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Emperor of All Maladies: A Biography of Cancer [Anglais] [Broché]

Siddhartha Mukherjee
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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 Carla’s white gums.

Outgoing, gregarious, and ebullient, Carla was more 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 symptoms—overwork, depression, dyspepsia, neuroses, insomnia. But in the end, something visceral arose inside her—a seventh sense—that 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 blood’s color, obviously intrigued. Watery, pale, and dilute, the liquid that welled out of Carla’s 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 Carla’s 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 Carla’s case at seven o’clock 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/14thFloor/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 Carla’s 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 hospital’s spine—all 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 cells—cancer 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 limit—every 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 Carla’s 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 cells—blasts, 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 Carla’s 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 oncology—a two-year immersive medical program to train cancer specialists—and 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 desolation—vaccinated 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 child’s 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 Solzhenitsyn’s novelCancer 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 cancer—not the disease, but the mere stigma of its presence—becomes a death sentence for Rusanov. The illness strips him of his identity. It dresses him in a patient’s smock (a tragicomically cruel costume, no less blighting than a prisoner’s 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 more 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 power—the 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. “It’s called an immersive training program,” he said, lowering his voice. “But by immersive, they really mean drowning. Don’t let it work its way into everything you do. Have a life outside the hospital. You’ll need it, or you’ll 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 co... --Ce texte fait référence à l'édition Relié .

Revue de presse

“It’s 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 Post

"It’s 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 Yorker

“A compulsively readable, surprisingly uplifting and vivid tale.”—O, the Oprah Magazine

"With 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 Chains

“An 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 Texas

“Sid Mukherjee’s 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 patient’s perspective and how basic research has opened the door to understanding this disease.” --Bert Vogelstein, Director, Ludwig Center at Johns Hopkins University

“A labor of love … as comprehensive as possible.”--George Canellos, M.D., William Rosenberg Professor of Medicine, Harvard Medical School

“Rarely 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 --Ce texte fait référence à l'édition Relié .

Biographie de l'auteur

Siddhartha Mukherjee is a cancer physician and researcher. His book The Emperor of All Maladies: A Biography of Cancer won the 2011 Pulitzer Prize in general non-fiction. Mukherjee is an assistant professor of medicine at Columbia University and a staff cancer physician at Columbia University Medical Center. A Rhodes scholar, he graduated from Stanford University, University of Oxford, Harvard Medical School. He has published articles in Nature, The New England Journal of MedicineThe New York Times, and The New Republic. He lives in New York with his wife and daughters.  --Ce texte fait référence à l'édition Relié .
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