"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.

"Venus Endormie". Photo © Joanna Ebenstein

A selection of Joanna Ebenstein’s photos of medical museum artifacts are on display over at the American Medical News website.

Joanna is a graphic designer and photographer who runs the excellent blog Morbid Anatomy, where she explores the meeting of art and medicine.

For more of her work, including photos from several medical museums around the world, check out her online exhibition The Secret Museum and her morbid anatomy collections on Flickr.

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.

There’s a lot to explore on the exhibition’s website: image galleries with some of the most prominent items, an interactive anatomical Venus and videos on these Victorian wax wenches.

Also check out the Guardian’s image gallery and an audio slideshow from BBC News.

The pebbed glass door panel is lettered in flaked black paint: “Øystein Horgmo…Anatomical Investigations”. It is a reasonably shabby door at the end of a shabby corridor in the sort of building that was new about the year all-tile bathroom became the basis of civilization. The door is locked, but next to it is another door with the same legend which is not locked. Come on in – there’s nobody in here but me and a few volumes of Sobotta and Gray’s.

I do a lot of anatomical investigations, and I love it. Working with surgical videos I often do not understand what I’m looking at when I’m editing. It could be that the surgeon didn’t point all the anatomical landmarks during the video shoot or I’ve simply forgotten. But the surgeons have so much work on their hands, I can’t go asking them about every little detail. Besides, it’s much more fun finding it out myself. Especially when I’m right. Nothing impresses a surgeon like anatomical knowledge from a “layman”.

Case 4711: The Whipple Mystery

It was a dark and rainy night. I was editing some footage of a Whipple procedure and I hadn’t had the time to talk to the surgeon who handled the operation. I knew the basics, but I didn’t know what blood vessels where being cut and tied. Investigation needed.

First I checked the Internet. I found several descriptions of the Whipple procedure, but none of them so detailed as to reveal the mysterious vessels to me. I did however find out that one of the reasons the duodenum is removed together with the head of the pancreas, is that they share the same arterial blood supply. Sobotta down from the shelf. Yes, there was indeed both a superior and inferior pancreaticodudenal artery. A roll of thunder in the distance.

So the inferior one has to be cut from its source, the superior mesenteric artery. Intriguing. But wait a minute. Isn’t the distal part of the stomach removed as well? What arteries supplies that with blood? Leaf through Sobotta again. The right gastric and right gastro-omental arteries. And hey! The right gastro-omental is a branch of the gastroduodenal artery, and the superior pancreaticoduodenal is as well. They must be cutting the gastroduodenal then! And the right gastric! That must be it! I’ll be damned.

All these long words are making me dizzy. I head over to the editing station and try to pinpoint the vessels and check if the map fits the terrain. It does! Gottcha, you dirty shared blood supply!

Suddenly a greenish thug reveals himself and I have to dive for cover. I didn’t see that coming! I jump over to my copy of Gray’s and quickly whip out the cystic artery. Cut and tied. Gall bladder dealt with.

What the hell happened? Feels like I’ve been hit by a train. I need a bourbon.

I contact the surgeon and show him the edited video with voice overs. He can not understand how I managed to reveal his entire operation. “This is nothing,” I tell him. “You should have seen me when I got all the muscles right in a humerus resection.” He opens his mouth, but I’m too quick for him. “Hold your flattery,” I tell him. “It’s all in a days work for an Anatomy Detective.”

Post intro based on the opening of “The Little Sister” by my all-time favorite crime novelist Raymond Chandler.

Lego Mini Fig Anatomy by Jason Freeny ©. Click for larger image.

This is the coolest piece of art I’ve seen in a long time! The Lego anatomy schematic is one of several brilliant anatomy designs by New York artist Jason Freeny. Details of the schematic can be viewed on his blog. High quality prints can be ordered here. I know I will!

A surgeon wielding a big tool (Endo GIA) on Grey's Anatomy. Note the bloody glove.

When you enter an operating room for the first time, you’re probably a bit worried about how you’re going to react to the visual impressions.The only reference most of us have is television. If it’s hospital drama or news footage, the surgery is always only hinted at. They show surgery without actually showing surgery. We get to see some bloody, gloved hands and some skin. The rest is left to Mr. Imagination, and as we know, he needs a reality check.

I was at a medical convention promoting www.oncolex.no. As a part of our stand we had a 40″ LCD screen demonstrating the website and showing some of my videos. A lot of people passed by our stand, and now and then some convention attendees would stop and watch a video, maybe ask some questions. In the afternoon a from the convention hotel started fixing some defect lights not long from where we were. He went to and fro for half an hour and passed our LCD several times without taking any notice. But when passing for the fifth time he glanced at the screen as he passed it and stopped dead in his footsteps.

On the screen, an inguinal lymph node dissection (LND) was in progress. He stood there watching, looking rather disgusted, for fifteens seconds or more before asking me: “what the hell is that?”. I said it was a video of an operation to remove cancerous lymph nodes from a man’s right thigh. “Oh,” he said, and continued watching, the look on his face slowly shifting from disgusted to intrigued.

The insides of our bodies is a hidden world to most of us. A world we often associate with death and carnage and would rather not think about. There’s blood in there, and guts. If there’s something wrong and we need an operation, most of us would not want the details, just get it over with. And the surgeon would most likely want to spare us the details. Implying, of course, that the details are horrible and you’d have to be a surgeon to find it interesting. Just like television tells us.

I believe more people would be interested in the inner sanctums of our bodies, given the chance. Like the hotel janitor. But like watching a 2D pattern to reveal a hidden 3D image, you have to see beyond initial (disgusting?) visual impression to see the real structures. Let’s take a look at a still image from the inguinal LND video.

The left groin after an inguinal lymph node dissection.

This does not make much sense. If you don’t know what you’re looking at you’d probably say that Mr. Imagination was right, and look away. But what if we add some annotations to the still?

Clockwise: IL: Inguinal ligament. FA: Femoral artery. FN: Femoral nerve. SM: Sartorius muscle. ALM: Adductor longus muscle. FV: Femoral vein.

Suddenly the different structures become visible. Looking closely you can see the length of the artery and vein passing along the thigh side by side. If we supplement this image with an anatomical illustration of the same area it becomes even more interesting. Watch the drawing and then watch the image. Intriguing, isn’t it?

Litograph plate from the 20th U.S. edition of "Gray's Anatomy of the Human Body", published in 1918 (public domain). Click for a larger image.

Many people find interest in surgery to be incomprehensible and even a bit bizarre, referring to the diseases and inevitable memento mori the subject implies.

Lately I’ve been asking myself the question: Would I be as interested in surgery and anatomy if I wasn’t so detached from these implications myself?

In many ways my work is all about disease. I’m currently documenting diagnosis and treatment of cancer, so all my subject material is related to it. But it’s in a totally different way than to a nurse or a doctor. I seldom see the whole course of a treatment, from the discovery of cancer to curation or, in many cases, death. I don’t see the agony of the family and friends.

I get to read up on interesting little details of human anatomy, and marvel at complicated surgery seen up close. But I never get to hear about the fear of the patient the night before surgery. And I don’t know about the complications. The surgical wound hernias. The failed anastomosis.

Of course this makes my job easier. I don’t have to think about the human aspect that much. Although I often do (see here or here). I can focus on editing the surgeon’s movements so they are pleasant to the eye. Seeing the beauty of the anatomical structures as they unfold under the scalpel. But every now and then I get a little sting of bad consciousness. Should I be looking forward to a complicated operation because I’ve never filmed it before? Operations are good. They cure people. But it sometimes feels a bit like chasing ambulances, even though I’m working for the same guys who own the ambulance.

I try to keep dual thoughts on these things. Allowing myself to be fascinated by surgery and anatomy while still seeing the bigger picture. I wonder how the surgeons manage. Maybe it’s when they see the difference their work makes for other people that it really becomes fascinating? But what about those times they fail?

I feel privileged to be able to see, through my work, the insides of the human body, and the manipulation of it to cure diseases. Things most people never see. But I can’t shake the feeling I sometimes get, of being a free rider.

The photo at the top is of a retinal detachment (photo credit). A disorder I fortunately do not suffer from.