A patient, long before he becomes the subject of medical scrutiny, is, at first, simply a storyteller, a narrator of suffering – a traveler who has visited the kingdom of the ill.

Microhistories are probably my favorite sub-genre of non-fiction (after biographies), and of all the ones I’ve read so far, none was as epic and all-encompassing as The Emperor of All Maladies. I’m now convinced the history of cancer reflects (and sometimes even leads) global movements. I’m still in awe of the task that Dr. Mukherjee set out to accomplish and of the amazing result.

This book’s philosophy is that the history of cancer is not only a story of scientific activity, but also of the doctors, researchers and lobbyists that fought it, and, most especially, that of the patients:

Resilience, inventiveness, and survivorship – qualities often ascribed to great physicians – are reflected qualities, emanating first from those who struggle with illness and only then mirrored by those who treat them. If the history of medicine is told through the stories of doctors, it is because their contributions stand in place of the more substantive heroism of their patients.

Together with the stories of individuals struggling with cancer, Dr. Mukherjee tackles an impressive number of topics, from cell theory to the cultural movements of millions of people, from scientific achievements to political will, and he’s able to summarize this in close to 600 pages (or 21 audio hours) of clear and compelling story-telling.

Even the parts I found less interesting – genetics, methodology of medical trials – were still surprisingly accessible, and the most interesting ones like the fight with Big Tobacco, the story of palliative care and the rise of patient’s right, were downright gripping.

About 90% of The Emperor of All Maladies focuses of the USA, but on the other hand, most of the book is set in the 20th century, a time when the US led cancer research. Still, I missed a bit of a geographical range. which is my only little quibble with an otherwise fantastic book.

At the beginning of the book we’re told the story of Atossa, a Persion Queen born in 550 BC, who was the first registered case of breast cancer. At the end of the book Dr. Mukherjee imagines Atossa being diagnosed and receiving treatment over the centuries: in the Middle Ages her problem would become a blackbile unbalance (or trapped melancholia), to be cure with goat dung or holy water; the radical mastectomy favored in the 19th century would probably have cost her not only her breasts, but also muscles, lymph nodes and bones in her chest cavity; the 20st century’s passion for aggressive drugs, radiation and chemotherapy might have almost killed her without any results; and 90s/2000s’ doctors would be able to identify the mutation in her genes and better adjust her treatment to her cancer type.

This imaginary birds-eye view of Atossa’s life was my favorite scene because it illustrates perfectly the way Dr. Mukherjee associated cancer’s history to our history as humans.

Today, Atossa would live decades longer than she would have in the past, but, if instead of breast cancer she’d had metastatic pancreatic cancer, her prognosis wouldn’t change more than a few months over the last 2,500 years.

I appreciated the book’s balanced tone that avoided the cheerful optimist about developments and cures that always sound too cheerful, too optimistic, when compared to reality. We still have a long way to go. There’s hope, there’s life extension, but still no universal cure.

A little aside to say that as A Reader I loved all the literary metaphors and references used throughout the book: Alice in Wonderland, Calvino’s Invisible Cities,  Anna Karenina (“Normal cells are identically normal; malignant cells become unhappily malignant in unique ways.“), Aleksandr Solzhenitsyn’s Cancer Ward, etc. I was also strangely excited by getting his reference to HeLa cells, which I got to know through the wonderful The Immortal Life of Henrietta Lacks.

About the narration: Stephen Hoye was the only narrator in the Audies History category that was nominated for two books: this one and In the Garden of Beasts. This distinction is well justified. The Emperor is full of  technical explanations and complicated drug names that are accessible in part because of  Hoye.

There’s a cadence to his reading that’s very particular to him. I usually get a bit annoyed by this in other narrators, but surprisingly not with Hoye. I also appreciated how you could really notice the emotion in his voice during the last “pages” of the book, when he’s describing the brave, fearless but ultimately vain struggle of a cancer patient.

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Other thoughts: Avid Reader’s MusingsThe Book Lady’s Blog, S. Krishna’s Books, Book Addiction, My Books. My Life., let’s eat grandpa, Life… with books, Devourer of Books, Bibliophile by the Sea, Scuffed slippers and wormy books, Maple Gazed Kiwi (yours?)

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