As the author of a medical memoir myself (mine is vicarious, about Type 1 diabetes, which affects my husband and daughter), I was eager to read this account of a young man growing up with congenital heart disease and to find out how he coped.
Those who do not have to live with an incurable and potentially life-threatening illness, day in day out, from an early age, may not realise what an enormous burden it is, and Mannella's book is a compelling, lyrical and highly readable account of feeling forever on a knife-edge.
A Lesson in Denial
That he had chosen the semi-flippant title, The Zipper Club, made me think at first glance that this was going to be a jovial, upbeat, accepting account, but far from it. Instead it is an autobiography of denial, almost to the end.
Denial is a frequent characteristic of the seriously ill, and for most of his young life, Mannella is a master of it. Wrenched at the tender age of five from childhood innocence and security by the need for urgent open-heart surgery, Mannella's coping strategy for his condition is to pretend it doesn't exist.
Ignoring the Warnings
But he goes even further, trying to pretend he's almost super-human. Not only does he go through the usual teenage boy "I'm going to live forever so it's cool to drink as much alcohol as I like" phase, he pushes his body to limits that would test the healthiest of hearts. He trains himself up to high athletic standards, lifts heavy weights when his doctor's ordered him not to lift anything, and takes on manual labouring jobs that turn his replacement valve into a ticking time-bomb.
Unforgiving of Himself
People writing a medical memoir could be expected to include at least a little self-pity, but with Mannella it's quite the opposite - he is completely unforgiving of himself, not least because of a boyhood tragedy that sees his best friend killed in a freak accident. He continues to grieve for him, and it came as no surprise to me that when he chooses a sporting hero to emulate, he bears the same name as his lost friend. He even states that this hero, tennis player Pete Sampras, whom he completely idolises, is referred to in his household simply as "Pete", just as his late friend was.
A Dual Bereavement
I'm no psychologist, but I wondered how much his self-abuse through physical strain and alcoholic binges were as much to do with the loss of his friend as the loss of his health. For much of the book I just wanted to reach out to hug him and tell him to let himself off the hook, and to allow himself to grieve for both of these - because losing your health is just like a bereavement.
I hope it doesn't count as a plot spoiler to say that his writing the book is emblematic of his eventually coming to terms with his condition and learning to control his health, rather than letting it control him - a far less stressful and obviously much safer way to live.
Of course, we know all the way through that he is going to live through the medical emergencies and surgeries that he describes with both clinical and emotional precision, otherwise he'd not have been able to write about them afterwards. But I was still tense, rooting for him, hoping for the best possible outcome - that he would curb his self-destructive impulses.
Lyrical and Memorable Writing
While Mannella conveys the medical side of his experience very exactly, he also writes with great lyricism about the rest of his life - about the many rites of passage he goes through as a young boy and young man, playing school sport and pursuing adventures in the neighbouring wilderness and at music festivals, bewildering in a different way.
While for so long reluctant to show the world his scars - the "zippers" down his chest from the title - and to reveal the emotional turmoil he is living through, in this book he makes up for lost time, spilling out passionately and compassionately all the experiences, friendships and relationships that have empowered him along the way, turning him into an insightful and articulate author with incisive self-knowledge. He also demonstrates the compassion to want to share his story, to thank those who have shared his journey, and to help others in similar circumstances deal better than he did himself. Ultimately it is a life-enhancing story in every sense.
I am sure I'll be recommending this brave, memorable and moving read to others for a long time to come.