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The Emperor of Maladies: A Biography of
Cancer
Backed by a rigorous occidental training, Mukherjee mines medical, literary, historical, cultural and personal records in his meticulous effort to track down this elusive and unvanquished opponent. He retrieves, collects and processes data and then welds it all together in labyrinths of the mind and the imagination to give us a riveting narrative, about an invincible opponent infiltrating human lives over millenniums. All this and more forms part of the Pulitzer Prize-winning non-fictional tome wherein he historicises and documents countless time-capsules in cancer’s "visceral biography". The C-word in our time evokes unmentionable dread and terror surpassing the Voldemort factor in a Harry Potter Universe. Cancer haunts us not merely in its subterranean manifestations, but eludes and stymies us with its shape shifting, unpredictable, protean identities. Mukherjee’s gripping narrative begins in true epic tradition in medias res with the story of Carla, a young teacher and mother of three children who is suffering from leukaemia, a violent manifestation in which the white blood cells in the body multiply twentyfold, allowing little room for normative cells. Bit by bit Mukherjee fits in all the pieces of the jigsaw enabling us to view closely the slowly emerging outlines and details of this puzzling, bewildering and devastating disease. We travel into historic time, to 2500 BC, through a papyrus parchment (written in the 17th century BC, bought in 1862 and decoded in 1930) attributed to Egyptian surgeon Imhotep who documents the first known case of cancer and observes that it has no cure. Spiralling down 2000 years in time, we marvel at the dauntless Atossa, the Persian Queen who consents to chopping off her cancerous breast, only to slide through the crevices of the Histories recorded by the Greek Herodotus. Among thousand-year-old mummified copses in a gravesite near Peru, the autopsy of a 35-year-old Chiribaya woman in 1990, dead from a painful osteosarcoma in her left upper arm provided the first material evidence of cancer, announcing in no uncertain terms the need to revisit our understanding of cancer as a new age — illness, exacerbated by the longevity that has been the hallmark of the 20th century. We hurtle through the centuries as Mukherjee painstakingly unveils for us the shifts from Galen’s perception of cancer as black bile inhabiting the human body to a gradual understanding of the nervous system and circulatory system and human anatomy. Following up with the quantum leaps in chemistry, the discovery of the x-ray, and radium, the expansion of the dyeing industry in the colonial period and the subsequent use of mustard gas in WWI. Mukherjee weaves through each new thread, the warp and the weft of the cancer shroud. The key players in this story are men and women who grapple literally and metaphorically with the demons of cancer, sometimes succumbing to the disease themselves because of constant work-related exposure to x-rays, radiation and chemicals. Not all of them were medical personnel. They are soldiers in a senseless war, young women painting radium onto clock dials for decorative purposes, hapless young children struck by leukaemia. From radical mastectomies that mutilated hapless patients to root out cancer and the use of folates and chemical combinations to run cancer to the ground, Mukherjee chronicles the active medical engagement with cancer that began in the mid-19th century, reaching a frenzied pitch by the 1940s in Europe and America, from where cancer protocols continue to emerge till date. By the 1970s, surgery, radiation and chemotherapy were the therapies being fine-tuned to fight cancer. Carla’s leukaemia is in remission at the end of five years in 2009. CML, multiple myeloma, Hodgkins cancer and early breast cancers in situ no longer form part of the statistics of fatalities but can be efficiently managed through early screening and therapy. Atossa, had she lived today would have her life extended anywhere between 17 and 30 years, as a result of the strides that modern technology and molecular medicine have made. Her daughters and granddaughters would be able to exercise far greater options. Atossa’s imagined future and that of her daughters is the proverbial silver lining. Yet, the situation remains fraught as we deal with a complex adversary, whose mutant genes share with the human cell a similar hunger for immortality. We are still apping the pathways travelled by the cancer genome and on a cautionary note, Mukherjee warns us that metastatic cancers, full-blown sacronomas, and pancreatic cancers do not really exude much promise at this juncture. Cancer is an integral part
of the human scaffolding, a cell gone mutant and needs to be viewed in
much the same way as ageing, sickness and death are. Modern medicine and
societal intervention have yet to eradicate cancer. What they have
achieved is the ability to be alert to its visitation, deflect its
virulence, moderate aggressive therapies and focus on prolonging human
life. In that direction lies future engagement. This is a book that must
be read by everyone who wants to know more about cancer.
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THIS
is not the first book written by an oncologist on cancer. It is,
however, the definitive book on cancer for our times and could not have
been written any earlier. Siddhartha Mukherjee, an Indian doctor in New
York, breathes life into records that trace the long march of cancer,
the karkinos which has evaded capture and control by its potential to
move stealthily.