Linda Bowman came into the world in March 1960, the second-born in her family, and that status helped define her. Her big sister, Joanne, was two and a half years older. In the race of life, Joanne was Linda’s rabbit—the thing to chase. If Joanne had homework, Linda wanted to do it. Linda excelled at math in particular; she was so good, she had skipped third grade. The larger truth was that Linda could apply herself, loved to do it, had that internal drive that only some have and most don’t.
The first place she put that drive was into horse riding. When Linda was seven, her parents took her and her older sister to Wyoming to a family ranch, where you got to play cowgirl. Linda started playing for keeps. Back at home in a community north of San Francisco, Linda spent her afternoons and weekends practicing at a barn. Her family was privileged but not rich, her dad a midlevel executive at Chevron, and they lived in an Eichler home in Marin and got Linda her first quarter horse when she was ten.
She tried to stay lean so she’d look great on that horse. There was a period when she was around fourteen years old when Linda, of her own accord, would go on an all-protein diet for several weeks at a time, a regimen that was the precursor to the Atkins diet—meat and eggs, her only snack pork rinds, occasional cottage cheese. “My parents were a little worried, but I didn’t have any eating disorder.” She just liked to win. But horseback riding competitions were subjective. She hated not being in control of her results.
“It’s what I love about golf.” She started to attack the links as she had the stable.
At about this time, Linda first exhibited a health oddity. For years, her stomach had bothered her, even predating the periodic diets. Mostly it was constipation, sometimes terrible gas.
When she was fifteen, she went to play a round of golf with her parents at the Richmond Country Club. Just prior to tee-off, Linda went to the clubhouse restroom and had a bowel movement. It was partly a huge relief because she hadn’t defecated in days. But immediately afterward she also felt weak and dizzy.
Her mother saw her, wobbly, heading from the bathroom and to the first tee box.
“What’s going on?”
Linda explained, then swallowed some water and tried to shake the feeling.
Her mother responded: “Oh no. I hope you didn’t get my stomach.”
Linda’s mother, Carol, suffered from irritable bowel syndrome. This is a condition that causes a range of stomach disorders—pain, constipation, diarrhea, gas. It is not an autoimmune disorder per se, but it can often involve inflammation, which is caused by an excessive or prolonged immune response. It is a cousin of irritable bowel disease and Crohn’s disease, which are autoimmune disorders characterized by excessive inflammation. Imagine if the plumbing inside your body became inflamed, red and painful, swollen. For one thing, this causes physical discomfort simply because of the tight confines of your body; the space inside you has been engineered to near perfection by evolution, no space wasted. So when things swell, it hurts—potentially a lot.
Linda went right along, gifted, sure, but also willing and forging one success after the next. She worked her way into a golf scholarship at Stanford, eventually graduating with a degree in economics. Then she was tabbed to play on the European golf tour, at the time a struggling operation. The American women selected for the team, in addition to their golfing ability, all looked good, which was part of the marketing effort to sell the sport. This led to fun years for Linda, 1982 to 1985, before she’d had enough and moved on to the next stage of her life, as an MBA student at Stanford.
Linda married a man who would become a partner at one of Silicon Valley’s big-name law firms and took his last name, becoming Linda Segre. She joined the Boston Consulting Group, an elite organization of consultants where she headed down the partner track, matching her husband work hour for work hour. She’d call him from her office at eight P.M.
“How you doing?” he’d ask.
“I could use another hour.”
“Me too.”
He’d swing by to pick her up in the Porsche 911 at ten.
With success came added responsibility and pressure. She met each challenge. That’s how she saw it anyhow. One time, in 1989, she was vying for a project and stayed up ten nights in a row to compete for the deal. She won it.
“There were very, very few women, and plenty of very, very smart people and I felt a little insecure,” she reflected. “I can prove I’m as smart as the rest of you guys. I did it by just killing myself.”
Her husband worked no less hard, she recalled. Just like so many people in Silicon Valley—and in New York and Hong Kong and London and lots of other type A enclaves. Many of those people do not get autoimmune disorders. So this lead-up is not intended to suggest that Linda brought her condition on herself. Her genetics were expressly at play too.
But it is fair to say that Linda was building a life that was not consistent with her own limits—nor with those of most people’s. She was losing track of what was true and consistent with her, what was her real self. In a certain way, her life was being driven by the pathology of nonstop work, a foreign invasion that was threatening not just her emotional health but also her physical health.
In the late 1980s, the stomach pains got worse. Once every few months, she’d have such bad gas that she’d come home and crawl into bed. The swelling would be gone by morning. She kept pressing the limits until the bottom fell out.
In early September 1995, Linda gave birth to a son. He was the couple’s second child; their daughter was two. The family lived in San Mateo, a comfortable suburb south of San Francisco. It happened to be just a ten-minute drive from one of Boston Consulting Group’s major clients—a billion-dollar financial services company—and Linda was playing point on the account. The client relied heavily on her.
Linda convinced herself that she could continue to have it all. She took ten days of maternity leave. She was exhausted. “I would be taking calls at midnight and be up with my son every two hours breastfeeding.”
She got a terrible sore throat that December, as bad as she’d ever had. She suspected it was strep, a highly contagious illness caused by the streptococcus bacteria. Typically, it is treated by an antibiotic. Not in her case. “I didn’t have time to go to the doctor.”
It lasted weeks, coupled with the exhaustion.
Then in March 1996, she got the rash—raised and bumpy, red, all over the upper parts of her limbs. Now she did go to the doctor, who told her: “I don’t know what it is.”
Linda pressed on. Still working sixty-five-hour weeks, with her husband seeing and raising her work hours, she had the newborn and her daughter and was now trying to be the type of mother she idealized. She’d have conference calls in her Ford Explorer with the kids in the back seat. In September 1996, she had the dinner party with colleagues from Boston Consulting Group when her left big toe exploded to golf-ball size.
Her doctors didn’t know what it was. They speculated it was Lyme disease. They were wrong, but this is indicative of the mindset of medicine: There must be a pathogen or foreign agent at work.
Two weeks later, her right big toe blew up the same way. Then it was her left knee—like a grapefruit.
Linda was under full-fledged assault. Her primary care doctors weren’t sure why. No wonder. For as prevalent as autoimmunity is, its diagnosis can be worse than tricky. For a long time, the condition was invisible.