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  • Jessica M. Koren

Artist in the Operating Room

A major difference between myself (a medical illustrator) and a traditional illustrator is that I am able to work directly with medical professionals.

Some of my clients have a technology which requires a surgical implantation - or at least consultation with a surgeon. Other clients may be surgeons or researchers themselves who are needing to publish their research. In either case, I am usually required to work directly with the medical professional to get understanding of the content or nuances of the procedure so that I can illustrate it clearly. Sometimes that means getting a backstage pass into the operating room - a place seldom experienced by un-sedated people.

So what's it like? When I arrive to the operating room, I scrub in just like everybody else. My clothes go in a locker and I look like a surgeon equipped with a clip board and a pen (pencils aren't allowed in the OR because of pencil shavings and eraser bits-which could compromise a whole lot in a surgery!) So alas no charcoal or fan brushes in there.

Before a surgery I always brush up on the anatomy I'm about to see so that i can ask good questions and follow along to the surgeon's descriptions. It can be really difficult to see blood vessels or any recognizable landmarks under the skin unless you know exactly what you're looking for. I always leave an operation feeling amazed by the knowledge and skill of a surgeon. It also helps me understand why surgeons specialize in very specific regions of the body. In order to be effective, they really must master ALL of the anatomy which is quite a task when you account for the muscular, bone, lymphatic, nervous and circulatory systems in a given area. And every patient is different! Anatomy books only show an averaged, idealized representation of the way people look inside - so a surgeon has to learn and problem solve depending on the patient's individual anatomy.

An operating room is an exciting and intense place to be. In the surgeries I have witnessed, the team is usually very comfortable with each other. They have excellent communication and a streamlined routine. They speak in rational terms and are completely involved in the process. Something that surprises me is how the team is still able to be light-hearted with each other and listen to music sometimes. A surgery is pretty similar to any other job once enough hours have been spent doing it.

Drawing what I see is the only way for me to truly understand a surgery. Most of the time photography is not allowed in the Operating Room in order to protect the privacy of the patient. Even when photography is allowed, seeing a photograph of a surgical area actually doesn't help me much when I go to illustrate the procedure in steps. The anatomy is often-times so obscured by blood, harsh lighting, surgeon's tools, etc. that it's difficult to make sense of what I see. Notes are my best friend.

I’ve been asked “Doesn’t it make you feel ill when you are watching a surgery?” In my experience, I sense two reactions when I witness a surgery - admittedly my initial reaction upon first glance makes me want to look away or to feel a sort of pain empathy for the patient in front of me. In my second reaction, a

sense of curiosity and professionalism take over - my need to understand the operation puts me in a state of total involvement and dare I say educational bliss? It is deeply fascinating for me to see what is beneath our skin! Additionally the techniques of a practiced surgeon’s hand manipulating these layers of tissue make me feel like I’m witnessing a sort of scientific exploration of lesser-known territory akin to space or sea exploration. I have asked myself the question though “Is there something wrong with me for enjoying this kind of thing?" Well, I'll just use positive self talk here and say that my fascination is my gift. :) My job puts me in a constant state of learning - which for me is the definition of an engaging profession!

After viewing the surgery, it's time to put my skills to use. I draw out the surgical steps according to my memory and records of the event. I then give it to the surgeon for review. Here's what commentary from the surgeon usually looks like - I'll admit that I need to refer to my anatomy books in order to translate some of these!

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