I’m Ill Here

The Undying: Pain, Vulnerability, Mortality, Medicine, Art, Time, Dreams, Data, Exhaustion, Cancer, and Care BY Anne Boyer. New York: Farrar, Straus and Giroux. 320 pages. $26.

“I was diagnosed with breast cancer in 2014, at the age of forty-one,” the poet Anne Boyer writes early in her panoramic, book-length essay The Undying. Elemental and unadorned, the sentence does not leap out for quotation, and in the context of a review of some other essay, some other book, summary would be adequate (“At the age of forty-one, the poet Anne Boyer . . .”). But in a story about breast cancer, the voice of the speaker is consequential and Boyer makes this plain when, in consulting other women writers who suffered from the disease, she observes whether or not they have used the first person. Audre Lorde, for example, in The Cancer Journals (1980), her cancer memoir avant la lettre, has. Susan Sontag, who wrote Illness as Metaphor (1978) while being treated for the disease, has not. Boyer remarks on these choices not to find fault with them but to stress that decisions regarding whether and how to write about breast cancer are among its many agonies. The disease, she tells us, presents as “a disordering question of form.”

Before the 1970s, the subject of breast cancer was all but taboo, the disease stigmatized. Written traces of the illness could be found mostly in medical narratives, where men (doctors) were the actors and women mere hosts to the drama’s antagonists (tumors, metastases). Those who had been diagnosed would scarcely utter “I” and “breast cancer” in the same sentence. Women said little on the subject in part because they were not asked to. They were also fearful: A stubborn, long-standing conviction branded the ill personally responsible for what ailed them. (This is, of course, in part the subject of Sontag’s book.) The medical treatment then most common, the radical mastectomy, was disfiguring and, what’s more, seemed not to influence the outcome of a diagnosis. Death from the disease was reputed to be stealthy—and terrifying.

It was into this void, this vacant room, that women began to speak: first in the columns of women’s magazines (Ladies’ Home Journal, McCall’s, and Vogue), then in the headlines of national newspapers; first lady Betty Ford’s candor about her diagnosis and radical mastectomy, in 1974, made front-page news. Over time, the pronoun “I” would become essential, its invocation seemingly sure to lead to awareness, early detection, fewer women falling ill—and to fewer women acquiescing to life-altering, unnecessary surgeries. The logic, empowering and intoxicating, was soon formalized into charities and fundraising events, among the first of these the Susan G. Komen Breast Cancer Foundation’s inaugural Race for the Cure in Dallas in 1983.

Today breast cancer is a brand, its logo a ribbon in pink, all cheer and optimism, its tagline some variation on “winning the war,” its donations amounting to some $6 billion each year. The once empty room is now crowded with a cacophonous swell of reminisced triumphs, combat metaphors, and self-help pieties. Although more than forty thousand women die each year in the United States from the set of diseases known as breast cancer, access to this room, as Boyer points out, is reserved for those recounting a hero’s journey—for “survivors” whose prefab dramas fixate on plot and character, circumscribing the kinds of emotions women with breast cancer can express and eliding the world in which they take place. When Boyer writes “I was diagnosed with breast cancer,” she realizes that she risks reproducing the contrived sentimentalities common to the narrative form—and being drowned out by the same. “That sentence with its ‘I’ and its ‘breast cancer’ enters into an ‘awareness’ that becomes a dangerous ubiquity,” she goes on. Whereas once the threat to the cure for breast cancer was silence, now it is “the din of breast cancer’s extraordinary production of language.”

Kiki Kogelnik, Female Robot, 1964, acrylic, India ink, and enamel on paper, 28 3⁄4 × 21 5⁄8". © Kiki Kogelnik Foundation

She writes the sentence anyway. If silence is no longer the threat, Boyer understands, it is also not worthy of nostalgia. We learn that she is a single mother on a tight budget with a steady job teaching at a college for art and design in Kansas City. She finds a lump in her breast. She is diagnosed with triple negative breast cancer, so called because her tumor has none of the three types of receptor known to fuel most breast cancers. This also means it has no targeted treatment options. (About 10 to 20 percent of breast cancers are triple negative, but they account “for a disproportionate number of breast cancer deaths.”) Her tumor is growing at a rate greater than four times the threshold for what is considered “highly aggressive.” Her odds of survival, she learns using an online prognostic calculator, are a little higher than 50 percent. She begins a common treatment called “dense-dose AC” chemotherapy. Her tumor does not shrink. She reads studies, advocates for herself, changes doctors. She begins a controversial chemo treatment believed to be effective for her specific cancer subtype. Her tumor shrinks. She undergoes a double mastectomy. She returns to work. She is pronounced free of the disease.

Boyer chooses to write about her experiences in the first person, but she also offers a caveat—“I would rather write nothing at all than propagandize for the world as is”—and transforms her reluctant “I” into a kind of transgression. She refuses to write in the cheery, pink-ribbon style, to use the word struggle, to praise the medical establishment for the treatment advances it has made. She devotes a chapter to her education in pain, another to exhaustion. She speaks of corpses and of death. The Undying is an examination of how to write (or not) about breast cancer and at the same time an elegant, devastating example of such writing. These questions—about what writing is for, and whether, from within our debased social and economic relations, we are better served by embracing or refusing it—have preoccupied Boyer throughout her work, including her collections of poetry, memoir, and short prose essays Garments Against Women (2015) and A Handbook of Disappointed Fate (2018). In The Undying, Boyer resumes the self-reflexive, episodic style she explored in her previous books, only now with a more explicitly narrative form. She tells us that her chemotherapy infusions take place at a “pavilion” where doctors have no permanent stations and the sick are “kept in maximum circulation at a maximum rate” for “maximum profit.” She tells us that the A in AC is for Adriamycin, a liquid so corrosive “it is rumored, if spilled, to melt the linoleum on a clinic floor”; that the C is for cyclophosphamide, a “medicalized form” of the same mustard gas “outlawed as a weapon in 1925”; that as the infusion begins, her brain’s mitochondria will begin to die, the damage often sustained for years. She loses her hair and her eyelashes, her vigor and her fertility; her fingernails and toenails lift from their beds and fall off. Her friends disappear, her lovers abscond—and those who stay to tend to her do so in “stolen slivers of time” because, in the United States, “if you are loved outside the enclosure of family, the law doesn’t care how deeply,” and no one will be guaranteed leave from work to take care of you. We learn that her double mastectomy is considered an outpatient procedure, that she is evicted from the recovery ward soon after a nurse wakes her from the anesthesia, four drainage bags hanging from her torso; that she returns to work ten days later, even as she can’t use her arms, can’t carry her books; that she has worked all through her treatment at a job where she is “advised to never let on” she is ill.

These are details a woman with breast cancer is supposed to share only to say how strong she has been to overcome them. To linger in the grammar of pain or anger or sorrow, in the bleak syntax of one’s illness, risks summoning “a chorus of people, many of whom have never had cancer, accusing her of ingratitude, saying she is lucky, warning her that her bad attitude might kill her, reminding her she could be dead.” These impositions, Boyer explains, arrive as diktats from a new boss: “the boss that is everyone.” “Self-manage,” they cry from their open-plan workspace. Avoid speaking of death, practice meditation, do yoga. Take care of others. Summon your inner warrior. Smile. Fight! This new boss is doing the bidding of our unjust and unhinged economic system (“white supremacist capitalist patriarchy”): If the onus of responsibility—for recovery, for health, for well-being—falls on the person who is sick, the rest of the world gets a pass, is not accountable for whether a person lives or dies, and if she lives, in what state.

The “rest of the world” includes the US government, which can offer grossly inadequate support for those who need care and for those who do the caring; the medical establishment, which can subject women to painful, life-altering treatments they don’t need or can’t afford, at billions of dollars in expense; the pharmaceutical industry, which can set the price of one chemotherapy infusion at a cost greater than a college teacher’s annual salary; the various industries that can leave, with impunity, pollutants in the air, water, and soil and expose us to all manner of carcinogens and radiation; the government (again), which can fail to protect us from these threats; and the breast cancer awareness organizations that can keep “the war” profitable at the expense of research toward prevention and a cure. It is a world with priorities so warped that a surgical amputation federally guarantees a woman the right to breast implants but not to a night in the hospital—a world where pink ribbons have adorned buckets of KFC and carcinogenic cosmetics, fracking drill bits and guns.

When eventually Boyer is pronounced free of the disease, it is a form of resistance to refuse the label of “survivor.” Instead, she comes to think of herself as “undying,” a zombie, a reanimated corpse. For Boyer, this self-designation is a way of reckoning with the “world as is.” We are not to understand the calamity of her circumstances as unusual; no, in the United States, in the twenty-first century, this is perfectly ordinary, she insists. Boyer is merely sliding away the rose-colored glass to show us what lies behind it—misogynist and racist, brutal and mercenary, distributing suffering and death unequally by class, this is the world we have made. Awareness culture has failed women and will continue to fail them because on its own it neither acknowledges power nor tries to address its inequities. We already know this: So much is shared in our newsfeeds and yet so little is changed. Breast cancer, Boyer insists, cannot be understood as an ahistorical sameness, an uncontrolled division of abnormal cells. It is, rather, a socially and historically constructed nebula, and the women who have it do not suffer from the illness alone. They suffer from the world.

Sarah Resnick’s writing has appeared in the Pushcart Prize and Best American Essays anthologies.