Chapter summaries Broken (in the best possible way) Jenny Lawson

Chapter 20: Am I Even Still Alive? Summary and Analysis

⚠️ Spoiler Warning: This guide contains detailed spoilers for the entire novel. Proceed only if you've finished reading or are comfortable knowing the plot.

Summary

Jenny receives a phone call from her doctor saying she tested positive for tuberculosis — a shock because she had no symptoms. She goes in for retesting, and the experience triggers a reflection on the constant medical surprises that come with her collection of chronic diseases. She explains that her rheumatoid arthritis (RA) is managed by monthly biologic injections, which put her into remission but also suppress her immune system. One side effect was medication-induced lupus, which she endures because RA pain is worse. The blood work also reveals that she has Hashimoto’s disease, adding another condition to her list.

A digression about treating a family outbreak of “buttworms” (pinworms) showcases the absurdity of living with a body that constantly betrays normalcy. After the retest, Jenny learns she has latent tuberculosis — inactive but dangerous because her immune-compromised state could activate it. To continue her RA injections safely, she must first complete a nine-month course of TB medication. That drug makes her sick and requires total abstinence from alcohol, a difficult sacrifice. During the treatment her RA symptoms return, reminding her how terrible uncontrolled inflammation feels. She finishes the regimen successfully, only to discover later that she lost too much blood — a crisis covered in another chapter.

Key Events

  • Jenny gets a call about a positive tuberculosis test and returns for a confirmatory test.
  • She describes the difficult balancing act of treating RA with immune-suppressing biologics, which led to medication-induced lupus.
  • A tangent about treating her entire family for pinworms (“buttworms”) illustrates the chaos of chronic illness management.
  • The doctor confirms she has inactive TB and also diagnoses her with Hashimoto’s disease.
  • Jenny stops her RA injections while taking a nine-month course of TB medication, enduring nausea and sobriety.
  • Her RA flares up again, reminding her of the severity of untreated disease.
  • She completes the TB treatment only to face a new blood-loss problem (referenced from a later chapter).

Character Development

Jenny Lawson continues to navigate the medical system with dark humor and self-awareness. Her resilience is evident in her willingness to endure months of nausea and forced sobriety to get back to the RA medication that gives her a functional life. She also shows vulnerability when reflecting on how depression often accompanies chronic pain, and how outsiders can trivialize her struggles with advice about diet or prayer. Victor is briefly sketched as unsympathetic but practical (threatening to burn the house), while Hailey is portrayed as unembarrassed and resourceful when tracking down pinworm medicine — a contrast to Jenny’s own anxiety.

Themes, Symbols, or Motifs

  • The Domino Effect of Illness: Jenny describes her conditions as “like a big game of stop hitting yourself” — treating one disease often triggers or worsens another, creating an exhausting cascade.
  • Absurdity and the Grotesque: The buttworm digression is a deliberately shocking comic motif that underscores how undignified and surreal chronic illness can be. Even a serious TB diagnosis is undercut by the memory of parasitic worms.
  • The Cost of Wellness: Every treatment carries a hidden price — lupus from RA meds, TB from a weakened immune system, liver damage from TB drugs. Jenny makes the trade-offs explicit, showing that survival requires constant negotiation with one’s own body.
  • False Positives and Diagnostic Traps: The initial TB scare is a false positive, highlighting how the medical system can generate more fear than clarity, especially for patients with complex histories.

Why This Chapter Matters

“Am I Even Still Alive?” is a microcosm of the entire book: a candid, darkly funny account of living with multiple chronic illnesses. It shows the reader what it means to manage conditions that interact in unpredictable ways, forcing impossible choices. Jenny’s voice — equal parts outrage and gallows humor — makes the medical minutiae accessible and human. The chapter also foreshadows the serious blood-loss episode, reminding us that for many patients, there is no final victory, only ongoing battles.

Study Questions and Answers

  1. Why does Jenny decide to stay on her RA biologics even after developing medication-induced lupus?
    Answer: She judges that the pain of uncontrolled rheumatoid arthritis is worse than the lupus symptoms, so she accepts the trade-off. This illustrates the relative severity scale that many chronic illness patients must create.

  2. What does the buttworm digression reveal about Jenny’s approach to telling her story?
    Answer: It demonstrates her use of shocking, lowbrow humor to destigmatize bodily failures and to create comic relief from more frightening medical topics. It also shows that life with illness often involves undignified, embarrassing incidents that can be turned into shared jokes.

  3. How does the domino effect of diseases operate in this chapter?
    Answer: The RA treatment suppresses Jenny’s immune system, making her vulnerable to latent TB. To treat the TB, she must stop the RA treatment, which causes her RA to flare. Meanwhile, the TB medication harms her liver and forces her to abstain from alcohol, adding new burdens. Each intervention triggers a new problem, creating a cascade that never fully resolves.

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