Wellcome Book Prize 10th Anniversary Blog Tour: The Two Kinds of Decay by Sarah Manguso


The Wellcome Book Prize 2019, which rewards exceptional works of literature that illuminate the many ways that health, medicine and illness touch our lives, marks the 10th anniversary of this prestigious award. Over the last decade, the prize has recognised an eclectic variety of titles from novels (Mend the Living, Maylis de Kerangal) to memoirs (The Iceberg, Marion Coutts) to popular science (It’s All in Your Head, Suzanne O’Sullivan). In 2019, the prize will celebrate this legacy and this extraordinary genre of books that add new meaning to life, death and everything in between.

I hugely enjoyed being a part of the Wellcome Book Prize Shadow Panel in 2018, so I was  thrilled to be asked to participate in the Wellcome 10th Anniversary Blog Tour. Along with Harriet Devine, I’ll be showcasing a title from the 2011 shortlist, which was as follows:

  • Turn of Mind by Alice LaPlante [winner]
  • The Two Kinds of Decay by Sarah Manguso
  • My Dear, I Wanted To Tell You by Louisa Young
  • Nemesis by Philip Roth
  • The Emperor of All Maladies by Siddhartha Mukherjee
  • State of Wonder by Ann Patchett

I’d only read one of these titles before – Patchett’s incredible State of Wonder – so I had a lot of fun deciding which title I wanted to review. In the end, I went for Sarah Manguso’s The Two Kinds of Decaya memoir which chronicles her experience of living with CIDP (Chronic Idiopathic Demyelinating Polyradiculoneuropathy), which has been described as a chronic form of Guillain-Barre syndrome but, like many autoimmune diseases, is still poorly understood.


Rather than attempting a chronological account of the nine years she spent suffering from CIPD, Manguso presents us with a series of arresting and disturbing vignettes. The first treatment she received for the condition, she explains, was apheresis, or the removal of her blood from her body in order to separate it into its constituent parts to allow the purging of the diseased part, which in her case, was the plasma. She was then reinfused with healthy plasma from a blood donor, a procedure that took four hours each time. This removed the antibodies secreted by her immune system that were destroying her healthy neurons and causing her symptoms, which included a creeping paralysis.

However, each time Manguso had to have the apheresis performed, she shook with cold, no matter how many heated blankets she covered herself with. Why?

The temperature in blood vessels is warmer than room temperature… I was very slowly infused with several liters of  fluid that was thirty degrees [F] colder than the rest of my body… the cold infusions went in very close to my heart. I need to describe that feeling, make a reader stop reading for a moment and think, Now I understand how cold it felt.

But I’m just going to say it felt like liquid, thirty degrees colder than my body, being infused slowly but directly into my heart, for four hours.

The plasma infusions also gave her a persistent chemical taste in her mouth: ‘there was nothing I could do to change the taste of it. It wasn’t touching the surface of my tongue… it was in my tongue.’ She found that only sucking on wintergreen candy throughout the course of the treatment gave her some relief.

Manguso’s brief glimpses into the world of her illness mean that The Two Kinds of Decay, unlike other chronic illness memoirs such as Porochista Khakpour’s Sickdoesn’t become repetitive but remains continually riveting. Manguso doesn’t try to draw together her experiences into some great message about life – even the title of her memoir remains somewhat oblique – but simply presents them to us, in prose that is totally and brilliantly boiled down.

Since publishing The Two Kind of Decay in 2008 (it wasn’t published in the UK until 2011, hence its eligibility for the Wellcome Book Prize of that year), Manguso has gone on to publish three more works of biographyThe Guardians (2012), Ongoingness (2015) and 300 Arguments (2017). I’m very glad to have been introduced to her writing.


Some of my other favourite titles from past Wellcome shortlists are as follows [links to my reviews where they exist]:

Make sure to check out the other stops on the blog tour! And thanks to Charlotte at Midas PR for inviting me to participate in this tour and sending me a free copy of Two Kinds of Decay.


8 thoughts on “Wellcome Book Prize 10th Anniversary Blog Tour: The Two Kinds of Decay by Sarah Manguso

  1. Wow, 2011 was such a strong year for the Prize! I’m glad you enjoyed your first taste of Manguso’s work. I’ve read the four of her books that you mention (I think she also published some poetry beforehand?), and I’d say this is the best one. All of her work has the same fragmentary nature, which she takes a bit too far in 300 Arguments — to the point where it’s composed solely of pretentious aphorisms. But in general I really like her stuff.

    I’d read four of the 2011 books; I’ll have to seek out those Roth and Young novels. I’m liable to focus on health-themed nonfiction to the exclusion of fiction, so I’d like to do a good trawl through these old shortlists and catch up that way.

    Liked by 1 person

  2. I’m glad that you pointed out that this book doesn’t have some chipper message in the end. For that reason, I often and medical memoirs. I read Barbara Ehrenreich’s book Bright-Sided, which years apart the pervasive desire of non-patients to tell patients to be positive, and how those messages make patients who are depressed or weak feel worthless. If you like creative nonfiction, Hilary Plum write an amazing book about her husband getting cancer at the same time she contacts an unidentifiable illness and mixes that with the Boston Marathon bomber. The book is called Watchfire.

    Liked by 1 person

  3. Pingback: February Superlatives | Laura Tisdall

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