Guts is the third mid-grade graphic memoir in a trilogy by author/illustrator Raina Telgemeier through which she relates the true story of her childhood. Guts specifically records Raina’s fourth- and fifth-grade years, when she transitioned from nine to 10 years old. During this period, she first experiences gastrointestinal issues, eventually diagnosed as irritable bowel syndrome (IBS). Panic attacks accompany the IBS, and the two conditions exacerbate each other, intensifying her distress. Her narrative chronicles how she tries to cope with these illnesses as a preadolescent while simultaneously encountering bullying and injustice at school and benign chaos in the two-bedroom apartment she shares with her parents, sister, brother, and occasionally her grandmother. The cartoon strips she draws to mitigate her distress become a major part of her adult life, along with anxiety and IBS. In 2020, Guts received two Will Eisner Comic Industry Awards, graphic literature’s highest honors—one for Best Writer/Artist and one for Best Publication for Kids. In September 2019, Guts rose to the top of the New York Times Bestseller List for all books.

Summarized here is the 2019 paperback version of the book published by Graphix.

Summary

Nine-year-old Raina wakes up nauseated in the middle of the night. She rouses her mother, who tells her that a stomach bug is active in the family. Her mom accompanies her to the bathroom, where she vomits. Later that night, she becomes nauseated a second time without throwing up. She notes that the fear of vomiting is quite distressing.

Raina reports that stomach flu is prevalent during the last months of her fourth-grade year. After throwing up on the playground and dropping his pencil in it, one boy experiences taunting from his classmates. Leading the jeers is Michelle, who delights in tormenting other students. Raina, a shy and anxious girl, finds this troubling.

Raina describes the distinct foods each person in her family eats, pointing out that they each might eat a different meal during supper. On one occasion, while eating her mother’s favorite dish—artichokes with mayonnaise—Raina grows nauseated but does not vomit. She goes to bed feeling terrible. When a doctor’s examination reveals no medical cause behind her sickness, Raina returns to school and does poorly on a math quiz. The bad grade causes her stomach to hurt again.

Raina transitions to the fifth grade. Also in her class are her best friend, Jane, and her other friends, Nicole and Dina. Raina feels wary of Michelle, who is also in her class. Her teacher, Mr. Abrams, had been her teacher in the second grade. He tells the class about a year-long program where each student will be asked to lead the class. Frightened at the prospect of speaking in front of her classmates, Raina feels relieved to know she can make her presentation with someone else. She and Jane present to the class about their participation in Girl Scouts. Raina draws on the board as Jane speaks. When it is Raina’s turn to talk about her badges, her stomach churns, and she rushes to the girls’ bathroom. Afterward, Michelle taunts her, and Raina responds by yelling at Michelle. Mr. Abrams criticizes Raina for the outburst, telling her to be nice to Michelle. Michelle quietly continues to taunt her.

When Raina’s brother Will develops an intestinal problem, Raina refuses to stay in the house for fear of contracting his illness. She stays outside until her mother forces her to come inside at bedtime. The following day, Raina will not come into the house when she arrives home from school. She sits on the porch, chewing her fingernails. When her mother sits beside her, Raina apologizes for being a problem. She stays home from school the following day, curled up in bed despite having no physical symptoms. Raina overhears her parents talking about her.

Raina’s mother takes her to a therapist, Lauren, for the first of what will become weekly sessions. When her mother leaves the room and Lauren begins asking her questions, Raina is quite anxious and says she does not think she can respond. Lauren asks her to try. Over several sessions, Lauren helps Raina realize that hearing the word “vomit” causes her to become anxious.

At school, Raina finds it increasingly difficult to behave “normally.” When Jane rushes to the bathroom, Raina fears she may have a contagious disease and quizzes her until Jane snaps back at her. Michelle’s taunting prompts Raina to tell Michelle that she hates her guts. Alone with Mr. Abrams, Raina complains about Michelle, only to have him tell her that perhaps Michelle also has troubles.

After a sleepover at Jane’s house introduces her to kimchi and a bout with intestinal gas, Raina learns that different foods may heighten stomach troubles. Following this, she worries that almost every food may upset her system. Lauren helps her acquire tools to decide what foods she can comfortably eat. The therapist also points out that Raina worries about what others in her family eat, which is beyond her control. These sessions make Raina late for class. Though Jane asks Raina why she is late so often, Raina does not tell her about Lauren for fear Jane will think she is “crazy.”

Raina notices that some girls exhibit unusual behavior, including going to the restroom frequently and speaking secretively to a select group of other girls, of which Raina is not a part. Her mother explains these girls have hit puberty. Raina understands that hormonal changes may be happening to her too. She wonders if this might be the source of her intestinal and emotional conditions.

Raina’s parents curtain off a portion of their bedroom to give her more privacy, so she no longer shares a room with her sister and brother. The biggest problem Raina has with this is her father’s snoring. When she asks to sleep downstairs on the sofa, she learns her grandmother will move in with them for six months before going to a retirement community.

Raina and Jane create comic strips together, with Jane writing the stories and Raina illustrating them. Jane calls Raina in a panic. She explains that her family will be moving from the city to the suburbs, meaning they will not attend middle school together. After Michelle taunts Raina and Jane, Mr. Abrams once again cautions Raina to be kind to Michelle, and when girls on their bus mock her, Raina tells Jane she is lucky to be moving away.

In her next session with Lauren, Raina discusses the mistreatment she receives at school and how that starts the cycle of physical and emotional distress. Lauren teaches her how to ground herself through her feet and calm herself through her breathing. Lauren expresses that most of Raina’s classmates also have problems weighing them down.

Raina becomes distressed when she arrives late to class and sees Jane and Michelle having a friendly conversation. Jane explains to Raina that Michelle seems to have changed. Raina’s despair deepens as she watches the friendship between Jane and Michelle deepen. Raina ends up in bed, unable to go to school. Her mother takes her back to a physician who conducts a thorough examination. The doctor diagnoses Raina with IBS, telling her to watch her diet. She also tells Raina to avoid stress, which causes Raina and her mother to roar with laughter.

Back in school, Jane invites Raina to an end-of-school slumber party. Seeing that Michelle also has an invitation, Raina is reluctant to attend. Jane begs her to come to the party since she will be moving away. In the last counseling session recorded in the narrative, Raina reports on the good things happening in her life and her progress in coping with her fears. Lauren points out that, despite the heartbreak she feels over Jane moving away, Raina now has the tools she needs to cope.

In her last in-class presentation, Raina discusses her bouts of fear and how a body-and-mind cycle perpetuates her anxiety. She has the class stand and leads everyone in a breathing exercise. Raina realizes that, throughout the presentation, she never felt any fear.

Raina and Jane note that Michelle misses school for several days in a row. Mr. Abrams reports to the class that Michelle has had intestinal surgery, is still in the hospital, and will not return for the remainder of the school year. Raina suggests that the class create a giant get-well card out of rolled paper with personal notes of encouragement.

Jane holds her year-end slumber party. As they play a game, Raina tells the group she is in therapy. The other girls tell her they or other close family members are also in therapy. They decide to call Michelle in the hospital. Raina is the last to speak to her. They discover they have a great deal in common. Michelle tells Raina that the breathing exercise helped her control her fear before the surgery.