The DO Book Club, Aug. 2021: The Undying

Welcome back to The DO Book Club!

For August, Joan Naidorf, DO, read The Undying: Pain, Vulnerability, Mortality, Medicine, Art, Time, Dreams, Data, Exhaustion, Cancer, and Care by Anne Boyer.

If you’ve read this one, please share your thoughts in the comments below. And if you’d like to write a book review for a future month, please email rraymond@osteopathic.org.

Plot summary

A few years after Ann Boyer, noted poet and professor at the Kansas City Art Institute, was diagnosed with triple-negative breast cancer, she drew on her stamina, curiosity, soaring intellect and anger to write a memoir unlike all other patient memoirs. It won the 2020 Pulitzer Prize for General Nonfiction.

The book’s full title fails to capture the emotion and scope of what Boyer offers. This is not a light volume to slip into your bag as you head to the beach. Those who do take it on, however, will be rewarded with an unflinching look at cancer treatment and one women’s lonely experience.

Boyer’s prose reads like a loosely organized journal of her thoughts, feelings and research as she navigates what she (tongue firmly planted in cheek) calls her “cancer journey.” This is the term used in the patient literature distributed through her oncologist’s office.

The research of her own diagnosis brought her to the works of Susan Sontag, Virginia Woolf, several ancient philosophers, and John Donne. She quotes those sources liberally to help the reader understand the literary depiction of illness and treatment throughout the centuries. She takes the reader along on her quest to understand her own experience and to illustrate that artists and philosophers have tread this ground for centuries.

Boyer expands the narrative with multiple chapters of poetic musings on her fears and her experience of pain.

“A widely held notion about pain seems to be that it ‘destroys language.’ But pain doesn’t destroy language: it changes it. What is difficult is not impossible. That English lacks an adequate lexicon for all that hurts doesn’t mean it always will, just that the poets and marketplaces that have invented our dictionaries have not — when it comes to suffering — done the necessary work.” (p.213)

In the years after her grueling diagnosis, chemotherapy, mastectomy, reconstruction and rehabilitation, Boyer works most admirably to expand the language of breast cancer so that others might understand.

The author quickly realized that her original oncologist, whom she dubs “Dr. Baby” due to his cherubic face, is not offering aggressive enough chemotherapy.

“Dr. Baby is making the decisions he believes are best for me, saying that a more aggressive treatment holds too great a risk for a younger patient because of its debilitating future effects. I tell him not to offer the most aggressive treatment holds too great a risk for a younger patient because the survival numbers for the standard-of-care treatment are not acceptable. I do not want to die, I tell him. I still have a lot left to do. It is precisely because I still need time, I plead, that I will do anything to live.” (p. 82)

Boyer gets the second opinion and chooses the more “aggressive and controversial” course of treatment. Her result confirms that her decision was correct.

Boyer methodically takes down some wayward physicians, dishonest researchers, malingering patients, pharmaceutical companies and misleading internet sites as exploitive in their quest for attention, virtue signaling and profit. On page 170 she says, “The pharmaceutical companies lie. The doctors lie. The sick lie. The researchers lie. The internet lies.”

She struggles mightily to relate her own truth as a sick woman who chose to take chemotherapy with dangerous and debilitating side effects. The cardiac symptoms she suffers as a side effect of Adriamycin treatment leave her perilously close to disqualification from further chemo or surgery. After the cardiologist finally clears her for further treatment, Boyer writes, “Mine is a heart that is hurt, but it is not a heart that is failed.” (p.277)

Boyer shares deeply personal insights about her own experiences of loneliness and pain. She documents the poorer survival statistics of minorities and patients without life partners. The oncology and pharmaceutical industries get criticized for the soaring costs, systemic bias, and victim blaming. In part of the chapter titled The Hoax, she eviscerates the pink ribbon movement as representative of the exploitive publicity and profit made off the suffering of women battling breast cancer.

She writes, “Every month is Pinktober when you have breast cancer, and every actual October is a season in hell. The world is blood pink with respectability politics, as if anyone who dies from breast cancer has died of a bad attitude or eating a sausage or not trusting the word of a junior oncologist.” (p. 171)

Interesting tidbits for DOs

For osteopathic physicians, this is a hard but necessary read. For those of us who have not had a cancer diagnosis or experienced the suffering of a loved one, this memoir helps us to walk in another’s shoes. As a single mother with limited sick leave, Boyer depicts the struggle to cobble together home care, transportation to appointments, and the need to get back to work.

At one point, she literally puts on makeup and cons the hospitalist to let her leave the ICU so she can go teach a college class. Patient memoirs such as this serve as a useful glimpse into the lives of the people we work so hard to treat with empathy. For a little while, a physician can feel the suffering and isolation of her cancer patients.

Notable quotes

The below quote brings Boyer’s devastating experience into heartbreaking focus.

How can your heart not ache when you read: “My cancer was not just a set of sensations nor lessons in interpretation nor a problem for art, although it was all of these things, too. My cancer was a captive fear that I would die and leave my daughter in a hard world with no resources, a fear, too, that I had devoted my life to writing and sacrificed all I had to never come to its reward. It was a terror that all I’d ever written would sit data-mined but not read in Google’s servers until even Google’s servers were made of dust, and in the meantime, I would become that unspeaking thing, a dead person, leaving too soon who and what I loved the most behind, unprotected, and alone.” (p. 130)

Takeaways

While this is overall a challenging book, the author’s moments of desperation and frustration are tempered with quotable prose of eloquence and great beauty. Most of us will require the dictionary function on our e-reader or computer.

With effort and dedication to the text, one cannot help but come away with an unforgettable glimpse into one woman’s course of breast cancer diagnosis and her brutal treatment experience. Boyer’s memoir richly deserved the Pulitzer Prize. In The Undying, the author gives voice to the unspeakable horrors of breast cancer. She also rewards the rest of us with her lifetime devotion to writing.

September’s book

For September, The DO Book Club will be reading The House of God by Samuel Shem. We encourage all who are interested to read along (this book club can be followed at any pace)! If you are unable to get out to a local library or bookstore, we recommend checking out eBook options.

As a reminder, if you read The Undying or any previous Book Club selection and want your reflections to be shared in future posts, or want to write your own book review for a future month, please leave a comment below or email rraymond@osteopathic.org.

Happy reading!

Related reading:

The DO Book Club, July 2021: Mutual Rescue

The DO Book Club, June 2021: How Not to Die