on The Two Kinds of Decay, a memoir by Sarah Manguso (Farrar, Straus & Giroux)

As a Harvard undergraduate in 1995, Sarah Manguso contracted a neurological disease called chronic idiopathic demyelinating polyradiculoneuropathy or CDIF, though her illness was initially misdiagnosed. “My disease has two steps,” she writes. “The immune system secretes antibodies into the blood. Then the blood delivers the antibodies to the peripheral neurons. The antibodies destroy the neurons. First, they eat away the cells’ myelin sheaths, then they eat away the cells themselves, which heal more slowly, if at all. And so I had a nerve doctor and a blood doctor.” The Two Kinds of Decay presents (and reiterates) enough clinical information both to convince you that Manguso grasps every detail of her condition and to make you queasy. The narrative covers about five years of repeated hospitalizations, vascular surgeries, relapses, collapses, infusions, drug dependencies, depression, and changes of doctors, facilities, therapies and technologies. On the level of medical drama alone, it’s an engrossingly desperate story.

manguso.jpg“This is the usual book about illness. Someone gets sick, someone gets well,” Manguso says in the final chapter. “Those who claim to write about something larger and more significant than the self sometimes fail to comprehend the dimensions of the self.” But this isn’t the usual book about illness (and she knows it), and part of what makes The Two Kinds of Decay unusual is Manguso’s impatience with failures of comprehension. Another unusual element is her calculated advance toward the specific kind of comprehension she most favors. In the first half of the book, she engages us in the shock of sudden symptoms, diagnoses, and invasive treatments, one of which is apheresis, a method that removes, cleanses, and reintroduces the blood to the body through an implanted tube – in Manguso’s case, a direct line to the heart. Then, we arrive at a chapter called “Other People.” Here it is, in full:


"Most apheresis catheters like mine are implanted in women with breast cancer.

A visiting nurse asked me how long I’d had cancer. Then, after I told her I didn’t have cancer, she swore, and apologized for swearing, and told me all the nurses in the office had gathered for a moment that morning, in the break room, and comforted each other that someone so young, so much younger than they were, was so sick.

Either before or after that – though it doesn’t matter now, since I remember things in the order that they make sense, and any order is fine – my primary care doctor visited me and said I’d already endured something much worse than most people have to endure in an entire regular-length life. His voice shook. He was forcing tears either forward or back.

Before the diagnosis, I would have loved hearing him say that.

The doctor was older than my parents, and he must have had plenty of younger patients, but he didn’t understand yet that suffering, however much and whatever type, shrinks or swells to fit the size and shape of a life.

I refused to let him in my hospital room again, and my parents and I re-enrolled in our health plan with a different doctor. I felt no antipathy, just a certainty that his pity would accrue to me, and would grow in me like the sea of antibodies, with which I was already invisibly killing myself, and that I couldn’t take in any additional poison."


This shot across the bow of Manguso’s doctor is no less than a warning to the reader. Here at mid-book, after following this candid young woman through fright and dread, wincing and empathizing, she now suggests that perhaps we have missed the point. In fact, we’ve been misled. This story isn’t being told to memorialize an experience or expose human fragility or critique the healthcare system, though it does all three with terse skill. The second half of the book moves to answer its own question, stated with just three pages to go until the end: “Why is it important to me to know the beginning and end of this particular decay I think I’m writing about – which is just part of my own whole decay?” If suffering accommodates the shape of a life, then reflecting on the years of pain and worry gives Manguso an opportunity to sense her life’s shape. This is why “any order is fine.” It isn’t pity as much as any sentimentally fixed measurement of her life-shape that she resents. Thus, we must be on alert to watch for the speculative. Otherwise, we turn into Manguso’s detested neurologist: “Every time I’d seen him after a hospitalization, he told me to pack my things and go back to college because the disease was gone.” Doctors/readers must look closer and take the patient/narrator more seriously.

MangusaGuernica.jpgManguso-as-patient is most usually depicted as alone, suspended within her situation, among nurses (attuned or insensitive), lovers, and even her parents whose main function is to provide transportation between various humiliations. “My college boyfriend called the day before his graduation. I said hello, and then I said I didn’t want to see him or speak with him. I already felt the numbness creeping into my hands, my face, my tongue. The antibodies would stay there until I replaced my plasma or died. Sever all complications now, the numbness said, no matter how dear.” She recalls this behavior, and then qualifies it: “I could have gone to the hospital without making any phone calls – everyone would have understood – but I preferred pretending I had to quit everything. Chosen to get sick again. That it was all part of my plan.” Memories of illness give Manguso opportunities to feel more like herself, to depict herself in higher relief. Cutting off one’s choked up primary care doc or pulling the plug on her unsuspecting boyfriend are gestures perfectly suited to this narrator – and they make her interesting, above all else. Later, in “Before and After,” she says, “Though during the bad relapses I knew I was a better person temporarily, in general the disease made me furious, jealous, resentful, impatient, temperamental, spiteful. My sense of entitlement grew enormous. I knew the steroids had triggered what is now called a mood disorder, and I didn’t care.”

As “Other People” displays above, The Two Kinds of Decay plays out in 80 very short chapters, indulging a mordant tone with just enough restraint, and almost always offering an incisive view, often surprising. This style has come to be called “lyric essay,” though I don’t know why. It is simply very terse prose, laid out airily on the page. Manguso’s use of this compressed form is masterful, mainly because she crams a lot of sly complexity into the speaker’s own voice. Her story encompasses more than hospitalizations. There are episodes about college, love affairs, childhood memory, and mini-meditations on many topics.

“My disease has been in complete remission for seven years,” she writes near the end, “but I still act as if I expect it to come back tomorrow.” Uncertainty has inspired a provisional life, “I don’t want to buy a place until I’m sure I won’t meet someone who’ll share the down payment with me.” What, then, is this narrator’s relationship to her audience? Also provisional. We are the attentive ears in this one pointed moment of telling (such is this book’s artful illusion). “My existence shrank from an arrow of light pointing into the future forever to a speck of light that was the present moment. I got better at living in that point of light, making the world into that point. I paid close attention to it. I loved it very much.”

The Two Kinds of Decay concludes with a nod to meta-memoir, a gesture bound to keep Manguso in good standing with her fellow Iowa MFA grads. Her grudge against those who “sometimes fail to comprehend the dimensions of the self” is also a vote for attentiveness that cancels out conclusiveness, for the knowing unknowingness that has become a postmodern stutter. “I don’t know if I changed because of my disease or in spite of it,” she says, then adds, “How can I stop thinking about the disease long enough to write about anything else? How can I stop thinking about everything else long enough that I can write about the disease?” Aren’t these the usual, banal questions of any writer, sorting out everyday existence from whatever stirs the art? But that may be Manguso's point: illness doesn't confer exceptionalism. In any event, the meta-content goes on too long. “What times aren’t open to debate? What times are clear?”

manguso2.jpgManguso’s second book of poetry, Siste Viator, was one of my favorites in 2005. On hearing she had written a memoir, I decided not to read it, since I didn’t want anything explanatory to gloss the poems. The Two Kinds of Decay is a gruesomely alluring book of transitions: well to sick, highschool to college, girl to woman, ugly to beautiful, numb to over-sensitized, pained to sexy. Yet something in me remains reserved for her poetry alone – and I send the memoir on its way, perhaps to you, my reader, the way Manguso sent her poor old doc into the cold.


I am not asking to suffer less.
I hope to be nearly crucified.
To live because I don’t want to.

That hope, that sweet agent –
My best work is its work.
The horse I ride into Hell is my best horse
And it bears its name.
So, friends, drink your cocktails and wear your hats.
Thank you for leaving me this whole world to go mad in.

I am not asking for mercy, I am asking for more.
I don’t mind when no mercy comes
Or when it comes in the form of my mad self
Running at me. I am not asking for mercy.

[Published May 27, 2008, 192 pages, $22.00, hardcover]