These snoozing inmates in the Activities of Daily Living Unit, or ADL, at the Massachusetts Correctional Institution in Norfolk are prisoners who have been in custody for years, even decades. When they could no longer care for themselves — feed themselves, stand in lines for medication, or use the bathroom on their own — they were transferred to this “sub-acute care” facility, where round-the-clock staffers tend to their basic needs.

There’s another ADL unit at the prison in Shirley, and together the two facilities have 29 beds. Soon, that won’t be nearly enough. In the past decade, the number of state prisoners older than 60 has jumped 80 percent — from 325 to 584 — and inmates older than 55 are now the fastest-growing segment in state and federal prison populations. According to projections released by the Division of Capital Asset Management in January, the state will need about 900 additional beds by 2020. Massachusetts, in other words, is on the hook for a lot of very expensive care in the years ahead. One study found that it costs three to nine times more to provide care to elderly inmates.

This jump in older prisoners partly reflects the aging of baby boomers, but it’s also the result of tough-on-crime legislation such as the mandatory minimum and “truth in sentencing” laws, which require lengthy sentences. The result: Record numbers of people are now serving record amounts of time.

While the elderly presently account for just 6 percent of state inmates, the fiscal impact of the changing demographic could be huge. In 2008 the legislature authorized $550 million for upgrades to correctional facilities, commissioning a master plan to lay out spending options. Adding the necessary beds, the plan found, would likely require building three new ADL units.

And if the legislature passes a “three-strikes” law it’s currently considering, the number of elderly inmates in state custody is sure to increase even more. To counter the trend, lawmakers have proposed the “compassionate release” of infirm prisoners into private care, which would unload most medical expenses onto Medicare or Medicaid.

Whether the state builds new facilities or moves to private care, it has to do something. “When you have somebody who has grown old in the system, who now has any number of debilitating diseases, we have a constitutional [responsibility] to provide the standard of care to that inmate,” says Sandra McCroom, the state’s undersecretary of criminal justice. “They don’t just go away.”

The e-mail that changed Doug Ulman’s life arrived in the fall of 1997:

Doug, yesterday I received an article (from the Brown Alumni Magazine) in the mail from a friend of mine. After reading the article and relating to…what you have gone through, I decided to drop you a line. Being a young man in the prime of your life both athletically and physically then to be struck by cancer is devastating. As you alluded to in the article, cancer is a life-altering event and a rough road. But I feel as if we are the lucky ones. Nobody can really have the perspective and the focus of a cancer survivor. If there is anything I can do to help your cause, please let me know. Otherwise, look after yourself and take care.

The e-mail was signed Lance Armstrong.

Ulman ’99, then a junior, had been the subject of the BAM article, which detailed how a routine chest X-ray had revealed a tumor attacking the cartilage in Ulman’s ribs. As an athlete recruited to play soccer at Brown, Ulman had found himself suddenly unable to play the sport that was his passion. Although he loudly cheered his teammates from the sidelines, Ulman, who went through three separate rounds of treatment for bone cancer and melanoma over the next year—including the removal of a portion of the affected rib—was determined to play again. He returned to competition briefly, but ultimately turned his attention to a new challenge.

Ulman’s experience with the disease revealed to him how little support existed for young adults facing a cancer diagnosis. “I needed to talk to someone else my age who’d had cancer,” he told the BAM, “but I didn’t know anyone.” With the help of his family and a Royce fellowship, he founded the nonprofit Ulman Fund for Young Adults With Cancer. He set up a website and organized a celebrity auction and a charity soccer game. During his sophomore year, he completed an independent study that allowed him to produce pamphlets aimed at helping young people find information on different cancers and deal with the roller coaster of emotions that follows a diagnosis.

All of this caught the notice of Armstrong, who in 1997 was not yet the celebrity athlete he has since become. Just a year earlier he’d dropped out of the Tour de France and a few months later was diagnosed with testicular cancer. In 1997 Armstrong’s first Tour victory was still two years away, and accusations of doping were seven years into the future. More importantly, perhaps, the Lance Armstrong Foundation, whose yellow Livestrong wrist bands have since become ubiquitous, had not yet become the iconic brand that it is today.

Although Armstrong was the public face and the driving force behind the foundation, it would take an organizational mastermind to create its enormous success, a president and CEO who could take it from a small startup to an international force. Armstrong found that mastermind in 1997, when he hit the send button on his e-mail to Doug Ulman.

At Brown, Ulman remained outwardly upbeat during his cancer treatment, but he felt alone. He was either too old or too young for every support group he could find. His classmates were encouraging, but Ulman could see their discomfort with someone whose presence was a reminder that none of them was invincible after all.

“Everybody around is so unsure of what to do that they either won’t talk to you, or are very solicitous,” recalls Professor Emeritus of Engineering Barrett Hazeltine, a mentor to Ulman during this time. Ulman used to tell Hazeltine, “Nobody seems to know how to treat me. I’m really on my own.”

Ulman threw himself back into the soccer team, attending practices even when he was too sick to play and screaming enthusiastically from the sidelines during games. He had always wanted to be a teacher and a soccer coach, so he enrolled in the Undergraduate Teaching Education Program, and did his student teaching at Seekonk Middle School.

“It was awesome,” he says. “I loved it. I loved being around kids.” He worked with Hazeltine on a series of independent studies, studying such topics as nonprofit management and finance. After graduation he won an Echoing Green Fellowship, which provides two years of salary and health insurance to young entrepreneurs. He left teaching and moved back to his parents’ house outside Baltimore to run the Ulman Fund full time.

But before he made that move Ulman flew out to Austin to meet Armstrong, with whom he’d been exchanging e-mails off and on for two years. When he showed up at the Lance Armstrong Foundation’s Ride for the Roses in 1999, the cyclist was so busy the two barely had a chance to shake hands. The event included a cancer symposium, and when the speaker opened up the floor for questions, Ulman’s arm shot up. He talked about the Ulman Fund and about the overlooked needs of young adults with cancer. He was so convincing that the Foundation invited him to a meeting in Chicago later that year. The meeting included the leaders of most major U.S. cancer organizations, each of whom had fifteen minutes to address how their work might fit in with the Lance Armstrong Foundation. The room was filled with executives in their forties and fifties. Ulman had just turned twenty-three.

The following October Ulman was visiting his then-girlfriend in San Francisco when Armstrong phoned. He was in the Bay Area for a few days and wondered if Ulman would join him for dinner. Their conversation over that meal turned into a five-hour discussion about all that Ulman and Armstrong might accomplish if they joined forces. Two months later Ulman moved to Austin to become the Lance Armstrong Foundation’s fourth employee.

The Foundation was still a tiny organization struggling to find its place. Its three employees, who were motivated by a vague mission of helping people with testicular cancer, had little management experience. Armstrong has since written on the foundation’s blog: “We thought we’d put on a good bike ride, donate a few thousand dollars to those doing research, and see where else we could help out.” However, partly as a result of the Chicago symposium, the board had identified a niche that Ulman would ultimately help grow into a movement. He was hired as director of survivorship services. “Everybody’s doing research,” Ulman says the board had decided. “Let’s figure out something else. Let’s not put all of our eggs in the sort of basket that’s ten years or twenty years off. How do we help people today?”

Since that time, the primary focus at Livestrong (as the foundation is more familiarly known), has been “survivorship.” The idea is not only to survive cancer; beating the disease is a cause for celebration, for living a fuller, more active life. When I visited Ulman in Austin, his assistant drew up a list of Livestrong employees that Ulman wanted me to meet during my visit, and he was quick to point out who among them were cancer survivors. Each of them, he said, was “phenomenal,” “unbelievable,” or “awesome.”

These are adjectives Ulman uses often. He is almost preternaturally energetic and optimistic. He likes to say that his staff is “naíve and audacious,” and explains: “We’re naíve enough to think that we are going to change the world. And we are audacious enough to try.” To the Livestrong staff, he is simply Doug. They joke that in a typical day Ulman can run a marathon in the morning, meet with world leaders before lunch, solve all the world’s problems by early afternoon, and throw a party for Livestrong’s donors in the evening. “We all wonder how he sleeps,” says Rebekkah Schear, Livestrong’s program manager for international programs.

Ulman has short brown-blonde hair, squared sideburns, and striking green-blue eyes. He is tall and lean, and his physique reflects the fifteen marathons he’s completed and the 100-mile course in the Himalayas he’s run. He says he’s in better shape now than he was back at Brown. The culture around the Livestrong office encourages this sort of athleticism: there are yoga and Pilates classes for employees, a workout room with Livestrong-branded spinning bikes, and showers in the bathroom for those who bike to work.

Located on a prominent corner in the working class but quickly gentrifying Spanish-speaking neighborhood of East Austin, the organization’s LEED-gold headquarters is spacious and airy. Dozens of pieces of artwork from Armstrong’s personal collection are displayed around the building, and every employee—including Ulman—has an identical low-walled cubicle. The walls of the conference rooms are either glass or slatted wood. The layout was the geography of collaboration. When the foundation bought and renovated the building—they moved in during 2009—Ulman says, “We tried to make it a startup feel. There’s never a meeting where you don’t know who’s in it.”

The atmosphere at Livestrong is both intense and playful. When I visited in November, Ulman was sporting a horseshoe-shaped mustache. During that month—known as Movember to participants—men grow mustaches to raise money and awareness for prostate cancer and other men’s health issues. This year the “Mo Bros” raised almost $14 million throughout the United States, 35 percent of which went to Livestrong.

Livestrong has only ninety employees. Ulman frequently uses the words nimble and impact, as in “We want to be the small, nimble group that can attack these problems when we see them.” And: “Our goal is not to be the biggest. It’s to have the biggest impact. If we can use Lance’s visibility, the Livestrong brand’s presence, to bring people together to accomplish things that none of us can do on our own, that’s the best use of our energy.”

“It’s been a wonderful thing,” Hazeltine says, “how somebody Doug’s age took an organization really struggling to find a purpose and a mission and put together an organized, directed, well-managed social enterprise. He really matured the organization remarkably effectively—and remarkably quickly, too.”

Hazeltine, who has taught courses in entrepreneurship and organizational management at Brown for fifty years, has seen many nonprofits come and go. Lots of nonprofits, he says, were started by someone able to grow an organization until it employed ten or fifteen people but “then just simply couldn’t make a larger impact because they just weren’t ready to do the planning.” What Ulman has been able to do, he says, is to accomplish the detailed work of identifying opportunities and focusing on realistic goals.

One of those opportunities has been helping patients live with cancer. At the front of the Austin headquarters is the organization’s Patient Navigation Center, a series of cheerful rooms where professional “Navigators” help people affected by cancer deal with their diagnosis and its complications. The navigation model was pioneered by a surgeon named Harold Freeman, whose Patient Navigation Institute was the first of its kind when it opened in Harlem in 1990.

Ulman remembers vividly when Freeman—now a member of Livestrong’s Board of Directors—gave him and Armstrong a tour. As they passed a series of exam rooms, Ulman says, “He stops us and he says, ‘These people represent the difference between what we know and what we do. Millions of people in our country and around the world die needlessly because we don’t apply what we already know.’ So it started us on this whole path to figure out: if we didn’t do any more research—no more biomedical research—how many lives could we save with just what we know works today?”

Navigators at Livestrong help patients get access to the treatments that medicine already offers. “A lot of the people who show up, they don’t have transportation,” Ulman says. “It’s not that they couldn’t get treatment, but they may have skipped treatment yesterday because they couldn’t get there. Or they didn’t have child care. This Venezuelan woman walked in the other day with $7,000 in [medical] bills. She didn’t know what to do. It took our navigators maybe fifteen minutes to realize that she was eligible for a federal program that took $5,500 off immediately.”

Chris Dammert, director of the Navigation Center, remembers one client who came into the Center with her four-month-old daughter. Her doctors had told her that treatment for her breast cancer would make it impossible for her to have children. “Because of our program, she and her husband were able to afford fertility preservation,” Dammert says. “So they froze embryos, and her sister-in-law acted as a surrogate and carried the baby.”

Dammert, who came to Livestrong from the for-profit world, wears a dark suit and dark glasses, and his face betrays little emotion. But his voice catches as he recalls this woman bringing in her baby. “And she said, ‘Thanks to you, we have a family. Otherwise, we wouldn’t have been able to afford it, and we wouldn’t have done it.’”

It’s a Monday evening at the Four Seasons Hotel in downtown Austin, and Doug Ulman is tweeting. He wears a trim black suit with a blue-and-white checked shirt. Seeing so many partners and great friends at the @cprittexas dinner, he thumbs on his Blackberry. Social media sites like Twitter and Facebook have “changed everything we do,” Ulman says. “For a nonprofit, it is a free way to communicate in real time with people who self-select to get the information you’re putting out there.” More people with cancer are now referred to the organization through Facebook than from any other source.

Ulman and a handful of his staff are at the third annual dinner for the Cancer Prevention and Research Institute of Texas (CPRIT), an organization established in 2007 with a $3 billion Texas state bond initiative. The idea was to provide $300 million a year for ten years so researchers and scientists could make Texas a cutting-edge center of cancer science. In Texas, however, incurring debt requires a constitutional amendment, which is difficult to get in a state known for fiscal conservatism. Ulman and Livestrong actively campaigned on behalf of the amendment. Getting it passed, Ulman says, “took every ounce of our energy and being. But I loved it.”

The CPRIT campaign, he says, was “an example for us as an organization. I think we spent $800,000 on this effort. We got $3 billion! And it doesn’t come to us. We don’t care. It’s not about us. It’s about: what’s the biggest leverage? A lot of people on our board are entrepreneurs and venture capitalists, and they’re all about taking risks and trying to have the biggest impact. We feel like that’s somewhat of our sweet spot.”

This evening’s keynote speaker is Tachi Yamada, former president of the Global Health Program at the Bill and Melinda Gates Foundation. He talks about the importance of making sure funding leads to real results. Quote of the night, Ulman tweets as Yamada speaks. If you aren’t keeping score you are simply practicing. Yamada talks about the “crazy, out-of-the box” ideas his program has funded over the years, ideas that would never get by peer review. That doesn’t matter, Yamada insists, and Ulman mouths his next line along with him: “Because true innovators have no peers.”

Ulman leans over to his colleague Andy Miller. “He uses that line every time,” Ulman whispers. “Because it’s true!”

At Livestrong all employees are encouraged to spend up to ten percent of their work time on a creative project of their choosing. Last year, for example, Miller decided to work with the cooks at Canyon Ranch to create a cookbook for people with cancer. This year, Rebekkah Schear is using her creative time to plan a musical comedy revue, a revue that will include a staff roast of Ulman.

Ulman loves this kind of creative thinking, whether it serves the organization’s mission directly or not: “If someone comes up with a great idea—or even an idea—we should start at yes, and work through every reason why we can’t do it. We never start at no. I can’t stand when people are like, ‘No, we don’t do it that way.’ Let’s try! A venture capitalist funds fifty companies, and if two of them make it they hit the jackpot.”

When an employee who had served in the Peace Corps approached Ulman with the idea of expanding Livestrong’s mission to include international work, Ulman gave her $100,000 and one year to conduct research. As a result of this one employee’s enthusiasm and interest, the organization has thrown itself into such efforts as a global anti-stigma campaign, joining with the Haiti-based nonprofit Partners in Health (cofounded by Jim Yong Kim ’82, who is now president of Dartmouth) to inject cancer treatment into health systems already established to treat HIV, malaria, and tuberculosis.

Livestrong’s most innovative idea has been its hugely successful corporate fund-raising strategy. Because Nike has sponsored Armstrong since the beginning of his cycling career, Nike was its first, and continues to be the foundation’s closest, corporate ally. Nike’s Livestrong store offers such items as yellow-and-black shirts, shoes, watches, and hats, all with the Livestrong logo beside the Nike swoosh. Before 2010, the foundation received all the profits from the sale of these items, which amounted to $12 million in 2009. But a new arrangement Ulman negotiated in 2010 encourages Nike to build the brand by splitting the profits. Nike makes a guaranteed minimum annual payment to Livestrong of $7.5 million and then pays a royalty to the foundation on sales above a certain amount. In addition to Nike, Livestrong also has corporate partnerships with RadioShack, Oakley, Nissan, and others. Livestrong is also the first nonprofit organization to brand a sporting park. Kansas City’s Livestrong soccer stadium has an enormous yellow wristband glowing at its entrance and the foundation’s yellow logo can be seen at every turn.

The Nike arrangement, and others like it, is an example, Ulman says, of “democratizing philanthropy.” After all, the money is not really coming from Nike, he says: “The reality is, it’s coming from individuals. People are buying the T-shirts.” In the past, he says, charitable donations came mainly from the affluent. With the advent of the frequently copied Livestrong bracelet, people of all socioeconomic classes can give a dollar to cancer treatment and raise awareness by wearing the yellow rubber band on their wrist.

What’s more, Ulman says, by creating the Livestrong brand, the foundation has created value for the makers and buyers of Livestrong products. Livestrong actually hired a brand valuation firm to figure out the brand’s worth, which in turn helps the foundation negotiate the royalties it receives from its corporate partners. This is a far cry from traditional philanthropy, which simply asks people to be generous and give money. By licensing the Livestrong brand to manufacturers, the foundation helps them seem noble and cool, which helps them sell their own products.

Not all corporations are alike, however. Livestrong refused to license its brand to an insurance company, for example. “People are calling the Navigation Center every day, saying, ‘I’ve been denied coverage; they’re not paying for my treatment,’” Ulman says. “How could we be taking money from that industry and at the same time fighting that industry? It just didn’t feel right.”

To Ulman, using a company like Nike vastly broadens the reach of the ninety people working in Austin. To those uncomfortable with the idea of using the fight against cancer to sell products, Ulman says the only question that matters is: “Is this going to help more people with cancer? If the answer is yes, then we do it. If the answer is no, we don’t.”

Meanwhile, the Ulman Fund continues to grow as well. Although he no longer is involved in day-to-day business, Ulman and his mother sit on the fund’s board of directors. The organization now has more than a dozen full-time staff members, including several young adult patient navigators who work at hospitals in the Washington, D.C., area.

And Ulman still sees a dermatologist and oncologist several times a year for a thorough check on his skin. He gets CT scans every few years. The odds of the bone cancer returning at this point are low, but the chances of melanoma recurring, Ulman says, are high.

If he must one day fight cancer a fourth time, Ulman will surely have an awesome, phenomenal, unbelievable team of people to back him.

After all, he’s a survivor.

Viewfinder by Rebecca Pronsky ’02 (Nine Mile Records).

Rebecca Pronsky was raised in 1980s Brooklyn by urban hippies. Her parents told their kids they could be anything in this world. “Which is kind of bullshit, honestly,” Pronsky ’02 says with a laugh. “I guess I’m struggling with that: disappointment about being a grown-up and having to make sacrifices.”

The eleven tracks on Viewfinder, her new album, are jaded country-and-western. They’re twangy and upbeat, but with a darkness that hints at Pronsky’s struggles with coming of age during uncertain economic times.

In “Hard Times,” Viewfinder‘s opening track, she laments, “Numbers used to be so small: pennies, nickels, dimes / Now, the same collectors call, fallen on hard times.” (National Public Radio chose “Hard Times” as its April 18 Song of the Day.) Over the pop-music hook and a percussive bass of “Give Up Too Easily,” Pronsky sings, “And we give up too easily each time / ‘Cause we never can make up our minds.”

Pronsky, who favors red cowgirl boots, cat-eye glasses, and red lipstick, says she was always “that singer girl” at her liberal Brooklyn high school, the one taking musical theater–oriented voice lessons, going to guitar camp, and studying jazz. At Brown she majored in music and played folk gigs around Providence, including a monthly show at Café Zog on Wickenden Street.

But since “everyone around me wanted to save the world and be a doctor,” Pronsky says, she didn’t at first take music seriously as a career option. “I wanted to work for a nonprofit because that’s sort of the whole vibe of Brown: being a good person and giving back,” she says. But when, after college, she took a job at the Vineyard Theater in Manhattan and found herself “in the basement of a theater doing spreadsheets,” she realized that “I don’t think this is where I’m really going to shine.”

Despite not listening to country music while growing up, Pronsky says she accidentally stumbled upon her trademark “noirish twang” (as NPR describes it) in her twenties. “Oh, weird,” she said to herself at the time. “We’re playing country music.” But it somehow captured perfectly the yearning and the sense of always being dissatisfied that seemed to characterize her generation.

As she sings on “Give Up Too Easily,” “I’m dreaming of the day when I’ll take flight / Follow my path far and out of sight.… We’ve been holding our breath for so long.”

Lady Gaga’s mom sent me an email last week. “We’re moving towards a braver and kinder society, Beth, and it’s all thanks to you!” she wrote.

I probably need not clarify that Cynthia Germanotta doesn’t actually know me. She got my name when I surfed over to the website of the foundation that she and her pop-phenom daughter are launching today at Harvard’s Sanders Theater. The site had a place to type in my name along with a button that said, “was born this way.” As in, “I, Beth, was born this way.” Born what way?

Like Lady Gaga’s hit song and 2011 album of the same name — and, like Gaga herself — the Born This Way Foundation is clearly queer without being exclusively gay. Pink triangles open and close the song’s freaky futuristic music video, and lyrics like “don’t be a drag, just be a queen” are side-by-side with lyrics that include anyone who might at some point have been “outcast, bullied, or teased,” like “black, white, beige, chola descent, / You’re Lebanese, you’re orient.” Lady Gaga has built her career on not being pegged or boxed in or predicted, and it seems her foundation plans to similarly spread the message to be yourself, no matter who you are. The website speaks of individuality, self-expression, bravery, and empowerment without ever actually saying the word “gay.”

The Foundation has partnered with Harvard’s Berkman Center for Internet and Society to learn what the data say about bullying and other issues affecting young people. “The Born This Way Foundation is trying to ask the hard questions about how they can be most helpful to youth, and to try to ground it in what the data say, and trying to do their homework before they jump in,” says John Palfrey, faculty co-director of Harvard’s Berkman Center for Internet and Society and co-author of the book Born Digital: Understanding the First Generation of Digital Natives. “When a celebrity of Lady Gaga’s stature weighs in on an issue, it has a large impact, and I’m really impressed that they’re taking the time to learn so carefully about the issues before they make large moves.” Palfrey insists that “we on the research side have many ties to the LGBT community and that’s certainly a big piece of the research that we’ve been doing.”

Still, there were some hurt feelings on the Harvard campus in the weeks leading up to this afternoon’s high-profile launch, which, in addition to Gaga herself, will feature Oprah Winfrey, Deepak Chopra, and U.S. Department of Health and Human Services Secretary Kathleen Sebelius. Members of campus LGBTQ groups like the Harvard Gay and Lesbian Caucus, the Queer Student Alliance, the Harvard Trans Task Force, and LGBTQ Student Life had no hand in the planning, and when the LGBTQ Student Life asked that the Foundation set aside a block of tickets for LGBTQ students or groups, the request was denied. Members of an organization called Their Day in the Yard are planning a demonstration at Sanders Theater today, timed to coincide with the launch. The group, which seeks amends for nine students who in the 1920s were expelled from Harvard for being gay, does not mention the Foundation in any of their press materials, but the group’s founder, a Harvard alum who asked not to be named here because her work is tied to the University, says, “they have ignored and snubbed the very population here on campus that I thought they were supposed to be reaching out to help. The queer community here on campus is going to show up and we’re going to raise our issues that day. They’re planning this launch here at Harvard for a reason and we’re going to be out there too.”

Spokespeople from the Born This Way Foundation’s press organization did not respond to questions, and the Harvard Graduate School of Education, which is co-hosting the event, did not respond to emails and phone calls.

Yesterday morning, Palfrey invited about a dozen LGBTQ student leaders on campus to a meeting to discuss the research that Berkman is doing in its partnership with the Foundation. Sam Bakkila, of the Harvard Trans Task Force, who initially said he was “kind of offended” by the way the Foundation handled its relationship with the LGBTQ community on campus, was at this morning’s meeting and has reconsidered. “I feel like it would be rather presumptuous or self-aggrandizing for me to imply that this huge team of celebrities and policymakers should have collaborated with an undergraduate student group,” he wrote in an email last week. “Hopefully the BTW Foundation found a way to engage the LGBT community and troubled youth in particular — but it really doesn’t have to have anything to do with giving privileged Harvard students in a very LGBTQ friendly environment the chance to see Lady Gaga and other celebrities.”

“Dear Mr. Cole,” the letter began. “My name is Jerry Wayne Johnson. I’m presently a Texas prisoner. You may recall my name from your 1986 rape trial in Lubbock.”

Ruby Session was shaking as she read on. The year was 2007, and the letter was addressed to her son Timothy Cole. “I have been trying to locate you since 1995 to tell you I wish to confess I did in fact commit the rape Lubbock wrongly convicted you of.”

Ruby sat down, stood up. A picture of Tim in a tuxedo, taken at his junior prom, smiled from the mantle. Before his trial the prosecutor had offered him a deal to plead to lesser charges. “Mother,” Tim had said, “I am not pleading guilty to something I didn’t do.” He was sentenced to 25 years in prison. Thirteen years later, he died behind bars.

The Texas criminal-justice system has long had a harsh reputation, but it has drawn renewed scrutiny with Gov. Rick Perry’s run for president. During the past 11 years, Perry has presided over 238 executions, including the infamous case of Cameron Todd Willingham, who was put to death based on a dubious arson investigation. In a September debate, Perry famously said that he had lost no sleep over the possibility of an innocent man being executed on his watch.

Yet during his governorship, Texas has exonerated no fewer than 56 people. All had served years, sometimes decades, in prison; five were on death row. As Perry sees it, these exonerations don’t suggest a problem with the system—they demonstrate that it’s working. “We have a very lengthy and methodical process of appeals,” he said in March 2010. “And that is a great and good mark for Texas.”

Perry made those remarks during an extraordinary ceremony in which he handed down the first posthumous pardon in Texas history. Timothy Cole, imprisoned while a 26-year-old student at Texas Tech University, had been failed by the justice system at every turn. But what makes his story particularly gut-wrenching is that he perished in prison even as the real rapist, Jerry Johnson, tried repeatedly to confess to the crime. By the time Johnson’s story was heard, Cole had been dead nearly a decade.

The tale of Tim Cole and Jerry Johnson, which I investigated for more than a year, reveals a system in which an innocent man, once convicted, has virtually no chance of redemption—even with the guilty man fighting for it. For the thousands of Americans spending years of their lives in prison for crimes they did not commit, the odds couldn’t be much bleaker.

On the night of March 24, 1985, Texas Tech sophomore Michele Murray was parking her car near campus when a tall black man in a yellow terry-cloth shirt approached and asked her for jumper cables. He reached into the window, unlocked the door, and shoved Murray to the passenger side. He forced her head down onto the seat and held a knife to her neck. He told her that if she kept screaming she wouldn’t come back alive.

He smoked while he drove. He asked her name, her major. He took her to a field outside of town and raped her. He smoked when he was done. Then he made her drive him back to town, stole her jewelry and money, and took off on foot.

It was the fifth rape on or around the Texas Tech campus in four months. Female students were frantic. Police were on high alert. In all the cases, a young woman was approached in her car by a tall black man—identified as a smoker by three of the victims—who drove her outside of town at knifepoint and raped her. Composite sketches of the “Tech rapist” in the local papers seemed to change daily. Only about 500 of the 22,000 students on campus were black, and it became a grim joke among them: Don’t walk around campus at night or they’ll say you’re the rapist.

The shoddy police investigation and sensational trial that followed were capped by a remarkable coincidence. When Cole was taken to the Lubbock County Jail after his sentencing, in September 1986, the real rapist was right there in a nearby cell. Johnson, who was awaiting trial for two other rapes and a murder, had followed Cole’s story in the paper. He listened to Cole cry. “It was terrible to learn that Tim was…on trial for something I knew he hadn’t done,” Johnson wrote to me in a letter in 2010. “Seeing him cry his first night in jail and seeing him leave to be taken to prison was difficult, I cried.” But he did nothing. He was already facing the death penalty. “I knew it wasn’t good to say anything before I went to trial.” Later he would learn in the prison library that there was also the statute of limitations to consider. So he kept his mouth shut—for nine years.

Johnson grew up in the 1960s on the east side of Lubbock, an impoverished neighborhood of cotton fields and ramshackle houses. He was raised mostly by his great-grandmother; his mother, JoNell Johnson, and grandmother lived nearby, as did his estranged father, Lorenzo Harris. “Sometimes Jerry would come over to the house, be out there at the fence,” Harris recalls. “He knew I was his daddy, but my wife would run him off.”

Johnson was 12 years old the night in 1971 when his mother shot and killed a boyfriend after he assaulted her with a pool cue. (She was eventually sentenced to 10 years’ probation.) He dropped out of high school but managed steady employment in blue-collar jobs. He had two children and got married in the early 1980s. But by 1985, Johnson says, he had lost control. “Obviously I had a psychological breakdown,” he says. “Why, I don’t know.” When pressed, he demurs. “I cannot form a reason or cause for my actions.”

Johnson raped Murray in March, he now admits, but investigators never pursued him as a suspect. He was arrested that July, however, for raping a woman he met at a party. In October, out on bond, he was arrested for kidnapping and raping a 15-year-old girl from Estacado High School; two years later, he was convicted of those crimes and sentenced to life in prison. He was also charged with murdering an insurance saleswoman, but those charges were dropped.

Johnson and I had been corresponding for about a year when we finally met in March 2010, in a bright, empty visitation room at the Price Daniel correctional facility in Snyder, Texas. Tall and thickly built, Johnson was dressed in the facility’s standard white cotton shirt and pants and was soft-spoken and polite. Now 52, Johnson is certain he’ll never be free again. “There’s a lot of people live a false life; everything they do is a lie. Never no honesty. And you have those people that go to their death like that. I don’t want to go to mine like that.”

When I ask him about the four other Texas Tech rapes—so similar to Murray’s but never solved—he says, “I don’t have a comment about that stuff.”

Hill View Drive, the leafy middle-class block where Tim Cole and his six younger siblings grew up, was overrun with kids. Cole was a big brother to them all: He organized sports games, led neighborhood jogs, and gave advice. “Tim used to always tell me to be the best I could be,” recalls neighbor Leon Warren. “He would tell me, ‘Make sure you go to a major university and do good,’ and ‘You can make it.’”

From an early age Cole was sure he would play basketball in college—despite his severe asthma, he loved sports—study business, and own his own company. He went to Texas Tech and the University of Texas-San Antonio before joining the Army in 1981; in 1984, he moved in with his younger brother Reggie in Lubbock to go back to school at Tech. He studied long hours, worked as a dishwasher, and partied occasionally. In January 1985, he was robbed outside a party, and when he reported the crime, police found some marijuana and a gun in his pocket. (He was charged with a misdemeanor.)

One night that April, outside a pizza parlor, Cole chatted up a woman named Rosanna. After Cole had driven away, she got into her partner’s squad car, sure she’d found her mark. Rosanna was an undercover police officer—bait for the Tech rapist. Two days later, a detective stopped by Cole’s place. He needed to take a picture, he said, for the investigation of the robbery Cole had reported. Cole looked straight into the camera and the detective snapped a Polaroid.

Later that day, an officer brought a photo lineup over to Murray’s dorm. All but one of the photos were mug shots—men looking away from the camera, holding their book-in cards. Murray hesitated. She pointed to the Polaroid of Cole. “I think that is him,” she said.

“Are you positive?” asked the officer.

“Yes,” she said. “I am positive.”

Eyewitness identification has long been the most powerful tool in a prosecutor’s arsenal. Even when there is a dearth of forensic evidence, juries are swayed by a victim’s certitude—how could she forget the face of the person who raped her? But researchers are learning just how often eyewitnesses are wrong: Nationwide, incorrect identification was a factor in the convictions of more than 75 percent of people eventually exonerated by DNA. Gary Wells, an Iowa State University psychology professor who has studied the issue for decades, says the Lubbock police did exactly the things that can influence an eyewitness to choose the wrong guy. In a good lineup, he says, the witness must be warned that the perpetrator might not be in the lineup at all. “The tendency is to pick the person who looks most like the perpetrator—relative to the other lineup members,” Wells explains. He also argues that the process must be double blind: Neither the officer nor the witness should know which photo shows the true suspect. “It’s so natural for the lineup administrator, if you pick the person they had in mind, to smile, react, to reinforce.”

For his 2011 book, Convicting the Innocent, University of Virginia law professor Brandon Garrett examined hundreds of DNA exonerations and found that in at least a third of the cases the victim was shown a “stacked lineup” like Cole’s, where the actual suspect was highlighted. Even if victims were uncertain initially, he says, “by the time of trial, almost all of them were absolutely sure they were identifying the right person.”

At trial, Cole faced a jury that included one member whose ex-wife had recently been a victim of sexual assault. His brother Reggie and his friends testified that on the night of the rape they were home, partying, while Cole sat at the dining room table all night studying. Reggie also testified that his brother never smoked due to his asthma. But the prosecutor, Jim Bob Darnell, portrayed them as liars who would say anything to save Cole.

No evidence tied Cole to the rape. His attorney, Mike Brown, brought up Jerry Johnson several times and even submitted a picture of him as evidence. Johnson had been charged with two rapes by then, and Brown recognized similarities with those assaults. It didn’t matter. “What the jurors saw, and heard, was a courageous young woman unshakeable in her belief of who had raped her,” District Court Judge Charlie Baird would write many years later in exonerating Cole. “What they did not know was how that belief had been shaped and formed by the police.”

Ruby Session chokes with sorrow as she recalls the moments after her son was sentenced, when he fell to the courtroom floor and cried. She got off her chair and down on the floor with him. She hugged him and rocked him. “My son, a 26-year-old man, lying in his mother’s arms. And that’s all I could do. And that’s the last time my baby was in my arms like that.”

Johnson’s plan from the start, he says, was to contact Cole directly. “I believed at some point I would connect with him,” he says, “and he would probably send a lawyer to talk with me and try to get himself out.” He began by writing letters to everyone he knew in prison, asking if they’d run into a guy named Tim Cole. It was a fool’s errand—Cole could have been among any one of more than 100 prison units. But Johnson says he couldn’t think of another way to find him.

Johnson did not approach the authorities until years after the statute of limitations for the Murray rape had run out. Then, in 1995, he petitioned the court to appoint an attorney for him so he could confess. He copied the petition both to Brown and the district attorney. He got no response.

For five years Johnson worked on his own appeals and helped other prisoners with their legal paperwork. “Never during this time period did I not think about Tim and the petition or a way to contact him,” he says. But he took no further action.

Then, in 2000, Johnson sent the court a letter: “Judge I believe I have properly raised an important issue the court should have long ago addressed. Certainly the convicted man would want to see his name finally cleared.” In January 2001, he got a two-line order in the mail, with no explanation. It simply said, “Denied.”

Most appeals in Texas criminal cases end up at the Court of Criminal Appeals, which consists primarily of former prosecutors elected to the bench. The court rarely reverses a case, even in the face of glaring errors or unfairness—in one case, it upheld the conviction of a man cleared by DNA evidence—and its conduct has prompted the US Supreme Court to rebuke it several times.

The Texas Board of Pardons and Paroles is similarly stacked with former law enforcement officials and prosecutors. They rarely meet in person, typically passing a file from one office to the next for an up-or-down vote. The inmate has no right to demand a hearing from the board or receive an explanation. “Either they hire a lawyer or they pray to God,” says William T. Habern, former executive director of the Texas Criminal Defense Lawyers Project. “They can write something in if they want to, but who do you think the board is going to believe? Some inmate?” When Cole was up for parole in 1996, Texas considered 1,024 cases classified as SB-45, or “Extraordinary Vote,” which include certain types of sexual abuse and violent crimes, and require a vote by the full board. Among those 1,024 cases, not a single prisoner was granted parole and released.

Until the advent of DNA technology, wrongful convictions were thought to be extremely rare. But as the number of DNA exonerations rises—at least 281 as of this writing—we confront the uncomfortable truth that the number of innocent people behind bars is far higher than we realize. The vast majority of DNA exonerations are in rape cases. In many felony cases—robberies, shootings, murders, drug-related crimes—there is no DNA to test. Even in rape cases, forensic evidence often is lost or destroyed.

DNA testing provides false assurance, then, that there is recourse for people failed by the justice system. What it really does is underscore what a true solution would require: a system equipped to deal with the significant number of people locked up for crimes they did not commit. Experts say that number is nearly impossible to nail down. But a conservative estimate, extrapolating from research on eyewitness identification and DNA exonerations, ranges from at least a few thousand to more than 20,000 people wrongly imprisoned nationwide.

A string of devastating stories has put Texas justice, in particular, under a cloud. In addition to Cole’s postmortem exoneration and the execution of Cameron Todd Willingham, chronicled in The New Yorker in 2009, there is also the case of Anthony Graves, who served 18 years for a gruesome murder while the true killer confessed again and again. Graves was finally freed in 2010 following a Texas Monthly exposé.

Cole, Willingham, and Graves were all convicted under prior Texas governors. But Perry has done little to improve the state’s criminal-justice system, which has almost a million people in its grip. In 2001, he vetoed a bill banning the execution of the mentally disabled. In 2003, he cut the prison system’s budget by $230 million, slashing education programs, drug treatment, and food; when an independent auditor warned that was untenable, Perry cut the auditor’s office too. In 2007, his administration backed a bill making some child sex offenders eligible for the death penalty. While Perry has signed legislative reforms covering eyewitness identification and access to DNA testing, the system still offers scant options for the many people imprisoned for crimes they did not commit.

During his years behind bars, Cole tried to keep himself busy. He took business classes, corresponded with family, and subscribed to magazines like Nature, Jet, and Money. “I want to become vindicated as well as totally exonerated in order to receive a Pardon from the Governor of the State of Texas in order to place it on my wall in my future office or the den of my home,” he wrote in one letter. As he told his mother to stay strong and his brothers to study hard and go to college, he repeated this phrase like a mantra: “vindicated and totally exonerated.”

In 1991, Cole won an appeal on procedural grounds, but the Court of Criminal Appeals still ruled his conviction would stand. In 1992, his case was considered by the pardon and parole board. He was asked if he was sorry for what he did. He said he didn’t do anything. He was denied parole. He kept up on emerging DNA technology, and in 1995 he wrote a letter to the newly founded Innocence Project in New York City, but the organization did not take his case. In 1996, he was denied parole again.

Cole was running out of options. The dust, heat, and poor ventilation had brought back his asthma, and he was shuttled between hospital wards and prison cells—twice he was found unconscious and rushed to the emergency room.

In Cole’s letters, upbeat sentiments like “I will continue to patiently wait for this unfortunate matter to resolve itself” began to give way to “How far does this miscarriage of justice have to go before I can prove my innocence?” And finally, “I don’t have any more dreams.”

On December 2, 1999, Tim Cole was on his way to the infirmary with chest pain when he collapsed on the floor and never woke up again. He was 39.

There is no formal legal means in Texas to confess to a crime for which someone else has been convicted. “I guess you can contact whatever law enforcement agency handled the case,” says Lubbock District Attorney Matt Powell. That, of course, is precisely what Johnson did when he copied his petition to the district attorney in 1995.

“Here you’ve got a guilty guy saying, ‘I did this crime,’” says Jeff Blackburn, chief counsel for the Innocence Project of Texas. “All the ears went deaf and all the eyes went blind.”

The Innocence Project of Texas itself receives thousands of letters each year from inmates claiming to be innocent, and Blackburn says that has fine-tuned his BS detector. Even guilty prisoners have nothing to lose by trying; indeed, Johnson wrote to the Innocence Project about Cole in 2005, but his confession was buried in a diatribe about other issues and got no traction. Johnson also fired off letters to newspaper reporters, law professors, and even a private investigation firm. Some were angry rants about Lubbock law enforcement; some asked for help with his own innocence claim; some expressed a wish to confess. Many of the letters contained all these things, perhaps making them difficult to take seriously.

But then, in 2006, Cole’s former attorney, Mike Brown, received one of Johnson’s letters. (Brown says he doesn’t recall ever receiving a copy of Johnson’s 1995 petition.) He forwarded it to Powell, who sent an investigator to look into it, not expecting much.

By April 2007, Johnson still had gotten nowhere. But then, while looking through some old papers, an idea struck him. He had his stepmother look up Cole’s jail book-in card, which contained Cole’s home address. Soon afterward, Ruby Session held Johnson’s letter to her son in her hands.

After recovering from the shock, Session sent a copy of Johnson’s letter to the Lubbock Avalanche-Journal, which during her son’s trial had run his name under headlines referring to the “Tech rapist.” Now, the paper noted: “The family of Timothy Brian Cole, who was 26 when he was convicted of rape in 1986 and died in prison while serving a 25-year sentence, hope a letter they received last week from a man imprisoned for two brutal rapes around the same time will finally clear the former Tech student’s name.”

Reading the paper in his cell, Johnson was stunned. He’d had no idea Cole had died. “I remember not coming off my bunk the rest of that night,” he says. “I reread and reread that article.”

The paper also quoted a skeptical Jeff Blackburn of the Innocence Project. “We’ve had several of these guys,” he said. “None of them have checked out.” Cole’s youngest brother, Cory, took exception to Blackburn’s comments and called to tell him. The two men soon became friends. After the Innocence Project sent a lawyer to interview Johnson, Blackburn agreed to represent the family to clear Cole’s name. With public pressure mounting, the DA’s office discovered that the original rape kit was still in storage; it conducted DNA testing with Johnson’s cooperation and soon confirmed that he was indeed the rapist.

The proceeding to posthumously exonerate Cole took place in Austin in February 2009. Michele Murray (now Mallin) was there to confront Johnson for the first time since 1985. She and Session hugged and cried, and she told Johnson that she hoped he’d suffer for what he’d done to her, and to Cole. “No man—no person—deserves what that young man got,” she said.

Cole’s brother Sean rocked in his chair and cried as Judge Baird read his ruling: “I find to a 100 percent moral, factual, and legal certainty that Timothy Cole did not sexually assault Michele Murray Mallin.”

Session listened, expressionless.

“I find that Timothy Cole’s reputation was wrongly injured, that his reputation must be restored, and that his good name must be vindicated.”

Cole’s brother Reggie pumped both fists in the air.

“I find that Tim Cole shall be and is hereby exonerated and freed from any guilt or blame related to the sexual assault of Michele Murray Mallin.”

It was all over the news. Texans in their living rooms heard about it, the Board of Pardons and Paroles heard about it, legislators heard about it. The Tim Cole Act, establishing one of the nation’s most generous compensation programs for the wrongfully convicted, passed three months later.

On a windy day in March 2010, Rick Perry, impeccably groomed in a camel-colored jacket and green tie, stood in a hotel conference room in downtown Fort Worth. Perry quoted from Proverbs and flashed a solemn grin around a room filled with family members, reporters, and exonerated convicts. “Ruby, it means the world to me to be here today to look you in the eye and tell you that your son is pardoned,” he said. He commended her for her “graceful persuasiveness” and called her a “wonderful, loving, Christian woman.” Then Perry leaned in to hug her, adding, “And I want to say: I love you.”

But if Perry learned anything from the exoneration of Tim Cole, it was not in evidence 18 months later, when he went on national television and declared his absolute faith in the Texas justice system. Ruby Session clearly had not shared that faith as she received Perry’s pardon, somber-faced. That night she went home and, next to her son’s junior-prom picture, carefully placed on the mantle the piece of paper he had died waiting for.

January/February 2012

Before we talk about how many people may be behind bars for crimes they did not commit, we must acknowledge that it’s nearly impossible to know—only broad estimates are possible. There are several key reasons, experts say, why a number is so hard to ascertain. Because the sprawling criminal justice system is a patchwork of federal, state, county, and municipal courts, prisons, and jails—each with its own system (or lack thereof) of record-keeping and data-reporting—we don’t even know how many people are convicted, let alone wrongfully convicted, of crimes in the United States. “We don’t even have a denominator,” says University of Virginia law professor Brandon Garrett. “But the wrongful convictions we do know about suggest that there’s a big problem.”

Extrapolating from the 281 known DNA exonerations in the US since the late 1980s, a conservative estimate is that 1 percent of the US prison population, approximately 20,000 people, are falsely convicted.

In fact, since the late 1980s there have been as many as 850 exonerations nationwide, according to University of Michigan law professor Samuel Gross, a leading researcher in the field. Many of them float under the radar, Gross says, unlike the highly publicized DNA exonerations.

These cases are the tip of an iceberg. “One difficulty in making generalizations about false convictions is that the ones we know about, exonerations, are clearly a small and unrepresentative sample of all false convictions,” wrote Gross in his 2008 paper, “Frequency and Predictors of False Conviction.” There are several reasons why the known exoneration cases are unrepresentative:

• Because the average time from conviction to exoneration is about 13 years, only those sentenced to serious crimes with decades-long prison terms are likely to even bother undertaking the long, arduous, and resource-intensive process of clearing their names.
• The vast majority of DNA exonerations are in a tiny sliver of cases: aggravated rape and rape-murders that occurred in the 1980s. That’s because it’s almost exclusively rape cases in which there is DNA available to test—and because these types of wrongful convictions rarely occur anymore.
• Now, prosecutors typically test DNA before charging a suspect. In one study in which the FBI did DNA testing during the course of its investigations, 25 percent of suspects were ruled out by the DNA testing. Before the advent of DNA testing, some of these suspects may well have gone on to be tried, and, possibly, convicted.

Moreover, a tiny amount of total criminal cases actually go to trial. Nineteen out of twenty, or 95 percent, of convictions in the US are by plea bargain—and so we know little about them. They “generate virtually no records that can be retrieved,” writes Gross: “no trial transcripts, no appeals, frequently no court hearings of any sort, in many cases no description of the investigation at all beyond a single police report, which (if it could be found) might include little factual information of any value.”

The only cases for which we know the denominator, and for which we almost always have trial transcripts, are death penalty cases. However, the wrongful conviction rate in death penalty cases is probably higher than that of other cases, Gross says, for two reasons: First, capital cases are high-profile, emotional cases in which prosecutors face a lot of pressure to secure a conviction. On the other hand, because of the seriousness of the crime, capital defendants are afforded many more legal protections than those facing lesser penalties—unlike other defendants, they are provided lawyers for every step of the appeals process, and their cases receive major scrutiny from innocence projects and other advocates.

Gross’ 2008 analysis found that the rate of exoneration for all capital defendants in the recent era is 2.3 percent. If the rate of exoneration for all non-death-row crimes (which is unknown) were the same, then there could have been as many as 87,000 exonerations of that kind from 1989-2003.

Read my related post on the Boston Daily blog.

IT’S TUESDAY AFTERNOON just before fourth period, and groups of teenagers are smoking cigarettes outside their high school. Standing among them is Billy, who has the smooth cheeks and soft-edged features of a typical 16-year-old. But there’s also a hardness to him. His hazel eyes are impassive. His dark hair is buzzed close to his head, and he has a wispy goatee and his last name tattooed in black script on his forearm.

When Billy was 14, his father, Bill Sr., went to jail on drug-related charges, and the family lost their house and split up. Billy stayed with his mother in a homeless shelter and a series of hotels, each of them trying to hide their drug use from the other. Eventually they stopped pretending and started hustling together to come up with the money for their $200-per-day heroin habit.

At most schools, an adolescent heroin junkie would be a pariah, and probably even be expelled or arrested. But Billy goes to Northshore Recovery High in Beverly, one of three state-funded schools attended exclusively by teenage drug and alcohol addicts. And according to his teachers and principal, he’s been thriving — it’s the first time he’s consistently shown up for school since seventh grade. Having completed a 90-day residential treatment program for his heroin use, he’s now living with his father, who was recently released from jail, and his uncle. (His mother also sought treatment, but eventually relapsed and is now locked up.) He met his girlfriend, Lexi, at the school, and the two of them help each other stay sober. Billy and his father both agree that if he weren’t at Northshore, he wouldn’t be in school at all.

It may sound like trouble — a bunch of teen addicts spending their days together in an alternative school — but Harvard psychologist John Kelly, the associate director of the Center for Addiction Medicine at Massachusetts General Hospital, says a recovery high school can “provide a safe social context,” which helps teenagers resist temptations.

Perhaps that’s so, but resisting temptation can apparently mean different things to different people. Billy may be attending a school specially designed to help him overcome his drug addiction, but he and Lexi openly admit that they regularly smoke pot. In fact, Billy keeps failing the drug tests that are required at the school. After each positive test, he sits down with his principal and the school’s recovery counselor, and they call in his father or uncle for a group discussion on how to help him stay sober. The school’s approach has been to focus on the major concern — heroin — first. Billy says the message he’s been given is “We’re not really worried about you failing for weed. Opiates are the problem right now.”

Most recovery schools across the country require students to commit to sobriety in order to enroll. But Northshore director Michelle Lipinski, who functions essentially as the principal, takes a much different approach. She believes that even if students are using, her school provides them with a safe environment to work through the recovery process. If they’re struggling with drug use, she reasons, better they do so at Northshore than on the streets. “These are the kids who will eventually be the dropouts of our society, not just our schools, if we don’t do something for them,” she says. “Sobriety isn’t how I measure success.”

NORTHSHORE RECOVERY HIGH occupies the ground floor of an old public school in Beverly, and the hallways are filled with the familiar sound of sneakers squeaking on linoleum and lockers slamming. Students curse freely and wander in and out of class without much reprimand. During gym, they are allowed to “take a walk” (i.e., go outside to smoke). At one point during math class, the teacher looks up from drawing sine waves on the board to discover there are only four students at their desks. “Where did everyone go?” he asks.

The woman overseeing this chaos, Michelle Lipinski, has wavy brown hair and a gregarious center-of-attention personality. The familiar, intimate way she relates to her students makes her seem, at 45 years old, more like a mother than a principal. At any hour of the day, and even on weekends, she can be found texting with students and their parents.

Before arriving at Northshore, Lipinski worked as a science teacher at an alternative school in Salem, eventually becoming the school’s director. For years she watched her students leave for rehab, come back looking healthy, and then relapse within weeks. When one of them died of a drug overdose, she says she began “thinking about what we can do differently as a school system to really address the problem.” It’s then that she started to question how well abstinence actually works in a classroom setting.

The country’s first recovery high school opened in Minnesota in 1989, and the model has since spread to about 20 schools in 10 other states. In 2006, Massachusetts opened recovery schools in Beverly, Boston, and Springfield, and one is scheduled to open in Brockton next month. The schools in Massachusetts are small, with no more than a few dozen students at any given time, but collectively they have enrolled some 450 kids in their first five years. Half of them have either graduated or are still in school.

Recovery highs are structured much like traditional schools, with students attending classes taught by certified public school teachers. The kids are referred by parole officers, other schools, fed-up parents, the Department of Children and Families, and rehab and detox centers. Tuition, which averages around $10,000, is paid for by their home school district, while the Department of Public Health provides each recovery high with up to $500,000 a year for substance abuse counseling, drug testing, and training. Students are required to create and follow an individualized recovery plan, which can include anything from attending 12-step meetings to working with a therapist or joining a sober bowling team.

Though most addiction research has focused on adults, studies demonstrate that two aspects of the adolescent brain make teenagers particularly susceptible to problem drug use. The first is that the nucleus accumbens — the brain’s pleasure center — has not yet fully matured in teens, meaning they often look for easy ways of finding excitement and rewards. The second, says psychologist Robert Miranda, an associate professor at Brown University’s Center for Alcohol and Addiction Studies, is that the frontal cortex — the part of the brain responsible for caution — is not yet completely developed.

Of course, drug use is a major concern even among teens who don’t qualify as addicts. The National Institute on Drug Abuse has found that nearly half of all 12th graders nationwide have used a drug at some point, and almost a quarter have done so in the past month. More than 5 percent of 12th graders smoke pot every day — the highest rate in three decades — and almost 8 percent of kids ages 12 to 17 used prescription pills like Vicodin to get high last year. Here in Massachusetts, the Department of Public Health reports that about 1,700 kids ages 12 to 17 receive state-funded treatment for substance abuse annually. And they typically relapse within a year.

And it turns out that the younger a person is when he begins using drugs or alcohol, the worse his long-term prognosis. “There is a huge push to try to identify kids with drug problems early on, and try to treat them before they get out of adolescence,” Miranda says. That’s part of the motivation for a national effort to integrate substance abuse support services into schools. “The White House and the Office of National Drug Control Policy are right behind this issue,” says Kelly, the associate director of MGH’s addiction center.

Getting kids sober, in other words, is a major priority. But keeping them that way can be a tricky task. A lifetime of unbroken sobriety is a lot to hope for no matter when you begin the recovery process — scientists believe that falling off the wagon is actually part of recovering — but it’s a particularly long trajectory when you’re starting as a teen. And Kelly points out that while adults tend to relapse in isolation, “adolescents nearly always relapse in social environments. If you can create a social environment where recovery and non-use is the norm, they can do much better.”

But does recovery have to mean non-use? To most experts it does, but a vocal and passionate minority — groups like the Harm Reduction Coalition and the Drug Policy Alliance — argues that, in the long run, insisting on total abstinence is unrealistic at best, harmful at worst. Lipinski comes down on that side of the debate, which makes Northshore Recovery High an outlier within the larger recovery movement: There are no 12 steps, no strict path that students must follow. The notion of safe and sober is not black and white, Lipinski argues. Her students don’t “live in a world that’s safe. They’re in and out of homeless shelters. We would never be able to keep them here if we had that zero-tolerance policy.” Lipinski’s approach is aligned with what’s broadly known as “harm reduction,” which holds that, for better or worse, some people will use drugs no matter what. Needle-exchange programs and “wet houses,” where alcoholics can continue to drink, were born of this philosophy. The idea is that if someone can’t stop or won’t stop using, we should at least make his drug use safer and less harmful, both to him and those around him.

Lipinski’s unwillingness to demand that her students remain drug-free pits her against her colleagues. In fact, Lipinski recently resigned from the board of the Association of Recovery Schools, which sets standards and guidelines for recovery schools nationwide, because of what she believes to be its overly rigid approach to adolescent addiction. Traci Bowermaster, the board’s former chair, insists that allowing a young person to use drugs in a recovery environment is detrimental to him and the other addicts in the school. “In order for kids to really be able to embrace a new identity as a person in recovery, they have to remove ties from those who might still be using,” Bowermaster says.

Indeed, most recovery high schools ask students to commit to some version of a 12-step program prior to enrolling. At Boston’s William J. Ostiguy High School, for example, the expectation is abstinence. The school’s philosophy is that a student who is actively using doesn’t belong there. He belongs in treatment. Like Alcoholics Anonymous and Narcotics Anonymous, the school believes that no drug use is safe, and that total sobriety should be every drug user’s ultimate goal. “This is not a small thing for me,” says Ostiguy principal Roger Oser. “To put us under the same umbrella? I don’t think Ostiguy High and Northshore are recovery highs in the same sense.”

IT’S MONDAY MORNING, just a week into the school year, and all 52 students at Northshore shuffle into the school’s cafeteria and plop down on drab tan couches, arranged in a circle, for their daily check-in. Billy and his friend Alex, both wearing baggy jeans and oversize hoodies, sit together on a couch. Alex, a sweet-faced kid with blond hair and blue eyes, is recovering from an addiction to sedatives. “Alex,” Michelle Lipinski begins, “can you share where you were yesterday and where you are today?”

“Sure,” says Alex, 16. “Last couple weeks, I had the mindset that I was going to just smoke weed, and just control it. Then I talked to my mom, and she started crying. I just couldn’t fucking handle it. So I was like, Fuck it. I’ll just be sober, for now at least.”

“Do you feel like you just stopped a tidal wave from hitting you?” Lipinski asks.

“Yeah,” Alex nods. “But I just want to smoke weed and be a normal teenager, you know?”

Smoking pot is so common at Northshore that Lipinski says “students really do perceive of marijuana as legal.” And like its students, the school treats the drug as different from others, essentially handling it the way the state does — as a misdemeanor. But its ubiquity seems to confuse students about just what being clean means. One young woman who smokes marijuana every day tells the group that she likes to think she’s in control of her daily pot use, but knows that she’s not.

As the meeting continues, a guy tells everyone that his plan to have one or two beers the night he got out of rehab ended with him drinking so much that he burned a hole in his pants with a cigarette. “There’s no way I can have [only] a couple,” he says.

“You’re not alone,” says another classmate. “Everybody wants to be a normal teenager. You know what I mean?”

Lipinski nods from the corner, beaming with pride. “That’s fellowship,” she says. “And that’s where the strength comes.”

At William J. Ostiguy High School in Boston, however, the strength comes from fellowship of a different kind. During the second week of school, principal Roger Oser waits outside as students arrive for the day. The school is housed on the third and fourth floors of the Action for Boston Community Development building in Downtown Crossing, and on the sidewalk outside it’s not unusual to see business people in suits walking past actors in Colonial-era dress taking breaks from reenactments on the Common.

Oser stands with his hands in his pockets and greets each student by name.

“Hey,” one kid says to his friend as he arrives, stopping to smoke a cigarette. “You got a lighter?”

“We don’t say, ‘Good morning’ at Ostiguy,” Oser says. “We say, ‘Got a lighter?’”

The student smiles as his friend tosses him a lighter. “Good morning,” he says.

Oser, 42, is short, with a boyish face, an easy smile, and a wide girth. He’s wearing a shirt and tie, and his cropped gray hair is about the only part of him that recalls the years he spent in the Navy. Before Ostiguy, he worked as a teacher with the Department of Youth Services and then as an administrator in other settings for at-risk youth. He’s playful — the students affectionately call him “Rog” — but also stern. His staffers stress civility, respect, and order: no cursing in school, no revealing clothing, no hats, no phones, no headphones. Those with negative attitudes are evaluated daily to determine whether they’re exhibiting the school’s “five P’s”: prepared, positive, productive, polite, and personally responsible. If their attitudes don’t improve, they can be suspended. “I hate the concept that a kid’s going to come to Ostiguy and we’re going to ‘save’ that kid,” says Oser. “It’s not a treatment program. It’s not a daycare program. We’re a school. They’re here to learn.”

Suspension is not punitive, Oser insists. At Ostiguy, “When a kid relapses, that’s a time to engage them more.” When a relapse at Ostiguy does occur, the student works with his or her parents, and with Oser and the school’s drug counselor, to revise the recovery plan — attending more meetings, for example, or getting a sponsor — and is allowed to come back to school only after completing the steps.

Last year, Oser recalls, one student started missing a lot of school, and when he did show up, he looked disheveled and refused to go to meetings or therapy. Teachers suspected he’d relapsed, but because he was passing his drug tests, they didn’t suspend him. By the time they realized he was using K2 — an herbal compound sold as incense that can cause seizures and paranoia — he had already turned several other students on to the drug. (Because K2 was legal until earlier this year, schools only recently started testing for it.) “The kid was not ready last year. He was a mess,” says Oser. “Keeping him in here as long as we did was a mistake.” Eventually they removed him from school and sent him to rehab. These days, Oser says, that student is an intern at Ostiguy and “a leader of the recovery community.” The school has since revised its relapse policy, which now states that mere behavior indicating a setback can be grounds for suspension. “I’ve never regretted suspending a student,” says Oser. “I have regretted allowing students to stay in the population, hoping things would get better. I can almost say it never works.”

PRELIMINARY DATA FROM THE TWO schools highlight the stark differences in their philosophies and goals. According to the Massachusetts Department of Public Health, 97 percent of the 153 students referred to Northshore in its first five years actually enrolled and stayed — and nearly every one of them was actively using drugs at the time of enrollment. That’s no surprise given that the school will take all comers, regardless of whether they’re sober.

By contrast, the tougher standards at Ostiguy meant that while 84 percent of the 142 students referred to that school wound up enrolling and staying, just 22 percent of them were actively using at the time. What’s really striking, though, is that while fully 90 percent of Northshore students reported that they continued substance use, at least occasionally, after leaving the school, just 12 percent of Ostiguy students reported the same. Even so, according to the DPH, students at both schools who were still using when they left were doing so less often than when they initially enrolled.

It’s easy to think that Northshore is simply too chaotic and too permissive to be doing its students much good. Especially when you factor in the conclusions of Harvard’s John Kelly, who says that adolescent addiction programs “generally have the best results” when they “reward moves in the right direction” — that direction being reduced use and abstinence — and have clearly defined sanctions in place. The truth is, there are times when you wonder whether Northshore has the kind of sanctions Kelly is talking about. Do the students there have the sense that there’s something — anything —  at stake? The bar at Northshore can seem extraordinarily low. As long as you want to get better, and as long as you’re not in imminent danger of killing yourself or others, the message seems to be: At least you showed up. We’re glad you’re here. Let’s talk about it. Don’t kids need to be pushed harder than that to do the miserable, difficult work that recovery requires?

But there’s something else that’s true: Northshore offers at least some kind of structure and support to the teens who need it most. And if the choice is between a low bar and an unsupervised 14-year-old boy hiding in the woods outside an ATM so he can rob people — as Billy once did to pay for heroin — well, the low bar may win.

LATER IN THE DAY at Northshore, Alex and Billy go outside to smoke a cigarette and continue their conversation about marijuana. People can say what they want about weed, Billy announces, “But for me, that’s not a serious drug addiction.”

Alex nods. “I don’t think it’s that bad,” he says. “If you’re coming up positive for opiates, you’re going to have a problem.”

But Billy knows that eventually Lipinski will push him to cut down or stop with the pot completely. “When it does come time,” he tells Alex as their teachers start calling them in for fourth period, “I don’t know how I’m going to stop smoking weed. I have smoked weed every single day of my life since I was 11. And when I don’t smoke, I’m a dickhead. I’m such an asshole.”

Alex says that’s how he is about quitting cigarettes. “Butts?” Billy says, blowing out smoke. “I don’t plan on quitting them anytime soon. You don’t have to worry about that.”

If you’re a “woman of a certain age” in Israel, you don’t have a straightforward term like “menopause” to refer to that stage of life. In Hebrew you’re stuck with gil ha’blut, which translates roughly to “the age of worn out.” In Arabic it’s sinn al-ya’s — “the age of despair.” So when Dana Weinberg and Raghda Elnabilsy set out to adapt the seminal text “Our Bodies, Ourselves” for Hebrew- and Arabic-speaking populations in Israel, they had to reinvent some of the very words that defined the original version.

A groundbreaking paradigm shifter that taught women to value themselves and helped usher in women’s rights, the original pamphlet — written by 12 feminists in Boston — included sections on masturbation, virginity, orgasms and abortion. Detailed photos demonstrating such forbidden topics as proper use of contraceptives led groups across the country to attempt to have the book banned from local libraries. Yet its influence was enormous: Since “Our Bodies, Ourselves” was first published in 1970 as a 193-page newsprint booklet, it has sold more than 4 million copies, been through nine revisions and numerous translations, spearheaded by grassroots women’s groups in more than 25 countries. Each new American edition reflects changing attitudes toward women’s health and sexuality.

The Hebrew and Arabic versions, released in September, boast timely topics that are of interest to their respective demographics. For example, because treatments for infertility are so expensive in the United States, the chapter on assisted reproductive technologies in the American edition is relatively short; in Israel, in vitro fertilization and other infertility interventions are government subsidized and in widespread use, so the corresponding chapter in the Hebrew edition is 80 pages, more than five times as long.

“It’s not just the language, but women’s culture, resources — everything is different,” explained Weinberg, author of the Hebrew edition, at a recent health symposium hosted by Boston University, celebrating the 40th anniversary of “Our Bodies” and the release of the latest American version. This is true even among different groups of women within Israel. Elnabilsy, who is editor-in-chief of the Arabic edition and is also a social worker and sex educator, said that Palestinian women “are a national minority, and also a gender minority.” So the Arabic edition addresses the prejudices that Palestinian women face — both in the wider society and from men within their own community.

The idea for the Hebrew-Arabic versions was born a decade ago when Weinberg, now 40, received a copy of an American version of “Our Bodies” from a friend. Having recently given birth, she felt frustrated and depressed by how medicalized the experience had been. “I didn’t know that labor could be an empowering, amazing experience,” Weinberg said. Inspired, she chose home births for her next two children, and began researching ways to bring the book that changed her life to other women in Israel.

In 2005, Weinberg founded the Israeli nongovernmental organization Women and Their Bodies in order to create the Hebrew and Arabic editions. “We cannot talk about women’s health in Israel without addressing Palestinian women’s health issues,” Weinberg said. She recruited Elnabilsy, a former student whom Weinberg knew from her previous job as director of the Women’s International Zionist Organization’s School for Political Leadership for Women, to spearhead the Arabic adaptation.

The first meeting was held at Neve Shalom/Wahat al-Salam, a village halfway between Jerusalem and Tel Aviv that was jointly established by Jewish and Palestinian-Arab citizens of Israel. It was a symbolic choice in a country where geography is a matter of life and death, made by activists acutely aware of the imbalance in resources available to women from their respective communities.

For example: Elnabilsy points out that she interviewed women who had given birth in hospitals where they didn’t understand a word the doctors were saying. “They spoke with them in Hebrew, and gave them papers in Hebrew, and they asked them to sign papers in Hebrew,” she said. “And sometimes they signed and the doctor did whatever he wanted” because the women were too intimidated to ask for a translator. The Arabic version includes information on how to navigate the health care system in a country in which Palestinian women are a minority.

Although the women pool their resources as a single organization, Weinberg said they have agreed “to work together, and apart.” With 350 volunteers, the Hebrew team had so much material that the finished book, at 26 chapters, can’t contain it all. An additional 10 chapters will be published as booklets in the coming years.

Weinberg said, however, that “in Arabic, you cannot have so many volunteers, because women don’t have the resources to volunteer.” What’s more, because the process she and Elnabilsy employed has been to adapt the English version into Hebrew and then the Hebrew version into Arabic, help is needed from people facile in all three languages. With 30 volunteers working on the Arabic translation, that edition has only 10 chapters. Still, this marks the first time that a women’s health resource written by women for women has been published in either language.

The feat is substantial, according to Lucy Candib, a physician who wrote an introductory essay, “Women, Medicine and Capitalism,” in the original pamphlet. “The close and careful creation of text together will require a constant consciousness about power and vulnerability familiar to women everywhere, but even more ever-present in the world where this work will be created,” she said.

Women and Their Bodies received a grant from the Rosa Luxemburg Foundation to distribute the first 1,000 copies of the Arabic-language books for free. (The Hebrew edition costs $50.) With the goal of making the books as accessible as possible, the organization is seeking grants and donations.

In addition to producing the books, Women and Their Bodies runs an online information center (which has been hacked multiple times since the book was published) and an ongoing series of health workshops designed for women of various ethnic groups throughout Israel. One, designed to address the frustrating lack of a nonderogatory or childish Hebrew word for “vagina,” was called, “What Is Between Your Legs?” Weinberg’s favorite word to come out of this workshop is n’ga, derived from oneg, the Hebrew word for “pleasure.”

The women also coined new words for “menopause” in both languages. In Arabic, they chose sinn al-amman, the “age of confidence.” This connotes “having a center, knowing who you are, and where you want to go,” Weinberg said. In Hebrew, the team chose emtza chayim, the “middle of life.” Or, Weinberg said, the age when “you have everything ahead of you.”

Long before hipster bars and boutique hotels lured tourists to New York City’s Lower East Side, the promise of a better life drew generations of Jewish immigrants to the neighborhood’s crowded cold-water walk-ups. As a vestige of that time, the Tenement Museum is an apt venue for singer-songwriter Clare Burson ’97 and writer Anna Solomon ’98, whose creative collaboration made its debut at the museum on September 7 before traveling to other cities. Solomon read from her novel The Little Bride, about a Jewish mail-order bride, and Burson performed what she calls her “little suite” of songs inspired by the novel.

In rich, deep prose, The Little Bride tells the story of sixteen-year-old Minna Losk, who flees poverty and pogroms in 1880s Odessa and travels to the United States, only to discover that her intended, Max, is a devout Orthodox man more than twice her age, whose first wife left him. He lives with his two teenage sons in a one-room sod hut in North Dakota. The Great Plains is a bleak place in which to eke out an existence, and Max’s stubborn adherence to the laws of Judaism makes it even harder. When Minna finds herself attracted to her stepson, Sam, she must navigate her new life and her new identity in an increasingly fraught situation. The most stunning aspect of The Little Bride is the way in which its characters are never so likeable as to be perfect and never so unlikeable as to be villains. Max and Minna develop a real affection for one another, even as Minna feels increasingly trapped and frustrated by their life together. The story is brutal but also infused with hope. Minna’s ingenuity saves her in the end, but her survival does not come without great personal cost.

Solomon, who grew up in one of a handful of Jewish families in the port town of Gloucester, Massachusetts, says she’s “always been drawn to stories about people living in places where they don’t seem to belong.” Her short stories, which have won a Pushcart Prize and a Missouri Review Editor’s Prize, are set in such far-flung and rural places as Alaska and North Dakota. So, when she stumbled across a website called “Stories Untold: Jewish Pioneer Women,” she discovered a forgotten time when Jewish women drove wagons and roped cattle.

Solomon met Clare Burson several years ago through their husbands, who are longtime friends. “We totally hit it off,” Burson recalls. “We talked about how cool it would be to collaborate, but we didn’t have something obvious to build that collaboration on.” When the completion of The Little Bride coincided with the release of Burson’s acclaimed 2010 album Silver and Ash—which in ten interrelated songs tells the story of her grandmother’s German childhood and 1938 immigration to the United States—the timing seemed right.

Burson studied modern European history at Brown, focusing on Judaic studies. She took two extended trips to Germany—one during a year off from her studies and the other on a Fulbright after graduation, during which she studied German identity politics in the wake of the Holocaust. She learned to play classical violin and then fiddle, beginning at an early age, but picked up a guitar only when one of her roommates in Germany gave her a hand-me-down and taught her a few chords. About halfway through her Fulbright, Burson decided to forego graduate school and joined a rock band.

She won a dedicated following of indie-folk fans after the 2003 release of In-Between, which was followed by Thieves in 2007. But it was Silver and Ash, she says, that “allowed me to bring in the things I studied and was really passionate about in college, and bring that together with my music in a really meaningful way.”

Upon hearing Silver and Ash, Solomon wondered, “Wouldn’t it be cool if Clare were interested in writing a song or two” about The Little Bride? Her publisher sent Burson a copy of the galleys, and “it just took off for her,” Solomon says, “because so much of it resonated. We write so much about immigrants, and about women, and about memory and loss—it just felt really natural.”

Listening to the songs Burson wrote, Solomon says, is “like hearing my book come to life. And actually I’ve been amazed at how certain parts of the book have become much more powerful to me when I hear a song about them.”

When

White was not the sort of young man to complain, though. “We, Brown’s African American students, didn’t feel affronted by this plain discrimination,” he says. “Quite the opposite. We felt happy to be at a place so liberal that it accepted Negroes at all.”

Almost sixty years later, the University has an Office for Institutional Diversity. The students and, to a lesser extent, the faculty members walking across the College Green on any given day hail from all over the world and have parents and ancestors from every imaginable race, background, and religion. Students arrived on College Hill this fall from more than 100 countries. Thirty percent of undergraduates are nonwhites.

And we have Gus White to thank for that.

The influence White’57 has had on Brown’s racial and ethnic diversity reflects the steady, deliberate effort of an unlikely pioneer. A groundbreaking orthopedic surgeon, he was the first African American medical student at Stanford, the first black surgical resident at Yale, the first black professor of medicine at Yale, and the first black department chief at a Harvard teaching hospital. One of the nation’s preeminent experts on the biomechanics of the spine, White has coauthored textbooks that remain seminal references for surgeons and clinicians. When his book for a popular audience, Your Aching Back: A Doctor’s Guide to Relief, appeared in 1990, the New England Journal of Medicine decreed that it “should be read by every person afflicted with low back pain, and perhaps everybody.”

Despite these accomplishments, it would be difficult to find a more modest man than Gus White. His perpetual optimism and quiet good cheer have been key to his acceptance in places normally inhospitable to African Americans. Yet he has never for a second forgotten how lucky he has been to be in such places, or how essential it is that he use his position to make more space at the table for all victims of prejudice.

For Gen Xers and Gen Yers who were raised on Martin Luther King Day assemblies and class projects about Harriet Tubman and the Underground Railroad, diversity is sort of like puppies and rainbows. We take for granted that it’s desirable, good, even quaint—with all the jadedness that last word implies. But Gus White wants you to know that despite the huge strides we’ve made—including the first black president, both at Brown and in the White House—we still have a long way to go. In fact, White argues in his latest book that our ongoing lack of both diversity and good cross-cultural communication is making us sick. Literally.

Since his retirement from the operating room in 2001, White has taken on a medical issue that he says is far more difficult to solve than even the most complicated spinal problem. A combination memoir and manifesto, White’s new book, Seeing Patients: Unconscious Bias in Health Care, lays bare the troubling and insidious ways that prejudice gets in the way of good medicine.

If you want good medical care in the United States, White asserts in Seeing Patients, your best bet is to be a young, fit, straight, white, and middle-class male. He means this as a wry joke—and, when he repeated it at a lecture this summer at Boston’s Brigham and Women’s Hospital, the audience chuckled on cue—but it’s also true. The time it takes for EMTs to transport women to a hospital after a heart attack, he told the audience, is longer than it is for men. Hispanics receive fewer bypass surgeries for heart disease than other patients and fewer basic health-care measures such as flu vaccines. Similarly, African Americans receive fewer kidney and liver transplants than other patients, and more castrations when they have prostate cancer. African American diabetics undergo more amputations than other groups, White says, and Native American, immigrant, obese, and homosexual patients all receive inferior care simply because of who they are. And this remains true even after researchers control for such complicating factors as education, economic class, and insurance status.

What’s going on here? How is it possible that a country with one of the most advanced health-care systems in the world is failing such a large proportion of its patients?

The answer, Gus White says, lies in our nation’s history, and also within ourselves.

Gus White’s great-grandparents were born into slavery. In the segregated Memphis, Tennessee, where he grew up, the legacy of that recent past was everywhere. The city had its black middle class, White recalls in Seeing Patients, but “the white world did not mix with the black and the black did not mix with the white.” Although White grew up as an only child in that middle class—his physician father graduated from the all-black Meharry Medical College and was a house physician at the local black hospital—his family had to use colored bathrooms and colored water fountains. White and his friends watched their favorite Westerns at all-black movie theaters so they could avoid having to sit in the balcony at the segregated ones. At the hospital where White’s father worked, even the blood at the blood bank was segregated. As a young boy delivering the black newspaper the Pittsburgh Courier, White occasionally saw front-page photos of the lynchings that were still commonplace. On those days, he writes in Seeing Patients, “I didn’t want to take the newspaper around. I didn’t even want to handle it.”

Still, the middle-class black community in Memphis was committed to “advancing the race.” Teachers at the black schools stressed that “education was going to drive forward our right to equality that we had been struggling for so long to achieve.” White’s mother, Vivian, and his Aunt Addie were proud women who refused to be belittled or underestimated.

As a teenager working at a drive-in movie theater, White and his friends clashed with white workers who took to calling them “darkies.” When they retaliated by calling the white workers “Nabisco Boys,” the workers followed White and his friends home one night in their car, shooting BBs and shouting curses.

After White’s group was attacked, “Mom and Aunt Addie practically had a fit,” White recalls. “Vivian White and Addie Jones were not going to take this kind of thing, and after some discussion they made it clear that I was not going to take it either.” The next day they drove White to work and gave a stern talk to the manager of the drive-in, who ensured White’s safety for the rest of that season and the one after it. “I didn’t know at the time that this incident would stay with me for the rest of my life, but what a lesson it was,” White notes.

When White was eight years old, his father died suddenly, and he and his mother were forced to move from their two-bedroom house into the home of Aunt Addie and her husband, Uncle Doc, a pharmacist. The family doubled up on couches and cots, and White’s college-educated mother got a job as a secretary at a high school, where she eventually became a teacher. Still, as White writes in the book, “My father’s death when I was so young meant that most of my relationship with him ended up being my relationship with his reputation,” and the question he heard more often than any other was, “You going to be a doctor like your dad? Your dad was a fine man, a great doctor.”

A bright and a diligent student, White at thirteen left Memphis for the Mount Hermon School for Boys, an exclusive New England prep school (now Northfield Mount Hermon). Students earned tuition money by waiting tables and sweeping floors. Although he suffered from culture shock at this tiny northwestern Massachusetts enclave, he thrived at Mt. Hermon, singing in the choir, excelling academically, and earning varsity letters in football, wrestling, and lacrosse.

In 1953 White opted for college at Brown. “Brown had good athletics, highly regarded premed studies, and, my grapevine informed me, they not only took Negroes, they treated them well,” he writes in Seeing Patients. “Four or five each year. Never more, but never fewer, either.”

At the University, White worked grueling hours in order to play football—he was a varsity offensive and defensive end—while simultaneously earning high grades in his premed studies. When psychology professor Anthony Davis helped White research and write an honors thesis, it “increased my level of confidence by several magnitudes,” White writes.

He also became the first African American fraternity brother at Brown when he rushed Delta Upsilon. And it was because of White’s designation as the Brown DU chapter’s delegate to the 1956 national convention, to be held in Vermont, that he and his fraternity brothers received the following telegram: “the middlebury chapter regrets that due to circumstances beyond its control… it is necessary to postpone the delta upsilon convention… until 1957.” (Thirty years later, the fraternity formally apologized to White. “I can tell you that the delivery and celebration of justice does feel good to all concerned,” White writes. “No matter how long you might have to stick around to see it.”)

After graduation and medical school at Stanford, White did an internship at the University of Michigan Medical Center and an orthopedic residency at Yale. But soon he was forced to confront yet another foreign world.

In August 1966, White arrived in Vietnam as a combat surgeon. Subject to a special doctors’ draft, he could have found alternative service but opted not to. He wanted to “jump over there and do what I could,” he writes in Seeing Patients. While he was in Vietnam, he couldn’t help but notice that he was “seeing more wounded black soldiers than I might have expected. . . . What I heard from the black troopers was that they were more likely than not to be chosen as point men when they went out on patrol.”

As a respite from the brutality, White volunteered at a nearby leprosarium, performing surgeries to help patients regain some mobility in their crippled hands and feet. “For me, the St. Francis Leprosarium was an oasis,” he wrote. “After all the blood and gore, it seemed almost a place of meditation. . . . In many cultures leprosy is regarded with such horror that if anybody just makes eye contact and looks at lepers and acknowledges them as human beings, they are profoundly grateful. And if you help them? You fix them up? . . . The feedback is incomparable. . . . I didn’t know who was helped most at that leper colony—the helpers or the helpees.”

On the bumpy jeep ride out to the leprosarium, White writes, he would reflect that “at the hospital I was seeing the worst that man can do to man, then I go down the road to see the worst that nature can do. Man’s inhumanity to man and nature’s cruelty to man—both of them an absolute bitch.”

The “equal opportunity employers”—pain and death—that White saw in Vietnam helped crystallize one of his most resonant realizations about race and humanity. He writes, “Our humanness supersedes our cultural issues, our difference in status or rank, our racial selves. A superior officer, a trooper, black, white—under the knife they’re all the same. . . . In the final analysis, that’s all we are—human.”

After his surgical residency, White spent eighteen months earning a PhD in orthopedic biomechanics at the Karolinska Institute in Sweden. It was there he met his wife, Anita, a Swede, and it was also there, he realizes in retrospect, that he made a formal commitment to promoting diversity in medicine. In Sweden, he says, race was simply not an issue.

“Nobody cared,” White recalls. “When people said hello, it was just hello. Not hello—I see by the color of your skin that you are a white person; what kind of white baggage might you be carrying toward me? Or, hello—I see by the color of yours that you’re black; wonder what kind of baggage you might be carrying toward me?”

White knew that one of the reasons race isn’t an issue in Sweden is that there is essentially only one race there—something neither possible nor desirable in the United States. But Sweden gave him a glimpse of true equal opportunity for African Americans, and he resolved to make medicine a more welcoming profession for blacks. He joined the admissions committee at Yale Medical School, where he was about to become a faculty member, and began advocating on behalf of qualified black applicants who might otherwise have been overlooked.

To this day, White notices that too many black students play down their accomplishments, underestimate their own worth, and try to blend in and be as inoffensive as possible, with the result that they are hesitant to speak up and share their ideas. When he meets such students, White invariably asks them a favorite question: “Do you know that you’re a national treasure?”

Some years later he and a handful of his peers founded the J. Robert Gladden Orthopedic Society, a group of African American orthopedists who saw the need for “an effective platform for sharing concerns and research both among ourselves and with the larger orthopedic community.”

“I’m aware of only one or two organizations that are similar,” says former Secretary of Health and Human Services Dr. Louis Sullivan, “and none that I believe is as viable or active as the Gladden society.”

After White became a Brown trustee in 1971—he later served on the Board of Fellows from 1981 to 1992—he began to realize that “diversity was a black question, yes, but not only a black question.” Increasing the number of underrepresented minorities in a given community, he argued, not only benefitted those minorities; it also enriched the community as a whole. All people, he writes in Seeing Patients, “should be willing to share knowledge with each other and learn from one another and teach one another, to achieve better understanding of cultural differences and the implications of them, and to appreciate the importance of working together and getting beyond the isolation of cultures from each other.”

Seeing Patients is full of stories—some funny, some not so funny—of things people have said and done before realizing Gus White is black. (A woman he once dated assumed he was Puerto Rican. When he told her he was black, she slumped down in her chair in tears and asked, “Are you absolutely sure?”)

In addition to being fair-skinned, White is tall and lanky, usually at least a head taller than anyone else in a room. There’s an inherent gentleness and elegance about him, and his calm, unflappable demeanor puts people at ease. “He was an athlete in his younger days,” says David Chanoff, the coauthor of Seeing Patients, “and he still has that kind of presence. He’s a combination of congeniality, collegiality, and drive.”

Thinking positively is something of a reflex for White. In a notebook he kept during the 1960s, he jotted down the phrase “Black brother, don’t hate. Calculate.” Where others might get angry, White is unflappable. “Hate doesn’t help,” he says. “It only pushes you down. It depresses you.” His daughter Atina White ’98 says, “He has this ability to be strategic about letting yourself cool off and finding other ways to accomplish what it is you’re trying to do. He is very logical—almost to a fault sometimes.” His favorite bit of fatherly encouragement to his three daughters, Atina says, is to be “strong in the head, strong in the heart, strong in the whole body.”

At his talk at Brigham and Women’s, White ran through slide after slide of dispiriting, frustrating evidence of unequal treatment in medicine. As an orthopedist, he said, he was particularly upset by the fact that blacks and Hispanics are less likely than whites to get adequate pain medication after a long-bone break or fracture. Pain is pain, he said; it has nothing to do with culture or race. This fact, White says, “is not presented to abuse anybody or accuse anybody or make anybody feel guilty. It’s not your fault. It’s not my fault. But it is your responsibility and my responsibility to do something about it.”

In surveys, White writes in Seeing Patients, physicians say they do not discriminate on the basis of sex. And yet in 2008, when researchers sent a male and a female patient with identical osteoarthritis in their knees to seventy-one family practitioners and orthopedic surgeons, 67 percent recommended knee replacement for the man, while only 33 percent did so for the woman.

“I think this is not conscious bias,” White argues, quoting Mayo Clinic orthopedist Mary O’Connor, the past chair of the Ruth Jackson Society, which tries to correct health disparities affecting women. “I don’t believe these physicians had the female patient in their office and thought, ‘I’m going to withhold a recommendation for surgery.’”

O’Connor continues: “But there’s still something going on. . . . There’s the stereotypic—Oh, she’s going to be a whiner. . . . The most difficult thing to realize is that, yes, you may be the one doing it. You may be guilty of giving different care to people who don’t resemble you.”

White admits his own bias against obese patients. But, he says, “If you can be aware, let that be a yellow light.” That yellow light forces you to pause and remind yourself about what the evidence says you should do with this particular patient, and make sure you do it.

Three decades after graduating from Brown, White was serving on Brown’s Board of Fellows, watching with dismay as the hundreds of black students now at Brown voiced their discontent.

“They felt they weren’t being treated properly, that their needs weren’t being addressed,” White writes in Seeing Patients. “From what I could see, the school cared about its minority students—it just did not know what to do about them.” So White approached then-President Howard Swearer with an idea. Rather than “responding to brushfires,” why didn’t the University convene a committee to study what might help improve relationships among students of all races at Brown?

Swearer asked White to lead the effort. White and his colleagues spoke to hundreds of students, faculty, and staff about diversity at Brown, and compiled, synthesized, and analyzed what they heard. The resulting report, The American University and the Pluralist Ideal, was released in 1986. It made seventeen recommendations, including broadened course offerings on race- and ethnicity-related subjects (the ethnic studies concentration was born as a result) and increased support for minority clubs and organizations. At its heart, the report asked the University to move past diversity and aim for the broader goal of pluralism.

“Diversity meant that the University community would include people of different races, religions, and so on,” White writes. “To a certain extent Brown had achieved diversity. Pluralism moved beyond diversity in that it conceived of a community where minorities were not simply present, but where they were welcomed, where their cultures were acknowledged and valued. . . . We were asking Brown to make diversity into one of the pillars of its fundamental identity.” (Brown awarded White an honorary degree in 1997. He also worked on a follow-up report, which was released in 2001.)

Now that White is looking to make culturally competent care one of the pillars of medicine’s fundamental identity, he thinks he knows intuitively what will help. Doctors must be honest with themselves about their biases, for example, and medical schools must increase the number of medical students from underrepresented minorities. But will it make a difference, really?

“I’m sorry to say,” White says, “that we did a review of the literature and we said, ‘Culturally competent care education pedagogy: what works? What are the teaching methods that work?’ So far, there’s not anything that has been demonstrated experimentally, on an evidence basis, that says, if you teach these things, you can get these better outcomes in patients that are getting disparate care.”

After White retired at age sixty-five from performing surgery—”I wanted to exit at the peak of my skills, while I was still providing the highest level of care I could,” he writes—he founded Harvard’s Culturally Competent Care Education Program to try to address the problem. The program consists of White, his assistant, and piles of papers, books, and sticky notes. It is fueled by White’s unfailing optimism. Each day he puts on a jacket and tie—even on days when he has no appointments or meetings—and goes into his office to do research, write papers, give lectures, collaborate with others in the field, and mentor students.

In medicine, evidence is king. Without a clinical trial demonstrating the effectiveness of one type of intervention versus the other—without data to prove that, say, teaching medical students one way versus another results in better outcomes for minority patients—White is, he admits, “just flailing away at things that ought to make sense, that ought to work.” He adds, “Hopefully at some point we’ll show that they can work.”

White has always drawn great pleasure and comfort from music, and several of the chapters in Seeing Patients begin with quotes from the blues great Memphis Slim. One of the chapters, “A Man Ain’t Nothing But a Man,” draws its title from “John Henry,” that quintessential American folk song about the man who beats the steam engine and dies trying.

When great bluesmen like Lead Belly and Mississippi John Hurt sing about what John Henry told his captain, the words are layered with meaning. John Henry, a former slave in some accounts, says that he is only a man—there is only so much he can do to beat the steam engine—but he promises to die trying. At the same time, he is making a simple yet deeply profound statement that he, like his captain, is a human being. And yet, because of who he is, he, like his ancestors, is going to die with his master’s tools in his hands.

As important as our cultural identities are, White notes in Seeing Patients, “In the final analysis, we are all so much more similar than different. Once you make the incision, once you look inside, everybody is the same. Open up that skin and underneath it’s all one. The reality of the body tells this to you. . . . A man, in John Henry’s enduring words, ain’t nothin’ but a man.”

When White was invited to lecture at Brigham and Women’s in June, he was the keynote speaker at a function celebrating the achievements of underrepresented minority faculty and fellows at Harvard Medical School. From behind the lectern, White took a quick tally in his head: about twenty of the fifty doctors, medical students, and other health-care professionals gathered before him that day were from racial or ethnic minorities. There were medical students from programs aimed at recruiting underrepresented minorities into medicine. There were doctors, now mentors, who had previously been mentees in these programs. White felt deeply gratified, even as he prepared to talk about how racism and other “isms” were getting in the way of good medical care.

He smiled. “Good afternoon, my fellow humans,” he began.