“The Emperor of All Maladies—A Biography of Cancer” by Siddhartha Mukherjee - Solid A

Every once in a while, I read a book which I describe as, from beginning to end, one of the best books I have read in a while.  Sometimes, a book starts off strong (see “The Instructions”), I get excited and then my hopes and dreams are dashed as the book either fizzles altogether or stretches out too long.  Sometimes, I have a difficult time initially with a book.  I may put it down for a while or forever.  I may struggle through it.  I may experience a breakthrough making the book no longer difficult.  And then there are the books that are just ok.

“The Emperor of All Maladies—A Biography of Cancer” is one of the best books that I’ve read in a while.  I was skeptical about whether I would enjoy this book.  It was written by Siddhartha Mukherjee, an oncologist and assistant professor of medicine at Columbia, and my skepticism was two-fold.  First, I could not imagine how a non-fiction book about a disease could hold my attention.  Second, I was concerned that the science would be overly technical.

I was incorrect on both counts.

“Biography” is the right description for the book.  Dr. Mukherjee tells the history of cancer discussing everything from factors involving causation to diagnostic techniques to the evolution of treatment.

Dr. Mukherjee clearly recognized that a purely chronological history would have been a nonsensical approach because discoveries relevant, for example, to isolating the cells responsible for producing cancer cells in the body occurred over many time periods.  Also, parsing the subject purely by topic (causation, treatment, etc.) would have required significant temporal overlap and would not have created a cohesive narrative.

Therefore, Dr. Mukherjee’s approach is generally period-based where early approaches to treatment and diagnosis transition to the next evolution in thought and innovation.  In other words, he has chapters on forms of chemotherapy and approaches to surgical treatment in the early 1900s and then often reviews those topics when new discoveries lead to innovations in future periods.  He talks about environmental and behavioral causation generally when discussing the mid-20^th Century after virtually no discussion preceding the period since the link between smoking and lung cancer, for example, was not considered until the later period.  In this way, the reader clearly understands the evolution regarding causation, diagnosis and treatment of cancer.  Also, Dr. Mukherjee backtracks where necessary to earlier periods and reviews material for the reader to assist in context for later periods.

Dr. Mukherjee also interweaves vignettes from his own experience in treating cancer.  We meet some of his patients, and we meet some of the physicians with whom he has worked.

The book has a “mystery” feel to it.  For instance, some early research often focused on leukemia because at that time, unlike cancer of an organ, cancer in blood could be measured.  The problem (leukemia) is presented, the players (researchers, physicians) are introduced or reintroduced, the process (investigation, research, trials) is discussed, and then there is a conclusion.  In some cases, the conclusion is a huge disappointment—more so for the researchers and physicians than for you as reader.  In any event, tension builds as the reader invests in the history.

Back to the science.  Yes, there are a number of techno-babble terms in the book.  Dr. Mukherjee does an excellent job of defining them.  I found it more impressive, however, that Dr. Mukherjee could explain difficult concepts by comparing them to everyday situations that anyone can understand.  While I am certain that Dr. Mukherjee was being somewhat simplistic, he knew the depth of the topic that he needed to explain in order for his lay reader to understand the concept.  Some of the science was more than my brain could handle, but I expect that readers will not find, and have not found, the science to be an obstacle to reading and enjoying the book.

Even with all of these positives, the book could not succeed on such a high level without Dr. Mukherjee emotional connection to the disease and the patients.  He takes the reader with him to visit his patients.  He effortlessly describes the patient’s state of mind, the states of mind of the patient’s family members, his own state of mind.  He cares a great deal about his patients, really about all cancer patients and the families of cancer patients.  Dr. Mukherjee’s emotional investment draws the reader in to the subject matter.  He is clearly a post-cancer William Hurt from the film, The Doctor.

My family has had its health issues, but we have fortunately not been hit hard by cancer.  I am curious whether those with family or close friends who have suffered from cancer will want to read this book and, if so, how they will feel about it.  I wonder the same about cancer survivors.  My suspicion is that because of the tone and approach of Dr. Mukherjee, they, too, will be sucked into the book.

Dr. Mukherjee is a phenomenal author.  He effortlessly explains his subject matter, and his language is impeccable.  At every turn, he selects exactly the right wording to convey his message.

I didn’t intend to enjoy “The Emperor of All Maladies:  A Biography of Cancer” as much as I did.  I actually expected that I would put the book down when I got the gist of the message.  This book was never a chore for me.  I was shocked at how much of a page-turner it was.

Live long, read and prosper.  We’ll leave the lights on for you.