The Emperor of All Maladies by Siddhartha Mukherjee

“In 2010, about six hundred thousand Americans, and more than 7 million humans around the world, will die of cancer.” With this sobering statistic, doctor and researcher Siddhartha Mukherjee begins his comprehensive and eloquent “biography” of one of the most devastating diseases of our time. He frames it as, “an attempt to enter the mind of this immortal illness, to understand its personality, to demystify its behavior.” It is an epic story that he seems compelled to tell, like a priest might attempt a biography of Satan.

The oldest surviving description of cancer is written on a papyrus from about 1600 B.C. The hieroglyphics record a probable case of breast cancer: “a bulging tumor . . . like touching a ball of wrappings.” Under “treatment,” the scribe concludes: “none.” From the Persian Queen Atossa, whose Greek slave cut off her malignant breast, to the nineteenth-century recipients of primitive radiation and chemotherapy to Mukherjee’s own leukemia patient Carla, the book is about those who struggled fiercely to survive and the doctors who attempted to understand the disease. It is also a story of human ingenuity, resilience, perseverance, hubris, paternalism, and misperception. Mukherjee recounts centuries of discoveries, setbacks, victories, and deaths, told through the eyes of his predecessors and peers.

He talks about the horrors of the radical mastectomy, which got more and more radical, until it arrived at “an extraordinarily morbid, disfiguring procedure in which surgeons removed the breast, the pectoral muscles, the axillary nodes, the chest wall and occasionally the ribs, parts of the sternum, the clavicle and the lymph nodes inside the chest.” Cancer surgeons thought, mistakenly, that each radicalization of the procedure was progress. He talks about the struggle to link smoking and lung cancer. By the early 1940s, as one epidemiologist wrote, “asking about a connection between tobacco and cancer was like asking about an association between sitting and cancer.” In the decade and a half after Nixon declared his war on cancer, lung cancer deaths among older women increased by 400 percent.

It is amazing to sit and think about just how much work went into this book. Even organizing the book into chapters would be an impossible feat for me. Mukherjee weaves together all the various facets of this iconic disease throughout history, from describing cancer from the patient’s perspective, to viewing the never ending battles of physicians and medical researchers with cancer over the centuries, to examining the mysteries of the cellular nature of cancer itself. The book’s 600 pages fly by and even those without a scientific background should be able to follow along. The book is the perfect marriage between science and poetry and rekindled my dream of becoming a doctor. It is just that good.

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