The Emperor of All Maladie: A Biography of Cancer

The Emperor of All Maladie: A Biography of Cancer

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Language English
Contributor(s) Siddhartha Mukherjee
Binding Paperback
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Overview: The Emperor of All Maladie

A magnificent, beautifully written biography of cancer - from its first documented appearances thousands of years ago through the epic battles to cure, control and conquer it to a radical new understanding of its essence.In The Emperor of All Maladies, Siddhartha Mukherjee, doctor, researcher and award-winning science writer, examines cancer with a cellular biologist’s precision, a historian’s perspective, and a biographer’s passion. The result is an astonishingly lucid and eloquent chronicle of a disease humans have lived with - and perished from - for more than five thousand years.The story of cancer is a story of human ingenuity, resilience and perseverance, but also of hubris, arrogance and misperception, all leveraged against a disease that, just three decades ago, was thought to be easily vanquished in an all-out ‘war against cancer’. Mukherjee recounts centuries of discoveries, setbacks, victories and deaths, told through the eyes of predecessors and peers, training their wits against an infinitely resourceful adversary.From the Persian Queen Atossa, whose Greek slave cut off her malignant breast, to the nineteeth-century recipient of primitive radiation and chemotherapy and Mukherjee’s own leukemia patient, Carla, The Emperor of All Maladies is about the people who have soldiered through toxic, bruising, and draining regimes to survive and to increase the store of human knowledge.Riveting and magesterial, The Emperor of All Maladies provides a fascinating glimpse into the future of cancer treatments and a brilliant new perspective on the way doctors, scientists, philosophers and lay people have observed and understood the human body for millennia.

Features: The Emperor of All Maladie

  • Biography and Autobiography
Product Details
Language English
Publication Date November 25, 2010
Publisher Fourth Estate
Contributor(s) Siddhartha Mukherjee
Binding Paperback
Edition 2011
Page Count 592
ISBN 10 0007428057
ISBN 13 9780007428052
Dimensions and Weight
Product Weight 2.7 grams

Editorial Reviews

Review

'Sid Mukherjee's book is a pleasure to read, if that is the right word. Cancer today is widely regarded as the worst of all the diseases from which one might suffer - if only because it is fast becoming the most common. Dr. Mukherjee explains how this perception came about, how cancer has been regarded across the years and what is now being done to treat its protean forms. His book is the clearest account I have read on this subject. With The Emperor of all Maladies, he joins that small fraternity of practicing doctors who cannot just talk about their profession but write about it.'
Tony Judt, author of Postwar and III Fares the Land

‘Rarely have the science and poetry of illness been so elegantly braided together as they are in this erudite, engrossing, kind book. Mukherjee's clinical wisdom never erases the personal tragedies which are its occasion; indeed, he locates with meticulous clarity and profound compassion the beautiful hope buried in cancer's ravages.’
Andrew Solomon, National Book Award-winning author of The Noonday Demon

Review

‘Mukherjee calls this great and beautiful book a biography, rather than a history, because he wants his reader to understand his subject not just as a disease, a scientific problem or a social condition, but as a character – an antagonist with a story to tell. His intensely vivid and precise descriptions of biological processes accumulate into a character, fully developed and eerily familiar. The notion of "popular science" doesn't come close to describing this achievement. It is literature.’ Observer

‘This is a riveting book…profound, eloquent and searching’ John Carey, Sunday Times

‘”The Emperor of All Maladies” is the book that many will have been waiting for. This elegantly written overview allows us to look a once whispered-about illness squarely in the eye.’ Independent

‘So beautifully written; this is literature, not popular science. “The Emperor of Maladies” empowers us, makes it clear that we really do know this enemy, and so brings us another step closer to victory.’ Evening Standard

‘Mukherjee never condescends, yet he manages to write lucidly and tellingly about complex experimental, technological and theoretical matters’ Will Self, New Statesman

About the Author

Siddhartha Mukherjee M.D., Ph.D., is a cancer physician and researcher. He is an assistant professor of medicine at Columbia University and a cancer physician at the CU/NYU Presbyterian Hospital. A Rhodes Scholar, he graduated from Stanford University, University of Oxford, and from Harvard Medical School and was a Fellow at the Dana Farber Cancer Institute and an attending physician at the Massachusetts General Hospital and Harvard Medical School. He has published articles in Nature, New England Journal of Medicine, Neuron, the Journal of Clinical Investigation, The New York Times, and The New Republic.
He lives in New York with his wife and daughter.

Excerpt. © Reprinted by permission. All rights reserved.

Prologue

Diseases desperate grown

By desperate appliance are relieved,

Or not at all.

—William Shakespeare,
Hamlet

Cancer begins and ends with people. In the midst of scientific abstraction, it is sometimes possible to forget this one basic fact. . . . Doctors treat diseases, but they also treat people, and this precondition of their professional existence sometimes pulls them in two directions at once.

—June Goodfield

On the morning of May 19, 2004, Carla Reed, a thirty-year-old kindergarten teacher from Ipswich, Massachusetts, a mother of three young children, woke up in bed with a headache. “Not just any headache,” she would recall later, “but a sort of numbness in my head. The kind of numbness that instantly tells you that something is terribly wrong.”

Something had been terribly wrong for nearly a month. Late in April, Carla had discovered a few bruises on her back. They had suddenly appeared one morning, like strange stigmata, then grown and vanished over the next month, leaving large map-shaped marks on her back. Almost indiscernibly, her gums had begun to turn white. By early May, Carla, a vivacious, energetic woman accustomed to spending hours in the classroom chasing down five- and six-year-olds, could barely walk up a flight of stairs. Some mornings, exhausted and unable to stand up, she crawled down the hallways of her house on all fours to get from one room to another. She slept fitfully for twelve or fourteen hours a day, then woke up feeling so overwhelmingly tired that she needed to haul herself back to the couch again to sleep.

Carla and her husband saw a general physician and a nurse twice during those four weeks, but she returned each time with no tests and without a diagnosis. Ghostly pains appeared and disappeared in her bones. The doctor fumbled about for some explanation. Perhaps it was a migraine, she suggested, and asked Carla to try some aspirin. The aspirin simply worsened the bleeding in Carla’s white gums.

Outgoing, gregarious, and ebullient, Carla was more puzzled than worried about her waxing and waning illness. She had never been seriously ill in her life. The hospital was an abstract place for her; she had never met or consulted a medical specialist, let alone an oncologist. She imagined and concocted various causes to explain her symptoms—overwork, depression, dyspepsia, neuroses, insomnia. But in the end, something visceral arose inside her—a seventh sense—that told Carla something acute and catastrophic was brewing within her body.

On the afternoon of May 19, Carla dropped her three children with a neighbor and drove herself back to the clinic, demanding to have some blood tests. Her doctor ordered a routine test to check her blood counts. As the technician drew a tube of blood from her vein, he looked closely at the blood’s color, obviously intrigued. Watery, pale, and dilute, the liquid that welled out of Carla’s veins hardly resembled blood.

Carla waited the rest of the day without any news. At a fish market the next morning, she received a call.

“We need to draw some blood again,” the nurse from the clinic said.

“When should I come?” Carla asked, planning her hectic day. She remembers looking up at the clock on the wall. A half-pound steak of salmon was warming in her shopping basket, threatening to spoil if she left it out too long.

In the end, commonplace particulars make up Carla’s memories of illness: the clock, the car pool, the children, a tube of pale blood, a missed shower, the fish in the sun, the tightening tone of a voice on the phone. Carla cannot recall much of what the nurse said, only a general sense of urgency. “Come now,” she thinks the nurse said. “Come now.”

I heard about Carla’s case at seven o’clock on the morning of May 21, on a train speeding between Kendall Square and Charles Street in Boston. The sentence that flickered on my beeper had the staccato and deadpan force of a true medical emergency: Carla Reed/New patient with leukemia/14thFloor/Please see as soon as you arrive. As the train shot out of a long, dark tunnel, the glass towers of the Massachusetts General Hospital suddenly loomed into view, and I could see the windows of the fourteenth floor rooms.

Carla, I guessed, was sitting in one of those rooms by herself, terrifyingly alone. Outside the room, a buzz of frantic activity had probably begun. Tubes of blood were shuttling between the ward and the laboratories on the second floor. Nurses were moving about with specimens, interns collecting data for morning reports, alarms beeping, pages being sent out. Somewhere in the depths of the hospital, a microscope was flickering on, with the cells in Carla’s blood coming into focus under its lens.

I can feel relatively certain about all of this because the arrival of a patient with acute leukemia still sends a shiver down the hospital’s spine—all the way from the cancer wards on its upper floors to the clinical laboratories buried deep in the basement. Leukemia is cancer of the white blood cells—cancer in one of its most explosive, violent incarnations. As one nurse on the wards often liked to remind her patients, with this disease “even a paper cut is an emergency.”

For an oncologist in training, too, leukemia represents a special incarnation of cancer. Its pace, its acuity, its breathtaking, inexorable arc of growth forces rapid, often drastic decisions; it is terrifying to experience, terrifying to observe, and terrifying to treat. The body invaded by leukemia is pushed to its brittle physiological limit—every system, heart, lung, blood, working at the knife-edge of its performance. The nurses filled me in on the gaps in the story. Blood tests performed by Carla’s doctor had revealed that her red cell count was critically low, less than a third of normal. Instead of normal white cells, her blood was packed with millions of large, malignant white cells—blasts, in the vocabulary of cancer. Her doctor, having finally stumbled upon the real diagnosis, had sent her to the Massachusetts General Hospital.

In the long, bare hall outside Carla’s room, in the antiseptic gleam of the floor just mopped with diluted bleach, I ran through the list of tests that would be needed on her blood and mentally rehearsed the conversation I would have with her. There was, I noted ruefully, something rehearsed and robotic even about my sympathy. This was the tenth month of my “fellowship” in oncology—a two-year immersive medical program to train cancer specialists—and I felt as if I had gravitated to my lowest point. In those ten indescribably poignant and difficult months, dozens of patients in my care had died. I felt I was slowly becoming inured to the deaths and the desolation—vaccinated against the constant emotional brunt.

There were seven such cancer fellows at this hospital. On paper, we seemed like a formidable force: graduates of five medical schools and four teaching hospitals, sixty-six years of medical and scientific training, and twelve postgraduate degrees among us. But none of those years or degrees could possibly have prepared us for this training program. Medical school, internship, and residency had been physically and emotionally grueling, but the first months of the fellowship flicked away those memories as if all of that had been child’s play, the kindergarten of medical training.

Cancer was an all-consuming presence in our lives. It invaded our imaginations; it occupied our memories; it infiltrated every conversation, every thought. And if we, as physicians, found ourselves immersed in cancer, then our patients found their lives virtually obliterated by the disease. In Aleksandr Solzhenitsyn’s novelCancer Ward, Pavel Nikolayevich Rusanov, a youthful Russian in his midforties, discovers that he has a tumor in his neck and is immediately whisked away into a cancer ward in some nameless hospital in the frigid north. The diagnosis of cancer—not the disease, but the mere stigma of its presence—becomes a death sentence for Rusanov. The illness strips him of his identity. It dresses him in a patient’s smock (a tragicomically cruel costume, no less blighting than a prisoner’s jumpsuit) and assumes absolute control of his actions. To be diagnosed with cancer, Rusanov discovers, is to enter a borderless medical gulag, a state even more invasive and paralyzing than the one that he has left behind. (Solzhenitsyn may have intended his absurdly totalitarian cancer hospital to parallel the absurdly totalitarian state outside it, yet when I once asked a woman with invasive cervical cancer about the parallel, she said sardonically, “Unfortunately, I did not need any metaphors to read the book. The cancer ward was my confining state, my prison.”)

As a doctor learning to tend cancer patients, I had only a partial glimpse of this confinement. But even skirting its periphery, I could still feel its power—the dense, insistent gravitational tug that pulls everything and everyone into the orbit of cancer. A colleague, freshly out of his fellowship, pulled me aside on my first week to offer some advice. “It’s called an immersive training program,” he said, lowering his voice. “But by immersive, they really mean drowning. Don’t let it work its way into everything you do. Have a life outside the hospital. You’ll need it, or you’ll get swallowed.”

But it was impossible not to be swallowed. In the parking lot of the hospital, a chilly, concrete box lit by neon floodlights, I spent the end of every evening after rounds in stunned incoherence, the car radio crackling vacantly in the background, as I compulsively tried to reconstruct the events of the day. The stories of my patients consumed me, and the decisions that I made haunted me.

 

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  1.  Glorious story of the ongoing courageous fight against the Monster 11 April, 2013 On Junglee.com
    A dark depressing topic made available to the uninitiated in a way that it is both easy to absorb and decipher - this is a chronicle of how cancer and more importantly cancer treatment has evolved. It is a fine tribute to man's unending pursuit of this two millenium old challenge posed to science and medicine in all forms. The reading of this book is also a fine lesson in humility in terms of how staying ahead of the monster requires quantum steps that have always been so near yet so far. The reasoning on why cancer is so different for any other form of ailment that has ever surfaced is plain and lucidly explained right at the start and what must be commended here is the author's perseverance even as he browses centuries of cancer chronicles dissecting every effort, placing it on record for both its merit and where it fell short and how every step is taking us closer to answering this one nagging question that medical science has been faced with. This book also takes your regard for oncologists a couple of notches higher when you discover their incessant fight with the unavoidable. We need more such works on cancer as we near the solution.
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  2.  Cancer- Simplified and explained 1 March, 2012 On Junglee.com
    The Emperor of Maladies analyses Cancer s roots precisely and provides valuable insights into this 5000 year old malaise. Its more a story of the humans who have lived through and fought the disease than cancer itself.
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