Coma recounts the initial days of the author’s hospitalization in England in 2013 for streptococcal sepsis with multiorgan failure and necrotizing fasciitis and its complications.¹ Author Zara Slattery combines artistic representations of her delirious, hallucinatory visions with more straightforward storytelling from the perspective of her husband Dan, who diligently journaled as he worried about Zara, cared for their children, and prepared for her possible death.

Fortunately, Zara did not die, and the retelling of her harrowing course gives readers a sense of a drama unfolding in real time, a chapter for each day of her most critical illness. It is a disorienting, frightening, and heart-warming book that is a welcome addition to the growing body of work in graphic medicine.

After an ominously illustrated frontispiece and written panel recounting events in the lead-up to her hospital admission, the book begins as a line-drawing rendering of her husband’s diary. He matter-of-factly recalls Zara’s initial pain, the phone calls to physicians, and their dismissiveness and false reassurance. Soon we enter Zara’s world and are introduced to her multicolor, delirious, strange, and frightening visions suffused with feelings of guilt, shame, and paranoia. Beneath the weight of septicemia and sedation she feels she is to blame for her predicament. The story alternates between Dan and Zara’s recollections, and it’s a wild journey. At first their versions of reality have little in common: 2 parallel experiences depicted in divergent visual styles. But as her infection is vanquished, her levels of sedation ease, and she regains her sensoria, their experiences begin to merge, and at the book’s close, Zara and Dan’s stories come together to feel whole.

Though the book covers a span of just 18 days, the events seem to last forever, and time itself becomes fluid and strange. Readers feel the oddness of ICU time, where a moment can seem like an eternity and a day can elapse in the blink of an eye. Clinicians are typically unaware what patients experience when they are seriously ill and how therapeutic intentions can be misunderstood as malevolent. Zara isn’t the only one whose thoughts are distorted by the ICU; time and place are fundamentally transformed for Dan as well, who is attempting to carry on with his daily responsibilities despite the turmoil. In one memorable scene, Dan is overseeing their son’s backyard birthday party with his mind firmly fixed in the ICU. As the children spin around to play “Pin the Moustache on the Puffle,” the reader is reminded of the vertiginous challenges Zara and her family face, both in the moment and as she recovers. The book closes with artifacts from the experience: reproductions of a diary entry from her ICU nurse that put the book’s events in clinical context; letters from her children that reveal their reactions to her illness; and an afterword with Zara’s astute summary: “Fifteen days in an induced coma. Six weeks in intensive care. Three-and-a-half months in hospital.…What’s not easy to measure are the emotions that followed and the trauma to be worked through.” Coma is part of that process.

A gorgeous, tender, powerful report from worlds seldom represented: delirium, family response to trauma, and care provider witnessing. Assembling multiple voices and powerful imagery, Zara Slattery has created an absolute treasure for patients, families and carers alike.

What an amazing, beautiful and honest book. It is sometimes difficult to read, emotionally, but so worth reading. It leaves the reader in owe of the bravery of the author and her family.

In May 2013, Zara Slattery’s life changed forever. What started as a nagging sore throat developed into a potentially deadly infection called necrotising fascitis. She spent 15 days in a medically induced coma and woke up to find that one of her legs had been amputated. As in Orwell and In, colour is used to differentiate different realms. Monochrome sketches in thick crayon illustrate her husband Dan’s diary of the everyday life that kept going while she was in hospital, yet it’s the coma/fantasy pages in vibrant blues, reds and gold that feel more real.

Slattery remembers, or perhaps imagines, being surrounded by nightmarish skulls and menacing animals. She feels accused and guilty, like she has to justify her continued existence. In one moment she’s a puppet; in another she’s in ancient China, her fate being decided for her. Some of the watery landscapes and specific images here happen to echo those in McPhail’s novel: a splash park, a sunken theatre; a statue on a plinth. There’s also a giant that reminded me a lot of one of the monsters in Spirited Away.

Meanwhile, Dan was holding down the fort, completing domestic tasks and reassuring their three children. Relatives came to stay; neighbours brought food, ran errands, and gave him lifts to the hospital. He addresses the diary directly to Zara as a record of the time she spent away from home and acknowledges that he doesn’t know if she’ll come back to them. A final letter from Zara’s nurse reveals how bad off she was, maybe more so than Dan was aware.

This must have been such a distressing time to revisit. In this interview, Slattery talks about the courage it took to read Dan’s diary even years after the fact. I admired how the book’s contrasting drawing styles recreate her locked-in mental state and her family’s weeks of waiting – both parties in limbo, wondering what will come next.

Brighton, where Slattery is based, is a hotspot of the Graphic Medicine movement spearheaded by Ian Williams (author of The Lady Doctor). Regular readers know how much I love health narratives, and with my keenness for graphic novels this series couldn’t be better suited to my interests.

I recognised so much of my own dream world here – the guilt, the fear – that I could really relate to Zara's experience. But, as she says, it was so intense because of the pain she was suffering. I have never been through an experience like this, but I have been in hospital and once nearly died (acute appendicitis) and recognised the feelings of fantasy in the institution of the hospital, in the process of receiving care.

As a reader, I found the way Zara structured this really satisfying. I could follow the journal simply, with her husband's glum, simple, coping despair detailing each day in a kind of zombie-like state (for want of a more articulate word!) while numbly going through the days. In contrast, Zara is battling demons behaving like a warrior hero in the Matrix (while lying on her hospital bed). The drawings express this journey in a beautiful rhythm which give a sense of comfort with expression that great art gives to those who witness – cathartic. Although one might come to this story, like me, with a kind of gruesome titillation, eager to salaciously look at the vulnerability of our own bodies, taking a ride on this story that happened to Zara, it’s a journey of the mind. And a tremendous yet ordinary love story. I think it's a really beautiful thing.  Well done for making it through, Zara and Dan.

COMA is an amazing book – I loved reading it. What a story. Another brilliant Myriad volume to inspire us all.

Storytelling is a strange art. Finding the hook that draws in the reader comes in many different forms. And it certainly helps if that hook is an original one. I wasn’t anticipating the story in Coma – I thought it would exclusively be a trippy, Gaimenesque journey through a fantastical world serving as an allegory. There are aspects of this, but the driving force is something different entirely.

Coma is based on the real-life experience of the author. Starting with a sore throat, her health deteriorates until she’s barely able to stand. Doctors at the hospital are initially baffled until, eventually, a deadly bacterial infection is diagnosed. Drastic surgery, intensive care, and a coma follow. She’s barely recognisable as the person she was just days before due to the swelling. It can’t get more serious. 

Throughout Zara’s coma, her mind attempts to rationalise her experience. In her delirium she is confronted by many oddities and confusing scenarios, and this bizarre journey is documented throughout the book. Fascinating as it is to experience her frenzied inner battles, it’s the other story that takes a firm hold of your heart. For in the outside world Zara has a husband and three children. A father, wider family, and friends. And it’s through their eyes that we really get to understand the trauma of the situation.

The intensive care staff encourage Dan, Zara’s husband, to keep a diary. This is for Zara’s benefit, so she can make sense of the days she will lose to the coma. And it’s largely (but not exclusively) this diary that Zara uses later to construct the narrative of the book. Dan’s faith in the NHS, and his initial optimism, wrong-foot him entirely, and by the time the full seriousness of the illness is revealed he becomes increasingly lost in helplessness. Surrounded by routine, necessity, and the kindness of family and strangers he wants for nothing in the care and provision of the children, not to mention emotional support. But, when all’s said and done, there’s simply nothing he can do that can make a difference to his wife’s sickness. That’s a battle she must fight alone.

Because it’s a diary, it’s honest, it’s immediate, and it’s raw. Some things the family does, like shopping trips, enjoying fish and chips, and a birthday party, all feel incongruous. Almost an act of unfaithfulness when a wife and mother fights for her life across town. But what else should they do, and the diary helps to underscore that Zara is far from forgotten or ignored. The distractions are, of course, essential.

I took this book to bed with me to read. It’s quite thick, so I figured two evenings would do it. I read it in one, unable to step away from the heart-wrenching experience.

The following morning my mind keeps churning over aspects of the story. The fragile nature of our health, the brilliance of our NHS, the kindness of neighbours, and the importance of family. It’s a book that shows us what’s really important. Genuinely moving and extremely thought-provoking, Coma is a book everyone should spend some time with.

And if you liked that: Pick up Biscuits (assorted)

Your book is just incredible.  Your illustrations really highlight what you went through in a way that the written word wouldn't be able to do.

[There are] stunning illustrations detailing Zara's time in her 15-day coma, I love the insights into domestic life, and the letters from her children, and the really moving letter from the intensive care nurse who looked after her. It’s a stunning book.

Zara Slattery fell ill and slipped into a coma. During this time her husband was encouraged to keep a diary. In this extraordinary debut graphic novel Zara splits the narrative between her husband coping at home, alongside the nightmare visions she was experiencing while the doctors fought to keep her alive. A beautifully illustrated and moving portrait of love and fortitude.

I couldn’t put it down. This is truly terrific, and terrifying. There isn’t really anything else like it. The artwork is stunning. The structure is spot-on, without unnecessary exposition and it begins and ends at just the right points. It is a hallucinatory masterpiece which tells a tale of tenderness and family love, an example of what can happen when something truly horrific happens to someone already very talented and skilled at making images – an incredible work of art, and so important. I hope ICU workers read it – the staff come over well, and the idea of writing a diary for the patient is lovely. Having worked in ICU, I think it is so easy to forget that the inanimate body on the bed may be still have a very active brain.

A coma story, a love story, and the best case I’ve seen for diary writing.  A story of medical misfortune set against the background of everyday life. You find yourself living alongside a family and within a community you recognise, you watch them coping and carrying on. At the same time you hover over their beloved Zara’s bed, drawn into her terrible imaginings, fearful for how she will emerge from this life-changing experience, but grateful for every time someone reports ‘you are still alive’. Prepare to be moved. I certainly was.

What a fantastic book. The interweaving of Zara’s delirium memory alongside her husband’s diary offers insight into the world of the ICU patient and their family. It opens the eyes of both junior and senior healthcare professionals to the realities of patient and family experience, the acute distress, trauma, and confusion. The medium of a graphic novel means the book potentially provides a space for catharsis for former ICU patients, as the pictures of Zara’s journey depict the what patients often struggle to put into words. Relatives may find comfort in the familiarity of the husband’s story, told through diary entries.

A stunning piece of work. In this extraordinary debut graphic novel Zara splits the narrative between her husband coping at home, alongside the nightmare visions she was experiencing while the doctors fought to keep her alive. A beautifully illustrated and moving portrait of love and fortitude.