Review for the Emperor of All Maladies

Sublimely Unmasking Cancer - Siddhartha Mukherjee

If a man die, William Carlos Williams once wrote, “it is because death/has first possessed his imagination.” … And so begins an incredible read from Siddhartha Mukherjee.

Death possessed the imagination of my patients that month, and my task was to repossess imagination from this. It is a task almost impossibly difficult to describe, in operation for more delicate and complex than the administration of medicine or the performance of the surgery. It was easy to repossess imagination with false promises; much harder to do so with nuanced truths. It demanded an active exquisite measuring I and reading measuring, filling and unfeeling a psychological respirator with oxygen.  Too much repossession and imagination might bloat into delusion. Too little and it might asphyxiate hope altogether. Mukherjee takes us on a long journey–stepping through a few thousand years of history while masterfully maintaining the thread of a living life force-field where we co-exist with cancer and marvel how culturally we empower its very existence as a kind of metaphorical cosmological black hole - at least for now.

The style in which Mukherjee delivers what is surely a masterwork and compassionate (in its powerful optimism) in the field of cancer; is in itself a nuanced empathetic, (a no judgment no blame delivery and not for the profession of medicine but for the lay community) exposé of the history of cancer. I would venture to say that he is telling it like it was and most likely currently still is if we embrace the theory that institutions take a few generations to first shift then evolve. This work moves far beyond informing, it enlightens the lay community in its informed grounded-ness as a reference for evaluating the medical profession and its treatment protocols more objectively.

Note this excerpt from Amazon’s reader’s book reviews to offer another shading of this portrait on The Emperor of all Maladies.

In "The Emperor of All Maladies," we meet a variety of patients, doctors, scientists, and activists. We also hear the voices of such iconic figures as Susan Sontag, author of "Illness as Metaphor," and Alexander Solzhenitsyn, whose "Cancer Ward" is a desolate and isolating "medical gulag." Cancer is such a complex subject that it can only be understood by examining it in all of its facets: through myths, the anguish of its victims, and the untiring efforts of its adversaries, both past and present, some of whom were well-meaning but horribly misguided. Mukherjee says in his author's note that he has made an effort to be "simple but not simplistic." In this he has succeeded.

An organ Bouquet

This work’s style is direct the its content richly explored, its narrative as engaging as a novel giving us a peek into a closed society, a deeper step , a clearer insight. More importantly allowing everyone touched by cancer a profound snapshot of the behind the scenes occurrences that shaped treatment only a few decades earlier and how it continues in its unfolding. Here we have Mukherjee quoting a leader in the field “For cancer therapeutics, the mid and late 1980s were extraordinarily cruel years, mixing promise with disappointment, and resilience with despair.… To say this was a time of unreal and unparalleled confidence, bordering on conceit, in the Western medical world is to understate things”….  When the outcome of treatment was not good, it was because the host was aged, protoplasm frail, or the patient had presented too late–never because medical science was impotent.

There seemed to be little that medicine could not do…. Surgeons were embarking on 12 to 14 hour cluster operations or liver, pancreas, duodenum and jejunum  were removed en bloc from a donor and transplanted into a patient whose belly, previously riddled with cancer, had now been eviscerated, scooped clean in preparation for this organ bouquet.

Yet even the patients in eviscerated and re-implanted with these organ bouquets did not make it: they survived the operation, but not the disease.”

Take a minute here and assess for yourself the quality that Mukherjee is able to weave in detailing through a style of delivery and the yin and yang temperament, which is the daily encounter, an ordeal with which patients and families confront. “The doctor was totally pessimistic. There was no hope, he told her flatly. And not just that; there was nothing to do but wait for cancer to explode out of the bone marrow. All options were closed. His word–the Word–was final, immutable, static. “Like so many doctors” Rieff, the son of Susan Sontag speaking about his mother, recalls, “he spoke to us as if we were children but without the care that a sensible adult takes in choosing what words to use with a child.”The sheer inflexibility of that approach and the arrogance of its finality was nearly a deathblow. It took months before Sontag found another doctor whose attitude was vastly more measured and who was willing to negotiate with her psyche. But Sontag’s new physician also told her precisely the same information, without ever choking off the possibility of a miraculous remission. He moved her in succession from standard drugs to experimental drugs to palliative drugs. It was all masterfully done, a graded movement toward reconciliation with death, but a movement nonetheless–statistics without stasis. A movement nonetheless into being simple but not simplistic is precisely why this book is able to put a face on cancer, which is what Susan Sontag in her work illness as metaphor champions as well. Wherever one finds oneself in the black hole of cancer, statistical data which is a nice way of presenting odds relative to making it or not making it is a means in accessing a gravitational force sucking life and implanting fear. The Emperor of all Maladies squarely plants a mirror within the sucking vortex of the black hole of cancer and reflects back in ways, in which data is simply data, and then depending on the filter can become information, then depending on the filter can become knowledge. This final sentence summarizes knowledge becoming intelligence “ I noted that he had said “when,” not “if”. The numbers hold a statistical truth, but the sentence implied nuance. “We will tend to it,” not “we will obliterate it.” Not hammer it, surgically remove or poison it but gracefully attend to it!A graded nuance towards compassion In a conversation with which Mukherjee shares with us he unmasks an ugly linear cancer and its treatment by the numbers. “ The Numbers told a statistical truth. but the sentence implied nuance a graded movement towards reconciliation.” This graded nuance gives us another more compassionate approach to the living organism that is part of our living human ecology; it shares a humanity that is ever present in our community of humans where cancer is part of our journey in one form or another and this knowledge in his gift. Mukherjee, turns knowledge into healing intelligence and through it all cancer can never look or be the same.

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