Reading List Roundup: The Emperor of All Maladies, by Siddhartha Mukherjee (first 100 pages)

Every now and then there comes a book whose critical reception can’t but make you wonder if you somehow live in a parallel universe.

As a case in point, for years I have heard about “The Emperor of All Maladies”, Siddhartha Mukherjee’s so-called “biography of cancer”, as if it were some rite-of-passage in science writing, a study so masterful and compelling that even those whose lives had never been touched by the disease could scarcely put the book down without having been deeply moved if not awed. Friends of mine mentioned the prospect of reading it in tones of reverence similar to setting out from Everest Base Camp (though notably, without letting on whether they had actually done so). The opening pages of reviews offer a crystal gallery of elite paeans hardly to be surpassed, and of course there is the Pulitzer, king of literary trinkets, which Mukherjee won for the work.

Yet instead of a crystalline gem, a rousing and haunting accomplishment, “Emperor” is a turbid, uneven, meandering, yet self-congratulatory bore, a thoroughly sophomoric effort that, for a claimed “biography” of cancer, takes curiously little interest in characterization while proudly displaying its linguistic and even factual ineptitude.

One of the most insufferable aspects of the text, with which the reader will find herself pelted from the very first few pages, is Mukherjee’s crutch-like reliance on labored, mixed, garish or just plain erroneous metaphors and images where actual content and structure is called for. These in fact comprise such a disproportionate part of the text that, in the same way one might stop and gawk at a vegetable garden filled with misshapen gourds and monster rutebegas, we may as well go ahead consider a few of their endless varieties. They range from the ludicrously overblown:

[A single case of] “acute leukemia still sends a shiver down the hospital’s spine” (3).

…to the awkwardly obvious:

[Of the outbreak of WWII:] “by 1939, those skirmishes had fully ignited” (26)

…to the flabbily poetic:

“…surgeons were left to hack their way through the body like sailors sent to sea without a map—the blind leading the ill” (51)

[with the advent of WWII,] “the social outcry about cancer also drifted into silence” (26)

[the choice between surgery and radiation is] “a choice between the hot ray and the cold knife” (23)

…to the floridly surrealistic:

“a malnourished biological factory oddly reminiscent of the cloth factories of Bombay” (29) [of bone marrow in leukemia]

“their chromosomes condensing and un-condensing, like tiny clenched and unclenched fists” (33)

[Of surgeon George Pack, a.k.a. “Pack the Knife”:] “the surgeon and his favorite instrument had, like some ghoulish centaur, somehow fused into the same creature” (70)

…and last but not least, there are my favorites, the unintentionally comic:

[Of a surgeon:] “the fierce, hot blast of his intellect” (40)

[Of an early anesthetic drug] “…the fast food of surgical anesthesia (62)

“…a beaker with arms, legs, eyes, brain, and soul” (83) [this could also go under surrealistic]

As authorial tics go, Mukherjee’s knack for always finding the most irritating turn of phrase and then carrying on as though a Wordsworthian mot juste had just occurred was almost enough to impel me to put the darned thing down for good—but not quite. “Emperor” does offer some interesting material, for example on Galen’s notion of the enigmatic fourth bodily humor “black bile”; the medical madness of radical mastectomy and its protagonist, the reclusive surgeon W. S. Halstead; and the first chemotherapy agents. There is particular potential, by the way of “biography” of cancer, in this quote about its putative personality or even philosophy:

“The cancer cell is a desperate individualist, ‘in every possible sense, a nonconformist’… [metastasis] captures the peculiar instability of modernity” (38).

Yet this is not elaborated in any detail. Indeed, even in its brighter spots “Emperor” is badly uneven: the sections either lack depth on the one hand, so that one feels one still has not really learned even the basics let alone the roots of the subject or, on the other hand, they stray into interminable drudgery and stenography. Mukherjee’s long and eye-reddening discussion of the dye industry in 19th century Germany or his strangely hagiographic history of the first big-money cancer research fundraising drives surely count among the latter; his discussion of Galen or the history of cancer in antiquity count among the former. (Mukherjee caps this discussion with yet another trademark malaprop-as-mot-juste, informing us that it was not Helen’s face, but “Atossa’s tumor, that quietly launched a thousand ships” (42).)

Combined with its issues of continuity—the sections seem minimally connected to one another and follow little evident progression—we might conclude that “Emperor” was badly in need of an editor at least as unstinting as Pack the Knife was, and this is certainly part of the problem. But there are also issues of tone. The work is brimming with a fawning/triumphal air that strangely jars with the sober reality that over a century and unbelievable sums spent on cancer research have often borne a stubborn stagnation in outcomes as their chief fruit. The “breakthroughs” Mukherjee mentions, such as aminopterin, a derivative of vitamin B9, are extremely poisonous substances, and their successes are only temporary, leading children on to deaths hardly less cruel given the brief (often only weeks) false hopes they inspired. The surgeries, such as Halstead’s radical mastectomies—in which surgeons essentially raced for the honor of having removed more tissue than any previously had—left a generation of women horridly deformed, and seem at best ethically fraught and at worst the ghoulish results of depraved recluses with scalpels (there is surely a bizarre sexual dimension here of men deconstructing women, crippling or even emasculating them to “save” them). Yet, Mukherjee seems so enraptured by his own field that these horrors do anything but bother him: he sees the mastectomies part of “an incandescent century of cancer surgery” (58)… and extols the “nearly godlike creative spirit” (59) of the butchers… I mean, surgeons.

So what really finally did it for me, what inspired me to say bye-bye to Mukherjee after 100 pages of valiant effort? Probably that would be the little matter of the factual errors; “Emperor” appears to be riddled with them. Here are a few that I noticed with my fact-checker hat on, and in just a few pages of each other no less:

>That radium emits X-rays (74): incorrect term; radium emits gamma rays.

>That cancer is “inevitably waiting to explode out of its confinement” (79). Incorrect; does Mukherjee somehow not know about indolent cancers, the extremely slow-moving kinds you are “likelier to die with than of”, and on the basis of which many unnecessary surgeries continue to be performed?

>“…rusty carmines from Turkish madder root” (81) Incorrect: carmine dye actually is derived from an insect, the cochineal.

>That nitrogen mustards used in chemo are the same as the mustard gas used in WWI (88): Incorrect; the gas used in WWI was sulfur mustard.

Some of these may seem like niggling errors, but not all, plus we’re inevitably left to wonder what else Mukherjee might have gotten wrong, especially on finer details of cancer treatment that are even harder for the lay reader to catch. It was at this point that I lost all confidence and firmly decided that finishing “Emperor” was simply not worth sinking any more time into.

When one encounters a work of such middling quality and poor organization, replete with basic errors of execution, that nevertheless receives such wild praise as “Emperor” has, it is impossible not to wonder if there were other factors at work in its rise—whether favor(s) owed, or a very fortunate choice of agent. But amusing as the political-conspiracy hypothesis sounds (almost as much fun as my parallel-universe one), I would have to guess that “Emperor of All Maladies” is simply one more instance of that most well-accustomed fixture of bien-pensant literary circles: the “received” masterpiece that almost everyone receives, but almost no one actually reads.

And so, as a word to the wise, if you just want to learn a bit about cancer and have a decent (“fun” is not quite the right word for this subject) time doing it, I would say skip the whole “Emperor” trainwreck. Instead, try George Johnson’s “Cancer Chronicles”, a cohesive, often poetic, and mercifully much shorter reflection on cancer, its origins, its human impact, and the current research climate. Or, if you simply must read Mukherjee, go with his far better-written (and better organized) long-form article in the New Yorker, “Cancer’s Invasion Equation“.

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