“I got sick the way Hemingway says you go broke: ‘gradually and then suddenly.’”

O’Rourke begins her story with a reference to Hemingway, situating herself among other authors right from the start with the intention of establishing her dual status as both a person with a chronic illness and a writer with literary prowess comparable to the authors she quotes. The use of this particular quotation in which sickness is compared to going broke emphasizes the ways in which her sickness results in tangible forms of loss.

“As Susan Sontag pointedly observes in Illness as Metaphor, illnesses we don’t understand are frequently viewed as manifestations of inner states. The less we understand about a disease or a symptom, the more we psychologize, and often stigmatize, it.”

Citing Susan Sontag in her introduction, O’Rourke places herself in conversation with an author who writes often of illness and emphasizes the connection between Sontag and the title of the book. This quotation initiates the theme present throughout the book of how a lack of systemic knowledge of a disease leads to the punishment of the patient.

“It took years before I realized that the illness as not just my own; the silence around suffering was our society's pathology.”

This quotation marks an experience of agency and transformation in the narrative that O’Rourke creates around her own illness. Instead of allowing society’s doubts of her symptoms and experience to dominate her actions, she instead transforms the narrative claim that society itself has the pathology, not patients with chronic illnesses whom its prejudices serve to stigmatize.