(Jeff_L) #1


Evolving Dialogues between surgeon and Drawing Practitioner

A drawing given to medical students of the knee,
made by Mr Pramod Achan, was similarly used to
rehearse surgical movement. Pens were used by the
students not only to further annotate and analyze the
particular structure, but took on the role of syringes
and scalpels as part of the preparation for the opera-
tion they were about to observe and assist at.
Miss Narciss Okhravi has produced many
drawings in her medical retina clinic at Moorfields
hospital. A key example did not use pen or pencil
marks but demonstrated a crucial movement on
paper during a debriefing session with a junior
doctor. The essential action needed to perform a
Capsulorhexis^3 during an operation to remove a
cataract from an eye was shown by the deft tear-
ing of a circle on a scrap piece of paper. This drawn
image showed simultaneously the movement of the
hand and the flexibility of the creative surgeon in
educating future ophthalmic practitioners.
Surgeons are not limited to drawing upon two
dimensional paper surfaces but mark structures
on the body. At the opening stages of an operation
these marks are often using pen on the skin surface,
indicating underlying anatomical structures. Some
of the drawn codes were included in sketches made
by Jenny as a record of the procedure as well as part
of the investigation into the anatomy of the head
and neck.
Whilst watching Neil using a Harmonic scalpel,
an instrument that uses high frequency sound to
cauterize tissue, connections between the actions
of the surgeon and the action of the drawing prac-
titioner began to be made. Neil at the time being
unfamiliar with the tool, worked quite slowly mov-
ing over the surface of the tissue. It was at this time
that there was a realisation that hand movements of
surgeon and drawer appeared synchronous. Analys-
ing the drawn marks in the sketchbook led to infer-
ences of tactile sensations. (Figures 1 and 2)
Subsequent drawings produced in theatre
reflected something of the range and pace of physi-
cal interventions in surgical procedures both in
terms of the character of mark and the substance of
the resultant image. The drawing work had to incor-
porate features of haptic, kinaesthetic, tactile and
proprioceptive sensations as well as the visual.
Alison Dutoit (2008) in her essay Looking as
Inquiry: Drawing the Implied Urban Realm explains
some of the physical intensity of drawing.
“The meanings of the English word “draw” sug-
gests the tactile nature of the act: to drag, to elicit,

to provoke, to eviscerate, to accumulate, to delin-
eate. Only the last implies a purely visual activity,
or more appropriately, an activity addressing visual
For her “drawing is an activity in which the
whole body participates.”
Taking on board the physical links between the
act of making a drawing and performing surgery,
drawing activities were devised to analyze and make
a mimetic action based on observed surgical proce-
During surgery the surgeon moves a variety
of instruments across and around different tissue
structures. Tissue appeared to vary in terms density
and substance. The challenge was to find some way
of recording movement which changed speed and
direction, and which also recorded movement of
different surgical tools through different qualities of
tissue onto a two dimensional support. Marks made
to follow the movement and weight of hand and
tool inevitably influenced the form of the resultant
images produced.
Working in the busy operating theatre also
meant adapting drawing techniques, whilst consid-
ering methods of collecting information that were
applicable to the haptic nature of drawing and sur-
gery. The continuous removal and restructuring of
tissue meant that any images made were rapid and
small. Drawings also had to be made whilst mov-
ing around the operating table as the position of the
surgeon and medical staff changed as they worked
on different parts of the patient’s body. Images were
made in the hand, an echo of the dynamic tactile
movement being observed.
Errol Barron in his work Drawing in the Digital
Age, explains some of the tactile nature of draw-
ing as related to pressure sensitivity and the way in
which it can demonstrate thought processes.

Much of drawings value derives from what
one thinks and what one feels ...the feeling
which helps formulate ideas also supports
the judgment...”

Simple linear drawings reflected some of the
movement and weight of the tools. Surgical instru-
ments have different and distinct purposes and
functions, and these leave marks on the surface
of the tissue. In the drawings one observes darker
lines, which have been made to correspond with the
depth and weight as well as the movement of the
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