Build your own surgical sketchbook

Sketchbooks come in every imaginable size, binding and paper to suit any purpose. Coupled with my stationery obsession, I have more sketchbooks than I will ever need or use. One limitation to the sketchbooks, in all their variety, is the lack of customization. You are essentially stuck with whatever order your drawings are in and whatever paper is in that sketchbook.

I came across the Arc Customizable Notebook system from Staples a few months ago. It has been amazing for my Bullet Journal. It contains 8 rings, a durable poly or leather cover and pages that can be moved around. Like a binder in its flexibility but feels like a notebook. I’ve recently thought of applying it to a surgical sketchbook for use as I transition into practice.

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Here’s what one will need:

  • Small Arc Notebook (6-3/8″ x 8-3/4″)
    • Poly cover – $7.99 USD
    • Leather cover – $16.99
  • Tab dividers – $4.99
  • Arc System Desktop Punch – $42.99 (whoa!)
  • Lined paper for written notes
    • Comes with notebook
  • Sketchbook paper of choice
    • For me, it’ll be mostly white paper and a few pages of toned paper
    • 8.5″ x 11″ 45-lb white paper for dry media (cut in half)

My sketchbook will contain sketches for common surgeries, divided into 5 main sections. I have been dragging my feet on this due to the desktop punch. Not only is it pricey, it is also heavy as sin. And I’ll be transporting it across the country for the big move after fellowship.

This book will serve as my own personal surgical atlas and flexible enough to make changes as my techniques evolve.

I’ll post again once I actually do this!

-LCTL

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“You have to learn to look without preconceptions. To let go of what you think and learn to really see.”

Last week, I left class and shared a short walk with the Director of Bioethics at my home institution. Our lively conversation started with bioethics, then went to grant writing, then arts-based research methods and finally, to the intersection of art and medicine. She remembered hearing Laura Ferguson, the artist in residence at NYU School of Medicine, speak at a recent American Society for Bioethics and Humanities conference. It was an odd thing to hear an artist speak about her experience with scoliosis and teaching an art and anatomy at a bioethics conference:

Drawing the Human Heart

For those who want to hear about her experience teaching medical students art and anatomy, I would recommend starting at 24:00 min.

I’ll end this with some beautiful quotes from Laura Ferguson.

On seeing in art:

“The key to good drawing is openness. You have to learn to look without preconceptions. To let go of what you think and learn to really see.”

For those who are learning (and never cease to learn):

“You may not have always the tools or the techniques to get what you see onto the paper, to allow others to see through your eyes. But that is the goal. To bring others into the experience.” 

-LCTL

How to Overcome Your Fear of Drawing

To date, I’ve spoken to three groups of surgeons and trainees, as well as other individuals about the use of drawing for surgical education, documentation and generally “figuring stuff out”. The most common response is, “I can’t draw.” This is coming from surgeons who have two fully-functioning hands, trained for years to operate and have fine motor skills better than the majority of the general population. And yet, the act of drawing is what they do with the scalpel or Bovie (a.k.a. electrocautery tool) in the operating room. For me, I had an inherent fear of drawing until my early thirties. In the end, it took an influential mentor, supportive family and friends, an art class, a sketchbook and the will to try.

It was a mental hurdle, rather than a lack of ability.

Here are 10 steps for anyone to overcome their fear of drawing:

  1. Forget about perfection.
  2. Buy a notebook – Something that is nice enough that you’ll want to use it but not so expensive that you’ll be afraid to use it (ahem, Moleskin). I started off with a regular $2 lined notebook from Staples. I made both written + visual notes and found the lines were less intimidating than blank pages.
  3. Get into a routine of drawing (daily if possible) – This could mean taking 5 minutes at the beginning or end of your day. The key is making it a habit.
  4. Roughly outline the image(s) first and fill in the finer details later – Do this without erasing anything at first. You can always return to this later with a darker pencil or pen over your outline, erasing mistakes later. The key is getting it down when your memory is fresh.
  5. Draw from reference photos or other stationary objects – Learning to draw is not just about mark-making but also honing your skills of observation. Photos and stationary objects will give you more time to observe. For instance, those who are learning to draw figures might go to a museum or gallery to learn on statues first.
  6. Listen to music – This might help for some distraction and “loosen” you up.
  7. Take beginner drawing class or buy a beginner drawing book – I prefer the art class, since it gave me a chance to be among other beginners and realize that I’m not totally off. They might get you to do some exercises to loosen up and be freer with your drawing, depending on the instructor. I found this to be immensely helpful.
  8. Show your work to (supportive) family and friends – Depending on who they are, you might have to be a bit selective on this one. People are generally very encouraging and not expecting you to be Michelangelo.
  9. Deconstruct your subject – Breaking down the object into simple geometric shapes is what many experienced artists still do and makes drawing much more accessible to novices. Then for shading, breaking tones down into 5-6 discreet tones will add realism (but not a necessity at this stage).If you can simplify it, then do so.
  10. Accept that you will never be done – Along the same vein as “Forget about perfection”, there is always something that you could add or change. If you accept that you’ll stop at (arbitrarily) 50% or 75% or 80% of completion, then it will allow you to move on.

Do you have any other tips to share? If so, leave a comment or share them with me @SurgicalArt on Twitter. Oh yes, I’m on Twitter now. Something I never thought I would say.

-LCTL

Retractors

So I had a 5 minute phone conversation about chest retractors over the holidays. I was asked to sketch an open chest (with the lung, rib and intercostal muscles visible) and a chest retractor. After another 5 minutes on Google, this is what I figured it would look like. No idea if the scale is right!

4. Thoracic Surgery - Thoracotomy PS

The Tactile Aspects of Surgery

The other day, I was contacted by a pediatric surgery resident from Portugal whom I had met months ago. He was wondering if I could do a few drawings for a presentation. It would cover different aspects of his training, including urgent surgery, neonatal surgery, abdominal surgery, thoracic surgery, urology, head and neck, burn care and oncology. It would be pro bono and it might get some exposure to the faculty at his hospital. Being early January, I was faced with ethics paper deadlines, research projects and setting up my private practice upon graduation. Nevertheless, I cannot say no.

Given the time constraints, I plan to send him six rough sketches and two completed sketches from my portfolio. Here’s a rough sketch that illustrates midgut volvulus in a newborn baby. It is very “visual pathology”, as my Portuguese colleague put it.

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Perception affects drawing abilities

When learning new skills, some struggle to learn the basics while others pick it up (seemingly) effortlessly. A friend and mentor recently sent me this article:

Why Are Some People Better At Drawing Than Others?

The article states that people who draw well are able to properly “see” their subject and have an innate ability to recognize proportions, light/shadows, etc. In contrast to those who struggle with drawing, who may not properly take in these subtle features. It is no surprise that skilled artists develop an “eye” for detail. Parallels can be drawn for skilled surgeons as well. The medical student may recognize obvious anatomical features. As they progress through their training, they learn to recognize normal versus abnormal characteristics. Further on, they recognize “planes” which broadly describe the natural spaces that occur between tissues. An operation can go well if you get into the right “plane” and the first step is recognizing it.

Fortunately, there is hope for us all!. Practice is the key to improving one’s skill, whether in art or surgery. In addition to the repetitive act of practicing, the important step is also reflecting on the last art piece or the last surgical case and thinking, continuously, how one can improve. In learning either discipline, people have a misconception that practice involves repeatedly “going through the motions”. In other words, “If I just do 100 cases of x, I will be an expert!” That is simply not true or even feasible as a trainee in this day and age. The phrase that comes to mind is, “Insanity is doing the same thing over and over again and expecting different results.” Reflection is integral to practice and without it, one cannot hope to improve. There is often this pressure to do more cases, hurry up!!! It takes every bit of my effort to slow down. Be mindful. And reflect.

-LCTL