The grand round sweeps into the patient’s room.
There is a lot of mumbling and fumbling about.
Finally the words come out.
“I’m sorry it was malignant.”
The grand round sweeps out of the patient’s room.
In a flash, their life has changed.
And you are left to pick up the pieces of a devastated patient and family.
Siddhartha Mukherjee is a cancer physician who has written an outstanding and fascinating book about cancer.
The Emperor of All Maladies is self described as a biography of cancer.
Written in 2010, the book was awarded the Pulitzer Prize for Non-Fiction.
Woven through the book is a very personal compassionate account of the effect of cancer on his patients and his practice.
As well it is a story of cancer through the ages.
Beginning with a Persian Queen, from over two and a half thousand years ago, who asked her slave to cut off her diseased breast.
Through the first recipients of radiation and chemotherapy to Carla, a modern day patient, the book recounts the discoveries, disappointments, wins and deaths that have led to the current state of play in cancer treatment.
The development of radical mastectomy with a large excision of the tumour and removal of the deep chest muscles and lymph nodes under the armpit and the collarbone is described in an astonishing and compassionate way.
In 2016, such a procedure seems horrifying.
Then X-rays were used to remove the tumours locally with alarming consequences for some patients.
Eventually, the two strategies were combined to treat breast cancer with a lumpectomy and radiation.
New breast cancer therapies arose in the “war on cancer” with the use of chemotherapy, Tamoxifen, Herceptin and screening for mutation in BRCA-1 or BRCA-2.
While breast cancer, chronic myeloid leukaemia and Hodgkin’s lymphoma treatments has led to an increase in survival years post-diagnosis.
The same cannot be said for other cancers such as metastatic pancreatic cancer.
Homage is paid to those who have persevered through the arduous prescribed treatments to survive and increase our understanding of cancer.
The future direction of cancer treatments is targeted therapy, prevention and understanding the behaviour of cancer.
At the end the chapter titled Thirteen Mountains, Siddhartha Mukherjee writes
“Taken to its logical extreme, the cancer cell’s capacity to consistently imitate, corrupt, and pervert normal physiology thus raises the ominous question of what ‘normalcy’ is. ‘Cancer’, Carla said, ‘is my new normal’, and quite possibly cancer is our normalcy as well, that we are inherently destined to slouch towards a malignant end. Indeed, as the fraction of those affected by cancer creeps inexorably in some nations from one in four to one in three to one in two, cancer will, indeed, be the new normal – an inevitability. The question then will not be if we will encounter this immortal illness in our lives, but when.”
The Emperor of All Maladies demystifies cancer.
It is a remarkable achievement.
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