The Emperor of All Maladies

When I was 9 or 10 I held my mother’s hand while a tearful neighbor lifted her sister’s head, showing the bald back of her head and some hair that have fallen off on the pillow. Her sister was in her 30s. A teacher. And she was dead. Leukemia – the cancer of the blood.

When I was 12 or 13, a distant aunt died from breast cancer. Her white dress, particularly the bosom area, was slightly tainted with blood. Seventeen years later, both my cousin and my maternal lola got diagnosed with breast cancer. My cousin is in her 30s, my lola in her 90s.

So when I chanced upon Siddhartha Mukherjee’s 2010 Pulitzer Prize winning book The Emperor of All Maladies (A Biography of Cancer) I knew I had to have it. And so I did.

In Mukherjee’s book, the cancer cell is an antagonist, a character so volatile and sneaky. We are introduced to the scientists who have studied and battled cancer for decades, striving to learn more about it, and concocting medicines that could prolong but sadly does not save lives.

We meet Queen Atossa in 440 BC Greece who orders her slave to cut off her breast. We meet Carla, the author’s cancer patient, who has a very poignant moment at the end of the book. We meet a middle-aged woman who wistfully wonders why she was diagnosed cancer, why she had to suffer severely when she took on a test drug, and why only she survived among a handful of test patients. She was 14 then.

We get tons of information and bits of trivia. Like for example the Pap in Pap smear – which is used to detect cervical cancer early – is the first syllable of the scientist who developed the test. And that Pap smear was first used by its creator on female pigs to correctly predict when they would menstruate.

Most importantly, the reason why I bought the book, we learn what cancer is. That cancer is part of our DNA. That cancer is cell division gone crazy. That cancer cells mutate from normal cells. That cells normally divide. That inside a cell, there is a gene that triggers or activates (turns ON) cell division and there is a gene that suppresses or stops (turns OFF) this. When one gets cancer, cell division is activated forever and is never suppressed.

In the bravura last chapter, we read about the author admitting that there can never really be a cure for all types of cancer. What he and other scientists can do is to strive and experiment based on the mistakes and successes of the past.

He writes: “But with cancer, where no simple, universal, or definitive cure is in sight – and is never likely to be – the past is constantly conversing with the future. Old observations crystallize into new theories; time past is also contained in time future… History repeats, but science reverberates. The tools that we will use to battle cancer in the future will doubtless alter so dramatically in fifty years that the geography of cancer prevention and therapy might be unrecognizable. Future physicians may laugh at our mixing of primitive cocktails of poisons to kill the most elemental and magisterial disease known to our species. But much about this battle will remain the same: the relentlessness, the inventiveness, the resilience, the queasy pivoting between defeatism and hope, the hypnotic drive for universal solutions, the disappointment of defeat, the arrogance and the hubris.”

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