Cancer lends itself to the realms of myth.
Siddhartha Mukherjee gave the disease some regal treatment in the title of his prize-winning book "The Emperor of All Maladies," but cancer's no emperor. It's a beast.
Where actual mythological monsters are concerned, cancer is like the Hydra instead of the Kraken -- it isn't the latter's strength that suits it, it's the Hydra's horrible ability to multiply its heads each time a hero strikes it with a sword.
Or, in another mythic sphere, it possesses the dark intelligence of Tolkien's Sauron, always looming in places where one fears to find it the most.
That's why the simple title of a new collection of essays about cancer,
"Malignant: Medical Ethicists Confront Cancer"
edited by Rebecca Dresser (
Press: 236 pp., $32.95), was so resonant to me that I couldn't resist picking it up. What frontiers of philosophy would the book engage? Why was that ominous single word chosen for the title?
When you think about it, it's extraordinary that this particular M-word -- whose etymology is partly rooted in references to malice, witches and the followers of the Anti-christ (ecclesiam malignantum) -- is routinely applied to a mass of cells that refuse signals to implode and just keep on growing.
At one time, I thought such language was a bit silly and too extravagant -- until I saw what cancer did to my father and one of my sisters. Then, I understood. And from that time on, no other word seemed better suited than this one usually equated with the Devil and his minions.
The contributors to Dresser's book once existed in a world like mine, an intellectually curious but hopelessly ignorant one. Though I'm a layman, these writers have all spent much of their professional lives in the worlds of
. They have confronted this illness on a constant basis, and yet the stories they tell show that they didn't fully grasp cancer's effect on a patient -- not just physically, but on every level -- until they themselves were diagnosed.
His post as a professor of medical ethics at Harvard University didn't give Dan W. Brock a privileged position when he was diagnosed with
. He turned -- like anyone -- to the Internet and to friends for insight. The debate over use of the PSA test -- to test or not to test? -- troubled him as he weighed his options, and his experience leads him to a firm point that may seem obvious or enlightening depending on your health experiences. Doctors don't know very much.
"Most patients are unaware of the uncertainties they will face," Brock explains. ""Few members of the general public appreciate the uncertainty that doctors confront in medical practice."
That uncertainty is no better illustrated than in the essay "Diagnostic Quests and Accidents," in which Norman Fost, director of the University of Wisconsin's bioethics program, describes how mistakes in the diagnostic stage have affected many patients, including two contributors to this book: Arthur Frank (his doctor thought he had
) and Dresser (an ache in her ear and mouth didn't seem unusual to her regular doctor). Not only do such mistakes delay the right treatments, they instill a lot of frustration and disappointment.
"Their experiences with cancer diagnosis left [them] feeling betrayed," Fost writes. "Their slow paths to diagnosis left [them] painfully aware of their vulnerability "
"Malignant" is a helpful, thoughtfully assembled book, and its selection of contributors is esteemed and impressive. Much of what they offer provides an unexpected angle -- such as Franks' discussion of how support groups foster a powerful feeling of belonging that can help with healing. But the book also presents much that you may have heard before.
That's not a bad thing. I was just expecting that trained ethicists would somehow raise this situation to even greater philosophical heights to help readers and patients see the disease in a fresh way.
But that's probably why we have poets. When I first encountered "Malignant," I also found Stanley Plumly's new
"Orphan Hours: Poems"
(W.W. Norton: $25.95), which includes the poem "Cancer," featured in the Times book pages a few weeks ago. Consider the majestic opening lines:
Mine, I know, started at a distance
five hundred and twenty light-years away
and fell as stardust into my sleeping mouth,
yesterday, at birth, or that time when I was ten
lying on my back looking up at the cluster
called the Beehive or by its other name
in the constellation Cancer
In thinking about what the disease does to patients and their families, I wanted something more ennobling -- not of the cancer itself, like the Mukherjee title does -- but that reminds every patient what an incredible creation he or she is and how to see their experiences, just for a moment, in a far more transcendent way. I was craving some starlight.
* * The mention of Sauron above points this column in an entirely different direction. It's better in almost every case to spend your time reading a story instead of what a critic has to say about it (and, well, the irony of saying this hasn't been lost on me). But there are exceptions to every rule, as in the case of J.R.R. Tolkien. Tom Shippey's writings on the creator of Middle-earth are always superb and enjoyable, and so are those by Verlyn Flieger, a professor of English at the University of Maryland, whose new essay collection is
"Green Suns and Faerie: Essays on Tolkien"
(Kent State University Press: $24.95)
Her essays show us how the great Oxford don and myth-weaver's stories all fit together like facets of the same diamond. Flieger's collection shows immense breadth and depth as she considers how different stories interact with each other (how, for instance, his "Unfinished Tales" relate to "The Silmarillion;" how Tolkien's elves and fairies relate to the ones in traditional myth) and how they complement larger realms of myth, especially Tolkien's love-hate relationship with Arthurian legend.
Interested in an evocative, succinct parallel between the worlds of King Arthur and Bilbo Baggins'? All you need is in the following:
"For all his Odin-like trappings of staff and hat, and his predilection for wandering, Tolkien's Gandalf out-Merlins Merlin, and indeed has cast his own retroactive shadow over that most famous of wizards. Frodo's final wounding by his shadow-nemesis Gollum recalls Arthur's wounding by Mordred in the last battle. The maimed Frodo's departure oversea from Middle-earth to be healed in Valinor explicitly echoes the wounded Arthur's departure by barge to be healed in Avalon. And Sam's bewildered protest at Frodo's decision to leave the Shire…are strongly reminiscent of the last exchange between the despairing Bedivere and his departing king."
Whether you accept the parallels or not, what Flieger shows here and elsewhere (along with the tantalizing information that a long poem by Tolkien, "The Fall of Arthur," is in his son Christopher's possession) is that no myth exists in a vacuum. It overlaps with other myths like an enormous web -- which makes the reading experience even more satisfying and intriguing.