ዬ Early reader series ጬ ePUB Author Siddhartha Mukherjee ፴ The Emperor of all Maladies Prologue Diseases desperate grown By desperate appliance are relieved, Or not at all William Shakespeare, Hamlet 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 June Goodfield On the morning of May 19, 2004, Carla Reed, a thirty year old kindergarten teacher from Ipswich, Massachusetts, a mother of three young children, woke up in bed with a headache Not just any headache, she would recall later, but a sort of numbness in my head The kind of numbness that instantly tells you that something is terribly wrong Something had been terribly wrong for nearly a month Late in April, Carla had discovered a few bruises on her back They had suddenly appeared one morning, like strange stigmata, then grown and vanished over the next month, leaving large map shaped marks on her back Almost indiscernibly, her gums had begun to turn white By early May, Carla, a vivacious, energetic woman accustomed to spending hours in the classroom chasing down five and six year olds, could barely walk up a flight of stairs Some mornings, exhausted and unable to stand up, she crawled down the hallways of her house on all fours to get from one room to another She slept fitfully for twelve or fourteen hours a day, then woke up feeling so overwhelmingly tired that she needed to haul herself back to the couch again to sleep Carla and her husband saw a general physician and a nurse twice during those four weeks, but she returned each time with no tests and without a diagnosis Ghostly pains appeared and disappeared in her bones The doctor fumbled about for some explanation Perhaps it was a migraine, she suggested, and asked Carla to try some aspirin The aspirin simply worsened the bleeding in Carlas white gums Outgoing, gregarious, and ebullient, Carla was puzzled than worried about her waxing and waning illness She had never been seriously ill in her life The hospital was an abstract place for her she had never met or consulted a medical specialist, let alone an oncologist She imagined and concocted various causes to explain her symptomsoverwork, depression, dyspepsia, neuroses, insomnia But in the end, something visceral arose inside hera seventh sensethat told Carla something acute and catastrophic was brewing within her body On the afternoon of May 19, Carla dropped her three children with a neighbor and drove herself back to the clinic, demanding to have some blood tests Her doctor ordered a routine test to check her blood counts As the technician drew a tube of blood from her vein, he looked closely at the bloods color, obviously intrigued Watery, pale, and dilute, the liquid that welled out of Carlas veins hardly resembled blood Carla waited the rest of the day without any news At a fish market the next morning, she received a call We need to draw some blood again, the nurse from the clinic said When should I come Carla asked, planning her hectic day She remembers looking up at the clock on the wall A half pound steak of salmon was warming in her shopping basket, threatening to spoil if she left it out too long In the end, commonplace particulars make up Carlas memories of illness the clock, the car pool, the children, a tube of pale blood, a missed shower, the fish in the sun, the tightening tone of a voice on the phone Carla cannot recall much of what the nurse said, only a general sense of urgency Come now, she thinks the nurse said Come now I heard about Carlas case at seven oclock on the morning of May 21, on a train speeding between Kendall Square and Charles Street in Boston The sentence that flickered on my beeper had the staccato and deadpan force of a true medical emergency Carla Reed New patient with leukemia 14th Floor Please see as soon as you arrive As the train shot out of a long, dark tunnel, the glass towers of the Massachusetts General Hospital suddenly loomed into view, and I could see the windows of the fourteenth floor rooms Carla, I guessed, was sitting in one of those rooms by herself, terrifyingly alone Outside the room, a buzz of frantic activity had probably begun Tubes of blood were shuttling between the ward and the laboratories on the second floor Nurses were moving about with specimens, interns collecting data for morning reports, alarms beeping, pages being sent out Somewhere in the depths of the hospital, a microscope was flickering on, with the cells in Carlas blood coming into focus under its lens I can feel relatively certain about all of this because the arrival of a patient with acute leukemia still sends a shiver down the hospitals spineall the way from the cancer wards on its upper floors to the clinical laboratories buried deep in the basement Leukemia is cancer of the white blood cellscancer in one of its most explosive, violent incarnations As one nurse on the wards often liked to remind her patients, with this disease even a paper cut is an emergency For an oncologist in training, too, leukemia represents a special incarnation of cancer Its pace, its acuity, its breathtaking, inexorable arc of growth forces rapid, often drastic decisions it is terrifying to experience, terrifying to observe, and terrifying to treat The body invaded by leukemia is pushed to its brittle physiological limitevery system, heart, lung, blood, working at the knife edge of its performance The nurses filled me in on the gaps in the story Blood tests performed by Carlas 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 cellsblasts, in the vocabulary of cancer Her doctor, having finally stumbled upon the real diagnosis, had sent her to the Massachusetts General Hospital In the long, bare hall outside Carlas room, in the antiseptic gleam of the floor just mopped with diluted bleach, I ran through the list of tests that would be needed on her blood and mentally rehearsed the conversation I would have with her There was, I noted ruefully, something rehearsed and robotic even about my sympathy This was the tenth month of my fellowship in oncologya two year immersive medical program to train cancer specialistsand I felt as if I had gravitated to my lowest point 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 desolationvaccinated against the constant emotional brunt 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 childs play, the kindergarten of medical training Cancer was an all consuming presence in our lives It invaded our imaginations it occupied our memories it infiltrated every conversation, every thought And if we, as physicians, found ourselves immersed in cancer, then our patients found their lives virtually obliterated by the disease In Aleksandr Solzhenitsyns novel Cancer Ward, Pavel Nikolayevich Rusanov, a youthful Russian in his midforties, discovers that he has a tumor in his neck and is immediately whisked away into a cancer ward in some nameless hospital in the frigid north The diagnosis of cancernot the disease, but the mere stigma of its presencebecomes a death sentence for Rusanov The illness strips him of his identity It dresses him in a patients smock a tragicomically cruel costume, no less blighting than a prisoners jumpsuit and assumes absolute control of his actions To be diagnosed with cancer, Rusanov discovers, is to enter a borderless medical gulag, a state even invasive and paralyzing than the one that he has left behind Solzhenitsyn may have intended his absurdly totalitarian cancer hospital to parallel the absurdly totalitarian state outside it, yet when I once asked a woman with invasive cervical cancer about the parallel, she said sardonically, Unfortunately, I did not need any metaphors to read the book The cancer ward was my confining state, my prison As a doctor learning to tend cancer patients, I had only a partial glimpse of this confinement But even skirting its periphery, I could still feel its powerthe dense, insistent gravitational tug that pulls everything and everyone into the orbit of cancer A colleague, freshly out of his fellowship, pulled me aside on my first week to offer some advice Its called an immersive training program, he said, lowering his voice But by immersive, they really mean drowning Dont let it work its way into everything you do Have a life outside the hospital Youll need it, or youll get swallowed But it was impossible not to be swallowed In the parking lot of the hospital, a chilly, concrete box lit by neon floodlights, I spent the end of every evening after rounds in stunned incoherence, the car radio crackling vacantly in the background, as I compulsively tried to reconstruct the events of the day The stories of my patients consumed me, and the decisions that I made haunted me Was it worthwhile continuing yet another round of chemotherapy on a sixty six year old pharmacist with lung cancer who had failed all other drugs Was is better to try a tested and potent combination of drugs on a twenty six year old woman with Hodgkins disease and risk losing her fertility, or to choose a experimental combination that might spare it Should a Spanish speaking mother of three with colon cancer be enrolled in a new clinical trial when she can barely read the formal and inscrutable language of the consent forms Immersed in the day to day management of cancer, I could only see the lives and fates of my patients played out in color saturated detail, like a television with the contrast turned too high I could not pan back from the screen I knew instinctively that these experiences were part of a much larger battle against cancer, but its contours lay far outside my reach I had a novices hunger for history, but also a novices inability to envision it But as I emerged from the strange desolation of those two fellowship years, the questions about the larger story of cancer emerged with urgency How old is cancer What are the roots of our battle against this disease Or, as patients often asked me Where are we in the war on cancer How did we get here Is there an end Can this war even be won This book grew out of the attempt to answer these questions I delved into the history of cancer to give shape to the shape shifting illness that I was confronting I used the past to explain the present The isolation and rage of a thirty six year old woman with stage III breast cancer had ancient echoes in Atossa, the Persian queen who swaddled her diseased breast in cloth to hide it and then, in a fit of nihilistic and prescient fury, possibly had a slave cut it off with a knife A patients desire to amputate her stomach, ridden with cancersparing nothing, as she put it to mecarried the memory of the perfection obsessed nineteenth century surgeon William Halsted, who had chiseled away at cancer with larger and disfiguring surgeries, all in the hopes that cutting would mean curing Roiling underneath these medical, cultural, and metaphorical interceptions of cancer over the centuries was the biological understanding of the illnessan understanding that had morphed, often radically, from decade to decade Cancer, we now know, is a disease caused by the uncontrolled growth of a single cell This growth is unleashed by mutationschanges in DNA that specifically affect genes that incite unlimited cell growth In a normal cell, powerful genetic circuits regulate cell division and cell death In a cancer cell, these circuits have been broken, unleashing a cell that cannot stop growing That this seemingly simple mechanismcell growth without barrierscan lie at the heart of this grotesque and multifaceted illness is a testament to the unfathomable power of cell growth Cell division allows us as organisms to grow, to adapt, to recover, to repairto live And distorted and unleashed, it allows cancer cells to grow, to flourish, to adapt, to recover, and to repairto live at the cost of our living Cancer cells can grow faster, adapt better They are perfect versions of ourselves The secret to battling cancer, then, is to find means to prevent these mutations from occurring in susceptible cells, or to find means to eliminate the mutated cells without compromising normal growth The conciseness of that statement belies the enormity of the task Malignant growth and normal growth are so genetically intertwined that unbraiding the two might be one of the most significant scientific challenges faced by our species Cancer is built into our genomes the genes that unmoor normal cell division are not foreign to our bodies, but rather mutated, distorted versions of the very genes that perform vital cellular functions And cancer is imprinted in our society as we extend our life span as a species, we inevitably unleash malignant growth mutations in cancer genes accumulate with aging cancer is thus intrinsically related to age If we seek immortality, then so, too, in a rather perverse sense, does the cancer cell How, precisely, a future generation might learn to separate the entwined strands of normal growth from malignant growth remains a mystery The universe, the twentieth century biologist J B S Haldane liked to say, is not only queerer than we suppose, but queerer than we can supposeand so is the trajectory of science But this much is certain the story, however it plays out, will contain indelible kernels of the past It will be a story of inventiveness, resilience, and perseverance against what one writer called the most relentless and insidious enemy among human diseases But it will also be a story of hubris, arrogance, paternalism, misperception, false hope, and hype, all leveraged against an illness that was just three decades ago widely touted as being curable within a few years In the bare hospital room ventilated by sterilized air, Carla was fighting her own war on cancer When I arrived, she was sitting with peculiar calm on her bed, a schoolteacher jotting notes But what notes she would later recall I just wrote and rewrote the same thoughts Her mother, red eyed and tearful, just off an overnight flight, burst into the room and then sat silently in a chair by the window, rocking forcefully The din of activity around Carla had become almost a blur nurses shuttling fluids in and out, interns donning masks and gowns, antibiotics being hung on IV poles to be dripped into her veins I explained the situation as best I could Her day ahead would be full of tests, a hurtle from one lab to another I would draw a bone marrow sample More tests would be run by pathologists But the preliminary tests suggested that Carla had acute lymphoblastic leukemia It is one of the most common forms of cancer in children, but rare in adults And it isI paused here for emphasis, lifting my eyes upoften curable Curable Carla nodded at that word, her eyes sharpening Inevitable questions hung in the room How curable What were the chances that she would survive How long would the treatment take I laid out the odds Once the diagnosis had been confirmed, chemotherapy would begin immediately and last than one year Her chances of being cured were about 30 percent, a little less than one in three We spoke for an hour, perhaps longer It was now nine thirty in the morning The city below us had stirred fully awake The door shut behind me as I left, and a whoosh of air blew me outward and sealed Carla in.Its time to welcome a new star in the constellation of great writer doctors With this fat, enthralling, juicy, scholarly, wonderfully written history of cancer, Siddhartha Mukherjee vaults into that exalted company, inviting comparisons to Lewis Thomas and Stephen Jay Gould Washington PostIts hard to think of many books for a general audience that have rendered any area of modern science and technology with such intelligence, accessibility, and compassion The Emperor of All Maladies is an extraordinary achievement The New YorkerA compulsively readable, surprisingly uplifting and vivid tale O, the Oprah MagazineWith this riveting and moving book, Siddhartha Mukherjee joins the first rank of those rare doctor authors who can wield a pen as gracefully as a scalpel Jerome Groopman, Atul Gawande, Richard Selzer A magisterial, wise, and deeply human piece of writing Adam Hochschild, author of King Leopold s Ghost and Bury the ChainsAn elegant tour de force The Emperor of All Maladies reads like a novel but it deals with real people and real successes, as well as with the many false notions and false leads Not only will the book bring cancer research and cancer biology to the lay public, it will help attract young researchers to a field that is at once exciting and heart wrenching and important Donald Berry, Ph.D., Anderson Cancer Center, University of TexasSid Mukherjees book is a pleasure to read, if that is the right word Cancer today is widely regarded as the worst of all the diseases from which one might suffer if only because it is fast becoming the most common Dr Mukherjee explains how this perception came about, how cancer has been regarded across the years and what is now being done to treat its protean forms His book is the clearest account I have read on this subject With The Emperor of All Maladies, he joins that small fraternity of practicing doctors who can not just talk about their profession but write about it Tony Judt, author of Postwar and Ill Fares the Land Siddhartha Mukherjee has done something that should not have been possible he has managed, at once, to write an authoritative history of cancer for the general reader, while always keeping the experiences of cancer patients in his heart and in his narrative At once learned and skeptical, unsentimental and humane, The Emperor of all Maladies is that rarest of things a noble book David Rieff, author of Swimming in a Sea of Death The Emperor of All Maladies beautifully describes the nature of cancer from a patients perspective and how basic research has opened the door to understanding this disease Bert Vogelstein, Director, Ludwig Center at Johns Hopkins UniversityA labor of love as comprehensive as possible George Canellos, M.D., William Rosenberg Professor of Medicine, Harvard Medical SchoolRarely have the science and poetry of illness been so elegantly braided together as they are in this erudite, engrossing, kind book Mukherjee s clinical wisdom never erases the personal tragedies which are its occasion indeed, he locates with meticulous clarity and profound compassion the beautiful hope buried in cancer s ravages Andrew Solomon, National Book Award winning author of The Noonday Demon Emperor of Japan Wikipedia The Emperor is the head Imperial Family and state Under constitution, he defined as symbol State unity people Historically, was also highest authority Shinto religion In Japanese, called Tenn , literally heavenly sovereign Tarot Card Meanings Biddy Tarot Keywords Upright Authority, establishment, structure, a father figure Domination, excessive control, lack discipline, inflexibility p Description If Empress Mother archetype deck, Father The Mankind VS Battles Wiki FANDOM powered immortal ruling monarch Imperium Man, described by Ecclesiarchy Cult 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professor medicine Columbia University staff CU NYU Presbytarian Hospital Siddhartha Soon ll cure diseases with cell Current medical treatment boils down six words Have disease, take pill, kill something But points future that will transform way heal author All Maladies A Biography Cancer, winner Pulitzer Prize general nonfiction, Laws MedicineHe editor Best Science Writing Siddharth birth name founder Buddhism, Gautama Buddha film American based on novel same Hermann Hesse, directed Conrad RooksIt shot location Northern India, features work noted cinematographer Sven NykvistThe locations used were holy city Rishikesh private estates palaces Maharajah Bharatpur Must read science books years Business From discussions machine hybrids lost civilizations octopus brains, scientists writers have produced some amazing works nonfiction you TED Talk Subtitles Transcript This Cat Sensed Death What if Computers Could, Too Jan relapse appeared, full deluge Two months after left hospital, S returned see me sprays metastasis his liver, lungs and, unusually, bones CA BOOKS CA Books Online Asia Law House ca books, book, cabooks csbooks cma cabooksonline video lectures dvds scanners compilers cs chartered accountant ONLINE CPT IPC CS CMA Munish Bhandari Handbook Ethics Communication th edn aug incorporating companies act extent made applicable Find Doctor Kolkata Ruby General Hospital About Us Dr Kamal K Dutta Chairman first Non Resident Indian doctor hospitals Eastern India The Emperor of All Maladies eBook: Siddhartha Mukherjee: Amazon.fr: Amazon Media EU S.à r.l.
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- The Emperor of All Maladies eBook: Siddhartha Mukherjee: Amazon.fr: Amazon Media EU S.à r.l.
- Siddhartha Mukherjee
- 2016-04-25T17:42+02:00 Siddhartha Mukherjee