How Cancer Acquired Its Own Biographer

By CHARLES McGRATH

In Dr. Siddhartha Mukherjee’s lab, a Stanley Kubrick-like space at the Herbert Irving Comprehensive Cancer Center at Columbia University, enormous white freezers with digital temperature readouts keep tissue at 80 below zero. Sterile work stations with transparent hoods and bacteria-scattering blowers emit an unearthly blue light. And there is a bountiful supply of mice that, thanks to the addition of a jellyfish gene, literally glow either red or green in the dark.

Chang W. Lee/The New York Times

Dr. Siddhartha Mukherjee in his lab at the Herbert Irving Comprehensive Cancer Center.

Under the microscope, their blood-forming stem cells, a particular interest of Dr. Mukherjee’s right now, shine like tiny Christmas lights. Just recently, he said, he and his team had discovered what may be a new mutation associated with the precancerous condition myelodysplasia.

“Cell culture is a little like gardening,” he added. “You sit and you look at cells, and then you see something and say, ‘You know, that doesn’t look right.’ “

Dr. Mukherjee, an oncologist and assistant professor of medicine at Columbia, known as Sid by his friends, is married to the MacArthur award-winning artist Sarah Sze and looks less like a scientist than like the leading man in a Bollywood musical. He belongs to that breed of physicians, rapidly multiplying these days, who also have literary DNA in their genome, and his first book, “The Emperor of All Maladies: A Biography of Cancer,” comes out from Scribner on Nov. 16.

The book tells the stories of several cancer patients, and also of heroic researchers like Sidney Farber, who pioneered the treatment of childhood leukemia. But its main character, as the subtitle suggests, is the disease itself as it has been diagnosed, treated and thought about over the last 4,000 years.

In the early 1950s, Dr. Mukherjee points out in the book, cancer was still considered so unmentionable that a woman seeking to place an advertisement in The New York Times for a support group was told that the paper could not print either the word “breast” or the word “cancer.” How about “diseases of the chest wall,” an editor helpfully suggested. Then, a few decades later, cancer was in the public limelight, thought to be virtually curable if we just waged sufficient “war” against it.

What we understand now, thanks to advances in cell biology, Dr. Mukherjee writes, is that cancer is normalcy of a sort. Cancer cells are “hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves,” he says, and adds: “We can rid ourselves of cancer, then, only as much as we can rid ourselves of the processes in our physiology that depend on growth — aging, regeneration, healing, reproduction.”

Dr. Mukherjee grew up in New Delhi; his father was a manager for Mitsubishi, and his mother had been a schoolteacher. He went to a Roman Catholic school there, where he was required to learn by heart a staggering amount of poetry, but attended college at Stanford, which he chose mostly because some cousins lived in California. After studying immunology at Oxford on a Rhodes scholarship, he went to Harvard Medical School.

By the time he got there, Dr. Mukherjee had pretty much decided to specialize in oncology, but the experience of actually encountering patients was transforming. “All of a sudden it’s as if the world had turned,” he said. “Everything suddenly becomes real, and your emotional responses become hyper-acute.”

And it was because of a patient, he added, that he began to write “The Emperor of All Maladies.” “I was having a conversation with a patient who had stomach cancer,” he recalled, “and she said, ‘I’m willing to go on fighting, but I need to know what it is that I’m battling.’ It was an embarrassing moment. I couldn’t answer her, and I couldn’t point her to a book that would. Answering her question — that was the urgency that drove me, really. The book was written because it wasn’t there.”

He wrote most of it in bed, propped up on pillows, and by mastering what he called the “art of full indiscipline.”

“Instead of saying, ‘I’ll get up every day at 5:30’ or, ‘I’ll write from 9 to 12,’ I did the complete opposite,” he said. “I said: ‘I will write during the day for 5 minutes, 10 minutes, whatever. I’ll write in stretches until the book is done.”

“The Emperor of All Maladies” (which Dr. Mukherjee adapted into an article for The New York Times Magazine last month) employs a complicated structure, looping around in time, juggling several themes at once and toggling between scientific discussions and stories of people, and yet Dr. Mukherjee says he wrote it in pretty much linear fashion from start to finish, without moving things around. He was influenced by both Richard Rhodes’s study “The Making of the Atomic Bomb” and Randy Shilts’s “And the Band Played On,” each a big book about a historical moment, but his real breakthrough came, he said, when he conceived of his book as a biography.

“I began wondering, can one really write a biography of an illness?” he said. “But I found myself thinking of cancer as this character that has lived for 4,000 years, and I wanted to know what was its birth, what is its mind, its personality, its psyche?” At times in the book he even personifies the illness, talking about its “saturnine” quality, its “moody, volcanic unpredictability.”