The Two Kinds of Decay, By Sarah Manguso

Doctor, Doctor, can't you see I'm hurting?
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The Independent Culture

When Sarah Manguso was 21, her hands and feet became numb, she started to stagger, and was diagnosed with a rare auto-immune disease that caused her body to make antibodies to a component of peripheral nerves. The result was varying degrees of paralysis.

The immediate treatment was to exchange plasma containing these self-directed bullets for "clean" plasma, meaning IVs in her arms and neck, among other unpleasantries.

Manguso has published poetry, and this lucid memoir of her illness – which also included steroid-induced psychosis and depression – is structured like a series of poems. There is an ethereal edge: these are fragments of a life, not components of a conventional linear tract. Manguso's prose is spare, striking; her Harvard intellect shines brightly and wickedly. She has a sharp eye for both the laudable and the paternalistic in medicine, and delivers praise and barbed criticism.

The former can be found in her depiction of the compassion of the nurse who provided sweets to counteract the bitter taste induced by her treatment. Manguso's scathing disdain for those who fall short, though, is spiky and sardonic – as with the doctor who told her that she wasn't experiencing the symptoms she described because they were incompatible with textbooks, or the surgeon who, on seeing her tears at another impending neck line, commented within earshot that she "took things very hard". Neck-line insertion may seem a minor vascular procedure to a surgeon but, to a young girl, it was a ghastly prelude to a week of intense treatment for a disease with an uncertain prognosis.

Occasionally, Manguso is harsh. The doctor whose voice quavers with suppressed tears is berated and swiftly dispatched, but if you ask kindness of your doctors you must tolerate emotion. On occasion, one wonders about Manguso's own capacity for consideration – when driving into an oncoming van of kids in a suicide bid, for example.

I also have a severe auto-immune illness and have undergone many of the same procedures – indwelling neck lines, surgeries, regular, six-hour infusions of vile medicines – and am a doctor as well as a patient, so Manguso's shrewd observations have particular resonance for me. Her honest, insightful and stark memory album of a life on the edge of death – a seemingly insurmountable period of adversity seen from the other side – is an unusually piercing one.

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