The fifteen or so first-year medical students, most in blue scrubs, sit around a conference room table in the Trent Semans Center. They are looking at their hands through little horizontal frames, little more than pieces of clear plastic.
“These are called picture planes,” says artist Emma Skurnick, who passed them out along with grease pencils; the students have charcoal and erasers and other drawing supplies in little plastic bags. “This exercise compares the open-ended view of the world with the crystallized view.”
The crystallized view puts things in boxes—a nose looks like a nose because we know what a nose looks like. For the open-ended view, she says, think of, say, Picasso: a glimpse of nostril here, a flash of bridge there. “A much more natural and comfortable way of looking at people as they move through time and space.” She has the students gaze through that frame at their hand, using the grease pencil to not draw but trace it, turning it from a concept they know to a series of landmarks they perceive: knuckles, lines, pads. “The world,” she says, “is this amorphous, wiggly, in-motion place,” yet artists—like physicians looking at patients—need to accurately perceive, document, understand it, not as they unconsciously categorize the world but as the world actually is. “Distancing yourself,” she goes on, “from what your brain thinks it knows.”
She is teaching them another way to see.
Third-year student Winston Liu gently helps guide the class. “You guys have this running checklist of things you have to cover,” he says of the way new doctors are taught to extract information from patients. This program is designed to counter that check-box method of seeing. “There was a point this year,” he tells the students, “when I actually learned how to let the patient tell their story.” Liu and fellow third-year Emma Fixsen started this program during the 2016-17 academic year to encourage the wide-open, “wiggly, in-motion” way of perception Skurnick describes: to see people, not symptoms.
Fixsen studied art as an undergraduate and brought that perspective with her to medical school. As a prospective student, she encountered at NYU an anatomy curriculum that included drawing, and when she came to Duke, she brought the idea with her. She knew Liu from the Music & Memory program, which engages patients suffering from Alzheimer’s disease through music, and with support from the Trent Semans Center the two created “Art and Anatomy,” which adds five drawing classes to the students’ three-month anatomy course. Currently, she is doing research in Lima, Peru, but she described the program she and Liu created before she left.
“Drawing forces you to take something that’s three-dimensional and mentally configure it into a two-dimensional plane,” she says, “and on a subconscious level that allows you to engage with your subject in a very intimate way.” Making choices about what to represent sharpens your awareness of what you see. Drawing brings in other aspects of the physician/artist’s character. Fixsen describes drawing a diseased kidney during a time when she was working with kidney-transplant patients. The kidney was interesting anatomically, but transplant surgery is both amazing and often sad. The drawing itself, she says, “helped me emotionally process what I was doing.”
Emotion is very much present after the students working with Skurnick troop to the anatomy lab. In a long, silent room with two halls, each lined with cadavers on which the students work, first-year student Elena Drews addresses the heart of the person she has been dissecting in anatomy class. “I just felt like a lot of the structures here are so beautiful,” she says. And though she could draw anything she chose, she has returned directly to her usual station. “I felt like our cadaver has served us well, so we wanted to keep working with him.
“We’re always really rushed when we’re dissecting. It’s nice to have some time to be like, okay, this is a person, to reflect on the experience a little more.”
Fixsen sees drawing as just one way to help bring the fundamental human process of creativity into medicine. “I think science and technology are fantastic. But I think there’s an ineffable quality to the humanities that can really add a lot of value to your interactions with patients.”