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This photo of an operating theatre at Rikshospitalet national hospital ca. 1900 is one of my absolute favorites from our archives. Even though the lights are out and the room empty, there’s an intense atmosphere to it. You can almost see the surgeons and the eager students. The light falling on the wall, the wet floor and the wheeled table that’s slightly out of balance with the rest of the room. Very dramatic.

Wish I had more details about it, but even the photographer is unknown.

In an effort to bring surgery back into the public domain, the Wellcome Collection in London arranged a Live Surgery event last year, broadcasting live open heart surgery to an audience of 200 lay people.

It’s interesting to hear people’s expectations and reactions in this short clip from the event. It reminds of the time when I showed the start of a prostatectomy video to my grandparents once. When I stopped it after a minute or so saying “So that’s what I do for a living”, they yelled “Don’t stop, we got to see how it ends!”.

Surgery sure is intriguing.

"Diverticulosis". Painting by Penny Oliver.

About a year ago I was contacted by Penny Oliver, a reader of this blog who presented herself as a studio artist who concentrated her energies on anatomical and histological paintings. She wrote:

Your line of work is one of the resources that keeps me going!  Without the documentation of surgical procedures and the study of tissues, I would have a hard time doing what I do.

Medical photography as a basis for art! I decided to ask this interesting artist for an interview, and here it is.

Why did you start painting anatomy?

I have always been inspired by nature. Practically every color, texture and pattern that we visually recognize, can be found in nature. As a child I drew animals, as an amateur photographer I chose intimate nature scenes. Moving into the human body was an easy transition when I stumbled upon my husband’s pathology textbook in medical school.

Years later, as I was studying and researching for my undergraduate senior thesis, I began to formulate the connections and similarities between the imagery of our inner bodies to the natural landscape. I decided to make a few paintings based on histology slides of the eye, ear, bone, and brain. To enhance the connection of our inner landscape to the outer landscape I also created ceramic works using forms found in nature. I made molds of shells, seeds, coral etc.. created small sculptural pieces of art. All of this came together beautifully for my final exhibition at college.

Because my husband was a physician in training at the time, we invited many of his colleagues to the exhibit. They seemed to be inspired and excited about the artwork! I sold many pieces and began my first commissioned painting shortly thereafter, “Canals of Havers” (below). This was the catalyst for www.DiagnosisART.com.

"Canals of Havers". Painting by Penny Oliver.

How do you pick your subjects?

Since beginning DiagnosisART.com I have mainly worked on a commission basis. What that means is that a person might contact me with an idea or a desire to have something specific painted for them. We usually spend some time discussing their exact wants but often times I am given artistic license and can come up with the concept myself. I then present the idea and if accepted, I begin the work! Most of my studio time is spent on work like that.

Can you tell us a bit about the creative process?

My creativity is almost always sparked by something visual, as opposed to an idea or concept. I am inspired daily by nature. When I feel that surge of creative energy I try to pinpoint the source – it might be a recognized pattern or a color that mimics something from my past or even something I have seen in my past research. For instance, I recently saw some histology slides that were part of a study of the female breast. Without going into detail, I was instantly struck by the similarities in form and shape that could be drawn to certain plants. I also recognized the fact that this imagery could be used to mimic traditional japanese scroll paintings. Voila! A painting is born!

On a technical note, I spend a lot of time researching each given area of anatomy before any sketches are even attempted. It is really important to me that I have an understanding of the anatomy, its function and its relationship to the other landmarks near it. This is a scientific study as well as a visual study.

After I have researched and feel comfortable with the anatomy, histology and biology of the subject I will then do some sketches free hand as well as in Photoshop. After that, the process ebbs and flows between frantic painting, contemplation, and experimentation.

I do not always have a clear picture in my mind of the finished piece. It is the process which is of utmost importance. Each time I stop and start the painting I take time to write down the next 5 steps in my process. After those are done, then I can decide what to do next. I do hope to become more efficient at this process and of course, that will come with time and experience.

Are your paintings renderings of actual diagnostic images or inspired by one (or several)?

"Concha Bullosa". Painting by Penny Oliver.

Some of my first commissioned pieces were taken almost directly from one diagnostic image or another. I have begun to evolve in my work a little bit and find that working with many images or resources is better and lends a greater depth to the work. For most of my paintings now I collect a handful of really poignant images/sources and work from them. CT scans (Concha Bullosa is directly from a CT scan), actual gross anatomy, surgical videos, illustrations, histology and MRI are all part of my process.

If I choose to paint something that is very much like the diagnostic image, I always seek permission to do so. I have found that most of the people I contact for permission to use their research images are very excited at the prospect of their hard work being turned into a dynamic piece of art. Really, this is what first inspired me to begin DiagnosisART; the joy and pride I could extract from the physicians, professors, and researchers who spend so much of their lives generating these images in the pursuit of helping others!

Have you made any pathology paintings and why these conditions?

I have done some pathology and I am planning to do more (I will be doing some thyroid papillary carcinoma soon). I am always a little bit “torn” over the prospect of making beautiful a disease that causes suffering. I have to consider how to recreate the pathology in a respectful but also accurate way. There are many tools by which to do this. A painting isn’t just paint on a surface. It is made up of symbolic colors, meaningful lines and composition that should direct the viewer’s gaze. I try to use those tools to temper the mood and create peace in the midst of the disease.

The pathology may also help me in future charity work. Through my paintings I ultimately hope to collaborate with charities to make products and distributable information in a way that is artistically appealing. The public can be made aware of how they can help if their attention is caught by a work of art that is beautiful and has broader meaning.

What materials do you work with?

I generally pick from two types of surfaces; masonite (Hardbord™ brand) or canvas that I stretch myself. I paint exclusively in acrylics right now. I have been painting with acrylics since I was about ten years old, so I feel very comfortable with the medium and understand its capabilities and limitations. Often times I will add texture to my paintings: sand, moss, glass, even feathers or whatever suites the imagery!

"Cochlea Suite". Painting by Penny Oliver.

I often find it hard to get non-medical people enthusiastic about my work. What about you? Who are your clients?

I have to say that I have many supportive and enthusiastic, non-medical followers!  However, all of my commissions have come from physicians and the prints I have sold went to other medical professionals such as audiologists, nurses and therapists.  I get a lot of positive feedback from my non-medical friends, but I have to be honest with myself and realize that this is a specialty niche’. When I considered devoting my time to this endeavor, I never imagined that non-medical people would jump on board. I am focused on the medical field and more specifically, I have a focus on the head and neck area.

"Eustachian Lens Fovia Purkinje". Painting by Penny Oliver.

There are two reasons I am focusing so specifically. First, because to become proficient at something, you need practice, practice, practice. I am not going to be able to become adept unless I focus. Secondly, my husband is a head and neck surgeon and can help me with the resources and information that I need.

Now that being said, I think that everyone is innately interested in this type of art and that there is a way to make it presentable to the masses. After all, it is about each and every one of us! For instance, I am working on a set of female inspired paintings which would be relevant for any female as well as the obstetrician/gynecologist. They will be “feminine” via the palette I choose, composition and painting style.

Do you paint other things than anatomy?

I used to paint things mainly from nature, animals, plants, flowers – dead or alive, it didn’t matter! I don’t have as much time now to do those pieces but hope to find time in the future again. I have a particular propensity for decaying flora… for instance, I see the changing colors and textures of a dying flower as more beautiful than the perky brightness of it at its peak. Things like this speak to me about the spirit; life and death and the process of recreation!

I truly feel that I could paint anything I see. I am a photo-realist at heart and have to force myself out of that box from time to time.

"Grandpa". Painting by Penny Oliver.

Do you know of any other painters working with medical images?

Not personally, but I know that there are many! I have begun to compile a list of artists who use anatomy in their work. Perhaps someday I can create a web space for us to commune. There are of course a ton of illustrators but that is a genre all its own which I find useful for my research purposes, but it is not the way I would like to take my work.

Check out more of Penny Oliver’s art on her Facebook page and at www.DiagnosisART.com.

Credit: The Harvey Cushing Brain Tumor Registry, Cushing/Whitney Medical Library.

Head over to the New York Times to see a selection of photos from the collection of almost 10,000 glass plate negatives of patients treated by Dr. Harvey Cushing between 1902 and 1933.

The Cushing Collection, which also include tumor specimen photos, microscopic images and a massive 500 human brains is now open to the public at Yale University.

Check out the NY Times article about the neurosurgery pioneer’s collection here. For those interested in reading more about Cushing’s life and work, the Cushing/Whitney Medical Library at Yale has digitized and made freely available nine books by and about Harvey Cushing.

Hat tip to Morbid Anatomy.

Photo by Øystein Horgmo, Creative Commons BY-NC.

We went camping in Finland this summer and spent one day in the city of Turku. In the city museum part of Turku Castle I found this wooden figurine, depicting a victim of the Black Death.

By the time we reached this part of the castle however, my kids (3 and 6 years old) were so fed up (I can’t blame them) I didn’t have time to write down any details about the statuette. If someone reading this have, please write a comment.

Photo by Øystein Horgmo, Creative Commons.

I’ll spend most of the summer away from internet connections, so there won’t be any posts for some weeks. Have the best of summers and shoot some nice photos!

Joseph Lister's carbolic spray. Photo by Øystein Horgmo, Creative Commons.

A few months ago I was contacted by Legion Magazine, a publication affiliated with the Royal Canadian Legion, regarding use of the above photo of Joseph Lister’s carbolic spray. A deal was struck and today I received a copy of the July/August issue in the mail.

The photo is part of a feature called “Then & Now”, detailing 100 years of medical advancement, from bandages and ambulances to antiseptics and scalpels. Read it online here.

Harvey Pekar, hospital file clerk and comic book creator was found dead yesterday.

Pekar is best known for his American Splendor series, but he also wrote one of the most gripping accounts of cancer I’ve ever read – the autobiographical Our Cancer Year.

This is a story about a year when someone was sick., about a time when it seemed that the rest of the world was sick, too. It’s a story about feeling powerless, and trying to do too much…

Thus starts the story of 1990, the year of the Gulf War and the year Harvey Pekar discovered he had lymphoma. Written by Pekar and his wife Joyce Brabner and illustrated by Frank Stack, the book is an honest account of the couples battle with cancer, chronicling everything from denial, through resignation and finally beating the disease. Their battle against cancer is contrasted with the Gulf War, as Brabner finds several of her Middle Eastern friends affected by the conflict.

Often grumpy and always acerbic, Pekar wrote about his own life and the lives of people he knew in his comics. Out Cancer Year is perhaps where he exposes his vulnerability the most, and the very human story shines through his surliness.

Rest in peace Harvey Pekar.

Harvey and Joyce get the bad news in a bad way. Click to enlarge.

Images from here and here.

Atul Gawande scrubbing for surgery. Photo from gawande.com.

“How helpless human newborn babies are,” my wife commented as we were watching some TV programme about surrogate mothers. “I read something really interesting about that recently,” I said, and realized I’d just referenced something I’d read in “Better” or “Complications” by Atul Gawande for the umpteenth time that week.

I was a latecomer to the books of Atul Gawande. Having somehow formed the impression that the books were some sort of macho “surgical tales from the front”, I didn’t get them despite seeing a lot of other people doing so. How wrong I was. Better and Complications are two of the most thought-provoking books I’ve ever read.

Fallibility, mystery and uncertainty. Diligence, doing better and ingenuity. These are the subjects tackled by Gawande in Complications and Better respectively. Mixing patient stories, statistics and reflection, both books discuss medicine as an imperfect science, but from with different perspectives. In an interview on SAJAforum.org in 2007–when Better was published, Atul Gawande described the differences:

I found after I completed my surgery training that I was thinking about our imperfection in medicine from a new perspective. Complications was written by someone just out of medical school trying to understand why medicine is imperfect. Better is written from someone who has finally become competent but is wondering, given our imperfection and the complexity that medicine now requires, how does one actually become great at what one does. The answer has both mechanical and moral dimensions to it.

Both books are packed with fascinating and important insights. I recall a few:

• Despite vast improvements in diagnostic technologies (CT, ultrasound etc.) there were found no improvement in the number of missed diagnoses picked up in autopsies, when researchers compared cases in 1960 and 1980 (Better, p. 197).
• The groundbreaking antiemetic drug Zofran has reduced vomiting in chemotherapy patients, but has produced no improvement in the severity of their nausea. In fact, patients report having longer periods of nausea today than before the drug was introduced (Complications, pp. 140-141).
• Satiety is induced by stretch receptors and protein receptors in the stomach and duodenum. Eating fat foods stimulates this reaction quickly. We also have receptors in the mouth, however, that trigger the hypothalamus to accelerate our intake of food. And again fat is the most potent stimulus. Scientists call this the “fat paradox”. Eating fat foods cause us to eat faster, getting more down before the gut receptors signals we’re full (Complications, pp. 170-171).
• The fact that human babies are born relatively helpless compared to other mammals can be seen as a solution to an evolutionary problem. We have a large head because of our large brain, but we also have a small, fixed pelvis, so we can walk upright. To get that large head to fit through that small pelvis all human mothers, in a sense, give birth prematurely. The result is babies that can not walk or seek food for months (Better, p. 172).

First and foremost though, Gawande is a brilliant writer who tells both the stories of when medicine fail or fall short (Complications) and when it prevails against all odds (Better). Both books are highly recommended for anyone remotely interested in medicine, or just having their thoughts provoked.

For more on Atul Gawande’s writing, check out gawande.com.

Photos from mymedicalmuseum.com

In May Medgadget announced a competition called My Medical Museum, that encouraged people to visit their local medical museum and post a presentation on the competition website. The winner was announced yesterday: Adam Simone presenting the Warren Anatomical Museum in Boston. A great presentation combining text, photos and graphics to give you a virtual stroll around the museum.

With only 6 entries, however, the potential of this competition has not been fully realized. In my opinion the submission time was too short (about a month) and the competition website is very counter-intuitive and hard to navigate. There’s no easy way to locate the entries or find the winner.

The idea is too good to end with this, so I suggest to the good people at Medgadget to convert the competition into an ongoing project and make the site more user-friendly. There should be plenty of people interested in submitting, even without a prize.