The Two Kinds of Decay

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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, ...

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The Two Kinds of Decay: A Memoir

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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 the puzzles of adulthood, Sarah Manguso was faced with another: 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. In this captivating story, Manguso recalls her nine-year struggle: 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 transcends the very notion of what an illness story can and should be.

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Editorial Reviews

Juliet Wittman
Hers is not a day-by-day description of this grueling time, but an impressionistic text filled with bright, poetic flashes. The use of such terms as "spacetime" at the start of the book is a little off-putting, but before long Manguso has earned them: She is attempting, after all, to give form to a vast, formless and terrifying experience. Many sick people learn to live in the moment, but the power of Manguso's writing makes that truism revelatory.
—The Washington Post
Emily Mitchell
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…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…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.
—The New York Times
Publishers Weekly

In 1995, when Rome Prize-winning poet and fiction writer Manguso (Siste Viator) was a junior at Harvard, she suffered the first attack of a rare autoimmune disease called CIDP, 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." (June)

Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
School Library Journal

Poet and fiction writer Manguso's fourth publication (contributor, One Hundred and Forty-Five Stories in a Small Box) is her illness memoir. Thirteen years ago, in her early twenties, Manguso developed an unusual, life-threatening, and very debilitating viral infection that recurred over the course of the next several years, interrupting her relationships, her education, and her career. Her diagnosis was long unclear, and her treatment was sometimes incompetent and frequently painful and humiliating. Further, some of the medications she was prescribed caused serious physical and psychological symptoms; she eventually became an alcoholic and suicidal. Young adults are not "supposed" to get seriously ill, much less relapse repeatedly, so Manguso's story is a particularly compelling reminder of mortality and the isolation and loss imposed by an illness that doesn't follow the rules. But what makes it really stand out amid the glut of other illness memoirs is the author's literary talent. The writing is spare, with the story told in a series of one- to two-page vignettes and observations. That said, Manguso's final reflections reveal so little of her thoughts and feelings that the work seems incomplete. Young adults will strongly connect, but suitable for all public libraries.-Fran Mentch, Cleveland State Univ. Lib.

Kirkus Reviews
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 (Hard to Admit and Harder to Escape, 2007, etc.), 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 (chronic idiopathic demyelinating polyradiculoneuropathy), akin to Guillain-Barre syndrome. 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 apheresis, 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.
The Barnes & Noble Review
Acclaimed poet Sarah Manguso thought she was suffering from a weeks-long head cold during her junior year at Harvard in 1995, before tingling, numbness, and shortness of breath suggested something more mysterious -- and dire. She soon found herself in the intensive care unit of the local hospital, where they administered the first of 50 rounds of aphersis, an excruciating four-hour process of removing and replacing toxic components in the blood. Thus began Manguso's nine-year battle with a disease so rare it has no name. Its closest approximation is "chronic idiophathic demyelinating polyradiculoneuropathy" -- in other words, her immune system was decimating her nervous system. With spare, precise prose, gallows humor, and piercing observation, Manguso seizes and artfully organizes shards of memories of paralysis, breathlessness, extreme pain, and terror. She "grew used to being sick and looking forward to recovering" only to become "used to having no prognosis at all, because with a mysterious disease, all things are possible." Manguso masterfully evokes her yearnings to indulge her 20-something appetites (e.g., sex and alcohol) while instead forced to confront mortality -- enduring misdiagnoses and interminable hospital stays, encounters with former classmates turned nurses, and the death of a former lover. The Two Kinds of Decay is an indelible meditation on remembering what one longs to forget, by a woman emerging from the exile of illness. --Kera Bolonik
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Product Details

  • ISBN-13: 9780374280123
  • Publisher: Farrar, Straus and Giroux
  • Publication date: 5/27/2008
  • Edition description: First Edition
  • Pages: 192
  • Product dimensions: 5.74 (w) x 8.38 (h) x 0.74 (d)

Meet the Author

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.

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Read an Excerpt


The Beginning

The disease has been in remission seven years. Now I can try to remember what happened. Not understand. Just remember.


For seven years I tried not to remember much because there was too much to remember, and I didn’t want to fall any further behind with the events of my life. I still don’t have a vegetable garden. I still haven’t been to France. I have gone to bed with enough people that they seem like actual people now, but while I was going to bed with them I thought I was catching up. I am sorry. I had lost what seemed like a lot of time.


I waited seven years to forget just enough—so that when I tried to remember, I could do it thoroughly. There are only a few things to remember now, and the lost things are absolutely, comfortingly gone.


I wrote down some things while the disease was happening—there are notes from one hospital stay and a few notes from the sickest years—but it isn’t much.


Sometimes I think the content of those days might not have finished happening. It might have begun then, in 1995, but I needed to save the rest of it until I was stronger.


The events that began in 1995 might keep happening to me as long as things can happen to me. Think of spacetime, 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.

THE TWO KINDS OF DECAY. Copyright © 2008 by Sarah Manguso. All rights reserved. For information, address Picador, 175 Fifth Avenue, New York, N.Y. 10010.

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Reading Group Guide

Questions for Discussion
1. In her closing lines, the author writes, "There are two kinds of decay: mine and everyone else's." What other allusions lie in the book's title? What kinds of decay are evident in Sarah Manguso's memories, and in all confrontations with mortality? What kinds of regeneration also take place in such circumstances?

2. Discuss the special traits of this memoir's form, such as the author's use of text blocks, one-sentence paragraphs, and brief but dense chapters. What makes her use of a unique structure appropriate for the topic? In what way is Manguso's skill as a prizewinning poet evident in her prose?

3. One aspect of Manguso's illness is isolation. How do her relationships with other people -- medical professionals, family, lovers -- change throughout the near-decade of her illness? How do their perceptions of her change? Is illness always ultimately a solitary experience?

4. One of the defining traits of Manguso's illness is its shifting definitions. What are the challenges and advantages of facing an illness that has neither a firm diagnosis nor a prognosis?

5. How was the author affected by the time of life during which her symptoms first appeared? What transitions are specific to a twenty-one-year-old? How did your own circumstances at that age compare to hers?

6. Discuss the conundrums presented in "Causation," beginning on page 21. What do these questions indicate about the nature of suffering in general? To what degree do they mirror Catch-22, a book Manguso admires tremendously (and whose author faced the same diagnosis)?

7. How was the author shaped by being a public school girl at an elite private college? What do her observations about class, "determined not by schools or money but by family," reveal about the worlds she inhabited growing up? What were the essential components of her identity before the illness, and afterward?

8. To what extent does the author weave notions of sex and death? What deeply human responses were captured in her "superstition sex" with Victor? How do her thoughts on beauty relate to her other observations about the body and perfection (or imperfection)?

9. Manguso encountered a wide variety of health-care providers throughout her treatment, from nurses and hematologists to physical therapists and neurologists. What do her recollections demonstrate about good caregivers and bad ones?

10. What ironies and images are embedded in the nature of CIDP, in which patients' blood becomes both a necessity and a threat? How did Manguso capture the impact of her treatment procedures and their metaphors?

11. How does the author's depiction of her depression differ from other memoirs on this topic? How did she cope with the tandem of depression's physical and psychological roots? What emotional progression is marked by the book's varying landscapes, from the East Coast to Iowa and back again?

12. Manguso describes the onset of her addiction to tranquilizers in "Fear and Fright" (pages 76 to 77). Is there any meaningful distinction between someone who becomes addicted to tranquilizers as the result of a painful physical illness and an addict who has experienced no physical illness? Is there any meaningful distinction between those who are addicted to prescription drugs and those who are addicted to illegal drugs, or to alcohol, or to cigarettes, or to food?

13. On page 107 in "Attention," the author writes that one gamma globulin infusion cost her health insurance company thirty-five thousand dollars. Discuss the practical aspects of her treatment and what they illustrate about health care in the United States.

14. In the last chapter, Manguso urges readers to pay attention. "This is suffering's lesson," she tells us. In the past, has suffering sharpened or dulled your ability to pay attention? What could suffering allow you to notice, if you let it?

15. Discuss the most unsettling episodes of your life. How did you navigate uncertainty and confront deep-seated fears? Think about what you will take with you from Manguso's approach to memory and survival: "You can't learn from remembering. You can't learn from guessing. You can learn only from moving forward at the rate you are moved, as brightness, into brightness."
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