Saturday, April 22, 2017

The Emperor of All Maladies: A Biography of Cancer

Contrary to what alarmist clickbait articles say, our species had coexisted with cancer since our emergence.  At its roots, cancer is a copying error, and the older we get, the more likely we are to accumulate enough errors to knock out the safeguards against our cells' uncontrolled growth.  It's such a terrifying disease, eating the patient from within and leaving strange growths, that doctors would hide the diagnosis from their patients.  We've declared war on cancer and have to wonder whether cancer has won.

Siddhartha Murkerjee alternates between telling the overall history of cancer with a chronicle of his fellowship year at Dana Farber Cancer Institute.  The first great leaps in treatment didn't come from a doctor who focused on patient care but from Sidney Farber, a pathologist who with the help of antifolates formulated by chemist Yella Subbarow, managed to induce brief remissions in his young leukemia patients.  He'd only postponed the inevitable by a few months, but from there doctors moved onto drug combos and eventually to modern chemotherapy.  That, in turn, led to battles between the surgeons and chemotherapists, neither believing the other was in the right and both more concerned at times with killing the disease than saving the patient.  In the aftermath of AIDS activism, patients stood up and fought for more responsive care - less disfiguring surgeries, drug dosages correlated to cure the disease and spare healthy cells, and palliative treatments.

Murkerjee doesn't neglect prevention.  The first recognized environmental cancer was scrotal cancer in chimney sweeps.  Naked young boys were sent into the tight shafts and many developed a cancer almost unheard of in the general population.  Strangely, that explains why the link between smoking and lung cancer didn't jump out at researchers in the 1950s - smoking was so common that it threw off the signal-to-noise ratio.  Researchers linked chronic inflammation to some cancers, leading to a fall in liver cancer with the advent of hepatitis vaccines and in stomach cancer with better sanitation and the antibiotic treatment of ulcers.  I remember as a child hearing about the search for cancer vaccines, and while that hasn't panned out, less than a decade of vaccination against HPV is already causing a decline in the incidence of cervical cancer.  There's also secondary prevention, like mammograms and colonoscopies which find cancers early when they're more treatable.  With the identification of oncogenes, researchers are developing treatments which can turn off those genes, stopping tumor growth without harming surrounding tissues.  

Periodically, Murkerjee brings us back to 2004 and the cancer wards at Dana Farber.  We see patients struggle through treatment.  Some survive and some don't, and occasionally the patient comforts the doctor who has to say, "There are no more options."  He opens and closes the book with one patient, 30-year-old kindergarten teacher Carla Reed.  Her fatigue, odd bruises, headaches, and bleeding gums  were symptoms of acute leukemia, and Muurkerjee's intake notes say that she'll probably die during treatment.  Six years later, he visits her with flowers - not on a gravesite, but at her suburban house where they drink tea and discuss her treatment while her children and dogs play in the garden.  At 5 years, her remission can be considered a cure.

Friday, April 21, 2017

Eliza's Daughter

What happened to Eliza Williams after Willoughby seduced and abandoned her?  Joan Aiken's literary fan fiction answers that question.  Eliza Williams grew up in Byblow Bottom, fostered by  mercenary and neglectful Hannah Welcome and surrounded by illegitimate offspring allowed to run wild.  Fosters also cared for legitimate children, particularly rich ones, until they were out of toddlerhood.  Hannah Welcome's daughter fostered Therese Wexford, at least until she tried to sell the baby to a gypsy band.  Eliza rescued the child and became the frail, developmentally delayed (the child had spent her first two years barely spoken to or touched) girl's companion.

When the Therese's father, the local squire, dies in a riding accident, Eliza contacts Colonel Brandon's attorney with the request to attend school.  She never meets Brandon (he's rejoined the army and Marianne has left Delaford with him), but Eliza does stay briefly with poverty-stricken Elinor and Edward Ferrars before leaving for the Bath school their daughter Nell attends.  Lodging with a barely respectable relative of Elinor's, Eliza prepares for life as a governess or music teacher (the best that an illegitimate girl with polydactyly can hope) and has begun her career at 17 when fighting off an attempted gang rape leads to her disgrace.  From there she travels to London (staying in a millinery-brothel), comes under the protection of her late mother's last (and good-hearted) protector, and reunites with Therese an her mother in Portugal.

As a novel, Eliza's Daughter is entertaining if a bit too reliant on coincidence.  As Austen fanfic, it's just wrong.  Like The Private Diary of Mr. Darcy, the characters aren't consistent with Austen's.  Colonel Brandon would not abandon Eliza to Byblow Bottom.  She may have been Willoughby's daughter, but she was also the granddaughter of Brandon's first love.   Eliza's life would have been like Harriet Smith's - sent to a respectable school where she'd hope to marry a respectable man, maybe even one of Mr. Gardiner's sons.  I can't see Marianne as a bitter woman who'd punish Willoughby's daughter either, and even Fanny Price at her worst wasn't as priggish as Aiken's interpretation of Edward Ferrars.  Overall, I found Eliza's Daughter compelling, but frustrating.

Friday, April 14, 2017

Raiders of the Nile

We know before we open Raiders of the Nile how it will end.  Steven Saylor has gone back to Gordianus's youth in Alexandria, so we know he will survive any danger.  Maybe that's why we first see Gordianus breaking into Alexander's tomb and hours from the end of his adventure.

Our generally honest (but at this point still somewhat naive) hero ended up joining a pirate band while searching for Bethesda.  On his 22nd birthday, they'd met a mime troupe whose female member  could pass for Bethesda's sister.  Axiothea is also under the protection of a local criminal lord, and mistaken identity leads to Bethesda's capture.  The professional finder and solver of mysteries can't find his slave (and lover, and eventual wife), until Tafhapy shows him a ransom note - The Cuckoo's Nest had taken Bethesda in place of Axiothea.  A night of gambling at a disreputable inn leads to mass murder, and a contrived but entertaining series of events brings Gordianus into the Cuckoo's lair.  Accepted as a full member, Gordianus finds himself back in Alexandria where Saylor hastily ties together the plot threads.  It's far from his best mystery, but a highly entertaining novel.