Book Review: The emperor of all maladies (Siddhartha Mukherjee)

A dear friend lost a loved one to cancer this past month.

It was an unhappy coincidence that at the time I was reading Siddhartha Mukherjee's much acclaimed book on the disease - The Emperor of all Maladies.  Coming as it did right on the heels of a bereavement, there was unmistakably a sharper edge to the book for me.  How can one, I wondered, go through this sort of pain and grief every day of their working lives?  How can one live this disease for a living?  And how, when it comes right down to it, can one write about it with understanding, compassion and scientific inquiry, in a way that doesn't belittle the grief of those touched by the subject?

The Emperor of all Maladies is a book that achieves what at first blush seems unachievable.  It brings you face to face with one of the greatest killers of our age, opens it up to you, makes you intimate with it, and never ever lets the science or the history get in the way of the sheer humanity of the storyteller.

Readers of Brick and Rope likely know my weakness for doctors who can write.  Atul Gawande of course has been a longtime favorite and I am a bit of a sucker for others of his ilk.  That said, as much of the reviewing critics noticed last year when The Emperor of all Maladies made practically every Best Books Of the Year list on non-fiction, Siddhartha Mukherjee is a cracker of a writer.  For one, he is instructive without being pedantic.

We tend to think of cancer as a "modern" illness because its metaphors are so modern.  It is a disease of overproduction, of fulminant growth - growth unstoppable, growth tipped into the abyss of no control.  Modern biology encourages us to imagine the cell as a molecular machine.  Cancer is that machine unable to quench its initial command (to grow) and thus transformed into an indestructible, self-propelled automaton.

As I was saying, instructive, interesting, an evocative image to tell us what cancer is about.  Then right after that comes a passage with another catching turn of phrase.  (Wait for it till the end of the paragraph)

The notion of cancer as an affliction that belongs paradigmatically to the twentieth century is reminiscent of another disease once considered emblematic of another era:  tuberculosis in the nineteenth century.  Both diseases were similarly "obscene" - in the original meaning of that word:  ill-omened, repugnant to the senses.  Both drain vitality; both stretch out the encounter with death; in both cases, dying, even more than death, defines the illness.

Isn't that a remarkable last sentence?

One of the things I have wondered for a while about cancer is why it seems so much more visible now? It is the disease of our times, it appears.  It is the ailment that is most commonly visible in the context of mortality.  Why, I have wondered.  Turns out, there are some really simple answers.

With a few notable exceptions, in the vast stretch of medical history there is no book or god for cancer.  There are several reasons behind this absence.  Cancer is an age-related disease - sometimes exponentially so.  The risk of breast cancer, for instance, is about 1 in 400 for a thirty-year-old woman and increases to 1 in 9 for a seventy-year-old.  In most ancient societies, people didn't live long enough to get cancer.  Men and women were long consumed by tuberculosis, dropsy, cholera, smallpox, leprosy, plague, or pneumonia.  If cancer existed, it remained submerged under the sea of other illnesses.  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.  ... Civilization did not cause cancer, but by extending human life spans - civilization unveiled it.

And Mukherjee going on to offer more reasons on why cancer is so visible today, but I will let you read that in the book.

The triumph of The Emperor of Maladies is not merely that is a colossal compendium of knowledge about one of the most visible killers of our time, though it is that.  It is not even that it is such a wonderfully written book with language that practically pulsates with emotion.  It is that through the entire book, Siddhartha Mukherjee reminds you that he is, at the end of the day, a doctor.  If the history and the science of cancer are the heart of the book, it is the patients that provide the soul to the book.  They form the narrative thread that holds the book together, they keep the lesson from turning dry.  And they kept my eyes from staying dry.

The Emperor of Maladies was a universally acclaimed critic favorite in 2010.  I can see why.