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There were many things I had considered meditating on as my guest blog post come to a close, but the receipt of a link to a diary written by a mother who lost her child to a foreign body accident in 1917 had the power to displace all thought of possible musings. Instead, it seemed pertinent to use the occasion of the blog to share what had been just shared with me. The extraordinary first-person account was written by Rose Diamant, the great aunt of Dr. Michael Rothschild, who happens to be the President of the ABEA (The American Broncho-Esophagological Association), an organization founded by Chevalier Jackson. Dr Rothschild was recently in touch with me and took me to this story. But of course, it is more than a story, and the mother-author's decision to record in such detail the impressions of the final days of her two-year old son's life stands on its own as only a precious document can, as a trace of the raw and the real. The boy had accidentally inhaled a piece of walnut shell that eventually proved fatal, and I want to note that, according to the account, "the doctor [whom she took him to] ignored the suggestion, and said even if there was a piece, it was so small it would not hurt him." Even though we experience Chevalier Jackson's foreign body collection as a cabinet of curiosities — and there's no question that this is what it is — Jackson's mission was in fact to train his physician-colleagues to think of a foreign body not as an impossibility, a rarity, an odd, uncommon happening, but as a likely, commonplace, norm. He was on a quest to change an entire perceptual habit, and to replace disbelief with belief (in foreign bodies). He sought to bring foreign body ingestion into the realm of intelligibility. I close Swallow with the story of a four year old boy who had swallowed a coin, but whom no doctor believed when the coin failed to appear on x-ray. The boy lived the six remaining years of his life suffering various ailments caused by the foreign body, until, too late to be helped, he was finally believed, taken to Jackson's clinic where the foreign body was acknowledged but the boy could no longer be saved.

As Dr. Rothschild notes in his prefatory remarks to his great aunt's diary, in 1917, when Rose Diamant's child died, safe techniques for removal of foreign bodies in the lungs were "just being worked out by the famous Philadelphia surgeon Chevalier Jackson. Prior to the development of this endoscopic extraction technique, a foreign body in the lungs was essentially a death sentence, from progressive airway obstruction, infection, or the high risk of an open chest operation."

The diary entry lingers with me in so many ways: in one person's attempt to comfort the mother by telling her that she "was still young and would have other children"; in the image of Rolf playing with books in the family library, or the fact of his just learning to name the things of the world: he was "pointing out and naming everything that caught his attention. Now it was a tower and now a chicken, and then a clock would catch his eye. And then a horse and so on and he would name them all to me, and I would assent and question him." The desperate detail of Rose's husband being locked in the hotel bathroom; the remembered reflection of purplish early morning light, or the fact that the rooms where they cared for the child were drafty. The child's frenzied response to the sight of the nurse's cap. His mother's heart-breaking statement that "he knew her no more." The impression that his head was separated from his body. The wish that the nurse hadn't smiled.

Thanks to all the folks at Powell's Books for allowing me to share my thoughts these past five days! It's been a wonderful

I make a bold pronouncement in Swallow: everyone has a momentous swallowing story that tells them who they are. And in some ways that's been playing itself out in the amazing and intimate stories people have been sharing with me after I give a reading — most recently, of a boy, now a man, who put a bean up his nose when he was a child. He was living with his parents in a part of the world where witch doctors were called upon when other doctors weren't available, and this was one such time. The witch doctor pushed all manner of tools up his nose — rusty tools — and the boy began to bleed. The rust on the tools also made him sneeze — and thus eject the bean. Needless to say, he never quite got over the incident. Another person told the tale of having swallowed a coin when she was a girl. She'd been sick in bed, her father had given her the quarter to help her feel better, and told her to take good care of the quarter. She put it in her mouth. The doctor her mother took her to told her to wait a few days to see if she would pass it. To that end, her mother investigated her stools using a broomstick (this part of the story was rather mysterious). Another person told me about keeping his tonsils in a jar after they'd been removed, and showing them to classmates for years, until eventually they shriveled up. In a particularly intimate conversation with a stranger at a conference I attended last week, while walking from one hotel venue to another he told me about his adult phobia of swallowing glass, and how he'd accidentally swallowed a bottle of aspirin when he was a child, thinking they were candy, and was traumatized by having had to have his stomach pumped.

I know that some people would consider the sharing of such tales "TMI." The fact that we have an acronym for the feeling of learning too much about our fellow man might tell us something about the current moment that we're living in, complete with new conventions of disclosure: so much on-line chatting and sharing of things we never made public before, and yet people don't really seem any less fundamentally lonely. I'm the sort of person whom strangers confide in — on airplanes in particular, but pretty much anywhere. When I was a very young woman, I was such a good listener that I existed more as a repository for other people's egos than an expresser of my own. This is not a "true confession," and I don't think the people who share their swallowing tales with me are confessing. I think they are compelled, and I think they are remembering, and memories shared sometimes have the effect of feeling real.

I'm still a keen listener, but not as passive a listener as I was when just a girl. I'm pretty good, but I'm not a genius. I'll never forget the first time I met the Russian writer and philosopher, Mikhail Epstein: he listened like no other person I had ever met — he listened, with such felicity and excitement, to all three of the people I was meeting him with, and was able to show that he was hearing what was being said. I decided this was the mark of genius and that he was a genius. Of course there is a kind of listening that writers do — that could lead to an essay all to itself — because I sometimes wonder if I'm a better listener to the stories of people whom I do not know than to the stories of those whom I claim most to love.

When my breast cancer book came out, it was quite something to hear the stories of other women when I gave readings. It was amazingly intense, and I probably suffered a bit in the process from what Miriam Engelberg calls "compassion fatigue." On the other hand, I realized that, especially that, radiation's waiting rooms are places where narrative is produced, and I listened keenly to the stories of my cancer colleagues in those rooms, as though together we were making something lasting out of the fact of our shared, blunt encounter with mortality. Now with Swallow, I don't think that instant friendships are formed out of what the book incites — that would be absurd and probably unwanted; but I think that, as in those cancer rooms, there's an admission that becomes possible: the possibility to say something to each other on subjects that, though most close to us, we don't know how to share. It's interesting to me that these tales implicate the body in particular, but I don't know what to make of that at the moment.

The life of a book — what is it? A book always has many many lives beyond the one we hope for most: the one in which someone, in some quiet corner of an information-overloaded life, takes it into their lap and actually reads it. But the life of a book is also tantamount to the friendships made possible in the book's creation. These aren't visible or palpable in the reading of a book. They are exceedingly fleeting and at the same time indelible. I don't think anyone has written a book about the friendships made by the books we now consider "classics," and it might be hard historically to access such friendships outside of a paper trail of letters.

In the course of writing Swallow, I became friends with an 83-year-old woman named Margaret Derryberry who had coincidentally called the Mütter Museum in search of the hatpin that she had inhaled when she was 8 years old in the 1930s. I interviewed Margaret by telephone, and we struck up a wonderfully affectionate email correspondence. In the midst of working on the book — in fact in the very week when my book on awkwardness was set to appear in the world — I received a breast cancer diagnosis. I didn't tell Margaret right away, and by the time I was ready and able to tell her — about one month into my treatment regime — I learned from her daughter that she had passed away. I was kind of glad that she didn't have to depart this world with the burden of my sad news, but I felt pretty sorry for myself that she was no longer in my life at such a difficult time. Of course at that time, I didn't know if I would get to write Swallow, let alone finish it. I devote a chapter of the book to Margaret's story.

With the appearance of Amanda Schaffer's beautiful essay on Swallow in the New York Times yesterday, "Swallowed Objects That Went Straight into History," and in the aftermath of two wonderful readings that I did last week on the West Coast (one at the alternate universe that is the magnificent Velaslavasay Panorama, and another at the wonderfully accommodating Book Soup, both in LA), as well as an interview for CBC/Vancouver, I find myself — you probably think I'm going to say "exhausted," but, no — I find myself stimulated by questions that people are asking me about Jackson and his collection.

I was going to blog today about the way in which new, unexpected friendships are formed when one writes biographically, but it seemed more timely just this minute to share some of the questions — unsolved mysteries, really — that people are asking and to pose just a glimmer of a response.

Three questions in particular have emerged in the past few days: Why do people swallow nonnutritive things? What is the strangest item in Chevalier Jackson's collection? And was Chevalier Jackson autistic or could he be understood as being on an autism/Asperger's spectrum?

I think that I answer all three of these questions in my book, and from a variety of angles, though I don't raise a question of whether Jackson was autistic explicitly. Still, I'll try to offer sketchily provocative answers here, just to give a sense of how I think about these things.

Personally, I'm less interested in answers than in discovering new ways to think about what I thought I knew. For me, that's what's exciting about poetic investigation, or scientific investigation at its best. Trying to think about why people swallow nonnutritive things requires entry into a range of realms of experience, culture, and psychology. In my research, for example, I discovered that a number of women in the 1920s U.S. ingested hardware in great number (I discuss three very particular cases of this in my book — cases in which hundreds of items were found in the same person's stomach). I ask that we think about these cases in a socio-cultural way: I mean, is there anything people do that isn't somehow or other culturally instigated? That isn't in some way suggested to them by the very milieu in which they live? The time and place? And could we think, then, of all human behavior — even that which we find most strange, reprehensible, or incomprehensible, as being drawn from a cultural repertoire? With questions like these in mind, I try to understand swallowing acts like those of the women in the 1920s in terms of their historical context. (I draw on Ian Hacking's work in thinking about this — his work on what he calls "transient mental illness," the idea that some mental illnesses (so-called) appear at particular times and places in the history of humankind and then disappear.) The hardware swallowers, it seems to me, were responding to a demand of the age in which they lived — the age of Taylorism, the machine age, the age in which Charlie Chaplin is pictured swallowing nuts and bolts in Modern Times, an age in which people were required to be more machine-like. But of course no single ground, basis, or motivation does justice to people's ingestion of nonnutritive things, and I don't mean to explain away the problem with one attributable source.

Why do people voluntarily swallow objects? For this, we'd also have to consider a person's individual psychic disposition, their relationship to pleasure and distress in particular. And we'd have to put "volition" (or "voluntarily") in quotation marks — especially if we believe in something like a human unconscious. But it doesn't end there because the human mouth (unlike other bodily orifices) is the site of knowledge, language, breath, appetite, desire, and aggression, to name a few. Swallowing "things" can serve the purpose of self-soothing; as a stopgap to speaking; as a testing of the limits of one's capaciousness. Not reducible to hunger in the literal sense, it can represent a form of emotional hunger. Typically, the act is associated with an array of mental disorders, so-called, but cannot be easily pinned to ONE disorder, and this is partly why such swallowing feats confound psychologists.

After Swallow appeared, I discovered that a gastroenterologist in my own neighborhood in Providence, RI, had just published an article about the rather large number of items he had retrieved from people's stomachs in the recent past at Rhode Island hospital — items that had been purposely swallowed. In his article, Dr. Steven Moss notes that such acts are linked to mood disorders, anxiety disorders, schizophrenia, and other DSM-IV categories, thus making it difficult to treat or control. It is also found in autistic children, and in people who are identified as being developmentally disabled. It's found in pregnant women, too. It's sometimes a form of self-injury, but not always; it's often a form of self-pleasuring; it might seem to suggest a form of suicide, but it's often not. Indeed, as I note in Swallow, there are as many words for types of pica (the DSM-IV term for the swallowing of nonnutritive things) as there are different objects in the world.

When I try to answer the question, why do people voluntarily swallow things, I also find myself wanting to transform the question. I begin to wonder if asking what motivates intentional swallowers is the wrong question, and if the better question might be something like what makes such an act necessary or possible? What is the act continuous with or part and parcel of? Because it's really never explicable in a simple cause-and-effect way; nor can it be supplied with a reducible ground: it's more like a habit, and a way, and perhaps a route — but to what? A form of expression, of what?

It's also curious to me that people act aghast when they hear that some of their fellow humans swallow objects, but also take great pleasure in watching people test their capacity to eat beyond what's humanly possible, and have enjoyed watching people put swords down their throats for centuries. (I try to understand this in Swallow).

Over and against this, I'm moved to consider an even more counter-

How do you find a form for the questions that compel you as a writer? What form does a project dictate? How do you coax a subject away from or toward a genre?

These questions are some of my New Year's irresolutions. Aside from the fact that George W. Bush ruined the word "resolve" for me forever, I generally prefer to dwell in (I almost wrote "possibility" but that would be Emily Dickinson, not me), to dwell in what can't be solved but can only be pursued, not one way or another, but in many ways, unpredictably. I don't really claim to live this way, but this is how I write, and I do believe that writing, that literature, as altered state and alternative world, can transform the "real," the life, eventually.

What is it that you are writing or have written?

How often are you asked that question?

To answer the question, I turn to two brief sentences (of a sort) from Gertrude Stein. They appear in her wonderfully long (at least 50 pages last time I checked) prose poem, "Patriarchal Poetry":

"What is it?

Aim less."

She repeats the question and answer in numerous ways. I always took this question and answer to refer to a reader of Stein's "Patriarchal Poetry" who wants to know what it (Stein's poem) is because the reader can't readily recognize its form. And I've always thought of Stein, instead of answering the question, providing a reader both with an adjective (aimless) and a suggestion if not an imperative (aim less). "Try asking a different question," I imagine her saying; or, "this really isn't the best question to ask about this work" — the same question and the only question that is always ever asked about a piece of writing: "what is it?" Ask me a different, a better question, she seems to say, one that doesn't require so determining an answer. Insofar as this is the question that is perpetually asked, she, does, though, answer it, but not with a thing, a definition, or an expected answer but with a descriptor:

"What is it?"

"It is aimless": my writing does not seek to arrive. It is a wander, and a wondering. It is the shape of a thinking on-going.

What shape does Swallow take? In what way is it biographical without being a biography? How does a writer find a form for her material? I approach biographies and biographers with the greatest reverence and awe, but my book is not a biography in any conventional sense. It contains biographical elements and it hews close to a life not my own, but Swallow is neither chronological in the telling of the life, nor even entirely narrative; it's not interested in being definitive or official (words often associated with biography). It's really a hybrid of a book, an extended, deeply researched poem that tries to bring the informative, the beautiful, and the uncanny into the same space.

Chevalier Jackson himself grappled with questions of form in writing his autobiography. His editor wanted him to write a chronological success story, from starting line to finish line, whereas Jackson wanted to orchestrate his book around overlapping, repetitive, and discontinuous "phases" of his life; he wanted to reserve the right to shift between the first and third person when referring to himself; and he wanted the book to be thematically oriented around "Physique," "Hobbies," and "Episodes." (By 21st-century standards, he wanted to write a memoir rather than an autobiography, but that genre did not exist in 1938). He wasn't proposing something formless, just something unconventional. His choice was not driven by an interest in putting an imaginative free-for-all before the public and calling it "The Life of Chevalier Jackson." The form he was working with was meant to be more truthfully representative of the life than a chronology could be.

Swallow follows Jackson's cue, but also, in establishing its form, draws upon the cabinet of curiosity that is its subject. Its drawers are filled with mysteries that I approach as a poet rather than as a detective, desiring not to solve but to divine, to let other mysteries unfold, to let one act upon another.

My favorite articulations of audacity with the nonfiction form include, most recently:

Rosamond Purcell's Special Cases, in which she writes: "This book honors the form of a slide show or an exhibition organized around associative clusters of phenomena, yielding at all times to gravitational attraction."

And Roland Barthes who in his book, Roland Barthes, writes of disparate objects brought into view by contiguity. He describes his book as "not monumental" but as "a proposition which each will come to saturate as he likes, as he can." He offers a curious image for how he expects the work to act upon a reader: "I bestow upon you a certain semantic substance to run through like a ferret..."

In another book that pertains to biography but is not conventionally biographical, his strange and beautiful tryptich (his own Three Lives?), Sade/Fourier/Loyola, he introduces an idea I love, which he calls a "biographeme." It appears in the opening pages:

...were I a writer, and dead, how I would love it if my life, through the pains of some friendly and detached biographer, were to reduce itself to a few details, a few preferences, a few inflections, let us say: to 'biographemes' whose distinction and mobility might go beyond any fate and come to touch, like Epicurean atoms, some future body, destined to the same dispersion...

He closes with "Sade's white muff, Fourier's flowerpots, Ignatius's Spanish eyes."

What would constitute your own life's biographemes, or those of someone you love, or would love to write about?

Swallow is a set of carefully inlaid, contiguous drawers which I invite you to open and enjoy. In the end, literary nonfiction is tantamount to the shape a form of thinking takes. Here is a way we might think of this thing, here is a shape. What is your thinking like, or

"I admit to being moved by a peanut kernel" and "eventually I made a pilgrimage to a coat," are odd-sounding sentences on their own. For me, they are points of interest on the far edges of a map that began with an un-assuming visit to Philadelphia's Mütter Museum in 2006.

Among the numerous pathological specimens housed in the museum, the Chevalier Jackson Foreign Body collection stopped me in my tracks; I guess you could say it literally fascinated me (fascinate having origins in arrest and paralysis and the casting of spells). I wasn't alone in this — the beguiling drawers filled with thousands of items that people had swallowed or inhaled, items neatly framed, stowed, organized by type, and meticulously cataloged by the doctor who extracted them, is for many visitors to the museum among its most memorable displays; it may even be the museum's most popular attraction. The collection no doubt exerts a singular charge for each person — I'm convinced that viewing the foreign body collection is a visceral experience, sensuous at its core, and yet it is made manifest by presumably inanimate objects. Some people even opt to return to peruse it again and again, and eventually make art from it or write to it.

My own initial interest in Chevalier Jackson's collection of "foreign bodies" was an aesthetic one. Simply, I felt there was poetry happening in these drawers, in much the same way a poet like Talvikki Ansel (My Shining Archipelago) finds poetry inside of the periodic table of elements. Jackson's collection initially interested me as a cosmology of things — what a strange universe the maker of the collection had constructed, in which types and orders and clusters, combinations, constellations, and cross-references were built — but built out of what? Objects that people had swallowed or inhaled.

There was something ineffable about each object, and jewel-like, both because and in spite of the fact that each bespoke the body from which it hailed, a life nearly cut off, most of the time saved because of Jackson, an uncanny lodgment that re-made both the thing and the person who had ingested it.

I thought maybe an experimental essay could do justice to the objects' strange aura — from buttons, nails, and screws, to jackstones and toy binoculars, pencil nibs, coins, a padlock, more than one crucifix, and a Perfect Attendance pin. I'm a reader, and I saw from the exhibit that Jackson had also left a great deal of writing in his wake, including an autobiography that was a best seller in 1938 (written when the physician was 73 years old). Reading the autobiography was difficult. It was finely written — that wasn't the problem — but the first fifty pages were rife with tales of a barely survivable traumatic childhood. There was cause for an essay-poem as a response to the collection — that had been clear — but Jackson's autobiography showed me that there was an entire book waiting to be written from inside his cabinet of curiosities, that the collection was haunted by his own complex psychology and by the lives of his patients running like silent, invisible movies, the scenarios of accident and desire, the vectors of volition and struggle, of poverty and hunger (why do you think people put things in their mouths?) that each foreign body told. Nonfiction was called for because the stories buried in Jackson's papers and in the thousands of case studies in places like the National Library of Medicine collection were often stranger than anything I could possibly make up.

I didn't aim to offer a corrective to the foreign body display — as though it could be "completed" by the restoration of its missing parts, because the beauty of the collection is its inexhaustible suggestiveness, what it hints at, provokes, draws forth, points to, how it invites the imagination to wander. I was, though, excited by the social histories lurking inside each object and was moved to have stumbled upon a life as magnificent as Chevalier Jackson's.

Trauma plays about the edges of the foreign body cabinet — Jackson's, his patients', and my own (a stomach-pumping episode in my early childhood was the result of the otherwise deeply pleasurable imbibing of bubble bath). My father had a habit of warning my brothers and me that much of the object world was swallowable, and therefore dangerous. Is this what incited my interest in the Mütter Museum's collection of foreign bodies, objects caught, extracted, and stowed?

I think it was love, not aversion, that drew me closer, a love of miniatures, and paper dioramas — a particularly intricate miniature village that my mother unfolded each Thanksgiving, or the claymation theaterspaces that clicked into place and opened like a fan into awe when the View-master was held to the light. Though the foreign body collection's amplitude is part of what makes it astonishing, there's also a way in which you have to shrink in order to "enter" it. I'm a lover of secondhand things and a frequenter of yard sales; finding objects that lives have passed through is always more interesting than buying something new. Foreign bodies reversed that process: they had done the passing through; they were peculiarly secondhand.

In a recent interview with the Mütter Museum's director, Robert Hicks, the magnificent filmmakers the Brothers Quay discussed their film-in-progress (premiering this fall) based on objects in the museum. I've loved the Quay Brothers' films forever, and can't wait to see what they will make from these materials. Timothy Quay spoke of the "terrifying beauty" of particular objects in the museum — amputation tools, for example — and their current "benignity" bathed in a beauteous light. I have this same experience of terrible beauty when confronted with Jackson's foreign bodies — those ingredients of the sublime. And I suppose an ethical dimension enters in when one figure in that dyad displaces or competes with another — terror/beauty. Then I find another order of interest is called upon, and I can't retreat. A Perfect Attendance Pin first attracts me for its whimsy, until I learn the details of the case, whose poignant horror calls upon a different order of awe and need to investigate. A collection of 32 objects all swallowed by the same nine-month-old baby, carefully assembled into a hieroglyphic collage by Jackson, enmeshes me in wonder. Until I find in the case study major details that Jackson never told: that this boy was forced to swallow these things by a babysitter. Now a foreign body asks me to find a language for atrocity. To really take it in. It takes me into realms far from palatable — and I don't mean that in a humorous