Sarah Manguso - The Two Kinds of Decay

The technicians always ask whether it’s your first EMG. If it is, they say it’s all right to cry. And maybe they’ll add that men cry more than women, or that a great big juiced-up guy from South Boston is more likely to cry than a librarian from North Cambridge. Or that people who try hard not to cry are more likely to cry than people who are open to the possibility that they might cry. The EMG technicians watch people get tortured all day, but it is hard even for them to guess how anyone will hold up until the actual breaking point.

I got through my first three EMGs without crying. Each one got easier.

But then one day, when there were no lab technicians available, a doctor administered my EMG. He could deliver the test as well as interpret the results, right there, while the data from the first shocks showed on the computer screen.

And I asked him what the data looked like, and he said the data looked bad. My nerves’ conduction velocities were slower than they’d been the last time, and their conduction block had increased. The antibodies had destroyed more myelin.

And right away I knew I would need to get a new central line implanted and have my plasma replaced again, and I also knew that each time the myelin was stripped from my nerves, it was likelier to grow back imperfectly, and that I was likelier to lose strength and sensation permanently.

It wasn’t the EMG but the bad news that made me cry. It’s probably best to have an EMG while someone’s opening your mail and finding that you got into college, or while you’re watching the right lottery numbers appear on the television screen.

If you start crying during an EMG, you can pretty much forget about trying to stop crying until the test is over.

I’d guess that if you get a dozen EMGs in your life, it’s likely you’ll cry during at least one of them.

I don’t know any other hospital procedure that makes people cry as reliably as an EMG except the test of the blood’s clotting agents, when you just sit and bleed from a puncture wound, and the blood drips until your fibrinogens and platelets create a barrier to the bleeding, or it’s decided you’ve lost enough blood that it’s certain your fibrinogens and platelets aren’t going to be able to stop the blood, and then the test is over.

Tabitha called nail polish nail enamel . Her daughter was ten or fifteen years older than I was. The daughter had lived out of her car for a long time.

Rock and roll, I said after Tabitha told me that. Living out of your car was cool. It wasn’t even her car. It was her boyfriend’s car.

Tabitha never scolded me for saying stupid things. She told me her daughter had a skin-picking problem. Lesions on her face.

Lesions?

Just acne. Small inflammations. Tabitha liked using the proper medical terms for things. She told me the story of her first day of nursing school. She’d already read the text for the week ahead, and when the professor asked what p.o. meant in a clinical context, Tabitha said she raised her hand and said per os , by mouth, as if it were nothing at all. Rock and roll.

Tabitha manipulated the hell out of that apheresis machine. I hardly shook.

When my line stopped delivering blood to or from my heart, and the machine’s alarm rang, Tabitha twiddled with the pump until my blood flowed again. The other apheresis nurses moved my body around, unwrapped me from my cocoon of heated blankets, and twisted the tubes around like secretaries playing with telephone cords.

The worst nurses injected heparin, which was the fastest solution of all — nothing makes blood flow like a shot of blood thinner.

But Tabitha knew that even when you’re sick, when you no longer mind things that once horrified you, avoiding even one unnecessary subcutaneous injection can put you in a better mood.

Tabitha knew that machine, and she knew my heart — she could infuse anything into it, and I’d scarcely notice. And she brought those wintergreen candies with her as if it were part of my prescription.

Besides her daughter she only ever mentioned a deadbeat exhusband who’d abandoned her.

I returned to school after the first couple of hospitalizations, and both times I made appointments with the disabilities office.

A van would pick me up and take me to and from my classes and wherever else I had to go. The van was driven by a student, and it was free, and it never came when I needed it. I seldom went to class, and when I did, I was late.

The driver helped me into the van even though it wasn’t in her job description and she knew I could sue her if I were injured while entering or exiting the van. Since she got in trouble for being late, she helped me. I took too long to drag my body up the van’s three steps on my own.

At that point I was using two crutches. Crutches weren’t a good solution to my mobility problem, generalized limb weakness that worsened distally.

I wasn’t safely mobile on the crutches. I shouldn’t have gone back to school. My doctors were doing the best they could, but they must have been delusional to think it was safe to let me go back to Cambridge without a wheelchair. I was still poisoning myself a little more with every beat of my heart, barely able to manipulate my crutches, just waiting until I wasn’t able to manipulate the crutches at all.

I remember walking out of Adams House one night, after dinner with a friend, barely able to stand upright, crutches splayed out to the sides. Someone behind me said something. I realized my crutches were blocking the entire patio, from brick wall to brick wall, and that no one could walk past me. And of course I was walking very slowly. And of course I was not doing what properly could be called walking. I was slumped over the crutches, which were braced against the walls.

The brick walls were all that was holding me up.

My friend carried me the rest of the way down the slate patio and onto the sidewalk and into the van.

My third hospitalization was fourteen days instead of the usual ten because the covering neurologist didn’t schedule my five plasma exchanges right away. I had to wait a day or two before each one, and during those days the antibodies ate away at my nerve cells. By the end of the hospitalization I could breathe, but I still couldn’t walk.

And so on May 26, 1995, the last day of my longest hospitalization, it was decided I would move to a rehabilitation hospital where I’d learn to walk and use my hands again.

My parents had already been to my college dorm and packed everything and brought it home. Somewhere in there was a small pipe and a few extra screens and a film canister full of marijuana buds.

They drove me to a northern Massachusetts town none of us had ever been to.

I was admitted and shown my room, which I would share with an old woman who coughed and whose medications and preparations filled our bathroom.

I had a bed, a night table, and a chair. There was a window I could look out of. Outside was Massachusetts.

A nurse came in to take my temperature with one of the new infrared ear thermometers that no one knew how to use yet.

She reported my body temperature as eighty-two degrees Fahrenheit.

I suggested that that was not possible since I was still living.

She took my temperature several more times and eventually recorded it as ninety-two degrees.

My parents and I went back to the room I would share with the old woman. She was watching television, in bed, in semidarkness. My father picked up my suitcase. My mother wheeled me outdoors to the parking lot and helped me into the car.