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Under The Sign of Cancer

Indian Express
28 November 2010
By Nandini Nair
New Delhi, India

New Delhi–born, New York–based physician Siddhartha Mukherjee turns into cancer’s biographer, chronicling the battle between the malady and the medical treatment, its heroes and victims.

Mukherjee was obsessed with finding the faces behind the cancer stories. “It was like being an archaeologist of illness,” he says.Mukherjee was obsessed with finding the faces behind the cancer stories. “It was like being an archaeologist of illness,” he says.
Three years ago, an oncologist stood outside the children’s cancer ward at the All India Institute of Medical Sciences, Delhi. He watched them learn mathematics, Hindi and English in a tent set up by an NGO that provides support for children with cancer and their families.

A volunteer social worker was busy finding possible donors for families who could not afford medical care, trying to ensure that children didn’t suffer for lack of finance. An entirely makeshift and effective system, outside the hospital walls and beyond the medicines, had evolved to take care of the children.

Siddhartha Mukherjee, the physician who stood on the hospital steps, says, "I was so proud that I was almost in tears. It sounds maudlin, but it wasn’t. Here were men and women from far–flung parts of north India, who had packed their bags and brought their children to the city to be treated. And they had been received with open hearts, compassion and pragmatism."

The 40–year–old, a cancer specialist and assistant clinical professor at the oncology department at Columbia University, New York, brings a similar kind of compassion and pragmatism to his first book, The Emperor of All Maladies: A Biography of Cancer (Scribner).

The battle between medical treatment and cancer is told in cold detail, but also with a gentle touch. He recreates both past discoveries and personal battles.

And as he chronicles "victories and losses, campaigns upon campaigns, heroes and hubris, survival and resilience – and inevitably, the wounded, the condemned, the forgotten, the dead", the book turns into, what he calls, "the military history" of the malady. For, it is war – at an emotional, physical and, finally, logistical level.

The book, published in the US on November 16, has received reviews ranging from the effusive – the Washington Post called it a "fat, enthralling, juicy, scholarly, wonderfully written history of cancer" and The Economist "a rich and engrossing book" – to the cautious – The New York Times calls it "an informative, well–researched study. But it is in no way a biography of anyone or anything".

Mukherjee spent his first 20 years in leafy Safdarjung Enclave in south Delhi. That was the 1970s – when the lanes were quiet, and the music and the trousers loud. He attended St Columba’s School where he was "forced to memorise inordinate amounts of Shakespeare".

But he looks back fondly at those childhood impositions, calling it a "boon". A love for literature echoes in The Emperor of All Maladies, with chapters often opening with a quote from the classics. Beyond Shakespeare’s couplets and the classroom, he remembers school for introducing him to the ravages of cancer. His English teacher, his favourite, died of it.

From Delhi, Mukherjee went to Stanford, then for a course in immunology at Oxford University and finally Harvard Medical School. But how did he become cancer’s biographer? The book grew out of a series of questions that patients had asked him, he says, such as "what is cancer, where are we going with treatment and prevention, what happens next?" Mukherjee says these fundamental questions were seldom answered by books.

He wanted to highlight the stories of researchers, doctors and scientists but, most importantly, of patients – to create a "biography" of cancer. It started as a journal, a "view from the trenches" of cancer treatment, that Mukherjee started writing at the Massachusetts General Hospital in Boston, where he was working, in 2003. It slowly burgeoned and the chronicle of a 4,000–year–old battle against cancer also became a young doctor’s coming–of–age.

Mukherjee traces the disease’s timeline from its earliest reference, circa 2600 BC by an ancient Egyptian physician, to the early 1950s when cancer was still considered taboo in the US. A woman seeking to place an advertisement in The New York Times for a support group was told that the paper could not print either the word "breast" or the word "cancer." An editor conservatively suggested "diseases of the chest wall" instead.

Cancer’s factfile is scary: in 2010, more than 7 million people have died of it. But behind these numbers lie human stories, and Mukherjee was obsessed with finding the "faces of those stories". He found out about the first child who was treated for leukaemia – a three–year–old boy in America, Robert Sandler, in the late 1940s – while poring over newspaper archives in the Boston public library.

He says, "These stories provided the propulsion for the book. It was like being an archaeologist of illness – and yet, this illness was not of the past but very much of the present. I was amazed that these stories were not being told."

As someone dedicated to fighting cancer, Mukherjee continues to be surprised by it. Cancer, after all, arises due to the corruption or mutation of genes that are vital to our existence. "The astonishing thing about this cell division is that the genes which unleash this division are often distorted versions of genes that regulate our normal growth," he says.

Over the past 50 years, advances in the diagnosis and treatment of cancer have improved manifold but the war against cancer will be a continuous one, says Mukherjee. "It’s unlikely that we will ever eradicate cancer from our societies. But there are also concrete signposts of victory," he says, "Eliminating tobacco, particularly among young men and women, is an important landmark in this war."

Cancer often spells a death sentence and patients at times refuse further trials or treatment. At such times, Mukherjee the oncologist feels a sense of defeat, but not so much the patient, he suggests. "Choosing to stop anti–cancer therapy is often a conscious and powerful decision. It is a reconciliation," he says.

Would he one day leave New York to work in New Delhi? He doesn’t rule out the possibility. He still visits India once year and "loves and admires the practice of medicine here".

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