The Song of the Cell: An Exploration of Medicine and the New Human

by Siddhartha Mukherjee

When I went to meet Sam P. in the hospital, in May 2018, I was asked to wait outside. He was nauseated and excused himself to use the bathroom. He composed himself, and a nurse helped him back to bed. It was nearing twilight, and he turned a bed lamp on. He asked the nurse if we might speak alone. “It’s over, isn’t it?” he said, looking straight at my face, his brain boring a direct hole into the core of my brain. “Be honest,” he said. Was it really over? I mulled over the question. Here we had the strangest of cases—some of his tumors were responding to the immunotherapy, while others remained obdurately recalcitrant. And every time we increased the dose of the immune drugs, an autoimmune hepatitis—horror autotoxicus of the liver—would push us back. It was as if each individual, metastatic tumor had acquired its own program of rebirth and resistance, each battening down in its own niche in his body, each behaving as if it were an independent community of colonists trapped in its own island. We were fighting on multiple fronts at the same time—winning some, losing others. And every time we applied an evolutionary pressure on the cancer—an immunotherapeutic drug, say—some cell escaped the pressure and set up a new recalcitrant colony again. I told him the truth. “I don’t know,” I said. “And I will not know, right till the very end.”