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A Memoir


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About The Book

* A People Best Book of the Year * Time and The Washington Post’s Most Anticipated List * Longlisted for the Andrew Carnegie Medal for Excellence *

From the MacArthur genius, two-time Pulitzer Prize finalist, and playwright, this “captivating, insightful memoir” (Kirkus Reviews, starred review) is “a beautiful meditation on identity and how we see ourselves” (Real Simple).

With a play opening on Broadway, and every reason to smile, Sarah Ruhl has just survived a high-risk pregnancy when she discovers the left side of her face is completely paralyzed. She is assured that 90 percent of Bell’s palsy patients experience a full recovery—like Ruhl’s own mother. But Sarah is in the unlucky ten percent. And for a woman, wife, mother, and artist working in theater, the paralysis and the disconnect between the interior and exterior brings significant and specific challenges. So Ruhl begins an intense decade-long search for a cure while simultaneously grappling with the reality of her new face—one that, while recognizably her own—is incapable of accurately communicating feelings or intentions.

In a series of piercing, profound, and lucid meditations, Ruhl chronicles her journey as a patient, wife, mother, and artist. She explores the struggle of a body yearning to match its inner landscape, the pain of postpartum depression, the story of a marriage, being a playwright and working mom to three small children, and the desire for a resilient spiritual life in the face of illness.

An intimate and “stunning” (Publishers Weekly, starred review) examination of loss and reconciliation, “Ruhl reminds us that a smile is not just a smile but a vital form of communication, of bonding, of what makes us human” (The Washington Post). Brimming with insight, humility, and levity, Smile is a triumph by one of America’s leading playwrights.


Chapter 1: Twins CHAPTER 1 Twins
Ten years ago, my smile walked off my face, and wandered out in the world. This is the story of my asking it to come back. This is a story of how I learned to make my way when my body stopped obeying my heart.

But this story begins with hope—the very particular hope of a birth to come. I was lying down in a dressing gown, cold gel on my belly, waiting as the lab technician looked for a heartbeat. I already had a three-year-old girl, and was expecting my second child. I was also expecting to have a play I’d written to be performed on Broadway in five months, and was slightly nervous about the potential collision of two kinds of abundance.

Suddenly the lab technician pointed to the screen and said, “Do you know what that is?”

“No,” I said.

I flashed on the ultrasound I’d had before miscarrying my second pregnancy, when the obstetrician had said the fetus looked not quite right and probably wouldn’t last. “Don’t, like, go out and get drunk, though,” she had said in a tone not quite teasing, “just in case it’s viable.”

“Uh, not to worry,” I had said, wondering what gave her the impression that I would go out and get wasted that weekend.

So this time, I feared the worst as I lay there, nervous, while the lab technician squinted at a screen I could not see. “Look!” she said, pointing. There was movement, a heart beating, it seemed to me. A heartbeat, that’s good, I thought, but what was wrong? Why was her brow furrowed? Was she alarmed, or, wait, was she pleased? “Did you use fertility treatments?” she asked.

“No,” I said.

“Well,” she said, “you have twins!”

“Oh!” I said.

“Do twins run in your family?”

“No,” I said. My mind raced to keep up with my body.

“You can go to the waiting room,” she said. “I’ll give you a list of new providers. We can no longer be your ob-gyn because your pregnancy is now considered high-risk.”

This was a great deal to absorb—that I had two babies inside me and was also now considered high-risk, so much so that they wanted to get me out of their SoHo office as soon as possible before I got preeclampsia and sued them.

I got dressed. I happened to be alone for this appointment; I had planned to meet my husband afterwards for lunch, where we would celebrate if there was a heartbeat, or commiserate if there was not. Now I was sorry I’d come alone. I wanted to tell my husband, Tony, the news immediately, but it also seemed strange to reveal such big tidings over the phone.

So I texted him: “Meet me at Gramercy Tavern instead of at Rice.”

“Twins?” he texted back.

Gramercy Tavern was closed for lunch. Tony and I went to Rice, as planned. We were both in shock; Tony, on top of the shock, evinced buoyancy, elation. Coming from a family of three siblings, he’d always wanted three. Being from a family of two, I’d settled on two. I’d even, at one point, settled on one, when I read in an Alice Walker essay that women writers should only have one child if they hoped to remain writers. “With one child you can move,” wrote Walker. “With more than one you’re a sitting duck.”

At lunch, Tony and I talked about how my miscarried child had wandered back, not to be excluded from this birth. We talked about how we would manage with three. I told Tony my fears: that my body could not contain this much abundance and that I’d never write again. He said he had faith in my body and mind.

At the end of the meal, I got a fortune cookie. I cracked it open. It read: “Deliver what is inside you, and it will save your life.”

Everyone seemed jubilant about the news, but I was overwhelmed. I found myself feeling vaguely sick when thumbing through books about multiples in the pregnancy section of the bookstore. There were pictures of breastfeeding triplets, and I didn’t want to know about all that. It struck me as grotesque, as though I had once been a woman but was now hurtling towards becoming full mammal, all breasts and logistics. I worried that I wouldn’t be able to give enough attention to my three-year-old, Anna. I feared that my body wouldn’t tolerate two babies; I feared that my writing wouldn’t survive three children.

I called my mother with the news. I gave off a scent of “How can this have happened?”

My mother paused, then said, “Well, your great-aunt Laura had twins.”

“Why didn’t I know?”

“They were stillborn,” she said.

Twins run on the mother’s side, skipping a generation. Poor great-aunt Laura, whose heartbreak I never knew. Somewhere in Iowa in the 1950s she buried two babies on the prairie and never spoke of it. I imagined their graves on some grassy plain. I wondered whether Laura gave them names; Laura was dead so I couldn’t ask her. The ghosts of my great-aunt Laura’s babies would haunt me for the rest of the pregnancy.

When I told friends I was having twins, I was as apt to cry as to laugh. My dear friend Kathleen, a playwright, from a large Irish Catholic family, comforted me, saying, “I love big families. Small families are so boring in comparison.” Kathleen had already raised two daughters, and had shown me all the ropes, talking me through potty training and tantrums. Her most comforting phrase was, “I’m sure it’s just a stage.” At this seismic news she said quite simply, “I’ll help you.” And I knew she would.

Three months pregnant and terrified, I visited my former playwriting teacher Paula Vogel and her wife, Anne Fausto Sterling, an eminent feminist biologist, on Cape Cod. They said, come, we’ll grill fish, we’ll take care of you. Paula is the reason I write plays. She has the ferocity of a general in battle, the joy and humor of a street performer, and the tenderness of a mother. That week, she entertained Anna with tissues she made into a puppet. Anna laughed with joy. I was quiet. Paula observed me. “What’s wrong?” she asked. She gave me her conjuring, summoning look.

“Will I ever write again?” I asked her.

“Yes, you will,” she promised. I looked out at the ocean. This was the same view Paula had shown me years ago, when she’d invited her graduate students out to her Cape Cod home, entreated us to look out the window, and say to ourselves a mantra—This is what playwriting can buy.

My first Broadway play was supposed to go into rehearsal that fall; I was not only pregnant, I was extra pregnant. What luck, what abundance. All this bounty, why am I not happy? I thought.

And my mind went back to the fortune cookie: “Deliver what is inside you, and it will save your life.”

Did it mean that my life was imperiled, and if I didn’t deliver the babies speedily, the pregnancy itself would kill me?

Or did it mean something more metaphysical?

All through the pregnancy I thought, How could my children possibly save my life?

It would take me a decade to find out.

About The Author

Photograph by Gregory Costanzo

Sarah Ruhl is a playwright, essayist, and poet. Her fifteen plays include In the Next Room (or the Vibrator Play), The Clean House, and Eurydice. She has been a two-time Pulitzer Prize finalist, a Tony Award nominee, and the recipient of the MacArthur “genius” Fellowship. Her plays have been produced on- and off-Broadway, around the country, internationally, and have been translated into many languages. Her book 100 Essays I Don’t Have Time to Write was a New York Times Notable Book. Her other books include Letters from Max, with Max Ritvo, and 44 Poems for You. She has received the Steinberg Playwright Award, the Samuel French Award, the Feminist Press Under 40 Award, the National Theater Conference Person of the Year Award, the Susan Smith Blackburn Prize, a Whiting Award, a Lily Award, and a PEN/Laura Pels International Foundation for Theater Award for mid-career playwrights. She teaches at the Yale School of Drama, and she lives in Brooklyn with her husband, Tony Charuvastra, who is a child psychiatrist, and their three children. You can read more about her work at

Product Details

  • Publisher: S&S/Marysue Rucci Books (September 27, 2022)
  • Length: 272 pages
  • ISBN13: 9781982150952

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Raves and Reviews

“Easily one of the best things I’ve read this year… Not unlike her stage work, thoughts, moods and ideas skip through so seamlessly, you pause momentarily, not out of confusion but to look up, surprised at your destination. If you require a memoir to provide a lesson, it’s this: Stop trying to read a person’s face.” CHICAGO TRIBUNE

"A beautiful meditation on identity and how we see ourselves.” REAL SIMPLE

"In this stunning work, two-time Pulitzer Prize-winning playwright Ruhl reflects on her long and arduous battle with Bell’s palsy after giving birth to twins....As she recounts learning to find joy in small things—such as regaining the ability to blink—Ruhl proves that even life at its most mundane can be fascinating. This incredibly inspiring story offers hope where it’s least expected." PUBLISHERS WEEKLY (starred review)

“Wise, intimate, and moving…. A captivating, insightful memoir.” —KIRKUS REVIEWS (starred review)

"Smile is at once an illness narrative, a meditation on smiling as cultural practice and symbol, and a compelling, behind-the-scenes look at the life of a playwright and mother." —SHELF AWARENESS

"With a poet’s sharp eye for detail and a playwright’s grasp of both the tragic and the absurd, Sarah Ruhl has written a remarkable book. Smile is at once a gripping story and a profound exploration of the mysteries of illness. I know of nothing like it." —JAMES SHAPIRO, author of Shakespeare in a Divided America

"I’m now accustomed to Sarah’s whipping out profound and necessary books that I can’t put down even when I smell dinner burning, but I guess I wasn’t prepared for her book about Bell’s Palsy to provide some of the most deeply romantic passages about married love I have ever read. I smiled, for sure, but I also swooned and ached and was left with goose-flesh more than once. I adore this book."
—MARY LOUISE PARKER, New York Times bestselling author of Dear Mr. You

“Sarah Ruhl's ravishing memoir, Smile, is that rare and gorgeous melding of gemlike, literary insights, raw honesty, heart break and radiant wisdom. It took my breath away. For real.” —V (formerly Eve Ensler), New York Times bestselling author of I Am an Emotional Creature, The Vagina Monologues and The Apology

“I bet everyone reading this has had difficulty expressing an internal reality. Now imagine an affliction that separates the two physically. With poignancy and power, Smile helps us all to find ways of expressing our internal truth. It helped me to both learn and grow." —GLORIA STEINEM, author of My Life on the Road

Smile is staggeringly great. The idea of the tragic versus the disappointing would have frightened most writers into silence. But the truth is that the disappointing is often the high point of human agony. All of us have disappointments that we try to keep secret because we’re ashamed and want to be above them. We are not above them. And Smile speaks to this predicament with extreme insight.” —BETH HENLEY, Pulitzer Prize winning author of Crimes of the Heart

Awards and Honors

  • Carnegie Medal Honor Book

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