Did you read a book this year that left you craving more when it was over?

Although The Emperor of All Maladies by Siddhartha Mukherjee didn’t particularly leave me craving for me, it was the book I’d been wanting to read all of 2012 and I got to it at the end of the year (just finished it in fact). The reason I was so keen on reading this book is because it’s subject matter – cancer – hit close to home this year.

My best friend in Hong Kong was diagnosed with breast cancer at the end of 2011. She is 36 and it’s her second time. She had been having regular screenings and just got an all clear on her last mamogram, six years after cancer first struck her and in cancer terms, that’s normally a signal that you’re clear for life hopefully. Just a month later, doing a manual breast exam, she discovered a lump. And yeah, it was cancer.

I was nearing the end of my pregnancy when she told me and although I took the news calmly, it was a blow , not the least because I feel particularly gutted when terrible things happen to the best of people. After Mimi was born, in between caring for my baby, my friend and I had agonising discussions over the best course of action – single mastectomy?  double mastectomy ? Using tissue from the stomach? Or the back? Whether to use silicone implants or not?

Of course, she had these discussions with her doctors. But these are emotional discussions as well as medical ones. Although my initial reaction was get rid of anything that can put your life at risk, women’s breasts are part of their sexual and personal identity and it is not easy contemplating life without them. So while breastfeeding Mimi, I would be reading research papers on breast cancer treatments.

Although this was my friend’s ordeal and she suffered it alone, it contributed to my low this year. Her breast reconstruction didn’t take, and after a 9-hour surgery she had to go in the OT again for another round. It was one bad news after the next for her. She had hoped she would escape chemo but it was not to be and she spent three months or so being pumped full of chemicals.

I was wracked by the guilt of not being able to be there for her because Mimi was too young to leave. In the end, once Mimi was older, I took two days off work and stayed with my friend during a couple of chemo cycles. I didn’t do much except keep up a constant stream of chatter and remind her to eat. She said it gave her something to look forward to. If you have a friend or family member going through this, remember that this human company can be very important. But you need to be someone they are comfortable puking in front of.

I had been keen to read this book from the time I heard about my friend’s condition and then I noticed it at her place. I don’t think she read it herself, having lived through the whole thing. So I finally borrowed it, and what a read it was. The first few pages my heart was thumping as if it was a thriller. It presents the discoveries related to cancer in an exciting and human way interspersed with stories of cancer patients and survivors.

Some takeaways from the book:

  1. I have been under the impression that the incidence of cancer is increasing due to the modern lifestyle, specifically because we consume more harmful, chemical stuff. However, one of the points this book makes is that cancer goes back to ancient times – tumours have been recovered from mummies from ancient civilisations, for example – and that often it was subsumed under different diseases, and not categorized as cancer as such. Now, that cancer has been identified as such and diagnosed, it is more apparent. Also, it is a disease of old age and people are now living longer. Earlier, people would die before cancer developed. Also, drugs to treat cancer mean that many more people survive the first incidence of cancer and then relapse. In cases like CML, a form of leukemia with almost fatal prognosis in the past, it is almost completely treatable by a drug and thus “each one of us, on average, will know one person with this leukemia who is being kept alive by a targeted anticancer drug.”
  2. Chemicals are both our enemies and friends. Again, thanks to the messiahs of “natural” everything, I have begun to see chemicals as big bad wolves, quite ignoring the fact that we are all essentially atoms and molecules, the scientific meaning of the word organic is compounds which contain carbon. In terms of cancer, chemicals have been saviours. CGP57148 (to treat CML), Herceptin (to treat breast cancer linked to the Her-2 gene), the cocktails of chemicals dreamed up by scientists throughout history, the molecules engineered to fit into the genes that drive the cancer cell and block their action, they have quite simply been lifesavers. To these chemicals I owe my friend’s life. Yes, some chemicals like asbestos have been identified as carcinogens. And we now seem to be surrounded by chemicals, on food and product labels, and we seem to be in some race to reduce the number of them. But we need to calm down and consider that these chemicals save lives too, like preservatives that prevent food from going bad. Its important that we have sophisticated watchdogs screening chemicals introduced into the things we come into contact with. Granted that these watchdogs are susceptible to lobbying but their very existence means that we are better off than times gone by when we were unaware of the existence of harmful chemicals.
  3. On a related note, this book changed my perception of chemotherapy. I had this notion that if diagnosed with cancer, I would rather die than go through chemotherapy. I viewed chemotherapy as simply prolonging life in a horrible way, pumped full of drugs. But I have now seen chemotherapy first hand. I have seen that a few months after chemotherapy, one can be back to almost normal. That in the six years between my friend’s last cancer and this one, chemotherapy technology and drugs to alleviate its side effects have improved so much. Reading the stories of people who fought so valiantly against this disease, and experiencing my friend’s own struggle, ironically I have fresh respect for life.
  4. It has also taken the shine off smoking for me. Somehow, people I know who smoke seem to wave away the link between smoking and cancer as somewhat fuzzy. It is not. It is one of the most concrete links that has been proven, and something to think about is that when a person gets cancer, they create a genetic predisposition that could affect future generations. This doesn’t mean that I will never smoke (though I will try not to regularly). It means I will never say idiotic things like “oh, how come he smoked so much and didn’t get cancer?” He was just very lucky. Don’t reduce the odds on your own life. Chemotherapy prolongs life but it is far from a cakewalk. As women, we really need a better way to feel powerful than killing ourselves slowly.
  5. In addition to cancer, I learnt a bit about the human genome. Cancers are cells with mutations in their genes that allow them to keep dividing and to evade cell death. To understand death, we have to understand life and the sequencing of the human genome has helped us to map this out intricately. I don’t know if they teach genetics in school biology these days but I think it’s important for all of us to understand the basics of it because it will not only help us understand our own bodies better but it may explain aspects of human behaviour in general too.

Future reading: Something on genetics perhaps.