Without cancer we would never have evolution, and it's around the relationship between the two that US-based Irish oncologist Austin Duffy's first novel, This Living and Immortal Thing, revolves.

“There’s this awful paradox where underlying cancer is a process of genetic mutations and the biology of cancer is driven by that, but that’s also the process that underlies life as we know it, and evolution basically,” Duffy explains.

“There’s this horrible link between them; cancer is almost intrinsic to the human condition.”

Cancer is something Duffy is very familiar with. He moved to New York in 2006 after completing his oncology training in Ireland. He had won a fellowship, courtesy of a €200,000 scholarship programme, to take up a residency at one of the world's oldest and most renowned cancer centres, Memorial Sloan Kettering Cancer Centre, where he was undertaking innovative research surrounding gastro-intestinal cancers.

Confidence boost

Having won RTÉ’s Francis MacManus award for his short story

Orca

in 2011, he got a strong confidence boost and proceeded with his debut novel.

The protagonist in the book is also an Irish oncologist, though Duffy insists the book is entirely fiction. The character is working in a laboratory in a prestigious New York hospital, looking for a scientific breakthrough. He is dealing with his failing marriage to his wife who remained in Ireland when he moved, and struggling with increasing detachment from the world outside his lab.

“He’s separated, isolated and just a little bit bereft. He’s really gravitated towards this position where he works in an unusual environment, a laboratory, in a pretty high end academic centre . . . He’s hiding there a little bit and, on a basic level, the story is basically his emergence from that and kind of a re-engagement with life,” says Duffy.

The book begins describing in detail the treatment prescribed for Henrietta, and it is only soon after that it’s revealed that Henrietta is in fact a mouse in the lab. Henrietta’s progression with her cancer is followed as closely as other human patients and for good reason, Duffy says.

Strong link

“The role of the mice in the book is almost as a surrogate for the human role, just in a different situation. There is a parallel between the fates of Henrietta the mouse and the human patients.

“There’s a very strong link there, and the storylines, without giving away the plot, have a strong parallel from beginning to end. I was very aware of that and feeling empathetic towards the mice or the cell lines or whatever, is to express empathy for all situations,” he says.

Coming away from the book, sympathy with each of the characters is something Duffy hopes readers will feel, but not just for their plight, “the plight of all of us”, he says. “What I was trying to get at is that all these things that are happening in the book could happen to any of us and I hope it speaks more to the human condition and that people sense that.”

Duffy now works as a clinician in the National Cancer Institute in Washington, and his work is largely experimental. All the patients are on a clinical trial, trials that he has designed and drawn up protocols for, and he is their oncologist throughout.

Though his speciality remains gastro-intestinal cancers, his sub-speciality is pancreas and liver cancer, and he has been researching a relatively new area of immunotherapy as treatment.

“We’re getting the immune system involved in the fight against cancer,” he says. “The rationale is that the immune system is way more sophisticated and intelligent than any drug that we can design . . . There’s been extraordinary results they’ve been getting, mainly in melanoma but also in lung cancer and kidney cancer, where some of these immune-based approaches have been approved by the FDA. We’re trying to get it to work in pancreatic cancer and liver cancer. So far the process has been slow enough but there’s a great deal of optimism about that approach.”

Creative writing

While still living in New York, he began creative writing classes at the Writer’s Studio in the West Village in Manhattan. This was where he developed a habit of writing every morning, and he has continued since.

“It got me out of my own head and I just got into the habit of writing on a daily basis. It just sort of became part of life, the same way some people do running or yoga in the morning, but I wrote,” he says.

He’s just gotten a new study off the ground at the Cancer Institute and is actively accruing patients, after two years of work. He says this will keep him working in the US for the foreseeable future, but it hasn’t stopped him writing.

He’s now working on his second novel, but it definitely won’t be about cancer.

“I don’t want to be typecast as the doctor writer or, God forbid, the cancer doctor writer. I purposely made this different. Plus, I’ve done it, you can really write only one book about cancer,” he says.