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Between Two Kingdoms and the Leukemia Memoir That Doesn't End at Remission
Suleika Jaouad's memoir Between Two Kingdoms tracks her leukemia diagnosis and treatment — and the real medicine behind the story of survival after cancer.
Original commentary from the Cancer Explained editorial team.
Please note: this page is educational only — it is not medical advice, and it does not speculate about anyone’s health beyond reliable public reporting. For questions about your own health, talk with your healthcare team.
Suleika Jaouad was 22. She had just graduated from college and was living in Paris. Persistent exhaustion and unexplained itching sent her to a doctor. 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. Treatment often needs to start within days of diagnosis. Jaouad describes induction chemotherapy, long hospital stays, and eventually a bone marrow, or stem cell, transplant. This matches standard treatment for high-risk AML in young adults. Doctors use intensive chemotherapy first, to bring on remission. Then, if the risk of relapse is high enough, they follow with a transplant. Donor stem cells rebuild a functioning immune and blood-forming system.
Her account of survival odds also matches real prognosis data. Outcomes for AML vary widely. It depends on age, the leukemia's genetic subtype, and how the disease responds to the first treatment. A diagnosis with 30-40% survival odds is a real and serious statistic for some AML subtypes, especially in the past. 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 consistently 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. Most cases are not linked to lifestyle factors you can change. Known risk factors include prior chemotherapy or radiation exposure, certain genetic conditions, and exposure to some industrial chemicals. 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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Put the story in context
Prevention, possible warning signs, screening, and diagnosis
This story relates to leukemia. The information below is general: it does not reveal anything else about a public person’s health, and not every point applies to every cancer. Personal advice depends on age, symptoms, family history, exposures, and medical history.
Prevention and risk reduction
Not every cancer can be prevented. Avoiding tobacco, protecting skin from ultraviolet radiation, limiting alcohol, staying active, and receiving recommended HPV or hepatitis B vaccination can lower the risk of certain cancers. A risk factor is not a prediction or a cause in one individual.
Symptoms and possible early signs
Possible signs vary and are often caused by conditions other than cancer. Changes worth discussing include a new lump, unexplained bleeding or weight loss, a persistent cough, lasting bowel or bladder changes, a changing skin spot, or symptoms that persist or worsen. Some early cancers cause no symptoms.
Screening and early detection
Screening looks for certain cancers before symptoms begin. Recommended tests exist only for some cancers and depend on age and risk. Screening can have benefits and harms; it is not the same as evaluating a new symptom, and there is no single routine scan or blood test that reliably screens for every cancer.
How cancer is diagnosed
Diagnosis may involve a history and exam, imaging, laboratory tests, and often a biopsy. Pathology can identify the cancer type and may test biomarkers that guide treatment. Symptoms, screening results, tumor markers, or online stories alone cannot confirm cancer.
Learn about this story’s cancer topic
A public story may encourage questions, but it should not be used to estimate your risk or choose testing. Contact a healthcare professional about a persistent or concerning change. Seek urgent care for severe or rapidly worsening symptoms.