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The Reading Room: ‘Patients as People’

30 Jul, 15 | by cquigley


Emma Barnard MA (RCA)



PATIENTS AS PEOPLE – an Exhibition by Emma Barnard in collaboration with consultant surgeons and patients within the ENT department, Whipps Cross University Hospital, Barts Health NHS.

As a fine artist working predominantly within the field of photography, video and sound, I have for the past few years been resident at Whipps Cross University Hospital, Barts Health Trust, collaborating with ENT and more recently Dermatology consultant surgeons investigating what it means to be a patient within the NHS. My focus is on the human condition rather than diagnosis, and on how one might feel as a patient in a clinical, alien environment.

Four years ago, I found myself surrounded and engulfed by the pastel walls and polished floors of the hostile, medical space, as I was guided by the yellow line that led me to my appointment with an ENT consultant. Back then I was just another terrified patient sitting in a visually depleted waiting room, anxiety heightened by the wait itself. Two hours later, I was seen by the consultant when, hanging on to his every word, my auditory senses were heightened over visual ones – thinking just tell me it’s nothing serious…please! He did, I relaxed, and then without too much thought proceeded to blurt out ‘Has an artist ever done any work on patient experience?’ I subsequently wondered why I had voluntarily offered to spend time in a place that most people avoided at all costs.

The process that followed was not easy. In particular, convincing the relevant people at the hospital who believed that having an artist on site involved setting up an easel in a packed to the gills clinic, brandishing a palette and being creative with a paintbrush, took a lot of persuading.

‘Without your medical file you don’t exist within this environment’. First spoken to me by the ENT Head and Neck surgeon Michael Papesch FRACS, these powerful and thoughtful words triggered the name for the project, Patient As Paper. It was not long before the French philosopher Michel Foucault and his book The Birth of The Clinic came into view.

‘When medicine becomes the only social language, the distinction between the doctor and the patient gets more explicit. Their perception of each other becomes hierarchical. In this relationship, the physician is the healthy, wise and authoritative one; whereas, the patient is perceived by the doctor as sick and powerless, even though the doctor may also get sick sometimes. This is what Foucault calls the “medical gaze”.’

Hsuan and Lincoln 2007: 23

Foucault says: ‘Facilitated by the medical technologies that frame and focus the physicians’ optical grasp of the patient, the medical gaze abstracts the suffering person from her sociological context and reframes her as a “case” or a “condition.’

Hsuan and Lincoln 2007: 23


Patient As Paper – CType digital print 2013


As Nancy-Scheper Hughes exemplifies in her article ‘The Mindful Body’, ‘the doctor searches for the “real” cause of the headache, ignoring the social and personal implications of the illnesses with which the patient deals. Thus, through the discourse of medicalization, the sickness emerges as “a form of communication – the language of the organs – through which nature, society and culture speak simultaneously.

Scheper-Hughes and Lock 1987: 3

Patients are seen as the voiceless, lost in a system that reduces them to their diagnoses. Having previously been an advocate for various other groups, such as hard to reach NEETS (youth who are not in employment, education or training), Patient As Paper presented an incredible opportunity for me as an artist to once again make the unseen visible through art, by giving patients a voice. I am interested in using art to explore the patient’s perspective on being in hospital, and their emotional response to becoming a product of investigations and treatments. Patients may feel overwhelmed and disorientated by the hospital environment, and may experience loss of control. I am also interested in what doctors experience when looking after patients, particularly when this is emotionally challenging.

After a trail of recommendations, we were fortunate to meet Chris Mc Manus, Professor of Psychology and Medical Education at UCL, who wrote the following:

‘“Patient as Paper” explores photographically the meanings of silent biomedical artifacts such as notes, scans, micrographs and surgeons’ theatre drawings (be they on paper or skin). By inverting a patient and their notes, using superimposition and image-processing, photography forces a critical reflection on being a patient in the foreignness of hospitals, and on the complementarity of patients’ and surgeons’ visions of each other, as objects and people.’

Discussion dictated my next step. Following observation of the patient and surgeon consultation, I presented patients with an opportunity to express their reality, thoughts and feelings through art. In an ENT department, the face, the most potent visual correlate of the person, and personal identity are especially pertinent. The photographic portrait, taken after some discussion with the patient, is printed out and the person is encouraged to note what has impacted them the most about being a ‘patient’. Is there a defining thought, word or image? Proving that human beings can never just be a number, each individual is unique, and no two individuals have ever written or drawn the same content.


Emma Barnard working with patient Lee Anderson 2015

‘As a doctor I wanted to look at patient experience and different ways of understanding what the patients are going through mentally and emotionally and not just physically. Working with Emma allowed us to investigate this through the medium of fine art photography as a radically different way (from a medical perspective) of assessing patient experience. We as doctors are often subject to focusing on the science of medicine, despite our best intentions of treating patients as people. The core of this project is about the need for establishing this human connection as well as understanding what it means to be a patient.

To reflect upon these images invites the doctor and other healthcare professionals to consider what the patient is expressing about their care. Some images are very literal, others less so.  It is not so important that the viewer understands exactly what the patient themselves is thinking. The challenge for us as health care providers is to allow ourselves the opportunity to reflect on these images and thereby consider, in a novel, visual and artistic way, how the patient experience can affect us all.’

Mr Michael Papesch FRACS ENT Head and Neck Consultant Surgeon

‘Working alongside Emma has certainly changed my view of the patient consultation for the better. Many of the actions, words and phrases that are commonplace to me seem unusual or even shocking to a non-medically trained professional such as Emma. Emma articulates these thoughts and I gain greater insight into how the patients’ must be feeling. The images created by the patients never fail to amaze me. We all need to look at how we interact with patients during difficult and sometimes upsetting consultations. This kind of work reminds us that we are dealing with real people with real thoughts, fears and emotions and as such it has great value’.

Mr Paul Stimpson FRCS (ORL-HNS) ENT Head and Neck Consultant Surgeon

Now that I had secured this invaluable patient-centred work, it was important to give these people a voice in a more public way. Thus, the Patients As People exhibition was realized. Displaying artwork in a hospital setting comes with incredibly complex rules and regulations. Individual framed portraits on walls can be tricky, something that years of working with galleries and various venues had taught me. I sought inspiration from my biomedical environment and the many tests some of the patients had to endure in their pursuit of ‘getting better’. The idea was a play on the word and function of the X-Ray, a vision of one’s internal world. The exhibition itself could similarly be seen as a reflection of what was taking place within patients’ minds. A free-standing display was designed, containing several pockets where patient portraits could be contained.


Patients As People exhibition – George V Wing, St Barts, NHS Barts Health

Two and a half years ago, the launch at Whipps Cross University Hospital took place. Today, the exhibition is currently installed at its tenth venue, St Peters Hospital, Surrey, having toured the country to include the Department of Health London, Lancaster University and the NHS Leadership Academy in Leeds. One of the hosts Justine Thompson, Patient and Public Participation Lead, Strategic Clinical Network and Senate (East of England) Cambridge comments:

‘From the woman who is ‘boiling over’, to the young man who has totally obliterated his own face, every photograph in this powerful exhibition stops us in our tracks with its raw communication of human emotion.

Some of the pictures show outward serenity – but the self-authored graffiti often tells another story. These photographs are a graphic reminder that every person’s health story is as unique and individual as they are and that every encounter with a health care professional is likely to be an unwelcome voyage into the unknown. This is essential viewing to reconnect us all to the core of our own humanity.’

After a successful launch at St Peters Hospital the exhibition will remain there until the move to Ashford Hospital in September, launch date 19th October. If you would like to attend the launch, please contact: Giselle Rothwell on

Heather Caudle, Chief Nurse who commissioned the exhibition to be installed at Ashford and St Peters writes ‘Seeing the person before the patient’:


Future bookings are now being taken, if interested please contact Emma through one of the following:

Web –

Twitter – @PatientAsPaper

FB – Emma Barnard Artist

The Patient As Paper project is currently seeking funding/sponsorship. If you would like to contribute to this exciting initiative please contact Emma.

Other artwork, which explores medicine and religion from the Patient As Paper project, is being shown in the following touring exhibition:

‘If Yesterday Were Today’

Tuscany – 11th – 18th July

Berlin – September 12th – 20th

London – 3rd – 6th December 2015



Hsuan L. Hsu and Martha Lincoln, Winter 2007, Biopower, Bodies . . . the Exhibition, and the Spectacle of Public Health’, Discourse, Volume 29, Number 1

Nancy Scheper-Hughes and Margereth M Lock, 1987, The Mindful Body: A Prolegomenon to Future World in Medical Anthropology, Medical Anthropology Quarterly 1 (1)





Art in Arthritis by Nancy Merridew

22 Mar, 15 | by BMJ



I called Marco from the waiting room.


Everyone looked waxen under the fluorescent lights of Rheumatology Clinic. His olive skin looked grey. He rose like a grapevine on the trellis – thickset but gnarled through the seasons.


Marco helped his wife with her handbag and they walked together. Her gait was robust; his was antalgic and unhurried, though slower than he’d have liked.


In the consulting room we shared our introductions. I explained that I was aware of his medical history and asked “what are your biggest joint troubles today?”


Marco’s molten voice was rounded with a beautiful Italian accent and 80 years of life.


Apologising in fluent English Marco said that he didn’t speak English well and that it’s important to “talk the talk” of the doctors.


He looked down, reached into a shopping bag, and handed me three sheets of drawings.


I was stunned by beauty, utility, and clarity.


Brown ink outlined each picture, backfilled with camel watercolour. One image revealed the face of a younger man and the muscular shoulders of youth – his mind’s eye self-portrait.


Marco nodded to confirm that he had drawn them all.


Each drawing was anatomically correct and swelled from the parchment like parts of an amputee ghost. In some, his bones were bare. In others Marco had blended superficial features of skin with deeper structures of the appendicular skeleton.


A left hand floated on one page, like Adam’s in his Creation on the Sistine Chapel ceiling. Words – “Pain here” and “Here too” – were anchored by lines drawn to the hand, portraying metacarpophalangeal and proximal interphalangeal pain.



Figure 1. Annotated drawings of right shoulder, face, and left hand:

  • “Pain here” [SHOULDER]
  • “Pain here” [FINGER]


Six weeks earlier a rheumatologist had diagnosed Marco with recurrence of polymyalgia rheumatica, with shoulder and small joint features, and with a possible component of new onset rheumatoid arthritis. Recurrent carpal tunnel syndrome was diagnosed in his right hand.


On the other pages Marco had drawn his hips, knees, and feet, and annotated their aches with cursive writing.


These bones it seems that they are coming apart. When I walk for about ¾ of an hour then it start to give pain. Swells up and gets quite hot. The knee.



Figure 2. Annotated drawings of foot and knee:

  • “Pain here especially at night.” [KNEE]
  • “These bones it seems that they are comming (sic) apart. When I walk for about ¾ of an hour then it start (sic) to give pain. Swells up and gets quite hot. The knee.” [KNEE; TIBIOFIBULAR JOINT]
  • “Pain here last for days on both feet. Not all the time” [TALUS]


Marco was seen in the hospital’s Orthopaedic Clinic for severe osteoarthritis of his knees.


A carpenter, who still bent those knees to work, Marco explained that he once did a Fine Arts degree to support his business. Beyond that expertise, his careful handling of the autographed pictures revealed an artist.


The edge of one page cut through the word “foot” at “foo” which perhaps reflected Marco’s life.


Born during the Great Depression he was of the frugal generation – practical, resourceful, industrious. I wondered if Marco had ever rationed paper as a luxury, each sheet precious and saved for handsome cabinet designs.


Perhaps as an artist, unwilling to share flaws, he had cropped a larger page of sketches.



Figure 3. Annotated drawings of right foot, pelvis and right lower limb:

  • “Both feet hurt at times” [FOOT]
  • “Pain in here sometimes not all the time” [HIP JOINTS BILATERALLY]
  • “Right leg. Pain here” [FEMORAL HEAD, TIBIAL PLATEAU]


I was enthralled.


Marco’s eyes danced like bubbles from the surface of Prosecco – the muted pleasure of artistic pride.


Already he had offered his pictures to me three times as a gift.


Yet I had declined as it seemed too generous. I thanked Marco and encouraged him to keep bringing the drawings to appointments given their clinical value.


I completed the history.


Marco’s main concerns were steroid-related weight gain, although his arthralgia had improved.


As he talked I noticed subdued hand gestures. Given his Italian heritage, perhaps Marco suffered a cultural version of locked-in syndrome from the pain that restricted his upper limbs.


After completing the physical examination, I liaised with my registrar about Marco’s clinical plan. In a makeshift gallery behind the consulting suites I showed his artworks to the rheumatologists.


They advised that I could keep the pictures, and to take photocopies for the medical record. I made an extra copy either for me or for his art portfolio.


I returned to the clinic room. Marco’s wife, who had been silent, was keen to hear the consultants’ opinions of his drawings.


She beamed on learning that they were unanimously said to be “the most beautiful ever seen in clinic”, and particularly enjoyed by the Head Professor of Rheumatology.


Again Marco offered his pictures and this time I accepted with delight.


Smiling, he received his own copies as I explained his treatment changes and follow-up plan. We shook hands. Those aching hands created beauty and conveyed exceptional insights.


I watched as he left with his wife and wondered about their lives, leaving Italy to bring their charisma to Melbourne.


Two days later I framed the drawings – an exquisite medical document and gift. They hang in my home and evoke Marco’s grace, eloquence, and vitality.


* * *


Acknowledgements and Postscript


Marco, a pseudonym, has consented to the release of his artworks for the purposes of this article. See Figures 1, 2, and 3. Sincere thanks to the patient for his generosity and insights.


Thanks to Dr Thomas Lawson Haskell BMBS for his excellent photography of the drawings.


Correspondence: Dr Nancy Louisa Gwen Merridew BA BSc MBBS DTMH

Basic Physician Trainee, Launceston General Hospital

PO Box 1328, Launceston, Tasmania, Australia 7250

The Reading Room: A review of ‘Jo Spence, The Final Project’

23 Jan, 15 | by cquigley


Reviewed by Steven Kenny



Jo Spence, The Final Project, 1991–92. © The Estate of Jo Spence. Courtesy Richard Saltoun Gallery, London.


Jo Spence was a pioneering figure within the realms of photographic discourse, image based political activism and the application of photography as a therapeutic tool. From the early 1970s Spence worked within photographic collaborative modes, first with Terry Dennett to form the Photography Workshop Ltd and later co-establishing the Hackey Flashers and Polysnappers. Spence’s later works turned inwards, directing the gaze towards the body, and specifically her ill/diseased body, and her battles with breast cancer. Such works became charged with a context of survival and transgression, this photography ‘a response to her treatment by the medical establishment and her attempt to navigate its authority through alternative therapies’ (Vasey, s.d).


The Final Project is the last documentation of Jo Spence’s work. A book of eerie beauty and macabre investigation, The Final Project stands as the artist’s last photographic output before her death as a result of leukaemia in 1992. The resultant images stand as a testament of confrontation, expectation and spiritual transcendence. Within the book’s inside flap a small quote from Spence provokes thought, ‘“How do you make leukaemia visible? Well, how do you? It’s an impossibility”’. This quote particularly hit home as my uncle also died as a result of leukaemia. At the time I did not understand the condition, only hurt by its ramifications, never truly knowing its pathological effects nor its ability to conceptually redefine the body as sick and the other. The Final Project is a particularly significant book as it highlights the importance of representing the ill body, one that is affected by the invisible and the hidden. Spence’s work depicts a process of struggle, humour and later acceptance during her illness experience.


At the end of her career, Spence became too unwell to travel and work. However, the limitations imposed by physical frailty did not stop her determined and strong work ethic. During this time, Spence trawled through her vast photographic archive to create further visual documents from those that make reference to mystic realism. Her output became imbued with the anticipation of death, and as a result the imagery decoded visual artefacts of the iconography of the dead through the layering of two slides, one on top of the other. These objects, once photographed, became talismans of spiritual power, and as Louisa Lee (2013:11) comments, ‘allegorical props for representation’. The skull features consistently throughout The Final Project; in one photograph it engulfs the frame, in another the skull is depicted as a mask to be worn (see front cover above), and in others it appears to be used as an object to physically represent the artist’s presence. The skull is now a contemporary icon, a product of fascination that can be seen across various artistic forms and cultural practices. Her archive takes on its own being, and as a result comes to physically stand in for the artist; her visual history creating new histories that can be once again archived. The photographic montage can thus be seen within the book as a form of catharsis, the constructed image an item of therapeutic power with the ability to define new identities.


Jo Spence, The Final Project, 1991–92. © The Estate of Jo Spence. Courtesy Richard Saltoun Gallery, London.


On examining the work throughout the book, one might conclude that such images may be associated with Sigmund Freud’s theory on the death drive, which explored the apparent conflict between not having knowledge of our inevitable experience of death, and the resurgent repetition of unconscious exploration into gaining such insight. As suggested by the author Maria Walsh (2012), ‘Art can be tied to either of these strands, depending on whether an artwork is on the side of binding the chaotic force of the death drive or repeating its disruptive impulses’. Spence’s work within this series seems to lie preciously between the two, with such works seen as a taming or normalisation of death from acceptance of its iconography, yet becoming entangled within a mode of repetition as images are repeated and spliced with others to form new variations. It must be stressed, however, that such work is not at all chaotic, but is instead peaceful, dreamlike and calmly ambivalent. Thus it becomes difficult to categorise Spence’s final work, also true for her entire lifetime output, which confidently straddles various modes of representation and classification. The work is enigmatic, a photographic force in representing the invisible and redefining the ill body in transgression.

Humour has served as an important emotional device throughout Spence’s career and artistic work, and again is of great importance within The Final Project. Melancholy juxtaposed with laughter creates a darkly humoured conflict, the work’s methodology resembling the artist’s perseverance in contrast to her deteriorating health. Humour is utilised as a concept not only to promote positivism, but also to punctuate the isolation caused by disease. The skull as motif is disseminated as a cryptic symbol of both death itself and of its subsequent control over it. Spence does not trivialise death but instead attempts to seek some comfort and emotional release from its seriousness. As Sheri Klein (2007) suggests, ‘The intent of humour is to overcome the tragic impulse so that life is bearable’. Spence does not give up, nor does she stop creating. Instead, the artist utilises photography as a method to pictorially represent her own transition. The work serves as a form of therapy, much in the same manner as her previous phototherapy work represented her battle with breast cancer. One element has importantly changed, however. Spence now begins to absent herself from the frame, and instead presents her physical self through her previous constructed representations — a body not yet affected by the disease, a historical body that can be manipulated and freely controlled.

How do we come to terms with death? Perhaps more importantly, can we ever come to terms with our own limited physicality? I believe that these are deeply subjective, complex and quite probably impossible questions to answer, but as Klein (2007) suggests ‘Humour from art, as experienced through smiling and laughing, can be a catalyst for personal and collective healing, wellbeing and improved psychological health’. From reviewing the work of Spence, one could conclude that laughter and the ability to poke fun at death might be more therapeutic than resorting to a grief state that solely focuses on inexorable loss.


Jo Spence, The Final Project, 1991–92. © The Estate of Jo Spence. Courtesy Richard Saltoun Gallery, London.



Lee, Louisa (ed.) (2013) Jo Spence: The Final Project. London: Ridinghouse.



Klein, Sheri (2007) Art and Laughter [Scribd Edition] From: (Accessed on 13.01.15)

Vasey, George (s.d) Jo Spence – Biography. At: (Accessed on 13.01.15)

 Walsh, Maria (2012) Art and Psychoanalysis [Scribd Edition] From: (Accessed on 13.01.15)

The Artist in Theatre: On the Primacy of the Subjective Narrative by Jac Saorsa

8 Jul, 14 | by BMJ

Drawing Women’s Cancer explores the lived experience of gynaecological illness through a unique interrelation between art and medical science. Based in Cardiff and supported by Cardiff University and Cardiff and Vale University Health Board, the project began in 2012 as a collaboration between myself and Amanda Tristram, gynaecological surgeon. Since then it has produced two major exhibitions and several presentations both national and international.

Drawing Women’s Cancer project builds on the premise that philosophy, medical science and visual art all involve an inclusive, and often passionate form of ‘seeing’, and that they are brought into mutual relation through the equally inclusive concept of language. The concept of inclusivity here emphasises the idea that although language is the root and branch of dialogue, and indeed of narrative, neither of these phenomena are necessarily bound to the word.

As an artist and a writer, my concept of language constitutes far more than simply words, and as such it is the language of practice – and its corollary, process – that most concerns me. Consequently I understand both dialogue and narrative as practices and processes in their own right, both ‘creative’ and both profoundly and intimately immersed in experience, wherein language is evident and influential in all its forms. The Drawing Women’s Cancer project, which constitutes an in-depth exploration of experience, is therefore fundamentally and methodologically driven by a hermeneutic approach that embraces a multidisciplinary concept of language in order to delve deeply into areas of subjectivity that can often be felt impossible to express in verbal form.

Narrative language is a vital part of Drawing Women’s Cancer wherein personal narratives as related to me and transcribed either verbatim or in note form provide the foundation for the research as a whole. These are the bedrock of the experimental approach and, together with written narratives that reflect my own feelings about my encounters with women patients, and my experiences in theatre, they underpin the combination, the conceptual superimposition of word and image, verbal and visual, that is engendered through the creative process – itself unashamedly steeped in subjective experience. The creative process thus reflects and perpetuates the dialogical process that characterises my conversations with patients in a continuing dialogue between myself and drawings as I work on them. At the same time the process also responds to a further dialogue, one that speaks to my experience of the ‘Others’ experience of illness. Narrative here shakes off the strait jacket of monologue. It refuses to be confined to any prescribed spatial and temporal dimension. Narrative here becomes polyvocal and takes primacy as the vehicle by which the project as a whole continues and extends.

When a drawing is complete the story is far from over, indeed it has only just begun, and a drawing’s inherent communicative force lies in its capacity as an autonomous art object to maintain a dialogical character even beyond the relationship with its creator. As a work of art a drawing can simultaneously express and provoke emotional significance in an inter-subjective relation with the viewer, who in turn can creates his or her own narrative on ‘seeing’ in it the voices of those suffering the impact of illness, and this leads, ultimately, to the instantiation of what I want to call the meta-language, a form of communication beyond dialogue, beyond narrative and even beyond itself in terms of the expression of subjectivity. It is on the basis of narrative then, and its dialogical implications, that creative representations of the lived experience of gynaecological cancer can open up a ‘discursive space’ wherein a deeper understanding of the relation between a disease diagnosis and the overall existential impact of illness can potentially stimulate further conversations between patient and physician, between patients and their carers, and within the public arena in terms of awareness and acceptability.

So, in the true spirit of interdisciplinary practice in the Medical Humanities the Drawing Women’s Cancer project offers a direct challenge to the rationale of an uncompromising ‘art-science’ dichotomy by demonstrating that, in practice, neither can be disassociated from our understanding of humanity and the manner in which, as human beings, we engage or disengage with the society in which we are a ‘person’. Art, medical science and philosophy are all inescapably entangled here in a web of our own being and are constituent parts of the same overall human project, but visual art perhaps has the more obvious capacity to ‘bear witness’ to the trials that are often borne in the pursuance of being…in our physical enactment and psychological representation of life. Drawing Women’s Cancer is not only about disease, or medical intervention, or suffering, or the impact of illness; it is about all of these things. It is about, as Radley notes, what it feels like when ‘all sense of normality, and all the expectations of a future that accompany good health, suddenly become less real’. It is about the experience of illness, where that experience overrides all others. It is about creating a language that has the power to speak, not necessarily for the women whose personal stories are taken as the point of departure, but rather because of them, so that they may return.

For the rest of this post I would like to offer one of my own written narratives, an account of a recent opportunity to witness a gynae-oncological operation. I have attended various operations during the course of the project and all of the women who have allowed me to witness this part of their experience do so with the conviction that it will help me understand more profoundly what they are going through. Having, to borrow a term from legal channels, an ‘appropriate adult’ seems also to help sometimes as they try to deal with the natural anxieties that such an experience brings on.

Body in Flux

The image accompanying this post is a painting rather than a drawing. It is an ‘autoethnographic’ image that represents a similar operation to the one that the narrative below refers to. It serves, I hope, to demonstrate how visual language, even where there is no attempt to necessarily create an objective representation of the scene, can nevertheless communicate autonomous and coherent expressions of profound experience.

The painting is called Body in Flux. The narrative is called, simply, The Op.

Twenty minutes ago I was talking with her while she waited to be called down to theatre. She had smiled at me but it was a weak, anxious smile and there was fear in her eyes. We had a brief conversation – she seemed to appreciate the company. Hers is a difficult history, when she began to notice something was wrong she had tried to ignore the symptoms, ‘for the children’. She convinced herself it was just something minor, no need for a doctor, but she got tired of pretending she was OK and in the end she did go for help. As she lives in West Wales, she went to the local hospital and to her relief they told her there that it was nothing serious after all – ‘just abnormal cells’, nothing too much to worry about. They did however organise an appointment for here at the clinic here in Cardiff, for a biopsy. This was unusual, and even though they said not to worry, she did anyway. She worried about being in the city, she worried about her two small children at home, she worried she might die.

It is cervical cancer, quite advanced. She is to undergo a radical hysterectomy. The whole of her uterus and the surrounding tissue, the cervix and the upper part of her vagina are to be removed. The ovaries too, probably.

Reality hit hard a few weeks after the biopsy. It came suddenly, in a phone call. It was the shock! The word ‘cancer’ still makes her cry. She has no partner. She said she wasn’t ‘active in that way’ – not for ages – so she hadn’t been for Pap test for years. She had thought there was no need. She said she felt ‘stupid’ now. She is a primary school teacher; they had called her on her mobile as she was walking the kids to the classroom. They had the results of the biopsy. They told her that she had a tumour, that she had cancer. Now, here, waiting to go down to theatre, her eyes well up as she whispers the word. ‘It was the shock’, she says.

She is asleep now under the lights in the theatre. The lights are not harsh, just very strong. The huge circular structures from which they descend are acutely and disturbingly present, not just here in the room, but even more powerfully in my memory. The monstrous size of them and the pitiless, piercing illumination they provide still haunts me, despite my efforts to exorcise the horror of my own experience in the weeks that followed in paint on canvas.

I am anxious then, for her, for me, for us both. This operation is one that remains very close to the surface of my own consciousness and my presence here has psychological connotations that I cannot ignore or supplant with more rational thought, so deeply are they rooted. This is a test then to the personal limit of my focus on subjective experience. Amanda, the surgeon, knows this. She asked me when we arranged this visit, “Are you going to be OK with this one?” I felt the same way I did when she asked the very first question, the one that kick-started the whole Drawing Women’s Cancer project; she had said “Can you draw what it feels like to have gynaecological cancer rather than just what it looks like?” I knew then that I wanted to try.

Jonathon, the surgeon working with Amanda, reaches up to angle the bulbs. They are covered in their own protective ‘gloves’ so that he doesn’t burn his hands. His hands are so very important. I stand behind Amanda who is pushing paper wadding into the vagina – ‘packing’ it so that it doesn’t ‘move’ during the operation. There is so much paper left over on the floor between her feet. It is to ‘protect the excess’. The pushing, packing, continues and she says, “I pushed too hard once. I was in training and I was so scared of the consultant… we noticed that there was a lot of blood just dripping out onto the floor!”

Amanda goes to a side room to attend to the paperwork and Jonathon is left to make the first cut. Firm and certain. Vertical, from the navel to the pubic bone. He draws the diatherm slowly, painfully, through the skin of the belly and it trembles around the small part of it that is taut and stretched between his fingers. “A cut needs tension”. I am surprised that he uses a diatherm for this initial cut, deep and long as it had to be, so I ask. “Yes”, he replies, “it’s the way we do it now, but some surgeons do still use a scalpel.”

The edges of the cut sizzle and blacken. Smoke and the acrid smell of burnt flesh arise from the wound that becomes bigger, deeper as he works. He cuts down, confidently and deftly through layers of fat. My artist’s eye focuses on how the colours that move through the wound, from the skin, through the fat, to the fleshy muscle, are aesthetically beautiful in harmonious juxtaposition. First the hues of red: crimson, napthol, and the brightest perylene mingle with tiny glimpses of green and blue, the colours of shadows on the flesh, and then on through the spectrum of yellow, from the deepest cadmium to the palest, ‘prettiest’ lemon, the colours of the daffodils that are blooming outside and carry so much significance here in Wales. Cenhinen (kenHINen) means leek in Welsh, while cenhinen pedr means daffodil, or St Peter’s leek. Over the years the two became confused until the daffodil was finally adopted as a second national emblem of Wales. The cenhinen pedr then are blooming today, even as the wound is opened and the fat gives way and melts under the surgeon’s hand.

I think of Chroma, in which Derek Jarman, painter and filmmaker, extends Melville’s view that we ‘learn’ colour whilst not necessarily understanding it. It is understanding that I am seeking here, in subjective form, and in the wound as I watch it open, the red of the initial cut becomes Jarman’s ‘moment in time…quickly spent. An explosion of intensity.’ Further on, as the diatherm moves down through the soft tissuethe red ‘burns itself. Disappears like fiery sparks into the gathering shadow’. Jarman imagined four stages distinguishable in alchemy: the blackening of MELANOSIS, the whitening of LEUCOSIS, the yellowing of XANTHOSIS and the reddening of IOSIS. For me they appear here, but in a different order as I watch the diatherm cut beyond borders, deeper into the body, opening up and invading its private, once autonomous spaces. I feel the sting, but as Jarman says, Painters use red like spice’.

Amanda is back. She brings more even wadding to ‘mop up the excess’. The excess: ‘an amount of something that is more than necessary, than is permitted, or is desirable’. Excess here then, even beyond the metastasising cancer that in itself is excess to the normal cell structure.

I stand on a stool, watching as Jonathon cuts deeper into the muscle. The rectus abdominis yields to the unrelenting diatherm and allows him access to the peritoneum and the abdominal cavity. There it is, the uterus, itself now become ‘excess’. Amanda holds it in her hand. “Look” she says as she gently lifts it towards me, “and here are the ovaries”.

Fat, organs, tissue, all spill over the edges of the now gaping wound. Colours mingle at all levels of the ‘warm’ scale. I am shocked – no, not shocked – more bemused to witness what appears as a mess, a fluid ‘jumble’ of organs that belies the naïve impression that I now realize I have always held that inside we are very orderly and self-contained. Art takes precedence over science here as the boundary between order and disorder becomes confused. Either way the relationship between the two is here emphatically demonstrated through the idea of structure, the structure of the body in this case, which becomes simultaneous with function through the overall concept of process.

Jonathon and Amanda push the organs around with their hands, bullying them into compliance as they try to force them into the chest and pelvic cavities in order to isolate the uterus. But the organs keep spilling back out as if defending, even nurturing the one that is the object of attention. Yet more wadding is pushed in to hold back the tide, up into to the chest and down into the pelvis. Finally, with his arm up to the elbow inside the passive form Jonathon, like Canute, pushes and shoves with a physical force that promises a painful recovery. I am stunned by the seeming violence of it all, the brutality, the deeply and bloodily visceral reality of scene. The edges of the wound are pulled wider open with clamps that grasp the bloodied flesh and become bloodied in their turn. Now, the diatherm, held lightly first in Jonathon’s hand, then in Amanda’s probes and cuts on respective sides of the pelvic cavity, now an empty space devoid of organs and ‘excess’, save the hapless uterus, the one, which is soon to become the other. It sits isolated, bounded by smooth, ‘slippery’ walls that shine and appear translucent and yet opaque at the same time. It looks so small, so vulnerable under the threat of the diatherm, and the ovaries, white and tiny, are hiding, sheltering, in the darkness of the void.

The violence of the procedure is salutary in terms of my understanding. The pushing, the shoving, the manipulation of the bodily structures and organs, bloodied tools that are first discarded, then retrieved, then put into service to cut, to staple, to open and to close, all this is played out in front of me in sanguine ritual. The same blood pools in the crevices on the body and on the floor at Amanda’s feet, small bits of the flesh that it once made red are thrown up onto the green sheet, or down onto the floor. This is not clean, not clinical; this is raw, visceral, almost primeval. It feels… it feels. This is the unadulterated, non-sugar-coated authenticity of surgery; the cutting, the slicing, the pushing and the pulling, the packing, the mopping up… and it is all the raw bloodiness of real flesh, real wounds; nature rent and protesting. The body, once a closed space of quietude and privacy, now wide open, stretched, clamped and ‘mined’ for the tumours that threaten its very existence as they create of the acting Self (that part of being human which here, in this theatre, is absent) Sontag’s ‘non-self’.

I draw nearer to see as best I can while careful to avoid any contact with the green sheet that protects the human being who has become subject to – or is it object to –this therapeutic violation. Standing beside Amanda, I have a clear view of how she works, now with force, now with gentleness, but always with dominance. The body submits. Once the surface and the underlying defences have been breached there is little to resist the relentless subjugation of its autonomy. The chest is rising and falling gently however, normality and regularity at least in this respect confirmed by the anesthetist who watches the fluctuations of his parallel and multi-coloured digital lines.

Carefully now, the surgeons begin to work more slowly and delicately. Brutality is replaced – in the details – by the sensitivity that must dictate the smallest and most intimate of incisions. They need to explore, to single out the pelvic lymph nodes, the arteries the nerves. They are suspicious. The cancer may not have settled only in the cervix, there may be subsidiaries, so, like Selzer’s ‘predators’ on the prowl they move quietly, deliberately, stalking the prey, the obscure ‘lumps’ of flesh that have become firm to the touch and thus differentiated from the soft masses within which they hide.

And so they delve with life-preserving precision into the depths of the body, first one side then the other, moving slowly, constantly aware of how far they can to go before breaching a physical boundary impossible to cross with any hope of returning. The main tumour will be taken coldly and cleanly with the uterus, an eradication of the very taproot of the cancer’s existence, but its morbid potentiality may lie in the lymph nodes. Carefully then they search, steadily and without pity, isolating, feeling, cutting, debating, and moving on. They take various samples, all of which ‘feel’ benign, and then, there it is. A tiny lump of bloody flesh is dropped into a plastic vial and a phone call is made. This sample they are not so sure of, they need to do a ‘frozen section’. The operation has to be delayed while they await the result of the analysis because, they tell me, if it is positive there’s no point in going on. I feel suddenly cold although it is very warm in the theatre. They switch off the lights.

She is under anaesthetic for eight hours. I have to leave, and Amanda does another operation, the next lady on the list, while her first lies covered with the wound open but packed with the endless wadding paper while the sample is sent to the lab. I receive a text later in the evening. The sample was negative and they completed the hysterectomy. They left one ovary.


Jac Saorsa

July 2014

Beautiful Science at the British Library: A Review by Isobel Elstob

3 May, 14 | by Deborah Bowman


We are delighted to publish this guest review by Isobel Elstob who visited the Beautiful Science Exhibition at the British Library for Medical Humanities. The exhibition is showing until 26 May 2014.


Review of Beautiful Science: Picturing Data, Inspiring Insight

Folio Society Gallery, British Library

20th February – 26th May, 2014


Isobel Elstob

Correspondence to:



How do we represent the material – and immaterial – world visually? This is the question that underpins the Folio Society’s exhibition Beautiful Science at the British Library. The Folio Society Gallery, in which the exhibition is displayed, is a small and awkward space that functions vertically and can be entered from two sides. This is important because such a space has very little to offer the curators in terms of dictating a visitor’s viewing route. The result of this is a non-linear viewing experience that the curators have counteracted through a thematic, rather than chronological, display of objects.


The themes that the curators have selected for representation are ‘Weather and Climate’, ‘Public Health’ and ‘The Tree of Life’. Within each of these sections, too, there is less a sense of chronology than the ambition to compare like-with-like pan-historically; in fact, the desire to demonstrate either the accuracy or the usefulness of past methods of visualising phenomena by displaying them beside recent, most often computerised, models. A particularly attractive example of this approach is the inclusion of HMS Rochester Ship’s Journal from the early eighteenth century (1709-12) displayed dialogically beside the UK Met Office’s computerised and interactive two-dimensional globe on which bright pink and blue lines shift and shimmer. These lines represent weather data collected along the spice trade routes between the continents, such as that laboriously recorded by the Captain of the Rochester. This relationship between two examples of data collation and representation demonstrates the intelligent contemporary exploitation of the documentation of information historically. But it reveals something more problematic, too, for an exhibition that seeks to contrast the sophistication of our technology with the originality of our predecessors: the finely-rendered tabulated descriptions found in the Rochester‘s captain’s journal are more beautiful – to use the exhibition’s own choice of word – than the impressive computerised globe etched with brightly-coloured streaks. Beauty is not simply in the eye of the beholder. Beauty is inherently a natural phenomenon, and, therefore, one that exists – and that we will find – in our own, human, creations. The page of the Rochester‘s journal that has been selected for display demonstrates this – beautifully. Perched amongst the looping, precise handwriting of the ship’s captain, that describes ‘Moderate gales of Wind and fair Weather’, sits an ink drawing of a small, speckled bird. The captain, we are told, frequently interspersed his tables of data and description with similar sketches of ships, wildlife and places that he observed throughout his voyages. In such pages, then, are represented two aspects of this man’s – and all men’s – approach to the world: the objective and the subjective. The interaction and relationship between these two ideals permeates this exhibition. Before the mid-nineteenth century the concept of objectivity, as we understand its meaning today, did not exist. Rather than science requiring the removal of human agency in the representation of natural phenomena, it was experience, not self-effacement that had counted previously. We can see this in the words of Edmond Halley, whose 1686 map, An Account of the Trade Winds and Monsoons, is exhibited. Halley writes: ‘It is not the work of one, nor a few, but a multitude of Observers, to bring together their experience requisite to compose a perfect and complete History of these winds.’ The change in attitudes might be traced in Luke Howard’s 1847 Barometrographia, which we are told is amongst the earliest consistent scientific observations recorded, and, more than that, is, in part, mechanically drawn by a self-recording barograph over which Howard subsequently plotted the phases of the Moon. Mechanical objectivity in its genesis is thus displayed.


Objectivity today relies on the satellites and the supercomputers that are now at the disposal of scientists. But the representations that such methods produce may well still be beautiful, such as the NASA map depicting the ocean surface currents between 2005 and 2007 that is shown at one of the exhibition’s entrances. One wonders, however, if it is not the subject – our blue and swirling oceans as seen from space – rather than the method of representation, that makes such computerised renderings so appealing. A direct comparison can be drawn between paper and screen within the ‘Public Health’ section, which includes Florence Nightingale’s ‘Rose Diagrams’ depicting the causes of mortality in the ‘Army of the East’. Professor David Spiegelhalter of Cambridge University has taken Nightingale’s engraving and made it interactive to help the viewer better understand its purpose. Such an appropriation is a productive method, too, for highlighting the ‘Lady with the Lamp’s’ work as a statistician in her own right, rather than merely an attendant of wounds. Furthermore, whether it be the Rochester voyaging in gales along the spice routes, or Nightingale sourcing her data from the military field hospital through which she paced, many of the historical documents in Beautiful Science invoke a far wider cultural context than the particular information that they describe. John Graunt’s Natural and Political Observations upon the Bills of Mortality (1662), for example, is a collation of sixty years of London parish records on causes of death. Within the table we find that the number of people in the capital who died due to being ‘Burnt or Scalded’ was three in the year of 1647, and rose to eleven in the year of 1651. Medical conditions such as French Pox, Rickets and Worms are listed alongside causes of death such as ‘Hanged and made with themselves’ and even ‘Frighted’ (of which nine people are recorded to have died in 1660).


But it is Beautiful Science‘s exploration of the motif of ‘The Tree of Life’ that is the most poignant section of the exhibition (this is also borne out, perhaps, by the fact that this area appears to attract a far greater concentration of viewers). Interactive technology here, in the form of the One Zoom Tree, allows the viewer to discover the evolutionary links between thousands of species of mammals, birds, reptiles and amphibians. Interestingly, these, very modern, representations of our own – and many other creatures’ – location within the animal kingdom is depicted as a sprawling tree, with branches emerging intermittently from a central trunk. Life on earth has been represented in the form of a tree across the ages and across multiple civilizations. From Mayan to Nordic culture, to the tree from which Eve plucked the apple, this organic life form has functioned pan-historically and pan-culturally as the most apt metaphor for visualising the force and centrality of Life on our planet. Beautiful Science reveals this tendency through some remarkable inclusions. Ernst Haeckel’s The Pedigree of Man (1879) is displayed beside Charles Darwin’s On the Origin of Species by Means of Natural Selection (1859), which is open at the only page within the publication that contains an illustration: a lithograph by William West that depicts the relationships between various species and their descent from common ancestors in what has become known as ‘The Tree of Life’ diagram. At once more problematic and more affecting, cultural attempts to depict the very nature of life will always be more personal to us than representing ocean current patterns or even epidemics of disease. For what is being represented in such imagery is our selves. Beside the historical publications of Haeckel, Darwin and Jean-Baptiste Lamarck is displayed a pair of back-lit black panels that contain a series of brightly-coloured circular diagrams – each one shining with a luminosity that is indeed beautiful to behold. These Circos Visualisations of Genomic Data compare the human genome with those of the chimpanzee, the dog, the opossum, the platypus and the chicken. Within each circular frame these comparative diagrams rise and descend and swirl and ebb like a collection of precise but abstract paintings. Perhaps technological representation is most striking when it represents the essence of us and how it is that we slot into nature’s own material manifestations. In contrast to the evolutionary implications of Haeckel’s and Darwin’s diagrammatic representations of life stemming from a unifying central source, the curators also show us an example of the way in which the relations between creatures had been visualised in Western culture prior to evolutionary theory’s successful claim of the mantle for understanding the natural world. Robert Fludd’s 1617 The Great Chain of Being depicts an hierarchical pyramid encircled by the cosmos, with Sophia the Goddess of Wisdom represented in human form standing for the pinnacle of natural perfection: us. A human-centric model such as this has Aristotelian roots, and monopolised cultural interpretations of the natural realm right up until the nineteenth century. It is not only possible but probable, therefore, that the ‘Tree of Life’ itself will be replaced with what will be considered to be a more suitable model at some point in the unforeseeable future.


The question that Beautiful Science most explicitly asks is how have we represented the world around us. But perhaps a more intriguing thesis might be why do we possess the compulsion to represent it at all? It is clear from this exhibition that the motivations behind visualising data and information have been as numerous as the methods invented to do so. The ways in which such visualisations have been accomplished suggests that science is not yet (and may never be) entirely objective. Indeed, Beautiful Science demonstrates, rather, that the human, subjective desire for beauty is as strong as the human, objective desire to possess information, and that our thirst for images is as compulsive, perhaps, as our thirst for knowledge. But let us hope that the technological age in which we live does not alienate us from nature to such a degree that we consider ourselves once more to be Gods of Wisdom, superior and dissimilar to all that surrounds us.

Ayesha Ahmad: Call For Abstracts – Second Annual Western Michigan University Medical Humanities Conference

26 Mar, 12 | by Ayesha Ahmad

Second Annual Western Michigan University Medical Humanities Conference

September 27-28, 2012; Kalamazoo, Michigan

Proposals should be submitted electronically by July 15—in either .doc/.docx or .pdf format—to


Ayesha Ahmad: CFP: Comics and Medicine: Navigating the Margins, 22-24 July 2012, Toronto, Canada

14 Mar, 12 | by Ayesha Ahmad

The third international interdisciplinary conference* on comics and
medicine will continue to explore the intersection of sequential
visual arts and medicine. This year we will highlight perspectives
that are often under-represented in graphic narratives, such as
depictions of the Outsider or Other in the context of issues such as
barriers to healthcare, the stigma of mental illness and disability,
and the silent burden of caretaking.


Ayesha Ahmad: Forthcoming Symposium ‘Activating Theatre: people participating, performing politics’ at University of Leeds

13 Feb, 12 | by Ayesha Ahmad

Activating Theatre: people participating, performing politics

A practice-based symposium examining how theatre and performance work to change people and society

Tuesday 6 March 2012, Stage@leeds Building, University of Leeds


Ayesha Ahmad: ‘Looking and Healing Seminar’: King’s College London

10 Nov, 11 | by Ayesha Ahmad

Highly recommended is a forthcoming seminar to be held at the Centre for Humanities and Health, King’s College London by Dr Matha Fleming. Dr Fleming is a museum professional and academic working in the interdisciplinary nexus between the sciences, the humanities and the fine arts: her work over several decades has forged innovative and productive methodological alignments across disciplines.


MASK:MIRROR:MEMBRANE-A Deborah Padfield Exhibition, London 6-16th July 2011

15 Jun, 11 | by Deborah Kirklin

Here’s one for your diary, an exhibition of images by Deborah Padfield, in collaboration with patients & clinicians at University College London Hospitals NHS Foundation Trust, entitled Can you see Pain? Anyone who knows Deborah’s work from her previous exhibition and book entitled Perceptions of Pain won’t want to miss this. more…

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