The Emperor of all Maladies by S. Mukherjee

Siddhartha Mukherjee, an oncologist-cum-writer based at New York?s Columbia University Medical Center, has written a magnum opus treatment of cancer that is a testament both to the relentlessness of this multi-faceted disease and to the equal relentlessness and many-sided efforts to withstand, survive, understand and defeat it.

“Humankind,” T.S. Eliot wrote, “cannot bear very much reality. Time past and time future, point to one end, which is always present.”

In the starkest terms, this omnipresent reality, which we so struggle to bear, is, of course, death itself. And aside from war and natural disaster, there is one phenomenon more powerful, more inexorable in its death-bringing than any other, which has been the case across centuries, even millennia of human experience, as Siddhartha Mukherjee makes clear in his brilliant new book, The Emperor of All Maladies: A Biography of Cancer.
 
The book was undoubtedly the most unexpected non-fiction triumph of the season, a triumph owing, in no small part, to the ubiquity of cancer awareness in contemporary society ? a situation that, among many others related to the ongoing story of cancer’s deep-rooted place in human experience, Mukherjee accounts for in his pages.
 
The grim irony here is that cancer’s rise to pre-eminence in the modern consciousness is the unexpected result of 19th- and 20th-century cures for other diseases, among the broader improvement of human life in the modern age itself: “In most ancient societies,” Mukherjee writes, “people didn’t live long enough to get cancer. Indeed, cancer’s emergence in the world is the product of a double negative: It becomes common only when all other killers themselves have been killed.”
 

We have reached an age, in other words, when more people than at any other point in human history live long enough to die of cancer.

To explain how we reached this point and explore where we have gone since, with a focus on the impressive, at times discouraging progress made against the disease, Mukherjee brings together a vast array of cultural, political and historical material. This research documents the diverse responses people around the world have made to avoid the realities of cancer (around smoking, for instance) or to deal with the ravages of the disease (likewise with smoking, eventually).
 

More specifically, these range from a 4th-century-BC Persian Queen named Atossa who, upon falling ill with a bleeding lump upon her breast, wrapped herself in sheets and retreated to isolation where she had a trusted servant cut her breast from her body, to a cute, blue-eyed, baseball-loving kid from Maine who, after being diagnosed with lymphoma in 1948 by cancer-research pioneer and Boston doctor Sydney Farber, became, literally, the poster child for the Jimmy Fund, the first-ever national campaign for a cure for cancer.

At the same time that Mukherjee offers hundreds upon hundreds of such culturally packed anecdotes, he provides an eloquent, often-moving first-person account of the always difficult, occasionally uplifting doctor-patient encounters that he experienced as a young physician working in the cancer ward of Massachusetts General Hospital.
 

To this impressive combination of the personal and the encyclopedic, Mukherjee further adds a great deal of detailed (at times overly so) explanations and analyses of research, experimentation and particular surgical, chemical and biological actions, effects and behaviours that, comprehensively, form an oppositional pattern of hope and despair, bold experimentation and exceeding caution, while following unending cycles of insight, success and failure. This is all focused on beating back the “malignant proliferation of cells” that, in their rate of growth, adaptation and resilience, makes cancer cells, according to Mukherjee, “more perfect versions of ourselves.”

To anyone who’s suffered from cancer, or suffered alongside someone with cancer, such formulations might be remarkably offensive in the gratuitous poetic licence they would seem to take with such a potent source of death and misery, and yet, as Mukherjee makes clear in the range of references he brings to his work, people have sought analogies and metaphors and symbols to make sense of cancer from ancient Egypt and Greece to Victorian England and modern America.
 

Indeed, the cancer symbol itself, a crab, owes to Hippocrates’ efforts, in the 4th century BC, to find a creature that, in its tenacity, manoeuvrability and toughness reflected the full range of the disease’s powerful exertions upon the human body. Through that striking contextualization, among many others, Mukherjee corrects an understandable but facile conception of cancer itself, observing that “cancer is not merely a lump in the body; it is a disease that migrates, evolves, invades organs, destroys tissues and resists drugs.”

Nevertheless, as this book abundantly documents, billions upon billions of dollars, and tens of thousands of lab experiments and patient trials and therapies, have been expended to combat it, and will continue to be.
 

“With cancer,” Mukherjee writes, with sobering clarity, in his final pages, after explaining its inherent position in human genetics, “where no simple, universal, or definitive cure is in sight ? and is never likely to be ? the past is continually conversing with the future.”

As for the present, this remarkable book will be our best guide.
 
This article first appeared HERE.

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