The two kinds of decay
by Steve Danzis
[ bookreviews ]
Many people feel betrayed by their bodies when they suffer from a serious illness; and with autoimmune disease, this idea is especially fitting. As Sarah Manguso writes in her memoir The Two Kinds of Decay, "All autoimmune diseases invoke the metaphor of suicide. The body destroys itself from the inside."
Manguso was in her junior year at Harvard when she came down with a rare, chronic form of Guillain-Barré syndrome, an autoimmune disease that causes antibodies to destroy nerve tissue. If not treated successfully, the disease can lead to permanent paralysis and even death.
The Two Kinds of Decay opens with a dramatic description of the onset of Manguso’s illness. At first she noticed tingling and numbness in her hands and feet; within a few days she could hardly walk. Her parents rushed her to the hospital, where she was attached to a machine that separated plasma from her blood, removing the antibodies that attacked her nervous system. This treatment kept her alive, but her body quickly produced more dangerous antibodies, so she needed to return to the hospital frequently to have her blood purified.
Over the course of a year, Manguso endured more than fifty blood plasma exchanges. Her veins became so scarred from needles that a central line had to be implanted in her chest. She lost a lot of weight and became addicted to tranquilizers. Nearly as traumatic was her loss of independence. Some doctors and nurses were very competent and sympathetic; others drove Manguso to barely suppressed rages. In a chapter called 'Blood and Shit', she describes how humiliated she felt when she depended on nurses to wipe her ass.
Her condition only began to turn around when she found a second neurologist who put her on an aggressive course of steroids and gamma globulin. The steroids bloated her body and caused her bones to thin, but within nine months she recovered enough to have her central line pulled.
Manguso, the author of two books of poetry and a collection of short fiction, writes in a spare style. Her memoir is divided into short chapters that shift back and forth in time. Some of the chapters are flat and undeveloped, and readers may feel disappointed at how little she reflects on healthcare issues that relate to her experience. But Manguso is a compelling and evocative writer who can portray terrifying moments with admirable restraint. Here she is describing a botched attempt to attach a central line to her chest:
So the lidocaine began to wear off, and the doctor kept telling the interns and the surgery residents exactly what the trouble was, and he became frustrated when he couldn’t get the tube into me, and tried another, thinner tube, and sweated onto me, and stunk up the entire room with his frustration.
He tried again and again to jam the tube into my vein. Every now and then he had to stop and apply pressure, as I was bleeding. At one point I thought I felt a jet of blood spurt into my chest cavity, and that’s when I lost my composure.
Manguso was young and inexperienced when she became ill, and this memoir is as much a coming-of-age story as a chronicle of illness. As she states, her disease "constituted most of my identity." After her central line was pulled, she returned to college very self-conscious of her changed appearance - bloated body and face, acne, a big scar on her chest. But she decided that sex could not be put off, so after a night of drinking she wound up in bed with a "legendarily promiscuous" friend just before his graduation. It wasn’t the disaster one might have expected. Manguso believes she was cured of her disease by this man who "selflessly had intercourse with an ugly version of a girl he’d once had a crush on."
In fact, Manguso had to endure eight more years of illness, suffering from a variety of painful symptoms as well as chronic depression, which at one point became severe enough to require admission to a psychiatric ward. But the story of her "intercourse cure" is still revealing. After relying on others for the most basic needs, she was in some sense infantilized, and that night in her dorm room was a protest against this condition. True recovery involves reclaiming one’s own narrative, which Manguso fully achieves in this honest, insightful memoir.
