Book Review - The Emperor of all Maladies by Siddhartha Mukherjee

 The Emperor of all Maladies: a Biography of Cancer by Siddhartha Mukherjee

New York: Scribner, 2011                                        ISBN 9781439170915

This book won the Pulitzer Prize, and once you've read it, it's easy to understand why. Siddhartha Mukherjee  has written a page-turning, easy to understand tour through medical history to describe the past, present and possible futures of cancer.

The book really has two foci - a description of what cancer is, and the history of our efforts to cure, prevent and palliate it. As the book progresses, so does the reader's understanding of just how insidious an enemy cancer is, and how any success against it however small, is hard-won.

Mukherjee describes how cancer has been seen through the centuries, from black bile to our current understanding that genetic mutation is the prime cause of cancer but there is still some way to go in our journey to fully understand how cancer behaves. In the meantime cancer continues to grow as a cause of death for the world. While the sufferers wait for a breakthrough in treatment, Mukherjee tempers enthusiasm by suggesting, as has happened in the past, our fight against this disease is a long, slow campaign.

The metaphors of war appear many times in this book - Mukherjee covers the fight for funding led by the redoubtable Mary Lasker, who finally got the government to not only take the disease seriously, but to put dollars behind the effort of scientists and doctors to work for a cure.

The heart of Mukherjee's book is that effort for a cure - how the scientists made breakthroughs in our understanding, the doctors had fixations on how to cure, and the patients had very little say in their treatment. The history of cancer treatment is one of.... I want to write, brutalism. From early treatments of breast cancer with sulphur and mercury, to radical mastectomies, to toxic cocktails of drugs, it is the patient that has suffered from whatever latest fad had taken the medical world by storm.

For, until the twenty-first century and the discovery of cancer's genetic origins, all sorts of cures were thrown at patients in the hope that some stuck. Removal of tumours only worked if the cancer hadn't metastasized, X-Rays had a similar problem (and, insidiously, caused cancers of their own), and chemotherapy drugs are toxic to all cells, which cause the obvious problems that come from that.

Some of these therapies had some success, but cancer was a word that sent a shiver of dread through those that heard it, as it seemed that until recently it was a death sentence for those that had it. Mukherjee explains that cancer is simply our body malfunctioning, cells failing to know when to stop duplicating or when to die, and our new understanding of how cancer occurs and continues has enabled new genetic therapies that are much more effective in lengthening survival and even curing some forms of the disease, to the extent that cancer is now becoming one disease among many.

It is the failures and follies of medicine and science that Mukherjee documents that are the most painful things to read about (especially if, like me you have lost friends and relatives to this disease). Mukherjee chronicles the rise and fall of radical mastectomy, X-Ray, and chemotherapy as a cure. Each of these methods had their champions, and unfortunately they jealously guarded their "patch" to the detriment of patients. Mukherjee shows that it was only slowly by degrees that the medical establishment realised that a combination of therapies creates the best chance for victory over the disease.

For a reader that doesn't know much about what cancer is, or how and why treatments were tried and discarded, or how science has advanced our understanding, The Emperor of Maladies is a fantastic book - it would be fascinating to read an updated version to see what advances have happened in the ten years since this book has been published.

A few minor quibbles that I had with this book: overall Mukherjee writes a tight and informative prose, but when he reaches for "literate" quality his touch is less sure. There is one section where he abuses the metaphor of Achilles' heel which was hard to read. A failure possibly by Mukherjee, but certainly by his editors and proofreaders is to suggest that Richard Burton wrote the Anatomy of Melancholy in 1893....really got my goat.

Those are minor quibbles about what is truly an excellent book, and one I would heartily recommend.

Cheers for now, from

A View Over the Bell

 

Book Review - The diving-bell and the butterfly by Jean-Dominique Bauby

The diving-bell and the butterfly by Jean-Dominique Bauby, translated by Jeremy Leggatt

London: Fourth Estate, 1997                                   ISBN 1857027795


The front cover of this book has the following blurb from the Financial Times - "One of the great books of the century" - so there must be something special about it, right? Well....yes, actually.

Jean-Dominique Bauby was a Frenchman who had the misfortune to suffer a stroke, and who awoke from his coma to find he was a victim of locked-in syndrome, where he was almost completely immobile and without speech, but with his mental faculties fully intact. In Bauby's case, practically the only movement he could make was to move his left eyelid. The book came about by someone reading the letters of the alphabet and Bauby blinking when they said the correct one, so piecing the writing together must have been a painfully slow process for both the author and the transcriber.

And what has Bauby "written"? The title of the work was chosen to indicate that while his body is immobile and sunk beneath the waves of locked in syndrome (the diving-bell), Bauby's mind is free to go wherever it pleases (the butterfly). The outcome is a series of vignettes that describe his life as it was while writing the book (after the stroke) and incidents from his former life that come back to him for various reasons, as well as reports of dreams he has had or that he wishes are to come.

The circumstances of its production are what makes this an extraordinary book - one of the vignettes describes how Bauby goes over what he is to "write" again and again in his mind, editing and memorising it, so that the transcription process is as painless as possible.

Pain is a recurring theme throughout this book - the physical pain of being unable to move causing pressure spots, the immediate mental anguish of not being able to change channels on the TV, or draw the blind, or tell the neighbouring room to turn down their blaring radio, and the existential pain of seeing his children but not being able to communicate fully with them, or passing his old workplace (he was editor of Elle magazine) and wondering what's happening there.

Like many works that deal with memory - which, as Bauby points out, is really all he has left to him after the stroke - it is the small things that have meaning once we can't do them anymore: Bauby remembers shaving his aged father, trips to the seaside, childhood activities, activities never undertaken, and enjoys the simple things, like the smell of frying potatos at the seaside.

While occasionally Bauby refers to his anger and frustration, that is not the overwhelming tone of the book. He is thankful for the staff of the hospital (even the unpleasant ones) and grateful to his friends and family who support him. The reader also senses Bauby's amazement at just what the mind and imagination can do, even without the body's support.

The most painful vignette, both for Bauby and the reader, is his description of the day he suffered the stroke - the normal things that we naturally assume that we'll do again and again seem to gain some new emphasis in this retelling of what was a banal yet important day for him.

He finishes the book with a small pean to his transcriber, Claude, and to the small ordinary things of life. He finished the book in August 1996, and tragically died in March 1997, two days after it was published.

So, while this book is indeed one of the most extraordinary ones ever written, for its insights into the mind of someone who has suffered a stroke, I'd have to disagree with the blurb from the Financial Times quoted at the beginning of this review, for as literature I don't think it would rank highly in the books of the 20th century. However, I do recommend this book.

Cheers for now, from
A View Over the Bell