Wednesday, 12 July 2017

The holy trinity



   I have not just watched the surgeons work but the scrub nurse and the anaesthetist too. This is how it seems to me to work.
   The theatre nurse is at the feet. They act as a gyroscope for all needs external.Tools and people are kept in balance by a constant shifting of focus and awareness of what will be required.Whilst training a scrub nurse I heard the head theatre nurse explain to her how she must give the surgeon options of tools that he is about to need but not require him to answer questions,
''just hand him things, he's sensitive, don't mess with his head.''

The surgeon is in the middle. The bio-mechanic who uses a vast knowledge of consequences.They must see the wood for the trees.The mental toolbox is vast and the decisions are theirs to make.
Voltaire said ''perfection is the enemy of good'' and many surgeons understand why this is true.

The anaesthetist is at the head. They act as a gyroscope for all things unseen; chemical, emotional and even your sanity. Their regard for their patient is the same as the nurses and surgeons but their skill is to think for the unconscious.They have a ''sixth sense for where that space may be''.
 (Helgi Johansson)

Monday, 10 July 2017

The procedure with no name



   Can you tell what is going on in this picture? A hybrid procedure with two interventions perhaps. What happens when you have to keep going back to work because it doesn't fit? For me with textiles it is my least favourite thing to do.Every time you unpick work you risk making the joins or seams more fragile. Excess is always cut away from corners or areas where there may be bulk so if you have to undo a seam you now have hardly anything to work with. However the result has to look as if nothing happened.
    If you are having to mend something where the fabric is older and less likely to hold the stitches do you patch or darn? Do you replace a section or mount the worn area onto a new unseen support fabric? Will the weakened area just tear away anyway? Is there just too much stress at that point and any fix is only a temporary fix.
   In surgery hybrid procedures have all of these challenges both with ageing materials and the uncertainty of what you will actually find when you get in there. Unpicking another persons work is a strange business. You can often find yourself wondering why they 'did that' but alterations are curious things requiring pragmatic thinking and creative problem solving. These are found both in art and surgery.

Friday, 7 July 2017

Pleats


 
   Nobody wants a pleat in their anastomosis but when joining one tiny tube to another it is difficult to assess the fit .The most common problem is simply that the harvested vein is wider than the artery it will join.
  When making clothes the attaching of the sleeve to the body section is a big anastomosis .The problem of mismatched sizing is on a bigger scale. This is usually deliberate e.g. when you want 'ease' over the shoulder blade in a man's suit, the fibres of the material can be compressed in that area to add volume without pleating.
    A problem to avoid though is when the sleeve fabric gets pushed around the armhole during attachment so that you end up with a pleat at the point where you started. Some fabrics stretch more than others and the effect is rather like the dragging on the handrail of an escalator which is moving at a slightly different speed. To prevent this you use marker points called notches. These quarter mark the armhole with corresponding marks on the sleeve so spreading out any excess evenly. Best practise is to tack (also known as basting) the sleeve in first (see image) but most people just pin baste and then sew.

Monday, 3 July 2017

A trip to the vets



   After many visits to watch human surgery it occurred to me that this was not the only form of surgery out there, that in fact much smaller work was being done every day just down the road to me. My local vet was very generous and allowed me to spend time backstage in his surgery watching operations and procedures on small animals and reptiles.
   I was immediately struck by how high tech but hands on it all was. The range of specialist equipment was remarkable; x-ray machine, mini lab, blood analysis,endoscopy facility etc. ,all in one space.In a hospital everything is on different floors and an appointment is needed for each one, here you walk in and your beloved pet is treated straight away.
   During surgery itself I found that the way a vet works is very similar to me working in my studio. He sat at a small table and without the advantage of a scrub nurse had to select and manage all of the tools himself. One patient was a beautiful dragon lizard with a damaged tail. The scales must not be spilt during stitching and care must be taken of the skin (some of which was partially shed revealing a beautiful hexagonal structure). The versatility of understanding different materials rang a chord with my own varied practise.
   A vet not only understands mammals but other species too.Reptiles are now a popular pet and have very specific requirements for their health which are very different to a mammals, even their breathing is different to ours. While we waited for the next patient other occupants were taken care of; canaries, terrapins and axolotls each again with very different environmental and dietary needs.It appears that my vet is also a keen gardener fond of tropical plants.The tiny garden around the surgery is packed with plants which again all have specific needs and all of them are taken care of.
   The multi life-form care at this practise was fascinating and all were there because of a passion to care for those that can not communicate their needs.As we went from the aviary via the palm trees to then feed the terrapins surrounded by trailing plants he explained that it was all there as much for his benefit as for the customers.His quality of life is improved by the green environment and the pet owners can see best practise for caring for non mammals. Combined with the very immediate attention and care the patients got and the direct access to all facilities I wondered how it would be if human medicine were more like this.
   The vets at this practise are independent and capable of performing complex operations but sadly they are a disappearing breed.Local vets are slowly being replaced by corporate 'chains' with less surgical experience referring work out to expensive specialists, supported by the growing pet insurance market. It is a word of warning for human medicine that when money takes over everyone suffers.

Friday, 19 May 2017

Bifurcation



  I have watched several operations where stent has been used to repair or stents have been repaired. They are fascinating things both in the flesh and under x-ray. They are goretex and plated steel wire with tiny gold markers and seem otherworldly. They are also hand stitched and often made to order so I decided that I would try making one. Mine of course would not be surgical but an embroiderers version so I set about making a pattern for a tiny bifurcated construction.


    I used silk organza and hand stitched the french seams to make the two asymmetric tubes. Then the enamelled brass wire was bent into shape ready for stitching onto the trousers! I had to make a rig to put this onto as it had to be stitched in the round and the tubes were narrower than my fingers.I ended up using some of my jewellery making equipment (clamp, ring gauge and doming punch) to get a two legged form to put it onto.
    Using red silk it was simply a matter of whip stitching the wire into place.I say simply but in fact it was fraught with problems as the tubes shifted, the wires bent and the rig kept moving. Then there was the matter of the embroiderers training getting in the way ! I am so used to hiding all the threads and trying to make stitches invisible, especially whip stitch, that I kept trying to run the threads inside the tubes i.e. the hard way, when in fact the stitches must run on the outside of the work with a stent. And of course I use straight needles not curved.
   It was a mass of technical challenges but in the end it felt right in my hand, like a little bird, robust and yet fragile.

Tuesday, 16 May 2017

Colour



The one thing that still strikes me during surgery is the colour palette. I found myself pondering over how to represent this and so have begun with this piece of embroidery. It has a linear design to show the flow of activity, moving from sky blues and aquamarine into the reds and pinks that I have mentioned before.


For the central 'section' I have used more raised stitches both as reference to the inside of the body and to the difficulties of sewing in small spaces.Minimal access embroidery.

Friday, 14 April 2017

Femoral Bypass

 

This was a seven hour operation and nobody gets a break.Sometimes the surgeons get to sit. I stood and watched and these are my thoughts.
 A vein harvesting is like unpicking very fine fabric, you can't damage any of the surrounding material but it is securely and stubbornly attached to it.
 Over a hundred sutures needles are used; the endless counting and opening of sterile packets .All packaging is opened by a theatre nurse in a peel apart movement and then offered to the scrub nurse without handling the contents.
 Bead sutures have big beads on the end.
7-0 needles are very tiny, like thorns.
This procedure requires six surgeons working all at once.
The vein is passed through a metal tube which has been inserted under the flesh, it has been measured to make sure it is long enough and has been checked for twists. It has had a catheter passed along it to check that there are no obstructions.The surgeon noted any resistance he felt as threaded the catheter through. It is like threading elastic through a waistband or threading a rouleaux loop into trapunto quilting, it is all about the resistance, the pull and the timing.
Surgeons use glue.

Monday, 10 April 2017

Finger Tips


The image above perfectly illustrates how I use my fingers when making needlelace but it does not tell you what I can feel with them. Often I know where the thread is rather than feel where it is. The pressure I use to guide both needle and thread is so habitual that it can not be described.It has been written into me.
   This is a riddle that you have to unravel when you teach someone how to do anything.You show them, you guide them and then sympathise when things go wrong.Some learning can only be found during touch.Some teaching can only be done once someone has learnt.Some teaching conversations are just comparisons of experience. '' well you know when you do that thing and it felt like that, well this is a bit like it''.
  The use of tools is something uncommon amongst the creatures of this world and we humans specialise in it.We don't always know just how good we are at it until we teach or talk to others in different fields.
I spoke recently with Mr.Donald Sammut a consultant hand surgeon about what it is to be an expert. Mr.Sammut was drawing long before he was a surgeon and his work as an artist crosses over into that work with his informative illustrations of hand anatomy. We spoke about the importance of empathy in our work and how it is a mistake not to prepare properly beforehand.For Donald this means getting to know the patient and then making sure all decisions are informed ones. I must know about my work before I make it even if it is something I have never made before.Then comes technical preparation which comes from long experience.After that it is possible that you will not know what there is to find until you begin, both as an artist and a surgeon .You rely then on your expertise.
  Interestingly I was told that it is your fingernail that gives your brain the information about pressure. It gives the pulp in your fingertips a sounding board and without it there would be only wobble !

Thursday, 16 February 2017

Articles



Two articles have been published this year already about this project.
 The first is in The Lancet and focuses entirely on this project.
The second is in Nature and looks at the wider project base of Roger Kneebone's work with Imperial College London and the Royal College of Music, both articles are written by him.

Monday, 30 January 2017

Alterations



  Imagine that you have a beautifully embroidered dress with beading amongst the embroidery.The fabric is fine and the dress is lined (the lining always being a little shorter). Then you rip the hem and the fabric is too damaged to repair.For the most part the dress is still sound so you can just shorten it.There is, of course, no 'just' about it.
    Here is a checklist of things to remember:
1. What length do you want the hem to finally be?
2.How much hem allowance do you need?
3.Where are you going to cut the embroidery to minimise damage to the design?
4.Where will you cut the embroidery to minimise damage to the stitches?
5.How will you manage the beading when you cut through the continuous thread?
6.Remember the lining must be shortened.
7.You must allow for the hem allowance before you cut.
and will there be a sense of loss at the change? will it be the same dress?
   I watched a lower leg being removed and the list of concerns when shortening a person are also complex.The initial cut has to be carefully considered and then made with precision.After this there are parts to be secured, saved and fastened.The damage and excess are removed and the hem turned up.Some gentle manipulation to make sure that the delicate material hangs correctly and the work is done.