"The Emperor of all Maladies", by Siddhartha Mukherjee gives a very detailed, sometimes full of hope, and sometimes heart wrenching, a biography of cancer from the ancient ages to the modern days.
I came across this book a couple of years back in a random twitter thread., peeked a quick glance about what it is., and promptly saved it for "later". Cancer is one of those things you wish you will never have to learn more about it or having to do anything with it. But well, life happens. After seeing a close friend go through the cancer episode in the last months, I inevitably started reading more about it, and happen to read the 'Cancer's invasive equation', by Siddhartha Mukherjee in New Yorker. This really piqued my interest in the book again.
The book is a non-linear history of cancer. He writes about the origins of the disease, and touches upon one specific stream like 'radical surgery' or 'chemotherapy' and delves deeper into that and follows it until the latest developments in that stream.
Cancer as a single entity or a single disease - this line of thought which Siddhartha has used in most part of this book, enables the biography to be weaved in an intuitive way., rather than confusing users with the technicality of the disease. Incidentally, this is the same idea that the early cancer doctors and the activists who fought for cancer cure also held in mind. Siddhartha acknowledges, this idea all though hugely reductionist, helped them to pool all the resources they got against a common, single enemy. He writes, "Without this grand, embracing narrative, neither Mary Lasker nor Sidney Farber could have envisioned a systematic, targeted War". I think the same has worked for him as well in writing this book. And as the cancer doctors and scientists discover over the years that cancer is anything but a simple, single disorder, we the readers also "discover" the same in the journey inside the book.
Another thing which I really appreciated is the story of Carla Reed, Siddhartha's patient suffering from Leukemia. As the book progresses, he writes about the treatment Carla goes through, her experiences in the hosptial and with her friends and family. It really sets the mood for the book and also is synonymous with the successes, failures, and changes we, as a human race, have come across in cancer research, prevention, and diagnosis.
His narration of Carla Reed's experience is deeply human, it really moved me. When explaining about the intensive Chemotherapy routine she has to go through, he finds her growing more and more melancholic and alone. One day she is sitting there alone, without her friend who usually accompanies her. When he asks about the friend, Carla says, "We had a falling-out". And Carla continues, "she needed to be needed., and I just couldn't fulfill that demand. Not now." This got me thinking, we humans, even when we help our friends and family in need, we get narcissistic and try to make it about ourselves. We want to be acknowledged, we get upset that they refuse our help, we forget that us helping them is supposed to reduce their burden, not add one more burden on the top! In another place in the book, talking about the life-consuming qualities of cancer he writes, "Cancer is not a concentration camp, but it shares the quality of annihilation: it negates the possibility of life outside and beyond itself; it subsumes all living". We the mute spectators of cancer patients will be never able to absorb the full weight of the above statement. Siddhartha says even he, as a doctor, couldn't. For Carla, when he asks her about the same, she replies, "My friends often ask me whether I felt as if the disease has made my life abnormal. I would tell them the same thing: for someone who is sick, this is the new normal". As someone said, the first step of recuperating after cancer is to accept that you have had cancer and your life is gonna be different from now on. The myth that you can return to normalcy after the treatment ends is very dangerous and it is what it is: A myth!
Another thing the book talks a lot about is the cancer doctors and scientists. One way, they are the pivotal characters of this biography. They are, again, an excellent depiction of human nature: they are curious, they are hungry for knowledge, they are hungry for fame, they are humble at times, extremely cocky at other times, they win and lose magnificently, they rise up from the failure, some disappear in their failure. They take up this war against cancer into deeply personal levels. At one point, Siddhartha offers the explanation about the gene mutation which causes retinoblastoma and calls the explanation "beautiful". As much as it is an ironic word choice for a killer cancer cause, it is indeed beautiful in a scientific way that we were able to identify that explanation. As Siddhartha constructs the whole biography, its mind blowing how the current understanding of cancer and its diagnosis, rests on the shoulders of innumerable men and women who built this knowledge one brick at a time. It's that and only that collective knowledge that has brought us to this point.
The most intriguing thing for me personally, from the book, is the understanding of cancer itself. There are two revealing ideas that stand out. One, cancer is a huge, fucking, disgusting game of roulette. It's mostly about your luck and lack of precaution. For example, there is a huge correlation between smoking and lung cancer, but not every smoker gets it. You need some bad luck, probably some fucked up genes from your parents, and very unique(yes this is unique and peculiar, not a random sequence) sequence of gene mutations for you to get a malignant lung tumor. And as per the book, we can't predict or fix the cause for why that odd sequence of gene mutations will happen in one person, but not in others. Two, cancer is basically our fucked up, super-powered, doppelgnger. He writes, "Down to their innate molecular core, cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves.". He even takes it to another level and says if the goal of medicine is to intermediate the biology and try to increase the lifespan of humans, in a way to inch towards immortality, then cancer cells are already that: the immortal, ever dividing versions of our normal cells. He also notes, "cancer's immortality, too, is borrowed from normal physiology". This, in turn, makes targeting cancer for treatment/prevention inherently harder. But we do have come a long way in that., as one can read from the book. He concludes by saying, the fight against cancer can be won by redefining the "victory" from complete elimination, to the postponement of the inevitable: death. It can be summarised as what Siddhartha writes, "It is an image that captures not just the cancer cells capacity to travelmetastasisbut also Atossas journey,
the long arc of scientific discoveryand embedded in that journey, the animus, so inextricably human, to
outwit, to outlive and survive."
To conclude, this book is one of the best books I have ever read in my life. I absolutely envy the writing style of Siddhartha. This is a book everyone should read in their lifetime, considering the ravages cancer causes in almost all of our lives at some point. The fact that you can write a nonfiction book about a life crunching disease so much engaging to read is indeed a real achievement. Cheers to him!