November 5, 2020 41
with Asclepius. Aristides opens his Sa-
cred Tales by addressing the difficulty
of putting the experience of illness into
words, using a quote from The Iliad
that Boyer also takes as her book’s epi-
graph: “Not even if I had ten tongues
and ten mouths.”
Boyer introduces Aristides early on
in The Undying and returns to him
throughout the book, using his work
to underscore the ancient struggle of
writing about illness and to explore the
ways that medicine has changed and
stayed the same through the centuries.
“Once we were sick in our bodies,” she
writes of seeing her tumor on a screen
before she felt any discomfort. “Now
we are sick in a body of light.... Our
senses tell us almost nothing about our
illness, but the doctors ask us to believe
that what we cannot see or feel might
kill us, and so we do.”
She points to the similarities be-
tween the kind of faith that is needed to
believe one is sick from an image alone,
explained with authority by a doctor,
and the faith of Aristides and his fel-
low pilgrims, who followed the pre-
scriptions received in their dreams. For
Boyer, the modern- day asclepeion is the
cancer treatment center, or the “cancer
pavilion,” where patients submit to “a
cruel democracy of appearance: the
same bald head, the same devastated
complexion, the same steroid- swollen
face, the same plastic chemotherapy
port visible as a lump under the skin,”
moving through rooms where poisons
are injected into their bodies.
As the ancient Greeks once searched
their dreams for prescriptions, Boyer
says, now we search the Internet, find-
ing in statistics “an ulterior mysticism.”
On a website called LifeMath that
promises to “display the future in a
pictograph,” she enters her age and the
precise qualities of her tumor in order
to receive a prediction of her chances
of survival. She watches a vlog kept by
a woman who refused chemotherapy
and chose to treat herself instead by
diet, only to reverse her decision when
she became more ill; Boyer, having
considered this woman’s example, ac-
cepts chemotherapy.
She follows another vlogger who
was diagnosed with the same strain of
triple- negative breast cancer the same
year as Boyer but who died two years
later at thirty-four: “My treatment
worked and hers didn’t, and there is
no way to know how or why.” Kathy
Acker, who was criticized for refusing
chemotherapy, would likely have died
either way. “A cancer like Acker’s, one
that killed her in eighteen months, had
a similar two-year death rate whether
or not a patient underwent chemother-
apy,” Boyer writes. Her point is that on
a fundamental level, especially with the
more aggressive forms of breast can-
cer, there is no sure path to follow to
survive. “Cancer kills people, as does
treatment, as does lack of treatment,
and what anyone believes or feels has
nothing to do with it.”
Boyer points, again and again, to the
way the standard narratives around
cancer ignore how US health care and
its focus on profit affect our under-
standing of where the disease comes
from:
We are given only the noisy half
of probability that [cancer’s] cause
is located inside of ourselves and
never the quiet part of probability
that cancer’s source pervades ourshared world. Our genes are tested:
our drinking water isn’t. Our body
is scanned, but not our air.We like to believe the myth of the “sur-
vivor,” she observes—that good things
happen to good people—because it
helps us avoid looking at all the ways
that we are implicated in our own
nightmare. She wants the reader to see
that “the moral failure of breast can-
cer is not in the people who die: it is in
the world that makes them sick, bank-
rupts them for a cure that also makes
them sick, then, when the cure fails,
blames them for their own deaths.”
Despite stories of heroic survival, met-
astatic breast cancer has no cure. In the
United States, a woman dies of breast
cancer every thirteen minutes.
We are still, in 2020, in the realm of
dreams.We learn very little about Boyer’s life
in The Undying beyond the basic out-
lines of her circumstances while she
was sick. Her daughter is mentioned in
passing on page 37, and not again until
page 94. Boyer makes clear that she
is not asking for our sympathy; in fact
she doesn’t want it. What details of her
experience we do get she includes re-
luctantly, to illustrate her larger points
about the way our country treats those
who are outside of traditional family
structures and how the health care in-
dustry punishes those who don’t have
money to spare.
“In the United States,” she writes,
“if you aren’t someone’s child, parent,
or spouse, the law allows no one else
guaranteed leave from work to take
care of you.” Boyer works all the way
through her treatment, and has to teach
a class ten days after having a double
mastectomy: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 ordi-
nary, as was, apart from my prac-
tice of writing, my life.In a section called “How the Ora-
cle Held,” Boyer writes, harrowingly,
that “in the capitalist medical universe
in which all bodies must orbit around
profit at all times, even a double mas-
tectomy is considered an outpatient
procedure.” In 2013, 45 percent of mas-
tectomies “were performed in hospital-
affiliated outpatient surgery centers
with no overnight stay,” according to
a study she cites by the federal Agency
for Healthcare Research and Qual-
ity. After her mastectomy, Boyer was
woken from anesthesia and tried to
argue with the nurse that she was not
well enough to leave the hospital:I told her that my pain was not
managed, that I had not yet ac-
tually gone to the bathroom, that
I had not yet been given instruc-
tions, that I could not stand, let
alone leave. Then they made me
leave, and I left.
You can’t drive yourself home
the same day you have had a dou-ble mastectomy, of course, whim-
pering in pain, unable to use your
arms, with four drainage bags
hanging from your torso, delirious
from anesthesia and barely able to
walk. You are not supposed to be
alone when you get home, either.
But no one really asks how you
manage it once you are forced out
of the surgical center—who, if any-
one, you have to care for you, what
sacrifices these caregivers might
have to make or the support they
require.
It should be no surprise that
single women with breast cancer,
even adjusting for age, race, and
income, die of it at up to twice the
rate of the married. The death rate
gets higher if you are single and
poor.Looking at historical accounts of
breast cancer patients, Boyer illumi-
nates the way treatment has changed,
not always for the better. Fannie Bur-
ney wrote of holding her own breast
in her hand as the surgeon removed it
without anesthesia in 1811. Over 150
years later, Audre Lorde described
spending five days in the hospital after
the removal of one of her breasts, a lux-
ury few patients have today. “Despite
the lie of progress,” Boyer points out,
many breast cancer patients these days
are all but cast out on their own:While they don’t get a hospital
bed to recover in or rehabilitation
for the cognitive damage incurred
[later] during their treatment, what
they do get in the United States
is federally mandated access to
breast reconstruction—any type
of implant they want.This is a shameful reality, as is the
one that ties our health insurance to
our jobs. Months after her surgery,
Boyer had to fake being healthy (using
makeup and sitting upright, “as far
away from the sickbed as possible”) to
gain permission to be released from the
critical care unit where she had been
admitted because of heart complica-
tions, in order to go back to work when
her leave had run out. The implication
here is that, in the case of the mastec-
tomy, it was in the hospital’s financial
interest to discharge her quickly in
order to make room for more paying
patients, while in the case of the heart
condition, the hospital could earn more
money by keeping her longer. She gives
a stark inside look at the modern ascle-
peion, that structure created to admin-
ister treatment to cancer patients, and
notes that in all her time in the place,
she never once saw a bed:The sick and the partners, chil-
dren, parents, friends, and volun-
teers who care for them are kept
in circulation from floor to floor,
chair to chair. The doctors are
assigned a rotation of offices and
outposts, and in order to find out
where yours is each day, you have
to call ahead.
Cancer treatment appears or-
ganized for the maximum profit
of someone—not the patients—
which means cancer patients are
kept in maximum circulation at a
maximum rate.Boyer discusses the links between can-
cer treatment and our environment,including the origins and dangers of
the drugs most commonly used in che-
motherapy: Adriamycin, or “the red
devil,” made from microbes discovered
in the soil near a thirteenth-century
castle in Italy (and sometimes consid-
ered too dangerous to everyone and
everything, including the linoleum
floor, to administer by drip), and cy-
clophosphamide, the medicalized form
of mustard gas, which during World
War I “filled the trenches with brilliant
yellow plumes” and was outlawed as
a chemical weapon in 1925. (“During
cancer, it comes in plastic pouches, and
no one in the pavilion speaks frankly
about what it is.”) This drug passes
through our bodies only partially di-
luted, is not fully eliminated by water
treatment methods, and remains in the
common water supply for four hundred
to eight hundred days.
Another drug is harvested from the
Himalayan yew tree, endangered since
2011; yet another accumulates, once it
passes through the body, in aquatic en-
vironments, wreaking unknown dam-
age. “My desire to survive means I still
can’t bring myself to unravel surviv-
al’s ethics,” Boyer writes, even as she
attempts to do so. “Cancer spending
was $130 billion in 2017,” according to
Boyer, “greater than the GDP of more
than a hundred countries. The cost of
one chemotherapy infusion was more
money than I had then earned in any
year of my life.”
Boyer also lambasts the culture of
the pink ribbon—that now ubiquitous
symbol of support for a breast cancer
cure—which is, as Ehrenreich pointed
out in 2001, often corporate-backed,
ultra-feminine, and infantilizing, of-
fering women a way to embrace a faux
ideal of femininity by buying products
from Avon, Estée Lauder, and other
companies while ostensibly supporting
awareness and a search for a “cure.”
The message the pink ribbon broad-
casts is one of “can-do”-ness, suggest-
ing that optimism, mental strength,
and following the “right” combination
of medical advice and self-help axioms
have a direct effect on one’s chances
of survival. Cultural moralizing and
a focus on “attitude” is not unique to
breast cancer, but there is a unique
force to moralizing in this particularly
pink world.
The Susan G. Komen foundation, the
world’s largest breast cancer charity,
has raised almost $1 billion for breast
cancer awareness and research to date,
but, according to Boyer, it “has also
conducted a robust public relations
campaign against the criticism directed
at it by breast cancer activists.” Among
other things, the foundation has been
accused of “pinkwashing”—receiving
huge amounts of money from corpora-
tions while passing little of it on to re-
searchers—and using the pink ribbon
to promote products that may in fact
help to cause cancer.
Boyer notes that the Komen foun-
dation once partnered with KFC for
“Buckets for the Cure,” selling fried
chicken in large pink buckets, and on
another occasion marketed a perfume
that contained a handful of potentially
carcinogenic ingredients. Perhaps most
distressingly, in 2014 Komen partnered
with the Baker Hughes corporation
in the production of a thousand pink
fracking drills. Boyer quotes Karuna
Jagger, president of the activist group
Breast Cancer Action: “When future
generations have to choose between safe