himself to his surgery patients by sleeping next to their beds.

But the operation involving young James would be Dr. Windsor’s first pediatric pulmonary lobectomy, and James was in bad shape. The lobectomy of the lung was a surgical operation to remove an infected or diseased portion of the lung. Dr. Windsor was not certain whether the boy would make it.

“I’ve got my lucky penny,” James told the doctor when they met, showing him a flattened coin. He explained that he and his friends would wait for the trains of Junee to get close before placing pennies on the tracks and watching them get squashed. The boys had pockets full of squashed pennies.

James charmed doctors and nurses alike with his chatter and good spirits. In the days leading up to the surgery, James endured relentless tests, gagging every time antiseptic was sprayed into his mouth, and closing his eyes when exploratory tubes were pushed down his throat. The tubes felt larger than his throat. When they were removed, James could finally uncurl his fists and run his fingers over his flat penny. The nurses came to him every day for blood draws. Of the four major blood groups—A, B, AB, and O—James was universal blood type O negative, the blood of choice in emergency rooms and for use in transfusions. Just 7 percent of the population has O negative blood. With no major blood group antigens, O negative blood is the ideal for recipients with any blood type. But James, as O negative, could only safely receive transfusions of O negative blood. The positive or negative factors on one’s blood were determined by a protein called the Rh factor, which can be present (+) or absent (–), creating the eight most common blood types of A+, A–, B+, B–, O+, O–, AB+, AB–. Compatible blood for transfusions meant the difference between life and death.

The nurses complimented James on his prominent veins. He may have been weak and pale and prone to coughing bouts that were exhausting even to watch, but his veins were as strong as the Australian sun in summertime, he was told.

The nurses did their best to distract him from the tubes and needles by asking about girls, cricket, tennis, and school. James didn’t mind having a gaggle of pretty nurses around, and he told them stories of how he earned pocket change by selling the eggs of his family’s chickens to refugees who’d arrived in Junee after the war. He talked gaily about his mishaps and adventures, including the time he’d scared his mother nearly to death by flinging himself across the train tracks to see whether an approaching train would stop. His mates Ronny and Johnny had pulled him off the tracks in the nick of time. Peggy, upon learning of the incident, said she’d kill him herself and chased after him with a wooden spoon.

The nurses and nuns at St. Vincent’s were briefed on the risks of James’s surgery. They admired how James did a lot with a little, and could only imagine what sort of mischief he’d get into if given the gift of good health.

When surgery day arrived, James’s parents forced reassuring smiles while fighting back tears. James’s father, Reginald, was a mechanic who fixed the wheels on the country’s steam-powered locomotives. He never missed a Sunday church service, sang in the choir—becoming emotional with every rendition of “Amazing Grace”—and was the town Santa Claus. As Dr. Windsor explained the surgery, Reginald nodded, solemn and deferential. Dr. Windsor had told the Harrisons that he believed the best hope for their son was to remove the necrotic and infected parts of his right lung before it spread to the left side. There was a chance the doctor would have to remove the entire right lung. James’s single remaining lung could inflate to take up some of the extra space, the doctor explained, allowing him—assuming all went well during surgery—to function normally. But the high-risk surgery would culminate in a high-risk recovery. Lung surgery involved a great deal of bleeding. Patients who bleed excessively during surgery are at risk of continuing to bleed after surgery, because the loss of platelets impairs the body’s ability to make clots.

James’s younger sister, Margaret, who was nine years old, stood next to their mother. She knew the situation was serious because they were in the big hospital in Sydney, rather than in their small hospital in Junee. A Sisters of Charity nun walked beside the gurney that carried James. The nun told Peggy and Margaret that she would stay with James through the operation. For the first time since being hospitalized, James was scared. His long bouts of coughing had left him depleted. He’d had a fever off and on and had been in the hospital for a week now. He just wanted to get back to racing around town and playing cricket in the street. But he smiled bravely. He could see his parents were worried. A few minutes later, it was time for him to be wheeled away.

In the operating theater, an overhead light the size of a manhole shone on James. Faces in white cloth masks peered down at him; he recognized the nurses by their eyes. The anesthetist, inducing with ethyl chloride spray on a cloth, and continuing with an ether drip, told him to count back from ten. Instead, James launched into one of his sweet but rambling tales. “My schoolmates like to sneak a puff of a ciggy behind a building where the teachers can’t see,” he began. “I never once did that . . .” James trailed off as the anesthesia took hold. The team quickly went to work, double checking the inventory on tables and trays, including the sponges, towels, clamps, scissors, scalpels, saws, and other instruments. A glass bottle of blood hung on an IV stand next to James. The use of glass bottles for blood donations, surgery, and storage dated to World War I—then the first glass cylinders were coated with a film of paraffin to delay clotting, and packed into ammunition boxes converted into shipping containers filled with ice and sawdust.

Dr. Windsor conferred with the anesthetist and checked James’s vital signs. He made the first incision below James’s sternum. He slowly cut in what he called a “lazy S” pattern toward the wall of the shoulder blade and spine. He cut through skin first, then fat—James was thin as a rail—and then continued the incision into the subcutaneous tissue and muscle. When he reached the chest wall and the rib cage, a nurse handed him a rib spreader. Dr. Windsor began to spread James’s ribs, one crank at a time, like jacking up a car to repair a tire. To get to the muscles between the ribs and access the lungs, he would need to remove at least one rib.

Reaching the lungs, Dr. Windsor could see that the infection was worse than he had thought. The three lobes of James’s right lung appeared necrotic. The tissue had died, and the space between the lung and the chest wall was filled with abnormal fluid, bacteria, and pus. Dr. Windsor suctioned the infection and peeled away hardened areas, like he was removing skin from an orange.

Sweat formed on Dr. Windsor’s brow. James’s blood pressure was dropping; he was hemorrhaging.

“More blood!” Dr. Windsor ordered. He had never had a patient undergo such a massive transfusion. The use of transfusions had developed over several centuries, beginning with the discovery of the circulation of blood in 1628 and the first recorded successful blood transfusion in England in 1665, when a dog was kept alive by the transfused blood of other dogs. Further advancements had been made during World War II. The understanding of blood type compatibility involving the Rhesus factor—giving people the positive or negative to their blood type—was just over a decade old.

James had about eight pints of blood in his body and was losing blood as fast as it was being replaced. He had already received four pints of transfused blood—half the volume of the blood in his body. James’s breathing grew shallow and rapid and his heart rate accelerated.

More bottles of blood were rushed in for transfusion. Dr. Windsor, focused on the surgery, was relying on his nursing team to ensure that blood typing and crossmatching were executed to exclude incompatible mixtures for transfusion. A nurse wiped the doctor’s brow. Others sopped up the blood around the incisions. Towels heavy with blood were piled on trays. Dr. Windsor eyeballed the amount of blood he had suctioned from James and released into canisters. James’s arteries were constricting to prevent more blood loss, which could lead to organ failure. In the corner, the nun prayed the Rosary, her fingers moving from one bead to the next. The hours passed with this dance between life and death. Death approached, death was averted. Blood was lost, blood was given.

In the waiting room, James’s family grew more anxious as day turned into night. Ten hours into the surgery, Reginald and Peggy still knew nothing. They tried not to imagine the worst.

Finally, after eleven hours of surgery, Dr. Windsor was done. James had received thirteen units of blood. His blood was no longer his own.

The necrotic lung tissue was on a tray. Dr. Windsor sewed up James’s lungs, then the tissues, progressing methodically as if closing a door to each room he had entered. He then focused on closing James up. He sutured James’s skin, making more than one hundred stitches by hand in a jagged line running from his chest to the middle of his back. As he worked, more transfused blood flowed into James’s veins, moving through his wan body, replenishing what he’d lost. Now this brave boy, a fighter if ever there was one, would need to get through recovery.

When James awoke in the ICU, his family was all around him. The nun was there, too; she had stayed with him through it all. James faced tough days ahead, and he would have to remain in the hospital for months. He looked around his room. His parents were beaming, and told him he had done great. His father came bedside and clasped his hand.

“You were saved by the blood of strangers,” Reginald said. “You would have died without the gift of blood.”

Left to right: John Gorman with his younger brother, Frank, and sister Jocelyn, Rochester, Australia.

Now navigating the busy streets of Manhattan, Gorman was unlikely to run into anyone remotely familiar. But the sheer rush of so many people was its own kind of jolt. After taking several wrong turns and stopping to crane his neck at the skyscrapers, he finally arrived at his studio apartment. He had free room and board and would earn $50 a month as a pediatrics resident at St. Francis Hospital in the South Bronx. Settling into his new home, he began to unpack his few belongings, including a treasured book, Ideas Have Consequences, given to him by his father. He found the book interesting, but it was the title that spoke to him.

With the nearly two-month journey behind him, John’s thoughts returned to the morning he’d left Australia. He’d sailed out of the port of Melbourne on a ship called the SS Orcades. There he stood on the top deck, squeezed shoulder to shoulder with other passengers, everyone holding streamers connected to loved ones on the dock below. John was connected to his mother, Doris, by a white streamer that seemed to run the length of a football field. John held one end, Doris the other. As the ship’s horns sounded and the Orcades slowly pulled away, streamers broke all around, floating through the air like confetti. John and his mother held theirs for as long as possible, with John stretching out beyond the deck’s rail and his mother moving toward him on the dock below. But in an instant, the tie between mother and son broke. Doris waved tearfully, still holding her part of the streamer. The image played over and over in his mind. He was now on his own. He would focus on his work—and on becoming someone of note.

Drifting off to sleep in his new apartment, John remembered the stories of his forebears. Arduous journeys had marked the start of new lives in Australia for both sides of his family. His grandmother Aggie Maguire was nineteen years old when she traveled from England to Australia in 1888 with her older sister and brother. Her brother died along the way. By the time Aggie was thirty-nine, she had nine children and was a widow, forced to adapt to each new challenge. Similarly, the first Gormans to leave Ireland arrived in Australia in 1839 as indentured laborers or “bounty immigrants” aboard the fully rigged sailing vessel the William Metcalfe. They spent months at sea, cramped into shared living quarters where disease and infection spread rapidly. Those who died were wrapped in canvas and tossed overboard. The Gorman clan had a history of quick-minded adaptations.

It didn’t take John Gorman long in his pediatrics residency to discover important things about himself and the practice of medicine. He was surprised and dismayed to find that mothers in America challenged just about every diagnosis and recommendation he made. Exasperated, he told another resident: “In Australia, patients listen to every word you say. The doctors are king. Here, it appears that mothers run the case. I suggest antibiotics. They suggest no antibiotics.” No matter how firm he was in his diagnoses, families of patients were either skeptical or opposed and relentless in their questions.

What he didn’t admit was that he was terribly shy and not at all fond of interacting with people. He didn’t mind practicing medicine, but he would prefer to do it without the patients. It had been the same in childhood, where it was always his younger brother, Frank, who was the gregarious one. The two boys had had different interests from the start. Where John loved the challenges of math, geography, and tinkering in his workshop, Frank was interested in sports and had a spectacular imagination. John had watched his brother with envy. Frank had a way with people, and a way of turning mundane things into fun and elaborate games, taking small toy trucks and developing games that everyone wanted to play. Frank had always been outgoing and had a lot of friends; John was the reclusive one.

Gorman soon maneuvered his way out of pediatrics at St. Francis and into a new job at the prestigious Columbia Presbyterian Hospital in Manhattan. Columbia had started a new residency program in clinical pathology and laboratory medicine. Gorman cycled through microbiology, hematology, and chemistry before finding his calling in blood banking and laboratory medicine.

The pathology lab was his new workshop. It was quiet, full of instruments, and devoid of patients—perfect for the taciturn tinkerer. He could arrive at work mid-morning and had weekends to himself. Already he had started working on a machine that would automatically perform one of the more tedious of the routine blood tests, the prothrombin time test, which measures the amount of clotting factor in a patient’s blood.

Columbia had opened one of the first blood banks in the world, and Gorman was the teaching hospital’s very first clinical pathology resident. The blood bank had an impressive history, beginning with Charles Drew, who in 1938 received a Rockefeller fellowship to study at Columbia and train at Presbyterian Hospital. Drew went on to develop a method for processing plasma—the blood component that delivers nutrients, proteins, and hormones around the body—and preserving and drying it to be reconstituted when needed. As World War II escalated in Europe, Drew was asked to lead a medical effort known as Blood for Britain, in which he organized the collection of blood plasma from New York hospitals to be shipped out to treat casualties of the war. Drew, who was black, would later withdraw as head of the American Red Cross because of the military’s order to segregate blood by race, with blood donated by “Negroes” to be used only for other “Negroes.”

Gorman was thrilled to have landed in a place with an impressive pedigree and was energized by the enthusiasm of researchers around him. It felt like great science was done there. Pathology was the basis of medicine and Gorman’s road to understanding disease. He knew he could move from blood banking to immunology, which he found fascinating, and into the biochemistry of cells. Columbia was a place where there was pressure to get published, win the big prizes, and grab headlines.

Outside of work, Gorman, who had light blue eyes and a thatch of dark hair, began to socialize with a small group of colleagues and nurses. Together they’d head out for dinner or take in a Broadway show. Gorman loved big American cars, and had bought a pale green Ford, about the size of his studio apartment. One night out on the town, Gorman drove to dinner as the doctors and nurses swapped stories. Out of the blue, a nurse in the back decided to extend her legs all the way out the window. Her timing was impeccable: The police were cruising by. Lights flared, sirens sounded, and Gorman was pulled over, taken to the station, and tossed into a holding cell with a motley mix of drunkards and criminals. Clad in his usual attire of wool trousers and a white button-down shirt and tie under a rumpled V-neck sweater, Gorman declared repeatedly to no avail that he was a doctor at Columbia. Finally, at around three a.m., a friend arrived and had him sprung. On the way home, Gorman kept asking, “Why would the girl do that?”

On another occasion, Gorman was invited to a five-story, red brick townhome on the Upper East Side. As he sat in the sunlit family room, which opened to a lovely garden, in walked a gorgeous blonde, maybe twenty years old. She plopped down on the sofa next to Gorman and beguiled him with her charm. This is my lucky day, he thought. He was sure she was keen on him. But just as he was about to ask for her number, in walked a young man—her boyfriend. He hadn’t even had time to learn her name. Afterward, Gorman’s friends laughed at the story, saying, “That’s Henry Fonda’s daughter—we were at his house. His daughter is Jane. Jane Fonda.”

Gorman found safer ground back in the quiet of his lab at Columbia. There, he worked on a range of projects, from rethinking lab equipment to readying blood for transfusions. Mistakes happened more than anyone would like to admit. As he saw it, blood banks had three main problems: incompatible transfusions, where the patient was given the wrong blood, something that could bring a range of reactions, from inflammation to sudden death; hepatitis, which was being transmitted though donated blood; and Rh disease, which was taking the lives of tens of thousands of fetuses and newborns each year, wreaking havoc on families around the world. Blood bankers and researchers across the globe were struggling to understand and treat this blood-based disease.

There was no test for hepatitis—a rugged virus that plagued blood banks—and no cure for Rh disease. Though it had only been named and diagnosed for two decades, the symptoms of Rh disease had been recorded as early as 400 BCE. Some in the medical community speculated about famous cases of the blood disease—long before the Rh factor was discovered and named. King Henry VIII and the first two of his six wives, Catherine of Aragon and Anne Boleyn, had multiple miscarriages and stillbirths. In keeping with the mechanism of Rh disease, which typically spares the first child but is more destructive with each subsequent pregnancy, Catherine of Aragon had a healthy first child, Mary, and then suffered multiple miscarriages.

Gorman was in his office one day in the fall of 1959 working on ideas for a “lock” that would ensure safer blood transfusions, when in bounded a strongly built doctor who energetically extended his hand.

“Vince Freda, researcher and doctor,” the man said, shaking Gorman’s hand. Dr. Freda, who had a crew cut and thick black-rimmed glasses, was close to Gorman in age, and had gotten his medical degree at New York University.

Gorman, who had heard of Vince Freda but hadn’t met him, introduced himself as a pathology resident from Australia. The men exchanged pleasantries and Gorman invited him to have a seat. Freda, it turned out, was a former air force flight surgeon who had studied for a year under Alexander Wiener, a protégé of none other than Karl Landsteiner, “the Father of Blood Science.”

Landsteiner, the world’s leading blood researcher, had won the Nobel Prize in 1930 for his work in the discovery and classification of the blood of humans into the A, B, AB, and O groups. The classifications refer to antigens—the substances which produce antibodies—on the surface of red blood cells. In 1937, Landsteiner and Wiener, working at the Rockefeller Institute for Medical Research in New York, had discovered the Rh antigen—85 percent of people have the protein on their red cells, and are thus positive, while only 15 percent lack it, and are negative. Weiner called it the Rh factor, naming it after the Rhesus monkeys used as test subjects.

Gorman was full of questions and eager to hear stories about Wiener and Landsteiner.

Freda was as warm and gregarious as anyone he’d met, readily sharing stories and applauding the work of others. Freda talked about Wiener’s development of a complete blood exchange transfusion in a newborn with Rh disease, a treatment that led to a significant decline in the infant mortality rate. The procedure required him to replace the Rh-positive blood of the infant with Rh-negative blood. Wiener taught Freda how to perform these transfusions.

Wiener had told Freda that the discovery of the Rh factor was no accident, but the result of Landsteiner’s earlier work on the nature of antigens and antibodies. While Wiener and Landsteiner didn’t immediately understand its significance—new antigens were being discovered all the time—Wiener soon realized that the Rh factor was associated with problems in transfusions. His research showed that although someone with Rh negative blood would typically be unharmed the first time he received an Rh-positive blood transfusion, the transfusion would prompt the recipient to create antibodies that would make a second such transfusion dangerous or even deadly. The discovery of the Rh factor made possible the safer use of blood for transfusions.

At the same time Wiener and Landsteiner were working in New York, another researcher, Philip Levine, also a protégé of Landsteiner, was zeroing in on the mechanism of Rh disease. Where Wiener had identified the Rh factor and its risk to transfusion patients, Levine, working from his lab in New Jersey, was looking at how the Rh factor harmed babies.

Gorman liked Freda immediately, and found his knowledge impressive and optimism contagious. But soon, he watched as Freda sank lower in his chair and began to rub his brow. He exhaled loudly, looking exhausted.

Gorman asked whether he was okay.

Freda shook his head, telling him that he had just lost another baby.

“It’s this Rh disease,” Freda said, “this incompatibility between baby and mother that is killing babies.” Gorman nodded. He had studied Rh disease in medical school and knew the problem occurred when a baby inherited Rh positive blood from the father, and the mom’s blood was Rh negative. The mother’s antibodies, made by the immune system to fight things it didn’t want in the body, destroyed the baby’s red blood cells, causing anemia, miscarriages, and death in the baby. No one knew how to stop it, and thousands of babies were affected in the United States alone each year.

Gorman told Freda about his days as a medical student in Melbourne. During his obstetrics rounds, all students were required to sleep in the hospital. When the bell rang at three a.m., he and the other students knew to quickly dress and rush down to emergency. In this case, they had been summoned to watch a surgery involving a baby who was suffering from Rh disease. Gorman told Freda he remembered watching the doctors perform an exchange transfusion by using a needle to slowly remove some of the baby’s blood and replace it with donated blood. The procedure lasted for hours, but it ended with the baby dying on the operating table.

Freda listened intently. As an ob/gyn, Freda was the one who had to tell mothers and fathers that their babies hadn’t made it, and explain that the problem was rooted in something as simple—yet mysterious—as one’s blood group. Freda told Gorman that he had lost too many babies to this blood disease: babies who died in utero; babies who arrived in the world yellow from jaundice; and babies with severe Buddha-like abdominal swelling, and permanent brain damage. Some newborns waged a heroic fight, surviving for days or even weeks. One baby died after undergoing dozens of transfusions. Freda saw how the losses wrecked parents and left the mothers with a sadness that never went away.

Gorman could see that this was Freda’s mission He told Freda that he had done autopsies on Rh babies who had come into the world stillborn, brain damaged, or with little chance of surviving. This was one of the more difficult things to see in his residency.

Freda nodded with understanding. He enjoyed talking with this young Aussie and found him to be a keen listener brimming with ideas and energy. The kinship between the two was instant, and they talked nonstop, until Freda was pulled away.

Before leaving, Freda paused and said, “Rh is a disaster. We need to figure out how to stop this disease.”

Gorman saw the determination on Freda’s face.

“We do,” Gorman nodded. “Agreed.”

Gorman had always been drawn to simple inventions for complex problems. And Freda had come to the disease through the very men who discovered it.

Freda, now halfway out the door, had an idea.

“I need every file that you have on mothers who have been treated for this disease and who have had problems with their pregnancies.”

Gorman understood. He had already begun to zero in on blood and an unresolved problem of immunology: how the body detects and identifies an antigen and produces a specific antibody that will selectively search and destroy it. The unsolved questions of Rh disease were clear: Why would a mother’s body defy an almost universal law of nature and wage an attack against her own unborn child? How could this be stopped?

Gorman watched Freda head down the hallway before turning to head back into the lab.

He quickly called in a technician. He would need help pulling together every file on every woman treated at Columbia for Rh disease. On that day, Gorman—with Freda as his partner—committed to becoming a detective in the vexing global scourge of Rh disease. Gorman had been enthralled with the study of blood from his early days in medical school. The right blood could save your life, but the wrong blood type could end it. It was bright in the arteries, duller in the veins. Blood was life and death, health and disease. It delivered oxygen, and it could stop your breathing. Blood abounded in contradictions. It was given for free but was a commodity more precious than gold. It was powerful, sacred, and feared. Made in the bones, blood was always dying, always renewing.

In short order, Gorman had hundreds of 3×5 cards that had been created by residents who came before him and stored in a tall metal cabinet. The small yellow cards, spread across the tables in the blood lab, were a puzzle that needed to be pieced together.

Behind the numbers, names, and shorthand notes on the cards were lives altered: dreams of families dashed; nurseries decorated but never used; siblings that never made it home; baby names chosen and laid to rest. The cards in this one lab alone could stretch from wall to wall. Columbia Presbyterian was just one hospital in one city in one state. The same losses existed everywhere, from New York to Australia, from wealthy countries to the developing world. Gorman didn’t have to turn to complex math formulas or predictive analysis to know that the losses of past and present carried into the future: Countless descendants would never have a chance. Saving one baby could preserve a generation.

This global blood disorder between mother and child was a ghost that had already been chased for decades. But no one was any closer to catching that deadly apparition and halting its path of destruction. Gorman, whose mind raced far ahead of his teachings, joined in the chase of the rare and elusive: to know something no one had ever known. But he understood, in talking with Freda, that this was bigger than any prize. Each 3×5 card before him represented a life.