The Emperor of All Maladies has become my 
touchstone for medicine. Siddhartha Mukherjee writes in a poignant and humanist voice as he beautifully captures the “Biography of Cancer.” Interweaving science, stories, and his experiences as an oncology fellow, Mukherjee begins his examination of cancer in the ancient Egyptian times with the story of Imhotep, and carries us through to the modern 21st century diagnosis and management of cancer. From laboratory to bedside, Mukherjee provides both a panoramic and microscopic view of the advances and setbacks of cancer discovery, definition, and understanding.
Synopsis
As a scientist, this book appeals to the cerebrum: delving into the details of laboratory examination of cells, early gene discovery, pharmaceuticals and clinical trials, the use of monoclonal antibodies, and the ever-expanding world of person-specific and cancer-specific treatment. Mukherjee explores the evolution of modern medicine through the centuries, illustrating how the notion of “modern” evolves over millennia. At the same time, he draws connections between technological advances of present day, and the historical foundation upon which they formed:
“time past is always contained in time future.”
Mukherjee also captures snapshots of history, demonstrating how cancer impacted civilizations around the world, as well as how social and political circumstances affect the perception and treatment of cancer. Through details of his clinical work, we are offered a bedside look into the life of one of his patients, Carla Reed whom we follow from diagnosis through treatment over the course of the book.
The Art of Medicine
This book also illuminates to the reader the emotional depth of clinical medicine. Recounting the stories of his patients, and the experiences of his co-fellows, Mukherjee demonstrates that oncology (and medicine) is as much an art and experience, as it is a science. He shows how the history of cancer cannot, therefore, be told without the stories of all the people involved including the researchers, patients, and physicians. And of course, this includes himself and his colleagues. Through his narrative we see the impact that oncology has on him as a clinical fellow and the researchers who spend their lives endeavoring to understand the disease.
As one would expect, the journey through cancer for patients, families, clinicians, and researchers can be long, arduous, and tumultuous. There are moments of optimism, cautious hope, and joy. There are also moments of bereavement, frustration, and anger. The story comes together towards the end as Mukherjee recounts one of his last nights as an oncology fellow. What will remain for me as one of the most powerful moments in the book is the evening when each of the fellows, having completed their fellowship, is creating patient lists for the incoming fellowship class. As readers, we are privy to an impromptu memorial service behind the closed doors of their office as they recount not only the diagnosis of each patient whom they have lost over their fellowship, but also the person who was host and carrier of the malignant cells. It is moments like this that demonstrate the weight, responsibility, and burden that cancer puts on all those who become intertwined with its story.
Discussion Questions
- Page 338: In Part 5, Mukherjee describes how medicine has changed his colleagues:
“Our encounter with cancer had rounded us off; it had smoothed and polished us like river rocks.”
Patient interactions change the way we not only see medicine, but also each other and ourselves. Does medical curriculum provide sufficient time and space to allow learners to reflect on their personal changes as they begin to interact with patients? How can we help capture and foster the reflection necessary for learners to understand these changes in themselves?
- Page 400: “It is an old complaint about the practice of medicine that it inures you to the idea of death. But when medicine inures you to the idea of life, to survival, then it has failed utterly.”
Is it possible to prevent yourself from becoming inured to the idea of death? What advice would you give learners and juniors to not become inured to the idea of life, and death?
- Page 401: Mukherjee describes how cancer mortality changed in the early 21st century and the scientific advances that led to a decline in cancer mortality. Mukherjee also describes how the New York Times refused to print the word “cancer” in the paper in the 1950s. Over the past few years there has been an increase of the presence of cancer in media: with blogs, online support groups, twitter chats, and patient-focused websites becoming a part of a patient’s cancer experience.
How has the incrementally increasing presence of cancer in the media changed the discussion of cancer between a doctor and patient? In what way does it help or hinder the doctor-patient relationship?
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