"I am sorry, I know we have reached an end", a consolation doled out by a terminally ill, seventy-six-year old pancreatic cancer patient to her physicians, that so elegantly epitomizes the dismal side of present-day cancer medicine, is just one of the many heart- rending personal accounts littered throughout in The Emperor of All Maladies, by Dr Siddhartha Mukherjee.
In what can only be described as a literary masterpiece, Siddhartha Mukherjee, a cancer physician-scientist at Columbia University and NYU Presbyterian Hospital, eloquently sketches the 'biography of cancer' in his 2011 Pulitzer Prize winning book. The terrifying nature of this disease, cloaked charmingly in its title, captures the essence of all of the book's four hundred and fifty-odd pages.
The book starts out by recounting the history of cancer chemotherapy, and gradually delves deeper into the earliest known records of the disease itself. The historical roots of cancer radiotherapy and surgery are also unveiled to the reader, much in the manner of a novel- through a series of engaging real-life stories, each having its own 'plots' and characters. Almost every other page is punctuated with excellent accounts of landmark events in medical oncology and sometimes in medicine itself, which have served as scientific turning points.
What is so striking about this book is that the author has skilfully weaved together personal stories with scientific discoveries to narrate a gripping tale- and to top it all, he has also managed to recreate the socio-economic climate residing at the time of these happenings and at times, even the relevant political backdrop that puts the narrative in context. Indeed, the parallels drawn by Mukherjee between World War II and the 'war on cancer' and how fatally poisonous chemical agents used in military warfare were deputed as powerful anticancer agents by clever medical researchers, make for an unforgettable read.
Heroic tales of pioneers like Sidney Farber, who in Mukherjee's own words, underwent "a seismic transformation from a pathologist into a leukaemia doctor" and more importantly perhaps, "from a clinician into an advocate for cancer research" clearly highlight the 'people-first' approach that the author has taken in presenting cancer's biography.
An equally beautiful account of the circumstances that led to the practice of radical mastectomy for breast cancer treatment, instituted by William Halsted, also decorates this literary ambrosia. The historical accounts are intermittently laced with starkly realistic accounts of Mukherjee's own patients, especially that of Carla, a leukaemia patient. This serves to enliven the author's work even more so.
The later chapters of the book ease the reader smoothly into the concepts of modern molecular medicine which has transformed cancer therapy in recent times. Ideas relating to tailored cancer chemotherapy and of stratifying cancer patients based on tumor stage and grade to bring better meaning to prognosis and treatment, can be hailed as some of the other salient high points of this prize-winning book.
While some parts of this literary tour de force might read a touch esoteric to the layman, most of it is totally accessible to the non-specialist. This book not only lays bare the tremendous challenges that lie ahead of us in cancer diagnosis and management, but also gives ample laudatory sketches of the successes achieved so far in various disciplines within medical oncology.
Finally, what makes The Emperor of all maladies a 'hard to put down' read are the real stories of real people that it recounts, of both researcher- physicians and patients, who gave heroic battles against a seemingly indefatigable disease. Laid out in a tantalising manner, Mukherjee's accounts of cancer battles that end in partial victories leave us with a fond hope that we are on the brink of conquering this terrifying disease. However, in the same tone, he also presents in excruciating detail, the other, gruesome side of medical oncology - numerous battles that have culminated in dismal defeats which instil a morbid fear in us about the disease… and at the end of the book, we are left fervently praying that better cures for cancer be found soon.