Comic Time Out

Not every comic is meant to be funny. While the Scottish city of Dundee’s classic troublemaker Dennis the Menace always lunged for the elbow, one of its newer residents has gone for the incision.

01_Handiwork title

Handiwork: surgery in sequential art, by Emmanouil Kapazoglou, adapts the comic strip format to tell a serious story that is both strange and familiar.

It follows a typical operation on a typical day for a surgical team at the Tayside NHS Trust. Through the prism of the World Health Organization (WHO) Surgical Safety Checklist, we’re taken on a step-by-step journey of the pulse points and timeframes of a surgical procedure.

02a_Huddle

Scroll slowly. The panels, as with any comic strip or the boxes on the Checklist itself, can only succeed in linear, deliberate steps.

Handiwork_cartoon strip

First through the photographs and then through illustrations of those real life images, past the swinging doors and under the hot lights.

02b_Huddle

Watch as the seeming chaos of masked faces and machines reveals its tightly-rehearsed order – and the team’s intense focus on the safety of the one person not expected to play a role, the reason they’re all here: the patient, lying insensate on a table in the middle of the room. 03b_Huddle

You’re completing your masters in Medical Art at the Duncan of Jordanstone College of Art and Design, but this still seems like an unusual subject! What led you to the comic strip and the operating room?

04a_Transport_photoComics are so important in medical education. They have a visual impact and a strong message, but they’re also a helpful generalisation – they can expand the experience of an individual into human experience regardless of gender, age, nationality etc.

They can also speak to the non-medical community, and I was interested to see how they could translate what goes on in an operating room. I wanted to capture the teamwork necessary for a successful surgery. 04b_Transport_paint

What surprised you about the operating room?

How calm it was. Medical dramas on TV make it seem stressful – what a misrepresentation. The OR was such a calm place.

Why did you choose the Checklist?

I wanted to show something constant, and the Checklist is the backbone of how surgery happens nowadays.  I was very surprised to find out how recently it was introduced – and how difficult it is to change certain patterns of behaviour when people have learned to be kings in their theatres.

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Did you see it have an impact?

Seemingly small things, like an allergy not noted down – that could have been catastrophic, but the Checklist caught it. The simple communication it allows between the theatre staff, between the anaesthetist and the ward nurse – there’s a human life on the line, it’s essential. 08_Recovery

Did you feel like patients were in safe hands?

The teamwork at Ninewells is inspiring. There’s no place for egoism or career advancement in that room – everything happens for the safety of the patient.

It’s a powerful thing.

Yes, I find that very moving. The vulnerability of the patient under anaesthesia – it’s a person at their most vulnerable, unconscious and surrounded by so many people.

To find that calm mood, and all these people working together – it’s very tender in a way.

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Has it changed the way you think about surgery around the world?

I was looking on the Lifebox website and I was shocked – I never thought that lack of oximetry was an issue in so many countries.

You show the Checklist twice, once in photos and once in paint – why is that?

After the second viewing we thought that the pictures might be too intense for someone about to undergo surgery. The drawings are a simplification, and even though they’re the same scenes, people seem to prefer them. There are lots of things you don’t want to know before the operation – other than that you are going to be safe.

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They’re very vivid!

I used an impressionistic technique called speed painting where you set a timer, start painting and as soon as the timer goes off, you stop. It makes you keep only the most important aspects of the scene.

How did you relate to the Checklist it as a non-medic?

05b_lightsChecklists happen everywhere. It’s this methodology, a frame of mind behind a sequence of events that shows how teamwork is realised. I used to work as a production assistant at dance festivals – without a checklist we’d never be able to have a performance.

I found the surgical pause particularly poetic. A moment’s thought, everybody stops – it’s like this breath that a performer takes when they go on stage. The lights, the audience, the safety protocol – it’s no joke that the operating room is also called a theatre! 05c_lights

 

All photos copyright 2014 Emmanouil Kapazoglou, University of Dundee

I left my heart…

…in San Francisco,Arrow heart

where the American Society of Anesthesiologists (ASA) held their annual conference this year.

Trolley car

“How beautiful!” everyone back home told you.

Harbour

But you probably spent most of your time here:

Moscone Center

Never mind the early starts…

Coffee cup

…we  had a great time!

Dr Alex Hannenberg and cheque

But then, we had the best seat in the house – a beautiful booth alongside our friends at the ASA’s Global Humanitarian Outreach (GHO) committee:

Booth

With special shout out to the AAGBI’s Great Anaesthesia Bake:

Great Anaesthesia Bake

A Lifebox trustee on the front page of the ANESTHESIOLOGY 2013 Daily News:

Daily News_arrow

And a training workshop on how to implement safe surgical practice in a low-resource setting that inspired real conversation…

Lifebox workshop ASA

…so much conversation that we couldn’t get people to sit down again between sessions.

Lifebox workshop ASA 2We found a good home at a hospital in Nigeria for some oximeters:

Oximeter handover_ASA

and a friend to help carry them there!

Carrying oximeters

We felt like the sun was rising every time we saw this ad across the big screen…

Teleflex adand are enormously grateful to Teleflex, who gave a whole new purpose to trivia and presented us with this giant gameshow cheque.  It means real life change for surgical patients and providers in low-resource settings.

Teleflex presentation

(And comes it its own giant gameshow cheque box.)

Teleflex box

It felt good to work with the ASA as friends and allies for safer surgery, with our upcoming projects in Nicaragua and Guatemala, and the announcement of the First Annual National Lifebox Challenge led by the Residents Component.

Central American project

So even though we had to go home, we took the ASA’s advice –

Be Social

– and told you all about it!

It really was pretty.

SF from the air