Photo by Øystein Horgmo © All rights reserved.

A nurse talked to the family outside the room while I photographed the little girl they had just lost.

In black and white.

The teddy bear she had her arm around wore a t-shirt with a picture of her.

She had hair in that color picture.

Photo by Øystein Horgmo © All rights reserved.

Today, one week after the tragedies in Oslo and at Utøya, we went to the city center to lay down roses in front of Oslo cathedral in memory of those who died.

We were abroad when terror struck, and the city we left was not the same we returned to. But it was not a deserted, frightened place. It was full of flowers and people in silent contemplation.

Please consider signing the official book of condolence.

"Intensive Care". Painting by Joseph Dwaihy and Sara Dykstra.

An unusual request from the intensive care unit. Could I take some last photos of a patient before they switched off his life support?

I don’t know if it was the family’s or the nurse’s idea. I guess it was the nurse, finding a practical “ritual” to make it easier for them to say good-bye. Which would be especially hard in this case I realized, after climbing the stairs and entering the ICU. The patient was a young man in his twenties who had suffered a massive stroke while taking a shower one morning. His son, who ran up and down the corridor outside the room, could not have been more than 18 months old.

Lost for words, I tried to focus on the task, but it’s hard to think about light and shadow when what you see through the lens is a young wife kissing her unconscious husband, a mother running her fingers through her son’s hair for the last time. They wanted a photo of the boy hugging his father, but he didn’t want to. As they stopped trying and moved away from the bed, he suddenly reached over and hugged him. ”Daddy, ouch, ouch,” he said. The boy will not remember his father, but he will have a photo of that hug. Perhaps it can be helpful later in life.

When I went to the ICU the next day to deliver the photos, the family were gone. They had said good-bye the night before.

Photo by Øystein Horgmo © All rights reserved.

A hospital stay can be an adventure and it can be a nightmare. This is the story of two kids from the skin ward I photographed the other day.

I was first called down to the ward to take some photos. I knew nothing about the patient, just that it was a child. Walking towards the room I saw two nurses waiting outside, both wearing a kind of red jacket I’d never seen used before. At first I assumed the patient was contagious, although the protective garments in those cases are usually yellow. “You better put on one of these,” one of the nurses said and handed me one of the jackets. “This girl has developed a serious aversion against white hospital uniforms”. I put on the jacket and entered. What kind of reaction could I expect?

It’s quite common that kids are nervous when they come to the studio to be photographed or we arrive at the ward. Many of them are used to being prodded with instruments and pricked with needles and that’s what they expect when they meet another white-clad person. Knowing this, I take some time explaining what we’re gonna do, showing the kid my camera, how the flashes work etc. Taking a shot of one of the parents and then show it to the kid on the LCD is a good trick. When they realize it’s just regular photos they usually relax and the shoot goes smoothly. I’ve had kids who started out hiding under the waiting room couch ending up as the most cooperative subjects just by acknowledging that they’re afraid and talking them through it. Not so with this girl.

She was four years old and had epidermolysis bullosa (EB), which means she’s probably been a frequent visitor to the hospital ever since she was born. I seldom forget a face, and I knew I had photographed her about six months earlier. That didn’t go too well. This time however, I was prepared and wearing one of those red jackets. I was accompanied by one doctor and two nurses, in addition to the a nurse already in the room. As I thought “maybe the red jackets will calm her, but this crowd certainly won’t,” she started screaming.

I have two little girls myself and I photograph kids all the time so I’m quite used to crying, but this one was screaming in panic. Cries that pierced my heart. I was there to get the shots, but all I wanted was to comfort her. Her parents were apparently used to her reacting like this, but I was not prepared for it. Behind my large camera and in my too big, pyjamas-like red jacket I tried to finish the shoot quickly, muttering futile comforting words as I moved around. When I had gotten all the shots I needed except her face, she suddenly relaxed, like she realized I was actually not pricking her with a needle. I took the photo and said: “That’s all. You are a very brave girl.”

On my way out she started screaming again. The other people with red jackets were not just taking photos.

Later that day a 3-year-old girl was sent up to the studio. She had atopic dermatitis and this was her first visit to the hospital. She approached our counter clutching two teddy bears from our waiting room, looking a bit uncertain. I asked her if she wanted to bring her new-found furry friends into the studio, and she nodded. “All right,” I told her mom. “Just wait around the corner a few seconds while I prepare the studio.”

Crossing my fingers for this shoot to be a smooth one I opened the studio door just to see the mother racing after her toddler down the corridor. “Is it OK if we come back in 15 minutes?,” she shouted. “She heard some music and off she was. Everything’s so exciting here.”‘

Photo by Øystein Horgmo © All rights reserved.

"Green scrubs only". Photo by Øystein Horgmo © All rights reserved.

A man was sitting on a bench outside the hospital, chatting with a friend in the warm summer sun. He was wearing green scrubs, green shoes, surgical cap and a mask around his neck.

Although it’s explicitly stated in the hospital’s infection prevention guidelines that it’s forbidden to wear green scrubs outside the operating ward, it’s a common sight in the cafeteria, outpatient clinics and hallways. Even outside in the sun. Why?

Ten years ago Rikshospitalet (The National Hospital) moved from its old buildings downtown, some dating back 200 years, to brand new facilities on the outskirts of Oslo. Everybody was excited to get to work in what would be the country’s most modern hospital. The operating rooms would be fitted with new technology, like  laminar airflow ventilation.

Before the hospital moved, my colleagues tell me, no violation of the scrub guidelines was tolerated. Nobody would enter the cafeteria in green scrubs. OR nurses would be highly suspicious of anyone entering the ward that didn’t have their daily work there and treat them as infection hazards. Annoying if you were a photographer, but very efficient. “Did you disinfect your hands? What about your camera?”. No one asks questions like that today. Did strict attention to detail yield to technology? Back then they knew the facilities were old and they had to be pedantic to prevent infection. Did the laminar airflow make everyone relax? It can certainly seem so. And yet the infection rates has not decreased since the hospital moved.

Every year the department of hospital hygiene have campaigns to make personnel take off their watches and rings when treating patients. Maybe we need a campaign to make people change into white scrubs when leaving the OR ward too – “White scrubs only.”

Dirt roads in the Nordmarka forest outside Oslo. Photo by Olav Engen.

On Saturday I ran my first marathon. I’ve run a couple of half marathons before, but now was the time to go full length.

A note to my readers: This post is clearly off-topic for this blog, but hey, who wouldn’t write about an experience like this?

I had signed up for the Nordmarka Forest Marathon in Oslo. The entire course of this marathon is in the Nordmarka Forest to the north of Oslo. Most of it on even dirt roads with a short portion following a narrow path.

The elevation profile is quite tough, with a total climb of over 1400 meters. I live close to another Oslo forest, Østmarka, and I’m used to running hilly courses, so I thought this would suite me well. It would of course also be an extra challenge – the mileage plus the climb.

Nordmarka Forest Marathon Course Elevation.

I had the opportunity to run with friends who knew the course, which made it easier to adjust the pace and anticipate the hardest climbs.

So how did it go? I set out with a pace of 6:20 per km (4:27:15 total). This felt good. I saved energy by walking fast up some of the steepest slopes and running faster downhill. The first part of the race has most of the climbing, so I passed the halfway mark after 2 hours and 16 minutes (average pace 6:27). This held to about 28 km. Then my leg muscles started to cramp up.

I had never ran longer than 24 km before, so I was prepared to run into some kind of problem beyond that, but the muscle spasms became quite a challenge. From 30 km I had spasms in most of the different leg muscles at some time. Having run a lot I know that the best strategy when pain sets in is to keep on running, and I did. The spasms came and went and I had to alternate between walking fast and running. It became harder and harder to motivate myself to start running again after walking, but I kept on alternating.

View from Kikut, about halfway through the course. Photo by Chell Hill.

The only goal I’d set for myself before the marathon was to finish, but I had a secret hope of doing so in under 5 hours. At 38 km I saw that this was still possible, if I pressed on and cut down on the walking. This was hard, as my legs now felt and behaved like two tree trunks.

200 meters from the finish line the big toe on my right foot cramped up, curling up painfully under the foot. The pain made me crouch down, but I somehow managed to stand up and put pressure on the foot. The spasm stopped and I could finish the race running, at 4 hours, 57 minutes and 2 seconds (average pace 7:03).

During the race I drank 16 cups of sports drink and ate 3 half bananas, 2 half packets of raisins, half a slice of white bread with jam, 1/4 of an energy bar and 2 packets of energy gel.

It was interesting to find that it was not my endurance that set the pace, but the amount of pounding my legs could take. The mental fight to keep on going and finish in under 5 hours despite my legs cramping up on me was the greatest and most satisfying challenge of the experience.

So I’m going to run again next year, but I’ll have to take those legs out for longer runs if they’re not gonna cramp up on me again.

Photo by William M. Vander Weyde (American 1871–1929). Public Domain.

In my new job I have a lot more contact with patients than before. Patients not asleep, that is. Although this is an aspect of the job I really enjoy, it presents several new problems. How to say goodbye to a patient with a chronic disease, for example.

As a medical photographer you fall into the same group as the other “non-treating” personell at the hospitals. Just like with an orderly, patients often feel a visit from me is a break from the  hospital routine and a neutral person they can talk to. And a lot of patient’s need to talk, something the doctors and nurses not always have time for. My time schedule is most often not as tightly packed, so when time allows it I try listen and ask questions.

People that need to talk often start talking straight away, but what you say to the others can be more of a problem. When we photograph patients we know nothing more about them than what it says on the photo requisition card – name, number, diagnosis, body part to be photographed. I don’t know how they cope with their diagnosis and it’s not always easy to tell. That the patients most suited for photographic documentation often have very visible symptoms does not make it easier to start a conversation. Not talking about the condition is like not mentioning the elephant in the room, but if the patient is embarrased by his condition it can be totally wrong to do it.

We photograph some kids several times during their treatment. Most of these have craniosynostosis or cleft lip/palate. The first thing that springs to mind when you see these kids after surgery is how nice they look – how well the surgical treatment works. But as one of my colleagues told me, she long ago stopped saying that to the parents because it can imply that their kid didn’t look that good before surgery. And that’s not how parents think, or want others to think, about their kids.

And what do you say when a patient with a chronic disease leaves the studio? Do you say “good luck”? Do you say “get well soon”?

Lots of things to consider and lots of patients to meet. It’s challenging, and I think it brings me closer to the human aspect of what I’m doing. It removes some of my feelings of detachment.

(Photo source)

Photo by Øystein Horgmo © All rights reserved.

I’m used to being an annoyance. In my previous job I was working on a project where we should document all kinds of cancer treatment, from biopsies to surgery. We would decide that we needed to make a video of some operation, and then had to go find a surgeon who would agree to take me along. We always found one, but they didn’t always come easy.

So many times in the OR, I had the feeling of being there on borrowed time. I adapted a low profile, going in just in time and getting out as soon as I got what I needed. This worked very well, and made it a lot easier to get a “yes” from a surgeon. They knew I wouldn’t be in the way and would demand little if any attention from them.

In my new job the situation is the total opposite to this. The surgeons and doctors come to us if they want photos or video of an operation or a patient. They want us to tag along. This is a very welcome change for me, but I’m apparently finding it hard to adapt to.

Last week there was a phone call from an OR. They wanted pictures of some abnormal anatomy in the patient’s neck. I grabbed my camera and hurried up there only to find it was a surgeon I’d dealt with before in my old job, performing the surgery. I couldn’t recall him being especially friendly or interested in our project.

Just ten minutes later I was changing from green to white scrubs again. And I realized I’d been in and out so quick I didn’t even know what kind of operation it was, nor the patient’s name and number. It hadn’t even crossed my mind to ask what was abnormal with the neck anatomy. When I thought about it, the surgeon had actually tried to chat casually with me about some camera advice. I didn’t know what I’d answered, I was simply too focused on getting the shots and getting out of there.

Note to self: CALM  DOWN!

The photos turned out great, by the way. Somehow I managed to capture those abnormalities.

Patients are people – people with problems. They are often in pain and usually apprehensive. To them, the medical photographer is someone who, once more, submits them to an institutional routine. He takes their pictures, with part or all of their clothing removed, to show what is usually an embarrassing condition or deformity. Again, indispensable as photography is in the teaching and advancing of medicine, it does not present to the patient the same direct benefit as a radiograph or a blood test.

H. Lou Gibson, Medical photography; clinical-ultraviolet-infrared (1973). (photo credit)

It’s probably an everyday situation in the OR, and not remarkable in any way, but I found it a bit strange. Just an observation.

This percutaneous RFA was done in the OR because of the narcosis. Most of the procedure consists of the radiologist using ultrasound to locate the tumor and find the best placement for the RFA-needle.

Nothing I haven’t seen before, but every now and then the radiologist would call out “apnea” and the anesthetist nurse would immediately push a button on her anesthesia machine. At first I didn’t understand what was happening, but I soon realized she was holding the patient’s breath by pausing the ventilator. This would of course keep the liver more still, increasing the accuracy of the needle placement.

The radiologist was very fixed on his ultrasound machine, concentrating hard to get this 100% right. So much in fact, that he always forgot to order the nurse to resume the patient’s breathing. Eventually she would ask him, but to me it seemed like a lot of unnecessary apnea (image credit).

Anesthesiologist T. has some great posts on surgeons and anesthesiologists, here and here.