The Emperor of all Maladies

names1In the weekly team meetings at my hospice, we print a list of patients.

Everything on these stapled pages is confidential: the patient’s name, age, patient’s doctor, date of entry into hospice care, clinical staff assigned to the patient, and their disease.

I will tell you this. The names blur. Because I’ve lived in this community for several decades, I’ll occasionally recognize a name. But usually not, since there are nearly 2,000,000 residents in the region my hospice covers. Every week, scores of patients appear on the spreadsheet, some newly admitted, some served by our staff for weeks and months, and even—more rarely—for over a year.

But I study their names. I try to remember each is a gift. I try to remember they are brothers, aunts, fathers, grandmas, best friends, moms, bosses, colleagues, and children. My hospice has cared for members of street gangs. We have cared for the rich and famous. Are they that different? Ralph Waldo Emerson bluntly wrote, “Sorrow makes us all children again – destroys all differences of intellect. The wisest know nothing.”

The diseases that maim, wreck, and kill these people stun me. If the patients’ names inevitably blur, as if observed through the windows of a train speeding from a station, the ways of dying are even more stupefying. With the diseases, it’s like the levees protecting New Orleans during Hurricane Katrina’s fury have broken, spilling a floodwater of names.

Cancer is the worst disease.

How many cancers are there? Legion.

Last week, I grasped the stapled papers, outwardly steady, inwardly trembling (I try to appear as a calm professional in these calm, professional meetings), and gazed at an odd, unknown cancer. I’d never heard it mentioned. Never in a headline. Never in a book or article. But there it was, in black font against a white background. There it was, using the common letters of the English language. There it was, a word I might be able to pronounce, but would have no idea what I was saying . . .

Supra glottis neoplasm.

Neoplasm was familiar. It’s another word for cancer. Is “neoplasm” on our weekly lists because it’s a more accurate description of the disease, or because “cancer” is too mundane or too depressing?

I don’t know.

I considered asking the nurse beside me about supra glottis, but I like to limit how often I appear stupid about medical terminology. Later, Googling at home, I learned the supra glottis is the upper part of the larynx . . . the vocal cords. It’s where the precious oxygen we precious humans need for breathing—for living—passes through on its journey to the lungs. And those same vocal cords—the supra glottis—are what makes humans remarkably unique in all of creation. We speak different languages. We whisper words. We mutter curses. We woo and coo and tell sweet lies and bitter truths. We ask questions. We answer questions. We have accents. We sing. We scream. Some even yodel.

How wondrous breath is! How wondrous that words can be spoken and shared. How dare a cancer invade and ruin this part of the body. Or any part.

emperor-of-maladiesIn Siddhartha Mukherjee’s exhaustive, insightful 2011 book, The Emperor of All Maladies, A Biography of Cancer, he wrote . . .

“In 2010, about six hundred thousand Americans, and more than 7 million humans around the world, will die of cancer. In the United States, one in three women and one in two men will develop cancer during their lifetime. A quarter of all American deaths, and about 15 percent of all deaths worldwide, will be attributed to cancer. In some nations, cancer will surpass heart disease to become the most common cause of death.”

In his work, Mukherjee emphasized how many different types of cancers exist. I’m old enough to recall the 1971 National Cancer Act, the so-called “war” on cancer. Back then we vowed to fight and cure cancer . . . as if it were a solitary foe, an enemy that could be identified and then, like Hitler in Berlin or Bin Laden in Pakistan, we could launch an elite “army” of scientists to eradicate the horrible beast.

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Cancer stuns me. Even the known and pronounceable names are staggering; they do seem a floodwater of misery . . .

Cancer is not one thing. It is endless Bin Ladens, a legion of similar but unique manifestations of misery. Mukherjee writes, “All cancers are alike but they are alike in a unique way.”

In the weekly patient lists, I usually discover (and am dismayed by) another new name for cancer. There is, Mukherjee wrote, a kind of irony to all of these cancers assaulting our bodies: “Down to their innate molecular core, cancer cells are hyperactive, survival-endowed, scrappy, fecund, inventive copies of ourselves.”

Perversely, cancer mimics you and me.

Aren’t you and I hyperactive, survival-endowed, scrappy, fecund, and inventive?

Cancer stuns me. Even the known and pronounceable names are staggering; they do seem a floodwater of misery. But then I look at the names of the people. Precious. Later, because it’s my job at hospice, I will call many of the folks grieving the death of a loved one on the weekly list. We try to support these families during their time of bereavement. Whether their loved one was a gang member or famous, or more likely just another average hyperactive, survival-endowed fellow human, I don’t ask them to tell me the story of the cancer. If given the opportunity, I will ask them to tell me a little bit about their precious beloved.

Maybe someday there will be a cure for cancer, and the disease that is legion will only be a history lesson. Maybe. But today, there is someone grieving a person whose name and story and love is unique. What can you or I do, as “scrappy and inventive” humans, to help them honor and remember the name and life of their loved one?

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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