You need to be either sadist or masochist to endure this work without too much damage. At least 600 of the 720 pages of the book are intense descriptions of intricate sufferings. But I can tell you that you'll never look at your relationship with your significant other the same way ever again as she delves during the whole book on the relationship between the sufferer (Jude) and his friend/lover Willem. Yanagihara in her pursuit of pain is merciless and follows each ramifications to it's bitter end. A life changing work for me.