Emperor of All Maladies, Siddhartha Mukherjee

The Emperor of All Maladies is a book that should be on everyone’s shelf.  Sure, it’s a long one, non-fiction and filled with pages and pages of text about a pretty scary thing that we will all encounter: cancer, the Big C. Scary as it may be, we should all understand so big a foe – the whole bit about knowing your enemy certainly applies here.  This book is a wonderful roadmap to understanding the enemy – it is written with knowledge as well as empathy and describes an extremely complex, oftentimes unfathomable disease in about as layman’s terms as possible.  Most importantly, The Emperor of All Maladies is extremely informative, but also humanistic and relatable.  With one in two men and one in three women bound to personally hear a diagnosis of cancer in their lifetimes in the United States, of course we can all relate.  This is something that we will all experience, so pay attention people!

Cancer Cell

Breast Cancer Cell Dividing 

A pediatrician girlfriend recommended The Emperor of All Maladies by Siddhartha Mukherjee after we’d been chatting about recent books we’d loved, and I jumped right in – excited to learn something new.  And jump in you must because it is a pretty long, consuming and sometimes technical book.  But so well written and so vital to today’s society and human existence.  Mukherjee is an oncologist who intertwines the history of cancer and its varied treatments over the centuries with intimate and personal stories of his own experiences of cancer through treating his patients. He manages to take an extremely complicated disease (in fact so complicated that we still barely understand even the fundamentals of how cancer works and therefore how it can be stopped or alleviated) and break it down into relatively easy to understand language.  “Down to their innate molecular core, cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves.”  With cancer, it was the similarity of the cancer cell to the normal human cell that made it nearly impossible to target.

I myself am no doctor, of course, and I lament my lack of studying anything related to cells or pathology in school, but I was able to grasp the principles that Mukherjee discusses without being too lost in the technicality of the material.  I really enjoyed learning so much about the human body, cells and medicine.  And I was blown away by a lot of what he details in the book.  For example: his discussion of the blood brain barrier (when explaining that it blocked helpful chemotherapy drugs from the brain but somehow allowed those pesky, innovative, tricky Leukemia cells to break through).  I’m sure the BBB comes as no surprise to anyone with half a brain in the medical industry, but I’ve never heard of it.  What?!  There’s a filtering mechanism to make sure bad things don’t get to the brain?  But sometimes it keeps out the wrong things?  The human body is amazing. And I have so much to learn.

In The Emperor of All Maladies, Mukherjee walks his readers through the history of cancer – from its first known appearance in Egypt, which we discovered in ancient manuscripts of the Egyptians, to the current understandings of cancer after we have poured billions of dollars into researching it.  And he discusses the many surprises that we have learned along the way.  The horrifying treatments that doctors have imposed on patients under false understanding of the disease, the insistence in the mid-twentieth century that we were THISCLOSE to finding a cure for cancer, and the many, many things that we still have yet to learn about this illness.  “Cancer, we now know, is a disease caused by the uncontrolled growth of a single cell.”

But he also makes this a personal story, a story of human triumph and loss, and a story of how he as a cancer doctor has struggled to treat such a dynamic and aggressive disease.  He extols the virtues of his patients – the real soldiers in the war against Cancer: “Resilience, inventiveness, and survivorship–qualities often ascribed to great physicians–are reflected qualities, emanating first from those who struggle with illness and only then mirrored by those who treat them. If the history of medicine is told through the stories of doctors, it is because their contributions stand in place of the more substantive heroism of their patients.

So here’s why I think everyone should read this book:  nearly half of all humans will be diagnosed with cancer in their lifetimes, according to recent estimates. “In the United States, one in three women and one in two men will develop cancer during their lifetime. A quarter of all American deaths, and about 15 percent of all deaths worldwide, will be attributed to cancer. In some nations, cancer will surpass heart disease to become the most common cause of death.” That means that nearly every single person on this planet will be affected by cancer, whether directly or indirectly through loved ones, colleagues, friends.  With those kinds of odds, it strikes me as imperative that we understand what it is that we’re dealing with.  Now of course we are still learning every day about what cancer is, what it can do and what we can do to try to defeat it – or what we can do to learn to live with it in some instances.  So inevitably the discourse will change as new discoveries are made, but on a fundamental level The Emperor of All Maladies is an excellent introduction to what cancer is and how that knowledge has changed since its initial discovery, and in particular details all of the amazing breakthroughs that have come in the most recent decades.  It is fascinating now to consider what doctors and scientists ascribed to cancer in the past, sometimes in the not so distant past:  “Nineteenth-century doctors often linked cancer to civilization: cancer, they imagined, was caused by the rush and whirl of modern life, which somehow incited pathological growth in the body. The link was correct, but the causality was not: civilization did not cause cancer, but by extending human life spans—civilization unveiled it.”  It is also so interesting to consider how disconnected practicing physicians and academic scientists have often been in the quest to understand this disease.

It lives desperately, inventively, fiercely, territorially, cannily, and defensively—at times, as if teaching us how to survive. To confront cancer is to encounter a parallel species, one perhaps more adapted to survival than even we are.”  If I insist to Ryan one more time that cancer will survive the apocalypse, he may very well throw me out of the car.  “A cancer cell is an astonishing perversion of the normal cell. Cancer is a phenomenally successful invader and colonizer in part because it exploits the very features that make us successful as a species or as an organism.”  But there it is – when we have ruined the planet as we know it, pumped so much carbon into the atmosphere that we can no longer as a species (along with most other current living things on Earth) breathe and exist, it seems to me that cancer will keep on keeping on.  “That this seemingly simple mechanism—cell growth without barriers—can lie at the heart of this grotesque and multifaceted illness is a testament to the unfathomable power of cell growth. Cell division allows us as organisms to grow, to adapt, to recover, to repair—to live. And distorted and unleashed, it allows cancer cells to grow, to flourish, to adapt, to recover, and to repair—to live at the cost of our living. Cancer cells can grow faster, adapt better. They are more perfect versions of ourselves.”

emperor of all maladies movie

SURPRISE!  They made a movie based on The Emperor of All Maladies – it is called Cancer: The Emperor of All Maladies and you can stream it on PBS.  I haven’t had a chance to watch it (we are after all living in a camper at the moment with no plans for watching TV while we are exploring the West), but it is on my list.  So if you aren’t able to commit to reading the book (it is pretty long after all) or listening to it on audiobook (which for me would be difficult to absorb all of the many details because I’m a visual learner rather than auditory learner), you can watch the movie (which I believe is broken up into 6 hour long episodes).  Let me know how you like it!

The Emperor of All Maladies book
Cancer: The Emperor of All Maladies Movie

BY Jackie
BLOGGED FROM San Anselmo, California