Surgery Returns to NYU Langone Medical Center

Chang W. Lee/The New York Times

Senator Charles E. Schumer spoke at a news conference Thursday about the reopening of NYU Langone Medical Center.

NYU Langone Medical Center opened its doors to surgical patients on Thursday, almost two months after Hurricane Sandy overflowed the banks of the East River and forced the evacuation of hundreds of patients.

While the medical center had been treating many outpatients, it had farmed out surgery to other hospitals, which created scheduling problems that forced many patients to have their operations on nights and weekends, when staffing is traditionally low. Some patients and doctors had to postpone not just elective but also necessary operations for lack of space at other hospitals.

The medical center’s Tisch Hospital, its major hospital for inpatient services, between 30th and 34th Streets on First Avenue, had been closed since the hurricane knocked out power and forced the evacuation of more than 300 patients, some on sleds brought down darkened flights of stairs.

“I think it’s a little bit of a miracle on 34th Street that this happened so quickly,” Senator Charles E. Schumer of New York said Thursday.

Mr. Schumer credited the medical center’s leadership and esprit de corps, and also a tour of the damaged hospital on Nov. 9 by the administrator of the Federal Emergency Management Agency, W. Craig Fugate, whom he and others escorted through watery basement hallways.

“Every time I talk to Fugate there are a lot of questions, but one is, ‘How are you doing at NYU?’ ” the senator said.

The reopening of Tisch to surgery patients and associated services, like intensive care, some types of radiology and recovery room anesthesia, was part of a phased restoration that will continue. Besides providing an essential service, surgery is among the more lucrative of hospital services.

The hospital’s emergency department is expected to delay its reopening for about 11 months, in part to accommodate an expansion in capacity to 65,000 patient visits a year, from 43,000, said Dr. Andrew W. Brotman, its senior vice president and vice dean for clinical affairs and strategy.

In the meantime, NYU Langone is setting up an urgent care center with 31 bays and an observation unit, which will be able to treat some emergency patients. It will initially not accept ambulances, but might be able to later, Dr. Brotman said. Nearby Bellevue Hospital Center, which was also evacuated, opened its emergency department to noncritical injuries on Monday.

Labor and delivery, the cancer floor, epilepsy treatment and pediatrics and neurology beyond surgery are expected to open in mid-January, Langone officials said. While some radiology equipment, which was in the basement, has been restored, other equipment — including a Gamma Knife, a device using radiation to treat brain tumors — is not back.

The flooded basement is still being worked on, and electrical gear has temporarily been moved upstairs. Mr. Schumer, a Democrat, said that a $60 billion bill to pay for hurricane losses and recovery in New York and New Jersey was nearing a vote, and that he was optimistic it would pass in the Senate with bipartisan support. But the measure’s fate in the Republican-controlled House is far less certain.

The bill includes $1.2 billion for damage and lost revenue at NYU Langone, including some money from the National Institutes of Health to restore research projects. It would also cover Long Beach Medical Center in Nassau County, Bellevue, Coney Island Hospital and the Veterans Affairs hospital in Manhattan.

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Wall Street heads for longest losing streak in three months

NEW YORK (Reuters) - Stocks fell on Friday, putting the S&P 500 on track for a fifth straight decline, as President Barack Obama and top congressional leaders were set to make a last-ditch attempt to steer the country away from severe fiscal austerity next year.

Obama and lawmakers from both political parties will meet at the White House on Friday afternoon for talks in an effort to agree on a solution before a New Year's deadline to keep large tax hikes and spending cuts from taking effect. Economists say that combination of automatic higher taxes and lower government spending - known as the "fiscal cliff" - could push the U.S. economy into a recession.

Trading was volatile and stocks rebounded from their session lows after unconfirmed reports that President Obama was about to offer a new plan to Republicans.

But investors' pessimism about achieving anything more than a stop-gap deal by the deadline was reflected in the benchmark S&P 500's drop of 1.3 percent so far this week. The broad index was on pace for its worst weekly performance since mid-November.

A five-day decline would be the S&P 500's longest losing streak in three months.

"There's a pretty good chance that we won't have something in hand by year-end," said Jonathan Golub, chief U.S. equity strategist at UBS, in New York. "It should be pretty obvious that that is now the majority case."

Golub, however, said investors were still counting on a deal that would avoid most of the tax hikes and spending cuts next year even if it does come after the deadline.

"It is widely believed that we're going to get a deal," he said. "We are not going to go over the cliff to the extent that we have a huge economic contraction."

With time running short, members of Congress may attempt to pass a retroactive fix to neutralize tax increases and spending cuts soon after the automatic fiscal policies come into effect on January 1.

The Dow Jones industrial average fell 65.65 points, or 0.50 percent, to 13,030.66. The Standard & Poor's 500 Index dropped 6.03 points, or 0.43 percent, to 1,412.07. The Nasdaq Composite Index slipped 7.29 points, or 0.24 percent, to 2,978.62.

"It doesn't matter which side wins, but at this point, nobody wants to play a game where there aren't rules," said Joe Costigan, director of equity research at Bryn Mawr Trust, in Bryn Mawr, Pennsylvania.

"So everybody is talking about what the prospects are for changes in the rules. But at the end of the day, nothing is happening."

Highlighting Wall Street's sensitivity to developments in Washington, stocks tumbled slightly more than 1 percent on Thursday after Senate Majority Leader Harry Reid warned that a deal was unlikely before the deadline. But late in the day, the three major U.S. stock indexes rebounded and ended down just 0.1 percent after the U.S. House of Representatives said it would hold an unusual Sunday session to work on a fiscal solution.

With many investors away for the holiday-shortened week, volume is expected to remain light and that could exacerbate the stock market's swings.

Positive economic data failed to alter the market's downtrend.

The National Association of Realtors said contracts to buy previously owned U.S. homes rose in November to their highest level in 2-1/2 years, while a report from the Institute for Supply Management-Chicago showed business activity in the U.S. Midwest expanded in December.

Barnes & Noble Inc shares rose 6.2 percent to $15.24 after the top U.S. bookstore chain said British publisher Pearson Plc had agreed to make a strategic investment in its Nook Media subsidiary. But Barnes & Noble also said its Nook business will not meet its previous projection for fiscal year 2013.

Shares of magicJack VocalTec Ltd jumped 8.5 percent to $17.67 after the company, which provides VoIP or voice over Internet protocol services, forecast more than $39 million in GAAP revenue and over 70 cents per share in operating income for the fourth quarter. The company also said it has appointed Gerald Vento as president and CEO, effective January 1.

The U.S.-listed shares of Canadian drugmaker Aeterna Zentaris Inc surged 16.1 percent to $2.52 after the company said it had reached an agreement with the U.S. Food and Drug Administration on a special protocol assessment by the FDA for a Phase 3 registration trial in endometrial cancer with AEZS-108 treatment.

(Reporting by Edward Krudy; Editing by Jan Paschal)

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Snow in Chicago nothing like storm out East

A bicyclist fights the snow heading north on Halsted Street, north of Roosevelt Avenue in Chicago. (Chris Walker, Chicago Tribune / December 27, 2012)

Staff report

11:18 a.m. CST, December 27, 2012

As the Northeast gets battered by a powerful winter storm, Chicago is getting hit by a gentler weather system that could coat parts of the area with an inch or more of snow by Friday.

“There will be mainly light snow that will cause some visibility reduction,’’ said Richard Castro, a meteorologist with the National Weather Service.

The snow will fall, on and off, until the early evening hours with an accumulation of only two tenths of an inch. “There could be an occasional burst of snow in the lakefront areas,’’ Castro said. More light snow is expected Friday. Temperatures will reach only into the 20s or lower 30s both days.

“Some places could possibly see over an inch,’’ Castro said. “It’s going to feel like winter.’’

A storm that swept through the South earlier this week brought snow to inland parts of the Northeast and driving rain and wind to areas along the coast Thursday.

The storm, which was blamed for nine deaths, pushed through the Upper Ohio Valley and made its way into the Northeast Wednesday night. By Thursday morning, there was anywhere from a few inches of snow to a foot in some locations

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Christmas box-office haul paces Hollywood for record year

LOS ANGELES (Reuters) – A strong Christmas-day box office performance by musical “Les Miserables” and western “Django Unchained” put Hollywood on pace to set an all-time box office record with $ 10.8 billion in annual revenue, box-office tracker Hollywood.com said on Wednesday.

Universal Pictures‘ star-studded “Les Miserables” took in a weekday Christmas record of $ 18.2 million in the United States and Canada when it opened on Tuesday, according to studio estimates of weekday ticket sales.

Quentin Tarantino‘s spaghetti western “Django Unchained,” starring Jamie Foxx and Leonardo DiCaprio, hauled nearly $ 15 million for The Weinstein Co.

Studios “are definitely on the road to a record year with $ 10.8 billion expected (up 6 percent over last year and beating the previous record of $ 10.6 billion in 2009),” Hollywood.com analyst Paul Dergarabedian told Reuters in an email, adding that the number of tickets sold should climb 6 percent from 2011 to 1.36 billion.

Dergarabedian credits a successful marketing year for studios as a chief reason for the projected box-office record, as well as spring and summer smashes “The Hunger Games” and “The Avengers” helping boost revenue.

“It was not just the fact that most of the movies delivered, it was the timing of their release dates and the marketing was obviously effective as well with social media continuing to provide an outlet for the movie-going peer group to talk about their favorite flicks,” Dergarabedian said.

“The Hobbit: An Unexpected Journey,” based on the J.R.R. Tolkein classic fantasy novel, brought in $ 11.4 million on Christmas day after ruling the box office with nearly $ 37 million in sales over the weekend.

Billy Crystal family film “Parental Guidance” debuted in fourth place with about $ 6.4 million in Christmas sales while Tom Cruise’s “Jack Reacher,” which featured author Lee Child’s character in an investigation into a sniper shooting, was fifth with some $ 5.3 million.

“The Hobbit” was distributed by Time Warner Inc’s Warner Bros. Studio. News Corp’s 20th Century Fox released “Parental Guidance” and Paramount Pictures, a unit of Viacom, released “Jack Reacher.” Universal Pictures is owned by Comcast Corp.

(Reporting by Eric Kelsey; Edited by Ronald Grover and Andrew Hay)

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New York’s Mental Health System Thrashed by Services Lost to Storm

Marcus Yam for The New York Times

Dr. Richard Rosenthal, physician in chief of behavioral services for Continuum hospitals, at St. Luke’s-Roosevelt Hospital Center.

When a young woman in the grip of paranoid delusions threatened a neighbor with a meat cleaver one Saturday last month, the police took her by ambulance to the nearest psychiatric emergency room. Or rather, they took her to Beth Israel Medical Center, the only comprehensive psychiatric E.R. functioning in Lower Manhattan since Hurricane Sandy shrank and strained New York’s mental health resources.

The case was one of 9,548 “emotionally disturbed person” calls that the Police Department answered in November, and one of the 2,848 that resulted in transportation to a hospital, a small increase over a year earlier.

But the woman was discharged within hours, to the shock of the mental health professionals who had called the police. It took four more days, and strong protests from her psychiatrist and caseworkers, to get her admitted for two weeks of inpatient treatment, said Tony Lee, who works for Community Access, a nonprofit agency that provides supportive housing to people with mental illness, managing the Lower East Side apartment building where she lives.

Psychiatric hospital admission is always a judgment call. But in the city, according to hospital records and interviews with psychiatrists and veteran advocates of community care, the odds of securing mental health treatment in a crisis have worsened significantly since the hurricane. The storm’s surge knocked out several of the city’s largest psychiatric hospitals, disrupted outpatient services and flooded scores of coastal nursing homes and “adult homes” where many mentally ill people had found housing of last resort.

One of the most affected hospitals, Beth Israel, recorded a 69 percent spike in psychiatric emergency room cases last month, with its inpatient slots overflowing. Instead of admitting more than one out of three such cases, as it did in November 2011, it admitted only one out of four of the 691 emergency arrivals this November, records show. Capacity was so overtaxed that ambulances had to be diverted to other hospitals 15 times in the month, almost double the rate last year, in periods typically lasting for eight hours, officials said.

Dr. Richard Rosenthal, physician in chief of behavioral services for Continuum Health Partners, Beth Israel’s parent organization, said he was proud of how much Continuum’s hospitals had done to handle psychiatric overflow since storm damage shuttered Bellevue Hospital Center, the city’s flagship public hospital; NYU Langone Medical Center; and the Veterans Affairs Hospital. But these days, he said, as he walks on Amsterdam Avenue between Continuum’s Roosevelt hospital on West 59th Street and its St. Luke’s hospital on West 114th Street, he notices more mentally ill people in the streets than he has seen in years.

“When you have the most vulnerable folks, all you need is one chink in the system and you lose them,” Dr. Rosenthal said. “Whether they lost their housing, or the outpatient services they usually go to were closed and they were lost to follow-up, they have become disconnected, with predictable results.”

Similar patterns are playing out in Brooklyn, where Maimonides Medical Center has been overwhelmed with mental health emergencies from the Coney Island vicinity since Coney Island Hospital, one of the city’s largest acute care psychiatric hospitals, suspended operations, hospital officials said.

“Triage has reached a different level: You have to get sicker to get in,” said Dr. Andrew Kolodny, the chairman of psychiatry at Maimonides, citing a 56 percent increase in psychiatric emergency room visits there from Oct. 26 to Dec. 7, compared with the same period last year, and a 24 percent rise in admissions. The increase in admissions was possible only with emergency permission from the state to exceed licensed limits.

“Not only is there decreased capacity, because Bellevue and Coney Island are off line,” Dr. Kolodny added, “but there’s increased demand because the storm or the loss of their residence has been a stressor for mental illness.”

The storm battered a mental health system that still relies heavily on private nursing homes and substandard adult homes to house people with mental illness. Such institutions have a sordid history of neglect and exploitation, and the courts have repeatedly found that their overuse by the state isolated thousands of people in violation of the Americans With Disabilities Act.

Plans are under way to increase supportive housing — dwellings where mentally ill people can live relatively independently, with support services. But even before Hurricane Sandy, the expansion fell far short of demand.

The storm underscored the fragility of the system. Many disabled evacuees who were sent first to makeshift school shelters lost access to the psychiatric medications that kept their symptoms at bay, Dr. Kolodny said. Even those lucky enough to have the drugs they need are at greater risk of relapse as they experience crowded living conditions. “If they’re now sleeping in a gym with 100 people, that can tip them over the edge and start making them really paranoid,” he said.

On Staten Island, where the chief of psychiatry at Richmond University Medical Center says psychiatric resources have been stretched to the limit, clergy members report that mentally ill people transferred to a large adult home in New Brighton from one that was washed away in Far Rockaway, Queens, are now showing up at church rectories, begging for socks and underwear.

“It’s heartbreaking, because they just found us by chance,” said Margaret Moschetto, a missionary at the Church of Assumption-St. Paul in New Brighton. “They were just walking around the neighborhood. They really didn’t know where they were.”

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Toyota to pay big to settle suits

Toyota Motor Corp., moving to put years of legal problems behind it, has agreed to pay more than $1 billion to settle dozens of lawsuits relating to sudden acceleration.

The proposed deal, filed Wednesday in federal court, would be among the largest ever paid out by an automaker. It applies to numerous suits claiming economic damages caused by safety defects in the automaker's vehicles, but does not cover dozens of personal injury and wrongful-death suits that are still pending around the nation.

The suits were filed over the last three years by Toyota and Lexus owners who claimed that the value of their vehicles had been hurt by the potential for defects, including floor mats that could cause the vehicles to surge out of control.

ROAD TO RECALL: Read The Times' award winning coverage

In addition, Toyota said it is close to settling suits filed by the Orange County district attorney and a coalition of state attorneys general who had accused the automaker of deceptive business practices. The costs of those agreements would be included in a $1.1-billion charge the Japanese automaker said it will take against earnings to cover the actions.

"We concluded that turning the page on this legacy legal issue through the positive steps we are taking is in the best interests of the company, our employees, our dealers and, most of all, our customers," Christopher Reynolds, Toyota's chief counsel in the U.S., said in a statement.

Toyota's lengthy history of sudden acceleration was the subject of a series of Los Angeles Times articles in 2009, after a horrific crash outside San Diego that took the life of an off-duty California Highway Patrol officer and his family.

Under terms of the agreement, which has not yet been approved in court, Toyota would install brake override systems in numerous models and provide cash payments from a $250-million fund to owners whose vehicles cannot be modified to incorporate that safety measure.

In addition, the automaker plans to offer extended repair coverage on throttle systems in 16 million vehicles and offer cash payments from a separate $250-million fund to Toyota and Lexus owners who sold their vehicles or turned them in at the end of a lease in 2009 or 2010. The total value of the settlement could reach $1.4 billion, according to Steve Berman, the lead plaintiff attorney in the case.

The lawsuits, filed over the last several years, had been seeking class certification.

News of the agreement comes scarcely a week after Toyota agreed to pay a record $17.35-million fine to the National Highway Traffic Safety Administration for failing to report a potential floor mat defect in a Lexus SUV. Those come on top of almost $50 million in fines paid by Toyota for other violations related to sudden acceleration since 2010.

The massive settlement does not, however, put Toyota's legal woes to rest. The automaker still faces numerous injury and wrongful death claims around the country, including a group of cases that have been consolidated in federal court in Santa Ana, and other cases awaiting trial in Los Angeles County.

The first of the federal cases, involving a Utah man who was killed in a Camry that slammed into a wall in 2010, is slated for trial in mid-February.

The California cases are set to begin in April, among them a suit involving a 66-year-old Upland woman who was killed after her vehicle allegedly reached 100 miles per hour and slammed into a tree.

Edgar Heiskell III, a West Virginia attorney who has a dozen pending suits against Toyota, said he is preparing to go to trial this summer in a case that involved a Flint, Mich., woman who was killed when her 2005 Camry suddenly accelerated near her home.

"We are proceeding with absolute confidence that we can get our cases heard on the merits and that we expect to prove defects in Toyota's electronic control system," he said.

Toyota spokesman Mike Michels said the settlement would have no bearing on the personal injury cases.

"All carmakers face these kinds of suits," he said. "We'll defend those as we normally would."

The giant automaker's sudden acceleration problems first gained widespread attention after the August 2009 crash of a Lexus ES outside San Diego.

That accident set off a string of recalls, an unprecedented decision to temporarily stop sales of all Toyota vehicles and a string of investigations, including a highly unusual apology by Toyota President Akio Toyoda before a congressional committee. Eventually Toyota recalled more than 10 million vehicles worldwide and has since spent huge sums — estimated at more than $2 billion, not including Wednesday's proposed settlement — to repair both its automobiles and public image.

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Obama, Congress set for one last effort on 'fiscal cliff'

WASHINGTON/HONOLULU (Reuters) - President Barack Obama is due back in Washington early Thursday for a final effort to negotiate a deal with Congress to avert or at least postpone the "fiscal cliff" of tax increases and government spending cuts set to begin next week.

No specific bill dealing with the cliff was on the schedule of either the U.S. Senate or House of Representatives, which are expected to return on Thursday after the holiday break. In Congress, the corridors were almost empty and the doors to members' rooms were locked.

Investors are closely watching the talks, concerned that going over the cliff could throw the economy into recession. U.S. stocks slipped on Wednesday after retailers reported disappointing holiday sales as shoppers tightened belts possibly due to fiscal cliff worries.

Aides and members of Congress have said that a modest, last-minute measure to avoid the spending cuts and most of the tax hikes could pass the Democratic-controlled Senate if Republicans agree not use a procedural roadblock known as a filibuster, a commitment that Senate Republican leader Mitch McConnell has so far not made.

The legislative focus continues to shift from deficit reduction to averting the immediate shock of the December 31 cliff dive.

"This is the 'Break Glass' scenario that we have long believed would rise in probability the closer we go to December 31, which essentially calls for extending all the rates for those individuals making under $200K and households under $250K and does not address the debt ceiling or the deficit," analyst Chris Krueger of Guggenheim Securities wrote in a research note.

But to win approval in the Republican-controlled House of any bill that raises taxes on anyone, a rare bipartisan vote would be required. All 191 Democrats would have to team with up with at least 26 Republicans to get a majority if the bill included tax hikes on the wealthiest Americans, as Obama is demanding.

Some of those votes could conceivably come from among the 34 Republican members who are either retiring or were defeated in the November elections and no longer have to worry about the political fallout.

JANUARY SCRAMBLE?

In the alternative, Congress could let income taxes go up on everyone as now scheduled and then during the first week of January, scramble and get a quick deal to cut them back except for the highest brackets, along with a measure putting off the $109 billion in automatic spending cuts that most lawmakers want to avoid.

Once the clock ticks past midnight on December 31, no member of Congress would have to vote for a tax increase on anyone - taxes would have risen automatically - and the only votes would be to decrease tax rates for most Americans back to their 2012 levels.

Americans' optimism that Obama and congressional leaders will reach a budget agreement before January 1 has waned in recent days, according to a Gallup poll released on Wednesday. Fifty percent believe a deal will be reached - a drop of 7 percentage points from the previous week - and 48 percent are doubtful. The poll was taken just after talks ran into trouble last week.

Obama and congressional lawmakers left Washington on Friday for the Christmas holiday with negotiations to avert the fiscal cliff in limbo.

The president will cut short his vacation in Hawaii and leave for Washington later on Wednesday, arriving in the capital early on Thursday.

Obama is expected to turn to a trusted Democratic ally, Senate Majority Leader Harry Reid, to help craft a quick deal.

White House aides began discussing details of the year-end budget measure with Senate Democratic counterparts early this week.

Starbucks Chief Executive Howard Schultz is urging workers in the company's roughly 120 Washington-area coffee shops to write "come together" on customers' cups on Thursday and Friday to send a message to sharply divided politicians.

"We're paying attention, we're greatly disappointed in what's going on and we deserve better," Schultz told Reuters.

(Additional reporting by Thomas Ferraro and Richard Cowan in Washington and Lisa Baertlein in Los Angeles; Editing by Eric Beech)

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Ouch, Charlie! YouTube Sensation Kids Talk Christmas Toys

The infamous “Charlie Bit My Finger” video has surpassed half a billion views on YouTube — not bad for a 56-second clip of a one-year-old kid biting his older brother’s finger.

Charlie and Harry, now six and eight, returned to the web earlier this year with a new series through Viral Studios. The mini-episodes focus on the boys and their younger brother, Jasper, as they talk about toys, viral videos and — of course — biting things.

[More from Mashable: 8 Festive Christmas Tumblrs, Presented by Santa Dogs]

Mashable sat down for a Skype interview with the three boys last week. Unfortunately, the Internet connection wasn’t the greatest — Harry twice referred to me as a “man made out of boxes” because of the spotty video quality — but they were still able to talk about what toys they were most excited about this holiday season. Check ‘em out below:

[More from Mashable: Now and Then: 10 Awesome Past and Present Pics]

Charlie’s Pick: Playmobil Large Pirate Ship

Price: $ 95.50

Image courtesy of Playmobil

Harry’s Pick: Thomas & Friends Take-n-Play The Great Quarry Climb

Price: $ 19.99

Image courtesy of Fisher-Price

Jasper’s Pick: Turbo Snake Remote Control

Price: £38.45 (only available in the U.K.)

Image courtesy of Amazon

You can catch all the episodes on the “Charlie Bit Me!” series on their YouTube page. Which toys or gadgets did you score this year? Tell us below.

BONUS: 10 Gifts for People You Hate

1. 50 Used Toilet Paper Rolls

Price: $ 19.99 Mother Earth appreciates a little holiday upcycling. Your mother-in-law, on the other hand, may not. Cheaper DIY alternative: Your own toilet paper rolls.

Click here to view this gallery.

Image courtesy of Viral Studios

This story originally published on Mashable here.

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Britain’s royal family attends Christmas services

LONDON (AP) — Britain‘s royal family is attending Christmas Day church services — with a few notable absences.

Wearing a turquoise coat and matching hat, Queen Elizabeth II arrived at St. Mary Magdelene Church on her sprawling Sandringham estate in Norfolk. She was accompanied in a Bentley by granddaughters Beatrice and Eugenie.

Her husband, Prince Philip, walked from the house to the church with other members of the royal family.

Three familiar faces were missing from the family outing. Prince William is spending the holiday with his pregnant wife Kate and his in-laws in the southern England village of Bucklebury. Prince Harry is serving with British troops in Afghanistan.

Later Tuesday, the queen will deliver her traditional, pre-recorded Christmas message, which for the first time will be broadcast in 3D.

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Is the Cure for Cancer Inside You?

Claudia Steinman saw her husband’s BlackBerry blinking in the dark. It had gone untouched for several days, in a bowl beside his keys, the last thing on anybody’s mind. But about an hour before sunrise, she got up to get a glass of water and, while padding toward the kitchen, found an e-mail time-stamped early that morning — “Sent: Monday, Oct. 3, 2011, 5:23 a.m. Subject: Nobel Prize. Message: Dear Dr. Steinman, I have good news for you. The Nobel Assembly has today decided to award you the Nobel Prize in Physiology or Medicine for 2011.” Before she finished reading, Claudia was hollering at her daughter to wake up. “Dad got the Nobel!” she cried. Alexis, still half-asleep, told her she was crazy. Her father had been dead for three days.

Steinman: Photograph by Ingbert Grüttner/Rockefeller University. Dendritic cell: Rockefeller University Press.

Ralph Steinman in 1983. He would become his most compelling experiment.

Dendritic cell: Rockefeller University Press.

The cell Steinman hoped would save his life looks something like a sea anemone or a ruffled shrimp dumpling.

The Nobel Foundation doesn’t allow posthumous awards, so when news of Ralph Steinman’s death reached Stockholm a few hours later, a minor intrigue ensued over whether the committee would have to rescind the prize. It would not, in fact; but while newspapers stressed the medal mishap (“Nobel jury left red-faced by death of laureate”), they spent less time on the strange story behind the gaffe. That Steinman’s eligibility was even in question, that he’d been dead for just three days instead of, say, three years, was itself a minor miracle.

In the spring of 2007, Steinman, a 64-year-old senior physician and research immunologist at Rockefeller University in New York, had come home from a ski trip with a bad case of diarrhea, and a few days later he showed up for work with yellow eyes and yellow skin — symptoms of a cancerous mass the size of a kiwi that was growing on the head of his pancreas. Soon he learned that the disease had made its way into nearby lymph nodes. Among patients with his condition, 80 percent are dead within the first year; another 90 percent die the year after that. When he told his children about the tumor over Skype, he said, “Don’t Google it.”

But for a man who had spent his life in the laboratory, who brought copies of The New England Journal of Medicine on hiking trips to Vermont and always made sure that family vacations overlapped with scientific symposia, there was only one way to react to such an awful diagnosis — as a scientist. The outlook for pancreatic cancer is so poor, and the established treatments so useless, that any patient who has the disease might as well shoot the moon with new, untested therapies. For Steinman, the prognosis offered the opportunity to run one last experiment.

In the long struggle that was to come, Steinman would try anything and everything that might extend his life, but he placed his greatest hope in a field he helped create, one based on discoveries for which he would earn his Nobel Prize. He hoped to reprogram his immune cells to defeat his cancer — to concoct a set of treatments from his body’s own ingredients, which could take over from his chemotherapy and form a customized, dynamic treatment for his disease. These would be as far from off-the-shelf as medicines can get: vaccines designed for the tumor in his gut, made from the products of his plasma, that could only ever work for him.

Steinman would be the only patient in this makeshift trial, but the personalized approach for which he would serve as both visionary and guinea pig has implications for the rest of us. It is known as cancer immunotherapy, and its offshoots have just now begun to make their way into the clinic, and treatments have been approved for tumors of the skin and of the prostate. For his last experiment, conducted with no control group, Steinman would try to make his life into a useful anecdote — a test of how the treatments he assembled might be put to work. “Once he got diagnosed with cancer, he really started talking about changing the paradigm of cancer treatment,” his daughter Alexis says. “That’s all he knew how to do. He knew how to be a scientist.”

First, Steinman needed to see his tumor. Not an M.R.I. or CT scan, but the material itself. The trouble was that most people with his cancer never have surgery. If there’s cause to think the tumor has spread — and there usually is — it may not be worth the risk of having it removed, along with the bile duct, the gallbladder, large portions of the stomach and the duodenum. Luckily for Steinman, early scans showed that his tumor was a candidate for resection. On the morning of April 3, 2007, less than two weeks after his diagnosis, he went in for the four-hour procedure at Memorial Sloan-Kettering Cancer Center, just across the avenue from his office at Rockefeller University.

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