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an ode to joy, marginalia from the emperor of all maladies

This is the sixth piece for interrobang, ?!, our arts+culture+????? column. A film review was first, odes to joy: sanna wani second, odes to joy: alfabet/alphabet by s. de meijer third, followed fourth by a thank you note to a transit bus driver., and aunt jay pitter.

Context: Been a long time since I’ve written regularly in public in a way that is serious, sincere, and specific. The following post is part of a collection called odes of joy. We (me, myself, and I) are lucky to love a lot of people. Unfortunately this leads us open to heartbreaking diagnoses such as cancer. Lost track a long time ago of how many people I love who have died, battled, are battling, will battle some form of cancer. The younger, I believe, was 11/12 years old. The oldest I cannot recall. These are some marginalia I pulled from my second reading of Siddhartha Mukherjee's book on cancer, The Emperor of All Maladies.

Consider listening to Medicine by Daughter.

A short contextual piece:

One way to think about the world we live in is to think of it as a cancer. That is what capitalism and/or colonialism is. There is no finish line to extraction. The economy needs to keep expanding. The universe too. Attending an event at Aligarh Muslim University, in support of the conditions of rickshaw cyclists, the journalist P. Sainath (whom I ran into in Antigonish, Nova Scotia years later) said that the uninhibited behaviour of growth. Of not knowing when, how, ___ to stop, well this is the behaviour of cancer.

These are the parts that stuck out for me from the re-read a few years ago:

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. +Susan Sontag, Illness as Metaphor (via The Emperor of All Maladies, Siddhartha Mukherjee)

I had a novice's hunger for history, but also a novice's inability to envision it. +The Emperor of All Maladies, Siddhartha Mukherjee

In solving a problem of this sort, the grand thing is to be able to reason backwards. That is a very useful accomplishment, and a very easy one, but people do not practice it much. +Sherlock Holmes, A Study in Scarlet (via The Emperor of All Maladies, Siddhartha Mukherjee)

In the mid-1870s, Halsted passed an entrance examination to be a surgical intern at Bellecue, a New York City hospital swarming with surgical patients. He split his time between the medical school and the surgical clinic, traveling several miles across New York between Bellecue and Columbia. Understandably, by the time he had finished medical school, he had already suffered a mental breakdown. He recuperated for a few weeks on Block Island, then, dusting himself off, resumed his studies with just as much energy and verve. This pattern - heroic, Olympian exertion to the brink of physical impossibility, often followed by a near collapse - was to become a hallmark of Halsted's approach to nearly every challenge. It would leave an equally distinct mark on his approach to surgery, surgical education - and cancer. +The Emperor of All Maladies, Siddhartha Mukherjee

Cancer, even when it begins locally, is inevitably waiting to explode out of its confinement. ... It was a "systemic" illness, just as Galen had once made it out to be. +The Emperor of All Maladies, Siddhartha Mukherjee

Etymologically, patient means sufferer. It is not suffering as such that is most deeply feared but suffering that degrades. +Illness as Metaphor, Susan Sontag (via The Emperor of All Maladies, Siddhartha Mukherjee)

Perhaps there is only one cardinal sin: impatience. Because of impatience we were driven out of Paradise, because of impatience we cannot return. +Franz Kafka (via The Emperor of All Maladies, Siddhartha Mukherjee)

Li had stumbled on a deep and fundamental principle of oncology: cancer needed to be systematically treated long after every visible sign of it had vanished. +The Emperor of All Maladies, Siddhartha Mukherjee

Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing. +Voltaire (via The Emperor of All Maladies, Siddhartha Mukherjee)

I am not opposed to optimism, but I am fearful of the kind that comes from self-delusion. +Marvin Davis, in the New England Journal of Medicine (via The Emperor of All Maladies, Siddhartha Mukherjee)

"Doing 'relevant' research is not necessarily doing 'good' research," Watson would later write. "In particular we must reject the notion that we will be lucky. ... Instead we will be witnessing a massive expansion of well-intentioned mediocrity." +The Emperor of All Maladies, Siddhartha Mukherjee

  1. Self-sufficiency in growth signals
  2. Insensitivity to growth-inhibitory (antigrowth) signals
  3. Evasion of programmed cell death (apoptosis)
  4. Limitless replicative potential
  5. Sustained angiogenesis
  6. Tissue invasion and metastasis
    +The Emperor of All Maladies, Siddhartha Mukherjee

In Ersilia, to establish the relationships that sustain the city's life, inhabitants stretch strings from the corners of the houses, white or black or gray or black-and-white according to whether they mark a relationship of blood, of trade, authority, agency. When the strings become so numerous that you can no longer pass among them, the inhabitants leave: the houses are dismantled. +Invisible Cities, Italo Calvino (via The Emperor of All Maladies, Siddhartha Mukherjee)

In Lewis Carroll's poem, when the hunters finally capture the deceptive Snark, it reveals itself not to be a foreign beast, but one of the human hunters sent to trap it. And so it had turned out with cancer. Cancer genes came from within the human genome. Indeed the Greeks had been peculiar prescient yet again in their use of the term oncos. Cancer was intrinsically "loaded" in our genome, awaiting activation. We were destined to carry this fatal burden in our genes - our own genetic "oncos". +The Emperor of All Maladies, Siddhartha Mukherjee

"Well, in our country," said Alice, still panting a little, "you'd generally get to somewhere else - if you ran very fast for a long time, as we've been doing."
"A slow sort of country!" said the Queen. "Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!"
+The Emperor of All Maladies, Siddhartha Mukherjee

The success of Apollo 11 may have dramatically affected the Laskerites' own view of their project, but, more important perhaps, it created an equally seismic shift in the public perception of science. That cancer could be conquered, just as the moon had been conquered, was scarcely a matter of doubt. The Laskerites coined a phrase to describe this analogy. They called it a "moon shot" for cancer.+The Emperor of All Maladies, Siddhartha Mukherjee

Quick question:

ps. Would a support group be helpful? I keep meaning to put one together.

Additional Reading:

The Median Isn't The Message, Stephen Jay Gould How Doctors Die, Emily Wilson

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