MJM MedTalks
Artists and Doctors (Part 2): The patient’s and doctor’s experience

Introduction

00:00:12 Renée-Claude Bider (RB): Hello and Welcome back to the McGill Journal of Medicine podcast Series. MJM Med Talks where we speak with members of the Medical Community here at McGill and beyond. I’m Renée-Claude Bider, a Medical Student at the University of Ottawa and Podcast Associate here at the McGill Journal of Medicine.

This is the second part of my conversation with Professor Mary Hunter, who's a faculty member in the faculty of Arts at McGill University. In the first part of this conversation, we discussed the historical depictions of medicine in art starting from the 19th century and working towards the present and began discussing Frida Kahlo's depiction of Medicine from the perspective of a patient.

Interview

00:00:50 RB: We've talked a lot about paintings of the medical professional, but I think there's a beautiful opportunity to have, in the case of Frida Kalo, an Artist and a patient sort of depicting their own experience. So, I pulled up the painting here. Maybe I'll let you take the lead on describing this.

00:01:07 MH: Oh, no, just pretend you're doing a diagnosis of a patient, give it a go!

00:01:11 RB: So what I'm seeing this one* we have Frida Kahlo, she's in a wheelchair and she's posing in front -and this is a self portrait- but she is posing in front of a portrait that she's also made of Dr. Farill, who was her doctor as she went through these many medical procedures.

So she's posing in front of that easel, she's wearing a white dress and this is a pattern-I think I wrote some notes on this it's a- it's a pattern in Frida Kahlo’s work where she wears these Mexican traditional dresses, usually very colorful, but in this case, it's white, almost like a surgical gown.

And then, as you mentioned, she's holding her paintbrushes that are quite sharp, they're almost like scalpels and on her paint palette you can actually see a heart. So there's a bit of an interplay there again, between the surgery and the art, maybe a question of again, as an artist, her role almost as a surgeon or a doctor in this painting. Did I miss anything?

00:02:14 MH: Oh excellent, excellent! No, I think, again, we're looking at the interplay also with identities. It's a portrait, so it's about her identity as much as it is about that of the surgeon.

Interesting here she shows herself, you're right, in this mixed persona* part artist, part surgeon, part patient. Traditional- you know, she would wear traditional Mexican dress and promoting her identity, but also here, yes, the patient in this that she makes it look like a gown as well.

But this is different than the other images we've looked at because Doctor Farill is not shown as a doctor. We wouldn't know this unless we recognized him or had the title. Really, we just see, you know, a head and shoulders shot of a bald man with big eyebrows.

You know, so I think that's interesting here that she- the sign of his medical identity she has as being her tools, you know and I think in some cases, you know, where we looked at the earlier Toulouse Lautrec painting of the doctor Pean performing surgery where the patient is really just this object that gets cut into and even in the Hepworth - the patient doesn't even have a face.

Where, just here, or perhaps because Kahlo was the patient, this is a patient with agency and with power, and, you know, this is not just an object of medical inquiry, and I think that's where her works are quite different.

00:03:56 RB: And whether, you know, whether she's claiming that for herself or whether it speaks to her relationship with Dr. Farill, we talk a lot now about patient-centered care, and I think this portrait was sort of draws me in is that to me it seems almost emblematic of that patient centered care.

Frida Kahlo looks empowered, I think, in this painting in a way that our patients and the other depictions we've seen haven't seen empowered. So, there's a- there's a really a beauty there, I think it's quite an optimistic in some ways outlook on medicine, even though Frida Kahlo, to my understanding, underwent quite grueling Medical procedures in her lifetime.

00:04:37 MH: I- I agree, I think here her work, I don't think her complete celebrations of modern medicine. I think here she is certainly thanking and plays homage to the doctors that helped her. But you can also see in some of her other works the pain of those surgeries when medicine didn't help and when it actually caused more pain than good. So, her works really show both sides.

And I also think through our discussion today to also think through the history of your own profession, the good and the bad and it changes what, we think helps changes, you know, and looking at these artwork, how we've looked chronologically, you can start seeing that and you know where things have gotten a lot better for patients and for physicians, but also where there's still tensions between the power dynamic between patient and physician is certainly there in all of these artworks.

00:05:40 RB: Yeah, and l love this idea of not just looking at the chronology and- and sort of progress of medicine through, say, medical discovery, but also looking at it maybe more holistically through- through our, through literature, through personal expression. I think that's a hugely valuable take away.

Also, for talking about the patient experience, maybe a parallel to this painting would be to look at another self-portrait, maybe one more in the fire of the action. This is an Edward Munch painting from a little bit earlier in the nineteen hundreds.

And in this painting, Edward Munch is displayed lying down on the hospital table, fully exposed, very vulnerable and then with these sorts of like faceless medical professionals surrounding his hospital bed, there's some blood and there's also seems to be a viewing gallery where, again, we have faceless professionals looking in on him, which maybe tells a very different story of the patient-doctor relationship.

00:06:44 MH: So, with this one, I know a bit about what- how it took place before Munch painted this. So, this is himself, he had just been shot in the hand and was about to have hand surgery. But I think when we're talking about the power dynamic, I mean this is certainly an image of a patient vulnerability* here you have a naked man with a nurse who is left holding a bowl full of bright red blood, and we see blood also down on the sheet covering the operating table.

What's also interesting for those of you who know Munch’s work, most people know it through the Scream, so they have a sense of that, you know, scared face. If you think of that, imagine that in this work the face has very- some of these faces have little expression, but they're in that same shape.

And so, he's the patient on the table here is also being overseen by three faceless doctors and a crowd of faceless people looking through a window. So again, this also points to when surgery was really a spectacle. It's the “surgical theater” for a reason, but I thought it might be useful to read this quotation from Munch and this is how he wrote about the experience of himself during this surgery.

So, I quote, he said. “I watched as all the preparations were made, the knives that were brought out and the professor's every move. I felt the knife cut its way through the flesh, it scraped against the bones and blood, gushed forth. The bullet had exploded, leaving the bones in splintered pieces which needed to be trimmed. Pieces of bone and lead were embedded in the flesh and had to be removed. The operation lasted a long time. I saw my fingers and my hand bloody and swollen like a glove. The pain caused sweat to form on my brow. I wanted to scream, but the many eyes upon me forced me to clench my jaws together instead.”

I think this also speaks to the way in which patients sometimes keep things together for the doctor or when there's a crowd, so you're also not always having this completely honest communication.

00:09:07 RB: In some ways, it seems like Munch is trying to regain some amount of control from that situation. He's already so vulnerable, so he's gonna try to maintain as little vulnerability as he can and put on a bit of a facade where he's able to, even though he's going through quite a grueling procedure.

00:09:24 MH: Definitely. I think it's also worth looking at the idea of how a painting can represent an experience versus what was actually happening, One would guess that he wasn't lying completely naked for a hand surgery, but I think this is where the symbolism of that naked body- and it's Worth also noting that at this time in the history of art, it was actually very rare to show a naked male body when they were shown, this was kind of earlier, more heroic salon art, it would be in, as you know, a warrior and using Greek and Roman idealized body types, and they would be in these history paintings.

So, this is a very different type of image that shows a horizontal naked male body. So, this is an image of vulnerability. In terms of women, naked women lying down, there were a dime a dozen, you know you mentioned Tuberculosis, many showing women with Tuberculosis or unconscious or sleeping with hysteria, a million different things.

00:10:37 RB: And it's an interesting parallel, like this is our second naked body that we've looked at in these pieces of art, and the first one was a woman who was very idealized and a vulnerability wasn't really the- the theme and that interpretation.

And that stood out to me that here Munch had chosen to portray himself as naked and the feelings that you get off of that portrayal are so different, even looking at maybe the coloring that he's chosen, even the angle of how he's portrayed and we're sort of closer to his face else in that painting. So, we're a little bit closer, I would say, maybe to his eye, which makes sense for a self-portrait.

00:11:12 MH: And in a work like this, what's also different is we see that faceless crowd and the effect that that faceless crowd has, where in the Gervex painting, remember, we're a part of the faceless crowd, so there's no sense that our viewing is wrong or bad, we have the full freedom to look.

Where here, as viewers, we’re confronted with the effects of our viewing on that naked body. We're part of it. What's interesting, again, we see this happen in many of the works. We're also in these- actually in the Munch and the Hepworth and the Gervex and in the Lautrec, the angle that the artists are giving through that composition puts us in a position of power.

We are looking up and down on the patients or even into the Lautrec with the two sex workers, we're looking across at them. So, and again we are in that more medical view, so we are we are in the position of both the painter and the surgeon.

00:12:15 RB: Interesting, and I guess if I was to look at the- at the Kahlo that we had just talked about here we're also at sort of eye level with Kahlo, but in that sense we're looking the patient who's also the painter and maybe has a little bit of that surgeon connotation, but we're looking her in the eyes, whereas here with Munch, Munch is not looking at us, he's sort of in his own world, and our previous patients too that we have looked at were a little bit more isolated in their own world, not staring us down.

00:12:46 MH: No, and I think in these, yeah, they're definitely more the object, let's say, of the medical gaze, where Kahlo is looking right back at us.

00:12:54 RB: Maybe I'll finish this off talking a little bit- we've looked at a patient's view and then we've looked at sort of the artists looking on to the medical scene but maybe looking at medicine and art but through a doctor's eyes.

So, I'll finish this off with this photography piece by Heather Patterson called Shadow and Light, it's a collection of photographs that she took as a practicing Doctor during the COVID 19 pandemic.

The example that we're looking at here from her book isn't an ICU room, it's in black and white, the light is coming in from the window and we have professional maybe who's cleaning the ICU suite in full PPE and then we can see, but mostly hidden, a patient lying down on the bed beside them, and there's an enormous amount of medical technology in the room.

So, I think maybe there's something interesting to be said in this collection of work about how these sort of art pieces can help us understand or have us see the medical world through the medical professional’s gaze.

00:13:54 MH: No, they do, I think here- So these are from a book where Heather Patterson was given the opportunity to photograph hospital scenes during COVID.

So, I think these are a bit of a mix because on the one hand, they're very documentary. But on the other, they are completely artistic in that she was making specific aesthetic choices. You know, you can see here the way in which the contrast between light and dark, you know, the way in which the cleaner is posed.

I mean, these were all choices for this particular shot, but they do, I think, record and experience that is great that we have for history, you know.- So, I think this is a kind of mixed one, because I think this is one where- and a Doctor- again, this goes back and forth to this relationship between the physician and the artist.

Often physicians wanted to be artists that I know Gervex did and Toulouse-Lautrec always said* “if I wasn't a painter, I would be a surgeon”. So, the way in which they're looking and recording and capturing these medical scenes we can see is very similar and I also think in these- I mean, it's a beautiful book- but that she took, I think, tens of thousands of photographs and then picked these ones to represent those moments.

So even that act of kind of curating the book, choosing what is going to stand as a record of that hospitals experience of COVID, the patients, the doctors, the workers. But again, this points to a different type of image of medicine, where the book she has all types of workers.

In some of the images that we've seen, some we showed nuns. We didn't talk about it, but there's nuns who are nurses and some of the backgrounds of the scenes we have one of them there was an orderly, but she really puts in the foreground all the other people who are part of the medical community and the medical workforce, and they're much more present in her work.

00:15:58 RB: Well, like here we have in the room a cleaner, right? But you can see they're in full PPE, so we can also imagine. And we know that they're also essential to the functioning of the hospital, but exposed to COVID still in a very significant way. So, there's again that sort of element of paint that we've seen in those more contemporary pieces that sort of shining through here.

00:16:19 MH: I also think it's great if we're looking at this in comparison to the first painting we looked at, where in the Gervex you see, you know, a bunch of sponges and metal instruments in a bowl of water and that was considered quite innovative.

You know, you compare it to what we have here, I'm sure, you know, in another hundred years we'll say, Oh my God, look at all the different cords and all the wires and wasn't that such a mess? Why did we have all of that? You know, so this is cutting edge to us as we look at it now, but it won't be forever.

And here we also, if you see this as a book, part of what's written into it was that she had to get permission to reproduce the images that showed patients. And so that's also different* in earlier artwork actually in medical representations what you- the images of patients that you found in medical textbooks, journals, medical museums, the patients were named.

So, this has also changed a lot in the history of medicine and just medical practice,the concern for the anonymity of the patient is important to hear in her work.

00:17:33 RB: And here the patient isn't seen, but it doesn't feel as maybe dismissive of the patient experience then say that Gervex that has the patient in full view, but it's somehow very dismissive of the patient sort of as an individual, not just as an object that's helping the composition come to life.

So I'd like to close this off by shifting away from how medicine is portrayed in art and talking little bit about how art is used in medical spaces, and this is actually the inspiration for this episode, because I did my masters at the MUHC, the McGill University Health Center in the Oncology Department, where the walls were covered in artwork, namely these giant Matisse and Picasso prints, and I always thought it was such a contrast with the sort of antiseptic idea that we have of hospitals.

And with that in mind, I'd like to ask you what you think the value is of bringing art into our medical spaces.

00:18:36 MH: I think it's actually a complicated topic because I think there's sometimes a difference between art, let's say art proper, and decoration. So, sometimes, yes, it's, I think it is great if hospitals are nice spaces for people to be in.

And in one of the previous podcasts you had with Anne Marie Adams, she provided a bit of a critique about how in hospitals are meant to look, you know, especially birthing rooms are meant to look like your grandmother's living room, you know, with wallpaper and a rocking chair, you know, that- is this what hospitals are? Are we pretending to be something we're not? You know, and she brought up a lot of these questions, and I think they’re similar to some of the ones that I have.

I think it's great that hospitals are spaces that people feel welcome, but I don't think that art necessarily can do everything for everybody. And I think this is where I wrote with a colleague of mine, Tamar Tembeck, who's done wonderful work on art and hospitals and design spaces we had- we were trying to deal with this and saying, well, what kind of art is good for hospitals?

And I think that's more the question, you know, should we have our that's all clouds and teddy bears and feel good? Or does that gloss over the very real complex feelings that many people have in hospitals? Are we dumbing things down? Are we instrumentalizing our work to try to make people happy? Is it insulting? You know, or is it- doesthat type of art provide comfort and healing?

And I don't have an answer for you, but I do think these are things that we should think about and when part of the budget of building a hospital goes to public artwork, who is making the decisions about what kind of art is going in those spaces and what are we prioritizing?

I think we should all think about it, and I have opinions on it and perhaps we could like some of the art that's there, that's fun, you know, I'm seeing here you have one of the enlarged stethoscopes outside of the hospital. You know, these are playful, fun works. Does the symbolism of this work saying, you know the hospital is listening to you? You know, we are an open space, you know, I think that's a bit hokey.

00:21:22 RB: In my conversation with Anne Marie Adams who talked a lot about sort of the role of evidence based medicine in the design of hospitals and I think what you're saying here is a little bit of the same thing; that we're maybe over prescribing the kind of art that we're putting in hospitals based on, I don't even know if it's research or if it's founded in evidence, but a kind of evidence based mentality that art that is positive or that has some kind of medical connotation will enhance the patient experience more than other kinds of art that we could be putting on our walls.

But also, that maybe having art on our walls in the hospital or these big artworks, aside from sort of creating an enjoyable environment, are also maybe disingenuously disguising the purpose of the hospital.

I pulled up this stethoscope Prendre le pouls by Cook-Sasseville , which I think are artistic duo, because I would have lunch beside the side of the stethoscope every day, and I don't think I had that sort of messaging come across of the hospital's listening to me. It was just a really big stethoscope.

But on the other hand, I know in the Research Center they have that giant hemoglobin molecule that's suspended, and that when I would cross though the research center every day, that was kind of an amazing reminder of importance of research in the medical field.

So, I think it maybe it also comes down to which pieces you're choosing to put up and to the individual experience; a patient looking at the stethoscope might feel that messaging more strongly than I did.

00:22:56 MH: And I think this is where art in hospitals can mean different things to different people, and I think that's a good thing. You know, I think if we all decide that- we decide to only do one thing. For example, you're talking about the hemoglobin, we're talking here about the stethoscope, it's good that it wasn't all medical imagery because then it feels almost like a medical theme park.

So, I think it is good when we integrate different types of art. That's where in my article and you have it here a painting called Sausage Pants work with a bright red background showing a cowboy and his wife and a Horse. This is by Michael Farnon.

Now, this was in a hallway in the Royal Vic[toria]. And how we ended up writing about it is when we were just talking to people about art in hospitals, this work came up amongst physicians who just said, “Oh, I always want to buy it”, “It made me laugh”.

So, this is where I believe he won an art prize, somehow this ended up in the Royal Vic[toria] collection and when it went to the MUHC, it wasn't put on display and because it didn't kind of fit their messaging.

And I think this is where Tamar Tembeck and I started thinking, like, this is an artwork that made people laugh. It doesn't fit a hospital, it doesn't have a medical topic, it's just a painting, it's just art, and we wanted to say, you know what, there is room for other things.

It doesn't have to be prescriptive, it doesn't have to make you feel good, it doesn't have to have a medical theme, it doesn't have to look like it's in a home that's going to make you feel comfortable. We also have to remember that art makes you think, it's not going to solve all your problems, it's not going to always give you an easy answer and I think that's why sometimes having these works that make us ask questions, that's what's important about them.

00:25:08 RB: II think it was also maybe what struck me of the Picasso and the Matisse prince in the MUHC and the cancer unit was that unlike a lot of the art in the hospital, it also had nothing to do with medicine and that contrast was maybe what- what made them so fun to look at when you're walking down those hallways.

00:25:26 MH: Well, and I think that's where we have to think about who's occupying those spaces and I think that what's important about art in hospitals.

Years ago, I wrote an article in the Globe and Mail about art at the Princess Margaret Hospital when my mother was there and one of the things that I was writing about was a lot of them on this one floor were just incredibly depressing. They were called things like Last Summer, you know, with two empty dock chairs by a lake and a lot of people on that floor were dying, and this was also the case where these were donations.

So, people were giving art as donations to remember someone who died. The patients undergoing chemo were walking around looking at these depressing things. Yet, when I talked to doctors about it, they're like, “Oh, they're just whipping by, they saw, you know, a landscape”.

So, I also just think a lot of it is just putting the thought into it. Listen, Princess Margaret [hospital] might have changed things since then, so this isn't a criticism but I just think we also in these hospitals don't always have a curator. The MUHC does have a curator, so it's great that there's someone thinking about these things.

But, it doesn't always come to mind when people like, Oh, what do we need for Health care? Oh, we need the curator for every Hospital. That that's not what people are thinking about.

00:26:53 RB: But maybe if you're- if you're wanting to put art on the walls, maybe a consideration that has to come with that.

00:26:59 MH: I hope so.

00:27:00 RB: You were just mentioning sort of the patient experience of walking by those paintings, and it brought me back to earlier in conversation when we're talking about the experience of waiting and of the perception of time and the whipping by down those hallways, the patients might have had a very different experience of that time compared to the doctors and that got into their experience. So, it may be a nice parallel there.

00:27:23 MH: No completely, and I think again, I think we all agree that to think about the patient experience and also the doctor experience, you know, and to see how art works in both ways. And they also architecturally have a wayfinding purpose as well.

So, I think that's also- I think we put a lot, we make art do a lot in hospitals. You know, it has to entertain people who are waiting, make people feel good who are, you know, sad, help people find which hallway to go down, you know, all kinds of things.

00:27:56 RB: And maybe there's a beauty to sometimes just letting art be art.

00:28:00 MH: That's what I want.

00:28:03 RB: Some delight there. But it does sort of bring us back to our overall theme of the conversation that we attribute some objectivity to art and we use it in a sort of empirical way but there's always going to be a subjective element.

And so maybe on that note, we'll finish it off with our last question. It's a question we ask everyone who comes on the podcast, and it would be if you have any advice for our listeners. Our trainees in research and medicine, or hopefully, anyone who's just dropping in?

00:28:36 MH: I think for me, a big part of it is to think about history and- and think about our own place in it and the role that art has and how it tries to represent that. You know, I think sometimes we can't know everything, and looking at artwork about medicine, whether it's the past or our present, actually, just teaches us a lot about ourselves.

00:29:03 RB: On that note, Dr. Hunter, thank you so much for coming in on the podcast today.

00:29:07 MH: My pleasure.

00:29:08 RB: I really enjoyed this conversation, and I think everyone listening will too.

00:29:11 MH: Thank you so much.

00:29:14 RB: Thank you.

Outro

00:29:15 RB: Thank you for joining us for another episode of MJM Med talks. In the show notes for this Episode, you'll find a transcript, any of the papers we've referenced today, as well as images or links to artworks we've discussed. This podcast was edited and produced by MJM's Podcast team.

If you've enjoyed my conversation with Prof. Hunter, reach out to us on Twitter or Instagram at mcgilljmed and be sure to listen to our other episodes.