Thoughts on the Emperor

This is a review of The Emperor of All Maladies written by Siddhartha Mukherjee.

Before I write the review of this book, it would be justified to share the reasons of picking it up in the first place.

It was around 2010-11. The newspaper headlines showed that a non-residential Indian has won the Pulitzer Prize for Non-Fiction. The book was on cancer and the author was an oncologist. Impressed by the facts, I took a mental note of reading the book in future. Around four and a half years passes. On October 2015, I get a phone call from my mother. She is worried about her brother. He has been ill for sometime. The scans have showed that his intestines are lined with tumors. He has to undergo a major surgery. Though the diagnosis hasn't come yet, I already knew what was coming. A month later, the biopsy results came in. It is a Stage III colon cancer. The time to read the book has arrived. Cancer is now a personal crusade.

Before I pick up a book written on science, I first go through the qualifications of the author. Though a Pulitzer Prize winner, I still had to check. Siddhartha Mukherjee, in this case, is an assistant professor of Medicine at Columbia University and practices at CU/NYU Presbyterian Hospital(additionally a Rhodes scholar; he has graduated from Stanford University, University of Oxford and Harvard Medical School). All my doubts were put to rest.

The book surely was intense. It starts with the story of one of the author's patients and ends with another. In between, he described the entire history of the disease - from its first mention in ancient manuscripts to Sidney Farber's "Jimmy" campaign to our current understanding of cancer genetics. It was a journey of hope and despair, fighting against a shape-shifting disease of enormous resourcefulness.

This book was strikingly readable and humane. Cancer is a master of destroying human dignity. And so its medicine. Radical surgery, invasive chemotherapy and the haunting feeling of death suck out the life from patients. But it also shows how people don't lose hope even in the toughest of times. For instance, chemotherapy(which is a treatment using cytotoxic chemicals; cytotoxic means "cell-killing") may result in asphyxiation through vomiting apart from hair loss, kidney failure or infertility. People still go through treatments boldly.

Herein lies also the stories of researchers who painstakingly found new ways of controlling the menace. From testing of thousands of toxic drugs to obsessive collection of tumor samples to recruitment of patients for randomized trials; biochemists, radiologists, hematologists, surgeons and medical students helped humanity in the race against itself.

Cancer - fundamentally as a disease of mutations and cellular pathways - is a corrupt version of ourselves. It is a cell which has evolved to get a maddening urge to divide(in a sample present in the author's lab, the leukemia cells still divided furiously; the blood cells belonged to a woman who has been dead for thirty years). All death signals have been switched off - resulting in a scary version of immortality. Cancer cells use tactics which were only used during our birth, when we were developing as foetuses in our mothers' wombs. The tumors also create their own blood vessels for oxygen supply.

Though it may seem daunting, medical researchers are finally getting a comprehensive picture of the disease. Cancer therapy is finally becoming targeted. More and more drugs are being developed which specifically aim only mutant cells. Hope still stands tall.

If you're reading this, then allow me to thank you. I have another thing to ask of you as well. If you aren't, then please start going for medical checkups on a periodic basis. Take your family or close ones too. The best way to defeat this disease is to detect it early.

Postscript: My uncle has underwent the surgery removing a large part of his gastrointestinal tract. He was scheduled to have his first dose of chemotherapy on 9th November. But his body temperature is running high for unknown reasons. Therefore, it has been postponed for some time. As of now, he has trouble eating but continues to laugh over the phone. He is a brave man.