THE FIRST CELL

And the Human Costs of Pursuing Cancer to the Last

By Azra Raza

Throughout my career as a neurosurgeon, I have worked closely with oncologists. Many of my patients have cancer of the brain — one of the deadliest of the near-infinite number of cancers. I have always viewed my oncological colleagues with complicated, contradictory feelings. On the one hand, I’m in awe of their work, which can be so emotionally demanding. On the other, I suspect they don’t always know when to stop.

There’s an old joke in medical circles: “Why should you never give an oncologist a screwdriver?” The answer: “Because they will open the coffin and carry on treating the patient.”

Azra Raza, an oncologist at Columbia University, vividly illustrates this tug-of-war in her book “The First Cell: And the Human Costs of Pursuing Cancer to the Last.” It is, in many ways, a cry of protest against the disease that killed her husband (also an oncologist) and, over time, most of her patients. When it comes to cancer, Raza knows firsthand how hard it is to reconcile compassion with science and hope with realism.

She asks hard questions: “Why are we so afraid to tell the stories of the majority who die? Why keep promoting the positive anecdote? Why all this mollycoddling?” She says the time has come to think about the “ghastly toxicities of therapies” that often achieve so little. And she intersperses an impassioned argument about the ineffectiveness of current cancer medicine — at least for most patients with metastatic disease — with descriptions of the suffering of her husband and some of her patients (who are identified by first name, with photographs). By describing this suffering, Raza says, she hopes to jolt people into looking for a new paradigm in the so-called war on cancer.