Medicine,” says Mukherjee, “begins with storytelling. Patients tell stories to describe illness; doctors tell stories to understand it. Science tells its own story to explain diseases.” Mukherjee chooses a narrative structure that is one of the oldest and most appealing to human beings—storytelling with multiple voices—to shed light on the dreaded disease of cancer. The Emperor of All Maladies is both a history and a biography of the second largest killer in America.
Says Mukherjee, “I called my book a ‘biography’ because the word ‘history’ seemed too inert. This is a book in which I enter the history, and become a part of it. It is also a book in which I attempt to draw a portrait of a subject over time—hence, again, a biography.”
Siddartha Mukherjee grew up in New Delhi. A love of poetry acquired during his high school education at a Roman Catholic school explains his copious use of metaphors in his book, which has the happy effect of making medical erudition more comprehensible to the lay reader. Mukherjee is currently an assistant professor of medicine at Columbia University as well as a cancer physician at the CU/NYU Presbyterian Hospital.
Humanity’s struggle with cancer is at least 4,000 years old, and The Emperor of Maladies deals with the history of this brave endeavor by oncologists and scientists over the ages, and the equally important role of patients who participate in risky trials. Mukherjee’s skill lies in treating cancer as an elusive character that almost has a personhood.
The first recorded history of cancer appears on papyrus in 2,500 BC, from the notes of an Egyptian physician named Imhotep. More than 2,000 years later, Hippocrates, the father of Western medicine, gave it the name karkinos, the Greek word for crab. Even the ancient Greeks realized the persistent creep of the disease. In 1775, Percival Pott, an English surgeon, made the connection between environmental causes and cancer when he connected the high incidence of scrotal cancer in chimney sweeps to their exposure to ash and soot.
Mukherjee traces the other milestones in the fight against cancer, like the use of chemotherapy and radiation, to early screening options like Pap smears and mammograms, and the current use of targeted therapy. The future, he suggests, lies in a molecular understanding of cancer biology.
Emperor of Maladies is a timely study that fills an important lacuna in recording both the successes and failures in the quest to understand the most powerful disease of our time. It is a fascinating read for the lay person interested in following the history and chronology of this inimitable enemy.
Mukherjee’s interest in this king of diseases grew out of his attempt to answer a question put forward by one of his patients, Carla, who had acute leukemia: “What is it I am battling against?” This question is the raison d’etre for a tome of such proportions.
Lakshmi Mani writes on American and Indian-American literature, and is a National Endowment for the Humanities fellow.