“I’m in fourth grade. One day, I’m sitting in my seat in class, minding my own business. I’m kind of quiet, but everyone knows exactly who I am: Jeffrey Alper, That Boy Who Had Cancer. There isn’t a kid in the grade who hasn’t eaten spaghetti at the church hall’s annual Alper Family ‘Fun-Raiser’ Dinner, or gotten dragged to a high school jazz band concert in my honor, or—God help me—bought a Save Jeffrey T-shirt. If you were me, you’d try to keep a low profile, too.”

The opening paragraph of After Ever After introduces the protagonist and narrator, Jeffrey, revealing his backstory and desire for normalcy. It also establishes the story’s humorous tone, as Jeff and Tad often make fun of the assumptions and stereotypes that young cancer survivors can face.

“‘What do we do now?’ Mom asked.

‘What do you mean, “what do we do now?” We get off the turnpike and make a left.’

‘Ha-ha. I mean…what do we do now?’

‘I don’t know, honey. Maybe we go home and live happily ever after.’”

This conversation between Jeff’s parents echoes the novel’s title, establishing The Aftereffects of Cancer Treatment (physical and otherwise) as a central concern. It also characterizes his mother as anxious about her son’s future and his father as more hopeful. This highlights the narrative’s focus on The Impact of Life-Threatening Illness on Family Dynamics.

“See, I have this problem. I get kind of spacey sometimes, and I miss some of the things my teachers say. That happens to a lot of kids who have had leukemia, because the chemotherapy drugs and radiation can mess up your brain permanently. Some kids come through it totally fine, but I’m not one of those kids. I never even had radiation, but I did have ‘high-dose and intrathecal methotrexate,’ which is the fancy way of saying that the doctors used to shoot poison into my spinal cord and bathe my brain in it. And it left me a little scrambled up.”

Throughout the novel, Jeff experiences delayed effects from his cancer treatments, which have left him disabled. Jeff is characteristically blunt about the physical consequences of cancer treatment, describing the latter as poison. However, his refusal to mince words does not mean he is entirely comfortable with the aftereffects of treatment, which impact his self-perception and social life.