WHEN BLOOD BREAKS DOWN

Three patient stories illuminate the “malignant golem” of leukemia.

“People are both terrified and fascinated by leukemia in all its forms,” writes Sekeres, the director of the Leukemia Program at the celebrated Cleveland Clinic. “It is a monster…that grows out of control and invades the organs within our own bodies. It is metastatic at its genesis.” The events described are real, but the accounts are composites drawn from the author’s patients. Joan is a 48-year-old surgical nurse; David, a 68-year-old retired factory worker; Sarah, a 36-year-old pregnant woman. Each has a different type of leukemia, but their symptoms all reflect the uncontrolled growth of cells in bone marrow, which contains the cells that give rise to the red blood cells that carry oxygen, the white blood cells that are part of our immune system, and the platelets that aid in blood clotting. When the white cell progenitors become cancerous, they proliferate rapidly, crowding out red blood cells and platelets. However, the white cells do not mature, remaining functionless. Consequently, leukemia patients become anemic from lacking red blood cells, risk internal bleeding from loss of platelets, and suffer from a weakened immune system, making them prone to infection. Standard chemo treatment to kill the cancerous cells comes with side effects such as hair loss, skin rashes, nausea, and vomiting. What makes this narrative so compelling is the author’s ability to bring readers with him on his rounds as he meets each patient and family member, discusses treatment options, and follows them through weeks of treatment, reviewing lab results and bone marrow biopsies, and, when necessary, discussing next steps such as bone marrow transplants. These plot points, in addition to an epilogue, allow Sekeres to review leukemia research, including immunotherapy and the potential for more personalized therapies targeting specific genetic abnormalities. Nevertheless, leukemias remain among the most complex and difficult-to-resolve cancers, with no obvious causes and often brutalizing treatments.

That three patient narratives should prove so effective a lesson is a tribute to Sekeres as both storyteller and physician.