Review: The Two Kinds of Decay by Sarah Manguso

514x7Uld+tL._SY344_BO1,204,203,200_Sarah Manguso’s The Two Kinds of Decay was another one of the texts examined in a course in “tiny texts,” a memoir based on the author’s sudden development of autoimmune disease.  Throughout the text, Manguso struggles with questions of life and death, intubations, blood cleansing procedures, and even a rumor of her own death.  What sets The Two Kinds of Decay apart from other illness memoirs is the vast personality Manguso puts forth.  While a fair bit of the text is serious, Manguso is never far from humor, and she is always sure to share her humanity.

I paged through trying to find the right example, but this I think one does nicely–a chapter called “Vitamin K.”

After twenty-odd apheresis sessions, the veins in my arms had grown too scarred to access, and my body had grown too frail to tolerate having thick temporary catheters implanted in my chest and pulled after one week.  I’d already had three of those.

And so it was time for a permanent central line.

But that would require a long surgery, with general anesthesia which I wasn’t in any shape for, so I couldn’t get the permanent line right away.

I’d been taking azathioprine for two weeks, a cytotoxic chemotherapy drug often use as an immunosuppressive. It had killed a lot of my red blood cells and a lot of my white blood cells. I was anemic and susceptible to infections. That was the cellular problem.

Then there was the plasma problem. Throwing away my plasma got rid of the devil antibodies, but my plasma also contained other cells and proteins that the blood needs. If they’re missing, you get trouble.

My fibrinogens had disappeared almost completely. The hospital was 98328-004-5514AFACdoing a good job of removing my plasma and tossing out the fibrinogens with the bathwater.

Fibrinogens help knit the plasma together into a clot. When there aren’t enough of them, you bleed.

The evening before my surgery, my fibrinogen level was low. We’d been waiting for my fibrinogens to regenerate. But in order for that to happen, we had to take time off from replacing my plasma. So while the fibrinogens were coming back, the antibodies were coming back, too. So I was filling my blood with poison again, at the same time it was filling with the molecules I needed to tolerate the surgery.

My fibrinogen levels were checked all night, but by morning I still didn’t have enough.

Two hours before I was to go in to surgery, an Irish doctor appeared. His brogue was beautiful and thick. He had been called to give me a shot of vitamin K, which would help my blood clot during the surgery.

He shot it into my right triceps. God, was he handsome.

The injection site stayed sore for five years, but not once during those years did I mind remembering the Irishman who had shot me full of K.

What can I say?  It’s one of those books that I liked quite a bit.  Manguso interrupts the serious with deadpan and dry humor, and as I mentioned earlier, it imparts a humanity and authenticity that other memoirs seem to miss out on.

On the more technical side of things, Manguso employs no table of contents, a choice that mirrors the chaotic nature of what she experienced.  You can never be sure if the next chapter will be something more serious or an unfortunate development in her illness or a more light-heartedmitchell-190 one.  It’s a brilliant approach that takes advantage of juxtaposition between life and death and one’s own decay v. the decay of others.  Manguso’s short chapters and short paragraphs make for fast reading.  Again, by speeding up the pace, Manguso creates a sense of anxiety and the chaotic.

Each page also includes a large amount of white space, a reminder that for everything Manguso includes, there are also things she is omitting.  Still, the white space functions as a means of putting emphasis on everything she does say, making for an interesting dynamic between omission and emphasis.

I really enjoyed The Two Kinds of Decay, and even the cover brings to mind an intertwining of human life and nature.  Interesting to see I’m not the only one to have seen a comparison between dead trees and the human vascular system.

The Two Kinds of Decay is a memoir with teeth, with substance, and with humanity.  Absolutely recommended.


One thought on “Review: The Two Kinds of Decay by Sarah Manguso

  1. I’ve only read one other ‘illness memoir’, called It’s Not Yet Dark I think, and I really enjoyed it, so maybe I might give this one a go. The cover, first of all, is really beautiful, and, like you said, shows how human life is so closely intertwined with nature. I like that the book is filled with juxtapositions so each chapter is totally different. It does sound pretty heavy though so I’ll have to be a certain mood if I do pick it up. Thanks for the great review.


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