In his Pulitzer-prize winning book, Siddartha Mukherjee, MD sets an ambitious, seemingly impossible goal: to tell the story of cancer, a prevalent disease in modern medicine as well as the public mind, in a way that is both technically accurate and accessible to readers of all levels. This goal is complicated by the breadth of background details, years of medical research and countless scientific papers that are woven into the connotations of the word ‘cancer’ — connotations that for many are terrifying, confusing and depressing. Few of us will fail to think of an individual close to us whose family has been irreversibly changed by cancer in one of its many, many forms. The title of the book, “The Emperor of All Maladies,” conveys at the outset this theme of the book: cancer has an “empire” and it has, over its history, led many fierce battles against the wits and well-being of humanity. Dr. Mukerhjee is right to call this a biography of cancer; this titular subtlety lays the groundwork for demonstrating that cancer has a wild, unpredictable past with a life of its own.
The author’s proficiency in writing is obvious from the outset; he manages to employ a wide and richly textured vocabulary, choosing words that are both flavorful and accurate. To his credit, he manages to write eloquently without seeming pretentious; one instead gets the sense that he labored to use the exact language necessary for telling his story. His prose is remarkably readable, given the complexity of the subject matter. In discussing many technical points — statistical analyses, medical procedures, scientific laboratory endeavors and others — he never fails to engage the reader with illustrations that make what could be boring passages come to life. His imagery is often poetic. This is true of the book’s title and of the many allusions made to battles and war throughout.
One aspect of “The Emperor of All Maladies” that makes it a notable read is that it does not just paint the picture of a disease, as fascinating as that is, but the author brings to life the individuals and groups that played major roles in the characterization, research and treatment of cancer. When speaking of an advancement in cancer’s history, whether major or minor, Dr. Mukherjee exhibits the characters that made it happen. Not only does this drive along the narrative, but it creates a world that the reader can understand. In the midst of all of this, he weaves in his own experience as an oncologist, including many vignettes of his own patients and the battles with cancer fought on his own turf. Although these vignettes are not the majority of the content, they make the experiments and details applicable and relatable; in short, he gives a face to cancer. He does his patients a great justice by speaking of them with such honest reverence and sharing their stories of victory and defeat with the world.
My only criticism of the book is that at times it seems to jump around; this is especially true in the early parts of the book. My logical mind longed for a crisp, chronological record of all the steps taken by science to study this disease. From one chapter to the next, the book might move forward or backward a decade or more, which made it difficult to keep track of the chronological history. However, I must give the author the credit he deserves: I believe he does this in order to create a continuity of separate storylines. For example, there is an entire section on lung cancer, its connections to smoking, and the laws that were eventually passed as a result of this connection. While this chapter jumped around chronologically relative to the rest of the book, it created an internally consistent narrative about a specific aspect of the disease. I think the author took this approach because of the huge and complex nature of his subject. An important concept in this book is that “cancer” describes a category of diseases with a similar pathology, not just a single condition, which explains the breadth of the book. The history of cancer cannot be told in one sitting — there is no fluff in this book; it takes the full 500 pages to do the story justice — and neither is it a story that moves linearly. Like many things in science, it involved piecing together seemingly disjointed pieces of research until the whole picture could be seen. By presenting different aspects of cancer’s malicious reign in separate chapters, Dr. Mukherjee finally brings the reader to the current state of affairs with cancer, and the reader is left in awe of the depth and breadth of “The Emperor.”
This book is a must-read for anyone interested in oncology. I cannot imagine a more readable account of cancer’s history, or perhaps any scientific history at all. Further, medical students will love the clinical and basic science connections made throughout the novel. More than once, I would pick up the book and read a chapter, only to find mention of a gene, disease, treatment, or technique that we had just discussed in class. It serves as a powerful tool to connect often disjointed pieces of knowledge into a story of something so important — learning about this powerful disease and how to treat it. I also found it a refreshing break from the textbooks and notes that I read for class; the beauty of Dr. Mukherjee’s writing cannot be overstated. Despite the array of medical information presented, anyone whose life has been touched by cancer and who wants to know more could enjoy the book, as he largely avoids jargon when possible and tells the tale so interestingly. Although dense at times, “The Emperor of All Maladies” easily makes it onto my list of the best nonfiction books I have read. At its core, it is a story of medicine: victories and defeats, despair and hope, confusion and illumination. At the end, one is left feeling that “the war on cancer” is a war that humanity can win.
Prints, Pages, and Pagers aims to look closely at the lives of medical students and doctors, real or fiction, whose lives and experiences are told in novels, short stories, poetry, or any kind of writing. These book reviews are an opportunity for medical students to learn from the many fascinating stories produced by the field of medicine, and maybe to read something other than a textbook.