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The Two Kinds of Decay A Memoir

Sarah Manguso




Trade Paperback

192 Pages



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A New York Times Book Review Editors' Choice
A Time Out Chicago Best Book Book of the Year

A San Francisco Chronicle Best Book of the Year

The events that began in 1995 might keep happening to me as long as things can happen to me. Think of deep space, through which heavenly bodies fly forever. They fly until they change into new forms, simpler forms, with ever fewer qualities and increasingly beautiful names.

There are names for things in spacetime that are nothing, for things that are less than nothing. White dwarfs, red giants, black holes, singularities.

But even then, in their less-than-nothing state, they keep happening.

At twenty-one, just starting to comprehend all the traditional puzzles of adulthood, Sarah Manguso was faced with another unexpected challenge: a wildly unpredictable disease that appeared suddenly and tore through her twenties—vanishing and then returning, paralyzing her for weeks at a time, programming her first to expect nothing from life and then, furiously, to expect everything. Manguso recalls her nine-year struggle with Chronic Idiopathic Demyelinating Polyradiculoneuropathy, or CIDP, which disintegrates the myelin coating that protects the nervous system. She endured arduous blood cleansings, collapsed veins, multiple chest catheters, the deaths of friends and strangers, addiction, depression, and, worst of all for a writer, the trite metaphors that accompany prolonged illness. A book of tremendous grace and self-awareness, The Two Kinds of Decay surpasses the expectations for a story about illness; Manguso trains the eyes anew on the notion of illness and survival.


Praise for The Two Kinds of Decay

"In her second year of college, the poet Sarah Manguso developed a neurological disease so uncommon it doesn't even have a real name. The autoimmune condition, a rarer form of the already rare Guillain-Barré syndrome, is known as chronic idiopathic demyelinating polyradiculoneuropathy, and it took more than four years to run its course. For several of them, Manguso had to undergo periodic treatments in which her plasma was completely removed and replaced. The treatments worked, but sometimes only for a few days. Later, she moved to steroid treatments, which restored a degree of physical well-being but created complicated side effects. In her sharp, affecting new memoir, The Two Kinds of Decay, Manguso writes from the far side of a long period of remission. 'For seven years I tried not to remember much because there was too much to remember,' she writes. From an original welter of experience, she has carefully culled details that remain vivid. Filtered through memory, events during her illness seem like 'heavenly bodies' that 'fly until they change into new forms, simpler forms, with ever fewer qualities and increasingly beautiful names.' Manguso is acutely interested in these processes of renaming and remembering, the way time changes what we say about the past. Her book is not only about illness but also about the ways we use language to describe it and cope with it. The author of two books of poetry, Manguso brings the virtues of that form to the task of writing memoir. Her book is divided mostly into one- and two-page chapters titled like poems. She mixes high and low language, the crass and the scientific, with a lyric poet's sure-handedness. The chapters themselves—among them 'The Hematologist,' 'The Forgetful Nurse,' 'Corroboration'—resemble her own poetry, broken into aphoristic, discrete sections on the page. This disjointedness gives the prose a rhythm that mirrors the confusion and fragmentation of illness. It also clears space for one of the book's most remarkable aspects: its dark humor. What makes this account both bearable and moving is Manguso's keen sense of the absurdities that accompany severe illness. Often these come from its odd proximity to ordinary life . . . Manguso was already a writer when she became ill, and her obsession with words, their capacities and limitations, permeates her book. The world of hospitals and doctors has its own language, which she translates for the uninitiated reader. Her plasma replacement treatment is called 'apheresis,' which she notes is 'from the Greek aphairein, to take away.' She is amused that hematologist-oncologists abbreviate their titles to '"hem-oncs" (pronounced almost like he-monks).' But her interest is more than literary curiosity. When she has a line implanted directly into her chest so her plasma can be replaced more easily, she parses her reaction: "I had read Freud in school. He distinguishes fear, a state of worrying anticipation . . . from fright, the momentary response of our mind to a danger that has caught us by surprise but is already over.' For hours, she writes, 'I lay there, weeping in fright. Not fear. Fright.' Manguso's desire for precision is urgent, even if it cannot always be fulfilled. 'I need to describe that feeling,' she says of the deep cold induced by apheresis. 'Make a reader stop reading for a moment and think, Now I understand how cold it felt. But I'm just going to say it felt like liquid, 30 degrees colder than my body, being infused slowly but directly into my heart, for four hours.' As much as anything, this book is a search for adequate descriptions of things heretofore unnamed and unknown. Manguso concludes her account with questions—and an exhortation to the reader to pay attention. Through her own attentiveness, Manguso has produced a remarkable, cleareyed account that turns horror into something humane and beautiful."—Emily Mitchell, The New York Times Book Review

"Sarah Manguso, a poet, and the author of The Two Kinds of Decay, says that her memoir ‘is a usual book about illness' . . . Manguso vividly describes the morning she awoke at home with numb feet and tingling in her hands; how during the next few days at college she began to walk stiffed-legged and then to stagger; how finally, after she fell down in the courtyard, she was taken to the hospital by her parents, and promptly admitted to the intensive care unit."—Diane Johnson and John F. Murray, The New York Review of Books

"When she was 21, Sarah Manguso developed a rare form of Guillain-Barre syndrome, in which the body's immune system attacks the nervous system; with Manguso, the condition began as a numbness in her feet. To survive, she required long hospitalization; endless sessions of apheresis (the separation of blood into components); frightening and invasive medical tests; and a Hickman line in her chest because human veins can tolerate only so much piercing. Hers is not a day-by-day description of this grueling time, but an impressionistic text filled with bright, poetic flashes . . . Many sick people learn to live in the moment, but the power of Manguso's writing makes that truism revelatory. Her book is filled of generous-hearted descriptions of those who helped her: the nurse who always remembered to bring mints; the engineer who designed a new apheresis machine; and a boyfriend, Victor, who continued to sleep with her and to whose tender intervention she credits her recovery. Victor himself subsequently died of an aneurism."—Juliet Wittman, The Washington Post Book World

"It's an amazing book and I'm really looking forward to reading with students . . . Manguso's book is the only memoir I'm teaching, and I chose it specifically for its critical relation to the genre and the concepts of memory, self, and linearity by which it is conventionally defined."—Eden Osucha, Professor of English, Bates College

"The novelist Richard Yates, discussing his masterpiece Revolutionary Road, once told an interviewer that the success of his writing depended upon his 'avoiding the terrible traps that lie in the path' of autobiographical writing—'self-pity and self-aggrandizement.' In trying to to decide what makes a poet and short story writer Sarah Manguso's debut memoir, Two Kinds of Decay, feel so successful, so brazen in its emotional clarity, it would be easy to chalk it up to language—to the crystalline quality of perception and sheer accuracy of observation evinced in each of her going on in this beautiful book, something tied to avoiding those traps Yates cautioned against . . . Manguso's talents as a poet are evident throughout this book, in its concision and precision, but so is a kind of empathy she's able to establish . . . We're led by the parade of empathetically drawn characters that accompany our narrator through her ordeal—the parents, nurses, doctors, lovers and friends we meet only briefly, who come to inform us in a way that lets us in so fully to the experience of the wraith of illness, we gain just what we want from a memoir: Not self-pity. Not self-aggrandizement. Only what we need—the reality, the truth, told with all the efficiency and honesty possible."—Daniel Torday, The Kenyon Review

"The story of [Manguso's] diagnosis with [CIDP] and the ensuing years of illness, recovery, and relapse, Manguso's memoir is structured as a string of short, titled chapters that together read more like a series of related lyrical essays than sections of a traditional narrative. The book is distinctive also for its decidedly unsensational quality . . . she recounts her story as a meditation on her experience, on illness as metaphor, as metaphysical crisis, as spiritual awakening. The book explores questions about who we are to ourselves—how we reckon with our weaknesses and with the relentlessness of an unknown future—and to one another—how our seemingly minor day-to-day social transactions are really the roots of our humanity . . . Because Manguso's primary aim in her memoir was clarity, the writing is spare, the language economical . . . [she decided] to write about anything that had to do with the experience of growing up, being sick, and getting better."—Mary Gannon, Poets and Writers

"Few writers are memoirists by profession, and it's hard to imagine what the qualifications might be. A compelling and even awful life history helps (Mary Karr), but it's not really necessary or a guarantee. Exceptional success in some other field (Barack Obama) also creates basic narrative interest, but a talent for politics, for example, doesn't always translate into a talent for meaningful reflection. What does seem to distinguish many great memoirists, though, is an almost supernatural intuition with language: the ability to take recollections that have personal resonance and make them echo for readers in written sentences (Joan Didion, Jamaica Kincaid, and Elie Wiesel). In comparison with this gift, experience seems almost beside the point. It's no surprise, then, that poets so often write memoirs, and that they take to the prose form so naturally. Karr is the blockbuster example of a contemporary poet-memoirist, but other young poets who have written in the form in recent years include Nick Flynn (Another Bullshit Night in Suck City) and Paisley Rekdal (The Night My Mother Met Bruce Lee). Most recently, both Sarah Manguso and Lavinia Greenlaw have written memoirs that press on the boundary between poetry and prose and affectingly describe, in intentional fits and starts, the poets' tumultuous girlhoods. Sarah Manguso was 20 when she was diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP), an obscure neurological disorder. At first, before she endured four years in and out of the hospital and five more of sickness and recovery, she took solace in the rareness of her problem. For a young woman who already was in some respects an artist, the uncommon diagnosis was 'proof that my death, the end of my disease, whenever and in whatever form it came, was going to be remarkable.' By the end of the 12 years Manguso recalls in her memoir, The Two Kinds of Decay, this perspective is what has changed the most. Manguso, who became sick and then well over so many years, now believes that 'the most important things' happen incrementally. Manguso describes what happened to her in about 80 discrete sections, each focused on one character or moment and none longer than two or three pages. The paragraphs, or perhaps stanzas, tend to be short and are separated by one-line breaks that function like intakes of breath. Manguso's writing is similar to Rekdal's in that, as one reviewer wrote of Rekdal's memoir, the writing is poetic 'not in its dictions but in its elisions.' Like Rekdal, Manguso tends to let the most significant moments in the text fall in the line breaks between thoughts . . . Memoirs of sickness are common; what is remarkable about Manguso's is that it conveys more subtle developments. The years she describes as nothing were, as she slowly explains, not entirely empty."—Carla Blumenkranz, The Poetry Foundation

"Contrary to the usual cliché, illness did not make Manguso a better person. It made her a more thoughtful, self-aware person. In simple, unsentimental language, she describes her initial symptoms, her sudden attacks, her treatments, her suicidal depression, and her progress as a patient and, incidentally, as a person."—Barbara Fisher, The Boston Globe

"The poet and fiction writer recounts her struggle with the paralyzing disease CIDP—chronic inflammatory demyelinating polyneuropathy—and touches upon her life after remission: landing in the psych ward, heavy drinking and then sobriety, attending the Iowa Writers' Workshop and living in New York as an adjunct-teaching, freelancing renter. Manguso's lessons are hard won—and offer much hope—in this powerful and moving memoir."—San Francisco Chronicle

"About halfway through Manguso's new memoir, she recounts eating a hamburger. 'I'm not talking about the way ketchup and mustard taste in general,' she writes. 'I mean I can taste the particular condiments that were on that particular hamburger I ate in 1995. You can forgive Manguso for pausing over the memory of that burger; it was the first one she'd eaten in a long time, and some of the first solid food she's eaten after months of medical treatment left her on a liquid diet. Manguso was diagnosed in 1995 with CIPD, a rare blood disease that sets the immune system to attacking the nervous system, causing paralysis that begins in the extremities and encroaches in to the vital organs. As the Rome Prize-winning poet writes, 'My immune system was trying to destroy my nervous system. It was a misperception that caused me a lot of trouble.' With two books of poetry and one short-story collection under her belt, Manguso brings both of those influences to bear in this stunning story of illness and recovery. She divides the book into short chapters, most dealing with the literal pain of the disease, but many tackling the broader implications of suffering. Her deadpan tone works equally well in service of the painful and funny moments, or when the two meet, as when Manguso writes, 'There are two kinds of decay: mine and everyone else's.'"—Jonathan Messinger, Time Out Chicago

"Sarah, it turns out, is absolutely amazing. A revelation to me—I hadn't known her work. She stands in the dining room in front of the crowd . . . and reads from her new, completely devastating poetic memoir called The Two Kinds of Decay. I'm struck by the disconnect of seeing this tall, beautiful young woman and hearing her heart-rendering story of enduring a terrible illness. A brave piece of work—the applause went on and on."—Dani Shapiro, Departures magazine

"Manguso got sick in college. To fix bad blood, doctors replaced it. Meanwhile, Manguso—anti-hyperbolic—watched and listened. She took the pulse of catheters and examined her 'less-than-nothin state.' Her memoir preaches neither gray grief (Didion) nor high elegance (Sontag). Like Daniel Defoe, who monitored the Plague Year, Manguso concerns herself with the mundanely terrible arithmetic of being ill. Her body's collapse often talks luridly. Instruments get bad intimacy. But cells do not run riot and meat does not rot. Even if they did, Manguso is not that kind of spokesperson. She's a UN envoy within her malfunction. As merger of medical back roads and privacy violated, her report to HQ on the toll is lucid, beautiful, and tangibly a matter of hurt."—Christopher P. Winner, The American magazine

"Manguso's slender volume is written in a sparse, no-nonsense style that can be chilling but make you cheer for the author."—The New York Post

"A literary memoir set in the landscape of illness comes with a set of challenges: on one side lies the perennial vegetation of Reader's Digest drama-in-real-life with its banal melodrama, often accompanied by miraculous white-light conversations with God—and on the other that erudite border dug by Susan Sontag who so eloquently wrote a disquisition against poetic metaphor in describing disease. Sarah Manguso, in her memoir, treads lightly down this thorny path, seemingly conscious of both perils, and adopts instead an earnest understatement to describe her nine-year ordeal with Chronic Idiopathic Demyelinating Polyradiculoneuropathy, a disease also known as CIDP. In episodic short chapters, she contemplates the identity crisis chronic illness imposes on the person who existed and still exists adjacent to the patient created by the physical debilitation. In one haunting passage she writes, 'This person, whose hand I am shaking at this moment, is another person who never knew me before the diagnosis.' Sometimes she travels in first person, sometimes second; the latter makes her body our body. Most times her sentences are factual and lean of metaphor (one hopes Sontag would approve), with breaks that are more stanza than paragraph. Various forms are employed, including aphorisms and a section where every paragraph begins with 'I remember' in the style of Joe Brainard. A simmering frustration and fury are well conveyed in harrowing accounts that describe her stoic parents and an erroneous diagnosis; its accompanying steroid treatment gravely aggravated the real malady. In ending, Manguso delivers us not to the obvious trumpet calls of triumph over death, but to a certain detached contemplation, saying, 'This is the usual book of illness. Someone gets sick, someone gets well.' Here the tone grows increasingly remote, almost apologetic for the limitations of illness memoir, offering instead a list of poetic abstractions clearly earned from the excruciating concrete experiences her disease has exacted."—Jackson Taylor, The Brooklyn Rail

"The glory of good writing has always been its wonderful ability to transform the specific into the universal and to draw something profound from the human experience. In her memoir, The Two Kinds of Decay, poet Sarah Manguso works hard to do exactly that, and to tell her story as honestly as she can . . . She has a good eye for detail and her story has the ring of truth."—Nancy O'Connor, The Plain Dealer (Cleveland)

"Composed of sentences as spare as they are unsparing . . . Manguso pushes beyond the familiar confrontation between doctor and patient to explore the linguistic confusion at the heart of the power struggle."—Slate

"A stunning book, The Two Kinds of Decay comprises dozens of smaller chapters. Manguso's talent with language, combined with her fearless delving into her experience, is gift-like for the reader, who is continually astonished by her careful distillation of illness, memory and, ultimately, her own humanity."—Amanda M. Traxler, IG Living

"Sarah Manguso is a poet, and if the beautiful, terse sentences in The Two Kinds of Decay are any indication, she is a fine one. In this short, sharp memoir, Manguso describes the head cold she caught in February 1995. She was 21 years old, in college, second soprano in a choir scheduled to perform Gregorio Allegri's ‘Miserere' on March 5, 1995. She managed to keep her cold in check until after the concert, where the choirmaster praised her work. She went home for spring break and began a nightmare of illness that would last for next nine years. Sarah Manguso has chronic idiopathic demyelinating poliradiculoneuropathy. In layman's terms, this means her immune system secretes antibodies, which travel to the peripheral neurons, eat away the protective sheath covering the nerve cells—myelin—then eat the cells, which sometimes recover, sometimes not. Symptoms include numbness and tingling in the extremities, paralysis, and the inability to breathe . . . She could relapse at any time. And this had taught her to pay attention, and to see the world in space-time: everything is happening simultaneously, has already happened, has not happened yet."—Diane Leach, January magazine

"Manguso writes this account from the far end of the illness, looking back on it from a position of physical strength, biting ferocity, and unsentimental wit."—Wendy Lesser, Bookforum

"Here is a beautiful, brave memoir that takes us into the heart of a young woman's illness, its pains and terrors and mysteries, yet leads us somehow into brightness. For all its clinical precision of the physical, The Two Kinds of Decay is one of the most movingly humane books I have read in a long time; it is a hard-earned vision of life, every word grounded in both body and soul. Sarah Manguso is a brilliantly talented writer, and this is a book not to be missed."—John Burnham Schwartz, author of Reservation Road

"If art can be described as the paths one takes toward some form of compassion, this distilled and luminous book offers us one such a map. An exploration of a body at a particular moment in its history, narrated by an unsparing yet appealing consciousness, The Two Kinds of Decay brings the reader to a place of grace and compassion that is absolutely breathtaking."—Nick Flynn

"At the white-hot center of this book burns the intelligence and wit of Sarah Manguso, one of the most brilliantly talented writers at work today. She is a clear-eyed visionary, a connoisseur of the penetrating declarative, an unsentimental chronicler of the horrifying insult of illness and of the desires that drive us headlong into adulthood. With a poet's brevity, with riveting narrative energy, with searing insight and compassion, Manguso leads us into hell and back again; every step of the way, there's the thrill of knowing we're in the hands of a new literary master."—Julie Orringer, author of How to Breathe Underwater

"In The Two Kinds of Decay, Sarah Manguso has miraculously elevated the act of memory. She has found honesty, fear, longing and beauty in every moment of her young life, giving this book an intensity found nowhere else. You put it down panting with wonder and grief, but never with pity. A breakthrough in the memoir, and in writing."—Andrew Sean Greer, author of The Confessions of Max Tivoli

"[The] frank account of the autoimmune disorder that consumed the author in her 20s. The disease that plagued her in various ways for nine years had ravaging effects on Rome Prize winner Manguso, whose poetry and prose have never shied away from staring a subject in the face. In short chapters of slim paragraphs buffered by white spaces bearing as much emotive force as the poetic statements they insulate, she carefully unfurls the details of her eventual diagnosis of CIDP . . . Manguso's condition first manifested in February 1995 as a head cold that wouldn't quit; by March it had escalated to numb feet and almost complete paralysis. She landed in the hospital and underwent her first aphaeresis, a four-hour procedure that took her blood's plasma (whose 'devil antibodies' were stripping the myelin from her peripheral nerves and causing paralysis), removed it and replaced it with the plasma of others. The author endured more than 20 of these vampiric procedures before a central line was surgically implanted in her chest and a new neurologist recognized that curative treatment didn't involve apheresis but steroid and gamma globulin therapy. Manguso's abundant analytic and compositional gifts are evident throughout this harrowing memoir, from her expressions of hard-won appreciation for the relativity of suffering to a nuanced account of how serious illness can alter one's conception of time, robbing the afflicted of both compassion and accurate recall. 'I waited seven years to forget just enough—so that when I tried to remember, I could do it thoroughly,' she writes. 'There are only a few things to remember now, and the lost things are absolutely, comfortingly gone.' A powerful, direct examination of memory and suffering."—Kirkus Reviews

"A wrenching yet fascinating account."—Booklist

"In 1995, when Rome Prize-winning poet and fiction writer Manguso was a junior at Harvard, she suffered the first attack of a rare autoimmune disease called [Chronic Idiopathic Demyelinating Polyradiculoneuropathy], which would turn her body against itself. CIDP attacks the myelin coating of the peripheral nerves. The result is increasing numbness, followed by paralysis spreading from the extremities inward, until the sufferer can no longer control his or her breathing, and dies. In short, lyrical chapters—the book free-associates between memories, while sticking to a rough chronological order—Manguso recounts the harrowing indignities of her treatments, frequent relapses, descents into steroid-induced clinical depression, crucial college sexual experiences had and missed, and trips back and forth between schools, hospitals and her parents' Massachusetts home. What makes this lightning-quick book extraordinary is not just Manguso's deadpan delivery of often unthinkable details, nor her poet's struggle with the damaging metaphors of disease, but the compassion she acquires as she comes to understand her pain in relation to the pain of others: 'suffering, however much and whatever type, shrinks or swells to fit the shape and size of a life.'"—Publishers Weekly

Reviews from Goodreads



  • Sarah Manguso

  • Sarah Manguso is the author of two books of poetry, Siste Viator and The Captain Lands in Paradise, and the short story collection Hard to Admit and Harder to Escape. In 2007 she was awared the Rome Prize by the American Academy of Arts and Letters.

  • Sarah Manguso © Andy Ryan
    Sarah Manguso