Old silk

  The image above is one that is often with me when I see aneurysm repairs and was the subject of discussion with a surgeon recently. She described the stringing and disintegration of the inside of a diseased artery and I immediately could picture it and understand what the challenges were in trying to mend this. I spoke of the shattering of the silk and surrounding weak tissue and was similarly understood by her.
  A few weeks later a similar operation revealed all those problems writ large and with high drama. A complex operation with weak materials and then a rupture.Heavy blood loss ensued and a room of high emotion as the surgeons worked frantically, the scrub nurse worked frantically and likewise the anaesthetic team. I found that I was holding my breath as this 'piece of silk' disintegrated in their hands and I saw a miracle as they raised the Titanic.
  How does an expert work? they cope with deteriorating situations making difficult decisions in the moment. How do you spot invisible deterioration? How do you decide how far to go? How do you decide that you can't do anything, that the mend itself will do more damage than the tear. I know these decisions, they are material. How do you know when to cut your losses? How do you go from a planned small repair to a big unexpected one?There is no hindsight only expertise.
 All the while the other team members worked like bees, so quietly and efficiently. The clear liquid in the drip was changed for thick red, then clear red, then two shades of yellow. When the emergency was over it seemed that they all stood quietly and cleaned their antennae.
  I realised that pledgets are small promises made with each stitch.

In the moment

   I do not takes notes during surgery but rather allow the many new visual experiences to sink in as they happen. Afterwards I will sift through and do a quick diary which is often like writing down a dream; I don't always have a full view of surgery let alone an understanding of what I am watching from an anatomical perspective but I know colour and material and tool use. Above is an image of a piece of my work in progress at a rather confusing moment visually!  I know how to translate this but anatomy is another thing so below is an extract from one diary entry made about half an hour after coming out of theatre.

 ''Vertical incision so different, more solid layers revealed.....thick and compact.
Organs in detail-MANGO-finally named that colour! and pale blue pinks and organic egg yolk,'thought of 90's catwalk shows of bright colour clashes. Food colours in the abdomen, flame colours in the blood. Big crochet structure,uneven bobbles with thread capillaries and single cell clingfilm membranes.
(surgeon)opens out another fan shaped translucent structure with a fat pink edge and yellow centre and the light shines through it.
The cancer feels hard in the stomach lining, a suede beige, but hardly different to its' surroundings-a slight distortion but deadly. (I should point out at this point that once the tumour had been removed I was allowed under supervision to touch it).
Glimpses of pink things,smooth and shiny,translucent and dense......
The smell of someone's perfume mingled with blood stayed with me .A wild aromatic smell, otherness,strangeness,damp places of the world.
Theatre nurses,intense and watchful,quietly fetching equipment,listening.''

Torn lace collar

 

Recently I was given an old lace collar from the 1930's or older. It was all screwed up but still beautiful, an asymmetric design on fine lawn cotton with embroidery and a bobbin lace edging. There is a tear in the fabric at the front near the embroidery.
   It occurred to me that mending this would present parallels to vascular surgery and so I made these initial notes on examining it:
Mending Delicate Fabrics:
Prepare sequence of mending after assessment-washing, shaping, reassessing.
Tiny details almost invisible to the human eye which we disregard,detail was once more important and readable as a language of stitch.
Hand work that now looks to us like machine work so we don't believe it.
Tiny stitches in very fine fabric but no distortion from the needle despite heavy thread.

Raw edge to the cotton itself but so many embroidery stitches that finishing is unnecessary to stabilise the edge.
   After gently damping the collar with a wet cloth,(not submerging in water because the weight of water could be damaging) I carefully reshaped it onto a thick towel. It was not the asymmetric design I had thought but a symmetrical one that had lost a part.The true shape was now revealed as  rhomboid with an elliptical centre ,the lace still limply edging the whole. Once carefully ironed the original nature of the collar emerged as a 4D shape rather like a mesentery (organ of the digestive system) .....all frilly!!

  It is only after these observations that the job of mending the tear was the focus.

Poached eggs

  In the art world and related universes much is spoken of process, the strange path by which we create something. We all have our different ways but in general it is almost more important to us than the final product.Our work then goes out into the world as a mystery to all but a few. These mysteries are formed because we have hidden the process which we do for a multitude of reasons. One example is in the recording of music.I enjoy hearing the sounds of instruments themselves as it tells me that the music is human and is being made. In recording the sound though it had been decided that only the 'music' is worth hearing and not the creak of a pedal or sigh of the musician.
  By hiding the process, for whatever reason, we begin to lose connection to our possibilities of creation.We begin to feel that making an object is something done by 'others'. We lose sight of how what we do in the ordinary world is connected to more mysterious worlds. This is where the work I am doing with Imperial has relevance. I try and see the parallel world that we inhabit and try and investigate what I find. Some of these investigations are pieces of work like the Textile Body but others are more private.
   I have mentioned how I find myself doing garden surgery when planting bulbs but to understand the experience of vascular surgery for myself  I undertook a stranger process. For several weeks I had a poached egg for breakfast and each day I had to dissect the yoke out before I could eat it.Each egg was slightly different in texture and fragility and every day I would gently cut the surface membrane of the yoke and then attempt to slide my knife underneath or around it to remove it. Each day was unsuccessful but each day I learnt the feel under the knife of a delicate material which was unknowable in any other way.

Look ye also

   I suppose it was only a matter of time before I had to think about death. Two years ago I visited two medical museums and was profoundly affected by the emotion stored within them. I still think of all those people in jars and I want to sing them all home.
   It was on holiday recently that I found the story of Joan Wytte and the story of her remains and how they were only recently interred after being kept for decades in a museum. Europeans have strange habits, we collect everything and put it in museums for educational purposes.We look but we don't see, we inter information but don't touch it. All the evidence of life is carefully documented, a brief flash in the universe whereas death is eternal, is it a way of thanking the dead?
   By looking and feeling we can learn what we didn't know there was to learn.I have watched two operations recently that didn't go well and for very different reasons.One was a scene of heroic endeavour to save someone, successfully, and the other was unexpectedly doomed from the start. I saw one life go to the edge and I saw another given its' sell by date. I found myself at scenes of true drama,quiet and intense and unknowable.The liminal space between life and death was palpable in both cases but after one there was relief at a life saved and the other the abject sorrow of helplessness in the face of the insurmountable. I heard medical staff saying sorry to the patient even though they were under anaesthesia.
   It is often at these moments that we learn what our purpose is, when we look we must feel.
The writer Denys Watkins-Pritchard (BB) found an inscription on a gravestone which says,

The wonder of the world,
the beauty and the power,
the shapes of things,
their colours lights and shades:
these I saw.
Look ye also while life lasts.

illustration by Denys Watkins-Pritchard (BB)

Surgical dexterity

  You may have heard the report today discussing the work that Prof.Roger Kneebone is doing with surgical education and bringing the arts into science. He is about to start his series of Gresham lectures tomorrow at the Museum of London where he will elaborate on his ground breaking work.


image courtesy of Rachael Matthews who is also very dexterous.

More questions than answers

   'Two years into this project and the more I find the less I know !
I began with the idea of parallels, between my specialism in embroidery and that of vascular surgery and also between craft and medicine. I find that to dwell on the obvious parallels and differences is a distraction. I am not here to look at the obvious but to look at the unseen.
   What is unseen? Embodied knowledge in the hands, expert knowledge and assumptions.


(image from a series of pieces around the Norse myth of Gleipnir, this piece is the cats' footsteps)

Off colour

 

  To further my understanding of the use of colour in medicine I was studying the medical illustrations found in 'The Sick Rose' by Richard Barnett. It was not an easy viewing even in illustrative form but it was that very fact that made me focus on what I was seeing, the artists view of sickness. All kinds of conditions are illustrated, mostly of diseased or afflicted skin and there was something that linked them all;specific colours. These I found to be a range of browns with blue in, sepia with greys and teal blue washes.In order to suggest ill health you simply add shades of blue green, for decay a hue of grey brown.
  I had been reading about a very successful illustrator who gave his favourite colour to use as being sepia with a touch of ultramarine. A friend of mine, of the same ilk, agreed saying you had to watch which brand of Payne's grey you bought (it is usually a mix of ultramarine and burnt sienna) in case it was too blue. A quick internet hunt gave a similar picture: many illustrators like using blues and browns.
  A brief note on colour mixing;
red and yellow make orange,blue and red make purple, yellow and blue make green.
then.......mix all three to make brown, in fact keep mixing the lot for every shade of brown and dirgy grey (depending on the pigments used). To get a blue toned brown simply add more blue.
  Flat grey is a different beast all together and not popular as it kills the surrounding colours but this is where I found the surgeons differed. An interesting chat with an orthopaedic consultant revealed that she lives in a greyscale world. Her sensitivity to grey has developed over many years so that she can read an xray with more subtlety than her registrars.This means that she can spot things that are causing pain or have serious implications where others can not. It is a skill that only develops with time.

 (As an interesting glimpse of what it is really like to be an illustrator read here. )

Colours of the body

  Sensitivity to colour is part of the furniture for any textile artist.I can name or give names to any colour and can see and love subtle changes and shifts and vibrations within colours which give them life. Lighting is very important in the studio, I use three lamps all using different systems of full spectrum bulbs and get three different effects!!
  So, whilst watching an anti reflux procedure or fundoplication done laparoscopically with full spectrum LED lights I was captivated by the colour.Words were not enough to get across the range of shades so I went to my embroidery thread drawer and spent time looking at my ombre dyed silks and these are what I chose.
  The first image here looks at some colours that you might expect to find but gold?? Under LED and with minimally invasive techniques the fat in membrane glistens like gold dust.

Muscle  has a dark berry summer pudding range, fats are more peach melba and mango.

  Around the edges of the abdominal cavity you find bluer toned pinks which shift into the glistening opalescence of the abdominal wall, it made me think of freshwater fish. Bluey greys are around the margins with slatey browns like an approaching storm or cocoa. The deepest reds are like a cotinus coggygria or smoke bush with its shifting ember red to purple black

  

 A while back I spoke about gardening and knew I would have to use this as a tool for material understanding. Sensitivity to colour and understanding complex surfaces are also part of a gardeners'skill. The best gardens have sublime or unexpected colour use in their planting because the gardener has a sensitivity to which blue toned pinks match those chartreuse greens or which hot reds bring out a vibrant pink. They also know when something looks wrong, either aesthetically or because a plant is sick, by its' colour or texture.

 I am beginning to look at how we understand what we mean by 'wrong' by looking at colour perception.Over the next phase of my residency I will be exploring this facility and that of touch to learn to see what a surgeon sees.

p.s. this peony from my garden against a heuchera and an erysimum.

Surgical planes

 

 Planes in surgery may sound a bit odd but it is a term also used in the art world so I was not unfamiliar with it myself. In vascular surgery you are concerned with particular areas and the focus is on the access to arteries. I am fairly used to this view of the body now so it was when I watched a 'reflection' that I had a leap in understanding how the body is structured. It was still with a vascular focus though so when I watched a stomach cancer being removed the penny finally dropped.
  Secret compartments, sliding panels, hidden doors, inner rooms, magic cabinets, this is what it means! Like a puzzle box the body can hide and reveal itself in the same spaces like a magic trick. If you had those puzzle cubes as a child that turn and fold to reveal different pictures this is how the body can be.
 To see a glimpse of this marvel is profound, more so because it was only a slight shift in perception that gave it away.

Reflection

 

Reflection is such a gentle sounding word, with its watery esoteric meaning, so when I was told I was going to watch a surgical reflection I could not imagine what I was going to see. The point of the operation was to repair two aneurysms that were in very hard to reach areas, that is to say behind other organs. These organs had to move out of the way and that very very simply is a reflection.
   I can only use the metaphor of a tightly packed wardrobe to describe this procedure. Some of the clothes have to come out and the others must be carefully moved along one way and then the other to get at the mending behind. It is the kind of operation where a surgeon must see with their hands. This was the dominant feature of what I saw, that of hands moving with their own sight and understanding.Gentle cradling movements, sliding over one part to find another and lifting soft structures. This was how it was being taught too as it can only be learnt by touch.Hands were guided and taught to feel their way around delicate areas, membranes and connective tissue felt and tested and parted.So material knowledge is gained of all the mysterious areas of the body.
 Surgeons speak of planes within the body but it was not until I watched another type of operation later that I fully understood what this meant.

Imperial Festival

  Last weekend I was at Imperial College London's public festival where all can come and see the research work that is done at the college. The work that I am doing with ICCESS was on show and we were explaining how the Textile Body worked by having surgeons operate on it for a fascinated public. It was wonderful for me to see consultants happily describing what they do and engaging with it.They trained many future surgeons that day and I am very proud and grateful to them for coming along to help!

In my garden I am queen

 The other day I was planting some bulbs out in a tricky spot in the garden. The soil was a bit dry and full of rubble , there was the usual ground elder to remove and the bed is tilted and at an awkward angle. To top it all there is a very old clematis vine in front of the spot and somewhere very nearby its roots. The vine lay across the planting hole and I found myself reaching for my claw rake and using it as a retractor.

 Would this have come to mind had I not spent some eighty hours so far watching surgeons use their tools in tricky spots? I always look to nature for inspiration in my work ,usually for the subject matter, but now I find it  helpful to bridge the gap of experience. Naturally I am not allowed to actually get involved during surgery and this had initially presented me with a dilemma. How do I understand the hands of another without trying what they do themselves?

 Whilst planting I always have to remove weed roots, note the soil condition and not chop the worms up as I dig. The soil structure is 'healable' but there are schools of thought that regard pit planting as preferable to digging over the whole bed. Choice of planting relies on knowing the spot that you want to plant up; dry? shaded? well drained?

 A multi dimensional understanding is key in gardening. This means that you combine the understanding of the plants' needs, the ecosystem of your garden, choice of colour  and how time affects the outcome. And yet these are qualities of all expert practise, we all use multi dimensional thinking to produce our work, artist, surgeon or gardener.

 My thoughts turn to understanding colour and complex surfaces hence the image above.This demands a whole post later.........

.

Lace makers fingers

 

  A recent discussion with a hand surgeon open end up a new path of thought for me. An initial discussion about right angles cuts and the 'tip' of the cut dying back prompted me to make some stitch samples to illustrate how I tackle delicate cuts and repairs.
 I took these to our next meeting and our conversation took off! Our talk was all crossing paths between tiny stitches,straight needles, needle handling, needlelace, micro stitches,artery patterns in the hand,where you can cut and where you must avoid it, patching where there is loss and why aren't there more curved cuts.

 Two examples which I will expand on here show how we use the same solutions to very different problems. The first is with patching areas where there is tissue loss. Imagine the shape of the back pocket on your jeans and then removing it from a piece of fabric.Remove a little from the top edge of the hole so that it is now bigger than the patch. Now stitch the patch back in! This is accomplished by first seaming up part of the pointed end of the hole and then re-positioning the patch centrally and stitching it back. There are shades of 1930's pattern cutting in this with attendant issues of redistributing extra fabric. Similarly if you want to make an armhole smaller and fit the sleeve in you would do something very like it.
  It was also interesting to see my friends beautiful drawing of her techniques which were more than eloquent and very necessary.
 The other patch solution which impressed me was how to mend a hole with an asymmetric patch. As long as the length of each 'seam' is the same then it will work. This is not a mending solution for clothes but damaged fingers. However this principal is also used to create a good fit in tailoring and corsetry. What happens when you put two different shapes with equal sides together is that one side will kick out and give shape and volume and elegance of fit--the 'armhole to sleeve head' seam and sprung seams over the hips on corsets are two examples. This is because you are tricking a flat surface into curving over a 3D surface and thus giving it room to expand too.

  These things are always easier to see and understand then describe...which led our discussion to expert knowledge. At this point we went and discussed a magnificent piece of lace in the European gallery at the V&A! This marvel of point lace was a perfect parallel with its micro stitches and complex construction sequence.I find that surgeons always understand lacemaking !!!

Textile Body part five: The unknown

  It takes a while to get to the site of the operation but after passing through the labyrinth of the body we arrive at the cramped confines of the organs.Tucked away in the core they are mute and mysterious, their internal structures hidden from view underneath the smooth surface. Here is where the tiny stitches will be, the micro movements made with trained hands, the millimetre precision judged.

 It was with some interest that I found that different organs are tougher than others due to both age and structure so I chose three different types of fabric which would behave very differently. Not wanting to simply make bad anatomical soft toys I chose instead origami to represent the complexity of the body.I have loved the folded fortune teller since a child, the tactile experience of the folding sequence and then finding that you have made finger pockets and fold out layered areas to write messages on.

 In fabric they take on more mystery so I chose first paper silk which as its' name suggests behaves like paper and takes a fold very well.It is incredibly lightweight and yet resilient. Inspired by a conversation with a paediatrician I chose it to represent neonatal organs. I also chose a coarse weave linen and a slub silk.The latter was heavily frayed and after completing the folding  these were the ones that I chose to squash out of shape to show damage.

  Inside I have embroidered samples of stitches that I use in my raised embroidery and lacemaking work. The linen organs all have variations of buttonhole stitch whilst the silk organs have examples of picot stitch, french knots, cup stitch and, shown here, needlelace.

   Each of these stitches is relatively easy to work on their own and on flat fabric but when they are grouped together they present lots more difficulties.The needle is more likely to hit other stitches as you sew and your thread becomes spiralled and catches on the fabric.These are the same challenges as minimal access surgery both in the technicality of the stitch and of handling several materials at once.

Textile Body part four: Noughts and crosses

  My area of observation in surgery has so far been for vascular surgery. I understood that there would be examples of very fine stitch work but had not fully considered how it was that you arrived at the area to be mended. It was the detailed sequence of the route into the body that inspired much of this 'body' that I have made.

  Watching several surgeons working at the same time I was aware that they don't just have to stitch but plan and negotiate physical space, both within the confined area inside the body but outside it too.

Around the patient there are at least three surgeons plus a medical student and the scrub nurse...and sometimes me! The surgeons must both negotiate elbow space around the operation and assist each other with tight manoeuvres, referred to as 'following'. The sequence they must follow into their target area has already been planned and in some cases marked out on the body after studying scans and case discussions.

  The image above shows how I have divided up some of these skills; on the right the woven materials of muscle and fascia and artery with their attendant material challenges to negotiate in order to get at the problem. On the left a game of noughts and crosses in fine organza.

  There is a style of quilting called trapunto which was once very fashionably worked on sheer fabrics.Patterns were hand stitched as double rows of parallel stitches on organza.Through the transparent material you could see cords impossibly threaded through these channels but with no apparent entry or exit holes.The fineness of the material allows for no mistake not least because it can be easily damaged.

  My version has tubular ribbons threaded through the pattern of '0' and 'X' variations, each slightly different to illustrate subtle differences in the challenge of threading them through. The trick is planning and understanding your materials;where to start? what tool to use? how far can the material be pushed and does it have hidden qualities?

 It seemed to me that a thought experiment was just the thing for this layer in my 'body'.

Textile Body part three; fragility

  This third post about this piece looks at how fragile some materials are. I was fascinated by how parts of the gut are lifted out of the body during open surgery to give the surgeon better access to the mending site beneath. The living structure is cared for whilst out in the open and still functions despite what is going on around, in fact it moves.
  This led to some interesting discussions with surgeons as to the nature of the tissues involved and I began to understand the similarities between these and certain fabrics that I know. One of the most extraordinary is connective tissue and the mysentery. This tissue type has more poetry about it than any other as it is changeable and elusive and somewhat mysterious. It webs its' way through the body and reveals itself under a microscope as dewy, fibrous, filmy and like organza.
  Throughout this piece of work  I have represented it in four ways;as clingfilm around the 'spine', as silver lurex stitches between layers of 'skin', as wide organza ribbon weaving through the 'muscle' and as layered organza in the gut. This last one is featured here and is the one where I took the most artistic liberty with the form!
  My elastic band lucet braid gut was tested and approved by a colorectal surgeon and I added in different thicknesses of braid as directed. There are also areas of damage to it which can be 'repaired'. But then I felt that it should sit in a bag as it does when it comes 'out' for an operation and so I used an idea from a screen I made some years ago. Layered organza was finely stitched in patterns and then cut away between the stitches.Some areas were left complete and some are cut away and very fragile. Betweeen these are more unseen areas  of 'damage'.
  To complete the surface I added scraps of organza as strange little florets because the cut edges catch on all around them, rather like the regrowing fascia can in the gut after an operation.
 The final touch was to put a drawstring around the edge of the bag and sit the 'guts' inside.They then sit atop the 'vascular' layer of the 'body' and have to be carefully extricated every time we demonstrate it.
  The organza has interesting qualities in this its 'organdy' version, that is to say in cotton. Despite its fine weave it holds shape well and can be used for very sculptural work. As it is transparent it allows no faults or hiding of mistakes. It is both strong and very fragile, mostly when cut into smaller pieces where it starts to disintegrate.By layering it you can create what I have been told are perineal spaces within the work!
 The final poetic mysenteric bag is shown here.