the emperor of all maladies

A year ago, when I was first diagnosed with multiple myeloma and amyloidosis, I found myself with time between various appointments for all manner of tests that I was undergoing. During this spare time I would often wander into the Book Warehouse on Broadway, near the Vancouver General Hospital. There, on the best seller shelf, was a large paperback book titled "The Emperor of All Maladies: A Biography of Cancer" by Siddhartha Mukherjee. The book had an impressive embossed seal reading "Winner of the Pulitzer Prize". I flipped through its nearly five hundred pages and thought that I should probably read it. But I was not ready. I could not bring myself to learn about the story of cancer while I was still becoming accustomed to being a person with cancer. Then, a month ago, I was waiting to meet a colleague for coffee on Tenth Avenue near the University when I wandered into another outlet of the Book Warehouse. Sure enough, there it was, still sitting on the best seller shelf. This time, ten months and a stem cell transplant later, I bought the book. In the intervening period my identity has shifted. Cancer has become less a stranger, more familiar, less an outsider and more a part of me. I was intrigued to learn more about this part of me. I was not to be disappointed.

On Monday, while receiving my monthly infusion of pamidronate at St. Paul's Hospital, I finished the book. What can I say? If you want to learn about what we know about cancer and how we have come to know it then this is a wonderful introduction. The author is a cancer physician and researcher in New York. He spent five years writing the book in answer to his patients' questions about their disease and treatment. While I did need to reread some parts because of my non-scientific brain (and allowed myself not to fully understand every last detail when it got to be heavier sledding) I found the book to be well written, compassionate and even somewhat spell-binding. The search for a cure for cancer is like a great detective mystery and the book often has the quality of a detective novel. Imagine my delight, then, when I got to the end of the story and discovered the results of the latest breakthroughs in cancer research:

"More than nearly any other form of cancer, multiple myeloma, a cancer of immune-system cells, epitomizes the impact of these new discoveries. In the 1980s, multiple myeloma was treated by high doses of standard chemotherapy - old, hard-bitten drugs that typically ended up decimating patients about as quickly as they decimated the cancer. Over a decade, three novel targeted therapies have emerged for myeloma - Velcade, thalidomide and Revlimid - all of which interrupt activated pathways in myeloma cells." (p. 443)

This is the lone mention of multiple myeloma in the book. Am I glad that it comes in the context of the latest discoveries and breakthroughs. As one of those now receiving Revlimid I feel a strong connection with the researchers and doctors whose labours have led to the development of such treatments. Here are some more quotes from the conclusion of the book as examples of the kind of writing you will find here:

"Cancer's life is a recapitulation of the body's life, its existence a pathological mirror of our own. Susan Sontag warned against overburdening an illness with metaphors. But this is not a metaphor. Down to their innate molecular core, cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves." (p. 388)

"The bedlam of the cancer genome, in short, is deceptive. If one listens closely, there are organizational principles. The language of cancer is grammatical, methodical, and even - I hesitate to write - quite beautiful. Genes talk to genes and pathways to pathways in perfect pitch, producing a familiar yet foreign music that rolls faster and faster into a lethal rhythm. Underneath what might seem like overwhelming diversity is a deep genetic unity." (p. 454)

And, finally, this quote from the poet Jason Shinder: "Cancer is a tremendous opportunity to have your face pressed right up against the glass of your mortality." (p. 398). Amen to that.