For Surgeons, Artistry Is Vehicle for Helping Others

Visual art, particularly drawing, has been a part of medicine for centuries—albeit often less for artistic ends per se than the practicalities of explaining or recording details of clinical findings and surgical interventions.¹

However, there has never been a firm line between clinical imagery and art. Leonardo da Vinci’s studies of human anatomy have long been regarded as art, for instance, and the Nobel Prize-winning neuroanatomist Santiago Ramón y Cajal (1852–1934) produced ink drawings of neurons and glial cells that are now displayed in art museums.²

Founding ACS member Robert L. Dickinson, MD, FACS (1861–1950), a gynecological surgeon from New York, New York, created not only drawings meant to increase public understanding of health information, but also portraits and landscapes sketched during a 1926 trip he took to Scandinavia with other early ACS members to learn about surgical techniques.

In the present day, the idea of visual art as a support for medical practice is commonplace. Researchers have documented positive outcomes of programs for creating drawings and sculptures that teach anatomy, hand-eye coordination, and communication to medical students.³ Some have raised the point that, in an increasingly digital world, the analog quality of making art permits surgical trainees to develop manual dexterity by working with art materials.³

Others have advocated for close observation of fine art, particularly images of the human form, to hone students’ abilities to closely observe patients for diagnostic purposes.⁴ In one case, this activity has been more than mere skills practice: in 2019, a practicing cardiologist observing David, the famous statue by Michelangelo (1475–1564) in Florence, Italy, noticed a finely rendered jugular vein on the statue’s neck and renamed this sign of stress, elevated intracardiac pressures, and possible cardiac dysfunction the David sign.⁵

Still others have described art creation and appreciation as ways to preserve physician well-being.⁶

Very few studies seem to have investigated not just art, but craft. While some surgeons create two-dimensional fine art, other examples of current practitioners are in fact artisans: violinmaker Daniel C. Lu, MD, PhD, for example, or quiltmaker Eileen M. Bulger, MD, FACS, Medical Director of ACS Trauma Programs.

Grouping these two surgeon-artists with surgeon-turned-painter Steven Snodgrass, MD, FACS, reveals a new possibility about why surgeons create art. For these surgeons, this work is not necessarily or solely about developing clinical acumen or even maintaining personal well-being. Rather, for all three, a key purpose of making art lies in the social ties and practical impact connected to the objects they create.

Counterbalance and Refinement

Dr. Lu, a neurosurgeon, vice-chair of research in the Department of Neurosurgery, and principal investigator of the Neuroplasticity and Repair Laboratory at the University of California, Los Angeles (UCLA), began playing violin at age 12. His journey into making violins was much briefer than that long history might suggest, however.

One day in 2012, when visiting Angeles Violin Shop in Los Angeles, he spontaneously asked the owner, violinmaker Jeffrey Muller, if he could learn to make his own violins there. Although Muller did not typically offer lessons, he agreed to teach Dr. Lu. The match turned out to be uniquely powerful. “Not everyone is that open and generous in terms of offering their skills and wisdom on how to make this,” Dr. Lu said. “So, it was the right match at the right time and right place with the right person that brought this about.”

While many amateurs can make passable stringed instruments, Dr. Lu has attained the rather unique achievement of creating instruments suitable for professional-level musicians. Working mostly at night after his two young children are asleep, he creates violins that are so sought after they require a waiting list. “I’m quite backed up in terms of having two or three that I need to complete,” he said.

Although creating music, rather than fabricating the instruments to play it, is the more widely acknowledged musical art form, Dr. Lu believes his work is itself an art. “There are a lot of nuances and creativity that go into making a violin, in a way that you can still express yourself,” he said, explaining that individual luthiers, including the enduringly famous Antoni Stradivari (1644–1737) and Giuseppe Guarneri (1698–1744), have created instruments that reflect their personal approaches and feel and sound highly distinctive from those of others.

For Dr. Lu, the process of making violins is both a counterbalance to his surgical practice and a refinement of it. “I totally love the aspect that is rooted in tradition,” he said. “A lot of this stuff that I’m doing is untainted by advancements in technology. It’s a nice counterbalance to the modern world that we live in right now.”

Yet, he also placed violin-making in the range of other hands-on hobbies he’s enjoyed, such as fixing cars and playing video games. Dr. Lu said all these activities have honed his focus on understanding how things work and improved his hand-eye coordination and manual dexterity—skills he uses in his neurosurgical practice—while permitting him to experiment in a low-stakes environment.

The benefits flow both ways, he said, attributing his success as a violin maker in part to his surgical background as well. “The skillset for making a violin flows naturally from being a surgeon and being very exacting,” explained Dr. Lu.

A Way to Be in the Moment

Dr. Snodgrass, a surgeon turned painter, also connects his artistic practice to his surgical career.

After retiring from surgery at age 48 due to severe glaucoma, Dr. Snodgrass took up martial arts, eventually attaining a sixth-degree black belt. While contemplating the ways that surgery and martial arts both depend on understanding human anatomy, Dr. Snodgrass also began to wonder what using the motion of martial arts to apply paint to a canvas would create. Eventually, with some trepidation, he began to experiment.

The resulting abstract paintings have been shown at three galleries and received a warm reception from audiences. “I think part of why it’s liked so much is because it’s from the gut,” Dr. Snodgrass said of his work’s success. “It’s raw, and it’s real, and I think those are the qualifications that make for good art.”

As a result, he said, “I feel like I’ve turned a major negative diagnosis into a positive, because glaucoma has given me a special appreciation for color and texture. When you think you’re going to lose your eyesight, it becomes more precious.”

The diagnosis was indeed no small loss, since it precipitated an end to his surgical career. Dr. Snodgrass, a general vascular surgeon, was in private practice and affiliated with HCA Greenview Hospital and Medical Center (now TriStar Greenview Regional Hospital) in Bowling Green, Kentucky. “If you saw me as a patient, you were the sickest of the sick or the most injured of the injured. I did big, complex cases.”

The intensity of his case mix created a life of extreme busyness, which Dr. Snodgrass called a boon. “I really loved it. I was really in the moment all the time.”

Now, “I treat each canvas like a patient,” attending to it carefully, he said, a process that is “just like when you are doing a complex case. You’re in your own mind, working through it and solving problems, and that transfers over to the paint. It’s because you are so totally in the moment.”

Relaxation and Expression

Dr. Bulger, a surgeon in the Division of Trauma, Burn, and Critical Care Surgery at the University of Washington (UW), and chief of surgery at Harborview Medical Center in Seattle, began quilting as a surgical resident, when another resident offered to teach her to make a quilt for the baby she was then expecting. She began with no experience sewing anything but “surgical things,” she said, quickly coming to enjoy the craft.

Since then, Dr. Bulger has created a steady stream of quilts in a wide range of styles. She gently eschews the idea that quilting, with its aesthetic charms and meditatively repetitive motions, represents a kind of psychological corrective to the high-stress work of trauma surgery. Instead, she called it “a work-life balance sort of thing,” and explained, “It’s a great way to relax. It’s a great way to create things that you know give people joy or comfort.”

Indeed, Dr. Bulger has made some quilts for practical use, including as gifts for newborns and relatives’ wedding anniversaries. But she also feels quilting is an art form in itself. “I think anybody who quilts should probably be considered an artist,” she said.

She explained that the work can be sophisticated and complex in style and technique, as well as an important vehicle for expression. Speaking of quilting’s long history, she noted, “Some of the historical quilts were really a way for women in very suppressed environments to have their voices heard and show what they were thinking.”

While she herself evinces no particular oppression, she, too, has focused her quilting on communicating her interests. On the 24th floor of the ACS headquarters in Chicago, Illinois, a quilt by Dr. Bulger (she calls it “the best one I’ve ever done”) celebrates the ACS Committee on Trauma (COT)’s 100th anniversary in 2022. It also happens to reflect her own long history of working with the COT.

The quilt is divided into 37 panels, each of which Dr. Bulger carefully designed to reflect the COT’s mission. For example, two panels contain two halves of the globe, reflecting the worldwide reach of Advanced Trauma Life Support^® (ATLS^®), a program that has been taught in more than 80 countries. (Dr. Bulger herself has helped promulgate ATLS in Rwanda and other countries via the ACS Health Outreach Program for Equity in Global Surgery, the College’s domestic and global surgery volunteerism initiative.)

Elsewhere on the quilt, the range of colors for human figures captures the COT commitment to diversity, and one panel shows the US Capitol building in purple, a color chosen to combine the red motif of the Republican Party with the blue of the Democrats in a nod to bipartisanship in COT advocacy.

A large center panel shows the COT logo, which depicts a stylized injured patient. “We try to keep the patient at the center of everything that we do in the Committee on Trauma,” Dr. Bulger explained. “That’s the core of the philosophy of the COT.”

Doing Good for Others—and Oneself

For all these surgeon-artists, making art objects is a vehicle to a refinement of their own lives. But it is more than that: all three are also interested in seeing their creative work help others.

Over time, Dr. Snodgrass has expanded his interest in art to focus on sharing the benefits he gains from it—even as this transcends his initial interest in human anatomy and movement. “We focus so much on the anatomy. What’s broken? Fix it,” he said. “You have to pause and think that’s actually a human being there, and that human being is made up of much more than their disease, and we have to say, ‘What can we do to make this better emotionally for the patient?’ I think art therapy is vastly underused.”

He has developed a connection with Americans for the Arts, a nonprofit organization that advocates for the arts, to promote art therapy. He said his advocacy goal is for art therapy to be included in usual and customary insurance coverage, thus facilitating its wider use.

In addition, he has established an online venture, the Williams-Snodgrass Art Gallery, through which he donates a portion of each gallery commission to Vanderbilt University Medical Center (VUMC). The funds support the VUMC Arts program, which adds comfort and compassion to the patient experience through multifaceted art offerings.

For Dr. Bulger, making the quilts themselves is a kind of philanthropic act. Several years ago, she joined the UW Medicine Comfort Care Quilts Seattle which provides three hospitals in the Seattle area (including her own) free quilts for patients entering end-of-life care. She described the group as active and retired healthcare and social services professionals, as well as a few family members of former patients. Meeting on occasional weekends, they create and donate hundreds of quilts a year. “We put together at least 50 or so in a day,” Dr. Bulger explained.

Although Dr. Bulger is not a founder of the Comfort Care group, she has helped propagate the concept. During her trauma and surgical critical care fellowship at Harborview, Ashley D. Meagher, MD, MPH, FACS, a mentee of Dr. Bulger, was an active member of the quilting group. When Dr. Meagher became an assistant professor of surgery at Indiana University School of Medicine in Indianapolis, she founded Indiana Comfort Care Quilting group which replicates the Seattle group’s model and provides hundreds of quilts to palliative care patients in Indiana each year.⁷

Dr. Bulger said donating quilts to patients benefits her as well. “It’s really nice to be able to offer something to the family when medical care has exhausted all its options,” she said, a situation she communicates often in her role as a trauma surgeon.

“I think the other nice thing about the quilts is that we learn a lot from talking to the family. We learn about the patient and what they would like, and we can usually find a quilt that kind of matches that,” including one case in which a former rodeo rider received a quilt depicting the horses he’d loved. “We say the quilt finds the right person.”

Dr. Lu, too, connects his artistic output with those who can benefit from it. “I’d never sell my instruments,” he said, “because I think there are enough people who do this and want to make a living. They ought to do it. So, I donate my violins.”

Specifically, Dr. Lu donates instruments to University of California, Los Angeles’s Herb Alpert School of Music and the Conservatory of Music at the Colburn School, both of which are tertiary-level music schools in Los Angeles. “I identify people who are on the professional track to pursue music and are in need of an instrument,” Dr. Lu explained, before providing a bespoke violin to such a person.

As with many philanthropic acts, the benefit is not only to the recipient but also to the giver. “It’s a highly gratifying experience to have your instrument played and enjoyed in the concert hall,” Dr. Lu said. “It’s a remarkable type of experience to sit in the audience and hear that violin being played, and be proud of the sound that it produces, and know that it found the right home.”

Multiple Purposes

In total, art and artisanship in surgery offer much more than what research suggests. It can refine a surgical technique, reduce stress, add outlets for self-expression, and offer opportunities to contribute to the community. Just as the art itself eventually finds the right home, so do surgeons—within their chosen craft or artistic practice, and with the many benefits it might bring them.

Sophia Newman is the Medical Writer and Speechwriter in the ACS Division of Integrated Communications in Chicago, IL.

References

1. Card EB, Mauch JT, Lin IC. Learner drawing and sculpting in surgical education: A systematic review. J Surg Res. 2021;267:577-585.
2. Smith R. A deep dive into the brain, hand-drawn by the father of neuroscience. Published January 18, 2018. Accessed April 29, 2024. https://www.nytimes.com/2018/01/18/arts/design/brain-neuroscience-santiago-ramon-y-cajal-grey-gallery.html
3. Cohen SM, Dai A, Katz JT, Ganske IM. Art in surgery: A review of art-based medical humanities curricula in surgical residency. J Surg Educ. 2023; 80(3):393-406.
4. Khullar D. What doctors can learn from looking at art. Published December 22, 2016. Accessed April 15, 2024. https://www.nytimes.com/2016/12/22/well/live/what-doctors-can-learn-from-looking-at-art.html
5. Gelfman D. The David sign. JAMA Cardiol. 2020;5(2):124-125. doi:10.1001/jamacardio.2019.4874
6. Von Sneidern M. The surgeon as artist. No date. Accessed April 15, 2024. https://cas.nyu.edu/content/dam/nyu-as/casEWP/documents/sneidernsurgeon.pdf
7. Gutierrez M. IU School of Medicine trauma surgeon brings comfort to patients through quilting. Published January 15, 2020. Accessed May 15, 2024. https://medicine.iu.edu/blogs/surgery/surgeon-brings-comfort-to-patients-through-quilting