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‘The Emperor of All Maladies’

Siddhartha Mukherjee clarifies cancer with comparison

If you were … say … a brilliant oncologist and a spectacular writer, and you wanted to tell the story of cancer in a way that people who weren’t brilliant oncologists could understand and enjoy it, what literary tools might you use?

The Emperor of All Maladies
CAN’T PUT IT DOWN Siddhartha Mukherjee uses analogy to make the science of cancer clear and compelling in ‘The Emperor of All Maladies.’ (Photo by PopTech)

Siddhartha Mukherjee pulls out the stops in The Emperor of All Maladies. He uses storytelling, human interest, wordplay — and some killer etymological insights — to make his biography of cancer fascinating and accessible.

I promise to keep writing about Mukherjee’s book until you beg me to stop. But in the meantime, let’s look at how he uses analogy to make the science of cancer clear and compelling:

‘Like tiny clenched and unclenched fists’

Much of cancer research boils down to observing and reporting. Mukherjee uses analogy to give readers a peek into the microscope:

“His spleen, a fist-size organ that stores and makes blood (usually barely palpable underneath the rib cage), was visibly enlarged, heaving down like an overfilled bag. A drop of blood under Farber’s microscope revealed the identity of his illness; thousands of immature lymphoid leukemic blasts were dividing in a frenzy, their chromosomes condensing and uncondensing, like tiny clenched and unclenched fists.”

Analogy is key to good description. Mukherjee uses it to help us see key figures in cancer’s history:

“Hodgkin’s lymphoma was … announced late to the world of cancer. Its discoverer, Thomas Hodgkin, was a thin, short, nineteenth-century English anatomist with a spadelike beard and an astonishingly curved nose — a character who might have walked out of an Edward Lear poem.”

And this analogy helps me envision the dexterity of an early anatomist:

“In 1538, collaborating with artists in Titian’s studio, Vesalius began to publish his detailed drawings in plates and books — elaborate and delicate etchings charting the courses of arteries and veins, mapping nerves and lymph nodes. In some plates, he pulled away layers of tissue, exposing the delicate surgical planes underneath. In another drawing, he sliced through the brain in deft horizontal sections — a human CT scanner, centuries before its time — to demonstrate the relationship between the cisterns and the ventricles.”

‘A shiver down the hospital’s spine’

In addition to letting us see people, places and things, analogy can also let readers know what something feels like. In this passage, Mukherjee makes emotion tactile through metaphor:

“The arrival of a patient with acute leukemia still sends a shiver down the hospital’s spine — all the way from the cancer wards on its upper floors to the clinical laboratories buried deep in the basement.”

Note how Mukherjee syncs to the subject, elegantly plucking this analogy from the world of medicine and placing it in an emotional landscape:

“In those ten indescribably poignant and difficult months, dozens of patients in my care had died. I felt I was slowly becoming inured to the deaths and the desolation — vaccinated against the constant emotional brunt.”

‘One-eighth the cost of a half gallon of milk’

Comparison is also a great tool for taking the “numb” out of numbers, or making statistics more relevant and interesting. In this passage, Mukherjee’s comparisons dwarf the funds raised for cancer research:

“In the fast-growing, fast-consuming world of medical research in 1948, the $231,000 raised by the Jimmy Fund was an impressive, but still modest sum — enough to build a few floors of a new building in Boston, but far from enough to build a national scientific edifice against cancer. In comparison, in 1944, the Manhattan Project spent $100 million every month at the Oak Ridge site. In 1948, Americans spent more than $126 million on Coca-Cola alone.”

And in this one, he demonstrates how affordable a once-precious medicine became:

“Penicillin, that precious chemical that had to be milked to its last droplet during World War II (in 1939, the drug was reextracted from the urine of patients who had been treated with it to conserve every last molecule), was by the early fifties being produced in thousand-gallon vats. In 1942, when Merck had shipped out its first batch of penicillin — a mere five and a half grams of the drug — that amount had represented half of the entire stock of the antibiotic in America. A decade later, penicillin was being mass-produced so effectively that its price had sunk to four cents for a dose, one-eighth the cost of a half gallon of milk.”

‘More perfect versions of ourselves’

Because they compel attention, metaphors add power to your points. In this passage, analogy drives home the point that Mukherjee’s impressive training left him ill equipped for his cancer fellowship:

“There were seven such cancer fellows at this hospital. On paper, we seemed like a formidable force: graduates of five medical schools and four teaching hospitals, sixty-six years of medical and scientific training, and twelve postgraduate degrees among us. But none of those years or degrees could possibly have prepared us for this training program. Medical school, internship, and residency had been physically and emotionally grueling, but the first months of the fellowship flicked away those memories as if all of that had been child’s play, the kindergarten of medical training.”

I know that cancer cells spread quickly. But this analogy makes me think about cell division in a new light:

“Cancer cells grow faster, adapt better. They are more perfect versions of ourselves.”

Mukherjee’s analogy here makes a point beyond familiar hospital gown jokes:

“… a patient’s smock (a tragicomically cruel costume, no less blighting than a prisoner’s jumpsuit) …”

This metaphor makes leukemia vivid …

“Leukemia was a malignant proliferation of white cells in the blood. It was cancer in a molten, liquid form.”

… as this one makes its destruction clear:

“A monster more insatiable than the guillotine …”

‘Convenience stores for the medieval anatomist’

Sometimes Mukherjee’s analogies are just good for a laugh:

“The gibbet and the graveyard — the convenience stores for the medieval anatomist …”

‘The king of terrors’

Several of Emperor’s analogies come from medicine itself. Doctors and researchers developed them as they saw or experienced things they’d never seen or experienced before.

Mukherjee passes them on so the reader, too, can see or experience them in passages like this:

“In 1898, … an Austrian pathologist, Carl Sternberg, was looking through a microscope at a patient’s glands when he found a peculiar series of cells staring back at him: giant, disorganized cells with cleaved, bilobed nuclei — ‘owl’s eyes,’ as he described them, glaring sullenly out from the forests of lymph. Hodgkin’s anatomy had reached its final cellular resolution. These owl’s-eye cells were malignant lymphocytes, lymph cells that had turned cancerous. Hodgkin’s disease was a cancer of the lymph glands — a lymphoma.”

And this:

“Blood tests performed by Carla’s doctor had revealed that her red cell count was critically low, less than a third of normal. Instead of normal white cells, her blood was packed with millions of large, malignant white cells — blasts, in the vocabulary of cancer.”

Finally, of course, the title of the book itself is an analogy. For it, Mukherjee quotes a note a 19th-century surgeon once scribbled about cancer in a book’s frontispiece: “the emperor of all maladies, the king of terrors.”

How can you use metaphor to clarify complex concepts?

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