A thoroughly engaging, relentlessly moving and often provocative book about a disease that many people won't even mention by name or discuss in a hushed tone has won the Pulitzer, one of the most coveted honours in the United States.
Already a bestseller and recipient of some of the best reviews of 2010, Siddhartha Mukherjee's The Emperor of All Maladies: A Biography of Cancer won the award in the general nonfiction category. A Columbia University cancer researcher and a physician, Mukherjee, a Rhodes scholar who came to America as a teenager from New Delhi and then studied at Oxford University, has written a nearly 600-page book that is part history, part memoir, and part the story of cancer research over the last few decades.
The award comes with $10,000. The Pulitzer citation called the book, 'An elegant inquiry, at once clinical and personal, into the long history of an insidious disease that, despite treatment breakthroughs, still bedevils medical science.'
Eleven years ago, Jhumpa Lahiri received a Pulitzer for her short stories, The Interpreter of Maladies. Rajiv Joseph's play Bengal Tiger at the Baghdad Zoo (now on Broadway) was a finalist, and so was Suketu Mehta's The Maximum City in the non-fiction category.
"Cancer was an all-consuming presence in our lives," Mukherjee writes in the first chapter, while describing his initial encounters as a physician with cancer patients. "It invaded our imaginations; it occupied our memories; it infiltrated every conversation, every thought. And if we, as physicians, found ourselves immersed in cancer, then our patients found their lives virtually obliterated by the disease."
He writes about how in Aleksandr Solzhenitsyn's novel Cancer Ward, Pavel Nikolayevich Rusanov, a youthful Russian in his mid-forties, discovers that he has a tumour in his neck and is immediately whisked away into a cancer ward in some nameless hospital in the frigid north.
"The diagnosis of cancer-- not the disease, but the mere stigma of its presence -- becomes a death sentence for Rusanov,' Mukherjee muses.
"'The illness strips him of his identity. It dresses him in a patient's smock (a tragicomically cruel costume, no less blighting than a prisoner's jumpsuit) and assumes absolute control of his actions. To be diagnosed with cancer, Rusanov discovers, is to enter a borderless medical gulag, a state even more invasive and paralysing than the one that he has left behind," he writes.
Solzhenitsyn may have intended his absurdly totalitarian cancer hospital to parallel the absurdly totalitarian state outside it, Mukherjee observes. 'Yet when I once asked a woman with invasive cervical cancer about the parallel, she said sardonically, "Unfortunately, I did not need any metaphors to read the book. The cancer ward was my confining state, my prison."'
One reason the book hit the bestseller list, as one could realise from the book readings, is that many readers knew someone who is fighting cancer or has someone in the family who is undergoing treatment for it. The book offers a lot of case studies by delving deep into the minds and souls of the patients.
And there is a warning early on in the book that makes one want to know more about the mysterious and stubborn disease: "In 2010, about six lakh Americans, and more than 70 lakh humans around the world, will die of cancer."
The excellent reviews the book received and the extensive nationwide tours Dr Mukherjee undertook to promote it also bolstered its sales.
"Mukherjee translates the blocky languages of biology and chemistry into something resembling poetry," wrote Entertainment Weekly, "explaining lucidly why two people with the same cancer respond differently to treatment; what role stem cells play in the illness; why certain cancers run in families."
The Washington Post was just ecstatic about the book. "It's time to welcome a new star in the constellation of great writer-doctors," the review raved. "With this fat, enthralling, juicy, scholarly, wonderfully written history of cancer, Siddhartha Mukherjee vaults into that exalted company, inviting comparisons to ... Lewis Thomas and ... Stephen Jay Gould."
Mukherjee, 40, has said in interviews and at book readings that his literary talents owe a lot to his 'rigorous' education at a Roman Catholic school in New Delhi where he had to memorise poetry.
Coming to America soon after high school, he majored in biology from Stanford and won a Rhodes scholarship to Oxford, where he earned a Ph D in immunology. At Harvard Medical School, he trained as an internist, before beginning to specialise in oncology.
He had meant his book to be a journal of a grueling year in that cancer training programme, which left him 'in stunned incoherence.' after evening rounds, he told Columbia University publication The Record. But it grew into a larger project, he said, as he struggled to answer questions from his patients, "Where are we in the war on cancer? How did we get here? What happens next?"
He then felt he should look at cancer from the very early recordings of the disease -- some 4000 years ago.
He began to trace the history of cancer from the first recorded description of breast cancer on ancient Egyptian papyrus to the labs like the one he belongs to. Among the researchers he spends most time on are Sidney Farber, the man who invented chemotherapy, and Mary Lasker, the philanthropist who backed him
The book never offers hope of a cure but Mukherjee also notes, "Incremental advances can add up to transformative changes."