by Anne Boyer
Our century is excellent at the production of nightmares and terrible at the interpretation of dreams. Asleep, I break into the Whole Foods near Oakland’s Lake Merritt with an oncologist who praised the way I dress. Or Madonna is in two of my classes with her breasts exposed. I am in a village for a purpose, and I have too much equipment to haul, and there are famous people, but I can’t remember who. I get in a debate about all the world and about all the heavens, and a man I am debating sends me a message: “I am trying to figure out from what center you come.”
A newly diagnosed person with access to the Internet is information’s incubant. Data visits like a minor god. Awake, we pass the day staring into the screen’s abyss, feeling the constriction of the quantitative, trying to learn to breathe through the bar graphs, head full of sample sizes and survival curves, eyes dimming, body reverent to math.
The newly installed chemo port hurts. The nurses tell me chemo ports hurt more the younger you are. They tell me that everything about cancer hurts more. I resist bathing and grooming, stop moving freely. I don’t think about the other parts of my body, what they can still do, because the one part that hurts causes the others to fade from awareness. Someone sends me a link to a baking soda cancer cure. A former student emails to ask if I have heard about juicing.
Aelius Aristides writes his book of dreams sent to him from the god Asclepius, Hieroi Logoi, in the early 170s, years after his initial illness and during the anxious years of the reign of Marcus Aurelius.2 Asclepius was said to be the son of a mortal woman and Apollo and raised by a centaur who instructed him in the art of medicine. In one version of his story, Asclepius was such an effective medical practitioner that Hades had him killed out of fear of an empty underworld. Not only is Hieroi Logoi a record of prescriptive dreams, but it is also an autobiographical account of what it is like to have a body in a specific time and place. Sacred dreamers took papyrus into the incubation room. For Romans, it seems, dreams were had in order that they could be written down. Aristides claims to have written more than 300,000 lines in the dream journal he used as his book’s raw material. Scholars later call that journal we will never get to read “the rejected way” of telling the story.3
The Tibetan Book of the Dead also provides instruction for interpreting dreams as messages of prognosis. Its authors divine death from dreaming of being surrounded by crows or anguished spirits, or of being dragged along by a crowd of dead people, or of being naked with one’s hair cut off. Cancer treatment means I am often half-naked with my hair cut off. I read PubMed instead of my dreams for clues to how long I will live, and the more I read, the more I fear dying somewhere along the path of expensive and diabolical treatments, then for hours these statistics alternate with online shopping, reading wig reviews, dissatisfied. I imagine a thousand fake things on me and a thousand other fake things in me and then a thousand fake things pending and then another thousand fake things forming and another thousand fake things in retreat.
The ancient physician Galen wrote that Aristides was of the rare type whose soul was strong while his body was weak.4 Aristides continued to write, teach, and speak while “his whole body wasted away.” I google my disease and feel alone in the surreality of its quantitative production. Although I have no opinions of the strength of my soul, I am a common type of person, which means I must work for a living, so during my illness I also continue to write, teach, and speak. In the interstices of my to-do list I search for death, desperate for the study that says I will live. I begin to dream of death and know not to obey the night’s instructions. I wake up and search for my body’s mortal exception. I read the results of a prognosis calculator, LifeMath,5 then I fall asleep again, dream of death in its curves.
The day I found it, I wrote the story I was always writing, the one about how someone and I had been together again, how we shouldn’t be, and how I hoped we might finally be able to stop being together soon. We were not happy. We were never able to be together without going to bed. We were never able to go to bed with each other and be happy. We were never able to be happy when not together, and this is why we always found ourselves together, sad, and in bed. We had known each other for years and our knowing each other took the shape of a durable web of we shouldn’t in which extravagant forms of mutually self-inflicted suffering were caught.
First, there was sex, then the discovery, then there was the escalator ride to the box office for our movie tickets, then I called my doctor for an appointment, then I wrote in my journal how I hoped we might finally be getting closer to not being made miserable by the presence of each other upon the earth. I didn’t write down that we had found a thing in my breast or the name of the action movie we went to when we got out of bed.
My fear wasn’t of cancer itself, about which I knew almost nothing then. My fear came from a search engine. I was afraid of what Google gave back to me when I entered “breast lump” into it, afraid of the culture of disease as circulated on blogs and on discussion boards, afraid of how people were turned into patients with handles and signatures, agonies, neologisms, and encouragements. Mets. Foobs. NED.6 I was afraid, on the first day, for my vocabulary.
All that had happened was that I wrote in my journal with precisely avoidant detail, recorded the minor motions of what a person does when she is anxious for a reason she refuses to specify, how I did the laundry, swept the floors, made the beds, swore I’d get over a problematic love, told myself one story so I wouldn’t have to tell another.
We are told cancer is an intruder to be fought or an errant aspect of ourselves or an overambitious cell type or an analogy for capitalism or a natural phenomenon with which to live or a certain agent of death. We are told it is in our DNA, or we are told it is in the world, or we are told it is located in the confused admixture of genes and environment that no one can locate or wants to. We are given only the noisy half of probability that its cause is located inside of ourselves and never the quiet part of probability that cancer’s source pervades our shared world. Our genes are tested: our drinking water isn’t. Our body is scanned, but not our air. We are told it is in the error of our feelings or told it is in the inevitabilities of our flesh. We are told there is a difference between illness and health, between what is acute and what is chronic, between living and dying, too. The news of cancer comes to us on the same sort of screens as the news about elections, in email at the same minute as invitations to LinkedIn. The hash marks of the radiologists are the same as those of the drone pilots. The screen life of cancer is the screen life of all mediated global terror and unreality, too.
Cancer doesn’t feel real. Cancer feels like an alien that industrial capitalist modernity has worried into an encounter: mid-astral, semi-sensory, all terrible. Cancer’s treatment is like a dream from which we only half-wake to find that half-waking is another chapter in the book of the dream, a dream that is a document and a container for both waking and sleep, any pleasure and all pain, the unbearable nonsense and with it all erupted meaning, every moment of the dream too vast to forget and every recollection of it amnesiac.
The breast surgeon said the greatest risk factor for breast cancer was having breasts. She wouldn’t give me the initial results of the biopsy if I was alone. My friend Cara worked for an hourly wage and had no time off without losing out on money she needed to live, so she drove out to the suburban medical office on her lunch break in order that I could get my diagnosis. In the United States, 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.7 If you are loved outside the enclosure of family, the law doesn’t care how deeply—even with all the unofficialized love in the world enfolding you, if you need to be cared for by others, it must be in stolen slivers of time. As Cara and I sat in the skylit beige of the conference room waiting for the surgeon to arrive, Cara gave me the switchblade she carried in her purse so that I could hold on to it under the table. After all of those theatrical prerequisites, what the surgeon said was wha
t we already knew: I had at least one cancerous tumor, 3.8 centimeters, in my left breast. I handed Cara back her knife damp with sweat. She then went back to work.
The rest of the pathology report came in after I was sent from the surgeon to the oncologist. In Siddhartha Mukherjee’s “biography” of cancer, The Emperor of All Maladies, it is the Queen of Persia—Atossa—who becomes the iconic breast cancer patient, traveling from 550 B.C. through time in search of treatment. That first time at the oncologist’s—also my first time in a waiting room full of chemotherapy patients, none of them royalty—Mukherjee’s thought experiment of a fixed aristocratic sufferer, touring fungible medical contexts, became vividly emblematic of cancer culture’s myths. Cancer is not a sameness eternalized in an ahistorical body, moving through a trajectory of advancing technological progress.8 No patient is sovereign, and every sufferer, both those marked by cancer treatment and those marked by the exhausting routine of caring for those with cancer, is also marked by our historical particulars, constellated in a set of social and economic relations.
The history of illness is not the history of medicine—it is the history of the world—and the history of having a body could well be the history of what is done to most of us in the interest of the few.
On a scrap of yellow paper, the oncologist—the one my friends and I later called Dr. Baby because of how much he resembled a cherub—wrote in a childish hand, “hormone receptive positive breast cancer,” explaining that there were targeted treatments for it, then crossed it out. Then he wrote, “Her2 positive breast cancer,” explaining that there were targeted treatments for it, then crossed it out. Then he wrote “Triple Negative,” and explained that there were no targeted treatments for it. Accounting for between 10 and 20 percent of breast cancers, it has the fewest treatment options and significantly poorer prognoses than others, responsible for a disproportionate number of breast cancer deaths. He said this was the cancer I had. He said the tumor was necrotic, which meant that it was growing so quickly it failed to build infrastructure for itself. He wrote down “85%” for the tumor’s growth rate, and I asked him what that meant. He told me that a Ki-67 score of “anything over twenty percent” was highly aggressive.9 He then said, “Neoadjuvant chemotherapy,” which meant “right away.”10 I didn’t agree to dissect any nodes or biopsy the other potential areas the doctors feared were tumors: this one certain tumor was bad news enough, and its treatment would be so aggressive I felt like there wasn’t any point in a painful intervention to know what else was there.
Something that Mukherjee’s book got right was that if the Persian queen Atossa was diagnosed with chemotherapy-resistant triple-negative breast cancer, “her chances of survival will have barely changed.”11 To not submit to chemotherapy was to die, Dr. Baby suggested. To submit to it, I thought, was to feel like dying but possibly to live, or to die from secondary effects rather than primary disease, or to live, finally, almost restored, but not quite. On the way home, the car radio posed a question that I didn’t have the power to resolve: Should I stay or should I go? But as I moved through the dial, I couldn’t find the song with the answer. The staying or going involved the staying or going in this life. Should I live or should I die? But nothing was that frankly posed. As soon as a patient lies down on the exam table, she has laid down her life on a bed of narrowed answers, but the questions are never sufficiently clear.
What will be the outcome of this illness? resembles the questions asked by detectives, art collectors, and graphologists, or anyone who moves some unobvious incidental detail into the heart of a story.12 Enchantment exists when things are themselves and not their uses. That’s why enchantment begins to fade the moment we believe that a collection of cells can predict the agonies of next June. Under the conditions of suspicious interpretation, nothing is ever again as perfect as enchantment was, back when hairs that fell from heads were once records of the beauty of those heads, not soon-to-be-ziplocked evidence of a crime.
After a cancer diagnosis, very little is ever itself again. The nurses give me a glossy binder with a photo of a smiling silver-haired woman on its cover. The title is Your Oncology Journey, but I am certain that trip can’t be mine. Every step is on the road to Delphi, crowded with divination, every fortune now accompanied by the curse of it-could-be-worse, with the worst being even worse than that. All during, the fortune-tellers never stop offering fortunes and never stop offering along with their fortunes exotic guarantees for or against or faulty reasons why, all of which seem like more lies on lies layered into an increasingly repellent and catastrophic truth of I-can’t-know-anything-so-why-try.
Meanwhile, with each step every sensation is as spectacular as a crime scene. No detail is too small to be magnified into the evidence that everything in the world is wrong. And every crime scene of sensation is the future or concurrent scene of uncountable other crimes, some of these crimes in the name of cure and the others in the name of the world as it is, all of them happening all during the investigation, all of them themselves creating more sensation and along with that a spectacle and massacre and interpretive opportunity, layering hurt on hurt, fortune on fortune, lie on lie.
To be diagnosed with cancer right now is not to live in a binder’s trajectory: your oncology journey is a lie. “A painting is not,” wrote John Cage, “a record of what was said and what the replies were but the thick presence all at once of a naked self-obscuring body of history.”13 To be a cancer patient right now is to exist all at once as the thick presence of the naked self-obscuring history of bodies.
3.
Aelius Aristides called the period of his life in which he lived as an incubant at the temple of Asclepius his Cathedra. The visibly dying were never allowed into the temple, nor were the visibly pregnant: birth and death were kept discreetly in structures built in the adjacent territories. The faithful sick passed their time bathing, making burnt offerings, sleeping, waking up, and talking to each other about their dreams. Then they would follow their dreams’ prescriptions. The dreams of the incubants were often of two types. The first of these were dreams with instructions that fell inside the boundaries of Roman medical practice—fasting, dietary changes, drugs, phlebotomy, purges—and the other, dreams with prescriptions so wild that the physicians at Pergamum were said to shudder upon hearing them.
Diagnosis has diminished my ability to tell the difference between good advice and empty ideology.14 Everything I am advised to do in response to the cancer seems, at first, like a symptom of a world that is sick itself. I write in my journal, “the body in the intimacy of the machine,” then read on a discussion board that cutting my hair short will make its eventual loss easier to bear. I try to believe this. I usually cut my own, but this time make an appointment at a salon—the Belle Époque—and sit in the elevated chair, saying nothing, while a blond stranger chops my long dark hair above my shoulders. As my hair falls into a pile to be swept up later by a poorly paid assistant with a push broom, I realize then that without ever knowing it I had, at least some years of my life, almost been beautiful and now wouldn’t be anymore. I think, too, of how once I always insisted that the best thing about life was that hair grew, which was the simple evidence that nothing stayed the same forever, and therefore proof of the possibilities that the world could change. Now it wasn’t just that my hair would fall out, it was that my follicles would die, and painfully, that what once grew would stop growing even as I myself kept living, and everything I once understood about the world as evident would be subject to another proof.
“Variable and therefore miserable condition of man!” wrote the English poet John Donne in his 1624 sickbed masterpiece, Devotions upon Emergent Occasions, a prose work written in twenty-three parts over the twenty-three days of what Donne thought was a fatal illness. “This minute I was well, and am ill, this minute.”15
No one knows you have cancer until you tell them. I take a screen capture of John Donne’s first devotion and post it to Facebook: “We study health and we del
iberate upon our meats, and drink, and air, and exercises, and we hew, and we polish every stone that goes to that building; and so our health was long and a regular work: but in a minute a cannon batters all.”16
It gets a lot of likes. Then I follow the other instructions I find on the Internet: tell my mother, tell my daughter, deep clean the kitchen, negotiate with my employer, find someone to watch the cat, go to the thrift store to find clothes that will accommodate my coming chemo port, worry on the phone to my friends that I have no one to take care of me. It is decided without ceremony that the doctors will eventually take my breasts from me and discard them in an incinerator, and because of it, I begin the practice of pretending that my breasts were never there.
A person with aggressive cancer is rarely in a position to reject anyone’s prayers, magic, or money. Friends begin an online fund-raiser. Acquaintances give me crystals. On someone’s advice, I try past-life regression, where instead of the royalty everyone else seems to be in their earlier incarnations, I am an elderly man with leprosy who is begging, sick and sadder than I ever have been. In another life, I am a child who barely lives and mostly dies. I don’t believe in any of this, but it makes sense to me that I’ve been the greatest possible version of nobody in every possible life.
Ancient temples of healing were built in valleys next to springs and caves. The sick brought the god Asclepius votives of ailing body parts in exchange for healing: sculpted legs, arms, eyeballs. Asclepius’s powers were rumored to be so strong he could use the blood of Medusa to raise the dead. Some say that under the grandest of Asclepius’s temples was a pit of a thousand snakes. These temple snakes were sometimes let loose among the incubants, who would be pleased by any encounter with them, believing that the slither of a snake over a toe could heal them.