Yet Boyer would refuse the heroism that description implies, as she refuses “the angel of epiphany” that readers want from “the story of cancer.” She’s right. We need writers of illness to challenge our fears and desires, what we want cancer’s excessive suffering and immoderate treatment to mean — how we want this horror to be redeemed by personal transcendence, something a pink ribbon could signify. “I have always hated every shade of the heroic, but that doesn’t mean I’ve never had that look,” she writes, then tries to show us how mortal suffering is common, how it’s exactly our shared condition, not something that lets us transcend commonality. She’s skeptical toward the specialness, the proof of individual worth, that illness stories often seem to express, even when this isn’t their writers’ intention. Illness is a means to know how very ordinary, not how extraordinary, we are:
The common struggle gets pushed through the sieve of what forms we have to make its account, and before you know it, the wide and shared suffering of this world is narrowed and gossamer, as thin as silk and looking as special as the language it takes to tell it. […]
But I was a single mother without savings who existed in a world of profit, had no partner to care for me or family nearby in a world that privatizes survival, had to work all through my treatment at a job where I was advised to never let on I was ill, had never had wealth or been proximate to the seats of power. In other words, my cancer, like almost anyone else’s, was ordinary, as was, apart from my practice of writing, my life.
In his foundational work on illness narratives, The Wounded Storyteller: Body, Illness, and Ethics, Arthur Frank describes and critiques the dynamics of what he calls the “restitution narrative.” In this familiar plot, a sick person gets well and is restored to society and to their social responsibilities. In this kind of storytelling, only your body and not your sense of self is affected by illness, and your role as sick person is passive: to entrust yourself to medical care (“ritual obedience,” Boyer calls such moments). Frank discusses how this type of narrative privileges medical institutions, with their “telos of cure.” But it excludes and betrays experiences of chronic illness and of suffering that’s not resolved by an illness’s supposed end — which, for many in the United States, as Boyer is aware, includes poverty: cancer presents a considerable threat to individuals’ and families’ economic health. “Bodies are realized — not just represented but created — in the stories they tell,” Frank asserts. Thus cultural narratives that suppress and deny your experiences of illness have very real effects. Frank looks for ways stories of illness can better serve “a remission society,” in which “the foreground and background of sickness and health constantly shade into one another.” Boyer isn’t engaging directly with Frank’s work (his isn’t among the many texts she cites), but his theoretical framework illuminates her ethics and the gift of this book.
For Boyer, illness is an opportunity to better know and critique the society in which she has fallen ill; her suffering is an opportunity to better know the suffering of others. This ethical project manifests in her book’s overall approach and in small choices such as her attention to the debilitating cognitive effects of chemotherapy. In oncology settings, this phenomenon is often frustratingly downplayed and called “chemo brain” — as if memory loss and cognitive impairment were kind of cute, something to tuck under a pink knit cap. Throughout, Boyer ferociously insists on comprehending her cancer in its radiating contexts of labor, class, race, gender, technology, environmental pollution, capitalism: the systems she must, in this moment of extreme vulnerability, recognize as constituting herself, her living and dying. In a state of life-threatening illness, subject to profound need for “medical colonization” (as Frank terms it), the body reveals the systems it has been enmeshed with all along. “Cancer mediates all,” Boyer says, attesting not just to the totalitarian presence of the disease in your life, but to how it lays bare your interdependence with the “all” of a world you didn’t choose any more than you chose your cancer.
Boyer records how her illness exposes this world’s workings: its injustices, inequities, and profit motives. This process of exposure is radical and radicalizing. In the ceaseless data-gathering about her ill body, for example, she sees the gendered divisions of labor through which she becomes “a patient made of information, produced by the work of women.” “Triple negative [breast cancer] strikes black women disproportionately,” she writes of her disease (she herself is white), “and because of medicine’s institutionalized racism, I think, has been the last breast cancer left with no targeted treatment. […] These women’s deaths are racist and unnecessary, and our grief over them should tear open the earth.”
When Boyer writes, “I would rather write nothing at all than propagandize for the world as it is,” she is pointing to the difficult — but not impossible — task of the writer of illness who wishes to refuse the trajectory of restitution, who does not want her restored health to restore her to social function and its ideologies, complicit again with a sickening world. “It sometimes feels more painful to talk about having cancer than to have it,” she writes of this hard formal challenge: to tell a story while resisting how the story wants to be told, how both audience and writer might want to be comforted by it, cared for by epiphanies that could redeem the story’s brutality. She notes how “the telling is always trying to slide down into a reinforcement of the conditions that made us want to say something in the first place, rather than their exposé.”
The nature of cancer compounds the difficulty of a writer/patient’s quest for alternative frameworks of meaning and forms of possibility. The writer may hope to serve social and health justice — to write in the voice of an alternative, anti-epiphanic, anti-propagandistic angel, one who never stops raging and mourning, scoring the earth on which she still stands. Yet as Boyer notes, “cancer’s near-criminal singularity means any work about it always resembles testimony.” Cancer is immanently common — extending from life’s processes of growth — yet its stories and treatments and outcomes individuate until they seem to defy solidarity.
This aspect of cancer may only be enhanced by the current rise of immunological cellular therapies. As a July 2019 New Yorker article by Siddhartha Mukherjee describes, such therapies are wildly promising and wildly expensive. Because they’re made from the cells of each patient, they can’t be mass-produced and are likely to cost millions per person treated. Thus they’re immediately implicated in the unequal distribution of resources we know well from “the world as it is.” On the prevention side, cancer’s causes are hard to definitively identify. There’s no one villain in stories like Boyer’s, no one source of pollution she or her doctors can point to. There’s just the usual vast shadowy system, in which the technologies that sicken and kill seem hard to distinguish from the technologies that heal and sustain (as Boyer notes, the world of tumorous bodies made legible on screens is also the world of drones targeting distant bodies onscreen). What exactly should we be resisting, healing, making anew? What new reality could we envision here? What should the disease that is cancer mean to us, whoever we are, whoever it makes us?
Boyer chooses to stay with the difficulty of such questions, to honor them by not resolving them, not restoring us into a state in which our hardest questions have been answered for us. We are left instead active, unresolved, pained. There is a natural arc to the first two-thirds of the book, which recount Boyer’s diagnosis, treatment, the time and perspective of illness, cultural exploitations and paradoxes and hoaxes of cancer, and reflections on the collectivity of breast cancer in particular. The final third of the book has a feeling of plateau — deliberately, I believe — and its thinking becomes more abstract. Boyer examines such subjects as pain, exhaustion, time, and what is shared about suffering. The narrative moves from the exigencies of crisis into the ambiguities of remission.
I thought of Boyer’s terrific 2015 book of poetry Garments Against Women, which complementarily examines gender, class, work, motherhood, art, and consumption, in vivid detail and global context. There’s a lush, witty, bejeweled quality to its writing. I think of those poems as facing inward in order to show the reader how the public is private — how the economic is known daily by a woman presenting herself, necessarily, to the world. The subject matter of The Undying is rawer, more intensely intimate, and here the writer tends to veil the private. The writing keeps directing our attention back outward: from the concrete to the abstract, from memoir to art and literary criticism, from the personal to processes of systematization. Friends and lovers are present in the book, but rarely identifiable or marked by detail (which feels like a form of care, a writer carefully minding the privacy of those who have cared for her). And so in the last third, the book’s thinking about survival happens in a largely philosophical mode. Perhaps we readers wish for this writer to speak more personally, to draw closer to us as her inquiry comes to an end. But I doubt we’re owed this. The writer’s withdrawal — her slow vanishing from the sickbed where she asked us to bear witness to her, looking back at the world from the brink of its abandonment — may be the right conclusion.
“Maybe suffering pain is not for nothing, or is for nothing-plus: pain’s education is an education in everything and a reminder of nothing’s all.” This is the horizon that this book leaves me facing, and I’m grateful. A writer has let me live for a time in this nearly impossible space, the threshold where we know meaning in relation to meaning’s loss, where we know meaning as this relation to everything’s loss. “It’s like the condition of lostness is, when it comes to being a person, what finally makes us real,” Boyer writes in the epilogue. Illness allows us (because it forces us) to live on this threshold, where we know how near we are to lostness, the place we all end up. The mercilessness of such a gift is that we hope never to endure it again, though we know we knew something there. Writing illness as Boyer does is a mercy: she invites us into this education in how everything breaks into nothing. The writer offers herself into this difficulty, and her readers receive what she’s learned of us. “To write only of oneself may be to write of death,” Boyer says (in an echo of Sontag), “but to write of death is to write of everyone.”
Hilary Plum is the author of the novel Strawberry Fields, the work of nonfiction Watchfires, and the novel They Dragged Them Through the Streets. She teaches at Cleveland State University and in the NEOMFA program and is associate director of the CSU Poetry Center.