I took two years of chemistry in high school and another semester in college, yet I don’t remember specifically learning about the concept of alchemy until I was much older. Like many pieces of information stored away in my brain, this concept has been married with a visual image because of various reading experiences I’ve had. The image, not surprisingly, is that of a crucible. Not Arthur Miller’s, but a simple vessel. And a flame. For me, alchemy relates to transformation with a touch of magic thrown in – white magic or dark magic or maybe even gray magic – because we don’t know who practices the magic. In my dance with cancer, alchemy is a process that takes place regularly in my body, whether I am aware of it or not.
When my children were younger, we had a picture book floating around the house called The Toy Brother by William Steig. We had many children’s books floating around the house – some we purchased for the kids, some the kids ordered from Scholastic flyers once they were in school, books they got from the public library and the elementary school library. Books their grandma gave them, books from a monthly book club their uncle enrolled them in. The Toy Brother must have been one of the latter. I liked William Steig as a cartoonist and a children’s author, but it would not have occurred to me to buy a book about alchemy (and this book came out several years before Steig’s Shrek became a household word after the movie was released). Yet there it was, floating between the bedrooms, between bookshelves. Set in medieval times, the book addresses the story of a young alchemist-in-training, Yorick, who illicitly conducts experiments with his father’s potions in the lab while his parents are away, shrinking himself into a very small person. To negotiate the world in the days before his parents return from their week-long trip, Yorick must rely on his younger brother Charles, whose intelligence and skill level he has not always valued.
I remember being a bit mystified by the medieval setting for the book’s story, although once my children began their elementary school classes and teachers talked about picture books in relation to stories that presented problems and offered solutions, I began to see how the world of alchemy could provide a vehicle for a story about family and acceptance, about sibling rivalry and role reversal, giving children the charm of the magical and unexpected, not unlike a Mickey Mouse Sorcerer’s Apprentice tale in Fantasia or the equivalent of body transformation in Disney’s Honey, I Shrunk the Kids.
In the spring of my junior year in high school, Mr. Johnson, my fearless leader for two years of chemistry, gave us the rules and procedures for our “Unknowns” project. We would receive two substances to identify, and the process of identifying both would provide a major grade for the semester. We would deal with one at a time, starting with a series of lab procedures that would help us narrow down the possibilities. At any point, we could make a guess, but that option of making a guess came at a cost. We only had two guesses per unknown substance. If we were wrong with our first guess, a “C” was the highest grade for which we could qualify for that substance determination. If we were wrong with our second guess, we would earn an “F” for that substance and would move on to the next one. Those of us who protected our 4.0 grade averages with a mixture of intellect and fret moved slowly and carefully through the rule-out laboratory tests, squelching any impulsive guesses.
All of Mr. Johnson’s 11th grade chemistry classes were going through the same process. But early in that process, we came to class one day to find a substitute teacher who broke the news that Mr. Johnson had suffered a heart attack and was hospitalized. Though we all loved and revered him, it was a well-known fact that he occasionally smoked in the storage room of chemicals behind his classroom. Probably none of us knew back then that smoking lead to heart disease. My sisters and I had harped at our mother for smoking for years, but we focused on the specter of cancer, not heart disease.
I don’t remember the name of that substitute teacher who took Mr. Johnson’s place while he was in the hospital. We were all glad he’d survived, and several of us went up to visit him, avoiding the subject of cigarettes and his heart, focusing instead on our unknowns. He was sober about his health but almost gleeful in revealing that he’d been working closely with the substitute, and the “Unknowns” project would go on without him.
The substitute ended up having a much softer touch than Mr. Johnson, and when I guessed wrong on my first try for one of my substances, she found a way to provide a few hints, not an answer, to lead me in the direction of which tests I might perform next so that I could avoid the consequences of two wrong guesses: an F for that substance.
I’m not sure what final grade I earned for the project; I believe I scored a “C,” doing well on one substance and bombing on the other. But I felt pride that I’d been a scientist during those weeks – that Mr. Johnson from afar and the compassionate sub who replaced him helped us to explore the glory, tedium, and capriciousness of the unknown, in all its power.
My relationship with chemistry ended a few years later. Although I’d taken Advanced Placement Chemistry during my senior year and thought hard about going into science, the small creative writing scholarship I received from the English Department at Michigan State University required me to declare an English major. I entertained the idea of a double major but found the prerequisite chemistry class I took during my freshman year hopelessly boring and confusing with no Mr. Johnson at the helm using trademark humor to enliven discussions of electron configurations, my least favorite aspect of chemistry; I was much more engaged in my English classes. Yet when I took the 1-credit lab class that accompanied the intro chemistry lecture, I became temporarily entranced again by the process of exploration, confident in my skills of recording and framing data, largely because of my high school experience.
Those who happen to give thought to alchemy might view it as a search for a process or substance to turn another substance or element into gold (the pursuit of wealth) or the search for an elixir or substance to provide eternal life (the search for immortality). Another version of alchemy presents the search for an element that is basic to all matter. I read Honoré de Balzac’s novel The Quest of the Absolute for an independent study project with my European history professor when I was a senior in college. I was perplexed by the main character, Balthazar, a man who allows his family to fall into a life of ruin because of his obsession with searching for the absolute element. His quest, a mission borne out of what appears to be a combination of genius and mania, represents a pursuit of scientific research at the expense of personal life. When I see the word “quest” and think of a quest fueled by passion and obsession, it is hard not to slip in the adjective “heroic” to modify “quest.” Yet are all alchemy quests automatically heroic? Balthazar’s quest uses scientific methods, methods which issue from the world of reason. Yet I think that I, the reader of the novel, had and still have some prejudice in favor of science. We do not know that the purpose behind Balthazar’s questing is heroic or even altruistic. Yet I, lover of literature and science, have somehow made an association in my brain; scientific questing is noble. Alchemy is noble, regardless of the results.
A few years after I received my undergraduate degree, I would finally have a chance to read Sinclair Lewis’s Arrowsmith, a Pulitzer-prize winning novel which came to my mind the first time I read The Toy Brother with my children and again years later when my friend Marie and her husband bought me a copy of The Emperor of all Maladies: A Biography of Cancer, Siddhartha Mukherjee’s book on cancer, and we talked about Arrowsmith. While much of medieval alchemy may have been about turning substances into gold, one of the branches of chemistry and scientific research that evolved from alchemy centered on the search for cures for well-known diseases. Lewis’s 20th century hero pursues a quest that can certainly be described as “meaningful,” “noble,” “purposeful,” and “heroic” in conventional terms. Martin Arrowsmith, Sinclair Lewis’s protagonist, spends a career deeply rooted in the worlds of scientific research and medicine, two intertwined worlds that become, for him, and many other as well, full of contradiction and tension, neither world giving him the satisfaction he desires. When he watches his wife die from the plague, a disease whose cure is almost in his wheelhouse, he sees the opposition at play between a world of pure research in which controls must be established and observed and a world of humanitarian medicine in which all patients have access to the cure, regardless of circumstance.
These writers – William Steig, Honoré de Balzac, and Sinclair Lewis – have brought this concept of alchemy into the present day for me, collapsing the time that has passed since I read their works, making the transformative nature of cancer and cancer-fighting agents a reality.
My body has become the crucible that carries and harbors the unknown. I don’t have the kind of long-term history of hospitalization or compromised health that would allow me to speak from experience, but I have had enough health experiences – from asthma as a child and adolescent, to long-term chronic depression, to four pregnancies, one ending in miscarriage, to my parents’ failing health and eventual deaths in their sixties — to know that what happens in the body is NOT predictable and invariably involves a great deal of alchemy, whether in the manifestation of disease or in the course of treatment.
The makers of the drug that I take for my stage IV lung cancer have been involved in this process of alchemy. Erlotinib, the drug more commercially recognized as Tarceva, gives hope to thousands of lung cancer patients each year. It offers extended life to approximately 15% of individuals whose cancer has the epidermal growth factor receptor (EGFR) mutation. Scientists and lab researchers have isolated the genetic markers within the cohort of EGFR mutants that make one person more likely to respond to the drug than another. Yet no one has been able to determine why one individual’s lung cancer can be “controlled” for five years without progression, while another’s cancer thwarts the drug’s action.
All drug companies are involved in this process of alchemy, and as much as each step of research is qualified and quantified through multiple trials and studies and eventual FDA approvals, with documented science about the cell’s reaction to the drug – it’s still not that much different from the medieval alchemy in William Steig’s The Toy Brother. Yorick has been shrunk. What do we do?
We have potions, but once they enter the body, they become part of that other branch of science – biology – and the chemicals transform the cells, and the cells transform the chemicals and something magical – sometimes awful, sometimes seemingly miraculous and good – happens. Regardless of the outcome, a bit of magic has been involved, magic we’ll never know or understand.
It is good that the researchers work so hard to bring their drugs to the public. It is good that the oncologists fight so hard to save those who have the disease. Yet the lines between research and marketing and profit-turning and life-saving become blurred. Are all of these quests noble? For now, at least, there are unknowns.
I try to understand. I get lost in the maze of PUBMED articles and the clinical trials on government websites, but I try to make sense of it all. I understand the EGFR mutation, and the EXON deletions, and the role of erlotinib (Tarceva) as a tyrosine kinase inhibiter. But beyond that, the world inside my body becomes murky, even as I read articles co-authored by my oncologist, Shirish Gadgeel, on MET/HGF pathway activation as a paradigm of resistance to targeted therapies.
I view the doctors and the drug makers as alchemists, and to be honest, I worry that I relinquish too much control to them as transformers. I see them as the agents of change. My body the crucible of transformation. It happens, there inside me, whether the cancer is growing or dying off, the Tarceva beating it down. Action occurring.
But what is my role in this activity? I cannot be passive and merely observe.
I am thankful for all of the alchemy that takes place as my cancer is kept at bay. But there are times when I fear the unknown that is happening in my body in the same way I might have feared the “C” or the “F” in those days of the “Unknowns” project, when we all had to search for the answer to our mysteries.
I want to be able to embrace my fear and transform it.
I want to wrest the test tube and the Bunsen burner from the doctors and researchers and lead the transformation myself.
If only to feel one last surge of power before I die.
Alchemy. Cancer. Reinvention. 