Sarah Lippett's graphic novel A Puff of Smoke is a heartbreaking journey through illness

“I have wanted to tell the story of my long diagnosis process for many years,” says illustrator Sarah Lippett about her new book A Puff of Smoke, which chronicles her experiences of being diagnosed with Moyamoya when still a small child. The rare condition narrows the blood vessels that supply the brain, putting patients at risk of stroke. In response, the brain grows new blood vessels, which on x-ray look like whispy trails – the disease’s name, moyamoya, means “puff of smoke” in Japanese.

“It was a very isolating and lonely experience for me,” Sarah tells It’s Nice That about those initial years. “I kept thinking about how when I was a little kid, reading something so visual and accessible as a graphic novel would have been both helpful and hopeful.” In the novel, we follow Sarah from her first symptoms (crippling headaches and dragging her leg), through endless medical appointments where practitioners struggle to find a cause, a misdiagnosis, brain scans, scary and confusing drugs and finally, an operation. “I wrote the book for kids like me. I wrote it for all the kids, young people and adults living with chronic illness to give them hope and to remind them that they’re not alone.”

Sarah is no stranger to autobiographical works. Her 2015 graphic novel Stan and Nan was an emotional tribute to her maternal grandparents, made just after her nan passed away. When working on autobiographical non-fiction, Sarah is keen to make her stories as authentic as possible, which has meant extensive research periods involving interviewing her friends and family, visiting locations like her old school and wading through old photos and medical records.

“I was incredibly lucky that I was able to use an extensive archive of visual references, which I hadn’t been able to do for Stan and Nan as my Grandad had left hardly anything and there wasn’t very much of Nan, either.” But despite this advantage, writing A Puff of Smoke was far more painful than the process of putting together her previous graphic novel. “Stan and Nan was difficult in parts to make as I had so recently lost my Nan,” she says. But for A Puff Of Smoke, I was revisiting 11 years of my life, so many memories that I had pushed down and buried…and so exploring those years, breaking them down and piecing them back together for the graphic memoir was at times devastatingly difficult.”

What buoyed her during this period was her experiences speaking at medical conferences and hospitals across the country while writing the book. Showing medical practitioners, patients and carers her work-in-progress sketches and later finished pages helped her keep up the momentum. “Knowing it was resonating with the medical community and patients was – and continues to be – essential.”

Working in a “loose and expressive” style, which she finds the best way to express the emotive and sensitive themes, Sarah was keen that the narrative “wasn’t all darkness and tears – because that’s not what it was like,” she says. “My childhood and teenage years were also full of love and laughter. My parents and four siblings were a huge part of that. I really wanted that to come across through the narrative journey to my diagnosis – so there is a lot of humour, a lot of funny moments as well as the sadness and pain.”

The colour palette was inspired by the shell suit Sarah’s Dad wore in the early 90s – navy, turquoise and hot pink, with additional colours that worked with the base colours. “The palette needed to be bright to hold the attention of readers through the narrative and through the darker moments,” she explains. “I also wanted the colours to also reflect the era – which again, I feel they do well.” Sarah worked with illustrator and font designer John Martz to design a typeface for the book, which has also been used for an accompanying comic, wall text and guide.

In terms of what Sarah would like people to take from the book, she hopes it will encourage doctors to look for causes at the same time as treating the symptoms, ask for a second opinion sooner and to listen to patients regardless of age. She also wants 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” – and that invisible illnesses are real and that they are lifelong. “But, ultimately, I want it to be a resource for young people and adults living with chronic illness – be it common or rare,” she says. “We all face similar challenges and experiences no matter what the disease and it is my hope that A Puff Of Smoke can help patients and their families get through.”