Textile Body part two:bypass

 On of the most interesting operations I have watched was the unblocking of an artery which then required a patch. Whilst watching I often begin to compare what is happening to problems I have had when making something and when the blockage was removed I thought of some antique silk pearl string that I had.It was yellowed and tangled and had finally found a purpose!
 I wanted to replicate something of what I had seen of vein harvesting and arterial bypasses for the Textile Body and so my thoughts turned to the delicate stitches and structures which must be handled. 
  I chose cotton organdie which is both sheer and yet robust and used an old technique seen on 1920's afternoon dresses. I inserted rouleaux loops (thin fabric tubes) between two flawless panels of the fabric using a decorative but flexible insertion stitch to attach them. Using a space dyed thread  emphasised the challenges of unpicking such a structure from its surroundings.The colours of the thread change subtly along the work and would be difficult to match if you needed to replace them and the fabric shows every fault and flaw. Part of one of the rouleaux is stuffed with the old silk thread which can be seen above bulging out of the delicate fabric.
 The challenge here is seen in the contrast between the perfect fabric with its delicate embroidery and the problem bulge.How to remove the blockage or even the entire structure is the task,either would require planning and damage control. Which do you do? and how do you prevent damaging the surrounding material.There is a spare rouleaux which could be either used as a replacement or as a bypass to the blockage. The entire piece is woven through the muscle/french knitting layer.
  In fabric you can see the problems of such a procedure without having to have much surgical knowledge and yet the parallels can also be understood medically.

Textile Body part one

One thing kept occurring to me as I watched operations, particularly open surgery, was that the layers of different tissue structures in the body were all strangely familiar. I could see quilting and knitting, fine silk behaviour and embroidery difficulties. To express this I eventually came to the conclusion that I had to make some kind of 'princess and the pea' mattress structure.

  A favourite illustration when I was little was a picture of that multi layered bed.Over time it was reflected in the fabric swatch books that anyone in the fashion or interiors world would be familiar with. Finally the Great Bed of Ware (and its fabric samples that the public can examine) found at the V&A museum decided me on my course of action.

  It would not be anatomically correct but a parallel in material challenges.It would be in colours that I usually work in and not reds and pinks.There would be no cutting, no stitching and hopefully nothing for the squeamish to baulk at. It would be explorative both literally and metaphorically.

  The first layers are about the skin and fat, then muscle and artery.Underneath those are vascular challenges and delicate organ structures. OR quilting,plain knitting, french knitting, rouleaux loops, beading, trapunto quilting,lucet braid, machine embroidery, needlelace, hand embroidery and silk fortune tellers. OR linen, printed cotton, silk, wool, organdie,paper silk, raw silk, clingfilm and elastic bands. I may also include a little corsetry.
 Posts about the individual layers will follow but this one shows the first dissection down into the body.

Beginning

  Back in May I attended a craft seminar which culminated in a session of basket weaving. We had to weave a simple platter in willow. This quickly became an intense sensory experience which was strangely similar to my own practise and yet 'other'. I was taught by Hilary Burns who grows and harvests her own willow, her knowledge of which was to me like that of an alchemist.
   The colours and behaviour of the types of willow were all known to her and she spoke of them as a living force that she was accustomed too. For me the smell of the willow was mysterious and wild and transporting. It is damp,earthy,mossy and aromatic like incense. You are weaving the wild that is within.
   Into my platter I also wove some bramble (like the artist Burne Jones I am very fond of  briar) which had been de-thorned by being dragged through a punctured baked bean tin.
   It was the moment of starting the weave that fascinated me as it was a moment of impossibility. You need the counter tension of the material to hold the weaving together but it is that quality which fights against you.When you begin you feel that you need three hands to hold it all together.It seems unlikely that you will persuade the base struts to stay in place but once the rhythm takes over and the counter tensions are harnessed a platter emerges.
  The wild willow and the wild body, their mystery and the harnessing of their counter forces. The moment of near failure and the joy of using your hands to read and persuade natural materials to move. These are profound experiences for a human. To know courage and creativity changes you.
  It wasn't surgery but I bet surgeons would enjoy it.

Stress management

 ''The greatest need of our time is to clean out the enormous mass of mental and emotional rubbish that clutters our minds.''  Thomas Merton

  Here is a list of the mental and emotional rubbish that must be cleared before I can work:
computers, family problems,presenting work to the world, travel anxiety. admin., financial worries, helplessness, personal safety, invasion of self, dealing with rudeness, evil.
  It is not an exhaustive list but illustrates sufficiently what affects not just my ability to do work but to make work. And of course it is not just me that experiences this.I have seen how frustrating it is for a surgeon to come into work expecting to operate on someone in desperate need only to find that there is no bed for the patient. The consequences can weigh heavily on them and whereas you may not have a vested interest in my mental health you would have in that of your surgeon.
   How do we deal with the lunacy of our lives? It is the act of making and doing that keeps us sane whether you are an artist or doctor.The need to 'do' is a powerful force in our lives and this force must be allowed to flow through us.If thwarted it makes us unhappy and sometimes ill.
   If I could I would give every hospital a garden for the doctors to tend, an art room for them to paint in and a piano in the staff room so that they could keep their hands supple and their hearts peaceful.

Reflection

I have been asked a few times now how being involved with this project has affected my practise. On the first occasion I said ''ask me in two years time''.
  The answer clipped me 'round the ear recently. I had initially tried to produce a kind of 'chaine operatoire' or sequence of events which would lead to an answer. What I made was a pile of sticky notes. It was only this summer that I then felt my answer as a delayed reaction to events.
  As a sensitive soul I feel like one of those old fibre optic ornaments with tiny filament antennae responding to all stimuli around me. When overwhelmed (often) they tend to flatten down so that I can function until 'rebooting' in safety. A new environment will induce this response and so it was with observing surgery.
 The building in itself was a big challenge and I could say a great deal about the inhumanity of large buildings. Then the newby experience of orienting myself  and my 'self' to a new and alien environment. Watching the mechanics of surgery is utterly absorbing and informative and then there is the anti climactic feeling of coming out into the real world afterwards; all these were more than enough to stop me processing something else.
  Over the summer everyone was away and I turned my mind to creating work for the project and then the download began. What became sparklingly clear to me was what a deeply profound experience it is to be in a room with so many people healing another. The energy coming from them is intense.
  Barbara Hepworth spent time as a surgical observer and spoke of the 'unity of purpose'. It is a transcendent experience to be near or in the presence of focused healing energy and it is a lasting one.
  I realise too that this is what I have physically felt from surgeons hands. At first I was puzzled by their touch. When entering a lift or an 'after you' moment in a hallway I would feel their guiding hand on me and really felt that hand. What I was experiencing was their healing energy and it is an extraordinary thing. It was all so obvious but masked by the unfamiliarity of their environment and my struggling sensitivity. Hepworth also wrote about 'things felt but not seen' and now I understand what she meant.

(quotes from Barbara Hepworths letter to Herbert Read, 6.3.48)

Necessary Beauty

  ''Beauty is not adventitious but essential''.
Nan Shepherd made this observation on a mountain.She was speaking of the curve of an eagles' wing or the movement of a running deer.Form and function are one and since nature is very efficient the shape of a birds wing is not coincidence. Beauty lies in the total fulfilment of purpose.
 In conversation with my partner in this residency, a consultant vascular surgeon, we tried to express this by saying that if it looks good it is good. Although this phrase is not as eloquent as Nan Shepherds' we were trying to get to the same understanding of our work, the idea of form and function. Some would consider beauty in a surgical stitch unnecessary but to us it implies a deeper understanding of our materials and their interactions.
  As an embroiderer a finished piece has different requirements to that of a healer and surgeon but we take the same route to get there. We understand the mechanics of the needle in material, the effect of tension on thread and needle and the micro movements involved in seating a stitch in place. If all these are correct and we fulfill our purpose in doing the stitch it is then beautiful.
  At this time of year my garden is busy with the work of the finest lacemakers in the world - spiders. I take advantage of the master class outside my studio and watch them not only create webs from nothing but also repair their successful  but damaged ones. I say this because such an efficient creature does not choose its spot in the garden lightly. It sets up a place of work and knows when it is a good one and stays there.
  The use of tension in their spinning is a thing of wonder. Science is still exploring the biomechanical marvel of spider silk and spider 'glue' but one thing is clear in their webs - there are no ugly webs only beautiful ones that keep them alive.

(quote from Nan Shepherd's 'The Living Mountain'.)

Intuition

...more of my summer mulling! This time some thoughts on intuition.
 Intuition is a tool that you must learn to use.Skills and logic will get you a long way but without intuition you have to keep going the long way 'round. It is not a muddly form of guesswork but a sophisticated tool which must be learnt like any other.
  We have no word for the next phase of intuition use, I have learned to use it by trust.I have also learnt that the logical mind will keep trying to interrupt with suggestions and logical possibilities which usually end badly. It is well meaning but out of its' depth.Using intuition is like swimming rather than running.

(the image above is taken of a moss filled book,part of 'Lachrimae rerum' (found here) )

Perfection

  Over the summer I have been mulling over some of the less obvious aspects of what I see during surgery. In conversation with a few people, artists and surgeons, the ideas of perfection and beauty have come up.
  It is interesting to note what it is that people value in their work but something not so straight forward has become apparent to me. What is technically perfect can be boring to the mind. A work can be imperfect, technically, but still harmonious. Perfection can be very bland whereas glitches and quirks are much more interesting as they suggest possibility. Perfection closes the road to other thought.
  I am currently working on a piece for this project which encompasses my responses as a textile artist to the world of surgery .The image above is of a fortune teller made in fine silk.As I made it I strove to make it as perfect as possible because the material demanded it. The areas that required perfection were in the folds and creases but not always the obvious ones. The final piece needed me to partially destroy all of the work for it to be right

and so in its' imperfection it became the thing of beauty that I needed it to be.

The holy trinity

   I have not just watched the surgeons work but the scrub nurse and the anaesthetist too. This is how it seems to me to work.
   The theatre nurse is at the feet. They act as a gyroscope for all needs external.Tools and people are kept in balance by a constant shifting of focus and awareness of what will be required.Whilst training a scrub nurse I heard the head theatre nurse explain to her how she must give the surgeon options of tools that he is about to need but not require him to answer questions,
''just hand him things, he's sensitive, don't mess with his head.''

The surgeon is in the middle. The bio-mechanic who uses a vast knowledge of consequences.They must see the wood for the trees.The mental toolbox is vast and the decisions are theirs to make.
Voltaire said ''perfection is the enemy of good'' and many surgeons understand why this is true.

The anaesthetist is at the head. They act as a gyroscope for all things unseen; chemical, emotional and even your sanity. Their regard for their patient is the same as the nurses and surgeons but their skill is to think for the unconscious.They have a ''sixth sense for where that space may be''.
 (Helgi Johansson)

The procedure with no name

   Can you tell what is going on in this picture? A hybrid procedure with two interventions perhaps. What happens when you have to keep going back to work because it doesn't fit? For me with textiles it is my least favourite thing to do.Every time you unpick work you risk making the joins or seams more fragile. Excess is always cut away from corners or areas where there may be bulk so if you have to undo a seam you now have hardly anything to work with. However the result has to look as if nothing happened.
    If you are having to mend something where the fabric is older and less likely to hold the stitches do you patch or darn? Do you replace a section or mount the worn area onto a new unseen support fabric? Will the weakened area just tear away anyway? Is there just too much stress at that point and any fix is only a temporary fix.
   In surgery hybrid procedures have all of these challenges both with ageing materials and the uncertainty of what you will actually find when you get in there. Unpicking another persons work is a strange business. You can often find yourself wondering why they 'did that' but alterations are curious things requiring pragmatic thinking and creative problem solving. These are found both in art and surgery.

Pleats

 
   Nobody wants a pleat in their anastomosis but when joining one tiny tube to another it is difficult to assess the fit .The most common problem is simply that the harvested vein is wider than the artery it will join.
  When making clothes the attaching of the sleeve to the body section is a big anastomosis .The problem of mismatched sizing is on a bigger scale. This is usually deliberate e.g. when you want 'ease' over the shoulder blade in a man's suit, the fibres of the material can be compressed in that area to add volume without pleating.
    A problem to avoid though is when the sleeve fabric gets pushed around the armhole during attachment so that you end up with a pleat at the point where you started. Some fabrics stretch more than others and the effect is rather like the dragging on the handrail of an escalator which is moving at a slightly different speed. To prevent this you use marker points called notches. These quarter mark the armhole with corresponding marks on the sleeve so spreading out any excess evenly. Best practise is to tack (also known as basting) the sleeve in first (see image) but most people just pin baste and then sew.

A trip to the vets

   After many visits to watch human surgery it occurred to me that this was not the only form of surgery out there, that in fact much smaller work was being done every day just down the road to me. My local vet was very generous and allowed me to spend time backstage in his surgery watching operations and procedures on small animals and reptiles.
   I was immediately struck by how high tech but hands on it all was. The range of specialist equipment was remarkable; x-ray machine, mini lab, blood analysis,endoscopy facility etc. ,all in one space.In a hospital everything is on different floors and an appointment is needed for each one, here you walk in and your beloved pet is treated straight away.
   During surgery itself I found that the way a vet works is very similar to me working in my studio. He sat at a small table and without the advantage of a scrub nurse had to select and manage all of the tools himself. One patient was a beautiful dragon lizard with a damaged tail. The scales must not be spilt during stitching and care must be taken of the skin (some of which was partially shed revealing a beautiful hexagonal structure). The versatility of understanding different materials rang a chord with my own varied practise.
   A vet not only understands mammals but other species too.Reptiles are now a popular pet and have very specific requirements for their health which are very different to a mammals, even their breathing is different to ours. While we waited for the next patient other occupants were taken care of; canaries, terrapins and axolotls each again with very different environmental and dietary needs.It appears that my vet is also a keen gardener fond of tropical plants.The tiny garden around the surgery is packed with plants which again all have specific needs and all of them are taken care of.
   The multi life-form care at this practise was fascinating and all were there because of a passion to care for those that can not communicate their needs.As we went from the aviary via the palm trees to then feed the terrapins surrounded by trailing plants he explained that it was all there as much for his benefit as for the customers.His quality of life is improved by the green environment and the pet owners can see best practise for caring for non mammals. Combined with the very immediate attention and care the patients got and the direct access to all facilities I wondered how it would be if human medicine were more like this.
   The vets at this practise are independent and capable of performing complex operations but sadly they are a disappearing breed.Local vets are slowly being replaced by corporate 'chains' with less surgical experience referring work out to expensive specialists, supported by the growing pet insurance market. It is a word of warning for human medicine that when money takes over everyone suffers.

Bifurcation

  I have watched several operations where stent has been used to repair or stents have been repaired. They are fascinating things both in the flesh and under x-ray. They are goretex and plated steel wire with tiny gold markers and seem otherworldly. They are also hand stitched and often made to order so I decided that I would try making one. Mine of course would not be surgical but an embroiderers version so I set about making a pattern for a tiny bifurcated construction.

    I used silk organza and hand stitched the french seams to make the two asymmetric tubes. Then the enamelled brass wire was bent into shape ready for stitching onto the trousers! I had to make a rig to put this onto as it had to be stitched in the round and the tubes were narrower than my fingers.I ended up using some of my jewellery making equipment (clamp, ring gauge and doming punch) to get a two legged form to put it onto.
    Using red silk it was simply a matter of whip stitching the wire into place.I say simply but in fact it was fraught with problems as the tubes shifted, the wires bent and the rig kept moving. Then there was the matter of the embroiderers training getting in the way ! I am so used to hiding all the threads and trying to make stitches invisible, especially whip stitch, that I kept trying to run the threads inside the tubes i.e. the hard way, when in fact the stitches must run on the outside of the work with a stent. And of course I use straight needles not curved.
   It was a mass of technical challenges but in the end it felt right in my hand, like a little bird, robust and yet fragile.

Colour

The one thing that still strikes me during surgery is the colour palette. I found myself pondering over how to represent this and so have begun with this piece of embroidery. It has a linear design to show the flow of activity, moving from sky blues and aquamarine into the reds and pinks that I have mentioned before.

For the central 'section' I have used more raised stitches both as reference to the inside of the body and to the difficulties of sewing in small spaces.Minimal access embroidery.

Femoral Bypass

 

This was a seven hour operation and nobody gets a break.Sometimes the surgeons get to sit. I stood and watched and these are my thoughts.
 A vein harvesting is like unpicking very fine fabric, you can't damage any of the surrounding material but it is securely and stubbornly attached to it.
 Over a hundred sutures needles are used; the endless counting and opening of sterile packets .All packaging is opened by a theatre nurse in a peel apart movement and then offered to the scrub nurse without handling the contents.
 Bead sutures have big beads on the end.
7-0 needles are very tiny, like thorns.
This procedure requires six surgeons working all at once.
The vein is passed through a metal tube which has been inserted under the flesh, it has been measured to make sure it is long enough and has been checked for twists. It has had a catheter passed along it to check that there are no obstructions.The surgeon noted any resistance he felt as threaded the catheter through. It is like threading elastic through a waistband or threading a rouleaux loop into trapunto quilting, it is all about the resistance, the pull and the timing.
Surgeons use glue.

Finger Tips

The image above perfectly illustrates how I use my fingers when making needlelace but it does not tell you what I can feel with them. Often I know where the thread is rather than feel where it is. The pressure I use to guide both needle and thread is so habitual that it can not be described.It has been written into me.
   This is a riddle that you have to unravel when you teach someone how to do anything.You show them, you guide them and then sympathise when things go wrong.Some learning can only be found during touch.Some teaching can only be done once someone has learnt.Some teaching conversations are just comparisons of experience. '' well you know when you do that thing and it felt like that, well this is a bit like it''.
  The use of tools is something uncommon amongst the creatures of this world and we humans specialise in it.We don't always know just how good we are at it until we teach or talk to others in different fields.
I spoke recently with Mr.Donald Sammut a consultant hand surgeon about what it is to be an expert. Mr.Sammut was drawing long before he was a surgeon and his work as an artist crosses over into that work with his informative illustrations of hand anatomy. We spoke about the importance of empathy in our work and how it is a mistake not to prepare properly beforehand.For Donald this means getting to know the patient and then making sure all decisions are informed ones. I must know about my work before I make it even if it is something I have never made before.Then comes technical preparation which comes from long experience.After that it is possible that you will not know what there is to find until you begin, both as an artist and a surgeon .You rely then on your expertise.
  Interestingly I was told that it is your fingernail that gives your brain the information about pressure. It gives the pulp in your fingertips a sounding board and without it there would be only wobble !

Articles

Two articles have been published this year already about this project.
 The first is in The Lancet and focuses entirely on this project.
The second is in Nature and looks at the wider project base of Roger Kneebone's work with Imperial College London and the Royal College of Music, both articles are written by him.

Alterations

  Imagine that you have a beautifully embroidered dress with beading amongst the embroidery.The fabric is fine and the dress is lined (the lining always being a little shorter). Then you rip the hem and the fabric is too damaged to repair.For the most part the dress is still sound so you can just shorten it.There is, of course, no 'just' about it.
    Here is a checklist of things to remember:
1. What length do you want the hem to finally be?
2.How much hem allowance do you need?
3.Where are you going to cut the embroidery to minimise damage to the design?
4.Where will you cut the embroidery to minimise damage to the stitches?
5.How will you manage the beading when you cut through the continuous thread?
6.Remember the lining must be shortened.
7.You must allow for the hem allowance before you cut.
and will there be a sense of loss at the change? will it be the same dress?
   I watched a lower leg being removed and the list of concerns when shortening a person are also complex.The initial cut has to be carefully considered and then made with precision.After this there are parts to be secured, saved and fastened.The damage and excess are removed and the hem turned up.Some gentle manipulation to make sure that the delicate material hangs correctly and the work is done.