I’d heard the premise of this book—which sounded delightful—and starting reading very optimistic I’d like it. I’m sorry to say I didn’t.
Side Effects May Vary is promoted as a teen going through her bucket list after she is diagnosed with terminal cancer, and, certain she will die, she doesn’t worry about consequences. Then—surprise!—she unexpectedly enters remission, and has to figure out how to live with reality again. I expected to see wacky hijinks and the type of rash impulsive behavior we all sneakily wish we could indulge in, followed by trying to handle a real-life, not-so-shiny fallout.
Instead, our protagonist Alice is abusive, manipulative, and flat-out mean, and when she’s diagnosed with cancer, the promised “consequence-free” living is just her using cancer as an excuse to dial all those qualities up to eleven. Now, unlikeable characters are not at all a hard sell for me—particularly an unlikeable cancer patient, which plays against stereotype so beautifully. But an abuser and bully is a much harder type of “unlikeable” to root for.
This is especially true considering Alice never grows or learns. When people react to her manipulations and meanness, she either blames them or follows a brief admission of her awfulness with enough self-pity to fill a truck and then does it all over again. The book ends on her trying to do something positive, with the implication that she’s trying to be a better person, but the problem is this: Alice is an abuser. Every flash of her trying to do something kind has been followed by even lower abysses from her. Thus, even though the end of the book hints toward attempts at self-improvement, it just felt like the beginning of one more violent cycle.
There were a few other places I felt completely out of sync with the narrative as a whole—for example, though the book succeeds so excellently in not stereotyping cancer patients, it fails by falling into the tired trope of catty mean-girl portrayals. And when Alice’s ex-boyfriend is trying to pressure her into sex, despite the narrative wanting us to see him as a jerk, his sexual pressuring is never framed as evidence of his poor character—I felt I was much more horrified at his actions in that case than the book was intending me to be. Combine this with Alice repeatedly thinking of all other girls as skanks and whores, or with Alice’s choices to slut-shame people, mock them about their weight, or use their confusion over sexual orientation as ammunition for humiliation, and I couldn’t help feeling like Side Effects May Vary was reinforcing damaging attitudes about teenage girls, rape culture, queerness, and abuse.
So this book was not for me.
As I’m reviewing from the perspective of someone who had pediatric cancer, however, I’ll move on to that. The portrayal of teen cancer here had some good points, but there were also times I found it frustrating.
The best thing about the usage of cancer in Side Effects May Vary is that it avoids the infuriating stereotypes books like The Fault in Our Stars fall into. Although Alice’s morally corrupt character made me dislike the book as a whole, I have to admit it was refreshing to see a teen character with cancer whose portrayal makes her so unlikeable. Alice’s cancer is also never leveraged to try to make her more sympathetic, which I appreciated.
Nor does Side Effects May Vary fall into the usual narrative tropes about cancer—wherein Cancer Kids teach other people Important Messages about life before Dying Tragically—and this deviation was likewise refreshing. Furthermore, from a descriptive standpoint, I thought the book dealt well with showing exactly how Alice’s failing body affected her: for instance, the descriptions of her weakness and painful spontaneous bruising during the main characters’ sex scene together, or the times she flat ran out of energy while trying to do simple things like stand or run an errand. The author made no attempt to romanticize her illness or whitewash the awful results of both the disease and the treatment, and I was pleased to see this.
But in other aspects, the portrayal stumbles. First and most importantly, the book—which is told out of chronological order—skips over a very important step in the arc of Alice’s cancer treatment: namely, her prognosis. The premise of the book turns on the idea that its protagonist thinks she is dying. But the narrative skips directly from her diagnosis with acute lymphocytic leukemia (ALL) to the implication that she’s on her deathbed, which didn’t work at all for me. It leans on readers making the assumption that “cancer = death,” which I object to in the strongest possible terms.
As I’ve mentioned before, childhood cancer is much more survivable than many people think. In most cases, it is far from an automatic death sentence. And ALL, in addition to being one of the most common childhood cancers, is also one of the most treatable, with the vast majority of ALL patients entering remission. I would never assume upon meeting someone with ALL that they were terminal.
This is not to say cancer and its treatment are not themselves serious and traumatic—they are. And people with ALL do sometimes have poor prognoses. But portraying cancer as a difficult, painful, and, yes, life-threatening event that real people work through is different from reinforcing the dehumanizing pity that comes with the assumption that the Grim Reaper has already tapped us on the shoulder at the first utterance of the word “cancer.”
Side Effects May Vary does let Alice live. But before that, it goes straight from an ALL diagnosis to the assumption of death, without the intervening—and absolutely necessary, in my opinion—punch of discovering that, in addition to the cancer diagnosis, Alice also has a dire prognosis. When the “miracle” of her remission happened, I was left confused, because I’d still been waiting for the scene that confirmed she was dying in the first place.
Speaking of which, the conversation Alice and her parents have with her doctor in which he informs them of her remission is representative of another problem I had, which is that there were quite a few places where the characters’ responses to Alice’s cancer felt off. For instance, in that scene, the doctor reveals Alice’s remission and then goes on to tell them what’s next . . . and it’s so very, very odd to me that Alice and her parents don’t already know. Alice’s doctor tells her family (1) what remission means—as if they haven’t been hoping for exactly those test results—and (2) what’s coming next, as if every aspect of her medical situation and treatment protocol haven’t been their reality for many months now .
Having cancer is like a full immersion course in one’s particular type of illness and treatment—like becoming an expert in a bizarrely narrow field. It’s partly expertise by necessity, just to understand the basics of what’s happening and what the options are (if there are options), and partly expertise via osmosis, as living with that level of information can make things stick even if one were determined to enter the hospital room ignorant. Beyond doctors, many cancer patients and their families also seek further understanding from books, online searches, forums, support groups, second opinions, and friends and family with similar experiences. Now, if it were a particular character point for a fictional cancer patient to lack information, that would be a believable exception, but in this book, Alice and her parents (particularly her mother) are portrayed as both educated and aggressive. So it strains credulity for me that they would have no knowledge of the most basic aspects of ALL treatment.
(It’s worth mentioning that remission, though an important corner-turning result, is often not synonymous with a stopping point at which a patient can return to regaining health and normal activities. For some cancers—like Alice’s, and, incidentally, my own—treatment may continue post-remission in order to discourage relapse. I would have found it odd for the characters to exhibit less than expert knowledge of all this, so the fact that they are portrayed as entirely ignorant threw me completely out of the scene.)
Throughout the book, I kept having similar moments, as I repeatedly felt like Alice’s and her family’s reactions to her illness or treatment rang a bit false.
To contrast, every time a scene talked about dance—Alice’s ballet skills are a continuing plot element—I felt absolutely sure the author herself is or was a dancer. The little details about shoes, or about what dancing did to Alice’s feet, or just the way she would flex her feet and calves while resting, all felt incredibly, wonderfully true to life. And it made it doubly frustrating that some of the parts concerning her cancer were so jarringly strange.
Overall, I found the book’s portrayal of pediatric cancer iffy—better than some, worse than others. I did think it was clear the author strove to make her cancer patient a whole person outside the illness, and the areas in which she fell short were indicative of either oversights in research or a lack of personal experience rather than unthinking stereotypes. Though these shortcomings were frustrating to me as a reader who does have that experience, I do feel I could have looked past them had I not had such issues with the book as a whole.
How I Would Rate This Book:
Overall: 1.5 stars. I would have put this book down in the early stages if I weren’t reading it for review.
Portrayal of pediatric cancer: Average