Book Review: The Emperor of All Maladies: A Biography of Cancer

BRIAN KLEPPER

The opening page of Siddhartha Mukherjee’s The Emperor of All Maladies begins with a quote by Susan Sontag that is so on-point, yet so rare and fresh, that one can’t help being excited by the prospect of what’s to come.

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick.Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

Joy, With Reservations

A very quick update. Today was 3 weeks exactly since Elaine’s final chemo infusion, and we had an appointment with the terrific Dr. Buckley, who would give us an update. Last Friday she had a PET scan, which shows the progress of the tumors and provides a basis for evaluating the status of her cancer. Needless to say, we’ve been on pins and needles for the past few days, hoping the report would be good. We are not superstitious, but somehow we found ourselves not wanting to hope too much, for fear of jinxing the result.

The Moment

At 11AM Wednesday, Elaine called to say that she was done and on the way home. She had just finished her 8th and last chemo infusion. It seems like yesterday to Elaine and an eon ago to me that Dr. Buckley told us she needed six months of treatment and we steeled ourselves for the long haul. Now we're finished, except for periodic checks, at least unless the cancer returns and we need to go through another round of chemo therapies.

Who We Are

Receive news of cancer, and it immediately becomes all consuming. But at some point, day-to-day life returns, although slightly askew. Now that we’re face-to-face with the gravity of our circumstance, it has become Life, With Cancer. But as my close friend Jerry Reeves, a pediatric oncologist in his first career, observed, “You don’t stop being who you are, just because you have cancer.”

Elaine has been as positive and uncomplaining as is possible to be. We’re simply working our way through it. But we try to not become morbid either. Playing the cancer card is a way to poke fun at how crazy our situation is, and to remind each other that life goes on.

So, in the snappy repartee that dominates a fair portion of our dialogue at home, the tumor humor plays out something like the following:

Early Morning. I’m up and am doing emails in the living room. Elaine calls out from the bedroom.

“Where’s my coffee! I have cancer, you know. I can’t be getting up to make my own coffee!”

There are variations on this theme.

Her: Boy, I could really go for a hamburger with fries and a shake.

Me: You’re shameless. Don’t you have any standards?

Her: No. I have cancer.

Exhausted

Eight years ago, when I was recovering from open heart surgery, I wrote that it was difficult at times to stay focused on recovery and feeling better. That was a big surgery, yes, but within two weeks my prospects were good again. There was no protracted treatment or life impact, except of course for focusing on living a healthier life. That experience proved to me that a positive attitude is both a discipline - a constantly cultivated perspective - as well as key to a healthy outcome.

But Elaine’s experience is showing us that maintaining a sunny disposition becomes far more difficult as the challenge drags on, and the prospects for getting better become more uncertain. The most difficult part of a long disease could be the exhaustion that ultimately can overwhelm, or at least shake the resolve of, even the best efforts to remain positive and clear. After 6 months that have included 5 hospitalizations, 4 surgeries, an emergency visit and 5 cycles of having poisons infused into her body, Elaine and I are having our resolve tested. And we know we have a very long road ahead.

The Way It Is

On Thursday Elaine went in for her 4th of 8 every-three-week chemical infusions, a 4-hour exercise involving three very powerful drugs, followed by another 24 hours later. It is a communal event. A group of women sit together, each receiving a specific mixture. Some have been fighting cancer for 10 years or more. It goes into remission, then recurs. The doctors dig deeper and deeper into a limited arsenal to find something the cells will respond to. It is not a pleasant prospect.

A couple months ago I visited close friends, both oncologists, who now live in Truckee, CA, just outside Tahoe. Elaine was just beginning the chemo treatments. Larry told me, “The first round is the worst, because its unknown. After that, people say, “Well, it wasn’t pleasant, but I can get through this. Then around the 5th cycle, they’re literally sick to death of it and thinking, “Oh, just go ahead and shoot me!” Elaine’s not there, though.

Learning To Live With It

Dear Friends and Family,

It has been a little more than 6 weeks since the surgery where Elaine’s doctors found her tumors, and about 10 weeks since she first presented complaining of symptoms. Her wounds have healed beautifully. She is strong and her spirits are high. Most important, we’re over the shock, and so we’ve settled into the stark truth that this is about how we can manage a very serious situation over a very long period of time.

The texture of our lives has changed. Of course there’s the feeling that we’re sitting under the Sword of Damocles. But suddenly Elaine doesn’t have a day that’s chock full from beginning to end, and sometimes I can see she’s a little at odds that she doesn’t have as much to do as she’s used to. She tires easily, and will take at least one and sometimes several naps every day. She lost a good deal of weight through the surgeries, and must consciously focus on regaining at least some of it. She has lots of minor pains and inconveniences associated with her condition, but those are gradually ameliorating.