Paste your essay in here…Jenny Zhao
Dr. Gunderman
H241: Cancer
4 March 2018
The Whole and the Part
For as long as humankind has been in existence, so has cancer. The extent to which cancer is part of the human experience is well-established throughout Emperor of All Maladies, in which Siddhartha Mukherjee combines the history of cancer and cancer treatment with stories from his present-day experience as an oncology fellow. However, although cancer is within us, coming out of our very own cells rather than from a foreign pathogen, cancer is treated like an enemy; "war" has been declared on cancer, and common sayings are that someone is "fighting" cancer, "beat" cancer, or "lost" to cancer. This theme of trying to understand cancer, outsmart it, and eradicate it parallels an almost paradoxical theme of treating cancer as completely separate from the cancer patient in terms of research, but being unable to separate a patient from their cancer when treating the actual patient because of how pervasive the disease is.
To begin, Mukherjee gives a quote from June Goodfield: "Cancer begins and ends with people. In the midst of scientific abstraction, it is sometimes possible to forget this one basic fact. . . Doctors treat diseases, but they also treat people, and this precondition of their professional existence sometimes pulls them in two directions at once" (Mukherjee 1). This quote encapsulates the seemingly opposite directions of treating the disease versus the person; yet, with cancer, the disease takes over almost every aspect of the patient's life, so the treating the disease and the person may be in the same direction rather than two. Along with this quote, Carla Reed, one of Mukherjee's patients diagnosed with and eventually cured of cancer, is introduced, and she plays an important role throughout the text in the continuing theme of how to treat both cancer and the cancer patient. Thus, the prologue to the biography shows a very human side of cancer. Although Carla's medical symptoms and diagnosis are discussed, they are mentioned in conjunction with Carla as a person-how the cancer manifests itself not only in her body but in her day-to-day living. As a clinician, Mukherjee's personal voice is especially evident in the introduction; the "stories" of his patients consumes him, and he writes that he was immersed in the day-to-day management of the lives and eventual fates of his cancer patients (Mukherjee 5).
Conversely, once the explanation of the history of cancer begins, there is a shift in tone as Mukherjee moves from discussing his personal experience with treating cancer to the historical background of cancer research. The first major section of the book outlines the gradual emergence of cancer in medical texts throughout human history as well as the first cancer treatments, from Imhotep's description of cancer description of "bulging masses" with no treatment to Bennett's description of cancer as a "suppuration of blood." Eventually, the biography moves on to Sidney Farber's antifolates, the beginning of a long line of chemical treatments for cancer. In the discussion of the history of cancer as a disease, it is described as an entity separate from the person, with the doctors and researchers treating cancer without fully understanding why it appeared in the first place. Especially in the early days of clinical drug trials for cancer, there was little regulation for what the researchers could do to the test subjects. For instance, Farber began injecting children with drugs almost as soon as he received them; although it was often the last resort for the children, and retrospectively the drugs did work, Farber obsessively searched for a way to treat cancer, recording "every blood count, every transfusion, every fever" as if the children were more test subjects than once-lively children (Mukherjee 35). To gain more public support and funding, a human side had to be shown amidst the hard science, so "Jimmy" and his story were fabricated out of Einar Gustafson, a model child for cancer, which shows that although the humanity of cancer is generally well accepted, researchers treat patients' individual lives as irrelevant in comparison to the entire race to find a cure for cancer-Jimmy was "marketed" in order to fundraise for the research efforts (Mukherjee 99). Although Farber cared to some extent for "his children" and their families as individuals, he was still driven by the cancer cure that continued to elude him (Mukherjee 103). This theme is also especially evident in Mike Nichol's Wit, a film in which one of the main characters is a clinical researcher who clearly sees his patient as a subject containing cancer rather than a holistic person.
Similarly, when William Halsted treated his patients, his radical mastectomies focused purely on the disease, but cut away from the patient as much as it did from the cancer: in order to remove the cancer, many women were left permanently disfigured, and Halstead "accepted all these consequences as if they were the inevitable war wounds in an all-out battle" (Mukherjee 65). From a philosophical standpoint, the war wounds may have been more detrimental than the actual war. One of Aristotle's foundational ideas-albeit in relation to politics-was "the whole must necessarily be prior to the part; since when the whole body is destroyed, foot or hand will not exist except in an equivocal sense. . . and all things are defined by their function and capacity, so that when they are no longer such as to perform their function they must not be said to be the same things, but to bear their names in an equivocal sense" (Aristotle). When radical mastectomies were performed, the surgeons were so focused on ridding the body of the cancer that the distinction between cancer and patient was widened, and as a result, the part took priority to the whole, perhaps leaving some of the women to just exist in an "equivocal" sense rather than returning to the people that they were before the cancer consumed them.
Throughout the book, Mukherjee goes back and forth between his clinical experience and the storied history of cancer research. Often, although the two are inextricably intertwined, the science and the patient seem juxtaposed. In between discussions of the search for carcinogens and oncogenes and the development of new cancer therapies such as Herceptin, Mukherjee interjects with stories of the patients he and his colleagues have treated or lost and updates on Carla's life. Ultimately, the biography ends as it began: with a patient, described in terms of both their disease and their person. Germaine, a woman with a rare gastrointestinal stromal tumor, exemplifies the paradox of viewing cancer both as an enemy that must be defeated and as something that becomes one with the patients. As Mukherjee writes, "the characteristics of Germaine's personality that had once seemed spontaneous and impulsive were, in fact, calculated and almost reflexive responses to her illness"; although Germaine is "trying to outwit" cancer, the cancer also has pervaded her personality and carefully controls her (Mukherjee 469-470). An Emperor of All Maladies gives a very comprehensive analysis of cancer's history from both scientific and human perspectives, and in doing so, highlights a fundamental theme that manifests itself not only medicine but philosophy and countless other facets of human existence-to focus on the part, or the whole.
 
Works Cited
Aristotle. Aristotle in 23 Volumes, Vol. 21, translated by H. Rackham. Cambridge, MA, Harvard University Press; London, William Heinemann Ltd. 1944.
Mukherjee, Siddhartha. Emperor of All Maladies. New York, Scribner. 2011.