The Emperor of All Maladies
Picture this: It’s the early 50s and breast cancer survivor Fanny Rosenow calls up the New York Times to say, “I’d like to place an advertisement in the New York Times to create a support group around breast cancer.” There’s a long pause. Oddly, the society editor gets on the line.
He tells her, “Well, I’m sorry but the Times cannot print the word ‘breast’ or the word ‘cancer’ in its pages.” Perhaps, he suggests, “You could say there will be a meeting about diseases of the chest wall.”
Fifty years ago, you could not pay to get people to read about cancer. Now you have people clamouring to pay to read about it.
Cancer physician-turned-writer Siddhartha Mukherjee did the impossible last year. He wrote an epic biography of a terrifying, shape-shifting disease that has plagued humanity since the beginning of time and managed to get people outside medical schools to read it.
The 40-year-old makes it sound fairly simple. “Since cancer has such a large canvas — the first medical description of cancer was found in an Egyptian scroll written in 2500 BC — I use a small story to tell the big story. I took one character and followed him, Virgil-like, through the book,” he says. “This book is a biography, as it attempts to enter the mind of this immortal illness, to understand its personality, to demystify its behaviour.”
To bring the history of a disease that enveloped and devastated so many lives, he pored through medical and historical records, visited labs and people’s homes, and read through the diaries and letters of the men and women who led the battle against cancer.
“It took me six years to put it together. To look through the eyes of three-year-old Robert Sandler, the first boy to be treated successfully for blood cancer using chemotherapy in 1948, I visited his home in Dorchester and imagined the sick little boy sitting in his room looking out of his window, which overlooked a zoo. I looked up city records and found it had ostriches, polar bears and tigers at that time. A reader said later, ‘I grew up there and remember the animals. But how did you know?’” says Mukherjee, who is an assistant professor of medicine at Columbia University and a cancer physician at the Columbia University/New York Presbyterian Hospital.
The Emperor of All Maladies is dedicated to Sandler, who’s twin, Elliot, saw the dedication and tracked Mukherjee down through his publisher late last year. “He told me their mother had relented to donate Sandler’s body for autopsy. Since she was Jewish, that decision haunted her for years. She’s alive, in her 80s, and she said, ‘This book closes my story’. That’s more praise than I’ve got from anyone,” says Mukherjee, the Delhi boy who studied at St Columbia’s before leaving for America at the age of 18.
The book has many heroes, but Mukherjee’s favourites are the two poster-children of idealism and innovation — Sidney Farber, who became the father of modern chemotherapy after discovering a powerful anti-cancer chemical in a vitamin analogue. The other is Mary Lasker, a Manhattan political and social lobbyist, who brought cancer centrestage in the US in the 50s.
“Of them all, I identify with Farber the most, the pathologist who begins as a doctor of the dead in the cellar of a Boston hospital to lead the war against cancer,” says Mukherjee. “There are no villains, not even the scalpel-loving cocaine-addict William Halsted, who advocated radical and super-radical surgeries that mauled cancer
patients. Halsted did the best he could. Their goals were the same. To kill the cancer.”
With the understanding of cancer morphing radically, are we closer to a cure? “Breakthroughs have come from unexpected people in unexpected places, from chemicals in clothing dyes to mustard gas used in World War I. Today, we have surgery, chemotherapy, radiation, targeted therapy to increase life by 17 to 20 years. There’s reason for optimism, we are getting closer every day,” he replies.
When it’s a 4,000 years-old war, more than dumb luck, you need resilience and resourcefulness to survive. And a will to live and fight back, the best you can.