Sufferers of the World, Unite
A Review of Anne Boyer's "The Undying" by Bella Bravo
One day Anne Boyer felt a deep pain. A nurse had applied a numbing cream to her plastic subdermal chemo port, then inserted a large needle into it. Boyer visibly reacted to the needle’s sting and when she mentioned the feeling, the nurse dismissed her, insisting that the topical made the needle painless.
Welcome to the infusion room. The patient’s experience of suffering here, like almost all of our experiences, is socially produced—the result of actions motivated by profit. The Undying, Boyer’s memoir about enduring breast cancer, documents how capitalism has deformed care. Boyer’s meditation on the unbearable nature of cancer treatment reveals how our economic system exploits the fallacy that the weak are to blame for their own suffering. The end product of this system is an individualized burden for everyone that threatens to cut us off from a shared survival.
The logic of healthcare in the US forces doctors to quickly rotate the infirm through treatment: “cancer patients are kept in maximum circulation at a maximum rate.” The infusion room doesn’t provide sickbeds, because recovery is cheaper anywhere else: at home, work, the DMV, or on the sidewalk. Patients receive their injections in chairs. Their loved ones stand nearby. Nurses believe the product copy of an anesthetic they administer more than the face of the person they poke.
When the nurse disregards Boyer’s pain, a small insurrection erupts. The other sick patients hurt as well. They see their own suffering in hers:
“It really does hurt,” said a man surrounded by his adult children, all of us in the infusion room then joining together to say what should commonly appear to hurt actually does hurt so that no one would ever again say while they were hurting us that what really hurt us—hurt all of us—never did.
Pain is powerful, but so is empathy.
We instinctively recognize pain in half-thoughts, memories, split-second glances, and grimaces. We know when we see pain in someone else. “The idea of knowing, rather than believing, trusting, or even understanding has always been considered heretical,” Boyer quotes from Audre Lorde’s The Cancer Journals. But the economic exigencies of our medical system dehumanize us and discourage our access of knowledge through empathy. In capitalism, we become heretics when we witness and act on the anguish of others.
At 41, Anne Boyer, a poet, essayist, and single mother living in Kansas City, Kansas, was diagnosed with a highly aggressive type of breast cancer called “triple negative.” From 2014 to 2016, she taught creative writing at the Kansas City Art Institute while undergoing chemotherapy, an outpatient double mastectomy (also known as a “drive-thru mastectomy”), and excruciating tissue-expander breast reconstruction procedures. Despite these inimical treatments and their side effects, some of which are permanent, and the illness itself, she lived. But in those years, thousands of people, some of whom Boyer knew, died due to this same cancer or complications from medical care.
The Undying is a hybrid work of autotheory, comparative literature, and journalism, that began in Boyer’s notes on what she calls her education in pain and exhaustion. She fleshes out these notes with research into the contemporary cancer industry and cultural criticism that draws from memoirs of breast cancer throughout history. Unlike her earlier collections A Handbook of Disappointed Fate (2018) and Garments Against Women (2015), which were comprised of poems and lyrical essays, The Undying is written almost entirely in prose.
The autobiographical fragments in The Undying carry on the nomadic prosody of her prior work. But the wandering here is slower, perhaps because the drugs she received, like platinum, a medicalized form of mustard gas, and a ruby liquid that could melt linoleum, corroded the white and gray matter of her brain. Boyer laments that the damage made it difficult for her to do the labor of a poet: to think, speak, read, remember, and write. Her social critique and insights into the workings of the oncology industry do not try to fill in the gaps between her memories. By offering us only parts of her experience, Boyer suggests the whole eclipsed by anesthesia or duress. The form of the book points to the limits of individual experience, while the interstices in her narrative suggest what lies beyond our present constraints.
In the US, positive thinking is endemic. Boyer writes, “Attitude Is Everything for Breast Cancer Survivor,” using the grammar of a headline to emphasize the mass-market quality of this common sentiment. Nevermind that Susan Sontag debunked this thinking in Illness as Metaphor (1978), or that disease is not an affect. The fiction seems so obvious that Boyer quips, “Attitude Is Everything for Dying Coral Reef.” If you’d like to see what Boyer means by attitude, Google image search “chemo port.” Diagrams and close-up photos will pop up. Click on the suggested term “breast cancer.” The top six results are portraits of smiling women with their shirt collars pulled back to reveal the bulbous ports protruding under their skin.
It may seem like common sense that an attitude won’t save you, but in 1996, facing the choice of death by cancer or death by cancer treatment, writer Kathy Acker was publicly ridiculed for refusing chemotherapy. In 2014, Boyer decided to perform a digital reenactment of Acker’s prognosis with LifeMath, an online calculator that predicts the outcome for chemotherapy. LifeMath spit out an answer in seconds: “a two-year death rate whether or not a patient has chemotherapy,” which is comparable to the eighteen months Acker’s cancer took to kill her without treatment. Still, some friends blamed Acker’s passing on her “bad treatment decisions.” With a great reverence for women who make unexpected choices, Boyer writes “[b]esides living in the best way one can, with the kind of cancer Acker had, there isn’t really anything but dying left to do.” Cancer, its treatment, or the lack thereof are all potential killers.
No one’s fate is certain, but the focus on attitude obscures that the margin of survival for the cancer patient is “determined by income, education, gender, family status, access to health care, race, and age.” Boyer observes that triple negative breast cancer disproportionately hits black women, and is the last variant with no targeted treatment. Concomitant premature death, disability, and poverty exclude black cancer patients from wage labor, and represent macabre examples of the material reproduction of racism in the US. Just as positive thinking alone can’t stop a tumor, the black excellence mindset can’t be a wholly effective cultural shield against the sword of white capital. And yet, many in the US, like the Jay-Z and NFL-funded Crushers Club, which cuts off young black men’s dreads so they can have a “better life,” still act like Attitude Is Everything for Black America.
After Susan G. Komen, the US’s largest breast cancer charity, accepted a $100,000 donation from a fracking company, a Breast Cancer Action spokesperson commented that future generations may have to choose “between safe drinking water and developing breast cancer.” That future is now. We have a carcinogenosphere and a capitalocene that link up with racism, colonialism, and history’s other structural violences to make the Earth less and less habitable. When Flint, Michigan, attempted to disinfect its water by adding more chlorine, a byproduct of the chlorination was an increase in the levels of carcinogenic chemicals, making the water—again—unsafe. The predominantly black working-class residents of Flint who were pregnant, sick, and elderly were advised to consult a doctor about cancer risks before drinking water from their faucets.
One can no longer simply choose to live. The problem goes deeper than individual choice.
There is nothing that you can do by yourself. As a single parent with bills to pay, wage labor exacerbated Boyer’s already debilitating medical complications. Friends from near and far took time off from their hourly wage jobs to live on her couch, drive her to chemo, carry her books into the classroom when she couldn’t use her arms, and bestow gifts which included “cannabis popcorn wrapped in the poet Diane di Prima’s hand-me-down yoga pants.”
Her community cared for her, but in some moments Boyer still could not escape the loneliness of being in a body. A friend of Boyer’s noted what was missing from an early draft of The Undying: “There is only intermittently any Us.” At first Boyer replied, “I can’t lie,” until she realized “that itself is a lie, proof that I can lie and sometimes do. What I meant was that I can’t pretend to have felt less alone . . .” We see how the combination of cancer treatment, her wage labor—lecturing on Walt Whitman to art students—and the work of maintaining her femininity produced a contradiction in Boyer. Yet, despite the feeling of alienation, she also felt incomplete without her accomplices.
Boyer and her friends turned art and sabotage into acts of caretaking. They plotted to repurpose Emily Dickinson’s poems into pamphlets for a “new language of pain,” and leave them in the infusion waiting room. Boyer made plans for sites of common weeping, because a side effect of one chemo drug is endless crying and she “always hated it when anyone suffers alone.” The Undying includes a communiqué for throwing bombs of human hair lost to chemo, a direct action against capital and all of its attendant social distress. Beyond her friends, the admiration of nurses, many of whom were lovely “geniuses,” nourished her too. Boyer writes, “I try to be the best-dressed person in the infusion room, wrap myself up in thrift-store luxury and pin it together with a large gold brooch in the shape of a horseshoe. The nurses always praise the way I dress. I need that.”
Perhaps when Boyer wrapped herself in second-hand splendor, she felt like she was building a barricade. Her aesthetic recalls how radical historian Kristin Ross described the barricades of the Paris Commune. One communard crafted his blockades like “works of art and luxury,” going so far as to commemorate each with a photograph of himself in front of it. His creative practice stemmed as much from the commune’s armed defense as its abolition of the hierarchy separating the fine from the decorative arts. This removal of rank dissolved the distinction between mental and menial labor, which allowed everyone in the commune to participate in the beautification of their environment, at least for a few months in 1871. In her history of the communard legacy Communal Luxury, Ross explains that the communards’ commitment to the aesthetics of ordinary living reinvented wealth beyond capital’s equations of value and entitled everyone to a life of “communal luxury.” This is the beauty Boyer wants to create and encounter when she writes:
As if pain were the opposite of beauty, I walked through the decorative arts wings of a museum taking notes on how to turn the cancer pavilion’s IV poles into beaux arts chandeliers, how chemo bags could look like kaleidoscopic Grecian urns, how the endless feelings-less weeping of a chemotherapy patient could be done in the service of ornate lacrimal vessels and poisonous irrigation schemes.
Boyer positions beauty on the same reflexive register as pain, to argue, like Ross, that aesthetic practice may communicate across identity and history, allowing us to envision how to live together. And she dreams of infusing this beauty into the infusion room—the place she and her fellow undying endure—because she refuses to have her survival untangled from theirs and she rejects that beauty could ever be untangled from life.
Here, Boyer tries to extend simple practices of love and care into an infrastructure. In that way, The Undying joins an exciting, emergent chorus, which includes Saidiya Hartman’s Wayward Lives, Beautiful Experiments, Eduoard Louis’s Who Killed My Father, and Ocean Vuong’s On Earth We’re Briefly Gorgeous, all recent genre-bending books that narrate the caretaking structures that allow people to experience community in defiance of hegemonic power. In these books, and in Boyer’s experiences as a cancer patient, communal expressions of beauty, wealth, and luxury emerge to buttress the lives of the marginalized and vulnerable.
Boyer started to think about the aesthetics of survival in A Handbook of Disappointed Fate. In an essay included in that text, “The Kinds of Pictures She Would Have Taken, 1979,” Boyer analyzed a posthumously exhibited unfinished collection of Jo Spence’s documentary photography. Spence had been diagnosed with breast cancer and then leukemia. In the series Final Project, Spence positioned small, plastic skeletons in poses of pathos. The skeletons, unlike living bodies “in all their wounded particulars,” don’t bring to mind a specific gender, race, or class. Spence’s dioramas of skeletons revealed to Boyer the point where “identity as it had previously provided a seemingly solid grounds for politics began to give way, and a new ground—this one with a broader horizon—was exposed.”
Boyer became, not a skeleton, but a ghost in The Undying. The brain damage from the chemo made her feel that she existed “in a way that I feel I don’t exist.” Desire and identity peeled away with exhaustion. Which is to say, Boyer believes this exhaustion pushed her insight beyond the precise contours of needs, interests, and presentation, beyond what her merely tired, pained, and weary self could perceive as possible. She saw this detachment from “the things of living” expressed in the work of Acker, Lorde, Spence, and other artists and writers who were once terminally ill. While Boyer’s fragile body sat on the sofa watching Black Mirror with a friend, her mind also communed with these ghosts. She was able to forestall the fear that all her friendships could end with her, that this world would be all it ever had been, because the work of these dead women kept her company.
It’s easy to see that cancer has no special economic category: it’s part of the body. But medicine, like food, shelter, water, and most other basic necessities, is a commodity. One must work for the money to buy it. Unfortunately, nothing about this formula represents the richness of how we could live.
Looking back at the poverty of human history and forward to our fiery and flooded future, it’s hard to envision a future that’s livable, much less beautiful. The revelation Boyer offers us is not necessarily hers, but one taken from the gaze of a ghost, a small skeleton, and “the undying.” From that standpoint, we can see beyond our present moment to “a new structure to the world and with it, the world’s real possibilities.”
Pain, Vulnerability, Mortality, Medicine, Art, Time, Dreams, Data, Exhaustion, Cancer, and Care
By Anne Boyer
308 pages. Farrar, Straus & Giroux. $26.