The hieroglyphics record a probable case of breast cancer: “a bulging tumor. The oldest surviving description of cancer is written on a papyrus from about 1600 B.C. At the end of every evening he found himself stunned and speechless in the neon floodlights of the hospital parking lot, compulsively trying to reconstruct the day’s decisions and prescriptions, almost as consumed as his patients by the dreadful rounds of chemotherapy and the tongue-twisting names of the drugs, “Cyclophosphamide, cytarabine, prednisone, asparaginase.”Įventually he started this book so as not to drown. “But it was impossible not to be swallowed,” Mukherjee writes. “You’ll need it, or you’ll get swallowed.” “Have a life outside the hospital,” the doctor warned him. But by immersive, they really mean drowning,” he said, lowering his voice the way many of us do when we speak of cancer itself. “It’s called an immersive training program. During his first week, a colleague who’d just completed the program took him aside. Mukherjee started on the road to this book when he began advanced training in cancer medicine at the Dana-Farber Cancer Institute in Boston in the summer of 2003. He frames it as a biography, “an attempt to enter the mind of this immortal illness, to understand its personality, to demystify its behavior.” It is an epic story that he seems compelled to tell, the way a passionate young priest might attempt a biography of Satan. Many doctors become storytellers too, and Mukherjee has undertaken one of the most extraordinary stories in medicine: a history of cancer, which will kill about 600,000 Americans by the end of this year, and more than seven million people around the planet. Long before they see a doctor, they become narrators of suffering, as Mukherjee puts it - travelers who have visited the “kingdom of the ill.”

All patients begin as storytellers, the oncologist Siddhartha Mukherjee observes near the start of this powerful and ambitious first book.

The emperor of all maladies