Between Two Kingdoms and the Leukemia Memoir That Doesn't End at Remission

Suleika Jaouad was 22. She had just graduated from college and was living in Paris. The diagnosis was acute myeloid leukemia, a fast-moving blood cancer. Doctors told her she had roughly a 35% chance of survival. Her 2021 memoir, "Between Two Kingdoms," follows her life from that diagnosis. It covers years of chemotherapy and a bone marrow transplant. Then, in the book's most unusual move, it keeps going. Most cancer stories end on the day a patient is declared cancer-free. This one keeps going past that point.

The title borrows an idea from the writer Susan Sontag. Everyone holds "dual citizenship" in the kingdom of the well and the kingdom of the sick, Sontag wrote. We move between the two more often than either side likes to admit. Jaouad built her book from journals, medical records, and letters she kept during treatment. It spends as much time on rebuilding a life afterward as it does on the illness itself. That afterward is often disorienting.

What's medically accurate

Acute myeloid leukemia (AML) is a cancer of the blood and bone marrow. Abnormal white blood cells crowd out healthy blood cell production. It progresses quickly. NCI says AML should be treated right away. Jaouad describes chemotherapy, long hospital stays, and eventually a bone marrow, or stem cell, transplant. Doctors use chemotherapy first, to bring on remission. After remission, a stem cell transplant is an option. Donor stem cells rebuild a functioning immune and blood-forming system.

Outcomes for AML vary widely. They depend on age, the leukemia's subtype, and how the disease responds to treatment. Her description of post-transplant complications also rings true. So does her account of the long, uneven road to physical and psychological recovery. Survivorship research shows the same thing: finishing treatment is not the same as returning to normal. Many survivors describe the adjustment period as its own kind of ordeal.

What the story gets wrong or simplifies

Jaouad's memoir is honest about her own case. But AML is not one single disease. It includes many genetic subtypes, with very different outlooks and treatment approaches. One patient's odds and treatment course cannot stand in for "leukemia" as a whole category. Readers should be careful here. Don't treat any single survival percentage from a memoir as typical of leukemia outcomes in general.

Her leukemia also returned more than once after the book's publication. This is a reminder. A memoir captures one moment in an ongoing medical story, not a permanent resolution. This doesn't make the book less honest. It actually reinforces its central point: recovery from serious cancer rarely has one clean finish line.

Signs and symptoms

AML symptoms often develop over weeks. They can include fatigue, pale skin, easy bruising or bleeding, frequent infections, fever, and bone or joint pain. Abnormal blood cell production causes all of this. It crowds out normal red cells, platelets, and infection-fighting white cells. These symptoms overlap heavily with much more common, far less serious conditions, from viral infections to iron deficiency. So having them is not a reason to assume leukemia. But if these symptoms are persistent or getting worse, get a blood test.

Prevention and screening

Unlike some cancers, there is no routine screening test for leukemia in the general population. Known risk factors include prior chemotherapy or radiation, smoking, certain genetic conditions, and benzene. But many cases happen with no identifiable cause at all. Since there's no screening test, the most practical tool is awareness. Notice unusual, persistent blood-related symptoms, and follow up on them quickly.

Supporting real cancer information

Memoirs like Jaouad's give language to an experience that statistics alone can't capture. But they work best alongside solid, current medical information. Groups like the National Cancer Information Foundation work to keep that kind of information free and accessible. That helps patients navigating a new diagnosis, wherever they are in their own story.

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

Cancer Explained is published by the National Cancer Information Foundation. It is not medical advice and does not suggest a test or treatment.

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