The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee (London: Fourth Estate, 2011. 608 pp)

Siddhartha Mukherjee is a cancer physician and researcher. He is an assistant professor of medicine at Columbia University and a staff cancer physician at Columbia University Medical Center. Mukherjee is a Rhodes Scholar and he graduated from Stanford University, the University of Oxford, and Harvard Medical School. His book, The Emperor of all Maladies won the 2011 Pulitzer Prize in general non-fiction.

Flunking Pre-Med

Since the day I learned about cancer—I mean really learned about cancer—I’ve never been the same. It was an introductory class into physiology as an undergrad. I signed up for classes late and wasn’t able to enroll in the desired elective. I needed a science credit and this class was all that was left.

It was meant as a “weed-er” class, the kind designed to weed out hopeful pre-med students unable to do the heavy lifting required in the career path. I didn’t do very well. I never intended on doing pre-med, anyway.

But this class had a week devoted to cancer. The gruesome images in the slide decks forced a guttural reaction deep in my psyche. Seeing unmoored cells dividing, conquering, and killing gave me the wrong kind of goose bumps.

So with trepidation, I entered into a reading relationship with Siddhartha Mukherjee’s The Emperor of All Maladies.

A Biography

The core of this prize winning book resides in a story. In fact, the subtitle of the book is “a biography of cancer.” Mukherjee early and often references cancer not as an object of study, but a living, breathing entity.

“In writing this book, I started off by imagining my project as a ‘history’ of cancer. But it felt, inescapably, as if I were writing not about something but about someone. My subject daily morphed into something that resembled an individual—an enigmatic, if somewhat deranged, image in a mirror. This was not so much a medical history of an illness, but something more personal, more visceral: its biography” (39).

The person, cancer, unravels as a frightening, engaging, and mysterious personality.

Mukherjee begins with the beginning. A story always starts in infancy and cancer, while not necessarily attributed by name in the ancient world, has a long connection with humanity. Even though Mukherjee is quick to acknowledge the lack of stated cases of cancer, he counters with a recognition that cancer has only arisen after we’ve cleansed the world of other diseases more likely killing humanity before cancer ever had a chance.

“Cancer is an age-related disease—sometimes exponentially so. The risk of breast cancer, for instance, is about 1 in 400 for a thirty-year-old woman and increases to 1 in 9 for a seventy-year-old. In most ancient societies, people didn’t live long enough to get cancer. Men and women were long consumed by tuberculosis, dropsy, cholera, smallpox, leprosy, plague, or pneumonia. If cancer existed, it remained submerged under the sea of other illnesses” (44).

Immortal Cells

Cancer, then, seems to represent the outer limits of human survival; it’s the immortality of a cell that brings mortality to its host.

“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 grow faster, adapt better. They are more perfect versions of ourselves” (6).

Having set the table, Mukherjee spends the rest of The Emperor of All Maladies detailing the research and fight against this prevalent disease. From radical surgeries to the poison of chemotherapy, the reader engages in the history—or biography—of cancer to understand the subject.

Literary Cancer

Mukherjee flawlessly translates a century’s worth of research into easily understood prose. Even though I am certain many a physician would critique the simplicity by which Mukherjee explains such a complicated topic, it is laudable that Mukherjee is capable of translating complexity into simplicity for the common reader.

While the science and history of the topic provides the foundation of the book, I thoroughly enjoyed Mukherjee’s literary ambition. The Emperor of All Maladies is not designed as a textbook; it is meant to be an engaging read. Here is where Mukherjee shines.

For starters, Mukherjee believes in the power of story. If not, The Emperor of All Maladies would not be a “biography of cancer.” He notes,

“Medicine, I said, begins with storytelling. Patients tell stories to describe illness; doctors tell stories to understand it. Science tells its own story to explain diseases” (390).

The power of story brings the dry scientific facts in the fight against cancer to life. Seemingly, humanity connects with story and Mukherjee does well to utilize story to explain the complexity of cancer research.

Likewise, Mukherjee understands the value of form:

“In the end, every biography must also confront the death of its subject” (462).

Mukherjee is telling a story and every story needs a beginning, middle, and an end. Even though he does not go so far as to say the end of cancer is near, The Emperor of All Maladies offers a compelling overarching narrative for the cancer character.

Foremost in proving the influence of this book, the gruesome disease explained in my intro physiology class no longer lancinates my psyche whenever referenced. Through the Emperor of All Maladies, Mukherjee is able to explain a frightening disease and give hope in a seemingly hopeless place.

If you are interested in cancer, give The Emperor of All Maladies a read.

Verdict: 4.5 out of 5

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  • Amit Agarwal

    I read it as a book that would bring joy to me in times of sorrow. Although the topic of interest brings sorrows to the family of the patient I got be fall in love with Siddharth’s writings. As a doctor myself i did never know the delicate intricacies of cancer cells. How alike they were and how each single cancer in every single patient was different from others.A wonderful book for doctors interested in history and literature. Well written crisp but exhaustive. It shows how exorbitant efforts are needed to come up with a masterpiece like this. More than the efforts put for the book I congratulate Sid for his efforts in the field of cancer research. A fantastic book for doctors and public health persons who have never understood study designs in detail from Community Medicine books. the story telling skill makes medical subject of cancer which is dry and upsetting also very interesting. I would rate it as the best book I have ever read in life.

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