"Everyone who is born," Susan Sontag once wrote, "holds dual citizenship, in the kingdom of the well and in the kingdom of the sick." Sarah Lippett has spent far too long in the latter.

As her new graphic novel A Puff Of Smoke, outlines, Lippett first went there in the early 1990s when she was just a girl. The years that followed were full of headaches, loss of control over her limbs, stays in isolation wards, tests, tests and more tests, drugs, drugs and more drugs, more than one diagnosis and finally surgery.

And all the while she was fighting with her family, growing up, going out, meeting boys, listening to bands. (The Smiths and Mansun both get a namecheck. Boyband NYSNC too, though in their case not approvingly.)

A Puff Of Smoke – all scratchy lines and splashy yet controlled colour – is a journey from innocence to experience, and from hospital ward to hospital ward. It also charts how illness spreads its tentacles into the patient's relationships with friends and family.

One more thing. It's very funny.

Here, Sarah Lippett talks about the challenges of laying down her life story on paper, the use of graphic novels in medical environments and what songs she wants played at her funeral:


When did you decide you wanted to tell the story of your illness?

After my surgery, I started studying Illustration at the University at Brighton and my experience was still very vivid. Of course, leaving home is a very unstable time for anyone –- you are readjusting to your new life. I definitely struggled in those first couple of years of trying to figure out my identity, particularly because of what had happened for all those years before. It felt too early to unearth those memories then.

When I began developing my career as an illustrator, I had moments where I wondered if it was the time to do it, but I still didn't feel ready. It wasn't until I was studying at the Royal College of Art where I considered it as my major second year project and sat down with my tutor Debbie Cook, who has been instrumental in the making of A Puff of Smoke, as well as my first graphic novel (Stan and Nan) that I made during my time there, that I thought about coming back to it. She said that the RCA was not the time to do it as it was going to take too much of me. I didn't understand at the time and thought she was dismissing the project… But, actually, she was right.

After finishing my Masters and when I wrote the other half of Stan and Nan in 2015, I thought back to it again and finally decided it was time. I was in the most stable place I had ever been in my whole life both career-wise and in my personal life. I was ready to sort of "break" myself – which is what it took.

What was it about your experiences that you wanted to get across?

I wanted to make something that would resonate with young people living through similar experiences – the isolation, the mystery, the unknown, as well as the individual relatable effects on the body and the mind and how it impacts every aspect of your life.

I also wanted medics, doctors and medical practitioners to learn from it – I want it to be a reminder to keep looking for a cause at the same time as treating the symptoms, to ask for a second opinion sooner, to listen to the patient and to ensure they're treating them in the appropriate way dependent on their age.

I wanted the book to help people to understand illness and disability better and to not be afraid of it – to talk to the person in the wheelchair, not just the person pushing it. But, ultimately, I wanted it to be a resource for young people and adults living with chronic illness – be it common or rare. We all face similar challenges and experiences no matter the disease or condition and it is my hope that A Puff Of Smoke can help patients and their families get through.

I have already seen the positive impact the book is having on both people living with rare diseases (one in 17 people in the UK live with a rare disease) and the medical community. I was fortunate to be awarded a substantial Arts Council England grant whilst I was making the book. Public engagement is a huge part of the grant and so I spent a lot of time speaking at medical conferences and hospitals across the UK about my experience. Images from the book are now being used at Leuven University in Belgium to teach pharmaceutical students the importance of the pharmacist's role in relation to orphan drugs. I am continuing to speak at events and continue to work closely with the brilliant charity Medics 4 Rare Diseases to discuss many of the issues around rare disease patient care/diagnosis that require improvement.


Memoirs are inevitably revealing. Was it difficult to expose your own story in this way? (And how did the rest of the family feel about it?)

At times it was very painful for me to return to the memories of my past and depict them in the detail that I have in A Puff Of Smoke. But it never felt difficult to expose the story … I felt the need and the reason to make it was too important for those concerns. I had to tell my story with complete raw honesty – how else could it resonate and reach the people I was making it for?

My family have been incredibly supportive. There have been no "Knausgaard" style dramas. I gave them all copies of the original script before I signed my contract with Jonathan Cape to ensure they were all happy with it. There are parts I suppose that we share as "our stories" and parts that are solely mine of which perhaps the family didn't know at the time. I was often quietly coping with certain aspects of growing up with the additional burden of illness and so they may have been surprised upon reading.

Is the act of drawing your past distancing? Or does it feel very intimate?

It did feel very intimate. I spent a lot of time during the early stages collecting reference material to work from. I went back to both my schools, my hometown and my hospitals to take photographs, I went through an archive of hospital letters, family photos and memorabilia that my parents had kept and I interviewed doctors who had treated me and spoke with old friends. I took myself back to that place and so in drawing it all I really stepped back through those years.

I remember drawing and colouring the last few pages in the autumn of 2018, the scene of the night before my surgery at Great Ormond Street … I sat there sobbing at my desk, completely overcome with nostalgia and grief. Perhaps I was mourning a partially lost childhood and youth? Perhaps I was feeling empathy for my old self? The whole experience? I'm not sure.

Through all those days going back and forth to doctors and hospitals were you always drawing? Was it an escape?

Yes! Even on the morning of my surgery at Great Ormond Street. I remember handing over a drawing to one of the nurses and thinking that could be my last. I would sketch detailed imagined scenes of alternate realities and copy panels from my Calvin and Hobbes comics. Drawing gave me an identity that wasn't just the illness. I could take myself away (and still do), absorbed in creating.

What have you got against NSYNC anyway?

I don't have anything against them other than their songs … I was a teenager who had become an absolute music snob way too early due to my older brother's influence. He had been playing me the most weird and the most wonderful from very early on, so when most girls my age were into boy-bands, I was listening to stuff like The Cure, The Pixies, Syd Barrett, Alien Sex Fiend, The Clash and The Damned.

Note – I've actually created a playlist for readers to listen to whilst they read A Puff Of Smoke. It lasts about the length it takes to read the book and covers the music my Dad and brother played me in my early years(Steely Dan, Rolling Stones, The Cure, Siouxsie and the Banshees etc)through to what I discovered as a teenager through to my operation(Grandaddy, Mansun, At The Drive In, Pulp, Pavement etc).

What is currently on your list of "songs to play at my funeral"?

That's really hard. I think I'd still have The Pixies' Where Is My Mind? on there, but I think I'd have to scrap the original list. I'd now want a mixture of moving, nostalgic, danceable and silly … Stuff like this:

Smog – Cold Blooded Old Times

Rolling Stones – Gimme Shelter

Jonathan Richman – She Doesn't Laugh At My Jokes

The Cure – All The Cats Are Grey

The Breeders – Divine Hammer

Dinosaur Jr – Little Fury Things

New Order – Age Of Consent

Low – Lion/Lamb

Phillip Glass – The Poet Acts

Ivor Cutler – Pickle Your Knees

What do comics allow you to do that other art forms can't?

I always find this tough to put into words … Basically, I could not have told my story any other way! Comics have provided me with a visual language that no other art form can. When words can't explain a moment or an emotion within a narrative, comics are able to show it and as the reader we feel it. There were so many moments when I was making A Puff Of Smoke where I had written paragraphs of descriptions or my inner thoughts that I took out, as once the images came together I felt I could trust the reader to fill in the gaps, to spend time with the visuals and understand the message and experience within the frames. It's just such a brilliant, under-acknowledged form, isn't it?

A Puff Of Smoke, by Sarah Lippett, is published by Jonathan Cape, £18.99