A Biography of Cancer

So a friend encouraged me (translate: we were drinking and she made me take the book) to read The Emperor of All Maladies, by Siddhartha Mukherjee. "It's super good, and weirdly positive, even though it's about cancer and how much cancer sucks," she told me. I stuffed the book into my purse thinking I had a few other books to read first before I would tackle a long story about a depressing topic like Cancer.

But then today was rainy and cold so I looked at the three books in my queue, randomly picked up Mukherjee's, and started in. The introduction is a sad anecdote about a newly diagnosed patient and her journey into the world of Cancer - like the character Pavel Nikolayevich in Cancer Ward, she is placed in a world where "the illness strips [her] of [her] identity. It dresses [her] in a patient's smock assumes absolute control of [her] actions" (4).  As another patient related regarding that book, "unfortunately I did not need any metaphors to read the book, The cancer ward was my confining state, my prison" (4).

It was a rather bleak opening to the book, but the following chapters delve into the history of cancer, from a clear-cut description by Imhotep 4600 years ago, to the vague and completely wrong ideas of humors, to the incredible advances in the previously fatal childhood disease of leukemia. In other words, the book is a totally enthralling and surprisingly positive look on a horrible disease. I've only made it through part one, but so far it's an incredible read.

Unsurprisingly, it makes me think of all the patients I've taken care of who were diagnosed with cancer. One in particular stands out. She was in her late forties and I was her primary RN when she came in with shortness of breath, got a cardiac echo, and was given a diagnosis of "cardiac mass." A few months later, I took care of a woman who was dying of metastatic brain cancer who presented with uncontrolled seizures. I gave her meds for the seizures, pain, and nausea, repeatedly cleaned sweat and vomit off of her, and alternated between the nasal cannula and O2 mask so her husband could whisper comforting words to her without the deafening hiss of the mask. She passed away two hours later, her family having stated that they didn't want her to suffer and that she had wanted to die with dignity.

During the death process, I sat in the room and talked to the family. I asked them to tell me their favorite stories of the patient, and their hysterical accounts of her life kept me laughing through tears. Towards the end of the process, the husband asked my full name. After I told him, he got a quizzical look on his face and pulled out a little notebook of treatment dates, oncology phone numbers, and ER visit notes. He looked up, got teary eyed again, and told me that I was the same primary RN as the day she first came to the ER. I hadn't even recognized the patient. Cancer had ravaged her so badly that she was a totally different person to me; a new chief complaint, a new presentation, a new outcome.

It is a testament to both the horrors of cancer and the resiliency of the human spirit that I could spend a shift laughing while crying with a dying woman and her family and never once recognize her. This book has brought back all the feelings from the personal encounters I've had with the disease, and has once again made me evaluate how I can better care for my patients who have just been handed a diagnosis which puts them in such a confining state; a prison.