Conversations

Season

1

Episode

70

|

Oct 2, 2025

Questions Without Answers with Sarah Manguso

Writer Sarah Manguso joins us to discuss Questions Without Answers—a book born from a single tweet that drew thousands of kids’ startling, funny, and profound questions, later shaped with New Yorker cartoonist Liana Finck. Part poetry, part philosophy, part comedy, it’s an anthology of childhood wonder. She also revisits her memoir Two Kinds of Decay, which chronicles her diagnosis with CIDP, a rare autoimmune disorder in which the body’s immune system attacks the peripheral nerves, and how it shaped her understanding of illness, vulnerability, and the power of storytelling.

0:00/1:34

Conversations

Season

1

Episode

70

|

Oct 2, 2025

Questions Without Answers with Sarah Manguso

Writer Sarah Manguso joins us to discuss Questions Without Answers—a book born from a single tweet that drew thousands of kids’ startling, funny, and profound questions, later shaped with New Yorker cartoonist Liana Finck. Part poetry, part philosophy, part comedy, it’s an anthology of childhood wonder. She also revisits her memoir Two Kinds of Decay, which chronicles her diagnosis with CIDP, a rare autoimmune disorder in which the body’s immune system attacks the peripheral nerves, and how it shaped her understanding of illness, vulnerability, and the power of storytelling.

0:00/1:34

Conversations

Season

1

Episode

70

|

10/2/25

Questions Without Answers with Sarah Manguso

Writer Sarah Manguso joins us to discuss Questions Without Answers—a book born from a single tweet that drew thousands of kids’ startling, funny, and profound questions, later shaped with New Yorker cartoonist Liana Finck. Part poetry, part philosophy, part comedy, it’s an anthology of childhood wonder. She also revisits her memoir Two Kinds of Decay, which chronicles her diagnosis with CIDP, a rare autoimmune disorder in which the body’s immune system attacks the peripheral nerves, and how it shaped her understanding of illness, vulnerability, and the power of storytelling.

0:00/1:34

About Our Guest

Sarah Manguso is the author of ten books including the novels Liars and Very Cold People and the nonfiction books Ongoingness, 300 Arguments, and The Two Kinds of Decay. She is the recipient of an American Academy of Arts and Letters Literature Award, a Guggenheim Fellowship, a Hodder Fellowship, and the Rome Prize, and her work has been translated into fifteen languages.

About The Show

The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.

resources

Credits

About Our Guest

Sarah Manguso is the author of ten books including the novels Liars and Very Cold People and the nonfiction books Ongoingness, 300 Arguments, and The Two Kinds of Decay. She is the recipient of an American Academy of Arts and Letters Literature Award, a Guggenheim Fellowship, a Hodder Fellowship, and the Rome Prize, and her work has been translated into fifteen languages.

About The Show

The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.

resources

Credits

About Our Guest

Sarah Manguso is the author of ten books including the novels Liars and Very Cold People and the nonfiction books Ongoingness, 300 Arguments, and The Two Kinds of Decay. She is the recipient of an American Academy of Arts and Letters Literature Award, a Guggenheim Fellowship, a Hodder Fellowship, and the Rome Prize, and her work has been translated into fifteen languages.

About The Show

The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.

resources

Credits

The Nocturnists is made possible by the California Medical Association, and donations from people like you!

This episode is sponsored by The Physicians Foundation.

Transcript

Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily: This is The Nocturnists' conversations. I'm Emily Silverman. Today, I'm speaking with writer Sarah Manguso. I first encountered Sarah's work around 17 years ago when I read her book Two Kinds of Decay, a lyrical memoir of illness that has stayed with me ever since. In crystalline, poetic fragments, Sarah described her experience with CIDP, an autoimmune neurologic disease, and the strange world of hospitals, treatments, and survival. Since then, Sarah has written widely across memoir, aphorism, and essay. Her most recent book, Questions Without Answers, began as a Twitter experiment and grew into a collection of children's philosophical questions, illustrated by the cartoonist Liana Finck.

In my conversation with Sarah, we explore her formative memoir, Two Kinds of Decay, and what it feels like to revisit that book 17 years later, parenting and how toddlers are art machines whose logic and poetry can astonish adults, and the surprising themes that children return to: birth, death, chins and necks, and what they reveal about how kids see the world. I was so excited to speak with Sarah after being a fan of hers for so long, and I hope you enjoy this conversation as much as I did. First, here's Sarah reading from her new book, Questions Without Answers.

Sarah Manguso: In 2021, I opened a Twitter account and posted a single tweet, "What's the best question a kid ever asked you?" Within 24 hours, I had more than 100 questions. Within a week, I had hundreds more. I asked some famous friends to retweet the tweet. I asked everyone I knew to ask everyone they knew. I read multiple iterations of the if God is everywhere conundrum and multiple accusations of pregnant women having eaten their babies. I also had the privilege of reading a lot of accidental poetry and philosophy in multiple languages. Death was a common topic. So was birth. I was surprised to receive so many questions about necks and chins.

The poet Kenneth Koch, who taught at Columbia University for many years, also taught poetry to young children at New York City's PS 61 in the late 1960s. He wrote three books on teaching poetry to young children, including many examples of the poems that arose from his prompts. When I teach creative writing, I always bring in a few poems from his anthology, Wishes, Lies and Dreams, and I mix them in with my more recognizable texts. I love asking with a straight face if anyone has read the work of so and so, and then to announce that the author was seven years old when she wrote the poem we've just discussed.

My students are impressed and a bit unnerved that they weren't able to guess the provenance of the children's poems. Very young children, younger even than Koch's elementary school students, might not be old enough to write poems themselves, but they do have access to imaginative worlds that are just as interesting and just as notable a fount of worthwhile literature.

The word literature might first suggest to the lay reader a Shakespeare play or a Tolstoy novel, but I've spent much of my writing life composing and delighting in very short literary forms, among them the short poem, the very short story, and the aphorism. There's always something a bit magical about one great standalone line. The aphorist James

Richardson writes, "No one will ever write a novel by accident. A poem, too, takes time." If I say, "Pick a word," and you say one, where did it come from? You certainly don't say you wrote it or created it, more like you chose it or it chose you. One-liners must be in the middle of that spectrum.

One-liners, among them, the one-line questions that constitute this book, float somewhere between thinking and writing where verbal but preliterate young children dwell. That place is the origin of this text. My chief purpose in assembling the text of this book is to challenge the popular depiction of children as adorable idiots, instead portraying them as they are: intelligent, intuitive, inventive, philosophical, funny. Their questions are a work of found choral philosophy, a collective subjectivity that disappears from most people's lives by kindergarten.

[music]

Emily: I am sitting here with Sarah Manguso. Sarah, thank you for being here.

Sarah: Thanks so much for having me.

Emily: Sarah, I have been following your work for a long time. I first came across your writing 17 years ago when my husband came home from a bookstore with a copy of your book Two Kinds of Decay. He said, "I saw this, and I thought you might like it. It seems like it's related to healthcare, and it's a signed copy." It really felt like the universe plucked your book out of a bookstore, and I read it, and it really shaped me, I think, as a young person coming up in medical education.

I had learned a lot about different diseases, of course, the way that you do in medical school, but your first-person narrative of your experience going through illness and encountering the healthcare system, written in such a lyrical and poetic way, was a formative text for me coming up through medicine. First, I wanted to say thank you for writing

it.

Sarah: That means so much to me. Thank you, Emily. It's kind of thrilling to get to talk about a 17-year-old book today, and for you to remember your reading experience so vividly. Yes, this is quite special.

Emily: For the audience, if you haven't read Sarah's book, which I highly recommend, it's called Two Kinds of Decay, and it's about Sarah's experience with CIDP, chronic idiopathic demyelinating polyradiculoneuropathy, which is a mouthful, and I had to practice before I said it.

Sarah: You did great.

Emily: I want to just ask you about the book, reflecting back on it after a couple of decades. Before I do, I just wanted to share the one scene that has always stayed with me. I don't know if you've had other people tell you this, but there's a scene in the book where you're in the hospital and you're having a blood cleaning procedure called apheresis, and there's a scene where you're sitting in the chair or the bed, you're having the apheresis procedure, where the machine is filtering your blood and you're eating French fries.

Sarah: I'm eating French fries. Yes, yes. Actually, yes, I have had this remarked upon by young MDs who maybe haven't prescribed or witnessed this particular kind of apheresis where the plasma is removed. Why don't you describe what actually happens in the scene?

Emily: You're sitting there having the procedure, eating the French fries, and then you watch as the blood products actually get more greasy and fatty and filled with fat particles.

Sarah: Cloudy.

Emily: [laughs] Cloudy.

Sarah: They get cloudy and opaque.

Emily: That always stayed with me, and the book is just really poetic and beautiful. Was wondering if you could take a moment and just reflect back on that work, which was so long ago.

Sarah: Oh, sure, yes. Again, this is really very special. The first thing I should probably say is that the last time I really had a prolonged conversation about this work was 2008.

I was in my early 30s. I'm now in my 50s. Back then, I remember the process of writing the book and the process of talking about the book was extremely easy and clear compared to the way that I feel when I talk about any of my work now. As a young person, this was my first book with a commercial press. It was my first book of longer prose, even though the prose itself is made out of very short sections. It's about 200 pages. The three books that I had published before the Two Kinds of Decay were poetry collections or collections of 200-word stories.

All of this is to say that it felt very fresh. It was very easy to write. It was easy to talk about. Being older and having published more books and lived more years definitely changes my perspective. Some other things that change my perspective on the book are the fact that I've had two CIDP relapses since the book came out. There's also a love story that's wrapped in among the illness narrative. I did eventually marry the person that I wrote about and have a child with them and divorce them.

Emily: [laughs]

Sarah: There's a lot more plot than the book depicts. I think one more thing that I want to say is that, as a younger person, writing before or at the very lip of the illness memoir boom in publishing, I was asked more than once, "What is a young person like you doing, writing her memoirs? You've barely lived." I said, "It's just a memoir of this one experience. I was only remembering one thing."

In retrospect, I look at the book, and I think, "This is just blissfully uncomplicated and clear," because that's the way my life felt at the time. My diagnosis and my health history was probably the most interesting or unusual thing about me up to that point, and that fact has changed in the ensuing decades.

Emily: Well, I want to get to that. Before we do, for the medical learners listening, could you tell us about CIDP? What is it? Maybe you can take us a little bit along the arc of your journey of initial presentation, that initial bout of uncertainty and treatment, and then maybe even a couple of the relapse and what that's been like.

Sarah: Sure. Before I start, I just want to say that being treated at a teaching hospital was so intrinsic to my experience, not just of being sick, but of engaging with the people who were caring for me because I was 21. There are a lot of med students in their mid to late 20s. While I didn't really see them as peers exactly socially, the relationship was really collaborative and almost kind of fun, on top of the fact that this is a rare disease, and a lot of them treated me as this fun extra-curricular activity in their narrow rotation.

BRSS TACS. I imagine that many of your medical learners listening right now may have heard of Guillain-Barré Syndrome, which is a rare but not unheard of autoimmune disease that affects the peripheral nervous system and typically presents as numbness, paresthesia, and weakness. There are different siblings in this group of diseases, depending on the shape of the molecule that your personal immune system is secreting. My early diagnosis and treatment that I depict in this book, which took place during the '90s, was not as fine-tuned as treatments are now.

My experience was I woke up one day and my feet were asleep, and I had been a very healthy person up until that day, and so I did what I think many relatively healthy people do when they're faced with a kind of unexpected or unusual symptom, which is-- I just said, "Oh, that's weird. I must have slept on my feet weird, or maybe I'm tired, and this is just a new thing that happens when you're tired." I was 21. I was a healthy teen, and I thought, "Oh, okay, maybe I'm getting older, or maybe I'm learning about what happens when you smoke too much pot." I don't know.

Emily: [laughs]

Sarah: Everything was new. My initial reaction was not fear or even an inclination to medicalize the experience. With my numb, tingly feet, I walked down the hallway in my dorm to the bathroom, and I washed my face. As I was splashing water on my face, I realized that I was almost drowning because I couldn't hold my breath long enough to keep the water from being aspirated, if that's the word I'm looking for there. Okay, good.

Emily: [chuckles]

Sarah: Those two symptoms just kind of stayed like that for a few days, and I realized that my big muscles were getting weak. I was having trouble going up and down stairs. I was having trouble lifting things. Again, I just thought, "Well, these must be new symptoms of fatigue that I've never felt before." Because at that point in my life, my inclination was not to go straight to, "Oh, I must have a rare neurological disease."

I think it was when I fell down in the courtyard at my dorm, I thought, "I should probably call my parents," who lived 10 miles away. This is in Massachusetts. I had grown up very close to Harvard, where I was an undergraduate. Up until the point that I fell, I remember feeling embarrassed because I felt that I looked drunk walking. I was staggering around. I had foot drop. My balance was affected, my proprioception was affected. I just felt really embarrassed because it looked like I was day drunk. That was the presentation.

I was driven to Newton-Wellesley Hospital, which was a teaching hospital affiliated with Harvard. It was also where I had been born. Fun fact. I went through the emergency department, and the ED doctor who evaluated me did a gross examination, didn't seem to find anything. I wish I knew at what point in his medical career he was on that day. I will probably never know, but I do remember very well that he said, "You know what? Wait, I have a friend, and he's a neurologist. I think I'm just going to call him."

He called his friend, the neurologist, and I started putting my clothes back on because I thought, "Well, okay, I guess this is just one of these weird-- I must just be tired." I don't know what's going on. It was probably two or three minutes before the doctor came back into my little cordoned-off ward in the emergency department. He said, "I want to test your deep tendon reflexes." I sat and dangled my legs off of the gurney, and he tested for my reflexes.

In what became very quickly a really neat party trick that I did frequently over the next four and a half years, I had no deep tendon reflexes at all. My knees, at my feet, nothing in my arms. He tested everything. They were all gone. That was when he said, "Okay, I'm diagnosing you with Guillain-Barré Syndrome." We moved on from there.

Emily: It wasn't Guillain-Barré Syndrome?

Sarah: No, it wasn't, but there was no way that he could have known that at that moment. Guillain-Barré Syndrome is typically acute, monophasic, and the form of the disease that I had was chronic. I received the treatment that at that time was first-line, which was apheresis. As you described in the French fry scene, my plasma is what was removed and replaced with fresh frozen plasma and albumin, and some other stuff mixed in, for good measure, a little extra fluid.

The treatment for Guillain-Barré, it assumed that your body has a brief period of secreting these autoantibodies. Then it just spontaneously stops after having spontaneously started. My apheresis sessions would take place, and I would be sent home, but I would continue secreting antibodies. After a few more days, all of my symptoms would be back, and I would be back in the hospital.

It wasn't until at least a year into my treatment that a study was published about a group of patients who were in the Netherlands, and the findings were that IVIG, it had a more lasting effect on somebody with a chronic, remitting, relapsing, or more difficult case of the disease. Even at that point, I don't know that the doctors were saying, "CIDP is what you have." It was more like a gradual understanding that, "Okay, there is this chronic form of the disease. If Guillain-Barré is glancingly rare, this is that much squared."

Then it was-- Well, you can probably remember the plot points better than I can at this point, because you've probably read the book more recently. IVIG may have been what arrested the disease, and I had other ideas about what might have happened to finally turn off my faucet of autoantibodies.

Emily: Other ideas, meaning other treatments or just other--

Sarah: Well, I did have this superstition about sex. I was 21 when I first got sick, and I'd only had intercourse, what hetero people call intercourse, with one person. I thought

more than once, during my time in the hospital, I might die. It would be really sad, because I've only been with one person. This is something I talk about on page 1 of the

book, so this is not some terrible secret that I reveal. It's not some sort of sudsy sentimental moment in the book where I was fairly-- I thought, "Oh, intellectually, that's a bummer or kind of sad."

Then I became attached to the idea that if I had sex again, I might get better. I wasn't thinking about it quite so cause, effect, magically, but it definitely was something that I wondered about, and it may have been a pure coincidence that what I now know as a subclinical dose of IVIG might not have been the entire reason that I finally seemed to have stopped producing these autoantibodies, it was also the fact that I had sex with somebody else at last, within days of my Rhesus line being pulled out of my chest.

I've never really known or needed to know whether one or the other was weighted more heavily in the list of reasons why I finally got better, but it's just always been part of the story.

Emily: You did get better for a while, you went into remission, and it sounds like you're in your 50s now, have had a couple of relapses. Did you go completely back to normal, or what was that pattern?

Sarah: I went completely back to normal in that I've wholly stopped secreting the autoantibodies. In total, I've had two bouts in my 20s and two bouts in my 40s. Nothing since I recently broke my record for remission, which was 11 years. I'm going on 12 years now, since my most recent relapse, which is great. At the same time, I fully expect to get it again. It's not nearly as terrifying as it was that first time before IVIG had become the first-line treatment. In my particular body, my particular case, IVIG works like magic. It shuts it down immediately.

Emily: I love what you said about love and sex being a part of the story and potentially playing into the way your body responds. You said that you met someone, married them, had children with and then had a divorce, all in the last 17 years since the book came out. Was wondering if you could speak a little bit to the love story aspect of this.

Sarah: Oh, yes, sure. The love story aspect did, again, seem mysterious and important. I only began writing the book after I met my future ex-husband. I was at an artist residency in New Hampshire called the MacDowell-- At that time, it was called The MacDowell Colony. It's now just called MacDowell. If you're the kind of person who relaxes in the country where leafy green forests and fawns and bunnies and solitude works in order to get you to do the kind of work that you need to do, you'll understand just how innervating and exciting it was to be in such a place.

In the summer of 2006, I was there for the second time, and so I knew exactly what to do. I was there to write another book of stories like the one that I'd written the summer before. That book had become my story collection, which is called Hard to Admit and Harder to Escape, my longest title. This next summer, I thought, "I'm going to just do that exact thing again." One of the magical things that happens in a place like MacDowell is that sometimes your work just goes down a completely different avenue, one that you would never have anticipated or tried for if you had been in some other place. For me, that's the first interesting thing that happened that summer at MacDowell.

The second interesting thing that happened is that I met the person who would become my future ex-husband. I say that a little bit tongue-in-cheek. I mean, we had some good years before the X phase of things, but those two experiences were really bound up together for me, and it really did seem like very much part of the story that, A, I was finally ready to write about this substantial part of my experience as a young person. It was the thing that everybody told me, "Oh, you'll have to write a book about that someday."

The more I heard that from people, the less interested I was. It just felt so obvious. Like, "Yes, I'm the one with the weird ass autoimmune disease. Of course, I should write a book about it." I was just more interested in doing other things that seemed less obvious and less easy. It may well be that, finally, with this sudden intuitive understanding that it was time to write that book, combined with this sudden intuitive understanding that I had met somebody that I wanted to spend my life with, it just made the project palatable to me, in a way. I did write about the experience of meeting this person. We had some good years together, during which I wrote other books. Also, during our marriage, I had those other two relapses.

[music]

Emily: Let's fast forward to today. Your latest book is called Questions Without Answers, and it's a book that came out of parenthood. In the reading up top, we heard about how the impetus for the book was a social media post asking, "What's the best question your child has ever asked you?" Tell us about becoming a parent and then becoming a parent to this book.

Sarah: Oh, what a great question. Sure. I became a parent along with the person that I met in 2006, and we went into parenthood sharing the attitude that neither one of us had ever desperately wanted to be a parent. I had never had that experience that's frequently talked about as a sudden hormonal need to reproduce. I'd never had that. At the same time, we both knew a lot of artists who had a kid or multiple kids and whose work became richer and better.

Also, of course, we have lived in the human civilization where there's just a lot of evidence and self-reporting that children make your life better. We thought even though neither one of us is feeling that desperate, non-specific need to reproduce, we should probably have a kid because it'll make our lives better. So we did. Although I had gone through a lot of medical excitement up until that point, I was surprised and relieved that pregnancy was so much easier than having CIDP.

Once I actually had this small child, his name is Sam, I was struck by how unprepared I was, or rather how surprised I was about what I found actually interesting about parenthood, specifically about being around young children, toddlers, age two to four or five. These little creatures are art machines. They're philosophy machines. I think they're almost supernatural creatures, because they dwell in both worlds. That's something that I wrote about in my foreword to this collection.

When my little Sam was about three or four, the questions that he asked me were just-- He had very limited life experience, but he already had maximal capacity for logic, for creativity, for humor. His mind was as interesting as the most interesting adults that I knew. Combined with his lack of life experience, it made his questions just bananas. Some of his questions that I particularly liked set me on a path to considering these, maybe turning into some kind of art down the road were, "What does a gargoyle say? Do you like windows? Was Mom a baby, too? Did I play with her?"

Then there were three questions that he asked in really close succession one day. "When I was inside your body, did you know me? Did you want to meet me? Did I make the world?" [laughs] It sounds like it was something that an artist wrote. I have been accused of ventriloquizing these young children and making them sound wiser, funnier, or more interesting than they actually are. No, they really are that interesting. I think anybody who has paid any kind of attention to toddlers, like anybody who works in early childhood education, or even somebody who just has spent time around a kid as a caretaker or as a parent and really listened to them, I thought, "It can't just be my kid."

During COVID, I was writing a novel about a brutal divorce, and I really needed a side project. I thought, as I thought many times in the past five years since I had written down my kid's questions on this, it's just like one page, I thought, "Maybe it's time. Maybe I could ask other people for their questions, and maybe I could finally just do social media," which I avoided up until that point.

I opened a Twitter account. I posted one tweet, which was this question: "What's the most interesting question you've ever been asked by a young child?" I gave a couple of examples that my kid had asked me, and then I just laid back and let the questions come in. It was miraculous. I mean, it was even more amazing than I had hoped. There were writers, there were journalists, there were people whose work I read and loved, sending multiple questions. Then people sent questions in French, Spanish, Dutch. Questions were coming from all over.

Not understanding how algorithms worked, I thought, "Oh, my God, this is great. I'm just going to keep getting hundreds of questions every day for the rest of my life, and this will be a book. This absolutely can be a book." Of course, my tweet was buried in a week or two. I asked a couple of famous friends to retweet it, and I got a few more. Things really started humming when I hired a research team to crowdsource questions online. There were parent groups that-- One of my researchers just belonged to every parent group that you could imagine, and she was also an attorney. There were a lot of specific LA-area attorney mom groups. Oh, God, the attorneys gave me a ton of questions.

Then I had another researcher who was based in West Virginia and was a creative writing graduate student, and she was connected to all of the weird internet, or weird social media, and Reddit. I got the questions that my two researchers got for me on the internet. The Venn diagram were two completely separate circles. With their help, I eventually gathered more than 2,000 questions, and that was enough to prune it and really think about the order of the questions and how they intersected with each other.

By the time I had involved Liana Finck, the genius New Yorker cartoonist, she was my active collaborator on drawing the questions, on putting them in order. Eventually, we came up with what is now the book, Questions Without Answers.

Emily: The pairing of the questions with Liana's illustrations, it just takes it to a whole other level. I just opened the book to a random page, and the question is, "What is a

moment?" Liana draws a timeline with different intervals. There's a little interval that's second, and then there's a bigger interval that's minute, and there's an even bigger interval that says hour. Then she draws like a little cloud off to the side, off the timeline, with an arrow pointing to it that says moment.

I love this form, like you said, the short-- I think in the very, very beginning, in the reading up top, there was a great quote you had up there, which was, "There's always something a bit magical about one great standalone line. The aphorist James Richardson writes, 'No one will ever write a novel by accident. A poem, too, takes time.' If I say, 'Pick a word,' and you say one, where did it come from? You don't say you wrote it or created it, more like you chose it or it chose you." That's what this feels like. It feels like these questions and these illustrations are being pulled down from somewhere.

Sarah: I think you're onto something. There's a lightness about them. For those listeners who aren't familiar with Liana Finck's work, there is a kind of apparent lightness and

casualness to her work, which is actually incredibly deliberate. I use the word genius frequently, but she's the real deal. I reached out to her because she sells custom redrawings of the cartoons that she uploads to her Instagram, and there was a really wonderful one called Women tiptoeing around a man's feelings, which I bought for myself as a divorce present.

Emily: [laughs]

Sarah: I reached out to her. I had been her fan just from seeing her work in magazines over the years. She said that she knew my work too, and we developed an email friendship, and then she very kindly involved me in work on a project that she had been given a grant for by a foundation. We met at a mini conference in Boulder, Colorado, and I think we just worked really well together, although whenever there's a collaboration and somebody says we worked really well together, it's like I always assume, "Well, this is the person who was the asshole."

Emily: [laughs]

Sarah: We get along really well. Still, I didn't really come up with the magic recipe for this book all at once. It was incredibly gradual. I wrote the first questions down in about 2015, and then it wasn't until 2021 that I realized that Liana was the person to illustrate it.

Emily: You said a lot of the questions were about death and birth, which isn't that surprising, since those are philosophical, spiritual liminal spaces that you could imagine a child would be curious about, but you also said that there were a surprising number of questions about necks and chins. [laughs]

Sarah: Honestly, I couldn't believe it. What do you think about that?

Emily: [laughs]

Sarah: One very alert reader suggested that because children are short in stature compared to adults, and they're always looking up at us, they see our necks and our chins as just, visually, they're more present in their visual field. It also might be that, of all of the things on a head, everything has a really specific function. Like an eye has a really different function from an ear or a mouth or nose and a chin, like it has a name, but what is it really for? That might be another reason why. I don't know.

There could just be something in the kids' zeitgeist. There might have been some show or some pop culture joke about chins or necks that are like I never heard it, and this just may be following from that kind of generational awareness of how necks and shins are weird or funny or something.

There were so many questions about necks and chins. I think there's one about a dog's chin and one about-- Oh, there's a really lovely one. The question is, how important are necks? Which I thought was a lovely way of asking the question. Liana's drawing is just like-- it's a line drawing of a face and a neck, and then an arrow pointing to the neck. Some of the drawings are really literal, which, I think, makes them even funnier. In fact, the UK edition of the book is not called Questions Without Answers. It's called Do Dogs Have Chins? And Other Questions. It has a different emotional appeal to the original title, but it tickles me that that's the one that they chose.

Emily: As we wind to a close, I was wondering if you would permit me to share with you some things that my daughter has said to me.

Sarah: Oh, I would love to hear them. Yes.

Emily: I, too, have a Google doc where I jot down some of the funniest and most interesting things, and so I picked-- they're not questions, per se, but I thought I would share them anyway.

Sarah: Oh, wonderful.

Emily: The first one is about hair. [laughs] My husband is bald, and so we learned the word bald pretty early. One day, she exclaimed, "My bald is under my hair."

Sarah: Oh, that's so good.

Emily: The next one is about death. She had a great-grandpa, actually, who died. He was over 100 years old.

Sarah: Oh, wonderful.

Emily: One day, we were talking about great-grandpa dying, and she got this really serious look on her face, and she gave a long monolog, and she said, "I died, and my friend Leo died, and great-grandpa died, and the car seat died, and the high chair died, and the wipes died, and the elephant died." Then she goes around the room pointing. She goes, "This and this and this and this." She says, "They all died. All these people and all these things died. Then they put jackets in their mouths and went to sleep." I said, "Okay, what did they see when they went to sleep? Did they have any dreams?" She said, "Yes, they saw astronauts and Cookie Monster." I said, "Was it scary?" She said, "No, it wasn't scary."

Sarah: That's incredible. I want to hear more about these jackets.

Emily: [laughs] The jackets in the mouths was really specific.

Sarah: That's the detail that really carries it over the line. How amazing.

Emily: It's like taking something that's supposed to be on the outside and putting it on the inside or something.

Sarah: Oh, that's true. Right. Outerwear as internally-- I'm going to have to think about that one.

Emily: Like flipping inside out.

Sarah: Did you ask her any follow-up questions about the jacket?

Emily: I didn't, but maybe I will, and I'll report back.

Sarah: I would love to hear more about these jackets because she may be on to something. I really do think kids understand death better than we do, because we just try so hard

not to think about it.

Emily: Totally.

Sarah: Oh, God, that's incredible.

Emily: The last one is pretty simple. It's about love. She just said one day, "I'm sad because I'm happy." I said, "What do you mean you're sad because you're happy?" She said, "Because I love you, because I love you so much."

Sarah: Oh, God. How do you survive? I love that.

Emily: [laughs]

Sarah: That's the thing about parenting. You get a question like that, and then you get a question about poop, and then you're talking about food for the rest of the day. You, the parent, will never be the same, because you've heard this incredible question about-- or not question, but an educational statement about what you do with jackets after you die?

Emily: [laughs] Well, thank you for letting me share those with you.

Sarah: Oh, it was such a pleasure, believe me.

Emily: Thank you for Questions Without Answers, and all of your other work, but especially for me, and I think for our audience, for Two Kinds of Decay, and for coming on and speaking with me today. Is there anything you want to leave us with today?

Sarah: Oh, well, it was an absolute delight speaking with you. I'm always curious about what a medical audience would think about the book that I published after the Two

Kinds of Decay, which also has a medical component to it. It's called The Guardians, and it's about my very dear friend Harris Wolfson, who died by suicide, and who had what is now assumed to be schizotypal disorder. It's not really a book about Harris per se, but it is a book about what happens to the people who are left behind after somebody dies of suicide.

Emily: We'll have to add that to the list.

Sarah: It's a short book. I feel okay shilling it.

[laughter]

Sarah: You really will read it in one sitting.

Emily: All right. Sarah Manguso, thank you so much for coming on the show.

Sarah: Thank you so much, Emily. A pleasure.

[music]

Emily: This episode of The Nocturnists was produced by me and producer and head of story development Molly Rose-Williams. Our executive producer is Ali Block, and Ashley Pettit is our program director. Original theme music was composed by Yosef Munro, and additional music comes from Blue Dot Sessions. The Nocturnists is made possible by the California Medical Association, a physician-led organization that works to ensure the doctor-patient relationship remains at the center of medicine. To learn more about the CMA, visit cmadocs.org.

This episode of The Nocturnists' conversations is sponsored by the Physicians Foundation, which supports physician well-being practice sustainability and leadership in delivering high-quality, cost-efficient care. The Nocturnists is also made possible by donations from listeners like you. In fact, we recently moved over to Substack, which makes it easier than ever to support our work directly. By joining us with a donation of $2, $5, or $10 a month, you'll become an essential part of our creative community. I'm your host, Emily Silverman. See you next week.




Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily: This is The Nocturnists' conversations. I'm Emily Silverman. Today, I'm speaking with writer Sarah Manguso. I first encountered Sarah's work around 17 years ago when I read her book Two Kinds of Decay, a lyrical memoir of illness that has stayed with me ever since. In crystalline, poetic fragments, Sarah described her experience with CIDP, an autoimmune neurologic disease, and the strange world of hospitals, treatments, and survival. Since then, Sarah has written widely across memoir, aphorism, and essay. Her most recent book, Questions Without Answers, began as a Twitter experiment and grew into a collection of children's philosophical questions, illustrated by the cartoonist Liana Finck.

In my conversation with Sarah, we explore her formative memoir, Two Kinds of Decay, and what it feels like to revisit that book 17 years later, parenting and how toddlers are art machines whose logic and poetry can astonish adults, and the surprising themes that children return to: birth, death, chins and necks, and what they reveal about how kids see the world. I was so excited to speak with Sarah after being a fan of hers for so long, and I hope you enjoy this conversation as much as I did. First, here's Sarah reading from her new book, Questions Without Answers.

Sarah Manguso: In 2021, I opened a Twitter account and posted a single tweet, "What's the best question a kid ever asked you?" Within 24 hours, I had more than 100 questions. Within a week, I had hundreds more. I asked some famous friends to retweet the tweet. I asked everyone I knew to ask everyone they knew. I read multiple iterations of the if God is everywhere conundrum and multiple accusations of pregnant women having eaten their babies. I also had the privilege of reading a lot of accidental poetry and philosophy in multiple languages. Death was a common topic. So was birth. I was surprised to receive so many questions about necks and chins.

The poet Kenneth Koch, who taught at Columbia University for many years, also taught poetry to young children at New York City's PS 61 in the late 1960s. He wrote three books on teaching poetry to young children, including many examples of the poems that arose from his prompts. When I teach creative writing, I always bring in a few poems from his anthology, Wishes, Lies and Dreams, and I mix them in with my more recognizable texts. I love asking with a straight face if anyone has read the work of so and so, and then to announce that the author was seven years old when she wrote the poem we've just discussed.

My students are impressed and a bit unnerved that they weren't able to guess the provenance of the children's poems. Very young children, younger even than Koch's elementary school students, might not be old enough to write poems themselves, but they do have access to imaginative worlds that are just as interesting and just as notable a fount of worthwhile literature.

The word literature might first suggest to the lay reader a Shakespeare play or a Tolstoy novel, but I've spent much of my writing life composing and delighting in very short literary forms, among them the short poem, the very short story, and the aphorism. There's always something a bit magical about one great standalone line. The aphorist James

Richardson writes, "No one will ever write a novel by accident. A poem, too, takes time." If I say, "Pick a word," and you say one, where did it come from? You certainly don't say you wrote it or created it, more like you chose it or it chose you. One-liners must be in the middle of that spectrum.

One-liners, among them, the one-line questions that constitute this book, float somewhere between thinking and writing where verbal but preliterate young children dwell. That place is the origin of this text. My chief purpose in assembling the text of this book is to challenge the popular depiction of children as adorable idiots, instead portraying them as they are: intelligent, intuitive, inventive, philosophical, funny. Their questions are a work of found choral philosophy, a collective subjectivity that disappears from most people's lives by kindergarten.

[music]

Emily: I am sitting here with Sarah Manguso. Sarah, thank you for being here.

Sarah: Thanks so much for having me.

Emily: Sarah, I have been following your work for a long time. I first came across your writing 17 years ago when my husband came home from a bookstore with a copy of your book Two Kinds of Decay. He said, "I saw this, and I thought you might like it. It seems like it's related to healthcare, and it's a signed copy." It really felt like the universe plucked your book out of a bookstore, and I read it, and it really shaped me, I think, as a young person coming up in medical education.

I had learned a lot about different diseases, of course, the way that you do in medical school, but your first-person narrative of your experience going through illness and encountering the healthcare system, written in such a lyrical and poetic way, was a formative text for me coming up through medicine. First, I wanted to say thank you for writing

it.

Sarah: That means so much to me. Thank you, Emily. It's kind of thrilling to get to talk about a 17-year-old book today, and for you to remember your reading experience so vividly. Yes, this is quite special.

Emily: For the audience, if you haven't read Sarah's book, which I highly recommend, it's called Two Kinds of Decay, and it's about Sarah's experience with CIDP, chronic idiopathic demyelinating polyradiculoneuropathy, which is a mouthful, and I had to practice before I said it.

Sarah: You did great.

Emily: I want to just ask you about the book, reflecting back on it after a couple of decades. Before I do, I just wanted to share the one scene that has always stayed with me. I don't know if you've had other people tell you this, but there's a scene in the book where you're in the hospital and you're having a blood cleaning procedure called apheresis, and there's a scene where you're sitting in the chair or the bed, you're having the apheresis procedure, where the machine is filtering your blood and you're eating French fries.

Sarah: I'm eating French fries. Yes, yes. Actually, yes, I have had this remarked upon by young MDs who maybe haven't prescribed or witnessed this particular kind of apheresis where the plasma is removed. Why don't you describe what actually happens in the scene?

Emily: You're sitting there having the procedure, eating the French fries, and then you watch as the blood products actually get more greasy and fatty and filled with fat particles.

Sarah: Cloudy.

Emily: [laughs] Cloudy.

Sarah: They get cloudy and opaque.

Emily: That always stayed with me, and the book is just really poetic and beautiful. Was wondering if you could take a moment and just reflect back on that work, which was so long ago.

Sarah: Oh, sure, yes. Again, this is really very special. The first thing I should probably say is that the last time I really had a prolonged conversation about this work was 2008.

I was in my early 30s. I'm now in my 50s. Back then, I remember the process of writing the book and the process of talking about the book was extremely easy and clear compared to the way that I feel when I talk about any of my work now. As a young person, this was my first book with a commercial press. It was my first book of longer prose, even though the prose itself is made out of very short sections. It's about 200 pages. The three books that I had published before the Two Kinds of Decay were poetry collections or collections of 200-word stories.

All of this is to say that it felt very fresh. It was very easy to write. It was easy to talk about. Being older and having published more books and lived more years definitely changes my perspective. Some other things that change my perspective on the book are the fact that I've had two CIDP relapses since the book came out. There's also a love story that's wrapped in among the illness narrative. I did eventually marry the person that I wrote about and have a child with them and divorce them.

Emily: [laughs]

Sarah: There's a lot more plot than the book depicts. I think one more thing that I want to say is that, as a younger person, writing before or at the very lip of the illness memoir boom in publishing, I was asked more than once, "What is a young person like you doing, writing her memoirs? You've barely lived." I said, "It's just a memoir of this one experience. I was only remembering one thing."

In retrospect, I look at the book, and I think, "This is just blissfully uncomplicated and clear," because that's the way my life felt at the time. My diagnosis and my health history was probably the most interesting or unusual thing about me up to that point, and that fact has changed in the ensuing decades.

Emily: Well, I want to get to that. Before we do, for the medical learners listening, could you tell us about CIDP? What is it? Maybe you can take us a little bit along the arc of your journey of initial presentation, that initial bout of uncertainty and treatment, and then maybe even a couple of the relapse and what that's been like.

Sarah: Sure. Before I start, I just want to say that being treated at a teaching hospital was so intrinsic to my experience, not just of being sick, but of engaging with the people who were caring for me because I was 21. There are a lot of med students in their mid to late 20s. While I didn't really see them as peers exactly socially, the relationship was really collaborative and almost kind of fun, on top of the fact that this is a rare disease, and a lot of them treated me as this fun extra-curricular activity in their narrow rotation.

BRSS TACS. I imagine that many of your medical learners listening right now may have heard of Guillain-Barré Syndrome, which is a rare but not unheard of autoimmune disease that affects the peripheral nervous system and typically presents as numbness, paresthesia, and weakness. There are different siblings in this group of diseases, depending on the shape of the molecule that your personal immune system is secreting. My early diagnosis and treatment that I depict in this book, which took place during the '90s, was not as fine-tuned as treatments are now.

My experience was I woke up one day and my feet were asleep, and I had been a very healthy person up until that day, and so I did what I think many relatively healthy people do when they're faced with a kind of unexpected or unusual symptom, which is-- I just said, "Oh, that's weird. I must have slept on my feet weird, or maybe I'm tired, and this is just a new thing that happens when you're tired." I was 21. I was a healthy teen, and I thought, "Oh, okay, maybe I'm getting older, or maybe I'm learning about what happens when you smoke too much pot." I don't know.

Emily: [laughs]

Sarah: Everything was new. My initial reaction was not fear or even an inclination to medicalize the experience. With my numb, tingly feet, I walked down the hallway in my dorm to the bathroom, and I washed my face. As I was splashing water on my face, I realized that I was almost drowning because I couldn't hold my breath long enough to keep the water from being aspirated, if that's the word I'm looking for there. Okay, good.

Emily: [chuckles]

Sarah: Those two symptoms just kind of stayed like that for a few days, and I realized that my big muscles were getting weak. I was having trouble going up and down stairs. I was having trouble lifting things. Again, I just thought, "Well, these must be new symptoms of fatigue that I've never felt before." Because at that point in my life, my inclination was not to go straight to, "Oh, I must have a rare neurological disease."

I think it was when I fell down in the courtyard at my dorm, I thought, "I should probably call my parents," who lived 10 miles away. This is in Massachusetts. I had grown up very close to Harvard, where I was an undergraduate. Up until the point that I fell, I remember feeling embarrassed because I felt that I looked drunk walking. I was staggering around. I had foot drop. My balance was affected, my proprioception was affected. I just felt really embarrassed because it looked like I was day drunk. That was the presentation.

I was driven to Newton-Wellesley Hospital, which was a teaching hospital affiliated with Harvard. It was also where I had been born. Fun fact. I went through the emergency department, and the ED doctor who evaluated me did a gross examination, didn't seem to find anything. I wish I knew at what point in his medical career he was on that day. I will probably never know, but I do remember very well that he said, "You know what? Wait, I have a friend, and he's a neurologist. I think I'm just going to call him."

He called his friend, the neurologist, and I started putting my clothes back on because I thought, "Well, okay, I guess this is just one of these weird-- I must just be tired." I don't know what's going on. It was probably two or three minutes before the doctor came back into my little cordoned-off ward in the emergency department. He said, "I want to test your deep tendon reflexes." I sat and dangled my legs off of the gurney, and he tested for my reflexes.

In what became very quickly a really neat party trick that I did frequently over the next four and a half years, I had no deep tendon reflexes at all. My knees, at my feet, nothing in my arms. He tested everything. They were all gone. That was when he said, "Okay, I'm diagnosing you with Guillain-Barré Syndrome." We moved on from there.

Emily: It wasn't Guillain-Barré Syndrome?

Sarah: No, it wasn't, but there was no way that he could have known that at that moment. Guillain-Barré Syndrome is typically acute, monophasic, and the form of the disease that I had was chronic. I received the treatment that at that time was first-line, which was apheresis. As you described in the French fry scene, my plasma is what was removed and replaced with fresh frozen plasma and albumin, and some other stuff mixed in, for good measure, a little extra fluid.

The treatment for Guillain-Barré, it assumed that your body has a brief period of secreting these autoantibodies. Then it just spontaneously stops after having spontaneously started. My apheresis sessions would take place, and I would be sent home, but I would continue secreting antibodies. After a few more days, all of my symptoms would be back, and I would be back in the hospital.

It wasn't until at least a year into my treatment that a study was published about a group of patients who were in the Netherlands, and the findings were that IVIG, it had a more lasting effect on somebody with a chronic, remitting, relapsing, or more difficult case of the disease. Even at that point, I don't know that the doctors were saying, "CIDP is what you have." It was more like a gradual understanding that, "Okay, there is this chronic form of the disease. If Guillain-Barré is glancingly rare, this is that much squared."

Then it was-- Well, you can probably remember the plot points better than I can at this point, because you've probably read the book more recently. IVIG may have been what arrested the disease, and I had other ideas about what might have happened to finally turn off my faucet of autoantibodies.

Emily: Other ideas, meaning other treatments or just other--

Sarah: Well, I did have this superstition about sex. I was 21 when I first got sick, and I'd only had intercourse, what hetero people call intercourse, with one person. I thought

more than once, during my time in the hospital, I might die. It would be really sad, because I've only been with one person. This is something I talk about on page 1 of the

book, so this is not some terrible secret that I reveal. It's not some sort of sudsy sentimental moment in the book where I was fairly-- I thought, "Oh, intellectually, that's a bummer or kind of sad."

Then I became attached to the idea that if I had sex again, I might get better. I wasn't thinking about it quite so cause, effect, magically, but it definitely was something that I wondered about, and it may have been a pure coincidence that what I now know as a subclinical dose of IVIG might not have been the entire reason that I finally seemed to have stopped producing these autoantibodies, it was also the fact that I had sex with somebody else at last, within days of my Rhesus line being pulled out of my chest.

I've never really known or needed to know whether one or the other was weighted more heavily in the list of reasons why I finally got better, but it's just always been part of the story.

Emily: You did get better for a while, you went into remission, and it sounds like you're in your 50s now, have had a couple of relapses. Did you go completely back to normal, or what was that pattern?

Sarah: I went completely back to normal in that I've wholly stopped secreting the autoantibodies. In total, I've had two bouts in my 20s and two bouts in my 40s. Nothing since I recently broke my record for remission, which was 11 years. I'm going on 12 years now, since my most recent relapse, which is great. At the same time, I fully expect to get it again. It's not nearly as terrifying as it was that first time before IVIG had become the first-line treatment. In my particular body, my particular case, IVIG works like magic. It shuts it down immediately.

Emily: I love what you said about love and sex being a part of the story and potentially playing into the way your body responds. You said that you met someone, married them, had children with and then had a divorce, all in the last 17 years since the book came out. Was wondering if you could speak a little bit to the love story aspect of this.

Sarah: Oh, yes, sure. The love story aspect did, again, seem mysterious and important. I only began writing the book after I met my future ex-husband. I was at an artist residency in New Hampshire called the MacDowell-- At that time, it was called The MacDowell Colony. It's now just called MacDowell. If you're the kind of person who relaxes in the country where leafy green forests and fawns and bunnies and solitude works in order to get you to do the kind of work that you need to do, you'll understand just how innervating and exciting it was to be in such a place.

In the summer of 2006, I was there for the second time, and so I knew exactly what to do. I was there to write another book of stories like the one that I'd written the summer before. That book had become my story collection, which is called Hard to Admit and Harder to Escape, my longest title. This next summer, I thought, "I'm going to just do that exact thing again." One of the magical things that happens in a place like MacDowell is that sometimes your work just goes down a completely different avenue, one that you would never have anticipated or tried for if you had been in some other place. For me, that's the first interesting thing that happened that summer at MacDowell.

The second interesting thing that happened is that I met the person who would become my future ex-husband. I say that a little bit tongue-in-cheek. I mean, we had some good years before the X phase of things, but those two experiences were really bound up together for me, and it really did seem like very much part of the story that, A, I was finally ready to write about this substantial part of my experience as a young person. It was the thing that everybody told me, "Oh, you'll have to write a book about that someday."

The more I heard that from people, the less interested I was. It just felt so obvious. Like, "Yes, I'm the one with the weird ass autoimmune disease. Of course, I should write a book about it." I was just more interested in doing other things that seemed less obvious and less easy. It may well be that, finally, with this sudden intuitive understanding that it was time to write that book, combined with this sudden intuitive understanding that I had met somebody that I wanted to spend my life with, it just made the project palatable to me, in a way. I did write about the experience of meeting this person. We had some good years together, during which I wrote other books. Also, during our marriage, I had those other two relapses.

[music]

Emily: Let's fast forward to today. Your latest book is called Questions Without Answers, and it's a book that came out of parenthood. In the reading up top, we heard about how the impetus for the book was a social media post asking, "What's the best question your child has ever asked you?" Tell us about becoming a parent and then becoming a parent to this book.

Sarah: Oh, what a great question. Sure. I became a parent along with the person that I met in 2006, and we went into parenthood sharing the attitude that neither one of us had ever desperately wanted to be a parent. I had never had that experience that's frequently talked about as a sudden hormonal need to reproduce. I'd never had that. At the same time, we both knew a lot of artists who had a kid or multiple kids and whose work became richer and better.

Also, of course, we have lived in the human civilization where there's just a lot of evidence and self-reporting that children make your life better. We thought even though neither one of us is feeling that desperate, non-specific need to reproduce, we should probably have a kid because it'll make our lives better. So we did. Although I had gone through a lot of medical excitement up until that point, I was surprised and relieved that pregnancy was so much easier than having CIDP.

Once I actually had this small child, his name is Sam, I was struck by how unprepared I was, or rather how surprised I was about what I found actually interesting about parenthood, specifically about being around young children, toddlers, age two to four or five. These little creatures are art machines. They're philosophy machines. I think they're almost supernatural creatures, because they dwell in both worlds. That's something that I wrote about in my foreword to this collection.

When my little Sam was about three or four, the questions that he asked me were just-- He had very limited life experience, but he already had maximal capacity for logic, for creativity, for humor. His mind was as interesting as the most interesting adults that I knew. Combined with his lack of life experience, it made his questions just bananas. Some of his questions that I particularly liked set me on a path to considering these, maybe turning into some kind of art down the road were, "What does a gargoyle say? Do you like windows? Was Mom a baby, too? Did I play with her?"

Then there were three questions that he asked in really close succession one day. "When I was inside your body, did you know me? Did you want to meet me? Did I make the world?" [laughs] It sounds like it was something that an artist wrote. I have been accused of ventriloquizing these young children and making them sound wiser, funnier, or more interesting than they actually are. No, they really are that interesting. I think anybody who has paid any kind of attention to toddlers, like anybody who works in early childhood education, or even somebody who just has spent time around a kid as a caretaker or as a parent and really listened to them, I thought, "It can't just be my kid."

During COVID, I was writing a novel about a brutal divorce, and I really needed a side project. I thought, as I thought many times in the past five years since I had written down my kid's questions on this, it's just like one page, I thought, "Maybe it's time. Maybe I could ask other people for their questions, and maybe I could finally just do social media," which I avoided up until that point.

I opened a Twitter account. I posted one tweet, which was this question: "What's the most interesting question you've ever been asked by a young child?" I gave a couple of examples that my kid had asked me, and then I just laid back and let the questions come in. It was miraculous. I mean, it was even more amazing than I had hoped. There were writers, there were journalists, there were people whose work I read and loved, sending multiple questions. Then people sent questions in French, Spanish, Dutch. Questions were coming from all over.

Not understanding how algorithms worked, I thought, "Oh, my God, this is great. I'm just going to keep getting hundreds of questions every day for the rest of my life, and this will be a book. This absolutely can be a book." Of course, my tweet was buried in a week or two. I asked a couple of famous friends to retweet it, and I got a few more. Things really started humming when I hired a research team to crowdsource questions online. There were parent groups that-- One of my researchers just belonged to every parent group that you could imagine, and she was also an attorney. There were a lot of specific LA-area attorney mom groups. Oh, God, the attorneys gave me a ton of questions.

Then I had another researcher who was based in West Virginia and was a creative writing graduate student, and she was connected to all of the weird internet, or weird social media, and Reddit. I got the questions that my two researchers got for me on the internet. The Venn diagram were two completely separate circles. With their help, I eventually gathered more than 2,000 questions, and that was enough to prune it and really think about the order of the questions and how they intersected with each other.

By the time I had involved Liana Finck, the genius New Yorker cartoonist, she was my active collaborator on drawing the questions, on putting them in order. Eventually, we came up with what is now the book, Questions Without Answers.

Emily: The pairing of the questions with Liana's illustrations, it just takes it to a whole other level. I just opened the book to a random page, and the question is, "What is a

moment?" Liana draws a timeline with different intervals. There's a little interval that's second, and then there's a bigger interval that's minute, and there's an even bigger interval that says hour. Then she draws like a little cloud off to the side, off the timeline, with an arrow pointing to it that says moment.

I love this form, like you said, the short-- I think in the very, very beginning, in the reading up top, there was a great quote you had up there, which was, "There's always something a bit magical about one great standalone line. The aphorist James Richardson writes, 'No one will ever write a novel by accident. A poem, too, takes time.' If I say, 'Pick a word,' and you say one, where did it come from? You don't say you wrote it or created it, more like you chose it or it chose you." That's what this feels like. It feels like these questions and these illustrations are being pulled down from somewhere.

Sarah: I think you're onto something. There's a lightness about them. For those listeners who aren't familiar with Liana Finck's work, there is a kind of apparent lightness and

casualness to her work, which is actually incredibly deliberate. I use the word genius frequently, but she's the real deal. I reached out to her because she sells custom redrawings of the cartoons that she uploads to her Instagram, and there was a really wonderful one called Women tiptoeing around a man's feelings, which I bought for myself as a divorce present.

Emily: [laughs]

Sarah: I reached out to her. I had been her fan just from seeing her work in magazines over the years. She said that she knew my work too, and we developed an email friendship, and then she very kindly involved me in work on a project that she had been given a grant for by a foundation. We met at a mini conference in Boulder, Colorado, and I think we just worked really well together, although whenever there's a collaboration and somebody says we worked really well together, it's like I always assume, "Well, this is the person who was the asshole."

Emily: [laughs]

Sarah: We get along really well. Still, I didn't really come up with the magic recipe for this book all at once. It was incredibly gradual. I wrote the first questions down in about 2015, and then it wasn't until 2021 that I realized that Liana was the person to illustrate it.

Emily: You said a lot of the questions were about death and birth, which isn't that surprising, since those are philosophical, spiritual liminal spaces that you could imagine a child would be curious about, but you also said that there were a surprising number of questions about necks and chins. [laughs]

Sarah: Honestly, I couldn't believe it. What do you think about that?

Emily: [laughs]

Sarah: One very alert reader suggested that because children are short in stature compared to adults, and they're always looking up at us, they see our necks and our chins as just, visually, they're more present in their visual field. It also might be that, of all of the things on a head, everything has a really specific function. Like an eye has a really different function from an ear or a mouth or nose and a chin, like it has a name, but what is it really for? That might be another reason why. I don't know.

There could just be something in the kids' zeitgeist. There might have been some show or some pop culture joke about chins or necks that are like I never heard it, and this just may be following from that kind of generational awareness of how necks and shins are weird or funny or something.

There were so many questions about necks and chins. I think there's one about a dog's chin and one about-- Oh, there's a really lovely one. The question is, how important are necks? Which I thought was a lovely way of asking the question. Liana's drawing is just like-- it's a line drawing of a face and a neck, and then an arrow pointing to the neck. Some of the drawings are really literal, which, I think, makes them even funnier. In fact, the UK edition of the book is not called Questions Without Answers. It's called Do Dogs Have Chins? And Other Questions. It has a different emotional appeal to the original title, but it tickles me that that's the one that they chose.

Emily: As we wind to a close, I was wondering if you would permit me to share with you some things that my daughter has said to me.

Sarah: Oh, I would love to hear them. Yes.

Emily: I, too, have a Google doc where I jot down some of the funniest and most interesting things, and so I picked-- they're not questions, per se, but I thought I would share them anyway.

Sarah: Oh, wonderful.

Emily: The first one is about hair. [laughs] My husband is bald, and so we learned the word bald pretty early. One day, she exclaimed, "My bald is under my hair."

Sarah: Oh, that's so good.

Emily: The next one is about death. She had a great-grandpa, actually, who died. He was over 100 years old.

Sarah: Oh, wonderful.

Emily: One day, we were talking about great-grandpa dying, and she got this really serious look on her face, and she gave a long monolog, and she said, "I died, and my friend Leo died, and great-grandpa died, and the car seat died, and the high chair died, and the wipes died, and the elephant died." Then she goes around the room pointing. She goes, "This and this and this and this." She says, "They all died. All these people and all these things died. Then they put jackets in their mouths and went to sleep." I said, "Okay, what did they see when they went to sleep? Did they have any dreams?" She said, "Yes, they saw astronauts and Cookie Monster." I said, "Was it scary?" She said, "No, it wasn't scary."

Sarah: That's incredible. I want to hear more about these jackets.

Emily: [laughs] The jackets in the mouths was really specific.

Sarah: That's the detail that really carries it over the line. How amazing.

Emily: It's like taking something that's supposed to be on the outside and putting it on the inside or something.

Sarah: Oh, that's true. Right. Outerwear as internally-- I'm going to have to think about that one.

Emily: Like flipping inside out.

Sarah: Did you ask her any follow-up questions about the jacket?

Emily: I didn't, but maybe I will, and I'll report back.

Sarah: I would love to hear more about these jackets because she may be on to something. I really do think kids understand death better than we do, because we just try so hard

not to think about it.

Emily: Totally.

Sarah: Oh, God, that's incredible.

Emily: The last one is pretty simple. It's about love. She just said one day, "I'm sad because I'm happy." I said, "What do you mean you're sad because you're happy?" She said, "Because I love you, because I love you so much."

Sarah: Oh, God. How do you survive? I love that.

Emily: [laughs]

Sarah: That's the thing about parenting. You get a question like that, and then you get a question about poop, and then you're talking about food for the rest of the day. You, the parent, will never be the same, because you've heard this incredible question about-- or not question, but an educational statement about what you do with jackets after you die?

Emily: [laughs] Well, thank you for letting me share those with you.

Sarah: Oh, it was such a pleasure, believe me.

Emily: Thank you for Questions Without Answers, and all of your other work, but especially for me, and I think for our audience, for Two Kinds of Decay, and for coming on and speaking with me today. Is there anything you want to leave us with today?

Sarah: Oh, well, it was an absolute delight speaking with you. I'm always curious about what a medical audience would think about the book that I published after the Two

Kinds of Decay, which also has a medical component to it. It's called The Guardians, and it's about my very dear friend Harris Wolfson, who died by suicide, and who had what is now assumed to be schizotypal disorder. It's not really a book about Harris per se, but it is a book about what happens to the people who are left behind after somebody dies of suicide.

Emily: We'll have to add that to the list.

Sarah: It's a short book. I feel okay shilling it.

[laughter]

Sarah: You really will read it in one sitting.

Emily: All right. Sarah Manguso, thank you so much for coming on the show.

Sarah: Thank you so much, Emily. A pleasure.

[music]

Emily: This episode of The Nocturnists was produced by me and producer and head of story development Molly Rose-Williams. Our executive producer is Ali Block, and Ashley Pettit is our program director. Original theme music was composed by Yosef Munro, and additional music comes from Blue Dot Sessions. The Nocturnists is made possible by the California Medical Association, a physician-led organization that works to ensure the doctor-patient relationship remains at the center of medicine. To learn more about the CMA, visit cmadocs.org.

This episode of The Nocturnists' conversations is sponsored by the Physicians Foundation, which supports physician well-being practice sustainability and leadership in delivering high-quality, cost-efficient care. The Nocturnists is also made possible by donations from listeners like you. In fact, we recently moved over to Substack, which makes it easier than ever to support our work directly. By joining us with a donation of $2, $5, or $10 a month, you'll become an essential part of our creative community. I'm your host, Emily Silverman. See you next week.




Transcript

Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily: This is The Nocturnists' conversations. I'm Emily Silverman. Today, I'm speaking with writer Sarah Manguso. I first encountered Sarah's work around 17 years ago when I read her book Two Kinds of Decay, a lyrical memoir of illness that has stayed with me ever since. In crystalline, poetic fragments, Sarah described her experience with CIDP, an autoimmune neurologic disease, and the strange world of hospitals, treatments, and survival. Since then, Sarah has written widely across memoir, aphorism, and essay. Her most recent book, Questions Without Answers, began as a Twitter experiment and grew into a collection of children's philosophical questions, illustrated by the cartoonist Liana Finck.

In my conversation with Sarah, we explore her formative memoir, Two Kinds of Decay, and what it feels like to revisit that book 17 years later, parenting and how toddlers are art machines whose logic and poetry can astonish adults, and the surprising themes that children return to: birth, death, chins and necks, and what they reveal about how kids see the world. I was so excited to speak with Sarah after being a fan of hers for so long, and I hope you enjoy this conversation as much as I did. First, here's Sarah reading from her new book, Questions Without Answers.

Sarah Manguso: In 2021, I opened a Twitter account and posted a single tweet, "What's the best question a kid ever asked you?" Within 24 hours, I had more than 100 questions. Within a week, I had hundreds more. I asked some famous friends to retweet the tweet. I asked everyone I knew to ask everyone they knew. I read multiple iterations of the if God is everywhere conundrum and multiple accusations of pregnant women having eaten their babies. I also had the privilege of reading a lot of accidental poetry and philosophy in multiple languages. Death was a common topic. So was birth. I was surprised to receive so many questions about necks and chins.

The poet Kenneth Koch, who taught at Columbia University for many years, also taught poetry to young children at New York City's PS 61 in the late 1960s. He wrote three books on teaching poetry to young children, including many examples of the poems that arose from his prompts. When I teach creative writing, I always bring in a few poems from his anthology, Wishes, Lies and Dreams, and I mix them in with my more recognizable texts. I love asking with a straight face if anyone has read the work of so and so, and then to announce that the author was seven years old when she wrote the poem we've just discussed.

My students are impressed and a bit unnerved that they weren't able to guess the provenance of the children's poems. Very young children, younger even than Koch's elementary school students, might not be old enough to write poems themselves, but they do have access to imaginative worlds that are just as interesting and just as notable a fount of worthwhile literature.

The word literature might first suggest to the lay reader a Shakespeare play or a Tolstoy novel, but I've spent much of my writing life composing and delighting in very short literary forms, among them the short poem, the very short story, and the aphorism. There's always something a bit magical about one great standalone line. The aphorist James

Richardson writes, "No one will ever write a novel by accident. A poem, too, takes time." If I say, "Pick a word," and you say one, where did it come from? You certainly don't say you wrote it or created it, more like you chose it or it chose you. One-liners must be in the middle of that spectrum.

One-liners, among them, the one-line questions that constitute this book, float somewhere between thinking and writing where verbal but preliterate young children dwell. That place is the origin of this text. My chief purpose in assembling the text of this book is to challenge the popular depiction of children as adorable idiots, instead portraying them as they are: intelligent, intuitive, inventive, philosophical, funny. Their questions are a work of found choral philosophy, a collective subjectivity that disappears from most people's lives by kindergarten.

[music]

Emily: I am sitting here with Sarah Manguso. Sarah, thank you for being here.

Sarah: Thanks so much for having me.

Emily: Sarah, I have been following your work for a long time. I first came across your writing 17 years ago when my husband came home from a bookstore with a copy of your book Two Kinds of Decay. He said, "I saw this, and I thought you might like it. It seems like it's related to healthcare, and it's a signed copy." It really felt like the universe plucked your book out of a bookstore, and I read it, and it really shaped me, I think, as a young person coming up in medical education.

I had learned a lot about different diseases, of course, the way that you do in medical school, but your first-person narrative of your experience going through illness and encountering the healthcare system, written in such a lyrical and poetic way, was a formative text for me coming up through medicine. First, I wanted to say thank you for writing

it.

Sarah: That means so much to me. Thank you, Emily. It's kind of thrilling to get to talk about a 17-year-old book today, and for you to remember your reading experience so vividly. Yes, this is quite special.

Emily: For the audience, if you haven't read Sarah's book, which I highly recommend, it's called Two Kinds of Decay, and it's about Sarah's experience with CIDP, chronic idiopathic demyelinating polyradiculoneuropathy, which is a mouthful, and I had to practice before I said it.

Sarah: You did great.

Emily: I want to just ask you about the book, reflecting back on it after a couple of decades. Before I do, I just wanted to share the one scene that has always stayed with me. I don't know if you've had other people tell you this, but there's a scene in the book where you're in the hospital and you're having a blood cleaning procedure called apheresis, and there's a scene where you're sitting in the chair or the bed, you're having the apheresis procedure, where the machine is filtering your blood and you're eating French fries.

Sarah: I'm eating French fries. Yes, yes. Actually, yes, I have had this remarked upon by young MDs who maybe haven't prescribed or witnessed this particular kind of apheresis where the plasma is removed. Why don't you describe what actually happens in the scene?

Emily: You're sitting there having the procedure, eating the French fries, and then you watch as the blood products actually get more greasy and fatty and filled with fat particles.

Sarah: Cloudy.

Emily: [laughs] Cloudy.

Sarah: They get cloudy and opaque.

Emily: That always stayed with me, and the book is just really poetic and beautiful. Was wondering if you could take a moment and just reflect back on that work, which was so long ago.

Sarah: Oh, sure, yes. Again, this is really very special. The first thing I should probably say is that the last time I really had a prolonged conversation about this work was 2008.

I was in my early 30s. I'm now in my 50s. Back then, I remember the process of writing the book and the process of talking about the book was extremely easy and clear compared to the way that I feel when I talk about any of my work now. As a young person, this was my first book with a commercial press. It was my first book of longer prose, even though the prose itself is made out of very short sections. It's about 200 pages. The three books that I had published before the Two Kinds of Decay were poetry collections or collections of 200-word stories.

All of this is to say that it felt very fresh. It was very easy to write. It was easy to talk about. Being older and having published more books and lived more years definitely changes my perspective. Some other things that change my perspective on the book are the fact that I've had two CIDP relapses since the book came out. There's also a love story that's wrapped in among the illness narrative. I did eventually marry the person that I wrote about and have a child with them and divorce them.

Emily: [laughs]

Sarah: There's a lot more plot than the book depicts. I think one more thing that I want to say is that, as a younger person, writing before or at the very lip of the illness memoir boom in publishing, I was asked more than once, "What is a young person like you doing, writing her memoirs? You've barely lived." I said, "It's just a memoir of this one experience. I was only remembering one thing."

In retrospect, I look at the book, and I think, "This is just blissfully uncomplicated and clear," because that's the way my life felt at the time. My diagnosis and my health history was probably the most interesting or unusual thing about me up to that point, and that fact has changed in the ensuing decades.

Emily: Well, I want to get to that. Before we do, for the medical learners listening, could you tell us about CIDP? What is it? Maybe you can take us a little bit along the arc of your journey of initial presentation, that initial bout of uncertainty and treatment, and then maybe even a couple of the relapse and what that's been like.

Sarah: Sure. Before I start, I just want to say that being treated at a teaching hospital was so intrinsic to my experience, not just of being sick, but of engaging with the people who were caring for me because I was 21. There are a lot of med students in their mid to late 20s. While I didn't really see them as peers exactly socially, the relationship was really collaborative and almost kind of fun, on top of the fact that this is a rare disease, and a lot of them treated me as this fun extra-curricular activity in their narrow rotation.

BRSS TACS. I imagine that many of your medical learners listening right now may have heard of Guillain-Barré Syndrome, which is a rare but not unheard of autoimmune disease that affects the peripheral nervous system and typically presents as numbness, paresthesia, and weakness. There are different siblings in this group of diseases, depending on the shape of the molecule that your personal immune system is secreting. My early diagnosis and treatment that I depict in this book, which took place during the '90s, was not as fine-tuned as treatments are now.

My experience was I woke up one day and my feet were asleep, and I had been a very healthy person up until that day, and so I did what I think many relatively healthy people do when they're faced with a kind of unexpected or unusual symptom, which is-- I just said, "Oh, that's weird. I must have slept on my feet weird, or maybe I'm tired, and this is just a new thing that happens when you're tired." I was 21. I was a healthy teen, and I thought, "Oh, okay, maybe I'm getting older, or maybe I'm learning about what happens when you smoke too much pot." I don't know.

Emily: [laughs]

Sarah: Everything was new. My initial reaction was not fear or even an inclination to medicalize the experience. With my numb, tingly feet, I walked down the hallway in my dorm to the bathroom, and I washed my face. As I was splashing water on my face, I realized that I was almost drowning because I couldn't hold my breath long enough to keep the water from being aspirated, if that's the word I'm looking for there. Okay, good.

Emily: [chuckles]

Sarah: Those two symptoms just kind of stayed like that for a few days, and I realized that my big muscles were getting weak. I was having trouble going up and down stairs. I was having trouble lifting things. Again, I just thought, "Well, these must be new symptoms of fatigue that I've never felt before." Because at that point in my life, my inclination was not to go straight to, "Oh, I must have a rare neurological disease."

I think it was when I fell down in the courtyard at my dorm, I thought, "I should probably call my parents," who lived 10 miles away. This is in Massachusetts. I had grown up very close to Harvard, where I was an undergraduate. Up until the point that I fell, I remember feeling embarrassed because I felt that I looked drunk walking. I was staggering around. I had foot drop. My balance was affected, my proprioception was affected. I just felt really embarrassed because it looked like I was day drunk. That was the presentation.

I was driven to Newton-Wellesley Hospital, which was a teaching hospital affiliated with Harvard. It was also where I had been born. Fun fact. I went through the emergency department, and the ED doctor who evaluated me did a gross examination, didn't seem to find anything. I wish I knew at what point in his medical career he was on that day. I will probably never know, but I do remember very well that he said, "You know what? Wait, I have a friend, and he's a neurologist. I think I'm just going to call him."

He called his friend, the neurologist, and I started putting my clothes back on because I thought, "Well, okay, I guess this is just one of these weird-- I must just be tired." I don't know what's going on. It was probably two or three minutes before the doctor came back into my little cordoned-off ward in the emergency department. He said, "I want to test your deep tendon reflexes." I sat and dangled my legs off of the gurney, and he tested for my reflexes.

In what became very quickly a really neat party trick that I did frequently over the next four and a half years, I had no deep tendon reflexes at all. My knees, at my feet, nothing in my arms. He tested everything. They were all gone. That was when he said, "Okay, I'm diagnosing you with Guillain-Barré Syndrome." We moved on from there.

Emily: It wasn't Guillain-Barré Syndrome?

Sarah: No, it wasn't, but there was no way that he could have known that at that moment. Guillain-Barré Syndrome is typically acute, monophasic, and the form of the disease that I had was chronic. I received the treatment that at that time was first-line, which was apheresis. As you described in the French fry scene, my plasma is what was removed and replaced with fresh frozen plasma and albumin, and some other stuff mixed in, for good measure, a little extra fluid.

The treatment for Guillain-Barré, it assumed that your body has a brief period of secreting these autoantibodies. Then it just spontaneously stops after having spontaneously started. My apheresis sessions would take place, and I would be sent home, but I would continue secreting antibodies. After a few more days, all of my symptoms would be back, and I would be back in the hospital.

It wasn't until at least a year into my treatment that a study was published about a group of patients who were in the Netherlands, and the findings were that IVIG, it had a more lasting effect on somebody with a chronic, remitting, relapsing, or more difficult case of the disease. Even at that point, I don't know that the doctors were saying, "CIDP is what you have." It was more like a gradual understanding that, "Okay, there is this chronic form of the disease. If Guillain-Barré is glancingly rare, this is that much squared."

Then it was-- Well, you can probably remember the plot points better than I can at this point, because you've probably read the book more recently. IVIG may have been what arrested the disease, and I had other ideas about what might have happened to finally turn off my faucet of autoantibodies.

Emily: Other ideas, meaning other treatments or just other--

Sarah: Well, I did have this superstition about sex. I was 21 when I first got sick, and I'd only had intercourse, what hetero people call intercourse, with one person. I thought

more than once, during my time in the hospital, I might die. It would be really sad, because I've only been with one person. This is something I talk about on page 1 of the

book, so this is not some terrible secret that I reveal. It's not some sort of sudsy sentimental moment in the book where I was fairly-- I thought, "Oh, intellectually, that's a bummer or kind of sad."

Then I became attached to the idea that if I had sex again, I might get better. I wasn't thinking about it quite so cause, effect, magically, but it definitely was something that I wondered about, and it may have been a pure coincidence that what I now know as a subclinical dose of IVIG might not have been the entire reason that I finally seemed to have stopped producing these autoantibodies, it was also the fact that I had sex with somebody else at last, within days of my Rhesus line being pulled out of my chest.

I've never really known or needed to know whether one or the other was weighted more heavily in the list of reasons why I finally got better, but it's just always been part of the story.

Emily: You did get better for a while, you went into remission, and it sounds like you're in your 50s now, have had a couple of relapses. Did you go completely back to normal, or what was that pattern?

Sarah: I went completely back to normal in that I've wholly stopped secreting the autoantibodies. In total, I've had two bouts in my 20s and two bouts in my 40s. Nothing since I recently broke my record for remission, which was 11 years. I'm going on 12 years now, since my most recent relapse, which is great. At the same time, I fully expect to get it again. It's not nearly as terrifying as it was that first time before IVIG had become the first-line treatment. In my particular body, my particular case, IVIG works like magic. It shuts it down immediately.

Emily: I love what you said about love and sex being a part of the story and potentially playing into the way your body responds. You said that you met someone, married them, had children with and then had a divorce, all in the last 17 years since the book came out. Was wondering if you could speak a little bit to the love story aspect of this.

Sarah: Oh, yes, sure. The love story aspect did, again, seem mysterious and important. I only began writing the book after I met my future ex-husband. I was at an artist residency in New Hampshire called the MacDowell-- At that time, it was called The MacDowell Colony. It's now just called MacDowell. If you're the kind of person who relaxes in the country where leafy green forests and fawns and bunnies and solitude works in order to get you to do the kind of work that you need to do, you'll understand just how innervating and exciting it was to be in such a place.

In the summer of 2006, I was there for the second time, and so I knew exactly what to do. I was there to write another book of stories like the one that I'd written the summer before. That book had become my story collection, which is called Hard to Admit and Harder to Escape, my longest title. This next summer, I thought, "I'm going to just do that exact thing again." One of the magical things that happens in a place like MacDowell is that sometimes your work just goes down a completely different avenue, one that you would never have anticipated or tried for if you had been in some other place. For me, that's the first interesting thing that happened that summer at MacDowell.

The second interesting thing that happened is that I met the person who would become my future ex-husband. I say that a little bit tongue-in-cheek. I mean, we had some good years before the X phase of things, but those two experiences were really bound up together for me, and it really did seem like very much part of the story that, A, I was finally ready to write about this substantial part of my experience as a young person. It was the thing that everybody told me, "Oh, you'll have to write a book about that someday."

The more I heard that from people, the less interested I was. It just felt so obvious. Like, "Yes, I'm the one with the weird ass autoimmune disease. Of course, I should write a book about it." I was just more interested in doing other things that seemed less obvious and less easy. It may well be that, finally, with this sudden intuitive understanding that it was time to write that book, combined with this sudden intuitive understanding that I had met somebody that I wanted to spend my life with, it just made the project palatable to me, in a way. I did write about the experience of meeting this person. We had some good years together, during which I wrote other books. Also, during our marriage, I had those other two relapses.

[music]

Emily: Let's fast forward to today. Your latest book is called Questions Without Answers, and it's a book that came out of parenthood. In the reading up top, we heard about how the impetus for the book was a social media post asking, "What's the best question your child has ever asked you?" Tell us about becoming a parent and then becoming a parent to this book.

Sarah: Oh, what a great question. Sure. I became a parent along with the person that I met in 2006, and we went into parenthood sharing the attitude that neither one of us had ever desperately wanted to be a parent. I had never had that experience that's frequently talked about as a sudden hormonal need to reproduce. I'd never had that. At the same time, we both knew a lot of artists who had a kid or multiple kids and whose work became richer and better.

Also, of course, we have lived in the human civilization where there's just a lot of evidence and self-reporting that children make your life better. We thought even though neither one of us is feeling that desperate, non-specific need to reproduce, we should probably have a kid because it'll make our lives better. So we did. Although I had gone through a lot of medical excitement up until that point, I was surprised and relieved that pregnancy was so much easier than having CIDP.

Once I actually had this small child, his name is Sam, I was struck by how unprepared I was, or rather how surprised I was about what I found actually interesting about parenthood, specifically about being around young children, toddlers, age two to four or five. These little creatures are art machines. They're philosophy machines. I think they're almost supernatural creatures, because they dwell in both worlds. That's something that I wrote about in my foreword to this collection.

When my little Sam was about three or four, the questions that he asked me were just-- He had very limited life experience, but he already had maximal capacity for logic, for creativity, for humor. His mind was as interesting as the most interesting adults that I knew. Combined with his lack of life experience, it made his questions just bananas. Some of his questions that I particularly liked set me on a path to considering these, maybe turning into some kind of art down the road were, "What does a gargoyle say? Do you like windows? Was Mom a baby, too? Did I play with her?"

Then there were three questions that he asked in really close succession one day. "When I was inside your body, did you know me? Did you want to meet me? Did I make the world?" [laughs] It sounds like it was something that an artist wrote. I have been accused of ventriloquizing these young children and making them sound wiser, funnier, or more interesting than they actually are. No, they really are that interesting. I think anybody who has paid any kind of attention to toddlers, like anybody who works in early childhood education, or even somebody who just has spent time around a kid as a caretaker or as a parent and really listened to them, I thought, "It can't just be my kid."

During COVID, I was writing a novel about a brutal divorce, and I really needed a side project. I thought, as I thought many times in the past five years since I had written down my kid's questions on this, it's just like one page, I thought, "Maybe it's time. Maybe I could ask other people for their questions, and maybe I could finally just do social media," which I avoided up until that point.

I opened a Twitter account. I posted one tweet, which was this question: "What's the most interesting question you've ever been asked by a young child?" I gave a couple of examples that my kid had asked me, and then I just laid back and let the questions come in. It was miraculous. I mean, it was even more amazing than I had hoped. There were writers, there were journalists, there were people whose work I read and loved, sending multiple questions. Then people sent questions in French, Spanish, Dutch. Questions were coming from all over.

Not understanding how algorithms worked, I thought, "Oh, my God, this is great. I'm just going to keep getting hundreds of questions every day for the rest of my life, and this will be a book. This absolutely can be a book." Of course, my tweet was buried in a week or two. I asked a couple of famous friends to retweet it, and I got a few more. Things really started humming when I hired a research team to crowdsource questions online. There were parent groups that-- One of my researchers just belonged to every parent group that you could imagine, and she was also an attorney. There were a lot of specific LA-area attorney mom groups. Oh, God, the attorneys gave me a ton of questions.

Then I had another researcher who was based in West Virginia and was a creative writing graduate student, and she was connected to all of the weird internet, or weird social media, and Reddit. I got the questions that my two researchers got for me on the internet. The Venn diagram were two completely separate circles. With their help, I eventually gathered more than 2,000 questions, and that was enough to prune it and really think about the order of the questions and how they intersected with each other.

By the time I had involved Liana Finck, the genius New Yorker cartoonist, she was my active collaborator on drawing the questions, on putting them in order. Eventually, we came up with what is now the book, Questions Without Answers.

Emily: The pairing of the questions with Liana's illustrations, it just takes it to a whole other level. I just opened the book to a random page, and the question is, "What is a

moment?" Liana draws a timeline with different intervals. There's a little interval that's second, and then there's a bigger interval that's minute, and there's an even bigger interval that says hour. Then she draws like a little cloud off to the side, off the timeline, with an arrow pointing to it that says moment.

I love this form, like you said, the short-- I think in the very, very beginning, in the reading up top, there was a great quote you had up there, which was, "There's always something a bit magical about one great standalone line. The aphorist James Richardson writes, 'No one will ever write a novel by accident. A poem, too, takes time.' If I say, 'Pick a word,' and you say one, where did it come from? You don't say you wrote it or created it, more like you chose it or it chose you." That's what this feels like. It feels like these questions and these illustrations are being pulled down from somewhere.

Sarah: I think you're onto something. There's a lightness about them. For those listeners who aren't familiar with Liana Finck's work, there is a kind of apparent lightness and

casualness to her work, which is actually incredibly deliberate. I use the word genius frequently, but she's the real deal. I reached out to her because she sells custom redrawings of the cartoons that she uploads to her Instagram, and there was a really wonderful one called Women tiptoeing around a man's feelings, which I bought for myself as a divorce present.

Emily: [laughs]

Sarah: I reached out to her. I had been her fan just from seeing her work in magazines over the years. She said that she knew my work too, and we developed an email friendship, and then she very kindly involved me in work on a project that she had been given a grant for by a foundation. We met at a mini conference in Boulder, Colorado, and I think we just worked really well together, although whenever there's a collaboration and somebody says we worked really well together, it's like I always assume, "Well, this is the person who was the asshole."

Emily: [laughs]

Sarah: We get along really well. Still, I didn't really come up with the magic recipe for this book all at once. It was incredibly gradual. I wrote the first questions down in about 2015, and then it wasn't until 2021 that I realized that Liana was the person to illustrate it.

Emily: You said a lot of the questions were about death and birth, which isn't that surprising, since those are philosophical, spiritual liminal spaces that you could imagine a child would be curious about, but you also said that there were a surprising number of questions about necks and chins. [laughs]

Sarah: Honestly, I couldn't believe it. What do you think about that?

Emily: [laughs]

Sarah: One very alert reader suggested that because children are short in stature compared to adults, and they're always looking up at us, they see our necks and our chins as just, visually, they're more present in their visual field. It also might be that, of all of the things on a head, everything has a really specific function. Like an eye has a really different function from an ear or a mouth or nose and a chin, like it has a name, but what is it really for? That might be another reason why. I don't know.

There could just be something in the kids' zeitgeist. There might have been some show or some pop culture joke about chins or necks that are like I never heard it, and this just may be following from that kind of generational awareness of how necks and shins are weird or funny or something.

There were so many questions about necks and chins. I think there's one about a dog's chin and one about-- Oh, there's a really lovely one. The question is, how important are necks? Which I thought was a lovely way of asking the question. Liana's drawing is just like-- it's a line drawing of a face and a neck, and then an arrow pointing to the neck. Some of the drawings are really literal, which, I think, makes them even funnier. In fact, the UK edition of the book is not called Questions Without Answers. It's called Do Dogs Have Chins? And Other Questions. It has a different emotional appeal to the original title, but it tickles me that that's the one that they chose.

Emily: As we wind to a close, I was wondering if you would permit me to share with you some things that my daughter has said to me.

Sarah: Oh, I would love to hear them. Yes.

Emily: I, too, have a Google doc where I jot down some of the funniest and most interesting things, and so I picked-- they're not questions, per se, but I thought I would share them anyway.

Sarah: Oh, wonderful.

Emily: The first one is about hair. [laughs] My husband is bald, and so we learned the word bald pretty early. One day, she exclaimed, "My bald is under my hair."

Sarah: Oh, that's so good.

Emily: The next one is about death. She had a great-grandpa, actually, who died. He was over 100 years old.

Sarah: Oh, wonderful.

Emily: One day, we were talking about great-grandpa dying, and she got this really serious look on her face, and she gave a long monolog, and she said, "I died, and my friend Leo died, and great-grandpa died, and the car seat died, and the high chair died, and the wipes died, and the elephant died." Then she goes around the room pointing. She goes, "This and this and this and this." She says, "They all died. All these people and all these things died. Then they put jackets in their mouths and went to sleep." I said, "Okay, what did they see when they went to sleep? Did they have any dreams?" She said, "Yes, they saw astronauts and Cookie Monster." I said, "Was it scary?" She said, "No, it wasn't scary."

Sarah: That's incredible. I want to hear more about these jackets.

Emily: [laughs] The jackets in the mouths was really specific.

Sarah: That's the detail that really carries it over the line. How amazing.

Emily: It's like taking something that's supposed to be on the outside and putting it on the inside or something.

Sarah: Oh, that's true. Right. Outerwear as internally-- I'm going to have to think about that one.

Emily: Like flipping inside out.

Sarah: Did you ask her any follow-up questions about the jacket?

Emily: I didn't, but maybe I will, and I'll report back.

Sarah: I would love to hear more about these jackets because she may be on to something. I really do think kids understand death better than we do, because we just try so hard

not to think about it.

Emily: Totally.

Sarah: Oh, God, that's incredible.

Emily: The last one is pretty simple. It's about love. She just said one day, "I'm sad because I'm happy." I said, "What do you mean you're sad because you're happy?" She said, "Because I love you, because I love you so much."

Sarah: Oh, God. How do you survive? I love that.

Emily: [laughs]

Sarah: That's the thing about parenting. You get a question like that, and then you get a question about poop, and then you're talking about food for the rest of the day. You, the parent, will never be the same, because you've heard this incredible question about-- or not question, but an educational statement about what you do with jackets after you die?

Emily: [laughs] Well, thank you for letting me share those with you.

Sarah: Oh, it was such a pleasure, believe me.

Emily: Thank you for Questions Without Answers, and all of your other work, but especially for me, and I think for our audience, for Two Kinds of Decay, and for coming on and speaking with me today. Is there anything you want to leave us with today?

Sarah: Oh, well, it was an absolute delight speaking with you. I'm always curious about what a medical audience would think about the book that I published after the Two

Kinds of Decay, which also has a medical component to it. It's called The Guardians, and it's about my very dear friend Harris Wolfson, who died by suicide, and who had what is now assumed to be schizotypal disorder. It's not really a book about Harris per se, but it is a book about what happens to the people who are left behind after somebody dies of suicide.

Emily: We'll have to add that to the list.

Sarah: It's a short book. I feel okay shilling it.

[laughter]

Sarah: You really will read it in one sitting.

Emily: All right. Sarah Manguso, thank you so much for coming on the show.

Sarah: Thank you so much, Emily. A pleasure.

[music]

Emily: This episode of The Nocturnists was produced by me and producer and head of story development Molly Rose-Williams. Our executive producer is Ali Block, and Ashley Pettit is our program director. Original theme music was composed by Yosef Munro, and additional music comes from Blue Dot Sessions. The Nocturnists is made possible by the California Medical Association, a physician-led organization that works to ensure the doctor-patient relationship remains at the center of medicine. To learn more about the CMA, visit cmadocs.org.

This episode of The Nocturnists' conversations is sponsored by the Physicians Foundation, which supports physician well-being practice sustainability and leadership in delivering high-quality, cost-efficient care. The Nocturnists is also made possible by donations from listeners like you. In fact, we recently moved over to Substack, which makes it easier than ever to support our work directly. By joining us with a donation of $2, $5, or $10 a month, you'll become an essential part of our creative community. I'm your host, Emily Silverman. See you next week.




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