Tuesday, 30 October 2018

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.

Friday, 21 September 2018

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)

Wednesday, 19 September 2018

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. )

Monday, 9 July 2018

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.

Thursday, 10 May 2018

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.

Tuesday, 8 May 2018



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.

Thursday, 3 May 2018

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!

Tuesday, 17 April 2018

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.........


Monday, 26 March 2018

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 !!!

Thursday, 15 March 2018

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.

Thursday, 8 March 2018

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'.

Tuesday, 27 February 2018

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.